Merger Fantasies in Psychotherapy

Joseph Burgoin
Depression and Bipolar Disorder
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Detours
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The Psychotherapy Relationship
18

Certain clients, especially those with personality disorders or issues related to bipolar disorder symptoms, often idealize their therapists, putting them up on a pedestal and worshipping every word they say.  Behind these feelings often lies a desire to merge with the therapist and to take part in that ideal life as a means of escape from personal torment.  These ideas of merger represent a kind of growth-by-annexation where, in fantasy, the client wants to get inside of and take complete control over the therapist.  This wish usually goes hand-in-hand with a belief that the client's own internal world is so damaged as to be beyond repair; they believe this magical usurping of the therapist's identity represents their only hope to get better.

As a therapist, you might notice that the client starts talking like you, echoing your phrases and speech patterns or developing a collegial manner in your relations.  Such fantasies of merger are especially visible in dreams, however.  Two dreams from one of my clients, someone I saw many years ago, illustrate the dynamic very well.  He entered treatment because of occasional but severely debilitating depressions in which he felt unable to work.  On the surface, Jim (mid-20s) appeared extremely appreciative; he was always telling his friends that I was a wonderful therapist and every week he'd repeat to them my "brilliant" interpretations.  He'd been in treatment for a few months when he brought in the following dream.

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Existential Aloneness

Joseph Burgoin
Anxiety
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Destinations
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The Psychotherapy Relationship
10

During a recent session, my client Ellen was talking about how poorly she had done over our two-week Christmas break, in terms of looking after herself and using what she'd learned in treatment.  It worried her and she didn't  understand why it should be so since she'd recently been taking much better care of herself.  Coming back to her first session after the holidays seemed immediately to make her feel better, less distracted by the fantasies and obsessive thoughts that had troubled her during the break. I had some ideas about why this should be so but didn't at first mention them; I waited to see where this train of thought would take her.

Later in the session, Ellen mentioned that she'd had a "scare" earlier in the week.  She works as personal assistant to the boss of a medium-sized company; her boss had been away during the holidays and in his absence, some of his oversight duties had fallen onto her shoulders.  She took off a few days herself during that period but because her boss was away, she felt it would be irresponsible to take as many days as she would have liked; this made her feel resentful, to have to deprive herself in order to fulfill her duties.

On the first day after her boss returned from his vacation, it occurred to Ellen that she should probably consult the firm's calendar (which she had failed to do for a week or so), to see whether there might be an upcoming due-date for one of the firm's projects.  Sure enough, there was a project due that very day; she alerted the appropriate personnel and in the nick of time, they managed to complete the assignment for delivery.  It troubled her that she had "forgotten" all about the calendar and wondered why she should have remembered on that very day.

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Emotional Dependency and Stealth Control

Joseph Burgoin
Detours
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Points of Departure
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Relationship Issues
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The Psychotherapy Relationship
49

In my psychotherapy practice, I've had a number of clients who suffered from emotional dependency issues:  in their personal relationships, they often seemed helpless and extremely needy.  I'm sure you've known such people.  They may appear clingy and possessive; they often get involved with someone very strong and competent, a Rock of Gibralter type.  In extreme cases, the relationship consists almost entirely of one person taking care of the other.  Incapacitating depressions may be frequent or continuous, to such an extent that the emotionally dependent person may be unable to hold down a job or function as an independent adult, so completely reliant on the other person that at times he or she seems infantile.

As clients, such individuals quickly become dependent on treatment for support.  Even if they're coming for more than one session per week, the gap between those sessions will feel too long; they may make frequent "emergency" calls on weekends or in the middle of the night.  If a therapist isn't careful, such clients can become extremely taxing and emotionally draining.  We may feel intense pressure to provide emotional relief; if we're not empathic or supportive enough, these clients may become intensely angry with us.  In some cases, it actually feels like a relief when they quit in a rage and seek treatment elsewhere.

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Grief and the Attitude of Gratitude

Joseph Burgoin
Destinations
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The Psychotherapy Relationship
10

With one of my very long-term patients, I've set a termination date; it's still a year off but has already brought up a lot of new feelings and issues regarding the end of her treatment, grief and gratitude foremost among them.  With Thanksgiving upon us, I thought now might be a good time to discuss those feelings.

I began seeing this woman (I'll call her Diane) many years ago when she was in her late teens. She sought treatment because of a recurrent auditory hallucination (buzzing in her ears), visual hallucinations of spiders and other small objects in her peripheral vision, extreme insomnia,  symptoms of depression that verged on immobility, drug abuse, and a compulsion to cut herself with razor blades.  In short, she was in enormous pain and constantly on the verge of psychological chaos.  In our early sessions together, she was very difficult to reach.  She often came in and did headstands on my couch.  She would put on accents and pretend to be different characters; she was very good at it, quite funny, and used her humor to keep both of us at a distance from her pain.

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Psychological Damage and Emotional Transformation

Joseph Burgoin
Destinations
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The Psychotherapy Relationship
29

A recent comment by 'TB' on my post about my inner brat, along with this piece on resentment forwarded to me by Marla Estes, got me thinking about authentic change and how to describe it.  As I discussed in my earlier post about change, most people want to believe that insight and understanding produce a transformation that can make you
into a different person. The language current in the self-help field uses words such as "triumphing" over this problem, or "conquering" that issue.  As the author of the linked article makes clear, however, self-knowledge really means you have a choice about whether to express or inhibit certain tendencies that will always be with you.

It's difficult to describe what this choice involves, but I've come up with two examples that demonstrate the real, in-the-moment process of putting self-knowledge to work in a way that transforms emotional experience.  One comes from my own internal world, an everyday process for me; the other from one of my clients.

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