The first step in solving any problem is to identify and become intimately familiar with it. This is as true for overcoming depression and anxiety as it is for cracking cases on TV's CSI (Crime Scene Investigation), or even solving a crossword puzzle. Unfortunately, when people look at their personal difficulties, they often have blind spots that they don't even know are there.
Although people may not be aware of their blind spots, those around them frequently are. For example, Peter* came to therapy because his wife insisted that he had an anger problem. He acknowledged that he occasionally blew up, venting intense anger that seemed to come from nowhere. At one point, he blurted out, "I can't believe she would f***ing do that! What the hell was she thinking?!" I commented that he really sounded angry - which he resolutely denied. After a few similar interactions, he paused after my comment; then smirked and said, "I guess I am angry." After that, he could acknowledge his anger before it became explosive.
What Peter came to understand, after much discussion, was that he was unconsciously avoiding conflict with his wife out of a deep fear that she would leave him. His parents had had a nasty divorce when he was young, and his first wife had left him. While he acknowledged knowing all of this deep down inside, this was the first time he had been able to really look at it - and talk about it.
Much like Peter, people often protect themselves by closing off awareness to scary or painful experiences. So, while they can sometimes acknowledge the problems that arise due to this method of coping (like Peter's rocky marriage), they are blind to what is really causing those problems.
Another common illustration of this that I see in my clinical practice occurs with people who have low self-esteem. Some have struggled from a young age with feeling essentially flawed. This is so painful that they try to avoid failing at anything because they see it as a sign that something is wrong with them. They do this either by giving up trying to succeed, trying to do everything perfectly; or vacillating between the two. And, when they try to become happier people by focusing on the external tasks at hand, they are not focusing on the real problem; their sense of being damaged. So, their misguided attempts to feel better leave them feeling chronically unhappy.
Whenever people struggle because they have closed off awareness to some aspect of their experience, they need to face that part of themselves to find relief. Of course, this poses a problem, since this awareness is what they are defending against - because it is just too scary or painful. So, what they need to do is find a way to feel relatively safe while also experiencing threatening thoughts or feelings.
This is frequently the work that is done in therapy (or even self-help programs, such as Alcoholics Anonymous), though different models of treatment approach it differently. In the end, successful approaches help people to fully acknowledge those denied experiences.
By slowly acknowledging these experiences and working the edges of them (much like slowly wading into cold, deep waters), people can get to know, tolerate, and accept those aspects of themselves. Humans are social creatures, so this process frequently has to occur within at least one secure, supportive relationship (which may or may not be with a therapist). The agenda is to explore those aspects of themselves that they have been denying; or have never really known. And, with this exposure, they can begin to experience and understand themselves in new ways; freer to make healthy changes.
*Peter is not a real person, but rather a composite of patients I have treated. This fictional dialogue is intended to represent an actual problem presented by many different patients.
Dr. Leslie Becker-Phelps is a clinical psychologist in private practice and is on the medical staff at Somerset Medical Center in Somerville, NJ. She is also the ‘Relationship' expert on WebMD's Sex and Relationships Health Exchange.
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