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.