Emotional Dependency in Psychotherapy

Joseph Burgoin
Defense Mechanisms
·
The Psychotherapy Relationship
178

The concepts of neediness and emotional dependency have negative connotations in our culture; when it comes to psychotherapy, many people (especially those who've never had any kind of treatment) take a very dim view of clients who come to depend "too much" upon their therapist. You may hear the very cynical opinion expressed that psychotherapists deliberately instill a kind of emotional dependency in their clients in order to exploit them. It seems that a great many people think that emotional dependency in psychotherapy is bad.

In truth, for psychotherapy to be effective, a degree of emotional dependency is inevitable. Clients with extreme amounts of pain and confusion, who have a history of unstable or chaotic relationships, may become highly dependent for long periods of time. If your life isn't working, if you come from a deeply troubled background and never developed the kind of emotional capacity and self-awareness you need to get through life, you have to turn to and depend upon someone else to help you develop it. Effective work can't happen and you can't get what you need if you don't.

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Performance Anxiety and Shame

Joseph Burgoin
Anxiety
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Shame/Narcissism
21

Over the years, I've worked with a number of artists/performers and dealt with the issue of performance anxiety. I've also had to cope with my own anxieties, both as a public speaker and as a beginning pianist, playing for my family and friends. For most of my career, I've thought about performance anxiety as fall-out from the perfectionistic superego, how the hostile demand for perfection gets projected into the audience. I discussed these issues in an earlier post about self-consciousness.

I've also thought about performance anxiety in terms of fraudulence: for those of us who struggle with issues of precocity, who grew up quickly on the outside to escape unbearable feelings of needy smallness, we often believe our accomplishments are a sham, disguising the true state of affairs inside. One of my clients neatly summed it up with the first dream she brought to treatment: there was a scientist with big round glasses (like Mr. Peabody of the Way-Back machine) and a mortar board on his head, wearing diapers underneath his lab coat. Performance anxiety sometimes embodies the fear of being exposed as a fraud, of revealing that we're really only "babies" underneath that facade of competence.

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Shame and How It Produces Envy

Joseph Burgoin
Points of Departure
26

A teenage boy who I'll call Sam recently told me that he was having a "problem with jealousy." When I asked Sam what he meant, he explained that Ryan, another boy at his school, was incredibly charismatic and popular; all the other kids wanted to be around him and he seemed able to attract anyone he wanted. Sam's feelings of "jealousy" were so powerful, so painful that at times, he couldn't bear to look at Ryan. "He just makes me feel so bad about myself," Sam added.

When Sam uses the word jealousy, he's actually referring to what I would instead call envy. (I discuss the difference between the two in this earlier post.) Sam also has it backwards: Ryan doesn't make him feel bad about himself; Sam already feels bad about himself (full of shame), and because of this basic feeling that's he's defective or damaged, different from and inferior to other people, his envy of Ryan is excruciating painful. Envy is a normal human emotion, one virtually everybody feels at one time or another; as I've said before, it also has its value, teaching us what we want to have or to be, and thereby motivating us. When coupled with basic shame, however, it becomes toxic.

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ADHD Symptoms Revisited

Joseph Burgoin
Depression and Bipolar Disorder
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The Medicalization of Mental Health
28

Last week, I reviewed an article by L. Alan Sroufe that had appeared in the New York Times, seriously questioning the effectiveness of Ritalin, Adderall and other stimulants used to treat children with ADHD symptoms. Two site visitors, including my friend Dr. Bob Dick, raised some strenuous objections to my post, and more importantly to Dr. Sroufe's piece in the NYT. Both of their comments convinced me the issue deserved another look, and that because of my basic anti-medication bias, I'd been too quick to accept Sroufe's report at face value.

Shortly after Sroufe's article appeared, Harold S. Koplewicz MD, President of the Child Mind Institute, wrote a point-by-point rebuttal of it; if you're interested in this issue, the article by Koplewicz bears reading. I won't bother to summarize the whole piece, but suffice to say that he brings some fairly persuasive evidence in support of the effectiveness of stimulants to treat ADHD symptoms in children and raises important questions about the validity of the studies cited by Dr. Sroufe and the conclusions drawn from them.

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ADHD Symptoms and Their Treatment: Drugs Don’t Work

Joseph Burgoin
The Medicalization of Mental Health
51

In reading a recent article in the New York Times by L. Alan Sroufe of Minnesota's Institute of Child Development, I had a strong sense of deja vu. Based on his literature reviews of treatment programs for ADHD symptoms, along with 30 years' experience conducting his own longitudinal studies, Dr. Sroufe concludes that there is no evidence to support the "inborn defect" theory of attention deficit disorder and no lasting benefit to be had from taking Ritalin, Adderall and other drugs commonly prescribed for attention deficit disorder. It so reminds me of the scientific controversy around the chemical imbalance theory of depression, detailed by Robert Whitaker in his book The Anatomy of an Epidemic, and his conclusion that there is no evidence to support it, and no lasting benefit from the long-term use of anti-depressants.

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