Ever try to help a patient feel his feelings and get stuck? Did he keep saying he didn’t know where he felt his feelings? Or did he get depressed and feel worse? Or did he begin to accuse you of trying to control him? Inviting feelings is supposed to help, but in these examples it didn’t. Why?
Inviting feelings does two things: 1) it mobilizes feelings toward you because the patient senses your genuine wish for connection; and 2) it mobilizes the resistance system (defenses), which causes his presenting problems. And we discussed before the three resistance systems patients use: projection, repression, and isolation of affect. So let’s see how to invite feelings to build the different capacities necessary in each group.
Patients who use projection cannot tolerate feelings inside, so they project them outside. You meet them. Feelings and anxiety rise. To avoid the rise of anxiety, they project the feelings onto you and others.
Capacity to be built: ability to tolerate feelings inside without projecting them outside. So how do you invite feelings: “What feelings do you notice having here toward me, if you let the feelings be inside you for a moment?” Notice that we not only invite feelings, but we encourage the capacity to be built (experiencing feelings inside) while blocking the defense (projecting feelings outside).
Patients who use repression can tolerate feelings inside, but they cannot tolerate anger toward you. So they feel love toward you and turn the anger upon themselves. You explore feelings with them. Feelings and anxiety rise. Then they turn the anger toward you upon themselves through self-attack, depression, getting tired, weepiness, somatization, or character defenses.
Capacity to be built: the ability to tolerate anger toward you without turning it upon oneself. So how do you invite feelings: “What feelings do you notice having here toward me, if you let them come here?” “If you don’t protect me and don’t hurt yourself, what feelings are coming up here toward me?” Notice that we not only invite feelings, but we encourage the capacity to be built (experiencing the mixed feelings toward you), while blocking the defense (turning anger upon the self).
Highly resistant patients who use isolation of affect can tolerate feelings inside without engaging in self-attack, but they detach from their feelings by detaching from you.
Capacity to be built: the ability to feel mixed feelings toward you without detaching. So how do you invite feelings: “What feelings are coming up here toward me right now?” As the resistance rises, we point out the resistance and ask for feelings toward us. “Notice how you look away and avoid my eyes? Notice how this avoidance is coming up as a barrier between us? What feelings are coming up here toward me that make you put up this barrier?” As the patient lets go of the resistances by which he distances from people, his character resistance drops, and his essence emerges. Emotional closeness now becomes possible.
Take home point: inviting feelings takes many forms and is tailored according to the specific capacities we are trying to build and the defenses we are trying to block.
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