(Post 7)

In treatment, we will emotionally experience with our patients, their first two years of life during the first two years of therapy, as their unconscious comes to the surface when the patient “Says everything.”

Normal psychological development goes through the following stages in this order: Autistic Phase, Symbiotic Phase, Practicing Phase, Reproachment Phase, Object Constancy Phase.

Autistic Phase

According to Mahler (Pp. 3 & 4 of Dropbox link in Post 6: https://www.dropbox.com/s/66tivdvlyycfxxq/Transference%20and%20Countertransference.doc), from birth to four months, a newborn is in the Autistic Phase, where he isn’t aware that he is now outside his mother’s womb. Psychologically speaking, he “thinks” he is still inside the womb, where all of his needs are taken cared of.

For Example:

A patient comes into the session and talks non-stop about whatever is on her mind, such that you can’t get a word in edge-wise. You feel that she would be saying the same thing no matter who is sitting across from her. She also doesn’t make any contact with you in the session (doesn’t ask you for feedback or to even stop to give you a chance to make a comment). This is usually an example of someone in the Autistic Phase of treatment.

Treatment Suggestion:

When we observe that our patient is in the Autistic Phase, asking of one or two Object Oriented Questions would help the patient to realize that she is not in the room by herself. That, you, the therapist, is a separate Object, and you are present in the room with her.

Object Oriented Questions

These are factual questions aimed to help our patients to become more aware of her surroundings in the session. These questions consist of “what,” “who,” “where” and “when” that have to do with the content of what the patient is sharing. We ask these questions in order to either let the patient in Autistic Phase know that someone else is in the room with her, or, to slow down a patient who is flooded with too much emotions in the moment.

For Example:

The patient says: “I woke up this morning in a panic, as I had slept through my alarm! I didn’t have time to take a shower or even eat breakfast and had to run out of the house to try to catch the bus to go to work…” The therapist interjects and asks: “Which bus do you usually take to go to work?” Or, “What kind of breakfast do you usually have in the morning?” This type of question causes the patient to have to stop her rant and think of a response, thus slows her down, and/or causes her to realize that someone else is in the room with her…

Narcissistic Transference

While in the Autistic Phase, the newborn feels he is one with his mother inside the womb. During the second developmental stage of a newborn, the infant is in the Symbiotic Phase where he feels one with his mother, now on the outside of the womb. To him, however he feels is how his mother feels, and however his mother feels is how he feels.

The patient needs to be able to feel safe in order to share his deepest thoughts, feelings, desires, yearnings and needs with us. This is so the patient can then say everything in therapy (which is the goal of therapy: to bring what’s in the unconscious to the conscious (Please review Post 1). To accomplish this, the therapist taps into the Symbiotic Phase to help the patient form a therapeutic bond with her. Once the patient feels he is one with the therapist, he feels seen, heard, understood, accepted and loved unconditionally. This then enables him to open up and say everything.

The therapist needs to “insert” herself into the patient’s unconscious by helping the patient to become aware of the therapist’s presence.

For Example:

The patient says, “Everyone always abandons me. My father left my family when I was two, and shacked up with his secretary. My mother was so depressed that she checked out emotionally when my father left. My older sister left the house as soon as she could go to college, leaving me to fend for myself without a father, living with a depressed mother…” The therapist inserts herself into the patient’s conscious by asking, “What about me? Have I abandoned you as well?” This type of question helps to instill in the patient’s mind that the therapist is in his life and starts to think of the therapist outside the session.  Usually, when a patient reports in the session that he “heard” the therapist say so and so to him (in his head) outside the session, it is an indication that the patient has entered into Narcissistic Transference phase of treatment. He is now “carrying” the therapist in his conscious mind.

The goal of establishing the Narcissistic Transference is to eventually get to Objective Transference, where the patient is ready to see the therapist as a Separate Object, outside of himself. He is then ready to received feedback and direction from the therapist and to follow through with suggestions given by the therapist. This is when Cognitive Behavioral Therapy is most effective: the patient is ready to cooperate and use his conscious thought to combat his underlying issues.

