Negating reality in psychotherapy.

Psychodynamic treatment can be complicated, whilst also being complex. In life generally, moments of contact between otherwise separate elements are usually kinetic. Psychotherapeutic work is no exception, as emotional storms develop, becoming especially turbulent when hopes and expectations are present, particularly at the first meeting.

In describing the chaotic system of thoughts and feelings inevitable in therapy, one might use the water-cycle as metaphor. With its interwoven systems and dynamics, enclosing physical and molecular structures, this life sustaining complicated system can also be understood by its complexity, as gaseous dynamics offer a not insubstantial unpredictability.

Similarly the ‘complicated’ process of psychotherapeutic engagement is frequently made ‘complex’ through encounters, clouded by emotional disturbance.

Having developed over the last century or so, an abundance of psychoanalytic theories wash through training programs, like great rivers in spate.

The literature comprising this well of theory is vast and ever changing. A topography carved from a landscape of academic intent and a clinical striving to understand the motivations and desires captured within the human experience.

Reaching out and grabbing for what seems relevant to each patient requires particular  attention, specific to each case.

There are fundamental techniques that anchor the work, such as the frame of treatment (the time, cost, attendance, confidentiality and so on). However, once the work begins, selecting and harnessing the many theoretical ideas that might support a course of treatment, can weigh on one’s psychological buoyancy and that of the patient.

Having been swept along in the flow of the work, one fundamental concept I have found that adds ballast is the “negation of reality” which, I will go to illustrate. I believe this therapeutic stance to be foundational to how curiosity is established and maintained, for the duration of treatment.

By negation of reality I am referring to the way in which ordinary reality (that of the day-to-day) is obfuscated such that psychic reality (repressed thoughts, feelings, fears and truths) can be accessed. Seen through a psychoanalytic lens, repressed experience underpins an individuals difficulties and when once acknowledged one should safely place this insight onto the banks. Released of the whirling emotional currents, both parties are then free to discuss these symbolic ideas.

Of course negating ordinary reality can act as a defence against thinking or feeling something consciously - ordinarily - painful, as can the negation of psychic reality be a defence against facing something unconsciously painful. Indeed what then becomes consciously experienced can be considered ordinary reality and what remains unconscious, remain psychic. The chaotic interplay between psychic and ordinary or real, is where the unconscious is invited to be considered, if tolerable to both parties.

So in summary. In order to shift the conversation to something more meaningful and hopefully therapeutic, it is important to relate what is said or presented about the reality of things, to that of the unreality of things or, psychic reality.

For example. If someone explains how distressed they became, thinking about the mountain they intended to climb later that week, we might, in order to understand the extent of their fears, question anxieties surrounding the “mountains that were climbed” for them to attend therapy in the first place, or perhaps in overcoming other obstacles or challenges in life.

In doing so we are not avoiding the potential physical pain and jeopardy to be expected in this very real and perilous pursuit, but we are to the same point, attempting to appreciate the emotional (internal) task ahead.

In order to understand this symbolic reality within the relationship setting, we might also refer to the reality of things as being played out in the “transference” (i.e. How the client understands the therapist or the therapy to be? How they use the treatment and especially the therapist?). This brings a question of the experience into the room and in a visceral way uses the therapist as agent for the clients experience.

I might have in my mind how the patient is in “being with” me and/or the therapeutic situation? What internalised expectations and assumptions they are placing on the relationship and how these impact the internal worlds of both participants.

Below are some examples of how one might consider and perhaps interpret psychic reality, in the face of ordinary reality.

Where a patient might insist on consuming sweet fizzy drinks in a session, one might speculate that there is a need for her to sweeten her feelings and those between she and therapist, rather than assume the patient is simply thirsty or in need of physiological boost.

Where a patient frequently arrives early for a session. One might speculate that this patient hopes for more time with the therapist, rather than simply assume the patient’s train arrives early.

Where a patient describes a frustration about feeling the need to tidy up her own section at work, along with an irritation that others leave a mess in their sections. One might speculate that she anticipates me leaving her in an emotional mess and/or not be willing to tidy up our feelings during sessions together. Or perhaps appreciate how she tidies up her feelings before she leaves, rather than simply appreciate this as a common frustration.

Where a patient describes - as a young child - being charged with making and serving drinks for a crowd of adults at a party, one might speculate that at that time, she wished to share her feelings about being treated like a grown up, rather than simply wanting to develop her infantile skills as a bartender.

Where an over-weight woman persistently struggles to lose weight, one might speculate that she struggles to lose the weighty feelings she has become accustomed too, but that she would rather suffer carrying these feelings around with her, as they provide insulation from deeper feelings of worthlessness, rather than this being a question of will-power.

Where a patient always arrives with a smile and a sense of good well-being but appears to close his eyes and dose between jokes and stories, one might speculate that he expects me to be sad and wishes to cheer me up (perhaps as he did his parents), rather than assume he is simply pleased to see me, but tired.

Where a client enjoys only buying expensive watches for himself, one might speculate that he values his time and is willing to pay more for therapy should he value our time together?

Where a patient touches her face when speaking lovingly about her partner, one might speculate that she wishes him to touch her romantically and/or that our work is touching her in some way, rather than assume that she has an itch.

Where a patient ends the session abruptly, one might speculate that endings of any kind are emotionally painful and that he would rather deny any feelings of loss at the end of the session, than agree that it’s because he needs to leave promptly for another appointment.

Where a patient insists on completing a detailed explanation of her circumstances without interruption, one might speculate that she needs to “make her case” before being taken seriously, as being reflective of a caregiving environment inhabited by lawyers, rather than agree that this is about forgetting.

Where a patient repeatedly cancels sessions and falls to pay the fee one might, rather than assume she is busy and forgetful, speculate that she wishes to communicate that she expects her therapist to not care, be busy and be somewhat financially self sufficient, reflective of an upbringing where her fathers time was precious and her mother emotionally absent, without love.

Where a patient is over concerned with paying the fee on time one might decide this relates to a need to be pleasing and avoid moral judgment as being that which undermines a sense of importance. While this also ensures a position of moral authority should the relationship breakdown, it also provides a barrier to deeper intimacy which may be an aspect of the work.

Where a patient complains about their partners aggressive behaviour, one might in fact consider this, a curiosity for them, rather than a fear. One might also be pondering an aggressive aspect in them, rather than go along with their complaining.

Where a patient reports starting a gym membership during a period of psychotherapy, one might be pleased that they wish to strengthen themselves physically (reflecting their lifting of heavy emotional weights in sessions) however one might also consider a communication that not enough weight is being lifted in the psychotherapy.

These examples demonstrate the role negation plays in the contextual narratives of psychotherapy. However, the task that this is, and benefit therein, applies equally to the social world. This stance and speculative insight while discordant with social norms, encourages attention to and conversation in, turbulent waters. While not always welcome on the surface, this change permits cavitation and the steady transfer of feeling between people, disturbing defences and perhaps revealing what lies beneath.

1, Gregorio K. The Dead Mother. The Work of Andre Green. UK. The New Library of Psychoanalysis. (1999).