Primitive Defenses

The contents of this blog are my opinions and are not the opinions of any current or former colleagues. This is not to be construed as mental health or medical advice and does not constitute a relationship with a professional therapist.

“We often meet our destiny on the road we take to avoid it.”

Jean de la Fontaine

That is the epigraph in Dan Chaon’s Ill Will. Ill Will is a horror novel with a psychologist as a protagonist, which neatly covers a Venn diagram of many of my life interests. I’m 50 pages into it at the time of this writing; it’s good so far.

I’ve been reflecting recently on what makes therapy difficult for clients. It goes without saying that a variety of historical and current difficulties, as well as internal and external forces, can make the experience feel more challenging for anyone who chooses to enter a therapeutic relationship and embark on a journey of self-discovery.

Years back, I worked with a client who briefly saw me for therapy, after seeing a different therapist at the same mental health clinic I worked at. They switched therapists because of the apparent, numerous errors the other therapist made. I can comfortably say this client had a similar experience with me, as things ended with a not-amicable termination. Much of what the client focused on in therapy were mistakes I was making in sessions. It’s possible, at the time, I did not have the skill to address this with them. It’s possible I still don’t; I would also consider that my then-level of skill is the wrong framework with which to approach the issue. It’s important for a therapist and client to speak about and be able to speak about what is happening in the therapeutic relationship. It’s wonderful for a client to give a therapist difficult and honest feedback. My sense of this client, however, was that by excessively focusing on the therapist, it allowed them to avoid focusing on themselves. In our brief relationship, I did not learn the full extent of their trauma experience or narrative, but I imagine it was not insubstantial. Keeping the focus on an externalized other is a simple way to avoid looking there.

Therapists often work with clients who speak extensively during sessions. There are many plausible explanations for this. Sometimes clients experience hypomania or mood lability, which comes with rapid or pressured speech; it is simply quite challenging for them not to speak. Another explanation, which is a softball, is that by speaking, the client can avoid their own, inner experience, like the client I mentioned in the first paragraph. An interpretation I prefer, is that clients who speak excessively are afraid of what the therapist might do if the client allows them to.

I could continue to describe various situations which act as barriers to deeper therapeutic work but will restrain myself from producing such a list ad nauseam.

I was reading Philip Bromberg’s Standing in the Spaces: Essays on Clinical Process, Trauma, and Dissociation some time back. Bromberg discusses psychic multiplicity and working with clients’ various and shifting self-states (I picked up his book a few years ago in an act of pure confirmation bias.) He quotes analyst Peter Fonagy (1991) about transference and mentalization:

In individuals where the capacity to mentalize is severely impaired, dealing with this aspect of the transference may be considered a precondition of analytic treatment… failure to achieve this may lead patients to treat interpretations as assaults and analytic ideas as abusive intrusions. (p. 289, I shifted the italics to the latter portion of that quote to shift emphasis there.)

I am struck by how, for some clients, the physical or psychic presence of their therapist, or the therapist’s use of speech in a session of therapy, may be construed as an “assault” or “abusive intrusion.” Parts of the client bring them to therapy, desperately seeking aid; other parts of the client react strongly to the responses from the person tasked to do so. It is a lesson I continue to learn in my clinical practice, sometimes gracefully, and sometimes painfully. Speech as psychological defense makes much sense in this context, given what some clients may be cautiously or vigorously defending, and defending against.