Modern Psychoanalysts believe that unless the therapist is able to establish a Narcissistic Transference with the patient, the patient’s Resistance would stand in the way of cooperating in his treatment process.

(Post 6)

Countertransference

Transference is our patients mapping onto us, their unresolved feelings toward their significant others. Countertransference is our feelings toward our patients. There are two types of Countertransference: Objective Countertransference, and Subjective Countertransference.

Objective Countertransference is the feelings the patient induces in us, which comes from the patient’s transference. It gives us valuable insight as to the type of transference the patient is mapping onto us. These feelings help us to better understand the patient’s feelings, as well as whom we are in their transference.

When the Countertransference is Objective, we would feel how the patient is feeling in the session, and after the session is over, we’re able to move on to the next activity without the feelings we experienced in the session “lingering on.” Also, the patient would induce the same feelings in most anyone else. This shows what we are feeling are coming from the patient.

For Example:

Right after the terrorists’ attack at the World Trade Towers, I was in a session with a patient who was lying on the couch. She mentioned that she knew one of the stewardesses from the plane that went down in PA. She reported it without much affect and moved on to talk about her life. However, as soon as she mentioned that she knew one of the stewardesses, my heart felt a sharp pang, like it was breaking. I asked myself why I was feeling such strong feelings since I didn’t know the stewardess, and my patient wasn’t demonstrating any feelings of sadness? Twenty minutes after my patient’s sharing, she was in a fetus position, sobbing. I realized then, that the heart pain I was feeling was actually my patient’s feelings, being induced in me.

Subjective Countertransference is the feelings we as the therapist have personally, that the patient “triggers” in us. These feelings stem from our own unresolved issues, and it’s about us, not about the patient.

For Example:

When I worked in my first job as a social worker, I was unable to work effectively with depressed clients. These clients reminded me too much of a family member of mine, who was depressed, would complain about every ailment, but wouldn’t do anything to ameliorate her condition. Since I had just started my own analysis at that time and hadn’t worked through my own reactions to this family member, my personal allergic reaction toward this family member prevented me from being able to separate these clients from this family member. Thus, I emotionally reacted toward these clients the same way I reacted toward my family member. This prevented me from being able to be objective, empathic, or effective in my work with depressed clients.

Treatment Suggestion:

When we notice Subjective Countertransference at work, it would be helpful to identify whom our patient is reminding us of personally. Once we identify it, we say to ourselves: “This patient is this patient, and So and So is So and So. So and So is not this patient, and this patient is not So and So.” Just by bringing to the conscious our feelings, these Subjective Countertransference feelings naturally dissipate and lose their grip on us.

Most of the time though, when Subjective Countertransference is at work, there is also a component that is coming from Objective Countertransference. Therefore, it behooves us to examine all of our feelings in the session and constantly ask ourselves: “Am I feeling what the patient is feeling about herself, and/or is there a part of my personal feelings?” Or, “Why am I feeling what I am feeling? Is it coming from myself, or coming from the patient?”

 

*For an in-depth reading on Transference and Countertransference, please feel free to read this article: https://www.dropbox.com/s/uy1fio7x1y7x7cl/Transference%20and%20Countertransference.doc

 

(Post 5)

 

Spiritual Resistance
We looked at our unconscious and resistance in Post # 1. Spiritual Resistance is our unconscious’ way of coping with something we don’t like or are not ready to do, this time, through our “spiritual” beliefs. Christians can untentionally hide behind spiritual sounding “principles” as “reasons” why we are not pro-active in tackling our issues.
 
Some Christians believe that if we went to therapy, we are demonstrating our “lack of faith” for God to supernaturally heal us. Meanwhile, God doesn’t usually supernaturally intervene in our lives, as He has given us a free will, the empowerment of the residing Holy Spirit to help us do our part, as well as other believers, family, friends and therapists to aide us in our life’s journey.
 
