Friday, December 26, 2008

What Are We Going To Do About Stanley Schmulewitz?

There's this old guy who lives in my apartment building. He's lived in the building for about 35 years. He's in his late seventies.

This is what gets me about the guy. He works out every day in the building's fitness center. In his street clothes. He uses the reclining stationary bicycle. I know this isn't the Christian thing to say, but neither I nor Stanley Schmulewitz is Christian. The guy is a total pain in the ass. He listens to the radio while he works out. He laughs, talks to himself, sings to himself, makes weird jerky movements -- the guy is a veritable freak show on ice. He's very distracting to me as I work out. The stationary bicycle is next to the elliptical machine that I use. I can see Schmulewitz in the wall mirror directly in front of us.

Why can't Stanley work out at a different time of the day. You're a pain in the ass, Stanley Schmulewitz.

This is my Stanley Schmulewitz impression: "Mu-ah, mu-ah. Hahahahaha. Yea. Yea. Oh, yea. Hahahahahaha. Hehehehehe. Mu-ah, mu-ah. That's right. Yea. Yea. Hahahahaha. Oh, yea." This goes on for an hour every morning. I can't stand it anymore.

Wednesday, December 17, 2008

Psychotherapy of Schizoid Process

“PSYCHOTHERAPY OF SCHIZOID PROCESS” by Gary Yontef Transactional Analysis Journal, Vol. 31, No. 1, January 2001


Schizoid process is one of the most ubiquitous personality patterns, but it is insufficiently discussed in the literature. This article offers a description of both the true schizoid and the more prevalent schizoid process that runs through various types and levels of functioning. Schizoid process and personality type are described, including the characterological organization, interpersonal processes, and developmental origins of schizoid process. Therapy of schizoid process is discussed in terms of presentation of the schizoid in psychotherapy, development of the therapeutic relationship, stages of therapy, and treatment suggestions and cautions. The schizoid process is important enough to warrant more attention than it currently receives, partly because, to some degree, everyone experiences some facets of it. Discussions about the schizoid process can clarify issues related to contact, isolation, and intimacy in relation to people with a variety of character styles who operate at levels of personal functioning ranging from normal neurosis through serious character disorders. True schizoids are also fairly common. These are individuals for whom the schizoid process is central to their dynamics and who fit the DSM-IV (American Psychiatric Association, 1994) diagnostic criteria. They tend to be quiet patients who do not cause much trouble or make many demands. If the therapist does not know about the schizoid process and how to work with it, such clients may well be in therapy for a long time without really dealing with their most basic issues.

This article is a modified version of a keynote address given on 20 August 1999 at the annual conference of the International Transactional Analysis Association in San Francisco. In this article I use the term "schizoid" to refer both to the true schizoid and to the patient who functions with significant schizoid processes or defenses but does not fit the full diagnostic picture.

Presenting Picture of the True Schizoid

The true schizoid usually presents as a loner, someone who is profoundly emotionally isolated, who has few close friends, who is not very close even in "intimate" relationships, who drifts through life, and for whom life seems boring or meaningless. Schizoid patients usually show extreme approach-avoidance difficulties. They often come to therapy because of loss or threat of loss of a relationship or because of relationship difficulties at work. They frequently describe themselves as depressed and tend to identify more with the spaces between people than with interhuman connections. In therapy, as in many of their relationships, they tend to be present but not with vitality—-that is, not "in their body" or with their feelings. Schizoid patients tend to come to therapy regularly but do not appear to be engaged emotionally. A common reaction of the therapist in response to a schizoid patient is to become sleepy, even if he or she does not have this reaction with other patients. There is so little human connection during sessions that it is like not having enough oxygen in the room. The first time this happened to me was with a patient I liked. I thought perhaps I was getting sleepy because I saw her right after lunch, so I changed her hour. But that was not the problem. In fact, I never get sleepy with patients—-except occasionally with a schizoid patient.

