Joining and Toxic Introject

 

Joining

Joining is a way of coming alongside the patient emotionally, which enables the patient to feel understood and accepted. This requires that the therapist be willing to “go into the pit” with the patient, and to get in touch with his own feelings in the pit.

A therapist can work with a rape survivor without having been raped himself. He can identify with the feelings of being overpowered, overwhelmed, trapped, powerless and hopeless. So, as he counsels someone who was raped, he can get in touch with these feelings and feel them, along with the patient. This enables the therapist to be able to “go into the pit” with the patient.

There are two types of Joining: Ego-Syntonic Join, and Ego-Dystonic Join:


Ego-syntoic Join
This Joining sounds “smooth to the ear,” and the patient feels understood and accepted.

For example:
A patient says, “I feel like I’m doomed to be single for life! I can’t get my act together. I am now 35-years-old, and I still have never dated. I’ll never get married!” The therapist replies, “Things have never worked out for you to have anyone special!”

 
Ego-Dysyntoic Join
This Joining sounds “jarring to the ear,” while the patient feels understood and accepted. The goal is to help the patient to feel understood and accepted, but at the same time, hears how jarring what she says sounds - in order to start to re-think and to evaluate the truth of what she believes emotionally.

 
For example:
Using the same example above, the therapist this time would say instead, “It’s too late for you! If you haven’t dated by the age of 35, you’ll never get married!”

Joining only “works” when the therapist really feels the feeling behind what he is saying. The therapist needs to “Match” emotionally, how the patient is feeling. So, if the patient is loud and agitated, the therapist matches her in volume and agitation. If the patient exhibits a flat affect, the therapist Joins with the same flat affect.

When we Join, it’s important to join the feeling, and not get caught up with the content of what is being said by the patient. Feel the feeling beneath the content of what is being said, and join that.

When Joining is used solely as a technique, the Join will backfire, as the patient would experience it as a technique, and sometimes feels mocked, dismissed, and/or suspicious of the therapist’s intentions. So, it’s important not to Join your patient until you fully feel the feelings. This is especially so with Ego-Dystonic Joining. As a matter of fact, one should not use Ego-Dystonic Join until the therapist has a pretty good idea that the patient will respond favorably. This is because inappropriate timing of the Ego-Dystonic Join can damage the therapeutic alliance.

 
Toxic Introject
We internalize our parents' (aka: Primary Care Takers) negative views toward us, such that we believe their criticisms are "true assessments/evaluations" of ourselves. We then live our lives believing this to be true of us and of our worth.

For example:
A patient of mine had a father who was extremely critical of him and repeatedly gave him the message that he wasn’t smart enough, witty enough or eloquent enough. This person grew up believing his father’s judgment of him and believes he indeed is what him father had said he was. In treatment with me, he then projected onto me that I too, am not smart enough, witty enough or eloquent enough…

Treatment Option:

We are to help the patient to project onto us his Toxic Introject, to remove the toxicity, and to feed him now with the nurturance he needed but didn’t get from his parents. One way to accomplish this is through Ego-Dystonic Join. The patient feels understood through our Joining, and at the same time feel jarred by it. This can help the patient to re-examine what he has believed about himself all along. We then help him to externalize the toxicity, so he can view this false assessment (from him parents) more objectively. When he can realize that the assessment about him is false, then we can feed him with the nurturance he needed all along.

For example:
This aforementioned patient criticized himself in our sessions all the time: from his indecisions in life, to him having wasted his session criticizing himself. He told me that I wasn’t smart enough, witty enough, or eloquent enough. After working with him for over eight years, one day he said to me, “Why is it that my friends’ therapists always gave them interpretations, but you wouldn’t give me any?” By then, I was able to really feel and mean what I told him, “It’s because you are a Looser, and you picked a Looser therapist…We are well matched!” He laughed and laughed, and felt understood by my comment. For the next two years, I’d preemptively attack him by starting the session with, “So what does the Looser has to report on what a Looser he was this week?”

