I hate to cry! “I have a patient who becomes weepy and cries when I ask her how she feels. She begins to cry almost every time and then attacks herself for crying. She says she hates to cry and believes herself to be weak. She puts a lot of effort into not crying, which makes it hard for her to say what she needs in relationships. When I asked where she learned tears were bad and to be resisted she recalled her father. She often got what she wanted from him when she cried. But he criticized her, saying she was too soft and needed to stop crying over everything. He told her having too much emotion was for stupid. She has struggled with this problem her entire life. However, she learned to hold it in better as her life went on, and now she attacks herself when she cries. In this case, does weepiness represent something other than a regressive defense? Thank you for your time and I would very much appreciate your input on this.” Thanks to one of our community for raising this important question! Let’s take the last question first. Yes, this is not merely a regressive defense; it is the resistance of repression. When you explore feelings with patients, you invite them to become emotionally intimate with you. This triggers feelings toward you. Some patients have learned that when they have mixed feelings, they should protect other people from those feelings by turning the love and joy toward the other person and turning the anger upon themselves. People who use the resistance of repression turn the anger upon themselves by self-attack, depression, tiredness, weakness, somatic symptoms, and weepiness. Simply pointing out the defense offers intellectual help and understanding to the patient. But this does not change the patient’s strategy of handling feelings: turning on the self to protect the therapist. As a result, the therapist needs to do two things: 1) help the patient see the defense; and 2) invite the patient to face the feelings toward the therapist that are under the defense. Th: What is the feeling toward you father for criticizing you? Pt: [becomes weepy] [Defense] Th: Notice how the tears come in right now? Could that be making you depressed? Could we look under the tears and see what feelings are coming up here toward me right now? Pt: I hate this crying. [Defense: self-attack] Th: Sure. It sounds like these tears have been getting in your way. So could we look under the tears and see what feelings are coming up here toward me? Pt: These tears are so stupid. [Defense: self-attack] Th: Could that be a critical thought? Pt: Yes. Th: So if you don’t hurt yourself and if you don’t protect me, can we see what feelings are coming up here toward me underneath the self-criticism? If we look under the self-criticism, what feelings are coming up here toward me? Patient meta-communication: “I realize I must turn my anger toward you onto myself in order for you to love me and to maintain this insecure attachment.” Therapist meta-communication: “You don’t have to protect me from your feelings. I am willing to accept all of your feelings so we can form a secure attachment.” We always redirect her anger away from herself back onto the therapist. That allows her anger to go outward in a healthy way rather than inward, causing her depression. Keep asking about the feelings toward you. After several times, the patient’s weepiness should stop. After several more times, her depression will probably lessen. After several more times, she will begin to tense up as anxiety moves out of the smooth muscles into the striated muscles. And after several more times, she may be able to tell you that she is irritated with you. And that word, “irritated”, will be big progress for this patient. By that point, she can put her feeling into words without becoming depressed or weepy, and without criticizing herself. Therapists who do this for the first time get worried when the patient cannot say the word “anger.” Since the patient has been avoiding her anger for years, there is no reason she should be able to describe that feeling in two minutes. Your gentle persistence sends her the unconscious message that it is ok to be angry with you. You must pass the test many times until she takes the risk to say the word that was always too dangerous as a child. Rather than worry about whether she says the word “anger”, notice the drop in weepiness. Notice the drop in depression. Notice how her body begins to tense up instead of being slumped. Notice her first sigh. Notice how she becomes energized. All of those unconscious signs tell you that you are helping her overcome her depression. And those signals tell you to keep asking about the feelings toward you. After all, if your question is making her healthier, why not continue? After five minutes or more, she will tell you what she feels. In the meantime, she will already have become less depressed and anxious. I hate to cry? What a beautiful picture of how she identified with her father’s reproach as a way to protect him from her anger toward him. She was angry when he reproached her. To ward off her anger toward him she identified with him. Rather than be angry at the reproaching father, she became the reproaching father to herself. When angry with you, she fears your reproach, so she reproaches herself. Thus, when she reproaches herself in session, always ask about the feeling toward you. After all, this time she doesn’t have to protect you from her feelings by hurting herself instead. That’s the message you send when you ask, “What feelings are coming up here toward me
Posted on: Fri, 20 Jun 2014 17:59:02 +0000
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