Ch. 7: Willing Flashcards

1
Q

Japanese proverb

A

“To know and not to act is not to know at all.”

Early analysts were so convinced that self-knowledge was tantamount to change that they tended to see self-knowledge as the end point of therapy

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2
Q

“Responsibility”

A

“response” + “ability”, that is the ability to respond.

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3
Q

What is action?

A

Thought has no external consequences, although it may be en indispensable overture to action: planning, rehearsing, or mustering the resolve for action

  • Action extends beyond oneself: it includes interaction with the surrounding world
  • Action has two sides: not acting according to habits, not overeating, not exploiting others may be major action
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4
Q

The therapist’s final goal

Analytic model

A

The therapist’s final goal is action (i.e. change) - although they may on the way pretend to pursue other goals such as insight, self-actualization, comfort
- Unfortunately this isn’t (or wasn’t) taught as much, rather that interpretation and self-awareness will ultimately generate change… leading to people doing therapy for 3,4,5 and even 7-8 years

Therapist’s may find themselves thinking and saying things like “you have to try” and “people must help themselves”
But in this case, who are they talking to? In the analytic model of the mind there is no such psychic agency to which such an appeal can be made
- Freud’s man according to May: “is not driving but is driven”
- However, Freud in The Ego and the Id: “therapist’s task is to give the patient’s ego freedom to choose one way or another”

Even though traditional analytic thought views human behavior as completely determined (split into ego, superego, id; pre-conscious, unconscious, conscious) still it seems necessary to include a core that is not determined
- It’s as if a freely choosing homunculus were placed within one of the parts - May: “but how can a part be free without the whole being free?”

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5
Q

Subjective sense of freedom

A

Some therapist’s deal with this by saying that we have a subjective sense of freedom, although it’s an illusion
- Similarly, Spinoza: “a self-conscious and sentient stone that was set into motion by an external force would believe itself to be completely free and would think that it continued in motion solely because of it’s wish”

However, this is a corner, because this is entirely incompatible with one of psychotherapy’s overarching values: the quest for truth and self-knowledge!

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6
Q

“Will”

Aristotle

Arendt

Kant

Farber

A

The analytic model omits something central in every course of psychotherapy: “will”
- The bridge between desire and act

Aristotle: “it is the mental state that precedes action”

Arendt: “It is the mental ‘organ of the future’ - just as memory is the organ of the past”

Kant: “It is the power of spontaneously beginning a series of successive things”

Farber: “It is the seat of volition, the ‘responsible mover’ within”

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7
Q

Conflicting definitions of Will

A

Yalom: I’d prefer a happier and less controversial word with less conflicting definitions

Schopenhauer in The World as will and Representation: “a nonrational force, a blind striving power whose operations are without purpose or design”

Nietsche in Will to Power: “to will is to command; inherent in will is the commanding thought”

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8
Q

The opponents of the concept have changed over the centuries

A

Greek philosophers had no term for “free will”, it was incompatible with the belief of eternal recurrence, i.e. Aristotle: “coming-into-being necessarily implies the pre-existence of something that is potentially but not actually”

Stoic fatalist: what ever is or will be “was to be”

Christian theology could not reconcile the belief in divine providence with the claims of free will

Free will also didn’t fit with scientific positivism, with Newton’s and Laplace’s belief in an explicable and predictable universe

Hegelian idea of history as a necessary progress of the world spirit clashed with a free-will ideology that rejects necessity and holds that all that was or is could as well not have been done

Lastly, free will is opposed by all deterministic systems whether they are based on economic, behavioristic or psychoanalytic principles

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9
Q

Perhaps too, the clinician is not certain that he or she wishes to recognize it

A

“Will” was some time ago replaced by “motive”

  • Paranoia is “explained” (that is “caused”) by the unconscious motivation of homosexual impulses and genital exhibitionism is “explained” by unconscious castration anxiety
  • Yet to explain behavior on the basis of motivation is to absolve one of ultimate responsibility for one’s actions
  • Yalom: “Motivation can influence but cannot replace will; despite various motives, the individual still has the option of behavior or not behaving in a certain fashion.”
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10
Q