 After two years of my Ego-Dystonic Joining, he said to me, “Alright, alrighty! I get what you’re doing. I don’t need that anymore!” To which I quipped with, “Well! It’s about time that you shut me up!” His attack of himself was decreased after this repeated intervention.

Goal of Therapy: Dealing With Our Feelings:

Once we are able to bring to the conscious our feelings, a goal of therapy is to:

1.  Identify our feelings (label/put our feelings into words).

2.  Feel our feelings (give ourselves the permission to feel the feelings).

3.  Embrace our feelings (allow ourselves to really feel it).

4.  Understand why we feel how we feel.

5.  In spite of how we feel, we choose to act constructively. This is the hardest part: to feel however we feel, but not act on the feelings when they are not constructive to act on.

Secondary Gain

When we seem unable to stop a negative pattern (as poignantly put in Romans 7:15: “I do not understand what I do. For what I want to do I do not do, but what I hate I do”), there is an unconscious “gain” that keeps the pattern in place. The word, “Gain” is confusing, since we can conscious detest that particular habit/pattern. Nonetheless, our unconscious is “getting” something out of the continuation of that pattern.

For  Example: A patient complains that his children are always dependent on him: that they cannot do anything without his help. Although his children are adults, they still come to him for financial assistance. They don’t even take care of their own automobile, and need daddy to check and change oil to maintain their car. As your patient complains about his children, he continues to respond to his children’s demands and requests. The Secondary Gain could be the sense that he is still needed by his children, or that his children love and feel safe enough with him to approach him - unlike his own relationship with his distant and uncaring father.
 

Treatment Option:

To help a patient to “give up” his Secondary Gain, we need to first help him to become aware of it through exploration. I might say something like, “Psychobabble says that when we keep on doing something we consciously don’t want to do, we might be getting something out of it. If that was the case, what might be the pros and the cons of you continuing to do what you do?”

Repetition Compulsion

When we have unresolved issues with our primary care taker/”primary object,” we find ourselves repeating the similar pattern of interaction with others. This is our unconscious’ way of trying to resolve our relationship with our primary object. We do not consciously look for similar patterns or dynamics in our present relationships – it doesn’t make sense why we would ever want to repeat such similar relationship! However, our unconscious “picks up intuitively” which persons have similar issues with our primary objects, and we become “attracted” to these relationships. The unconscious idea is that, if we are able to resolve the dynamics in our present relationship, then maybe we can “undo” our relationship with our primary care object. The problem is that we cannot turn back time, and the person(s) with whom we are in relationship with presently, cannot fix what was broken in our primary relationship.

 For Example: A person grew up in an emotional abusive household where his parents ridiculed and emasculated his attempts to assert himself. He finds himself attracted to close friends or romantic objects who eventually (usually not right away - as he would know to stay away from such blatant similarity) are dismissive of him, do not respect him and demeans him; He finds himself being emotionally abused by these close friends and objects.
 

Treatment Option:

To help a person to resolve his Repetition Compulsion, we would ask the patient, whom do these present objects remind him of emotionally? We would help the patient to first identify and acknowledge the feelings suffered as a young child under the hands of his abusive parents. We would then encourage him to feel his feelings and to embrace his feelings. We encourage him to mourn what he had experienced, and then choose to forgive his primary object. We would also nurture him the way he needed to be nurtured as a young child, so he can have his needs met as a child, and move forward as an adult.

We would also explore his present relationships and join his present coping mechanism until he is ready to give it up on his own, by saying something like, “To be with the monster we know, is better than the monster we don’t know.”

 

Modern Psychoanalytic Nibbles

 

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Modern Psychoanalytic Nibbles

During my nine years full-time teaching at Nyack College's Alliance Graduate School of Counseling, students have asked me to put down on paper my quick explanations of Modern Psychoanalytic concepts and terminologies. So, I'll be blogging them as they come to mind. Hope you'll enjoy them and find them helpful in your mental health practice.

 

Conscious, Subconscious and the Unconscious

Our Conscious is where our thinking, logic, rationale and belief reside. This is where we are aware of what is being said to us and where we process our experiences.

