difficult, help-rejecting people and the resistance of the analyst

Frank Mankiewicz, George McGovern’s campaign manager, called Hunter S. Thompson’s Fear and Loathing on the Campaign Trail ’72 the “least factual, most accurate” account of the election. Jacques Lacan quotes are often like this. For example:

There is no other resistance in analysis than that of the analyst.

People that could be called schizoid, avoidant, or “over-intellectual” experience this problem. Are these people unusually difficult, or do they have a hard time expressing vulnerability to people that don’t like them? Are “normal” therapists simply unable or unwilling to empathize with these people? At any rate, they’re frustrating, “help-rejecting,” and hard to treat. To improve the situation, Robert Muller wrote Trauma and the Avoidant Client: Attachment-Based Strategies for Healing. This is a book by someone that’s genuinely interested in helping a group of traumatized people that’s actively avoided by some clinicians. The book is well-reviewed and seems to really help people.

If you approach the book with a fundamental distrust, as befits an avoidant person, you can find (probably unintentional) hostility directed at yourself. There are unspoken conflicts about values, priorities, and power. You get the impression that certain coping mechanisms are ok when employed by some people but not others. The following things are considered “avoidant defenses”:

  • Positive ending. “…the tendency to put a positive ending, a positive spin on an otherwise deeply distressing story.”
  • Self-perception as self-reliant, independent, strong, and normal. “Yet, when colored by interesting content–stories of personal misfortune alongside acts of bravery, philanthropy, optimism, and self-sacrifice–it is easy to get drawn into a position of viewing the client with admiration.”
  • Intellectualization. “We often see a tendency toward therapist disengagement when working with clients who rely heavily on intellectualized speech or activity…”

Any sort of “minimization” is to be discouraged, and it’s a problem that “the client attempts to keep himself from being identified as a victim.” Finding morbid humor in something terrible is bad because it makes the therapist uncomfortable (they don’t know whether to laugh or not). What’s the real problem here? The therapist is denigrating what the client has been able to achieve on their own, mostly because the client doesn’t want to cry in front of him. It’s almost like the point of therapy is to make the person cry, thereby humiliating themselves before the therapist.

Don’t some approaches to therapy revolve around retelling life stories in less depressing ways? Should traumatized people feel dependent, weak, and damaged? Why is “cognitive reappraisal” called “minimization” when a client arrives at the approach on their own? Is the therapist’s need to be needed being threatened?

This is a reading of a book intended to help avoidant people. Just because the therapist is stressing them out with mixed messages doesn’t mean the patient isn’t emotionally sensitive and observant. Also, clients can see what therapists think of them because therapists write those feelings down and publish them in books and professional journals. Jeffrey Seinfeld describes those feelings very well, in The Empty Core: An Object Relations Approach to Psychotherapy of the Schizoid Personality. It’s worth quoting at length, because the news is bad:

Some common manifestations of countertransference reactions to schizoids include: sleepiness in sessions; a lethargic hypnoticlike state; a loss of memory of the content of preceding sessions; an unusual lack of concern about the patient’s well-being; an inability to focus on the patient’s material; the sense that either the patient, the therapist, or both are no more alive than the nonhuman objects in the office; the sense that the therapist has become like a vending machine, the patient pays a fee and takes what he needs; the feeling that one is not earning the fee and that the patient is being ripped off; the wish that the patient would miss the next session because the treatment is a waste of time; ideas that the patient is untreatable.

The therapist often feels that the patient is not significantly improving but that a heroic effort to help is not necessary because the patient is not suffering acutely. The patient often anticipates that the therapist does not want to be bothered, that he finds the patient a burden and the patient plans to trouble the therapist as little as possible…

It is the therapist’s task to help the patient become a bother. The patient defends against the activation of dependency needs by making himself into an easy, nondemanding patient….

The therapist treating a schizoid may find that apathy is transformed into rage, which is acted out in passive-aggressive attitudes and responses. The therapist may become withholding, or late for his sessions, foul up scheduling and hope a different patient appears at the schizoid patient’s time. The therapist may take calls in session, fall asleep, select the patient’s hour if there is a need to cancel an appointment. The therapist is less likely to react in these passive-aggressive ways with the classic borderline patient if only because the borderline patient would not allow him to get away with it.

If someone knows that this is the effect they have on people, and they feel empathy for those people, the person might not wish to be a bother. The therapist would be better off if the patient left them alone, because the world would be better off without them. It’s like the patient has entered some kind of Twilight Zone of psychotherapy, but that very feeling is evidence of Cluster A psychopathology. Seinfeld explains how this is all the patient’s fault, appealing to something called “projective identification.” As if by magic, the therapist’s unflattering emotional reactions were caused by the patient and not the therapist’s own issues:

Grotstein (1985) states that in defensive projective identification, the patient experiences the unconscious phantasy that unwanted split-off aspects of the self or object have been translocated into the external object often to control or disappear into it. The borderline patient uses projective identification to place the sadistic self or parental image onto the therapist, thereby inducing hate in the countertransference. The schizoid patient uses projective identification to place the neglectful parental image onto the therapist, thereby inducing apathy in the countertransference. The therapist comes to feel as indifferent toward the schizoid patient as the parental object had been.

