“You Could Be Right,

But I’m Not Aware of Feeling That Way”

by Martha Stark, MD / Faculty, Harvard Medical School

 

Therapist – “I wanted to let you know that I'll be away for 4 weeks in August.”

                                   

Patient – “Oh, I'm glad you'll have a chance to get away this summer.”

 

Were the therapist, in an effort to make the patient “aware” of her underlying feelings, to “interpret” what she suspects might be lurking beneath the surface in the patient’s unconscious, then the therapist might offer the patient – “I wonder if you aren’t also upset and angry that I’ll be away for so long.”

 

…to which the patient (made anxious) might then reply with – “You could be right, but I’m not aware of feeling that way.”

 

The therapist might well be (technically) right, but if the patient opposes – as she is bound to do when an “id interpretation” is offered – defending against you for the same reason she is defending against what lies within, then you’ve gotten nowhere and have instead created the potential for a struggle.

 

If you go directly for the id material, most patients will oppose you – will reply with some version of “No.” In essence, they will defend themselves against acknowledging the id material (both to themselves and to you) for the very same reasons they had needed to defend themselves in the first place, namely, that acknowledgement of the underlying id content arouses too much anxiety.

 

And so it is that the patient replies – "You could be right, but I'm not aware of feeling that way."

 

So let us imagine that the therapist, in response to the patient's – "Oh, I'm glad you'll have a chance to get away this summer," let us imagine that the therapist instead says – “And it's important to you that it not bother you – my being away this summer."

 

Such a statement is attempting to highlight, in a gentle manner, the patient's ego defense, her need not to let certain kinds of things get to her.

 

Interestingly, let us imagine that the patient responds with – "That's right. I have always managed well on my own." The patient is now articulating her characteristic stance of self-sufficiency.

 

The therapist, now appreciating how much the patient prides herself on her ability to handle things on her own, accentuates (validates / reinforces) what the patient has just said with the following – "Much of your life you have had to fend for yourself, and you have always prided yourself on how well you’ve done at that, on how independent you’ve been."

 

The patient, clearly feeling understood, goes on to elaborate, with affect, as follows – “Yes, when I was a little girl, when my parents went out they would always have me look after my little brother. Nobody helped me. It was all my responsibility."

 

Therapist – "When you were asked to be the caretaker, you did it well and you did it without complaining. Even if it did get a little lonely sometimes, you knew you could do it if you had to."

 

The therapist goes on to say, softly – "So you know you can count on yourself to be able to manage just fine when I'm away in August."

 

Patient (now sad and with some tears) – “Yes.”

 

This example provides a powerful illustration of how effective it can be when the therapist simply “goes with the resistance” (that is, supports) by “coming down on the side of the defense.” When the therapist says, "And it's important to you that it not bother you – my being away this summer," she is letting the patient know that she understands and that she appreciates how important it is to the patient that she not let herself feel bad about her therapist's upcoming absence.

 

The patient is then able to go on, with some affect, to elaborate upon her need for the defense, namely, that it had served her well, in her family, to be self-reliant.

 

When the therapist offers – "Even if it did get a little lonely sometimes, you knew you could do it if you had to," the therapist is first gently suggesting that she knows that child must have felt lonely sometimes and then the therapist is respectfully acknowledging the pride that little girl must have felt at being able to manage things all on her own.

 

In other words, the therapist is offering the patient a conflict statement.

 

Again, in situations of conflict, we have three choices – we can come down on the side

of the force that says "Yes"; we can come down on the side of the force that defends "No"; or we can do first one and then the other. From moment to moment, we are deciding which kind of intervention we think will be most useful to the patient.