Problem corner #1: The talker

The problem:

It occurred to me recently that I don’t know what to do about clients who talk constantly. I’m sure that success with them has been superficial, at best. These are clients whose words are their thoughts, all animated at the topmost level of their living. Getting them to stop all and really feel something – quietly, deeply – feels as undoing as discovering that the planet Melancholia is going to crash into the Earth,* as wrecking as Data's informing his “mother” that she is an android.** These clients are living in one world that requires motile eyes and words like skipping stones on a raging river; that requires ideas instead of feeling facts. They are a shark: To stop moving is to die, and to know it.

Sometimes I have briefly slowed them down, or thrown a little wrench in the works: a reveal or a poignant question. The result is never pretty. They instantly get an oblique glimpse or “feeling glimpse” – as if they’re now standing, exposed, atop a narrowing cone showing the obscurest depth of their universe – of their true self. This is not where they wanted to be: an alien dreamlike world that they never knew they carried, yet may have sensed in the dimmest ineffable way, or in a dream. That’s the paradox that Janov described: Our cerebral, showy life feels real, and when we make contact with our truer child self, it feels unreal, maybe psychotic.

One would think they'd come to therapy to experience something, rather than just to tell stories and maybe cry through their words: to work, to descend, to be given disturbing information. But they just talk. They can only hear what I say part way, never all the way. The fact is for a long time they have unintentionally redefined everything in their world to be swallowable; as Ayn Rand said, “like food shot through the rectum, requiring no digestion.”*** Objects will be toxic and disturbing, life-changing, but the mind is enteric-coated. Sometimes they smile, frustrated by their own helpless flow of thoughts; some believe they feel good about their opaque soliloquies.

What can be done about them?

Next time:

(This would be a new client whom I’ve allowed to speechify for two or three sessions. Longer-term clients I would approach differently.)

“I can see you have many ideas about yourself and the way your life is going. Your mind runs fast. But I need to ask you to see that your thoughts and words are like the waves on the surface of the ocean, and your troubling feelings and predicaments, that bring you here, are like the still water beneath them. If anything, the depth affects the waves – deep shifts can even bring a tsunami – more than the waves affect the deep. We all carry an ocean; all of it has our name. It can seem light, or we don’t notice it, because we’re strong, but also because we almost never look beneath the surface.

“I can see that you are used to being a mind-racing, thinking person, a person of waves and whitecaps. It feels lively, masterful to see things, to think and to make decisions. It may feel wrong to be quiet, to sense this heavy silent ocean underneath. But actually there’s a great deal of life in there. And not only that, it’s the life that is your strongest, your most interesting, and it has the answers you want.”

Hearing this, the client would possibly pause (as you might pause a wave), part-way hear me. But then, if I didn’t want to see another client who generated empty air through a course of therapy, I would insist on quiet. She is not incapable of it. It might feel like the planet Melancholia rushing toward her, or rather, emerging from her sea.

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* Melancholia, the movie.

** Star Trek, The Next Generation, episode "Inheritance."

*** Ayn Rand, The Fountainhead, pdf facsimile at -- https://archive.org/stream/TheFountainhead/The-Fountainhead_djvu.txt. (Pages not numbered; search “rectum.”)

In-house #5: Surprise package

Picture these ingredients in a client who attended weekly, consistently for three months:

* Seventy years old.

* Vigorously eating disordered: eats when hungry and not; binges in great bulks, purges. Hates being misshapenly fat.

* High IQ (Mensa) with a single-strand narcissism: believes he knows all there is to know about himself, his past, his eating disorder, with the complementary attitude that therapy can actually give him nothing. Includes honest (seemingly humble) awareness of his failure to master a career, but ignorance about why he has tried so impotently, or maybe self-sabotagingly.

* Rabidly intellectualized, with a manner of quick and complexly wordy, bright-toned, imperious and savvy retorts and denials that builds quite the formidable wall against the therapist.

* Despite that, a blatant fragility that leads the therapist not to want to be too-soberly confrontational.

* He acknowledges having “always been impulsive.”