“Will” serves the purpose of the book

A

Despite these many problems, no other term than “will” serves our purpose

  • As a verb “will” connotes coalition
  • As an auxiliary verb it designates the future tense: a last will and testament is one’s final effort to lunge into the future
  • The future tense is the proper tense of the psychotherapeutic change (Hannah Arendt’s “organ of the future” is thus fitting)
  • Memory (“the organ of the past”) is concerned with objects; the will is concerned with projects
  • Yalom: “as I hope to demonstrate, effective psychotherapy must focus on patients’ project relationships as well as on their object relationships”
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11
Q

THE CLINICIAN AND THE WILL

Exhortative approach

“Will power”

A

So if will is the “responsible mover” then the therapist’s goal is to influence will. But how?

Exhortative approach is the simplest i.e. just saying: “You are responsible for what happens to you in your life! Etc”
Stems from the idea that if the person knows what’s best for them then they will do it
- Aquinas: “Man, insofar as he acts willfully, acts according to some imagined good.”
- This approach is occasionally effective

However, “will power” is only the outer thin layer of “willing”

  • Well-entrenched psychopathology will simply not yield to exhortation - more therapeutic power is needed
  • One must actively change if one is to change
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12
Q

Long middle work of therapy

Influencing will

Blind faith

A

The therapist embarks on the long middle work of therapy

  • Particular tactics, strategy, formulated mechanisms, goals
  • Interpretation, insight, interpersonal confrontation, trusting and caring relationship, analysis of maladaptive behavior

All of these can influence will (not “create” it - Yalom: “therapist can not create will in the patient, the therapist can liberate will - to remove encumbrances from the bound will of the patient”)

These rits require much patience and much blind faith - in fact, more than many contemporary free-thinking therapists are able to muster
- Yalom will try to separate the mutative steps in psychotherapy (that can influence will in its naked form) from the ritualistic decorative ones

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13
Q

OTTO RANK - WILL THERAPY

A

The topic requires Rank for he was the person to introduce will into modern psychotherapy.

Was one of Freud’s first students starting from 1905 but departed in 1929 because of differences

  • Highly influential figure in the early development of psychoanalysis, especially as director of the powerful Viennese Psychoanalytic Institute
  • However, in US, his works were badly translated and he didn’t gain momentum
  • Now, Ernest Becker believes in him a lot and calls him “the brooding genius waiting in the wings”
  • Books: Will Therapy and Truth and Reality
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14
Q

Rank’s focus

A

Rank was concerned more with therapeutic outcome than with the construction of a model of the mind and was convinced that strict psychic determinism was incompatible with effective psychotherapy

  • “I understand by will a positive, guiding organization which uses creatively as well as inhibits and controls the instinctual drives.”
  • “It’s astonishing how much the patient knows and how relatively little is unconscious if one does not give the patient this convenient excuse for refusing responsibility.”
  • “The unconscious is a purely negative concept, which designates something momentarily not conscious, while Freud’s theory has lifted it to the most powerful factor in psychic life. The basis for this, however, is not given in any psychological experience but in a moral necessity, that is, to find an acceptable substitute for the concept of God, who frees the individual from responsibility.”
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15
Q

The development of the Will

Emotions vs Impulses

A

Will arises in relation to instinctual impulses during parental impulse education when parents try to fit the kid’s impulse life to the community

  • Gradually the child begins to exert personal control over the impulses and decides on the basis of love for their parents to curb aggressive impulses
  • Thus, will is tied up with impulse: either it controls impulse or it resists outside efforts to control impulse

Emotions are different from impulses: we seek to discharge impulses but to prolong or dam up emotions
- Emotional life is a mirror image of impulse life whereas the will is a separate executive entity in power to the impulse system

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16
Q

3 types of will

3 character types

A

Rank viewed the parent-child relationship and the entire assimilative process - as well as the therapeutic relationship - as a struggle of wills. He described three

