What Is Acting Out?

The most common way of thinking about “acting out” is that it is self-destructive behavior. But originally Freud used the term to describe when a patient acts on the basis of an unconscious feeling rather than remembering it. For example, the patient may consistently pay late or miss sessions. The action covers over an unconscious wish or conflict and the analyst may understand it as resistance to treatment. Hence, the term "acting out" has developed a pejorative connotation.

Enactments in Treatment

Another type of acting out that contemporary psychoanalysts tend to call “enactments” refers to nonverbal behaviors in the treatment room that are growth-enhancing because they are attempts to communicate something unspeakable. I had a patient who suddenly jumped off the couch and ran to the bathroom and another who suddenly felt a pain in her side. These behaviors were attempts to re-create early traumatic experiences. Patients who have suffered sexual abuse, especially those who had an important relationship with the perpetrator, frequently suffer psychic flooding and disorganization. These experiences of childhood terror cannot be verbalized, but, rather, the memories are experienced as radical mood shifts, panic attacks, or somatic experiences. Adult survivors of childhood sexual abuse frequently experience repetitive episodes of abuse and in many ways epitomize the paradox of the repetition compulsion.

Survivors of childhood sexual abuse experienced the trauma by the parent or close person who is the abuser and the additional psychological trauma of having a parent who fails to protect them against the primary betrayal. In the transference, the survivor may experience the analyst as the perpetrator or the parent who betrayed her by not protecting her. The patient may also treat the therapist as she was treated—abusing the therapist by changing the story or accusing the therapist of making it all up. These different transferences may not be stable, but rather rapidly shift.

Risky Behavior Outside of Therapy

If the survivor is in therapy, the trauma may get acted out in the transference where the therapist can offer a safe haven and the enactments can be understood. But most survivors are not in therapy and act out in an array of self-destructive behaviors from self-mutilation, substance abuse, promiscuity, driving while drunk, stealing, and just repeatedly putting themselves in dangerous situations such as walking on deserted streets late at night or hitchhiking. Risky behavior turns passive trauma into active control over the timing, pace, and severity of the abuse. Subjecting oneself to abuse by entering dangerous situations often results in being a victim once again, but it is familiar and offers a secure identity. It is an attempt to master a traumatic experience or to maintain a fragile sense of self that is based on identifying as a victim. This is one of the ways that childhood sexual abuse has lifelong repercussions.

The term "acting out" can refer to actions that are self-destructive or growth-enhancing. Even repetitive behavior that has self-destructive outcomes can sometimes be unconscious attempts to work through an unconscious conflict or traumatic memory. The goal in psychoanalysis, through the mechanism of the transference, is to encourage the patient to act out in the safety of the treatment room rather than in the outside world and to transform the actions into verbal memories. Once the unspeakable is "speakable," there is the possibility of working through the conflict or trauma and mastering it enough to stop repeating it.