Most people understand what free association means: to voice all thoughts, feelings and ideas that come to mind during a therapy session, without deciding in advance whether they're relevant or "worth saying." At the beginning of traditional psychoanalysis, clients are instructed to freely associate and occasionally reminded to do so as the treatment proceeds. We call it the "fundamental rule" of psychoanalysis; we believe that free association brings apparently unconnected ideas into relation with one another, revealing links that give us access to the unconscious.

Here's an an example. In session this week, my client Tom was discussing his work schedule. Tom is a highly successful entrepreneur with several thriving businesses; he works enormously long hours and operates himself as if he were a machine, with little regard to his needs, feelings and limitations. In this particular session, Tom spent a long time discussing the demands of the workplace in a light-hearted manner, telling jokes about problems he encountered, making light of his frustration. In a practical vein, I kept pointing out that he could say "no" to certain demands upon his time. I wondered aloud whether he had room to acknowledge just how exhausted he felt, how far beyond his limits.

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What Hurts the Most

I don't usually relate to the trending topics on Twitter -- often about celebrities I don't know and TV shows I've never watched -- but earlier this week I noticed that #WhatHurtstheMost was a popular hashtag for the day. Out of curiousity, I searched the term on Twitter and read through a hundred or so tweets to see what it was that people found especially hurtful. There was a variety of answers, but the most popular one involved romantic rejection or unrequited love. Here's a sample of the variations on that subject:

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Keeping Secrets from Your Therapist

Joseph Burgoin

Sexuality

Shame/Narcissism

The Psychotherapy Relationship

January 20, 2013

When people enter psychotherapy, even if they're desperate and deeply in need, they don't fully reveal themselves in the early phases of treatment. As in any relationship, it takes time to develop enough trust so you feel safe making yourself vulnerable. A prudent reserve makes sense: how can you be sure the stranger sitting in the chair across from you won't judge or laugh at you? Sometimes people who struggle with borderline issues will disclose powerfully intimate information right away, but they nonetheless keep some deeply shameful details in reserve. Everyone does.

Like most psychoanalysts, I advise my clients early on to be as candid as possible, holding as little in reserve as they can. I tell them I know it's a difficult thing to do -- no one discloses 100% of their most painful feelings, thoughts and memories -- but they need to do their best. I acknowledge that it will take time to build trust, for them to feel I'm a safe person. As we come to know each other, they gradually disclose the more shame-inducing aspects of their emotional lives. Often their secrets relate to sex.

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Shyness and Self-Hatred

Joseph Burgoin

Self-Esteem and Self-Sabotage

Shame/Narcissism

The Psychotherapy Relationship

December 9, 2012May 4, 2013

Early in my career, when clients would talk about intense forms of self-criticism or self-loathing, I used to make interpretations that focused on the savage and perfectionistic superego. Over time, I'd help them develop the mental ability to withstand this savagery and protect themselves from it. Later, as I described in this earlier post, I began to think more about learning from experience and facing our actual faults: the ways that brutal attacks on the self can represent a refusal to accept who we really are, with all our warts and limitations, which then leads to a cycle of crime and punishment where we repeatedly atone for our "sins" but learn nothing about what drives them. I still believe both of these perspectives have value.

Lately, however, as I've begun to focus more on shame and the defenses against it, I've come to see that self-hatred is a kind of defense in itself. Especially as I delve deeper into the work of Sylvan Tomkins and Donald Nathanson, I'm coming to understand how both shyness and self-hatred are strategies for coping with the shame that comes from rejection. They're both examples of what Tompkins calls the "Attack Self" script for managing the painful experience of shame. From a lay perspective, for readers who aren't familiar with affect theory, this might seem counter-intuitive but bear with me. I need to lay a little groundwork.

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