  1. Counter will: opposition to another’s will
  2. Positive will: willing what one must
  3. Creative will: willing what one wants

The goal of child rearing is to develop the first two into the third. The major error is to teach the child that all free impulse expression is undesirable and all counter will is bad, then the child suffers two consequences: suppression of entire emotional life and guilt-laden will

Rank’s three character types were thus based on this approach:

  1. The creative character has access to emotions and wills what he or she wants
  2. The neurotic character has a will ensnarled with guilt
  3. The antisocial character has a suppressed will and is dominated by impulse
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17
Q

The Will and Psychotherapy:

Explaining away “will”

“Two wills clash”

A

Rank felt Freud and Adler explained away “Will”

Rank felt that Freud had made a mistake by naming it as “resistance” that should be gotten rid of

  • That the basic procedure in psychoanalysis requires a state of “will-lessness” - acts to weaken will: “Free association specifically asks to eliminate entirely the little bit of will which your neurotic weakness has perhaps not yet undermined and resign yourself to the guidance of the unconscious”
  • Sylvan Tomkins: “psychoanalysis is a systematic training in indecision”
  • Allen Wheelis: “knowledgeable moderns put their back to the couch and in so doing may occasionally fail to put their shoulders to the wheel”

Rank thought Freud’s view of resistance was a serious error, instead it should be viewed as a will that can be transformed into creative will

  • If the therapist will try to force the patient to do what is “right” the patient will resist and therapy will fail
  • If the patient resisted or suggested termination then Rank was careful to point out that he considered these stands as progress: “The neurotic cannot will without guilt. That situation can be changed not by himself but only in relation to a therapist who accepts the patient’s will, who justifies it, submits to it, and makes it good.”
  • Rank felt that termination had so much therapeutic power that he attempted a special device of setting, setting a precise “time limit” - this “end setting” thus projected the final phase of therapy forward to the onset of treatment

In therapy, “two wills clash”
The beginning of therapy is “therefore nothing other than the opening of a great duel of wills, in which the first easy victory over the apparently weak-willed patient is bitterly avenged many times!”
The patient engages in a will conflict and wishes both to resist and to submit

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18
Q

LESLIE FARBER - TWO REALMS OF THE WILL

A

Rank may have overstated the role of will power and willfulness. By and large, patients do not change in therapy as a result of an act of conscious will. What is so often perplexing to the therapist (and maddening to the researcher) is that change occurs at a subterranean level, far out of the ken of either the therapist and the patient

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19
Q

Farber’s two realms of will

A

The first one is not experienced consciously during an act and must be inferred after an event.
- Auden: “When I look back at the three or four choices in my life which have been decisive, I find that, at the time I made them, I had very little sense of the seriousness of what I was doing and only later did I discover what had seemed an unimportant brook, was, in fact, a Rubicon.”

The second realm is the conscious component. “I can do this to get that.”
- The goal of this realm is known from the beginning

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20
Q

Problems happen when you approach the first with methords of the second

A

The two realms have to be approached differently (Yalom doesn’t - yet - say exactly how to approach the first), because serious problems happen if you approach the first one with methods of the second - will power, effort, determination:

I can will knowledge, but not wisdom; going to bed, but not sleeping; eating, but not hunger; meekness, but not humility; scrupulosity, but not virtue; self-assertion or bravado, but not courage; lust, but not love; commiseration, but not sympathy; congratulations, but not admiration; religiosity, but not faith; reading, but not understanding.

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21
Q

ROLLO MAY - THE WISH AND THE WILL

A

May emphasises wish, and that wishes differ from needs, forces or tropisms in one important aspect: wishes are imbued with meaning

  • An individual does not wish blindly, a person doesn’t want to have sex with all people (of the opposite or the same gender or both, depending on preference), some are found attractive and others repugnant (unless stranded in an Arctic station Yalom says)
  • Wish is the “imaginative playing with the possibility of some act or state occurring”, the first step of willing

“Wish” gives the warmth, the content, the imagination, the child’s play, the freshness, and the richness to “will”. “Will” gives the self-direction, the maturity, to “wish”. Without “wish, “will” loses its life-blood, its viability, and tends to expire in self-contradiction. If you have only “will” and no “wish”, you have the dried-up, Victorian, neopuritan man. If you have only “wish” and no “will”, you will have the driven, unfree, infantile person who, as an adult-remaining-an-infant, may become the robot man.

