Monthly Archives: August 2018

ISTDP and Islam

An Iranian student asked me last summer, “What is the relationship between ISTDP and Islam?” I answered, “This kind of therapy operates under the assumption that the patient is transformed by becoming at one with the emotional truth in this moment.” I asked her, “What is the meaning of the word Islam?” She answered, “Submission.” I agreed: “Yes. Submission to the truth.” I then told her about the theologian Saint Thomas Aquinas who said we should never submit to another man because it invites him to sin. Why? because the truth is always larger than any person’s opinion. As the theologian Hans Urs von Balthasar said, “Meaning is greater than interpretation.”
Whether we operate in the realms of religion, psychotherapy, or Wilfred Bion’s mystical psychoanalysis, all of us are listening to the sound of the reed calling out to us in Rumi’s Mathnavi to reunite with the truth.
As the great Persian Sufi poet Rumi pointed out, separation from the truth is the source of our distress. In spiritual traditions and psychotherapy we help patients see their defenses: the ways we lie to ourselves about reality and our feelings about it. As we help patients see their lies and let go of them, the emotional truth can rise up within them. And by becoming at one with the truth in this moment, we help patients heal.
And what about submission? In Islam and psychotherapy, submission does not refer to the worldly distortion whereby a man or woman submits to the neurosis of another human being, for that is the path of perversion—honoring a false god. Submission refers to our bowing before the truth, a bowing which, in a certain sense, is not even necessary since the truth, as the Sufis say, does not need to be known by us in order to exist.
As we let go of our barriers to the truth, our lies and defenses, the imaginary door disappears and the truth enters, often in an unsayable form. But throughout the eras in different religions and in schools of therapy, the great mystics, thinkers, and healers have offered what they could say to point to the unsayable. And in this dialogue between different thinkers, different eras, and different lands we wend our way on this caravan to the land known as Truth.

The desire to be liked

“I have a question about the triangle of conflict. Are feelings always necessary for the formation of a presenting problem? Suppose you meet a stranger the first time, feel anxious, and, to make a good impression, you act superficially nice or smile too much. I understand that anxiety might rise because you fear rejection, but once you talk to the stranger, you would probably feel neutral. So the conflict appears to be between your desire to be liked, anxiety, and the defense to lower anxiety. Is this subtle desire the feeling base of the triangle? Thanks to Nikan for this stimulating question!
This question is so cool because it touches on a subtle theoretical distinction made by the affect researcher Silvan Tomkins. Tomkins noted that affects are the “amplifiers” of the drives. Thus, we might say attachment is an innate drive and affects are what give that drive energy.
Here, the patient has a drive to connect to another human being. Given the history of that drive, the patient has a variety of feelings, which arise, based upon his attachment history, and these feelings are paired through conditioning with that drive. Thus, whenever he wants to be liked, mixed feelings arise.
Some patients have very good attachment histories and the mixed feelings that arise will not be too intense or conflictual, thus little or no unconscious anxiety will arise. In this case, something else happens.
Drive: he wants to connect. Feelings: mixed feelings rise as he connects. Anxiety: as his feelings arise, he becomes anxious. Defense: to ward off that anxiety he has the thought that the therapist will reject him (projection) and then acts superficially nice and smiles in response to the supposed rejector (secondary defense in response to the projection).
If the patient’s projection is primarily in the form of intellectualization and his anxiety is in the striated muscles, merely talking to the therapist will bring anxiety down, and the thoughts about the therapist will diminish quickly. If the patient’s projection is primarily in the resistance system of projection and anxiety is in cognitive/perceptual disruption, neither the patient’s anxiety nor his projection will drop just from talking to the therapist. Anxiety regulation and restructuring the projection will be necessary.
So, short answer: yes, feelings are necessary for conflict. But we must differentiate feelings from the drives they amplify. Remember Leigh McCullough’s lovely statement on this. She asked us to remember how powerful the sexual drive supposedly is. Yet, once the emotion of anxiety enters the picture, notice how suddenly sex turns into a paper tiger!