 

The Subconscious is similar to the feelings we have when we first wake up from a dream…we wonder if what we just experienced was real or was it a dream? We are sort of aware of the feelings, it’s at the “tip of our tongue,” but we can't quite put our finger on it.

 

The Unconscious is the seat of our feelings, emotions, unresolved issues, coping mechanism and resistances. We are not aware of the feelings, "emotional motivations" we possess. We tend to "see" ourselves go into action, and wonder why we do what we do. This is also where our unconscious habits are formed and reside (versus the habits we intentionally develop).

Goal of Therapy: Becoming Aware of Our Unconscious Through the Resolution of Resistance:

One of the goals in therapy is to help bring to the conscious, our unconscious. We can accomplish this by helping the patient to talk "without an agenda" in therapy sessions. Since our unconscious is the seat of our resistances and unresolved issues, it is very keen on not allowing our conscious to become aware of what it is up to. Also, our resistance is the “Gate Keeper” of our coping mechanisms. Since our coping mechanisms worked to help us survive in the past, our unconscious likes to stick with what’s “familiar” and not change/give up the coping mechanisms. It usually believes: “If it ain’t broken, don’t fix it.” The sad truth is that what helped us to cope in the past, a lot of the times, can become detrimental to our present life circumstance.

Thus, the unconscious needs to be "coaxed" into coming up to the surface (the conscious) through attentive listening, unconditional regard and acceptance by the therapist.  We accomplish this through the process of Joining the resistance. Once the unconscious feels safe (when it is not being told that it has to change) we can then "make conscious the unconscious" and start to resolve our resistances and better understand our Core Beliefs.

Once we understand our Core Beliefs, we can then choose to think and view things differently, thus enabling us to be transformed by the renewing of our minds (Romans 12:2).

Core Belief

During the first two years of our life - before we have words to help us form concepts - our unconscious has been recording what is happening to us and "informs" us of what we can expect from our life.

Some parents believe in letting the infant to cry herself to sleep. While this is good concept to help the child to regulate herself, many times this is done too early in the child's development (it'd be good to start sleep training the infant at six months of age - NOT before then) and gives the child the idea that the world will not respond to her needs.

 
The well-meaning parent's heart is breaking, hearing his child crying, but believing that he is doing the "right" thing to sleep train his child. However, the infant has no concept of time. So the five minutes of crying that the parent institutes in this sleep training, feels like eternity to her. The infant feels she has no voice, helpless and powerless. She then believes that her needs will not be met and unconsciously lives her life in such a way where she would repeat and reaffirm this belief to herself. 

 


For Example: I worked with a woman who lived 10 years  at Stage Four (the last stage) of cancer. Her Core Belief was that she was abandoned and no one would attend to her needs. She therefore fought off being hospitalized, as she feared being alone and abandoned in the hospital where no one would come visit her. During the last two months of her life, I called to check on her while she was in the hospital. Each time I called her and asked her about her life in the hospital, she lamented to me that no one was visiting her and she was abandoned and alone - even though she reported that her daughter was bringing food to her daily. Over the phone, I also heard her aggressively dismissing her visitors. So, her Core Belief of abandonment "over-rode" the reality of people being there for her.

 

Pseudo-Independence

The signs of a Pseudo-Independent person are when a person is always there to give to others and to help whenever others have needs, and is unable to receive/accept help or nurturance for herself. This comes from when an infant experiences life as unresponsive to her needs (as stated in Core Belief above), she unconsciously “decides” that she can cry and not be heard and be deprived, feel powerless and helpless. Or, she could stop crying and take care of herself. Her unconscious “chooses” the former, so she doesn’t have to feel powerless. When others try to nurture her, she rejects the nurturance due to her desire to not get in touch with the sense of deprivation, powerlessness and helplessness she experienced as an infant.

Treatment Option:

To help a Pseudo-Independent person to receive nurturance, we need to give to her a little morsel at a time, to help her get acclimated to the feeding. This is because her unconscious would quickly reject too much feeding too quickly in order to stave off overwhelming feeling of deprivation that she experienced as an infant - when she really was helpless and powerless.