The Existential Terror Underneath

To people with schizoid character organization, real human connections are terrifying. In their fantasy life and their behavior, these individuals try to live as if in a castle on an island where they are totally safe. The main feature of this isolation is a denial of attachment and the need for other people. Of course, living that way brings on another terror—-the terror of not being humanly connected. If their tendency to defend themselves by isolating were to be fully realized, they would not be connected enough to maintain a healthy ego. Schizoid individuals have to struggle to maintain their human existence as individual persons. The human sense of self and good ego functioning cannot develop and be sustained without interpersonal engagement, but schizoid isolating defenses attenuate the interpersonal bond to the point of endangering ego development and maintenance. Often schizoid people will create in their fantasy life the satisfaction or safety they lack in their experienced interpersonal world. They also have human connections in safe contexts (e.g., at a geographical distance), and disguised longings are often found at a symbolic level (e.g., in dreams and daydreams). One frequent symbolic wish is to return to the womb, which is seen as a state of oneness and safety. But, if that were possible, it would make sustained human identity impossible since it would exclude interpersonal contact.

Contact and Contact Boundaries

To understand the importance of the schizoid process in all human functioning, we need to consider the concepts of contact and contact boundaries. Contact is the process of experiential and behavioral connecting and separating between a person and other aspects of his or her life field. The contact boundary has the dual functions of connecting and separating the person and his or her environment (including other people), just as a fence has the dual function of connecting and separating two properties. These dual functions involve movement along a continuum between the two poles or functions of connecting and separating. The connecting process involves a closing of the distance between people, a receptiveness or openness to the outside—-and especially to other people—-with the boundary becoming porous so that one takes in from and puts out to others. The separating process involves increasing distance, closing off the boundary, being alone and not taking in, with the boundary becoming less porous and closed to exchange; at the extreme, the boundary becomes closed, like a wall. People need both connecting and separating. All living creatures need to connect with their environment to grow. Just as we can only survive physically by taking in air and water from the environment, human psychological development and maintenance also requires connection with the environment, especially with other people. People can only grow and flourish by connecting to the interhuman environment. At the extreme end of the connection pole is merger, enmeshment, and a loss of separate existence, will, need, and responsibility; such total connection means death by merger, a disappearance of autonomous existence. Physically it means merger with the environment; psychologically it means a loss of individuation and separate existence. Human existence requires some degree of experienced separation from the environment. So we see that oneness can be healthy or unhealthy, just as separating can be. Intimacy is a healthy form of oneness, whereas a spiritual retreat is a healthy example of separation from ordinary contact. Ideally, the movement between contact and withdrawal is governed by emerging need. We become lonely, we need to connect; we move into intimacy, momentary confluence, or ongoing commitment. Then we move away from connecting with the other to be with self, to rest and recover, to center, or to find serenity. Thus we connect to the point of satisfaction of need, then change focus according to a new emerging need. We separate from a particular contact when withdrawal or different contact is needed. However, in health, a person withdraws from contact while sustaining a background sense of self connected with other people and the universe. This flexible movement between close connection and separation preserves the sense of being humanly connected. It is unhealthy when this flexibility is lost and either separation or connection becomes static because movement in and out of contact according to need is diminished or restricted. At one unhealthy extreme the individual separates and isolates to the point of losing a sense of being humanly bonded. Isolating in this way and to this degree is crucial to understanding the schizoid process. For schizoids, the process of separating with underlying connectedness and connecting while maintaining autonomy is foreign. Their lives are marked by the profoundly frightening and disturbing fact of separating without maintaining a sense of emotional connectedness and without a developed ability to connect again. They do not connect to others with much hope of being met and lovingly received. Schizoids do not believe they can be loved, and they fear that even if a relationship is established, the intimate connection means losing autonomy of self and other. Even feeling the need to connect would, in either case, be painful and/or frightening. It is dangerous to move into intimate connection if you cannot separate when needed. If you think you are going to be caught up, devoured, or captured in the connection, it is terrifying to move into intimate contact. On the other hand, if you do not feel connected with other people, especially if you do not believe you can intimately connect again, the separation or isolation is both painful and terrifying. Without movement one is fixed, stuck, stagnant, and unable to grow. Being stuck in any position on the continuum of connection and separation—-which is the case when the schizoid process is operating—-involves a degree of dysfunction, with some needs not being met. Being stuck in an isolated position, a connected position, or a middle position between intimacy and isolation are all problematic. Being fixed in a middle position is common in the schizoid process: The person is neither truly alone nor truly with another. This immovable position between connecting and separating is a compromise to avoid the terror of being completely alone in the universe, on the one hand, or of being threatened by engulfment, enmeshment, attack, and rejection, on the other.

