Meaningful You

Voices of contemporary psychoanalysis

Resistance and Resilience on the Couch

The path through anger to need in a client-therapist relationship

Image: Flickr/SimonBlackley
This blog curates the voices of the Division of Psychoanalysis (39) of the American Psychological Association. Shari Thurer, psychoanalytically oriented psychologist in Boston and author of the blog TheShinkFiles, submits this post:

It was hate at first sight. Not only did my office in an upscale neighborhood offend John’s radical Marxist politics, but my leather shoes violated his belief in animal rights, and my use of lipstick  piqued his feminist sensibility.  Plus he didn’t like my body type. I was too slim for him, despite the ten unwanted pounds I had acquired in my freshman year of college in 1965 and never lost. I think he was afraid I could not withstand his verbal assaults.

He conveyed all these grievances about me in our first session, that is, after I told John that he could say whatever went through his mind without censoring. I have to admit that I was a bit surprised: I’d never encountered a patient quite that honest, quite that quickly.  Instantly I had become become a toilet into which all his hate, anxieties and distrust could be expelled. When I pointed out that he was free to choose another therapist, John was quick to berate me for trying to get rid of him.

I am one of those therapists who believe it is the relationship that heals. That is my mantra: it is the relationship that heals. A good therapist conveys nonjudgmental acceptance, authentic engagement, and empathic understanding. But John’s vitriol was a bit much. How was I going to be able to heal John via such a contentious relationship? How could I deal with all that excrement?

John came punctually to our weekly meetings, and always maneuvered to stay late, despite the fact that he found therapy worthless, which he told me often. Into those hours flowed a continual torrent of complaint, blame and indictment. John did everything in his power to provoke me. The more tolerance , acceptance , forgiveness and understanding I mustered , the more contemptuous he became. He accused me of being cold, robotic, cliche, no good.

Realizing that empathy was getting me nowhere, I finally, I offered an interpretation. I told him that he was  insulting me because he was afraid…afraid of his attachment to me….afraid I would reject him.  He needed to do this, to push people to the point at which they rejected him, and then he could feel sorry for himself for being friendless. That was his pattern — to reject people before they would reject him. He wanted me to beg him to be my patient.

John exploded. He insisted he was not attached to me. How could I think he was attached when he spewed forth such venom? “I do not like you”, he said. “You are not helping me. I am not attached.”So much for my interpretation.

John was twenty-two when I first met him, bald and overweight, living “off the grid,” that is, residing in the offices of  large technical university at night, eating free food which was always available somewhere at some event on campus, showering in the gym.  He was passionately involved in the free open source software movement. At the time, I didn’t know what he was talking about.

He had grown up in a middle class home in the Midwest and attended Catholic school where he was the butt of taunts and sadism that makes a little fat boy’s life hell….and, sadly, he associated in spirit with his tormenters. His father was disappointed with his lack of athleticism and his mother, according to John, never paid attention to anything outside herself. No one protected him. The nuns were the worst.

All the privations John had endured in his life were now laid upon me. Week after week, John came to my office, scowled, plopped heavily onto my couch, and hurled insults. When I pointed out that hatred is a form of attachment….that the opposite of love is indifference, not hatred…he vehemently contended that he was indifferent to me.

Eventually he was offered a paying job in another city. We set a termination date. I wondered whether the designation of an endpoint would stir up any affect, or more precisely, I wondered whether  that it wound stir up feelings that he could acknowledge. But it did not. He kept insisting on his non-attachment.

It was our last appointment. I wished him well in his new endeavor. He told me, and yet again, that he thought psychotherapy was a “crock.”I opened the door for him to leave. He stepped outside and down the steps. I watched him as he reached the corner, a safe distance from my office…..and then he burst into  loud, heaving, soul wrenching tears.

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John is a fictionalized account of a group of patients.

Kristi Pikiewicz is managing editor of the American Psychological Association's Division of Psychotherapy DIVISION/Review.

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