Healthy/Unhealthy? Judging patients

There is nothing wrong in therapy. Feelings aren’t wrong. Defenses aren’t wrong. Resistance is not wrong. Even judging ourselves, in a certain sense, is not wrong. These responses are how patients tell us, “Heal me. This is where I hurt.”

But sometimes we tell patients, “This is your unhealthy side.” Patients already judge themselves enough; they don’t ours. They already have a pathological superego, why add our superego to the mix? After all, who among us can claim to have the “right” superego for other people to have? Imitate me? I don’t think so. It’s not the patient’s job to imitate me or my superego. It’s his job to become him, to fulfill his destiny in life, not mine.

When we tell patients they have an “unhealthy” side, we encourage them to split, to judge, and to disavow that so-called “unhealthy” side. While it is true that defenses cause the symptoms and problems that bring patients to therapy, telling them that they “have” an unhealthy “side” encourages splitting. Beyond these notions of right and wrong, healthy and unhealthy, there is this thing called self-compassion, unconditional love that embraces feelings, anxiety, defenses, and resistance in this moment.

This moment, the now in therapy, can be a place where we and the patient accept all of the reality of the patient. Although we can see defenses, and it’s important that we do, we can misuse those defenses to judge the patient as “unhealthy”, “pathological”, or “primitive.” How often we convey these judgments: 1) resistance = “bad” patient; 2) collaboration = “good” patient.

Judging is how we resist the reality of the patient in this moment. And our resistance is futile. The reality of the patient will keep on existing whether we resist or not. The question is whether we can learn to be with the patient’s defenses, to see them as his secret unconscious form of collaboration (showing us what needs to be healed now).

The patient’s resistances and defenses are not an invitation for our judgment. They invite our healing. Defenses show us the sore points, inviting us to come closer. And who will we find? We don’t know. When we judge the patient as “unhealthy”, we claim to “know” who he is. We relate to our projection (validated by cherry picked theories) rather than the mystery of the person before us.

When we judge the patient, we say, “He is not-me. I am healthy. He is not.” Pretty big claim for any of us to make. Perhaps if we can be gentler with the patient’s humanity, we can be gentler with our own. And part of that gentleness may be accepting our tendency to judge, our own refusal to identify with another human being who is struggling. Accepting our own humanity so we can accept the patient’s.







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