We were close to forty sessions into the work. My client–a non-binary 22-year-old college student with severe learning disabilities and depression–tearfully shared with me their frustration with their teaching assistant. Per their report, the client had been given permission to miss classes so long as they emailed the T.A. before class. Yet my client was enraged and hurt. They insisted that in other classes they had been able to get away with explaining their absences after-the-fact. They were entrenched in the belief that this made the T.A. an ableist. I felt no compassion. Indeed, I felt anger and irritation.
I could see compassion just over the fence. To hop over it I needed only to reconnect myself with this client’s issues (overbearing parents who fed into their sense of helplessness; interactions with people and systems that didn’t take their learning and mental health disabilities seriously, a culture that is ableist, etc) and thereby place their reaction to the T.A. within a broader context. And yet, even knowing this, I simply couldn’t. If anything I felt anger toward the client. Not a passing sense of anger but, rather, an anger that burned my chest a bit. What ensued was an enactment.
Enactments are not always big and dramatic or even obvious. They can be so insidious as to don the disguise of helpful benevolence. A client comes to a therapist in order to explore why she keeps “chasing partners away”. The client says that her partners start off seeming like “such nice guys” but that over time they become “jerks that don’t want to listen”. The client admits to yelling a bit at her partners but “only after they become jerks”. The work begins and the therapist validates and feeds warmth to the client. The client comes to session, “vents” and then leaves sessions appearing happy and satisfied. The therapist relishes being liked. Time passes and the therapy hasn’t changed much–both client and therapist are getting approval from one another despite being, in a sense, stuck. The therapist realizes that they are no longer looking forward to sessions with this client. In fact, they feel irritated and used and want to run away. They have fantasies about kicking the client out of therapy. The therapist is perplexed. When did this shift occur? What did I overlook? Why do I feel this way? I shouldn’t feel this way! The therapist begins to shut-down a bit in sessions–they are less attentive and present. The client complains that the therapist doesn’t listen and starts to grow irritated and become demanding. The therapist continues to want to flee or even to fight.
The enactment here is that the problematic interpersonal dynamics that brought the client to therapy are being repeated in the therapy relationship. The therapist unwittingly fell into the role of the “nice” boyfriend (perhaps out of a need to be liked) and the client was treating the therapist purely as a self-object to satisfy their unrealistic need for unceasing love, warmth and approval. From a more object-relations (vs self-psychology) perspective the therapist became a part-object (like a breast that provides milk but whose internal representation is detached from the human being to which the breast belongs) and the therapist initially enjoyed being that part-object because it made them feel helpful and needed. Over time they began to feel used. Like a thing. They began to pull away emotionally from the client in the way the people in the client’s life had done.
It is very important here to note that enactments are inevitable. One needn’t as a therapist be perfect along these lines. It is, however, incumbent on the therapist to look for signs of enactments and use them constructively. In this sense enactments can end up being very helpful. But let us return to my own client.
I felt repelled by the client’s tears and by their insistence that their T.A. was being unreasonable. They appeared ready to quit their class just to make a point. Rather than move toward the client I internally moved away. I intervened by asking the client if there were other ways of understanding the situation. Now this would not have been an inherently problematic intervention if it had been coming from a place of true curiosity or caring, but what made it unhelpful was that it was coming from an angry and sadistic part of me that needed them to assuage my anger by showing me that they could be “reasonable”. The client insisted on their point of view and appeared ready to self-righteously quit the class. This being near the end of the session, I succumbed to a feeling of defeat and emotionally bailed on the last few minutes of the session.
That weekend I spoke to friend and colleague over dinner about it. They validated the fact that my anger was not without merit; that the T.A. wasn’t being unreasonable. Just as importantly they also helped me come to some of my own important realizations.
My anger was not just about this one moment. I realized I walked on egg shells with this client frequently; I was afraid that they would crumble in the face of even gentle confrontations. In short, I had been leaning too far into holding back which had created some level of resentment within me. Additionally, this client’s helpless “inner-child” brings up for me the anger and shame I feel about my own inner-child; about my own depression. There was a certain amount of self-hatred being projected onto this client which only added to the very understandable part of my frustration. If I could summarize the enactment here I would say that the client was taking up their position as the helpless kid and I had subtly fed into this over time by not challenging the client frequently enough (here I was being the client’s mother who takes care of things for the child and enables their lack of self-efficacy). When finally a situation arose in which I felt the client was unreasonable, my pent up frustration rose up and I become a kind of quiet version of her father (who would yell at my client and get caught up into power struggles).
