Torn Inside?

"I, Others: Understanding"

Source: Kaspar Lunt/Pixabay

Psychotherapy gives a person greater freedom of thought, a richer way of being in the world and more gratifying relationships with others. But how and by what method? Addressing inner conflict is one approach.

Internal conflict is basic to the human condition and to how the mind works in both illness and health. The question is how a person deals with their own inner conflicts and to what degree these struggles interfere with daily life and who each of us has the potential to become. There are times internal conflict can be a response to old ways of being in the world and out of touch with current reality. It can keep us from developing in ways and prevent the pleasure that comes from self-knowledge and awareness. If an internal conflict is intense, it can deplete one’s internal energies and weaken the personality. It can undermine its sense of wholeness or integrity. Talk therapy addresses these concerns in important ways.

1. Verbalization. The English philosopher J. L. Austin said words do things. Talk therapy puts things into words as much as possible through free association or by speaking whatever comes to mind. No easy feat. While nonverbal communication is relevant and, at times revealing, the verbalization of thoughts and feelings is a primary focus.

A train of thought provides information for the clinician to consider how speech moves toward and also away from certain experiences. The patient’s articulations provide the data of observation and gives important insight into previously unexplained emotions and behaviors.

2. Co-participation. The patient is a co-participant in the therapeutic enterprise. As reported in the work of psychoanalyst Fred Busch, the clinician feeds back or re-presents the verbalized data by saying in effect: “You have presented this, and we can see so and so.” In this manner, the therapist is “objectifying” the patient’s thoughts, distancing him or her from the felt experience of the words allowing the patient to stand outside them.

By presenting the patient’s associations as the data from which to formulate certain questions, the therapist is objectifying something that is experienced primarily in an emotional way. Together the dyad begins to think about the patient’s own thought process. This also helps to identify and name internal conflicts the patient has.

3. Internal conflict. When verbalizations in a session grind to a halt, there is resistance, a term Freud used to convey how verbal and non-verbal material block access to the unconscious. Resistances themselves are often unconscious. So such a moment in therapy suggests internal tension or struggle. Often resistance to an awareness of one’s own feelings can have a profound impact on one’s life. While conflict in mental functioning covers a broad range of phenomena, the task is to understand the workings and origins of such conflicts. The following is an example of how an internal conflict becomes externalized or transposed onto external reality. This is a common occurrence.

Busch recounts how one patient used the early sessions of treatment to present their thoughts in a very organized and structured way, as if her life were “a series of short stories,” with a beginning, middle, and end. While moments were moving, the accounts felt schematic and unspontaneous. The content of the material had to do with how the patient felt controlled by the demands of work and family and how much she wanted time for herself. When the therapist pointed out the labored quality of verbalizations the patient agreed and spoke of how free association frightened her and felt dangerous. She was able to recognize her anxiety when faced with the prospect of her own free thinking. According to Busch, “Her associations then turned to situations where she felt out of control (e.g., fury at her younger sister, the rashes she developed when first dating, etc.). I could then point out to her that the theme of the session, resenting external controls, might be an externalization of an internal issue, her fear of loss of control and the resulting tight rein she needed to keep on herself.”

It is useful to reflect not only on content or what a patient is talking about but also the way he or she is talking. The patient’s unique take on free association demonstrated her internal conflict. Her words themselves revealed the theme, but the patient had not been able to view the conflict as within her until now. Another change in therapy is the increased ability to contemplate thoughts and feelings as a product of one’s own mind rather than something arising from the external world.

4. Self-reflection. Talk therapy results not so much in eradication of internal conflicts but changes in how one thinks about these internal conflicts. Over time one is able to contemplate his or her thinking in new ways. There is an increased self-observing and analytic capacity. Thoughts flow more easily between the experiencing aspects of oneself and the reflecting capacities, and one is able to consciously understand and express the conflict to a fuller extent.

So what changes is how a person thinks about their own thoughts, more specifically his or her ability to see internal conflict when it is operative and also the underlying perceived threats such as criticism or humiliation that leads to inhibition or self punitive tendencies. Rather than being swept away by an emotion, the person in therapy develops the capacity to recognize, step back from it and contemplate its meaning.

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“The capacity to observe one’s own thought process is a rather late development in life, and is not easily available to the patient caught up in conflict,” writes Busch. In advanced stages of treatment, the patient can also observe his or her own observations about feelings and experiences, both the obvious and the subtle, the concrete and the abstract, the real and fantasized.

This moment of reflection occurs retrospectively—only after a tide of emotion or some acting out, but gradually reflection comes quicker and acting out is lessened.

Another change that occurs through therapy: rather than being overwhelmed, there is increased tolerance for and understanding of one’s own emotions and knowledge of where they come from. The patient sees that his or her feelings are not so scary or shameful. They are recognized and often understood as a reaction to an earlier time, sometimes a survival mechanism from childhood that has outlived its usefulness. The patient develops the ability to live their emotions rather than avoid them or be lived by them in uncontrolled expressions of acting out.

5. Relief of symptoms. The word symptom means split and suggests a break between what a person has experienced and what he or she knows about that experience. A symptom is the signature of thinking caught up in conflict. This involves a cleavage between the conscious and unconscious parts of the mind. It is a way of expressing a conflict, what Freud understood as repressed mental contents beneath the surface of awareness. Such behaviors can take the form of substance addiction, compulsive sex, or psychosomatic disturbance such as an eating disorder. Acting out in these ways binds anxiety and gives momentary relief for emotional pain.

Through the development of observational capacity, enactment gives way to reflection. By putting such experiences, and the feelings and fantasies connected to them, into words, therapy creates the experience of moving across the gap, suturing the break between conscious and conscious, between these different parts of the mind. As a particular behavior or pattern of response can be thought about and owned rather than acted on, the psychic energy that fuels symptoms is transformed or lessened over time. The expanded capacity to reflect on and understand internal conflict leads to relief of symptoms.

Talk therapy is a method of discovering how to listen to oneself. More than the clinician imparting arcane knowledge of the patient’s life or mental workings—the aim is to show the patient him- or herself. It is clearing the way for the patient to access his or her own mind.

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