For Example:
Brian is an overweight, 42-year-old single unemployed male, who came to therapy with the goals to: lose 40 lbs, find a mate, and to procure a job. He told me at the beginning of the year that God has given him three words for the year: “Weight, Mate and Work.” When I asked him how he was coming along with his therapy goals? He replied that he just has to pray and wait on God to accomplish these goals. He was not willing to do his part of exercising or eating healthy in order to lose weight, or to put himself in situations where he could meet a potential mate, nor to send out resumes to look for a job.
 
Treatment Suggestion:
We can point out to our patients, that many of the Biblical promises are conditional: If we do our part, then God would do His part. Some Biblical references are:  

• “Submit yourselves, then, to God. Resist the devil, and he will flee from you. Come near to God and He will come near to you” (James 4:7). 

• “Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus. Finally, brothers and sisters, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable—if anything is excellent or praiseworthy—think about such things. Whatever you have learned or received or heard from me, or seen in me—put it into practice. And the God of peace will be with you” (Philippians 4:6-9).

I like to share this widely-known analogy with my patients: Once there was a huge rain storm, and a man’s house was flooded with water. He had to climb up to the roof of his house to wait for help. A rescue boat came by and tossed him a rope for him to climb into the boat. The guy refused the rope and told his rescuers that he was waiting for God to save him. Later on, a helicopter came by and threw him a harness for him to strap onto his body for them to air-lift him from the roof. He refused their help, saying that he was waiting for God to save him. As the water continued to rise, the man drowned. When he got to heaven, he complained to God: “Why didn’t you save me?” God replied, “I tried to save you by sending you the rescue boat and the helicopter, but you refused my help!”


God has provided us with modern medicine to heal our ailments. Therapy can be a means to our emotional and psychological healing. If we are willing to take insulin to treat our diabetes, why wouldn’t we utilize therapy to deal with our emotional and psychological issues?

Also, as therapists, we are to “not leave any stone unturned.” This enables us to explore our patient’s unconscious feelings and coping mechanisms. It is therefore a good practice to ask our patient to elaborate on what he means by what he is saying.

So, when a patient uses a spiritual/biblical terminology, we ask him to clarify what his definition might be. This way, we don’t take for granted what our patient means coincides with our definition of the same terminology/ concept.

It is also good to gently challenge our patient with what she is presenting as “spiritual,” in order to decipher whether or not she is using spiritual resistance to avoid doing her part of the work in dealing with life. For example: A patient states that she trusts God will change her husband and his drunken ways, and all she has to do is to love him. Meanwhile, she continues to enable him by cleaning after his alcohol-induced vomit, and puts him to bed “in order to show God’s love” to him. We can introduce the idea of Secondary Gain (Post # 2), and gently ask, “What might be the pros and cons of one having to take care of one’s husband when he is inebriated?” Through this exploration, we can help the patient to realize what she gets out of enabling her husband - all the while using the “biblical principle of showing unconditional love” - as her form of spiritual resistance.

It’s good to ask the patients at the end of the first meeting, what s/he thinks about seeing someone (you, the therapist) who is of the: same/different gender; same/different ethnicity; same faith? While the patient might say s/he has no problem with seeing someone who is different from her/him, we are planting a seed that we are open to hear her/his negative feelings toward us. I usually follow up with the statement, “Please let me know if and when you feel that I don’t quite understand you because of our (gender/ethnic) difference…”

Narcissistic Defense, Guilt is a Mask for Anger, Controlling Others via People Pleasing & Being in the Moment

Narcissistic Defense

Sometimes, we don’t allow ourselves to feel negative feelings toward others, thinking that we’re “protecting” them from our anger/negative feelings. However, it is actually our desire to protect ourselves from others’ reaction toward our anger/negative feelings…

 

For Example:

Alex is feeling resentful that his mother doesn’t approve of his choice to be an elementary school teacher, as she wants him to make more money and be able to take care of his parents when they retire. Alex doesn’t verbalize his resentment, hurt and feeling of rejection from his mother. He feels guilty for “letting her down” instead. In reality, if he does tell his mother how hurt and rejected he feels by her disapproval, he is afraid that his mother would minimize his feelings and attack him some more.

