the basics again – don’t diagnose yourself

Last week I posted an entry in which I pointed out how important it is to bear in mind that you may not know what’s wrong with you.  A recent session provides a good example of this, and of the layers of defense and resistance that must be mined to discover the real problem.

Erin came to see me complaining of long-standing feelings of unhappiness, in particular a sense of being chronically shy, “introverted”, uncertain.  Her relationship with her husband had deteriorated over the years, they hardly spoke, she felt chronically disconnected, nervous, lonely.  In inquiring about their relationship in some detail, I did not hear anything in her husband’s behavior to account for her feelings.  Erin had been passed over for several promotions and was given feedback that she came off tentative, awkward, often inaudible.  Unfortunately she began reading about Asperger’s syndrome and decided that this is what was wrong with her.  She came to see me armed with books and articles, and even insisting that nothing could be done, that she was doomed to go on living the same life and feeling as she always had.  She described obsessing a great deal and being “frozen” when her husband – or almost anyone – asked her almost anything.

During our sessions, Erin often spoke in a mutter, and she seemed irritated yet also very apologetic when I could not hear her.  She denied the former feelings and instead pled shyness.  She is not native to this country but insisted that there would be no difference if I was speaking to her in her native language – she would similarly struggle to find her words, similarly over-correct anything she did say, and speak with the same hesitancy.  She confirmed that felt herself doing the same thing in her own language with her husband who had the same observations about her speech and demeanor that I and her employers did.

The striking thing during our first months together was the ever increasing sense I had that she was capable of far more than she admitted, that she was at some less than conscious level pleading helplessness that wasn’t true.  I have worked with people who suffer from genuinely crippling anxiety or social deficits; she did not impress as one of these.

Still we made progress.  She thanked me when she was again passed over for a promotion and did not slip into the “depression” that she had about six months earlier when the same thing happened.  She quoted the  comments she received from her employers and they were in line with what I had said to her as well in my own way – speak up, speak with energy, why do you talk as if you are about to be slapped.

At this point her veneer slipped and I was able to confront the inconsistency in her presentation.  She maintained again that she had Asperger’s syndrome and that the cure, according to a book which she quoted to me, was to “fake it until you can pass for normal”.  I offered to help her do this but she insisted she could not.  Then she got angry and demanded that I work with her on her social skills, exactly what had just offered to do and what she said she could not do.  Over the course of an extended debate she acknowledged my conclusion that whether she suffered from Asperger’s syndrome – i.e. a real deficit in her ability to perceive and process social cues – or some kind of anxiety which blocked her existing ability to perceive and process cues – the cure was the same:  Review scenarios, real and hypothetical, generate possible responses, practice them, and if possible identify triggers for any anxiety that interfered with her ability to think and function clearly.  I’m a clever fellow and was able to force her to confront the flaws in her reasoning and see how she kept returning to her plea of being a helpless Asperger’s victim instead of actually doing what she was requesting I help her do, right at the moment that she had gotten me to accede to giving her that help.

It was very striking that she ended that session more relaxed.  She furthermore reported feeling resentful during sessions, something I’d noticed but not yet mentioned, and she attributed it to anticipated or perceived criticism from me which – once she was discussing this with me – she realized I don’t actually inflict on her.  In fact, she noted, I seemed a particularly supportive and sympathetic person.  Yet the resentment was there and had to be accounted for.  It was 1) habit, a way of perceiving and moving through the world; 2) a defense, a way of resisting the feelings and perceptions that might have led her to take action.

She came in the next session still feeling better, knowing that during the entire previous week she felt looser, more confident, more grounded and centered, and calmer.  She realized that she walked around with an attitude of “fuck you, this is who I am and what I feel; you don’t like it, fuck off!  I’m sick of trying to please people!”.  I asked her to elaborate upon this and she listed her employer, her husband, and others.  She then turned the discussion back to her feelings of awkwardness in social settings, parties, conference calls at work, etc.

This time, however, because she was more relaxed and had opened up to me over several months, I was able to really grill her about the details of what happens when she’s in the meeting.  It turns out that as she puts it “I’m on the Internet”, but this time was able to acknowledge just how she got on the Internet, the chain of responses, thoughts, feelings, and actions that led her to disconnect from the conference call.  Instead of being aware of all this, her story to herself – this all happens unconsciously, she is not a deceptive person – is that she is overwhelmed with anxiety and has no control over what happens to her.  This is simply not true.  Instead, she clenches with a mix of anxiety and rage, anxiety that she might reveal her nasty side, rage that she’s being pressured, criticized, etc.; she turns away from the people she’s dealing with in a mix of these feelings but protects herself and her self-image by editing out the anger and hostility from the story, leaving only the sense of helplessness.  In her tangled emotional state, she of course feels disconnected from the topic at hand and especially from the social aspects of the interaction – in part because she’s also desperately trying not to feel all that anger.  All she allows into consciousness is her feelings of helpless anxiety.  And she presents herself this way, to me and to herself, saying “I don’t know how it happened, I ended up on the internet, I can’t think of what to say, I don’t know what they were talking about….”.  Not true.

As proof of all this, in subsequent weeks Erin told me several stories from her past and her current life in which she realized how she slipped into the stance of helplessness and thus did not take the actions of which she was capable, did not make decisions, did not even perceive options, and seethed in resentment because of this perceived helplessness and victimization.  For example, she described her husband calling her at work to say that the cable installer or some such repairman never showed up.  In the past, she acknowledged, she would feel immediately tense, resentful, and paralyzed, but would be aware only of feeling anxious.  She would not notice her hidden assumptions that her husband was demanding she do something about the problem – just as she had not noticed until recent sessions how she anticipated such judgment, criticism, and demand from him.  This time, however, she was able to see more possibility and responded to her husband’s news with a sympathetic “yeah that stinks” instead of silently raging with the thought “what does he want me to do?!”  Her husband thanked her, to her surprise, and commented that her response was so unexpected, that usually she becomes “prickly”.  He told her he felt very gratified, warm towards her, and appreciated her sympathy that he’d stayed home to be stood up by a repairman.

As you may know from the website or your own experiences, such breakthroughs in treatment – and in life – do not change everything at once; there is always regression.  Thus, Erin then told me the story of her family being without power or heat following a hurricane and her husband resisting the idea of bringing their two young children to her parents’ home where there was power and heat.  As she told the story, I found myself becoming increasingly sleepy.  This made no sense as I was quite interested during the rest of the session.  In sharing my reaction with her, then reviewing the details of how she was talking, it became clear to us that she had slipped again into her mode of helplessness, telling the story as if she had no power, had made no decisions, and even as if her husband and children were vacant and robot-like; her voice, too, had slipped back into its previous near inaudible monotone.

Eventually she retold the story and we realized that both in the telling and in the event itself she’d again “frozen” instead of speaking up and saying what she knew – bringing the children to her parent’s home was a very valid option and in the telling realized she wanted to know, by the way, just what her husband’s objections were.

The final proof that all this is not mere psychoanalytic speculation is again Erin’s response.  She felt better, calmer, stronger, looser, “saner”; she was visibly more relaxed, her voice increased in volume and assertiveness, her body was looser; finally, and behavior changed at home and even to some degree at work.  In short, she felt and functioned better.

What a mistake it would have been for her to have sought an expert in Asperger’s syndrome especially if she’d ended up with someone limited in psychotherapeutic experience.  It’s easy to imagine her and this expert talking endlessly and fruitlessly about the deficits seen in Asperger’s syndrome rather than confronting her resistance to taking charge of her life.  So as I said last week, don’t diagnose yourself.  That’s what you pay us to do.

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