Saturday, June 14, 2014

In-house #1: False self

A long time ago I wrote, probably within a progress note or margin of a book, the sentence: “He’s asking the false self to dismantle the false self.”  If I recall, it was my response to some explanation by Masterson, the renowned expert in personality disorders.  Masterson’s therapy, featuring his specialized technique of confrontation,* consistently disputes the client’s defensive clinging and withdrawing (and other faults that I’m not remembering now).  The process is, as far as he described it, entirely cognitive.  That is, it’s the disproving – by the standard of reality needs – and undermining of one’s pathological states from the processes and fundamental ground of the reasoning intellect.**

Imagine that you are in tremendous physical pain – nerve avulsion and broken bones from a car accident – and you know the only thing that will keep you sane at that moment is morphine.  The doctor, however, proves to you by means of statistical research and your history of substance dependency that if he administers it, you will almost inevitably form an opiate addiction.  A reasonable person, you try hard to be dissuaded.  Yet in your weakness (the truth), you find yourself begging for the drug.

Reasoning and thinking slide above the Self that needs morphine and defenses.  Reasoning and thinking are the architect and the structural steel of our reincarnated self which replaces our bleeding and blind child.  Does it make sense that we could ever use reason to cancel itself, leaving only the wordless furnace of childhood?

Yet in therapy we are always negotiating with the false, reincarnated head.  Therapy seems vigorous and pleasant when falsity is at its apex: the articulate intellectual who grasps our theories and insights and therefore thinks he feels better.  It’s toughest when the head can’t be convinced because reality – the real self – importunes: “I’m not ‘catastrophizing.’  My life is as terrible as I feel it is.”  “I don’t have any reason to live.  I always feel dead inside.”

Are we living two separate realities, the real past and the unreal present?  The wounded past and the medicative present?  Do they ever touch, or fuse?  If so, in which time?

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* “A confrontation is a therapeutic intervention that demonstrates to the patient a resistance or defense against the operation and expression of the healthy ego or the emerging real self.”  From Psychotherapy of the Disorders of the Self, Brunner-Routledge, Inc., 1989, p. 216.  Definition is from a chapter written by Ralph Klein, M.D.

** Though Masterson’s aim is for the client to feel his “abandonment depression” (the psychic death blow of maternal unavailability), there seems to be no regression to, reliving of, this root depression.  Rather, it is touched or gazed at by the defensive-conceptual adult mind.

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Comments are welcome, but I'd suggest you first read "Feeling-centered therapy" and "Ocean and boat" for a basic introduction to my kind of theory and therapy.