No answer I ever give is good enough!

A client spent 2 sessions ruminating no matter how much I try to block him, saying he needs to understand the process of therapy before he engages. I identified and clarification to no avail (I didn’t challenge him as he was quite fragile). He just insisted he needed to understand before he continued.

So after a while I asked him if it is his will to do therapy, and he then spent a long time wondering what will is. After a while I mirrored it, “OK sure. Shall we spend 20 sessions understanding what will is, before we finally work on your depression? Let’s leave you drowning in that pit of anxiety and depression while we figure out what will is, then we can pull you out. How many sessions do you think we need?”

He then admitted this made him feel angry at me, while at the same time realizing that all I had done was mirror his words back to him. We had a productive session exploring his anger afterwards to me but I wasn’t sure if that anger was the right anger to explore.

Triangle of conflict: mixed feelings toward you; anxiety; wall of rumination, self-deprivation.

First of all: WOW!! You were fantastic here! You understood that his defense of self-deprivation was syntonic. So you mirrored it. Then he could see how he was sabotaging himself and depriving himself and asking you to collaborate with his self-defeating behavior. Albert, that was just brilliant.  Next, he says he is angry with you. I would still work on restructuring. “Yes, you are angry with me right now. But if I were you, I would be more angry at that self-depriving, self-sabotaging habit that has been hurting you. Do you see what I mean? It sounds like you thought I would hold you back, but now can you see how the rumination holds you back?” See, if he is angry with you as if you sabotage him, he will remain paranoid, unable to have an intrapsychic perspective where he sees the He causes His difficulties. This is a subtlety of differentiating the patient from his defenses, and then establishing correct causality: Albert doesn’t cause his problems, his defenses cause his problems. Always good to help patients get clear about that:-)






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