How a Therapist Thinks

An effective therapist helps the patient address the universal issues with which we all struggle...

    Dependence versus independence

    Inappropriate attachment versus the ability to separate.

    Self-sabotage versus self-actualization.

    Chronic grief versus acceptance of loss.

    Emotional isolation versus the ability to feel one's feelings.

    Distancing versus intimacy.

All of us have developed ways to avoid examining our most troublesome behaviors and feelings. The short-term therapist takes an "observant posture" to identify the patient's defense -- the common techniques we all use to shield ourselves from painful truths about our present or past experiences.

Defenses always conceal hidden feelings. So the therapist intervenes when the patient makes a defensive statement, and pursues the defense rather than the content of the statement.

Here is a sample session, greatly condensed. A hypthetical patient, Mr. J, age 52, has been laid off from his job and is very depressed.

    Therapist: "How did you feel when you lost your job?"

   Mr. J: "Well the economy is bad, and they needed to make cut-backs, so..."

    Therapist...hears Mr. J rationalizing: "Yes, but how did you feel?"

    Mr. J: "Like there's nothing I can do about it. I'm too old to start again."

    Therapist...challenging defense of helplessness: "You're taking a helpless posture here. How did you feel?"

   Mr. J: "Angry, lousy. After all I had done for that company."

    Therapist...hears defensive anger: "What was underneath the anger?"

    Mr. J: "I felt betrayed, and foolish for having expected the company to protect me, to be loyal. And I was scared. Where would I find another job? What would happen to my family?"

    Therapist: "Anything else?"

    Mr. J: "I felt ashamed. I felt that I was a failure."

    Therapist: "What do these feelings bring to mind?"

    Mr. J: "My father, telling me I will never amount to anything, and letting me down when I needed his help."

    Therapist: after further exploring the association with Mr. J's father: "Were there any positive feelings the day you lost your job?"

   Mr. J: "I felt relief, like I was suddenly free, and a strange sort of excitement that I might get to start over again doing something new.

    Therapist: "Anything in particular?"

    Mr. J: "Well, I've always wanted to teach French cooking classes.

    Therapist: "That doesn't seem like a viable occupation now. Are you going to put your energy into proving your father right? What are you going to do about solving this problem?"

By actively challenging a patient's defenses, the therapist helps him/her to recognize the underlying emotions and associations.

After this process, the therapist can then issue a call to action -- What are you going to do about remedying your problem?

The "work" of therapy involves learning to take inventory of our mixed emotions. We can learn to do this on our own.

Required: A sensitivity to -- and understanding of common defenses...and unrelenting honesty.

The aim: To reach a sense of emotional balance. This lets us see our options clearly...let go of our anxiety or fear of intimacy...take action on our own behalf...change our self-defeating behaviors...and move forward.

The Defenses

Each of us favors certain defenses over others. When you notice yourself being defensive, challenge yourself to search for the emotions and associations beneath the defense. There are three types of defenses: Helpless, emotional, and intellectual.

    The defenses of helplessness often reflect a lack of self-esteem.

        Vagueness. I guess I feel...Maybe I don't know...I suppose...

        Passivity and helplessness. I can't do anything about it...really means, I won't do anything, I won't change.

    The emotional defenses are used to mask underlying pain.

        Crying is an appropriate response to sadness or loss. But often it masks anger, hurt, or guilt. I got so frustrated I cried.

        Depression is also an appropriate response to grief. But defensive depression usually has a self-devaluing quality, and tends to come and go. My life is worthless.

        Anger is an appropriate response to an attack or threat. Defensive anger is a way to feel powerful and to mask feelings of hurt, insecurity, inadequacy, or powerlessness.

    The intellectual defenses are used to avoid dealing with the emotions.

        Rationalization. Explaining or making excuses to hide feelings. She only said that because she was under a lot of stress.

        Intellectualization. Retreating into philosophy to avoid taking action. Man was meant to be alone.

        Avoidance. Distancing from situations that are painful or intimate. Leaving the room to avoid conflict, avoiding social situations, using sarcasm to keep people away, being bossy or controlling to avoid feeling out of control.

        Denial. Denying that feelings or behaviors exist. I wasn't drunk, the cop was a jerk. I wasn't upset at all.

        Projection. Attributing one's own unacceptable feelings or qualities to another. Example: A man who is afraid to admit he is attracted to a woman who is not his wife says, "All these young guys want to do is chase girls."

Society's Defenses

Defenses work on a community level as well as a personal one. The more we understand how defenses work in our own lives, the better we can understand the greater issues that trouble us.

Example: Many Americans responded defensively to the Japanese accusation that American workers are lazy and illiterate, angrily Japan-bashing and smashing cars. If we were mentally fit, we would have accepted the comment in a spirit of challenge, rather than in rage. Underlying truth: Faced with a rather long, demoralizing recession, we have lost faith in ourselves. Our anger is a shield against the pain of believing the Japanese message.

Balance Yields Wisdom

The therapeutic process produces a growing awareness that an array of conflicting feelings usually lies beneath our defenses...that among them are positive feelings that can help balance the negative ones. (I am angry at my father's coldness, I feel the hurt of wanting intimacy, and I also feel love and gratitude for the lessons he taught me and our moments of tenderness.)

In taking responsibility for our own contributions to our problems, we learn to stop searching for outside solutions and are no longer hostages to situations.

The quest for balance -- pro and con...yin and yang -- yields wisdom: Understanding of the world's complexity.

Think Like A Shrink by Christ Zois, Patricia Fogarty out of print.