Love in the Face of Hatred

In an earlier post, I talked about how clients sometimes feel anger and hatred for their therapists; I believe this is inevitable on occasion and appropriate.  Today I’d like to discuss how therapists may respond when they’re hated, and how much it can help the people we treat if we’re able to tolerate them and not retaliate in kind.

Often these clients, especially severely troubled individuals, need to express their hatred.  They need to feel they can show what they actually feel and still be accepted.  One of my long-term clients, a man in his early 30s, would scream at me during session after session.  He’d vent in the most vicious tones, week after week, accusing me of any number of crimes even when I might have said very little.  For me as his therapist, it was extremely painful to be in the same room and feel his hatred — hard to be the object of his hostility but also to feel his pain. (See my much later post on countertransference issues in treating depression).  I knew he suffered from profound shame and that venting his hatred was a desperate effort to ward off that shame and hold himself together (see my earlier post on the ways in which hostility can function as a kind of psychic glue).

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Hatred and Anger for Your Therapist

As I discussed in an earlier post on psychological defensiveness, we humans try to protect ourselves from emotional facts too painful to bear – that is, we “lie” to ourselves about them.  That’s our nature and everybody does it.  The job of a good therapist is to make you aware of those things you don’t know about yourself (and probably never wanted to know).

As I listen to my clients talking, they inevitably reveal things about themselves without knowing it, and I try to tell them what I’ve heard.  I rarely get through on the first try (you know, that “resistance” thing).  I keep listening.  If I hear more evidence, I’ll try again to show it to my clients.   If I was right and my view becomes more persuasive, they usually become uncomfortable.  Maybe they’ll get angry.  Sometimes they hate me for telling them what they don’t want to hear.

With all of my patients, at one time or another, they’ve hated me … even when they agreed with what I’d just told them.  In my view, this is an expected part of the relationship, just the way it’s normal for children to hate their parents from time to time.   With severely disturbed clients in long-term treatment, one of the main jobs of a therapist is to allow room for their hatred.  With borderline personality disorder, hatred is often the central focus of early work.  My clients who’ve spent months or years hating me and come through on the other side always feel profoundly grateful that I could bear with them and not retaliate.

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The (Sometimes) Awful Truth

Early in my own psychotherapy, my therapist once asked me, “Are you interested in how you actually feel, or do you want to feel one particular way?”  I don’t remember what prompted that question, but I probably said something like, “I just want to be happy.”  Over the years, I’ve heard many of my own clients say similar things and I’ve responded in more or less the same words.

Wanting to be “happy” is understandable but in truth, it’s not possible.  I don’t mean we can’t find a basic contentment with our lot, but life is full of frustration, pain, disappointment, loss, grief and other “unhappy” feelings.  Even if we’re in a strong relationship, satisfied with our career and in good health, we’ll inevitably have our down days.  We may have difficult co-workers, friends can move away, a loved one will eventually die.

For those who seek professional help, the pain of their existence is usually much deeper and harder to bear than ordinary loss and disappointment.  Their suffering may be extreme; the symptoms of depression or anxiety can make their lives an ongoing agony.  “Take away my pain,” they plead, whether or not they say those actual words.  Empathizing with their pain, health care professionals understandably prescribe them drugs to relieve them of their unbearable emotions and feelings.  Whether you can actually eliminate anxiety or depression with psychotropic medication is an open question, though recent studies suggest that the anti-depressants currently in use work no better than placebos.  I believe these medications at best blunt awareness and in the process often create a new set of problems:  loss of sex drive, weight gains, emotional deadness.

[For a detailed discussion of the actual effects of psychiatric medication, read my later post about the dubious theory that medical illness is caused a chemical imbalance in brain functioning; another on the false claim that psychiatric medications have let to actual improvements in mental health outcomes; and a third discussing the false representation by pharmaceutical companies and the medical profession that taking “anti-depressants” for mental illness is just like taking insulin for diabetes.}

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Why Most People Don’t Really Change

Most people don’t change; they just become more the way they already are.

I must have said these words hundreds of times in my life — to clients, family and friends.  While there are exceptions, most people find change difficult for several reasons.  They don’t know themselves very well, to begin with.  Few people have an accurate view of who they are and therefore don’t recognize the aspects of themselves that could use improvement.  Most people want to believe they’re well-balanced and even exceptional in many ways:  how many of your friends would describe themselves as creative, talented or intelligent?  Do you know anyone who would say to you, I’m just average?  We all want to think of ourselves as special and gifted.

