One of the major theorists in the history of psychoanalysis, WRD Fairbairn, astutely observed that persons abused by their parents unconsciously develop negative self-images to preserve their parents as God-like figures. This “moral defense” renders such persons “bad,” and consequently their parents’ rejection of them makes sense.  Fairbairn also stressed how psychotherapists must compete with the relationship that patients fiercely maintain with their own internal “objects.” Giving up these “internal families” leaves patients feeling psychologically orphaned.

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Emotionally pained individuals can be approached from many, many different angles, some of them eloquently simple.  Recently I was struck by the absolute centrality of loss in the struggles of all the patients in my practice.  Randomly choosing four patients I see one of the mornings of my week, I find this among them: My first patient seeks to recover after his romantic partner suddenly left him; my second deals with the experience of nearly dying

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Psychologists experience varied deep feelings in reaction to working with their patients – love, frustration, envy, jealousy, sadness. If we are attuned and engaged, the entire range of human emotions will flood over us. This column explores a specific and most difficult counter-transference emotion – hopelessness – using one recent case example.

I currently have two patients who are actively suicidal, having lost all meaning in their love and work lives.  Lately I have noticed myself feeling more hopelessness in reaction to them. But there’s another patient who has recently elicited this feeling in me even more deeply. He has descended into a hopelessness of a different nature. The loss that catalyzed it is more subtle – not a loss of job, of health, or of love, but the loss of control over another person

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If the Anthony Weiner circus accomplished anything at all, it was the added boost it gave to the continuing decline of American culture. Public attention to anything meaningful was, for a gaudy fifteen minutes of infamy, snuffed out beneath the onslaught. Representative Weiner is entitled to a private life, perverse or not. But absolutely no one can really, seriously care about his puerile sexting or pitiful beefcake poses.

But the most dismaying aspect of the entire fiasco was the leave-of-absence Weiner took to obtain “treatment.” This relatively recent cultural phenomenon – the rich and famous seeking “treatment” following the public disclosure of embarrassing or disturbing behavior – cheapens our work as psychologists. Worse, it is reminiscent of Soviet-style psychiatry. Let me explain.

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Within minutes of the killing of Osama bin Laden, media outlets flooded us with giddy, gloating, repetitive descriptions of the event. Fresh details came in surprisingly few and far between, but that didn’t stop the news outlets from recycling the story over and over. In the true sense of the word, the media, and of course the American public which consumes its product, was obsessed.

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It was with some combination of horror and humor that I reacted to reading the National Institute of Mental Health (NIMH) website regarding the treatment of depression. The section describing non-medication related treatment interventions begins with a list of FIVE approaches, all neatly packaged into Three Letter Acronyms (TLAs), which as we all know is a category ingeniously represented by its own three letter acronym, TLA. The five TLAs consist of Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), Interpersonal Therapy (IPT), Family Focused Therapy (FFT), and Emotionally Focused Therapy (EFT). This is the order in which they are listed, and they are then described, adequately enough, but in the tone one might use to describe a list of the five antibiotics best used to kill the spirochete organism known as Syphilis.

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Individuals who suffer from compulsions also struggle mightily from constrictions in their personal freedom. Compulsive gamblers, stealers, overeaters, hoarders, alcoholics, obsessive seekers of sex, and those with similar conditions often feel as if they simply cannot stop their self-defeating behavior. They do not feel free to stop. In some cases, the compulsion is illegal. If the compulsion continues, society takes responsibility for controlling the behavior, typically through incarceration. Thus a lack of inner freedom can lead to a lack of outer freedom as well.

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“In the Room the Women Come and Go,

Talking of Michelangelo…”

Perhaps the ebb and flow of relationships, including the therapist-patient relationship, is what TS Eliot meant by these lines in The Love Song of J. Alfred Prufrock. Not only women, of course, but all those who consult us naturally come and go. They may leave psychotherapy weeks after beginning the process, or years after, with warning or without, improved or not. Since we cannot help but become intimately involved with our patients, we must exercise caution in managing our feelings as termination approaches.  

The termination process in fact elicits any number of intense emotions in us, many of which might be viewed as shameful or unprofessional. Who among us has not felt deeply hurt, even abandoned, by the unexpected decision by a patient to suddenly leave the psychotherapy process?

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