I want to avoid my pain!

“I have a patient suffering from severe cancer. In response, she became constantly angry at everything and everyone. When we tried to learn more about what is hiding behind the anger, I told that anger can be a cover for other emotions. And slowly she became aware that she was not only angry, but also scared and sad. She was also aware that it had major negative consequences for her to use anger as a defense. In our second session, she said that she would rather go back to just being angry rather than feel the sadness and fear so clearly. It was easier to bear, she said. How should I intervene?”
First, you might say, “Of course you would rather be angry at life and cancer rather than face your fear and sadness. Who wouldn’t? But if we avoid the sadness and fear, they will still be there for you. Shall we face this together so you don’t have to face it alone?”
Then, you might comment on her invitation: “If we avoid your sadness and fear, I would be abandoning you at the very time you need my help. Do you notice how you invite me to abandon you at the moment you feel most alone?”
Then you might ask about the larger ramifications: “Since you are asking me to abandon you emotionally, is this a pattern in your life, trying to go it alone? Why do you ask me to abandon you?”
It is not uncommon that we use anger as a form of denial: “If I’m angry enough at reality, maybe reality will change!” Yet, who among us is not tempted to use denial under the threat of death? If the patient’s use of denial is stronger, we can mirror and reflect the patient’s denial. “Maybe it’s important to be angry at cancer right now.” “Maybe it’s important to be angry at everyone else who is not facing death yet.” “Can we accept that you don’t want to accept this diagnosis yet?” “Have you noticed that although we don’t accept the cancer, the cancer has already accepted you?”
Often, this mirroring of denial deactivates the will battle the patient anticipates, the one he gets from almost everyone else. And it allows him to see that reality will be here no matter how much he rages. With the collapse of the defense, the grief can pour. And when it pours, who wouldn’t want to fight that off too? “I would want to rage too rather than feel this terrible grief. Do you think you need to rage a little longer before you let yourself cry?”
Notice how I keep avoiding a will battle. If you argue with this patient, he is completely alone facing death. As therapists, we need to place ourselves, at least metaphorically, right by the patient, side by side, facing reality and death. Hopefully, treatment will save him, but, even so, he will suffer, he will be sick, he will be terrified in the meantime. And he will need your support and understanding of every single feeling, bit of anxiety, and defense.
In a certain sense, this is not about how to intervene, but how to be together, living through the fear of dying, the suffering of illness, and the staring of death in the face, the experiences that deepen our sense of being human. Our task is not to run, but to stand still while the truth tears off the false from the patient—and from ourselves.






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