I left my consultation with both an understanding of what was happening and the knowledge that our enactment needed to be addressed. I felt reasonably comfortable in my skills but doubted my ability to bring this up from a place of caring.
The next day I was thinking about this client when suddenly the book The Catcher In the Rye came to mind. The protagonist in the novel (Holden Caulfield) is an alienated teenager who is obsessed with the idea of authenticity. He was repelled by the “phoniness” that the adult world seem to embody. When I was a teenager I identified deeply with the character. As I grew older and understood the novel through a different lens I began to see how it was not just a story about a rebellious teenager. Holden saw innocence as the highest virtue–adulthood was dangerous; it represented cruelty and artificiality. The novel is essentially about a sensitive–though, admittedly, immature–young man who is struggling deeply with the idea of growing up. He wanted to preserve his own innocence and, even more so, the innocence of his younger sister, Phoebe. His fantasy of being a catcher in the rye was really about being a part of world in which he had the power to keep himself and others from growing up–the preservation of innocence. I find this so poignant that even now my eyes well with tears. My client reminded me of Holden. Not the rebellious part, rather the part of them that seemed to want, at all costs. to preserve their innocence. This helped me locate my compassion. Instead of anger and sadism I felt warmth toward them (Here I am tempted to get on a soap box and talk about how good novels, graphic novels and films can teach us as much about humanity as psychology books but I’ll leave that for another entry).
In our next session I asked the client if they were okay with me addressing the last session. I explained that I had pulled away and grown irritated with them and that my responsibility in this was in the way I had been patronizingly treating them as a child by not challenging them enough (I left out “from a place of caring” but it is what I meant). I explained that I needed to provide more authentic and caring responses and that sometimes a caring response might paradoxically be one in which I share something difficult. My client reported that after the last session (once they were more grounded) they realized they were “overreacting” to the situation with the T.A. They also said that they felt hurt that I had been treating them like a child and yet bravely and insightfully acknowledged that they felt like a child in that very moment. This insight allowed us to name the dynamic: they frequently acted helpless; I in turn treated them as such, and so on (in a causality loop).
Fast forward to a couple of sessions later. I do not remember the exact context but the client named that their persona was of “an innocent little girl”. I told them how that resonated with me and asked them to talk more about that persona. Though the client struggled to elaborate (my client has processing issues that take them a while to gather their thoughts) they were able to articulate the following, “I want people to see me as an innocent little girl because if they believe that I am then I can believe that I am”. I asked, “And what does believing that you are an innocent little girl do for you?” “I don’t know,” the client responded. “I just associate being a little girl with purity and goodness and I want to feel pure and good”. Sufficed it to say this was a golden insight and has created new opportunities for the work.
I wish I could say that the work has gone smoothly since this session a few weeks ago. I wish this was one of those cases where the narrative is one in which the client and I engage in a harmonious dance leading to blissful termination and the resolution of their issues. The reality is my client’s defenses have been showing up again. However, I feel compassion for this and it lets me know to pull back a little on the gas pedal. The dilemma is that we cannot return to a place where I patronizingly go “too easy” on the client, but neither can I bulldoze the client’s defenses.
This is hard work. It burns me out at times. It takes a lot of thought and feeling. It is humbling. I have fantasies about being one of those therapists who stick with a strictly Rogerian approach or who strictly use handouts and do psycho-education: therapy that isn’t inherently bad but whose efficacy is limited by the lack of specificity. Actually…I don’t. Though that sounds easier in one sense, I think I would hate myself and the career in such a way as to reach a different kind of burnout. So this is it. A career and a calling that that keeps me engaged intellectually and emotionally. One which makes me feel a great sense of efficacy and, at other times, a sense of feeling helpless. One that often leaves me feeling like a husk (even if I do practice self-care). And yet I do believe this is my purpose. Or perhaps I need to believe it is my purpose so as to have a sense of meaning in my life. I’m off to work….