22
Q

The Will and Clinical Practice

A

Since there’s no place for will in the nosology, then it could be called

  • obsessive-compulsive,
  • indecisiveness,
  • agony,
  • timidness, shyness, unassertiveness,
  • being flooded with guilt when one attempts to will

Even without an apparent willing disorder it is inevitable that the issue of will will arise during psychotherapy: will is inherent in the very act of change

  • At some point a patient must come to terms with what he or she truly wishes, must commit to a certain course, must take a stand, must choose, must say yes to something and no to something else.
  • Resistance or dominance doesn’t have to be analyzed away, instead it can be seen as a stand the patient is taking which can be accepted and reinforced
23
Q

Effortless change is not possible

A

Even unconscious willing does not occur without determination and commitment: effortless change is not possible. The patient must:

  • Transport themselves to therapy
  • Must pay money
  • Must bear the burden of responsibility
  • Must experience the conflict and the anxiety that inevitably accompany the work of therapy
24
Q

Hannah Arendt said two different ways of understanding will

Importance?

To decide

A
  1. Faculty of choice between objects or goals, the liberum arbitrium, which acts as arbiter between given ends and deliberates freely about means to reach them
  2. “Faculty for beginning spontaneously a series in time (Kant) or Augustine’s idea of man’s capacity for beginning because he himself is a beginning.”

Important, because one initiates through wishing and the other through choice.

  • The clinician’s goal is change (action) and responsible action begins with the wish
  • The process between wish and action entails commitment, it entails “putting myself on record (to myself) to endeavor to do it
  • The happiest term seems to be “decision” or “choice”, which is used by both clinicians and social scientists (PS! Yalom will use them interchangeably)

To decide means that action will follow. If no action occurs, then no true decision is made. If wishing occurs without action, then there has been no genuine willing. (If action occurs without wishing then too there is no “willing”, only impulsive activity.)

25
Q

May’s inclination to shout “Don’t you ever want anything?”

A

“What shall I do? What shall I do?”
“What stops you from doing what you want to do?”
“But I don’t know what I want! If I knew I wouldn’t be here!

Few therapist’s have not shared May’s inclination to shout “Don’t you ever want anything?”

  • Work with such patients can be frustrating
  • Many want to appear to be strong and decide it is better not to want for it would leave them vulnerable
  • Others deaden themselves to internal experience to avoid disappointment or rejection
  • Others submerge hoping that an eternal caretaker will take care of them
  • Others fear abandonment and avoid wishing in fear of irritating the other
26
Q

THE INABILITY TO FEEL

Alexithymia

Yalom and colleagues

Explosion of new therapies

A

This inability hasn’t been widely discussed in clinical literature yet is generally embedded in a global disorder - the inability to feel.
- Therapists frequently meet patients who are unable to differentiate between various affects and seem to experience joy, anger, sorrow, nervousness in the same manner

Peter Sifenos suggested “alexithymia” aka “no words for feelings” (1967)

Yalom and colleagues in their research where they asked people to order 60 items from 12 categories found out that “catharsis” was selected TOP2 and TOP4 as important for personal change

Further, recent explosion of new therapies - Gestalt therapy, intense feeling therapy, implosive therapy, bioenergetics, emotional flooding, psychodrama, primal scream - closely resemble one another in the importance placed on awareness and expression of feeling. They all hold that this is important in two ways:

  1. Facilitating interpersonal relationships
  2. Facilitating one’s capacity to wish
27
Q

FEELING AND INTERPERSONAL RELATIONSHIPS

A

Alexithymic individual has relationship problems

  • Others never know how that person feels: wooden, lifeless, boring
  • Others feel burdened for having to generate all the affect
  • Others question whether they are cared for in the relationship

One who does not feel is not sought out by others, but exists in a state of loneliness, cut off not only from one’s feelings but from those of others.

