Friday, August 16, 2019
Psychotherapists’ Struggles with Intimacy
Representing perhaps the height of irony, it turns out that individuals with schizoid traits seem particularly drawn to work in the profession of psychotherapy.
Schizoid psychotherapists struggle with the most significant part of their work, namely intimacy.
Therein lies the irony.
Depth psychotherapists listen carefully to tales of their patients’ romances, friendships, relations with relatives, coworkers, and supervisors.
They listen closely to their patients relationships with themselves.
Being schizoidal works counter to these expected professional behaviors.
The word, schizoid, is a term of art in the mental health professions. It refers to a propensity to be more involved in one’s internal drama than in the real world of interpersonal relationships. Individuals with schizoid traits tend to be subtly withdrawn. They are overly cautious, even awkward, in their interpersonal relationships.
Traits, as opposed to personality disorders, are maladaptive trends in personality styles. Everyone has some maladaptive traits. Schizoid traits are, by definition, a milder version of Schizoid Personality Disorders. These more severe mental disorders are characterized by a lack of interest in social relationships, a tendency towards a solitary or sheltered lifestyle, secretiveness, emotional coldness, detachment, and apathy.
Sporting the same defensiveness as anyone else, I reacted to the news of this research by thinking of a number of my colleagues who, I immediately thought, have such schizoid personality features.
Many of them see too many patients.
They attend insufficiently to their own interpersonal needs.
Many become too involved in their patients lives.
Some skip lunch breaks, snack quickly at their desks, and then return to seeing one patient after another.
At days’ end, they head home, crack open beers, watch TV shows, brush their teeth, get ready for bed, and go to sleep.
Then, they rinse and repeat.
I turned inward after a day or two of reeling from this research finding, realizing—oh shit—I must have some of those traits myself.
Remaining on the defensive, I’ll get to my own schizoid traits in a minute. But first I withdraw into the world of intellectualization by briefly elaborating on the nature of psychotherapists’ work.
Depth psychotherapists engage patients in deeply intimate conversations in which they remain the invulnerable party, or at least the less vulnerable one.
Patients share fears, traumas, troubled relationships, and more.
They share secrets they’ve told no one else.
This is part and parcel of how psychotherapy, particularly the more psychoanalytic or depth approaches, work.
Lewis Aron, a New York psychoanalyst, brilliantly coined the phrase asymmetrical intimacy to describe psychotherapist-patient relationships. In other words, we psychotherapists absolutely have our own intimate reactions to patients.
We feel care, love, interest, irritation.
Sometimes these feelings extend to the sexual or the aggressive.
But, and herein lies the asymmetrical part, psychotherapists do not share such intimate reactions with their patients.
Instead—and this is how skilled psychoanalysts work—they are informed by the feelings they experience.
Sometimes the emotional reactions relate to patients. I might feel anger sometimes, for example, that turns out to be actually anger the patient feels. Unable to express it directly, the anger gets projected into me.
Other times, however, my reactions are entirely mine.
I may find myself irritated with some men who I perceive as more successful, handsome, or intelligent than me.
I find myself attracted to some women patients.
These emotions often have nothing to do with patients.
They are entirely mine.
In any event, we psychotherapists use a variety of methods to delve into the unconscious conflicts, deficits (unmet need states), developmental delays, or trauma experienced by our patients.
We pass our days hearing one deep story after another, deeply involved—at least on one level.
On another level, though, our involvement is limited.
We could not do our jobs if every sad story brought us to tears, if every tragedy disrupted our sleep, or if every dysfunctional relationship invaded our own love relationships.
Furthermore, we psychotherapists structure our professional relationships in specific ways. We set the beginning and ending times of sessions. We bring sessions to an end, effectively rejecting patients over and over again. We set limits. Some more naive patients may be surprised by our refusal to have lunch or coffee with them, meet their husbands or wives, or join them for family gatherings.
Professional psychotherapists, at least those who conduct themselves according to the legal and ethical guidelines governing our profession, adhere to these limits. It is what, in part, allows psychoanalytic processes to properly unfold. Patients feel safe within the confines of these boundaries. They feel empowered to share their dark thoughts, feelings, or behaviors which are often shameful (to them).
