When Alex first came to see me he was awash in insecurity and the buried rage that often accompanies it. He felt chronically left out of things at his job as a high level financial analyst, endlessly self-conscious about joining in the water-cooler chats, and he obsessed constantly about his shortcoming, possible Asbergers syndrome (wrong), and how to socialize. His marriage was a storm of outbursts from his wife, he lived in fear of them as if each would destroy his tenuous self-esteem and domestic security; his older son was in in college, and he was similarly insecure and obsessive about his younger boy, age 13. He worried that this son was isolating, too content to watch television and play video games, and drifting away from him. Upon inquiry it became clear his son was a fairly high functioning, quite normal 13 year old. Alex was, he quickly saw, mostly worried because of his own history of loneliness, social isolation – he’d been sick as a young boy and missed a great deal of school during which time he was home with his frantic and distant mother, yearning for social contact, very afraid of his parents’ loud quarrels and occasional domestic violence.
He came to treatment after living like this four 4 decades because he’d been passed over for promotion again and was told explicitly that it was because the bosses did not feel he fit in well socially; they told him he was tense, spoke in a whisper, not assertive or friendly enough. Alex was eager to get over these problems and not just because of his career. He was, he quickly saw, as lonely as he’d been as a child, and although had built a career and a family he felt as cut off and frightened as he did when he was 6.
His verbal style during sessions was an obstacle. He spoke in a very quiet, at times incomprehensible monotone, and he often interrupted just when he was getting the answers he wanted; he’d restate something, finish a sentence he’d already said twice, and so on. You may recognize these kinds of controlling efforts to contain anxiety, you may have seen them in others, you may recognize them as a form of passive aggression. And you may detect the anger underneath – at being made to feel so insecure all the time, at feeling he must control himself so perfectly, at just feeling so inhibited, so “strait-jacketed” as Alex put it.
One day, about a year into our work, he came in complaining of “a tightness” in his chest and the accompanying thought “I just wanna be left alone”. By this time, Alex had progressed to a point where he was functioning at work more calmly, he was making some friends, and he was in fact up for another promotion which looked more promising this time based on the feedback he was receiving from superiors. He’d relaxed a bit around his wife, did not leap to the defense every time she had a bad mood or asked him a question, and he was allowing his son to be his 13 year old self without agonizing over what each piece of behavior might mean for their relationship or the boy’s adjustment. He was more expressive in our sessions, although still wasting much of them repeating himself and insisting that everything stop in our discussion while he did so. His main problem at this point in our work was the inhibition that arose just when another person would assert, make a decision, take some kind of action, or at the very least breathe a healthy “O, %^*&!@ off” and go about his business; instead, Alex would become inhibited, tight, flustered, indecisive, and unable to think straight.
The tight feeling in his chest started, Alex told me, the night before. He’d driven his son to an informal hockey practice with the understanding between the two that the practice would last an hour, then they would return home and work on math in preparation for a test the next day. They boy had asked for this help and Alex looked forward to the quality time. But the hockey lasted a full 2 hours, then there was a leisurely shower at home, then finally the boy arrived in Alex’s room – Alex and his wife were sleeping in separate bedrooms – for help at 11 pm, about when Alex goes to sleep.
You may feel in reading the above paragraph the same anger for Alex that I did, the same tension rising in your own chest that makes you want to say – for Alex – “come on, kid, we have to get home; if you’re not ready to work by 10:30 latest, you’re on your own for that test”. (Alex confirmed to me the test was not crucial, his son was not likely to fail, and if he got a bad grade could make up for it over the rest of the semester.)
But instead of doing any of this, Alex got a tight chest. He also associated to – remembered – this sensation dogging him much of his life, and he gave an example of one occasion when he was about his son’s age. His own mother came into his room to ask trivial questions. Then, as now with his son, Alex was interrupted in his own reading but could not speak up about it. He recalls answering his mother with clipped, minimal responses – passive aggressively – until feeling “deflated” she left. Alex always felt “guilty” about this.
This time, I pressed Alex for a more visceral feeling than “guilty”, a word he uses indiscriminately as he tells me most stories about his life and with which he summarized his reactions both 35 years earlier with his mother and with his son the night before our session. With encouragement, he came up with “afraid” and also “tight, clenched”. I’m sure you get the parallel and what’s missing in both stories – Alex was pissed off but afraid to assert.
This fear is a major source of his resistance, seen in how he insisted on skipping over the scene at the hockey practice as he told me the story. I tried to ask about it – inquiring for example did he signal his son “time to go”, did his son come out and say/ask about staying an extra hour, and most importantly what Alex felt sitting there an extra hour. Alex not only denied any feeling during this – despite already told me how much he was looking forward to the study session – but he was irritated that I interrupted his story with such “trivia”, a feeling he covered with his usual politeness, ever quieter speech, and assurance that the important stuff was coming later.
Why all this therapy? Why can’t Alex just see what is so obvious to those of us hearing the story? resistance. What you most need to see in yourself is what you’re most likely to avoid; more exactly, it’s what you’re most likely to push away and remain steadfastly unconscious of, despite all evidence slamming you in the face (see this book chapter for more vivid descriptions and examples of how this works). Don’t forget, Alex grew up timid, cowed by his scary and sometimes violent parents, desperate to hang on to the little home he felt he had, especially during the years of being housebound and cut off from his peers and from other sources of adult support/guidance/modeling (e.g. teachers). Take a look at this case for an even more striking example of how what is most obvious to the rest of us remains out of awareness – unconscious – in the patient. This central fact of psychotherapy – that we resist what we most need to learn – is, by the way, why the field sounds so trite and inane on talk shows. We all can see what’s going on, the brilliant input from the therapist couldn’t be simpler, so why does it all take so long? Why do you need a specialist to get to the point? Why is there a need for psychotherapy at all? Again, the answer is resistance.
Alex’s story also illustrates something else to keep in mind as you approach psychotherapy: Don’t expect it to tickle. Don’t flee when your therapists asks, says, or does something unsettling. Wait it out and see where it goes. This is particularly true early in treatment. There is a strong tendency to flee in the early sessions because it’s not a massage, because you’re not being given “unconditional positive regard” (does anyone still use that expression?) Such reassurance and warmth has a place but it is not therapy. It may even be destructive, may be a kind of “enabling” which is opposite to treatment, which only reinforces the things that are messing up one’s life. Some people need to be reassured “you have every right to be angry” but some need to hear “that’s what got you so hot?”