Twin Existential Fears

The typical childhood of the schizoid patient is marked by the experience of too much or too little human connection. Too little refers to a lack of warmth and connectedness and a sense of emotional abandonment; too much refers to intrusive parenting that emotionally overrides the capability of the infant or young child and causes him or her to isolate or dissociate to survive. Sometimes the abandonment and intrusion alternate. Given what we know about the importance of flexible movement between connecting and separating for the growth and well-being of the individual, it is easy to understand how the typical childhood experiences of the schizoid leave him or her with deep-seated, often unconscious feelings of merger-hunger, on the one hand, and simultaneous fear of entrapment and suffocation on the other. These lead to universal twin fears that are fundamental to the schizoid process: the panic or terror of contact engulfment/entrapment and the panic or terror of isolation. These are particularly intense and compelling for the schizoid, who experiences them at the existential level of survival or death. Because the schizoid splits connecting and disconnecting, thus losing easy movement between them, he or she is faced with the threat of becoming stuck at one pole or the other. Therefore, schizoids think of relationships mostly in terms of potential for entrapment, suffocation, and bondage. They do not trust that they will not devour the significant other or be devoured. They do not believe that separation will happen as needed, and thus they do not feel safe to be intimately connected. Of course, the danger of entrapment comes in large part from their own hunger for oneness and fear of abandonment, and the connection between their own merger-hunger and the fear of entrapment is mostly not in their conscious awareness. Many schizoid patients start treatment with the expectation that they will be devoured or abandoned in therapy. Although they may be conscious of this fear early in the process, the extent of the dual fears and the connection to their merger-hunger is usually not in awareness until much later. Until then the denial of both attachment and the need for intimacy predominates. Their own merger-hunger is projected onto others as a way of avoiding the awareness by attributing it to someone else. Sometimes these anticipations or perceptions are a projection, although they can also be accurate. Total isolation or abandonment is like death, especially for the young child. Part of the schizoid process is terror—-although not necessarily conscious—-of a triple isolation: isolation from others, isolation of the core self from the attacking self, and isolation within the core self. A significant part of the schizoid process is a splitting between attacking selves and core selves. At a deeper level there is also a kind of isolation between aspects of the core self. In gestalt theory this is conceptualized as a boundary between parts of the self that interferes with the boundary between self and other. Experiencing the self in a vacuum means loss of the sense of self as a living person. The resulting loneliness is profound. It is real progress in therapy when the true schizoid patient is able to experience loneliness and the desire for connection.

The Schizoid Compromise: The In-and-Out Program

One solution to the problem of avoiding complete deadness of self from lack of human connection while also avoiding the threat to existence and continuity of self from intimate contact is what Guntrip (1969) called "the schizoid compromise" (pp. 58-66). This refers to not being in but also not being out of engagement with other persons or situations. An image that I think I borrowed from Guntrip seems apt here: "How do porcupines make love? Very carefully." There are several common "very careful" patterns of the schizoid compromise. For example, a writer is too lonely to write in his apartment, so he goes to a coffee shop with his laptop computer and manuscript. There he is not really connected with anybody, especially since he does not give out signals that he wants to talk to anyone, but he is not alone either. Another example is a man from Los Angeles who has a relationship with a woman who lives in New York City. He can have a weekend connection without the risk of losing himself or being trapped in the relationship. When Monday morning comes, he will be thousands of miles away in Los Angeles again while she stays in New York. Another type of schizoid compromise involves the person repeatedly pulling out of relationships before making a commitment. Such individuals go through a series of relationships, always finding a reason why they cannot con-tinue. A similar pattern is having multiple lovers at the same time; the person engages one part of the self with one partner and another part of the self with someone else. One typical configuration is having a sexual relationship with a lover, but without companionship and building a life together, while maintaining a primary but nonsexual relationship with a spouse. Sometimes individuals who show this pattern will say something like, "Gee, why can't I get this together?" or ask "Why can't I get a woman who has both?" Such patterns illustrate a core pattern: the schizoid is impelled into relationship by need and driven out by fear. When faced with someone with whom they might be intimate, they find it both exciting and frightening. They are afraid that they will devour their lovers with their need or that the lover will be devouring, deserting, or intrusive. They might lose their individuality by overdependence and merger-hunger or lose the relationship by being too much, too toxic, or too needy. The solution to these dilemmas is Guntrip's schizoid compromise—-to remain half in and half out of the relationship, whether in the form of marriage without intimacy, serial monogamy, or two lovers at the same time. Needs and fears will often be either denied or acknowledged in an intellectualized manner. Frequently such individuals will oscillate between longing for the intimate other and rejecting him or her, or they may stay in a stable halfway position not able to commit to being fully in the relationship or discontinuing it. They are tempted repeatedly to leave the relationship and live in a detached manner, but often they return again and again. When touched emotionally or feeling intimate, the schizoid may become annoyed, scared, fault finding, and disinterested. Meaningful contact with another leads to crisis, and crisis leads to abolishing the relationship. They cannot live fully with the other, but they cannot live without the other either. Being with threatens death-level confluence; being alone threatens death-level isolation. So the schizoid lives suspended between his or her internal world and the external world without full connection with either. Suspended in the death-level conflict between total isolation and being swallowed up, these individuals often feel tired of life and the urge for temporary death. This is not active suicide, just exhaustion from living a life with insufficient nourishment.