What is disturbing about the revelation of psychotherapists’ schizoid traits, however, is that there is always a risk of their using professional relationships as a faux source of intimacy. Like Aron noted, these relationships are asymmetrical.
No matter how troubled psychotherapists might be, their patients are always the more vulnerable party.
They may take refuge, excessively, in their invulnerable position.
Therein lies the rub.
Some psychotherapists use their professional roles to meet their own needs for intimacy—essentially a perversion of their role.
These therapists enjoy one deep relationship after another in their offices without taking any of the risks accompanying real intimacy.
And, intimacy is a precarious process.
Another well-known psychoanalyst, Donald Winnicott, famously wrote:
It is a joy to be hidden and a disaster not to be found.
That one sentence carries the trouble with intimacy for all of us:
On the one hand, we prefer to keep hidden in our own worlds. Those with more pronounced schizoid tendencies really hide.
On the other hand, we all really want, even need to be seen, known, understood, witnessed, by others.
Allowing someone into your life—to hear your own dreams, fears, and hopes—means to risk emotional hurt.
Someone may not like you.
They might use your personal information to hurt you.
They may outright reject you.
They might die.
It is a universal, human dilemma.
So what about me?
Oh, I’m sorry, but our time is up for today.
How tempting it is to end this post on that note.
In fairness, and in celebration of the year 2019 being the FORTIETH year I’ve practiced depth psychotherapy, I’m sure I too abuse this professional intimacy in some way.
I am blessed with a number of intimate friends, am close with my relatives as well as with my own (created) nuclear family.
And yet, I remember those few corporate America jobs I had before I entered the world of professional psychotherapists. I found talks by the water cooler uncomfortable. I could not stand the cliques and the gossip. I remember distinctly hating words like these from supervisors:
Would you please see me in my office?
I mean, did that ever mean a good thing?
Even now, in my relationship with my one employee, an executive assistant, I find myself highly anxious about allegedly normal parts of management. I despise doing work performance evaluations. I hate negotiating with her for pay raises. I find it difficult even mildly criticize her work.
Further, and contrary to standard commercial real estate wisdom, I signed a TEN YEAR lease on my current office space—mostly because I can’t stand negotiating with a landlord every few years.
By devoting my life’s work to depth psychotherapy then, I’ve effectively avoided water-cooler talks, corporate gossip, cliques, employment status hierarchies, supervision, or the other “normal” elements of working in groups.
Such avoidance comes with a price.
Despite the joy of hiddenness offered by working as a psychotherapist, it can be a surprisingly lonely job.
If practicing their art well, depth psychotherapists obtain little if any satisfaction of their own needs. They ideally remain intensely focused on their patients’ needs—listening patiently, following their patients conversational flows, and engaging in accordance with their patients desires.
If the work may be self-protective in a schizoid way, it is also extremely lonely in another way.
In closing, and gleefully avoiding further disclosure of my own vulnerabilities, I offer unsolicited advice to you consumers of psychotherapists’ services:
Make sure, if you can, that your psychotherapist has his or her own life. It will be hard to find out if they do because most competent ones share little of their personal lives.
You certainly want to avoid psychotherapists who rely excessively on their professional work as their own source of intimacy. They will be at greater risk of confusing their needs, their experiences, their lives, with yours.
That risk is serious.
One of the few commonalities binding all the various approaches to psychotherapy is to help you become a more authentic, autonomous YOU.
Well before the US Army stole the phrase, the Greek poet Pindar wrote:
Become who you are.
This phrase represents the battle cry of all competent depth psychotherapists.
To effectively fight for patients’ capacities to develop their personal power, and along with it their ability to love and care for others, competent depth psychotherapists must get out of the way.
And, in order to get out of the way, they should be meeting their own needs—including for personal intimacy—outside of their consulting rooms. That way, when they metaphorically open their consulting room doors and ask their patients,
What’s on your mind?
They are as completely present, to the unique, shimmering experiences of their patients.
Aron, L. (2001). A Meeting of the Minds: Mutuality in Psychoanalysis. New York: Routledge.
Winnicott, D.W. (1971). Playing and Reality. London: Routledge.
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