This is the second post of a series on befriending resistance.
The last post on resistance discussed the care and attention needed to work with a patient's resistance to the frame of therapy. For this post, I'd like to focus on loss.
There are so many ways to look at, or conceptualize, loss. You can say, for example, that the development of depression is a defense against the loss of an object (person). One of the most beautiful ideas (in my opinion) of Freud's is, "Thus the shadow of the object fell upon the ego," (Freud, 1917, p. 119). I think of it like this: If I am to maintain the good of whom I have lost, I must protect and harness the badness within me.
I have found depression in some patients to be incredibly stubborn. Many of my patients have had some form of depression almost as long as I have been alive. Realizing this can be daunting, and can bring about an immense sense of hopelessness and helplessness in both me and the patient. I chuckle at the prospect of a therapist coming in to treat some forms of depression with a manualized procedure of, say 8-12 sessions. There are times I wish I could be that confident (or naive) about my influence on someone's long-term suffering. Personally, it takes me that long to piece together and construct a cohesive narrative of the remnants of my patients' stories.
There is a darn good reason why our patients have difficulties getting better. Not only are they trying to hold onto the lost good object, they are also holding onto their depression for dear life. Have you noticed that some (if not all) patients form a relationship with their disorder(s)? It happens with eating disorders all the time - in fact, some people externalize and name their disorders (e.g., Ed, Ana). Jenni Schaefer, an author who suffered from bulimia nervosa, named her first book, "Life without Ed." Other disorders are not any different. Though I don't go around having my patients externalize their disorders only to attempt to "divorce" them, like Jenni did with bulimia, it brings up an important idea that we do not talk about enough: loss.
What does life look like without depression? I once had a patient imagine dipping her toe into a lake that was free of depression to test out the experience. This intervention failed miserably, not because it was a bad intervention I don't think, but because that lake didn't yet exist in her mind and she could not even imagine it. My guess is that many people would think of this "lack" of imagination as resistance. Why don't you just try really hard? Can't you see it? It's right there, in front of your nose.
Can you imagine how scary it must be to step into water without knowing what it contains? I've certainly had psychotic patients who think that such things would contain acid or bugs, but even for individuals without a psychotic disorder, it must be incredibly scary. We have to empathize with our patients when they have difficulty letting go of their disorders. Their white-knuckled grasp is not only protecting them from the fear of what is unknown in the water, but also holding onto something good inside of them they are not yet ready to let go and grieve. We have to respect and honor that.
Freud, S. (1917). Mourning and melancholia. Standard Edition, 14, 237-258.
- cg
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