Themes in Therapy

The discussion so far points out the major themes that emerge in therapy with schizoid individuals: isolating tendencies, denial of attachment, themes of alienation, and feelings of futility.

Isolating tendencies.

Since being close causes schizoids to feel claustrophobic, smothered, possessed, and stifled, they often turn inward and away from others. Thus commitment to relationship is very hard. They treat their internal world as real and the external world as not real. They often have a rich fantasy life and tepid affective contact with others. In isolation they often fantasize about merger or confluence as something to be longed for or to feel panicked about—-or both. In actual or fantasy contact they fantasize about isolation either as a positive way of getting their own space or as something terrifying—-or both. Schizoids manipulate themselves more than they interact with the environment. Such individuals usually appear detached, solitary, distant, undemonstrative, and cold ("cold fish"). They do not seem to enjoy much and have few if any friends. They appear to live inside a shell, and in most relationships (including in therapy), those with whom they are relating have the sense of being shut out while the schizoid is shut in, cut off, and out of touch. What is not always obvious with these individuals is that they still have a capacity for warmth, in spite of the schizoid process. This may come out in various ways, for example, with pets but not with people. I remember one schizoid woman who said that "the only people I trust are dogs," which she did not mean as a joke. With such patients the therapist needs to be sensitive to subtle shifts in order to pick up and gauge emotional reactions. This is especially true since schizoids often show a low level of manifest interest and affective energy, appearing to be absent minded and mentally half listening. Most often schizoids will express a desire to be free of any impingement or requirement to do anything. In a relationship they will often talk about how they want to be able to go out and not have to face any limitations. At these times the desire to connect is usually out of awareness. However, the schizoid process involves more than the simple isolating behavior of a shy or anxious person, more than social anxiety, obsessive compulsive behavior, or intellectualizing, although a schizoid character pattern may underlie any of these other isolating patterns. The issues of the schizoid involve life-threatening levels of existential vulnerability. Because this profound vulnerability makes the relationship with the therapist deeply terrifying, it takes a long time for the therapeutic relationship, including trust, to develop. It should be noted that the cognitive descriptions in this article provide a kind of a map for the therapist, but one that only points the way to work at a feeling level. Awareness and working through with these individuals requires developing a trusting relationship; no fundamental change can happen with the schizoid on a purely cognitive basis.

Denial of attachment.