The client “knows” that his childhood was distressed, with a semi-psychotic raging mother and a sweet, passive father who stayed away as much as he could. But he doesn’t attach that history, in any way but superficially (mother was abusive, even about eating, but they would have meals together), to his sick eating.

I wondered: Does he appear reachable by therapy? Might the intertwined contradiction of his consistent attendance and his disdainfully hopeless attitude about therapy eventually lean or wilt toward being helped?

Then this happened:

One session, I startled him by identifying his defense mechanism of knowing everything. “You don’t,” I suggested (though in softer terms). This was illustrated by two proofs. Have you read The Primal Scream? No. But it contains insights about you that are not in any literature you’re familiar with. Therefore, these are things you don’t know about yourself. And, you don’t know what motivating feelings are aflame in your core, forcing you to stuff your body with food. You can’t know because you haven’t returned to them – the only way to know what they are. You have run away from deeper feelings your entire life.

He ended the session with a “thank you.” Leaving the room and proceeding down the hallway, he brushed against one of the inspiration-type posters on the wall ("Challenge," "Opportunity," "Attitude," "Passion," etc.). In an instant, he had yanked it off its hook, swiveled into the doorway of an open therapist's office (without looking to see if it was occupied), and tossed the framed poster in the waste basket. Jarred, I said something a bit emasculated: “You can’t do that,” to which he responded: “Yes I can!”

Does he appear reachable by therapy now? This childish act completed the coalescing of a personality disorder diagnosis – Borderline-ish: Confronted with a little dethronement, a septuagenarian displaces anger at the therapist onto an object, a tantrumy pique. I believe this level of unconscious and ego-syntonic immaturity, added to the aluminum-foil intellectuality, narcissism and impulsivity – in someone riding his downward curve of old age, will not be brought to a place of adult recognition. Possibly the problem is partly mine: his frenetic wall scares me into silence. And I don’t want to undermine him by peeling back his life-deep surface.

Here is where contemporary therapy – always some shade of cognitive behavioral – saves the day by assessing my client as a simple soul: a person with a bad habit, irrational thinking and ADHD. The counselor wants to “cognitively restructure” his beliefs, create a treatment plan and a behavior plan with him, recommend a medication consult, have him keep an eating journal, join a bulimia support group, practice “mindfulness.” All of this will be as useless as lint. But at the same time, it will work: if keeping everyone (therapist and client) in their adult-state dream is “working.”

For in the adult-state dream a person’s ship consists only of the tiller and the sun ahead in the sky – a narrowed vision that does not acknowledge one’s position in the middle of a deep, churning ocean. In this state one can ride above the waves with brighter thoughts and reframes, illusory changes of direction, a map that shows land much closer than it is. This dream energy masquerades as real hope (which is based on clear vision and actual healing) until the waves come up to meet us, or we fall back into them.

My client proved to be a child in many ways: his voice, his denial, his conceit, candy and white bread and buckets of sour cream, history of rudderless impulses and mistakes, his facial expressions, his tantrum. Therapy can reach the child, but it has to do it through the adult who knows the child is right. It cannot do it through a child who thinks the adult is right.

Interpretation

In a 2014 New York Times op-ed, psychiatrist Robin Weiss quoted the renowned object-relations psychoanalyst D.W. Winnicott: “It appalls me to think how much deep change I have prevented or delayed by my personal need to interpret.” It is true that in the non-therapy world, one can throw off a talker’s working-through by any remark that is not a parroting reflection or an encouragement to continue. I’ve unintentionally done this when my wife has been on a harangue about school or work. Even a sympathetic comment like, “They certainly have a problem!” has visibly derailed her process. So it’s undoubtedly true that in therapy, crucible of self-discovery, interpretations can have a disruptive effect.