28
Q

FEELING AND WISHING

Patient examples

“Wishless” figures in modern literature

A

One’s capacity to wish is automatically facilitated if one is helped to feel. If one’s wishes are based on something other than feelings - e.g. on rational deliberation - then they are no longer wishes but “shoulds” and one is blocked from communicating with one’s real self.

A patient in a group didn’t understand why another patient was upset about the therapist going on vacation. “Why be upset if you can’t do anything about it?”
- I.e. he placed feelings and wishes secondary to a utilitarian goal

Another individual tries to find out what he or she should feel by trying to find out what the other wants, and becomes predictable and boring

  • Wish is more than though or aimless imagination, wish contains an affect and a component of force
  • Feeling is prerequisite to wish but not identical - one can feel without wishing and consequently without willing

“Wishless” figures in modern literature, Meursault in Camus’s The Stranger and Michel in Gide’s The Immoralist, were keen sensualists but were isolated from their own wishes and especially from wishes in the sphere of interpersonal relationships
- Impulsively explosive and profoundly destructive to others and themselves

29
Q

AFFECT-BLOCK AND PSYCHOTHERAPY

Weekend retreats

“Cyclotherapy”

A

Persistence is required with affect-blocked patients, i.e. time and time again asking “What do you feel?” and “What do you want?”

Do affect-generating therapies work with the affect-blocked patient?
- Yalom and colleagues sent patients in the middle of long-term therapy in three groups to weekend retreats
- Two groups used powerful encounter and Gestalt affect-arousing techniques
Third group as the control used meditation
- Although many patients had intense emotional breakthroughs, these affects were not sustained in subsequent individual therapy

Thus, while it is important to generate affect in therapy there is no evidence that rapid intensive arousal per se is therapeutic. (Psychotherapy seems to be “cyclotherapy” - a long process of testing and retesting issues worked on in therapy in the patient’s life environment.)
- The opposite of affect breakthrough - highly rational approach to therapy - is not the solution either

30
Q

Frits Perls: “Lose your Head and Come to Your Senses”

A

Perls worked only in the present tense because he felt neurotics live too much in the past

  • He would often begin with awareness of sensory impressions and kinesthetic impressions
  • If a patient complained about headaches, Perls might ask the patient to focus on the headache until the person found that it was associated with contractions of facial muscles
  • Perls might ask the patient then to exaggerate the contractions and at each step talk about what her or she was aware of
  • Gradually the patient would be led from kinesthetic sensation to affect
  • “It’s as if I were screwing my face up to cry”
  • Therapist: “Would you like to cry?”
  • Perls began with awareness and gradually worked toward “Wish”
31
Q

“Owning” feelings

A

Perls attempted to help patients to feel things, to “own” these feelings, and then to become aware of wishes and desires.

E.g., when repeated questions from patient then he urged him to verbalize the statement and the wish behind the question
P: What do you mean by support?
T: Could you turn that into a statement?
P: I would like to know what you mean by support.
T: That’s still a question. Could you turn it into a statement?
P: I would like to tear hell out of you on this question if I had the opportunity.

The purpose of affect arousal is not sheer catharsis but to help patients rediscover their wishes.

  • PS! Perls, in his reflective moments expressed dismay of therapists to focus expressively on these techniques and lose sight of the deeper purpose
  • “A technique is a gimmick. A gimmick should only be used in the extreme case. /…/ But the sad fact is that this jazzing-up more often becomes a dangerous substitute activity.”
32
Q

Other Therapeutic Approaches

A

All other techniques - psychodrama, encounter groups, hypnotic therapy, and bioenergetics - have the assumption that at some deep level one knows one’s wishes and feelings and that the therapist can increase the patient’s conscious experience of them

33
Q

Subtle nonverbal cues

A

Subtle nonverbal cues may provide important information about underlying but dissociated feelings and wishes

