Sunday, April 10, 2016

A dependent personality*

Most therapists are treating the wrong person: the mental construct, the walking house of cards** built of buried truth (childhood pain and need) and all the dissociative escapes from it. Our client is like someone who has evaded his torturers by changing his face, identity, his whole life, and now is a different person living in a wrong place. Like a Jew who converted to Christianity to survive the Nazis. A more accurate analogy is the man who, at death, is reincarnated as another human being: No one knows about or remembers the person who’s been lost.

Psychotherapy is aware of the false or unreal self and the as-if personality.*** But as far as I know, only Primal therapies focus eagle-eyed and consistently on the buried – not the surface – psyche. For most other clinicians, talking to a tragic Dependent Personality Disorder may be the one way to witness an unreal or derivative soul.

I remember a 45-year-old Dependent woman, who in two sessions revealed the complete replacement of her Self by her mother, the sickest of all narcissists whose family had always caved to her imperial personality’s delusion of perfection and infallibility. The client had of course melted into her mother’s solipsistic cushion as a baby and infant. An immature parent whose eyes are mirrors reflecting inward cannot see or touch the child as a separate being, react to or act with her as an independent reality. The entire relationship and atmosphere must make the child a living echo and a complaisant object. Like someone sucked into an enveloping whirlpool bath, she would grow up perplexed and ambivalent in surrender to the sensual danger.

As a middle-aged woman, my client could not imagine not calling her mother about any occurrence in her life; could not conceive of choosing something that was not her mother’s edict: “If I don’t do things the way my mother feels they should be,” would make her a “shameful” person. “I have to be a certain way, look a certain way.” For a Dependent personality, the concept of choice is strange. In her heart, there seems to be no reason to choose something outside of the authority figure, and no means to do it. This is the crux with two prongs: Following a powerful person of will feels natural; and there is no magnetic gold in her psyche that cleaves to desires. There is no center that wants, though there might be the meta-self that “wants” to want, to be strong, to have self-esteem.

So much therapy that fights a self-medicative behavior, such as alcohol addiction or a nest of compulsions, assumes the person will be better off when the behavior is eliminated. But if we look at the self-medicative Dependent personality – submerging, from cradle on, so fully into someone else – we have to wonder if this is true, if in the absence of the dependency there would be a person left at all. In another form, this is a question that has never been handled solidly by psychological theory: Is there some substantial “real self” that can emerge full-blown or be returned to its developmental path, once the dysfunction has been cast aside?**** What if all deep dependencies mean something about the insubstantiality of the person’s ego? What if the loss of any dependency – partner, substance, narcissism, intellectualism, money, work, power – is the returning to a pre-Self state, an emptiness, an egolessness?

This is most easily seen, or guessed, in my client. If she abandons her mother, her dependency, by cutting back on phone calls or failing to get her judgment of a piece of jewelry, she will become the abandoned two-year-old whose “psychological birth”***** did not happen. She will have no core, and the only thing that will mask this is the anxiety of a grown woman. There will be no seeds that grew, no rebellious energy.

I remember that she asked me, after two strong sessions, what therapy will be like when it begins. She did not grasp that it had already begun with her understanding of her mother’s shaming and absolute power, with a reading of the Power & Control Wheel that described her husband. It was an odd inertness, opaqueness: I believe she could not really question her life. That would have required being, in some small strand, independent of the answer, which was her disappearance into the unreal self of others.

- - - - - - - - - - -

* DSM 5’s criteria set for Dependent Personality Disorder: “A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, as indicated by five or more of the following: * Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others. * Needs others to assume responsibility for most major areas of his or her life. * Has difficulty expressing disagreement with others because of fear of loss of support or approval. . . . * Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy). * Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant. * Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself. * Urgently seeks another relationship as a source of care and support when a close relationship ends. * Is unrealistically preoccupied with fears of being left to take care of himself or herself.”

** "House of cards" metaphor by Paul Vereshack, p. 54.

*** Alice Miller’s conceptualization: “Accommodation to parental needs often (but not always) leads to the ‘as-if personality.’ This person develops in such a way that he reveals only what is expected of him and fuses so completely with what he reveals that one could scarcely guess how much more there is to him behind this false self. He cannot develop and differentiate his true self, because he is unable to live it. Understandably, this person will complain of a sense of emptiness, futility, or homelessness, for the emptiness is real.” (The Drama of the Gifted Child, revised 1997, pp. 11-12.)

**** James F. Masterson, M.D. believed the real self can come out of hibernation and be set on track once “confrontation” has done its job of disputing-away the Borderline’s defenses and accessing the “abandonment depression.” See Psychotherapy of the Disorders of the Self.

No comments:

Post a Comment

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.