When Alex first came to see me he was awash in insecurity and the buried rage that often accompanies it.\u00a0 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.\u00a0 His marriage was a storm of outbursts from his wife, he lived\u00a0in 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\u00a0insecure and obsessive about his younger boy, age 13.\u00a0 He worried that this son was isolating, too content to watch television and play video games, and drifting away from him.\u00a0 Upon inquiry it became clear his son was a fairly high functioning, quite\u00a0normal 13 year old.\u00a0 Alex was, he quickly saw, mostly worried because of his own history of loneliness, social isolation \u2013 he\u2019d 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\u2019 loud quarrels and occasional domestic violence.<\/p>\n
He came to treatment after living like this four 4 decades because he\u2019d 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. \u00a0Alex was eager to get over these problems and not just because of his career. He was, he quickly saw, as lonely as he\u2019d 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.<\/p>\n
His verbal style during sessions was an obstacle.\u00a0 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\u2019d already said twice, and so on.\u00a0 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.\u00a0 And you may detect the anger underneath \u2013 at being made to feel so insecure all the time, at feeling he must control himself so perfectly, at just feeling so inhibited, so \u201cstrait-jacketed\u201d as Alex put it.<\/p>\n
One day, about a year into our work, he came in complaining of \u201ca tightness\u201d in his chest and the accompanying thought \u201cI just wanna be left alone\u201d.\u00a0\u00a0 By this time, Alex had progressed to a point where he was functioning\u00a0at 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.\u00a0 He\u2019d 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\u2019s adjustment.\u00a0 He was more expressive in our sessions, although still wasting much of them\u00a0repeating himself and insisting that everything stop in our discussion while he did so.\u00a0 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 \u201cO, %^*&!@ off\u201d and go about his business; instead, Alex would become inhibited, tight, flustered, indecisive, and unable to think straight.<\/p>\n
The tight feeling in his chest started, Alex told me, the night before.\u00a0 He\u2019d 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. \u00a0They boy had\u00a0asked for this help and Alex looked forward to the quality time.\u00a0 But the hockey lasted\u00a0a full 2 hours, then there was a leisurely shower at home, then finally the boy arrived in Alex\u2019s room \u2013 Alex\u00a0and his wife were sleeping in separate bedrooms \u2013 for help at 11 pm, about when Alex goes to sleep.<\/p>\n
You may feel in reading the above paragraph the same anger for<\/span> Alex that I did, the same tension rising in your own chest that makes you want to say \u2013 for Alex \u2013 \u201ccome on, kid, we have to get home; if you\u2019re not ready to work by 10:30 latest, you\u2019re on your own for that test\u201d.\u00a0 (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.)<\/p>\n But instead of doing any of this, Alex got a tight chest.\u00a0 He also associated to \u2013 remembered \u2013 this sensation dogging him much of his life, and he gave an example of one occasion when he was about his son\u2019s age. \u00a0His own mother came\u00a0into his room to ask trivial questions.\u00a0 Then, as now with his son, Alex was interrupted in his own reading but could not speak up about it.\u00a0 He recalls answering his mother with clipped, minimal responses \u2013 passive aggressively \u2013 until feeling \u201cdeflated\u201d she left.\u00a0 Alex always felt \u201cguilty\u201d about this.<\/p>\n This time, I pressed Alex\u00a0for a more visceral feeling than \u201cguilty\u201d, 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. \u00a0With encouragement, he came up with \u201cafraid\u201d and also \u201ctight, clenched\u201d.\u00a0 I\u2019m sure you get the parallel and what\u2019s missing in both stories \u2013 Alex was pissed off but afraid to assert.<\/p>\n This fear is a major source of his resistance<\/a>, seen in how he\u00a0insisted on\u00a0skipping over the scene at the hockey practice as he told me the story. \u00a0I\u00a0tried to ask about it\u00a0\u2013 inquiring for example\u00a0did he signal his son \u201ctime to go\u201d, did his son come out and say\/ask about staying an extra hour, and most importantly what\u00a0Alex felt\u00a0sitting there an extra hour.\u00a0 Alex not only denied any feeling during this \u2013 despite already told me how much he was looking forward to the study session \u2013 but he was irritated that I interrupted his story with such \u201ctrivia\u201d, a feeling he covered with his usual politeness, ever quieter speech, and assurance that the important stuff was coming later.<\/p>\n Why all this therapy?\u00a0 Why can\u2019t Alex just see what is so obvious to those of us hearing the story?\u00a0 resistance.\u00a0 What you most need to see in yourself is what you\u2019re 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\u00a0(see this book chapter<\/a>\u00a0for more vivid descriptions and\u00a0examples of how this works).\u00a0 Don\u2019t 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).\u00a0 Take a look at this case<\/a> for an\u00a0 even more striking example of how what is most obvious to the rest of us remains out of awareness \u2013 unconscious \u2013 in the patient.\u00a0 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.\u00a0 We all can see what\u2019s going on, the brilliant input from the therapist couldn’t be simpler, so why does it all take so long? \u00a0Why do you need a specialist to get to the point? \u00a0Why is there a need for psychotherapy at all? \u00a0Again, the answer is\u00a0resistance.<\/p>\n Alex\u2019s story also illustrates something else to keep in mind as you approach psychotherapy:\u00a0\u00a0 Don\u2019t expect it to tickle.\u00a0 Don\u2019t flee when your therapists asks, says, or does something unsettling.\u00a0 Wait it out and see where it goes.\u00a0 This is particularly true early in treatment.\u00a0 There is a strong tendency to flee in the early sessions because it\u2019s not a massage, because you\u2019re not being given \u201cunconditional positive regard\u201d (does anyone still use that expression?)\u00a0 Such reassurance and warmth\u00a0has a\u00a0place but it is\u00a0not therapy. \u00a0It may even be destructive, may be a kind of \u201cenabling\u201d which is opposite to treatment, which only reinforces the things that are messing up one\u2019s life.\u00a0 Some people need to be reassured \u201cyou have every right to be angry\u201d but some need to hear \u201cthat’s<\/span>\u00a0what got you so hot?\u201d<\/p>\n","protected":false},"excerpt":{"rendered":" When Alex first came to see me he was awash in insecurity and the buried rage that often accompanies it.\u00a0 He felt chronically left out of things at his job as a high level financial analyst, endlessly self-conscious about joining … Continue reading