Why are You are controlling me?! “I just started working with a chronically depressed man with a history of failed relationships. In our second session I began pointing out defenses and ways in which he puts distance between us. On the way out the door he commented, "You really challenge me which is good," and then, "You sort of tried to control the session." I am wondering how to revisit the control comment in at our next meeting. Any thoughts? Thanks to one of community members for sharing this question! Patients come to us because they suffer. They suffer because, when faced with their feelings, they become anxious and use defenses to ward off those feelings. The defenses create the presenting problems and symptoms that cause their suffering. The patient does not see his defenses usually. He does not sit down with you, reflect for a moment, and think: “I’ll use externalization right now with my therapist. That is such a successful defense in my experience!” No. The defenses occur automatically and habitually outside of the patient’s awareness. One could correctly say that the defenses are controlling the patient. The defenses make him say and do things automatically which hurt him. When the patient enters the session and shares his problems with you, feelings rise because he is making the choice to become more intimate with you. And becoming intimate with humans in the past has led to painful results. Thus, as feelings and anxiety rise, defenses begin to control him and interfere with his ability to share his inner life with you. But since defenses emerge from the very beginnings of life outside of the patient’s awareness, he naturally assumes that these defenses are the “way he is” rather than “the way he handles his feelings.” So when you point out and interrupt the patient’s defenses he mistakenly thinks you are interrupting him. Why? Identified with his defenses, he does not see how his defenses have been interrupting his attempts to form intimate relationships, defeating his attempts to achieve meaningful goals. In short, unable to see his defenses, he has not seen how they have quietly been controlling his life in cruel and sadistic ways. If we do not block and point out the defenses, the defenses control the patient and his session, leading to treatment failure. But when you begin to block the automaticity of his defenses, the patient may reveal his mistaken causality. Pt: You aren’t listening to me. Correct causality: you are listening to him, but not to his defenses. Pt: You are controlling me. Correct causality: You can’t control the patient, but his defenses are controlling him. Pt: You are interrupting me. Correct causality: We never interrupt the patient; we only interrupt defenses that could hurt the patient. Pt: I want you just to listen. Correct causality: You want to listen to the patient; but if you submit to the patient’s defenses, then both of you will suffer together. [Recipe for disaster.] With this correct understanding of causality, you will be able to handle the patient’s projections more readily. Let’s take the example above: Pt: You sort of tried to control the session. Th: The good news is that is not possible. I can’t control you or the session. Only you can do that. What we noticed, however, is that as soon as you wanted to look at this grief over the loss of your father, your intellectualization took control of the session. Then your avoidance took control of the session. Then your dismissal took control of the session. So, in fact, I couldn’t control the session. I could only point out how these mechanisms were taking control of the session away from you. As a result, they were defeating your goal: to face this grief so you could get on with your life. Do you see what I mean? [Pointing out the role of the defenses and their price, then deactivating the projection onto the therapist.] Without seeing his defenses and their price, the patient will continue to project that the therapist is controlling him. As a result, he will be engaged in battle with the therapist rather than with the real enemy: his defenses. In this example, we also had another lovely defense. I say lovely because it is so smooth and subtle. Here it is again: Pt: You really challenge me which is good. [Projection] Th: The good news is that I can’t challenge you. All I can do is point out this self-dismissal and intellectualization you use to avoid your feelings. The question really for you is something different: Do you want to challenge these mechanisms so that you can be in charge rather than your mechanisms being in charge? Do you want to turn against the mechanisms so you can achieve your goals, or do you want to let the mechanisms continue to distract you? Notice here how the patient tries to create an interpersonal conflict: you will challenge my unhealthy defenses. Instead, the therapist must help the patient see that his conflict is between him and his defenses. The therapist cannot challenge the patient. Only the patient can challenge himself to go in a new direction. The path he takes, when he takes it, and the responsibility for his path is his alone. Only he can take those steps. We can point out the paths to health and illness, and we can point out the results of those paths. But in the end, only he can challenge himself to take a new path, the path toward health, love, and truth. Take home point: the patient’s mistaken causality results in projections which must be deactivated in order to establish an internal focus as the basis for a conscious therapeutic alliance. You can read more about this in the section on Self-Observing Capacity in my book, Co-Creating Change: Effective Dynamic Therapy Techniques.
Posted on: Thu, 19 Sep 2013 16:04:53 +0000