  • Clenched fists, pounding of one fist into one’s palm, assumption of closed arms or legs
  • Each of these Yalom says is an underlying feeling or wish
  • Perls attempted to facilitate repressed feeling by calling attention to the behavior and then asking the patient to exaggerate it - e.g. hit fist to palm faster
  • Some patients are so isolated that physical data are their only contacts with their inner world, e.g. “I must be sad if my eyes are teary”
34
Q

The question “What do you want”

A

The question “What do you want” also often can take patients by surprise
“After a rong recital of all the demands the professor experienced on his already overcommitted life, I asked him, “What do you want?” A pause .. and a gesture with his hands showing one hand fitting - but very loosely and with space left over - into another and then “I want some slop in my life”

35
Q

Focused inquiry on the here-and-now interaction

A

Focused inquiry on the here-and-now interaction may be productive

  • A deeply troubled young man lamented in group that he had no feelings and wishes and indicated that he could feel only if he knew what he should feel
  • Other members asked how he felt about loneliness, strong tranquilizers, problems on the ward which all left the patient more discouraged
  • Finally, “How do you feel about being questioned about your feelings?” - at this level he was able to experience a number of genuine feelings and wishes
  • Gradually, the patient gained confidence with his ability to have feelings and to identify them
36
Q

Generating an opposing feeling

A

Another patient considered feelings phony and contrived because whenever she was aware of a particular feeling, she could also generate an opposing feeling equal in magnitude

  • She had been in therapy for a long time and progress only occurred when a group session she was in was observed by ward staff and afterwards she was given the opportunity to observe the staff share notes on the meeting
  • She was annoyed by the fact that she was rarely discussed
  • When we investigated her annoyance - it turned to pain - to hurt from being ignored - then to fear that the therapist had put her in the chronic file.
  • She was then asked what she would’ve wanted the therapist to do - and she gradually experienced the non-phony wish to be cradled and sheltered by the therapist
37
Q

Fantasies & Wishes

A

Freud pointed out long ago that fantasies are wishes and that the investigation of fantasy is often a productive technique in the uncovering and the assimilation of wishes

  • One patient could not decide whether to break off a relationship
  • “What do you want?” or “Do you care for her?” led to frustration and bewilderment (“I don’t know”)
  • The therapist asked him to fantasize receiving a call from her in which she suggested that they end their relationship - the patient visualized clearly, sighed with relief and became aware of feeling liberated after the phone call
38
Q

IMPULSIVITY

Peer Gynt

Internal discrimination

A

One who acts immediately on each impulse avoids wishing as neatly as does one who stifles or represses wishes.

  • Peer Gynt is an excellent example of a person who attempts to fulfill all of his wishes and in so doing loses his true self - the self that wants one thing more deeply than another thing.
  • Nowhere is this more evident with another person - Peer Gyntish behaviour would result in violation or rape of the other rather than a true encounter

Internal discrimination is required and assigning priorities to each

  • If a loving, meaningful relationship is the priority then conflicting interpersonal wishes such as conquest, power, seduction or subjugation must be denied
  • If a writer’s primary wish is to communicate he must relinquish other wishes such as the wish to appear clever
  • Impulsive and indiscriminate enactment of all wishes is a symptom of disordered will: it suggests an inability of a reluctance to project oneself into the future.
39
Q

Sequential ambivalence and simultaneous ambivalence

A

In the first, the individual experiences first one and then the other wish

  • Mabel was a woman in a happy relationship with Greg, but then met Hal a widower and found herself having strong feelings for Hal
  • Didn’t want to lose her relationship with Greg and also didn’t want a simple fling with Hal

The therapist task is to help transfer from sequential to simultaneous

  • This results in a state of extreme comfort and it is extremely important that the therapist avoids diluting the pain or the autonomy of the patient
  • The therapist is tempted “to leap ahead of the other” (Heidegger)
  • However, if one is able to confront deeply and with full intensity all one’s relevant wishes then one will eventually fashion a creative solution

Mabel used her conflict to arrive at a truly creative insight:

  • “She realized how, all along, she had subtly used her husband to define her own being and how she had come near to doing the same thing with Hal.”
  • She chose to remain with Greg, but in a different way: it meant loving him, not loving herself and him as a fused entity.
  • It meant being able to face life alone without a loss of selfhood and without a devastating sense of loneliness.
40
Q

COMPULSIVITY

A

Appears more organized and less capricious than impulsivity. The compulsive individual acts in accordance with inner demands that are not experienced as wishes (something “ego-alien” is directing)

  • Though he wishes not to act in a particular way, he finds it extraordinarily difficult not to follow the dictates of the compulsion
  • Camus, through the protagonist of The Fall, said: “Not taking what one doesn’t desire is the hardest thing in the world”

Such an individual is often active, even forceful and at times possessed with a sense of purpose.

  • But there are often waves of doubt - times when the individual realizes that though he or she has a purpose, it is not his or her own purpose; that although they have desires and goals, they’re not their own desires and goals
  • It is only when the defence cracks (losing job, breakup, attaining the fake goals, e.g. money) that the individual becomes aware of the suffocation of his or her real self
41
Q

Decision-Choice

“Waiting for Godot”

A

Once an individual fully experiences wish, he or she is faced with decision or choice. Decision is the bridge between wishin and action.

Samuel Beckett’s Waiting for Godot is a monument to aborted decision - the characters think, plan, procrastinate, resolve, but they do not decide. The play ends with this sequence:
Vladimir: Shall we go?
Estragon: Let’s go.
[Stage directions]: No one moves.

42
Q

Therapy and a Specific Decision

A

Many seek therapy specifically because their in the throes of a decision: often one about relationship or career

Brief, focused and task-oriented therapy will help list the pros and cons and try to help the patient sort out both conscious and subconscious implications of each choice

More intensive therapy with more extensive goals will instead use the decision as a trunk from which different themes radiate

  • Conscious meaning of the decisional anxiety
  • Reviews of other past decisional crises
  • And, though the decision-making is not the goal, resolve in the conflicted areas hopefully helps the client make the decision in an adaptive fashion
43
Q

Therapy and Unconscious Decision

A

Many therapists focus closely on decision even if the patient does not enter therapy for some particular crisis of a decision

  • These therapists emphasize that every act is preceded by a decision
  • Thus the therapist focuses on the decision the patient makes to fail, to procrastinate, to withdraw from others, to avoid closeness, to be passive, depressed, anxious

Obviously these decisions were never consciously made, but the therapist assumes this since individuals are responsible for their behavior
- It is the choosing that Farber referred to as the “first realm” of will

44
Q

William James described five types of decision

A

William James described five types of decision and only the first two involved “willful” effort

  1. Reasonable decision: A rational balancing of the arguments and settling on one solution. Perfect sense of being free
  2. Willful decision: Strenuous decision involving a sense of “inward effort”. Rare. The great majority of decisions are made without effort.
  3. Drifting decision: No paramount reason for either course of action, either seems good and we make the decision by seemingly accidentally letting it be determined from without.
  4. Impulsive decision: Unable to decide and seems as accidental as the previous one. But it comes from within, and we find ourselves acting automatically
  5. Decision based on change of perspective: Often occurs suddenly as a consequence of some important outer experience or inward change (e.g. grief or fear) which results in a change in perspective
45
Q

Therapy, Decision, and Character Structure

Transactional analysts

Farber’s warning

A

In transactional analysis (T.A.) therapists believe that “The decision is the point in time when the youngster, applying all the adaptive resources of his ego, modifies his expectations and tries to align them with the realities of the home situation”
- Consequently, T.A. texts that the therapist’s task is to help the patient go back to the “original decision”, the “first act experience” (not unlike the original trauma of early Freudian theory), relive it, and make a “redecision”

This is what Farber warned against when attempting to try to force the will of the second (conscious) realm to do the work of the will of the first (unconscious) realm

  • The problem is that an individual’s character structure is not the result of a single momentous decision that can be traced and erased, but instead is constituted by a lifetime of innumerable choices made and alternatives relinquished
  • Psychotherapeutic change will not consist of a single momentous willful decision; instead, it will be a gradual process of multiple decisions, each paving the way for the next.
46
Q

WHY ARE DECISIONS DIFFICULT?