For children who later become schizoid adults, one way of coping with a world that is too big, menacing, intrusive, unresponsive, and/or abandoning is to deny any need, weakness, and dependency and to promote the illusion of self-sufficiency. They learn to survive by living without feeling dependence, desire, need, or fear. The schizoid is especially trying to avoid burdening and killing parents with his or her needs. Schizoids avoid awareness of attachment in various ways. The most common is splitting off or disassociating from needs and feelings that are overwhelming. Conformity can also be a means of avoiding awareness of need and fear as can obsessive-compulsive self-mastery, addiction to duty, or service to others. One can avoid attachment needs by being regulated by rules and regulations rather than by vitality affect, or by conforming and serving, thus forming a false self that consists of a conventional, practical pseudo-adult who masks a frightened inner child. Denial of attachment results in shallow relations with the world. Compulsive activity, compulsive talking, and compulsive service to causes can all mask a shallowness of affective connection. Some people who appear to be extroverted are actually schizoid in their underlying character structure. In the extreme, the schizoid's denial of attachment results in his or her being mechanical, cold, and flat to the point of depersonalization; the individual loses a sense of his or her own reality and experiences life as unreal and dream-like. Of course, not all schizoids depersonalize to this extent. Schizoids often may deflect the importance or impact of praise and criticism as protection against attack, disapproval, disappointment, and so on. Although they strive to feel and appear unaffected by praise and criticism, they are actually sensitive, quick to feel unwanted, and suffer from a deep underlying shame (Lee& Wheeler, 1996; Yontef, 1993). Their self-representation is always a shameful sense of self as being defective, toxic, and undesirable. They live internally as if they were always deserted because of their own defect. They are especially contemptuous of their own "weak (needy) self." When the need they have been denying starts to emerge into awareness, schizoids experience intense shame. In fact, shame is a fundamental process for schizoids. They are easily shamed, although that is not always obvious because they deny that they are attached or that they need anything. When they feel safe enough to start exploring their shame, they manifest a great deal of loathing for their needy self. However, if the therapy is confrontive (e.g., in the way encounter groups and some confrontive gestalt therapists used to be), demands quick change, or is insensitive to issues of shame, these feelings will not emerge because the patient will not experience the necessary fundamental trust in the therapeutic relationship.

Themes of alienation.

Schizoids feel so alienated and different from others that they can experience themselves literally as alien—-as not belonging in the human world. I have a patient from Argentina who quoted a saying in Spanish that describes her experience: She feels like a "frog who's from another pond." In their alienation, these individuals cannot imagine themselves in an intimate relationship. The people world seems strange and frightening, even if also desirable. When they see couples being intimate, they are often mystified: "How do they do that?" No matter how they force themselves to date or to meet new people, they cannot imagine themselves in a sustained intimate relationship. This leads to the fourth theme.

Feelings of futility.

The schizoid experiences loneliness, futility, despair, and depression, although the latter is somewhat different from neurotic, guilt-based depression. Both are comprised of dysphoric affects and an avoidance of primary emotions and full awareness. However, neurotic depression has been described as "love made angry." That is, the depressed person feels angry at a loss followed by sadness and broods darkly against the "hateful denier." This aggressive emotional energy then gets turned against the self. In contrast, schizoid despair has been described as "love made hungry." The person experiences a painful craving along with fear that his or her own love is so destructive that his or her need will devour the other. The schizoid feels tantalized by the desire, made hungry, and driven to withdraw from the "desirable deserter." The deep, intense craving is no less painful because it is consciously renounced or denied. In ordinary depression the person has a sense of the self as being bad; usually he or she feels guilty, horrible, and paralyzed. The schizoid, on the other hand, feels weak, depersonalized, like a nonentity or a nobody without a clear sense of self. Guntrip said that people much prefer to see themselves as bad rather than weak. They will typically refer to themselves as depressed more readily than weak, bad rather than devitalized, futile, and weak. Guntrip (1969) called the depressive diagnosis "man's greatest and most consistent self-deception" (p. 134). He went on to say that psychiatry has been slow to recognize "ego weakness," schizoid process, and shame. "It may be that we ourselves would rather not be forced to see it too clearly lest we should find a textbook in our own hearts" (p. 178). Fortunately, I think in the last few years there has been a real opening in therapeutic circles to recognizing relationship and shame issues present in the therapist as well as in the patient (Hycner & Jacobs, 1995; Yontef, 1993).

Healthy Development

The self can only experience itself in the act of experiencing something else—-and being experienced. Cohesive, healthy self-formation depends on contact with the mothering person that is neither too little nor too much. From birth, infants are equipped to be both separate from and connected with others. Stem's (1985) research confirmed that from the beginning infants know themselves and connect with the human environment. For their maturational potential to develop, infants must be welcomed into the world and supported in being themselves and being connected. This support starts with the mother restoring the connection severed by birth. The infant needs to be made to feel that he or she belongs in the world of people. Through a dependable mother and infant relationship, the infant learns that he or she is not emotionally alone in the world even when physically separated. This support for connection and separation is needed throughout infancy and toddlerhood. Ideally, the infant/child learns that he or she can be alone in the presence of the mother and thus in intimate relations with others. In this way children learn that they can have privacy and self-possession without loss of the other, that they can be physically separate or have their own feelings and thoughts in the presence of the parent and still feel connected and feel connected-with when they have needs and feelings. The child can be alone in outer reality because he or she is not alone in inner reality. The development of these capacities depends on early parental experience, the development of object constancy, and so forth.