Bruce Fink psychoanalyzes the projective identification excuse in Fundamentals of Psychoanalytic Technique: A Lacanian Approach for Practitioners:

Insofar as analysts are inclined…to take the analysand’s reactions personally, they often find themselves thinking rather negative thoughts and having rather negative feelings about the analysand. Instead of being encouraged to realize that they are erroneously situating themselves as the target of the analysand’s anger and that they should try to situate themselves differently in the analysis, they are often encouraged to believe that they are experiencing “projective identification…” The analyst’s countertransferential feelings do not, in this perspective, reflect either her personal idiosyncrasies or infelicitous stance in the therapy, but rather something “objective” about the analysand; as Paula Heimann (1950, p. 83) put it, “The analyst’s countertransference is not only part and parcel of the analytic relationship, but it is the patient’s creation, it is part of the patient’s personality.”

The first thing we should notice here is that…analysts are encouraged to think they have become exquisitely sensitive to something of which the analysand is not even aware. We should perhaps be suspicious of the fact that the analyst’s negative reaction to the analysand is thereby magically converted into a virtue, a dialectical reversal of the situation being effected here not for the analysand’s sake but apparently so that the analyst can have a clear conscience…This alchemical transmogrification of something lowly…into something worthy may well explain part of the popularity of the concept.

Guntrip’s Schizoid Phenomena, Object Relations, and the Self, which is very good, describes the whole trainwreck from the patient’s perspective:

The patient longs for the analyst’s love, may recognize intellectually that a steady, consistent, genuine concern for the patient’s well-being is a true form of love, yet, because it is not love in a full libidinal sense (Fairbairn reminds us that it is agape, not eros), the patient does not “feel” it as love. He feels rather that the analyst is cold, indifferent, bored, not interested, not listening, busy with something else while the patient talks, rejecting. Patients will react to the analyst’s silence by stopping talking to make him say something. The analyst excites by his presence but does not libidinally satisfy, and so constantly arouses a hungry craving.

The patient will then begin to feel he is bad for the analyst, that he is wasting his time, depressing him by pouring out a long story of troubles. He will want, and fear, to make requests lest he is imposing on the analyst and making illegitimate demands. He may say “How on earth can you stand the constant strain of listening to this sort of thing day after day?” and in general feels he is draining and exhausting, i.e., devouring, the analyst.

Where Muller hates on avoidant people for trying to be stoic, Guntrip understands the reasons. Importantly, Guntrip was also writing a long time ago, when deeply questioning society’s values was more tolerated:

So cultural attitudes drive them to feel ashamed of weakness and to simulate strength…The reason why there is a taboo on tenderness is that tenderness is regarded as weakness in all but the most private relations of life, and many people regard it as weakness even there and introduce patterns of domination into love-life itself. The real taboo is on weakness; the one great crime is to be weak; the thing which none dare confess is feeling weak; however much the real weakness was brought into being when they were so young that they knew nothing of the import of what was happening to them. You cannot afford to be weak in a competitive world which you feel is mostly hostile to you, and if anyone is so unfortunate as to discover that his infancy has left him with too great a measure of arrested emotional development and a failure of ego-growth in the important early stages, then he soon learns to bend all his energies into hiding or mastering the infant within.

Returning to the issue of intellectualization, Guntrip also gets it:

One patient began by saying that he looked on the analysis as a valuable course in psychology. Others will bring for discussion their intellectual problems about religion, or morality, or human relations in society, or their doubts about psychoanalysis. I do not think that this kind of material can just be rejected outright as a defensive manoeuvre. It can well be that the patient feels that his intellect is the one part of his personality that he can function with, and if he is just ruthlessly stopped from using it in sessions he may well feel merely “castrated,” or reduced to a nonentity, depersonalized. This is all the more likely to be the case if his early attempts to form his own views were ridiculed at home. The grown-up self needs support and understanding in analysis as well as the child, for the grown-up self has to stand the strain of carrying the child with him. For that reason, when treating patients who work in medical, psychological, or social fields, I have always accepted the discussion of some of their own “cases” in the session, for in fact these always lead back to their own problems.

Another way of saying this is that that complaining about intellectualization can be a sign that the therapist is refusing to accept metaphorical communication from the patient. It would be fair to call this “resistance of the analyst.” This entire post is an exercise in intellectualization. I’m stringing together citations to compare and contrast a contemporary attachment-based therapy with a classical British object relations approach, with a detour about Lacanian objections to projective identification. Psychoanalysis, itself, seems like it’s of greater academic interest than clinical interest. It would still be unfair to call this post evidence that I’m “avoiding emotions.”