Monthly Archives: March 2017

I feel empty

“I have a patient who suffers from a lot of anxiety and worries about things that could go wrong in the future, whether or not he will ever find a relationship. He is not objectively alone, but he has difficulty feeling content and safe without other people physically present.

Performing for others and himself is the main way to feel good about himself. When by himself, there is no one around who can confirm his worth as a person, and as a result, he describes a feeling of emptiness. How should I approach his difficulties?” Great question!

Triangle of conflict: mixed feelings; anxiety; defenses: rumination and self-attack.

I would ask if those thoughts are occurring in his mind at this moment.

Then I would ask, “Since those thoughts are coming up here now with me, I wonder what feelings are coming up here with me underneath those thoughts? If we look under the thoughts, what feelings are coming up here toward me?”

Why do I ask about feelings toward me? The patient attacks himself, saying he is not good enough, he should perform better, he will fail in the future. This is the resistance system of repression. He attacks himself.

You have formed a close relationship with him that triggers feelings toward you. As these feelings rise, he protects you from his anger by turning it upon himself. Thus, we ask about feelings toward you to block his self-attack and help him develop an outward pathway for his anger, so he does not have to turn the anger upon himself instead.

Here’s another example of how you could intervene:

Th: “You say you judge yourself according to how well you perform and you are worried about how others think of your performance. How is that in operation right now here with you and me?” “So if we look under these thoughts about performance, what feelings are coming up here toward me?”

Sometimes, of course, the patient’s self-attack and self-doubt is so habitual, he cannot see that it is a defense. If he insists on the wisdom of his self-attack, you might ask,

Th: “When you doubt your worth, could that be a form of self-doubt? Could that be hurting you? So if we look underneath the doubt, what feelings are coming up here with me? What are the feelings here toward me?”

Habitual self-doubt and self-devaluation are destructive defenses that cause depression. Interrupt them as soon as possible to prevent a regression into depression. Then invite feelings toward the therapist to form a new relationship: one based on feelings in a relationship rather than protecting others from feelings by getting depressed.

Oh, and the emptiness? He tries to empty himself of his anger because he believes no one could love him with his anger. Thus, we encourage him to face his feelings with us. Implicitly, he will experience our acceptance of all of him. Experientially, he learns that he does not have to be an empty man to be loved.



Acceptance in therapy

Acceptance has become all the rage in the psychotherapy community. Mindfulness therapies focus on accepting whatever passes through the mind and body in this moment. We have acceptance and commitment therapy, a new version of CBT. But, judging from the questions I receive from therapists, I sense a lot of confusion about acceptance.

Acceptance doesn’t mean taking a passive, helpless position. It doesn’t mean that you give up your agency, waiting until a crisis passes. Nor does it mean just accepting that someone is a “problem”, while remaining a “noble” victim. Nor does it mean that we “accept” pain as if you are some enlightened, detached observer, who somehow is no longer touched by life.

Nor does acceptance mean detachment, where you say, “I accept it” and mean, “I’m over it.” Nor does acceptance mean that you give up, waiting for others, life, the government, or the stars to change.

When I take a helpless position, I don’t accept responsibility for what I can offer. When I give up my agency, I don’t accept what I can do. When I “accept” that someone is a “problem” under whom I must suffer, I don’t accept my choice to suffer. When I “accept” pain as a detached observer in others, I refuse to accept my capacity to co-suffer with the other.

This pseudo-acceptance is just a closeted rejection of others and our capacity to respond. We make the other person someone or something else. We relate to our image or idea of that person, and then we react to that image and reject it. These reactions to our projections are so fast and habitual, they can masquerade as intelligence.

But our reactivity reveals that we are the slaves of our projections (“He’s a problem.” She doesn’t respect me.” “He just can’t listen.” As a result, we suffer the painful feelings that arise from the internal soap opera known as our fantasy life. We react to our fantasies, we accuse others of “crimes” based on our fantasies, and it all feels so incredibly real and powerful.

Then there’s this thing called reality.

When we accept this moment, we realize we have absolutely no idea what that other person thinks or feels about us at this moment. No idea. They are on the other side of town or in another country. Yet, we cook up these fantastic fantasies and live within them. Believing others don’t accept us; we don’t accept them. We are not accepting them as mysteries; we are accepting our fantasies.

Our task shifts: can we let go of our fantasies so we can accept the reality of the other person, someone whose thoughts and feelings we do not really know in this moment? Can we accept that other person as unknowable? Can we accept ourselves as really great story-tellers? We must be great, since we convince ourselves of these stories that are all made up!

Accepting this moment, you as story teller and the other person as unknown is accepting that reality has been here all along while we were busy cooking up stories about loved ones. If we can accept this reality, this is the place from which change could happen. Accepting reality is the place from which answers can arise. After all, realistic answers can never arise from our fantasies, but only from reality. It can seem boring and still without those stories, as if you are doing nothing.

That’s true. Before you were creating stories and reacting to them. Now you’re not. By contrast, it feels as if you are doing nothing. It’s not really the end of doing anything; it’s just the end of reacting to your stories. Instead of jumping to the ten top favorite fantasies about others, you receive the reality of the other. Instead of reacting to your stories, you respond to the real person before you.

One of the Zen patriarchs said that if you want to find the truth, first let go of cherished opinions. Why? Truth is everywhere. It’s all around us. Our cherished opinions are the veils preventing us from seeing the truth. We don’t have to seek it. It’s here.

Can we accept that we cherish our projections? Can we accept that we have been accepting our projections instead of reality? When we react to our projections, we don’t need to be curious about others because we “know” what they think and feel. We don’t have to be present because we know where we are “trying to go.” Without our projections, everything slows down. We need to find out who is this person? What does she think and feel? I have to be present in order find out who she is. I don’t have to go anywhere, because we are right here, right now.

This begins the three-way acceptance. I accept where I am in this moment. I accept that I cannot change the past. It is over. I also accept that I cannot fully control the future.

Acceptance in this moment means letting go of cherished opinions so we can relate to what is, now. Strange to say, reality has already accepted us. We are here: you and I. By accepting our oneness, our mutually shared humanity, we accept each other as mirrors, disguised reflections of ourselves.