I make interpretations all the time, every day. Often they are not merely observations after a disclosure or pregnant silence, but five- or ten-minute explanations, and occasionally forty-minute lectures. Do they snow the client’s mind? Do they drag him into my world, out of his? That notion could be understood to be a “reaction formation” to Carl Roger’s principle of reflection, described by Vereshack as the belief “that clear reflective statements allow the mind to heal along its own path rather than the paths dictated by psychological theory.”*

This “healing” may happen sometimes, but my experience suggests that most clients, given a reflective empty field in which to cerebrate and emote, will circle the drain forever, and sometimes spiral down into the toilet. They know what they already know, feel what they already feel; their personality is, contradicting its flaws, a homeostatic construct. A reflective, empathic statement by me will rarely get them to pause, look inward and slip to a deeper vision. This is one of the great techniques of psychotherapy, carved simple on the marble mountain from Rogers to every CACREP-accredited counseling program in the land. But it is too effete to shake the mountain of our psychological history, whose roots are deep underground, under time.

There are different kinds of “interpretation.” People are instinctively endowed with some of them, in the form of fact insights or rationalizations, long before they come to therapy. “I know why my dad beat me: His father was abusive to him.” “I wouldn’t say I’m an alcoholic, but alcoholism is genetic in my family.” “He gets in trouble because he associates with a bad crowd.” Or “it’s his chemical imbalance.” We’re all familiar with the Freudian interpretations, still august but nowadays painted in circus colors: penis envy; castration, Oedipal and Electra complexes, the death instinct.

There are interpretations contained within therapist confrontation:

Client stated that “heroin is everywhere,” therefore unavoidable.  I asked him if his particular addiction could take from Alcoholics Anonymous’s dictum about avoiding the ‘people, places and things’ that may trigger relapse.  Answer was strongly ‘no,’ as “heroin is everywhere.”  I confronted this observation, noting that a recovering alcoholic could say the same thing about alcohol, but that one determinative factor is ‘not to go looking for it.’ 

First session following Intake.  Main intervention this session was a gentle confrontation of client’s ‘bubbly-laughing’ defense (which she is amply aware of) and a detailed discussion of defenses.  She said, amidst the faux-laughing, that her buoyant manner “works for me,” but then acknowledged that “I smile and giggle a lot like I’m happy, but I’m not.” 

Main focus was my confrontation of client’s ‘militant opacity,’ that is, her failure or refusal to attempt the slightest emotional introspection into her apparent employment self-sabotage.  When I asked her to ‘feel into anything – five minutes ago, yesterday, last month’ – she instantly collapsed into tears and voiced her dysphoric and near-suicidal mentality, discussed only briefly in earlier sessions.  Life itself is intolerable to her; she has never wanted to live, even as a child.

I believe that what redeems interpretation, gives it surgical power, is its emotional soul. The last case, the woman opaque to all inner feeling, is an indirect rather than direct example of this. Asking her to “feel into anything” was a wedge into a forbidden place. But it was linked to my reiteration of her serial job failures and to the interpretive confronting of her emotional denial. A better interpretation would be the naming, or asking, of a truth that the body knows but has buried, probably long buried, indicating deep loss and leading to the loss of years. It may happen when the client has earlier learned some primal truth – you are floating in the sea of your history; your parents were decent people, but they could never see you; we are always, like the child, needing someone; people are dysfunctional not because they are defective but because they’ve been hurt – then, stripped somewhat of the adult delusion, are brought by words, an expression, silence and empathy to a clarity or epiphany inside this deeper place.

I've seen clients who, on occasion, like to quote their previous therapist’s observations or wisdom tidbits. They typically do this as an unconsciously askance response to some more challenging offering of mine. As a rule, these fond ideas have been inaccurate, or peripheral, or truistic insights about the person. This points to a dismal paradox of therapy: People will accept interpretations their mind can chew on, but will turn away from those that their feelings would have to chew on. Ideational, versus emotional, interpretations (bizarre or penile as they may be) are safe, engaging the defensive intellect. They deserve, as Winnicott might have said, some disrespect.

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* http://www.paulvereshack.com/helpme/chapt1.html. Vereshack may be expert at reflective listening. However, as a Primal-related, regressive therapist, he has established the underlying “psychological theory” prior to client’s arrival. That is, clients know they will be engaging in Primal theory-based process.