  

Guilt is a Mask for Anger

When we have committed a real crime, including cheating on our significant other, it is natural and healthy to feel guilty. Short of that though, we usually feel guilty for not being able to meet others’ expectations of us. This latter type of guilt is actually us masking our anger toward the person who has imposed their expectations toward us.

 

For Example:

Chris feels guilty for not getting off his sick bed with a fever of 101.2 to take public transportation to his mother’s house to pick up the soup his mother so “lovingly” made for him when she heard that Chris was sick earlier in the day. Chris did not ask his mother to cook him chicken soup when she found out that he was sick. His mother didn’t tell him that she was cooking him the soup, and called up after having made the soup for him to come to pick it up.

What Chris is feeling deep inside - if he was to allow himself to feel it - is resentment. His mother went ahead and made the soup without first consulting with him whether or not he could come pick it up (he shouldn’t be going out into the cold with a fever!), and said to him, “How could you reject my love by not coming to pick up the soup I made for you?” So, he feels guilty for being an ungrateful son instead.

 

Treatment Suggestion:

To help a patient to get in touch with his anger underneath his guilt, we ask the patient, “If guilt is a mask for a feeling, which feeling might the guilt be masking?” We then help the patient to get in touch with his anger/resentment toward the person who is imposing their expectation on the patient. This alleviates the unnecessary guilt, and helps the person to identify his feelings, to feel his feelings, and understand why he feels the way he feels. We then help the patient to choose to do what is constructive in spite of his feelings…(Please refer to Blog Post 2)

 

Controlling Others Via “People Pleasing”

Some of us shy away from confrontation and tense situations, and end up twisting ourselves into a pretzel to please others. When we examine what’s behind this “people pleasing” behavior/mechanism, we find that we are trying to “prevent” others from feeling hurt or having negative emotions.

Many times, we are over-identified with the person in pain and we want to protect her/him from the pain. But by acting in the manner of pleasing the other person - sometimes “at all cost” - we are actually “saying” that they shouldn’t feel how they feel…we are therefore, controlling the other person’s feelings. After all, why can’t the person feel however s/he feels?

 

Being in the Moment

Whoever has a personal saving relationship with Christ Jesus will live in eternity in the presence of God. Emotionally though, all we have is this present moment. Every moment comes to an end. We have good moments, and they come to an end. We can have a bad moment, and that too, comes to an end.

When we find ourselves regretting our past, we are “playing the tape” of our past. Since no one has yet to invent the time machine, regretting our past and revisiting what did/could’ve/should’ve happened, will only lead us down a spiral of depression.

When we assume the worst will happen to us in the future, we are “writing the script,” as if we know what will take place in the future. Since only God knows the future, we need to stop acting as God.

So, all we have emotionally, is the present. The more we are able to stay in the present moment, the better chance we will have to build a better future.

Treatment Suggestion:

We help our patient to “Stop Playing the Tape” of the past, and “Not Write the Script of the Future,” and stay in the moment instead. We encourage the patient to take a deep breath, look around her environment and verbally describe what she sees in her physical surroundings. This helps to ground the person and to bring her back to the present moment. We tell the patient to feel the moment and to stay in it, knowing that this moment will pass.

When a person can embrace her bad moment (instead of trying to fight it by panicking), the bad moment will pass quicker. The more the person tries to fight the bad moment, the longer the moment lasts.

We tell the patient that this moment will pass. The more she is able to stay in the moment, the better chance she would have to develop a better future. We also tell her that she can decide what type of moment she will have next…by staying in the present moment. The paradox is that the more we embrace our present bad moment, the likelihood of a having a better next moment increases.