Then there is the human propensity to explain one’s difficulties, short-comings and failures by blaming somebody else.  Look around you at the people you know.  The co-worker who’s careless and lazy but blames her poor evaluations on an exacting boss, or colleagues who have it out for her.  The cousin who gets under your skin because in every story he tells, he paints himself as a victim.  Have you ever known anyone who told you, “I got fired because I was doing a lousy job,” or “A lot of bad things have happened in my life because I make so many impulsive bad choices?”  Few people are willing to accept that their own character traits and choices are the main determinants of the kind of life they lead.

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Choosing a Therapist with a Psychodynamic Perspective

If you value my approach but feel that going it alone isn’t for you at the moment, here are some guidelines for choosing a therapist who might have a compatible orientation.  I’ll begin with some general suggestions about how to interview any mental health professional; I’ll conclude with specific suggestions for finding one who’ll offer you insights and guidance similar to those provided on this site.

First of all, remember that you are the customer and you have the right to ask as many questions as you like about the potential therapist’s background and credentials.  What degrees does he have and where did he earn them?  What professional licenses does she hold?  Is she a marriage and family therapist, a psychologist, a social worker, a psychiatrist (which means holding a medical degree)?  You can ask about internships, where they received their on-the-job training, and how many years they’ve been practicing.  If you’re in pain and hungry for help, it’s difficult to remember that you need to make an informed decision, the best you can make, and not simply sign on for treatment because one of your friends recommended her own therapist, or your physician referred you to his colleague. The answers themselves may not mean a lot to you (one university versus another, for example) but the process of interviewing the potential therapist can give you a lot of insight.  You might find she’s an authoritarian type who feels irritated by being questioned; maybe he seems insecure about his background and lacks the kind of confidence and experience you need. Beware the charismatic therapist who exudes the over-confident aura of knowing everything.

Most states have laws requiring mental health professionals to provide you with a statement of their policies about issues like cancellation, privacy, vacations, etc., but there are other areas where you might want information.  Here are questions you could ask:  What are your areas expertise?  Have you worked with many clients suffering from [name your pressing issue]?  What are your views on length of treatment and frequency of sessions?

Questions you should NOT ask:  Are you married?  Do you have kids?  Are you gay?  How old are you?  The therapist is entitled to his or her privacy and that information is none of your business unless he or she chooses to disclose it.  (You may notice that I speak frankly about my internal dynamics but am careful to keep the details of my personal life private.) I’d also beware of the therapist who discloses TOO much personal information.  This may indicate poor boundaries.  The therapy is about you, after all, and your therapist is NOT your social friend, however you may feel about one another.

Also feel free to schedule more than one evaluation appointment.  You don’t have to make up your mind after one session, nor do you have to interview only one person at a time.  As I said, you are the customer and you should approach this decision in a way that will give you as much information as possible.

As for finding a therapist with a specific orientation, that’s a greater challenge.  The mental health profession at present is dominated by cognitive behavioral theories and psychopharmacology.  I’m not saying anything against those orientations, but if you want treatment akin to my approach, your search may be difficult.  In addition to holding licenses as a clinical psychologist and marriage and family therapist, I was trained as a psychoanalyst; as part of my training, I had to go through years of treatment myself.  Most people think of psychoanalysis as an outdated modality that began and ended with Sigmund Freud, but in fact, it has grown enormously and continues to evolve.  Specifically, I was trained in an area of pschoanalytic thought known as “object relations”. If you find someone who describes him- or herself as having “an object relations orientation,” you may have gotten lucky.  Psychodynamic psychotherapy, depth psychology, transference-based therapy, insight-oriented therapy — these are some terms that also apply to the kind of work I do.

The most important element in making your choice is how the therapist makes you feel.  If he makes you feel all warm and fuzzy, totally accepted for who you are, I’d look elsewhere. If she intimidates you, seems controlling or has poor boundaries, I’d likewise move onto the next candidate.  In my first session with my own therapist, he made some observations about me that made me extremely uncomfortable and seemed undeniably true.  Feeling at ease isn’t the best indicator; feeling understood is what matters. The distinction here is between sympathy and empathy.  What you’re looking for is a person who can speak the truth to you, however uncomfortable it might make you feel, not someone who expresses a great deal of sympathy but doesn’t startle you with unexpected insights.

I don’t do Internet or phone therapy, but if you’d like to ask for specific advice about consulting a professional, please feel free to contact me:  AfterPsy@gmail.com.

I hope this help!