Schizoid Development

Unfortunately, the course just described is quite unlike the early experience of the schizoid, whose childhood tends to be marked alternately by experiences of intrusion and being overwhelmed, on the one hand, and feeling empty and alone in the universe, on the other. The schizoid then uses worry, fantasy, and isolation to protect against these experiences. Although nature and mother arouse powerful emotional needs in the child, if there are either insufficient warm, loving responses or an excess of intrusive, overwhelming responses, the need only increases, and the child experiences painful deprivation or unsafe feelings as well as anxiety at separation and/or connection. A deep intimacy-hunger grows in the child. The schizoid's early experience is that mother is not reliable, usually because she is alternatively intrusive and abandoning. Mother not only cannot tolerate, contain, and guide the child's affects (e.g., need, anger, exuberance, even love), she finds them threatening and overwhelming and treats them as toxic. These mothers usually become overwhelmed because of their own depression, life situation, or characterological issues; often they do not have the support they need to meet the child in intensive affective states and to stay with him or her until the affect has run its course. Clearly, the problem is with the mother, not with the child. However, the infant or child's experience is that his or her life forces and vitality appear to kill mother—-or at least the connection to and relationship with mother. If a young child has a tantrum and mother withdraws to her room for three days, the child's reality is that he or she has emotionally killed mother. And, of course, killing mother would make the infant's life impossible as he or she cannot live without a parent. The legacy for the child is that his or her life force threatens mother, which is equivalent to the child experiencing that "my life threatens my life." Anything from within, even something good, turns bad and destructive with exposure. The only hope is to keep everything inside and thus invisible. The child must, at all costs, avoid causing total emotional abandonment by or intrusion and annihilating counter-attack from mother. Therefore, the child suffers isolating himself or herself to avoid an even more devastating deprivation—-the loss of the mother and the child's relationship with her. Unfortunately, this leaves the child with a huge hunger that cannot be satisfied, a hunger that is projected onto the mother, who is then seen as devouring. And a mother who actually does devour makes this even more real and frightening.