A

Why do so many patients find it so extraordinarily difficult to decide?

  • Life decisions: marry or separate, return to school, have a(nother) child
  • Knowing what to do - quit drinking or smoking, lose weight, meet people - but cannot commit (decide)
  • Others know what’s wrong - that they’re arrogant, workaholic, uncaring - but don’t know how to decide to change

Highly painful to see these unmade decisions. Yalom: “When I analyze the meaning that decision has for my patients, I am struck first of all by the diversity of response.”

47
Q

Alternatives Exclude

John Gardner’s Grendel

Wheelis’s intersection

Aristotle’s hungry dog or Buridan’s ass

A

An unconscious level some patients refuse to accept the existential implications of renunciations.

The reality of limitation is a threat to one of our chief modes of coping with existential anxiety: the delusion of specialness.

The protagonist of John Gardner’s novel Grendel made a pilgrimage to an old priest. The old priest summed up his meditations on time with the words: “Things fade: alternatives exclude.”

  • For every yes, there is a no
  • As one therapist commented to a patient: “Decisions are very expensive, they cost you everything else.”

Wheelis: “Some persons can proceed untroubled by proceeding blindly, believing they have traveled the main highway and that all intersections have been byways. But to proceed with awareness and imagination is to be affected by the memory of the cross roads which one will never encounter again. Some persons sit at the crossroads, cherishing the illusion that if they sit there long enough the two ways will resolve themselves into one and hence both be possible. A large part of maturity and courage is the ability to make such renunciations, and a large part of wisdom is the ability to find ways which will enable one to renounce as little as possible.”

Same dilemma in ancient philosophical metaphors: Aristotle’s hungry dog unable to choose between two equally attractive portions of food or Buridan’s ass starving between two equally sweet smelling bundles of hay.

48
Q

Decisions as a Boundary Experience

A

To be aware of the fact that one constitutes oneself, that one assigns meaning to the world, that there are no absolute external referents, means to become aware of one’s fundamental groundlessness.

Decision plunges one, if one permits it, into such awareness. Heidegger says such a shift is ultimately good for authentic existence, but it also calls forth anxiety. If one is not prepared, decision will be repressed just as death.

  • By facing one with the limitation of possibilities, decision challenges one’s myth of personal specialness
  • Insofar as it forces one to accept personal responsibility and existential isolation, threatens one’s belief in the existence of an ultimate rescuer

A fundamental decision also confronts us with existential isolation - a decision is a lonely act, and our own act. Many people thus try to persuade others to make decisions for them.

49
Q

Decision and Guilt

Existential guilt

A

Will is born in a caul of Guilt; Rank said it arises as counter will.

  • The child’s impulses are opposed by the adult world and the child’s first will arises to oppose that opposition.
  • If the child is unfortunate then the will becomes heavy with guilt and they experience all decisions as evil and forbidden - feeling like one does not have the right to decide

Existential guilt - arising from one’s transgressions against oneself - may be a powerful decision-blocking factor, because it leads to reflections on wastage:
- if one accepts the responsibility for one’s life, the implication is that one alone is responsible for the past wreckage of one’s life and could have changed long ago.

50
Q

Bonny, 48 years old, had problems quitting smoking even though she had Buerger’s disease

A

Her outdoorsy husband said: “Smoking or our marriage?” and she still didn’t quit

  • “If I would’ve stopped smoking then or if I would now, then that would mean that I could’ve stopped smoking before.” – she was responsible for the wreckage of her life
  • She had to be helped to accept the guilt (and the ensuing depression) for having thwarted her own growth
  • She had to accept the crushing responsibility for her actions in the past by grasping her responsibility for the future

Yalom: “One cannot will backward. One can atone for the past only by altering the future.”