But her self-criticism was learned. How she learned it, and who she learned it from, we do not know. Therapy could take a good deal of time trying to get answers to these questions, and the answers might be interesting and even potentially helpful, but it is much more important, I think, that April understand that she could learn to pull back from a complete identification with the self-critical voices in her head.
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Reflecting on this session, I am reminded once again of the concept of the mind object, both Beth’s and my own. By focusing too much on the particulars of Beth’s food issues and trying too hard to make a change in her behavior, I was getting drawn back in to her closed world instead of helping her break out of it. I had lost track of Michael Vincent Miller’s essential point and was therefore, not surprisingly, sacrificing innocence for experience.
I have such a hard time relaxing,” she says. “With men especially, and if I’m attracted to them it’s worse.” There is a longing in April to be known, to be reached, and to be seen, but she is frightened of it at the same time and cannot help but throw up obstacles seemingly in spite of herself. She might spill something in such a situation, for instance. When immersed in her work, April is the opposite. She can be funny, irreverent, spontaneous, innovative, and free. We talk about the paradox. When she loses herself, she is being herself.
In some way, this is what I want to convey to April. We all wish we could just eliminate the dysfunctional parts of us. In pushing against what we do not like in ourselves, we get more knotted up. The shame, discomfort, embarrassment, and pain just reinforce the hold the whole thing has over us, and, in the process, we over-identify with an aspect of ourselves that does not need to define us so completely. Seeing this overidentification clearly is what I think of as insight.
But, as important as it is to understand the sources and details of one’s pain, understanding is rarely enough. My patients come to therapy wanting the burden of their accumulated experience lifted. Yes, they want to make sense of their lives, but that is not usually their fundamental or exclusive aim. First and foremost, they are trying to get over their accumulated trauma in order to feel less fearful, isolated, forlorn, helpless, alone, anxious, or depressed. They might not be able to say it so clearly, but they are reaching for things
beyond thought, trying to make contact with essential capacities that have been sacrificed in their efforts to adapt, adjust, comply, cope, or conform.
Dr. Kernberg was kind to me and helped me to see that, while their deprivation may have been real, these patients had lots of internal conflict around anger that was holding them back. In showing me this, he also, without having to say it directly, made me see that I, too, was pushing anger away. He gave me language to use. “You might not be aware of how angry you are,” he suggested I say. “But you are in danger of destroying the very support you need the most.” By beginning my communication with “you might not be aware” rather than confronting my patients’ anger directly, I could encourage them to reflect upon something they were otherwise just acting out unawares. My skills as a therapist improved dramatically as a result. Kindness without the proper intelligence to back it up was of little use, but the use of kindness in the service of therapy’s insights was very helpful.