“I have a patient who tells me first thing in the session that he is fighting great grief that he feels almost all the time between sessions. But when I invite him to tell me a bit more about the sadness, it goes away. The same thing happens when I ask what he senses in his body. He keeps the sadness inside and keeps me at a distance.
I have tried to work with his grief the same way that I have worked with other issues he has presented: making him aware of the defenses he uses, that he keeps me at a distance, etc. But I am not sure that this is the right way to go with his sadness. I can see and feel that he really wants to let go but does not dare. I feel stuck too. Maybe because I’m not sure what is the right way to go.” Thank you for this important question! Many others have felt this struggle too.
It sounds like you have done some very good preliminary work. You have helped him see he is struggling with grief. It makes him anxious. In response, he distances from his grief and you. Now it is time for stage two. What is that you ask?
You have been working with him as if he is warding off his grief. However, when he distances from his sadness and you, the key issue is his distancing from you. In other words, he is not resisting feelings; he is resisting emotional closeness with you.
Distancing and detaching are signs of a “mid-rise of transference feelings.” What does that mean? When we explore feelings with patients, we form an emotionally close relationship. Now he has feelings toward you. To avoid feelings toward you, he has to avoid you. If he can distance from you, emotional closeness drops, and feelings triggered by your relationship will drop.
So when the patient distances and detaches from you, we shift from asking about his sadness. Instead, we ask about the feelings toward you that make him distance from you.
Pt: My sadness went away.
Th: Notice how you are distant from your sadness now?
Th: So it’s as if there is a veil of distance that has come up now between you and your sadness and between you and me. [Identify the resistance to emotional closeness.] I wonder what feelings might be coming up here toward me that are making you distance here with me?
Why ask about feelings toward you? Since he distances from you, we want to know what feelings he has toward you that make him do that.
Th: Where do you sense that sadness in your body?
Pt: It went away. I don’t feel anything.
Th: You invite me to relate to an emotionally empty man. [Identify the resistance.] But then we would have an emotionally empty relationship. [Clarify the price.] I wonder what feelings are coming up here toward me that make you put up this barrier of the emotionally empty man?
Once he resists emotional closeness with you, focus on the feelings toward you. He will not tell you his feelings right away. That’s ok. Instead, he will show you another way he resists emotional contact. That is his form of unconscious collaboration: “here is the next problem that needs healing.”
Pt: [Pauses and goes up in his head.]
Th: Notice how you hesitate? Notice how you go up in your head? I wonder what feelings are coming up here toward me that make you withdraw and detach?
Through asking for feelings and continually identifying his resistance you help the patient see how he avoids emotional closeness in his life. In real time, he learns from you the things he does that harm his relationships.
This case is a beautiful example of how a patient presents initially with a conflict about feeling. But as the therapist explores, the patient shifts from avoiding feeling to avoiding the therapist. When the patient shifts from resisting feeling to resisting closeness with the therapist, we shift our focus to the feelings the patient has toward the therapist. As we maintain that focus on feelings toward the therapist, we continue to help the patient see the ways he avoids emotional closeness with the therapist. Maintain that focus on feelings toward the therapist until the resistance drops and the patient experiences a breakthrough to feeling.
Take home point: when exploring feelings goes nowhere, most likely the patient is resisting emotional closeness with you. Since the patient is resisting you, shift from asking about feelings towards others to asking about feelings toward you. Shift from describing his defenses against feeling to describing the wall he puts up with you.