Splitting the Self

An important part of how the child copes with this situation is by splitting the self. Survival is achieved by relating to the world with a partial self or "false self," one that is devoid of most significant affect and relates on the basis of conforming to others' requirements rather than on the basis of organismic experience. Guntrip (1969) used the phrase "the living heart fled" (p. 90) to describe the situation in which the vital energies, emotions, and vitality affects are held inside, leaving an empty shell to interact with others and to direct human relations. This schizoid pattern creates external relations that are not marked by warm, live, pulsing feelings. Instead, when interpersonal nurturance is available, schizoid individuals fear a loss of self from being smothered, trapped, or devoured. When strong desire or need is aroused, they tend to break off the relationship. Hatred is often used to defend against love with its dangers and disappointments, a pattern that starts in early childhood. However, what happens to the lively emotional energy that is held in? And how does the schizoid stay sufficiently related to people to support the survival of the self? One key process is the development of internal rather than interpersonal dialogues. Instead of someone with a relatively cohesive sense of self interacting with others, there is a sense of self in which aspects of personality functioning are split off from each other. The most commonly encountered manifestation of this in psychotherapy is the split between an attacking self and the "core" or "organismic" self. When the organismic self shows characteristics of being in need or emotional, the attacking self makes self-loathing, judgmental statements about being "weak" or "needy." One might characterize this as attacking and shaming the organismic self, which it calls the "weak self." The person often identifies with the attacking self and thinks of his or her own love as so needy that it is devouring and humiliating. To the degree that the person's contact is between parts of the self rather than a relatively unified self in contact with the rest of the person/environment field, the person is left with a deep and painful intimacy-hunger (often denied), dread, and isolation. The internal attack is usually not only on the self that is needy, hungry, and weak, but also on the self of passion and bonding—-even happy passions. Within the core self there is another split, which I will only consider briefly. This split is between the self (or the self-energy) that connects and fights with the attacking self and the core energy that has an urge to isolate even more, to go back to the womb. The retreat from the internal self-attack is designed to protect the core life energy, which is kept isolated in the background to protect it. It is a fight for life. There are a couple of other things that occur because of this process that I have not yet mentioned. One is that, as part of schizoid dynamics, cognitive processes are often used in the service of feeling humanly connected while remaining isolated rather than in preparation for interpersonal contact. Self-attack is an internal dualism that divides the person into at least two subselves. When the self-attack is on the feeling self, it results in shame, humiliation, and psychological starvation. It creates the defect of a divided rather than unified self and makes the life energy (i.e., feelings) a sign of being defective. It creates a sense that since I feel, want, and need, therefore I am unworthy of love and respect. So it is not surprising that schizoids often attempt to annihilate or master their feelings of need, sometimes in a sadomasochistic way. For them, self-attack is not directed toward their "doing"; it is an attack or attempted annihilation of the "being." However, being and being-in-relation are inseparable. The sense of self only develops in relationship, not in a vacuum. Feeling with and feeling for other persons—-and being felt for by them—-is vital for a healthy sense of self. Shared emotional experience is a part of learning to identify and identify with the self and to identify with bonding with others. Because of their isolating and denial of attachment, schizoids often operate without a sense of being—-the empty shell experience. This "doing" without a sense of "being" leads to a sense that being or life is meaningless. Schizoids usually feel this way, although they often attribute it to a particular activity being meaningless rather than to their own process. Even the core self—-in reaction to the top-dog, critical self—-is split. There is an engaged, contact-hungry core self that does battle with the top-dog self, which can manifest in sado-masochistic and bondage and discipline fantasies. In contrast, the passive, isolating core self is regressive and imagines going back to the womb. It is this self that is in danger of losing human connectedness; it fears existential starvation, loss of ego or sense of self, depersonalization, being alone in a vast, empty universe, even death. These fears can become known during quiet times, which may make calm, peace, quiet, sleep, or meditation frightening. The unfinished business of schizoids, their most central life script issue, centers on the struggle to make "bad introjects" into "good introjects." However, this usually does not succeed easily. The bad introject usually stays rejecting, indifferent, and hostile until very late in therapy. While the therapist may think that progress is being made as some of these issues are uncovered, the schizoid patient often experiences only intensified self-loathing. Frustration and failure trigger the unfinished business and the rest of this negative script, including isolating defenses, retroflected anger and rage, strong defense of the negative sense of self, harsh self-attacks, and shame. It takes a great deal of patience and a long time to work through these issues.

Working with Schizoids and the Schizoid Processes in Psychotherapy

The Paradoxical Theory of Change.

The gestalt concept of the paradoxical theory of change (Beisser, 1970) says that the more you try to be who you are not, the more you stay the same. That is, true change involves knowing, identifying with, and accepting yourself as you are. Then one can experiment and try something new with an attitude of self-acceptance. This contrasts with attempts to change that are based on self-rejection or trying to make yourself into someone you are not. Working in the mode of the paradoxical theory of changes promotes self-support, self-recognition, and self-acceptance as well as growth from the present state by experimenting with new behavior. This experimentation can be either the spontaneous result of self-recognition and self-acceptance or on the basis of systematic experimentation. The therapist's task is to engage with the patient in a way that is consistent with this paradoxical theory of change. With schizoids, this means engaging with the patient at each moment and over time without being intrusive or abandoning, without sending the message that the patient must be different based on demands or needs of the therapist or the therapist's system. While many therapists might endorse this in the abstract, often their nonverbal communication creates pressure for the patient to change based on willpower, conformity, or as a direct result of the therapist's interventions.

The Dialogic Therapeutic Relationship.

Some of the principles guiding work from this perspective are the characteristics of dialogue according to Buber's (I965a, 1965b, 1967; Hycner & Jacobs, 1995) existential theory. They include: inclusion, confirmation, presence, and surrendering to what emerges in the interaction. Buber's (1965b, p. 81; 1967, p. 173) term "inclusion" is similar to the more common term "empathic engagement." Inclusion involves experiencing as fully as possible the world as experienced by another—-almost as if you could feel it within yourself, within your own body. Buber (1965b) called this "imagining the real" (p. 81), that is, confirming the other's reality as valid. Both inclusion and empathy involve approximation; however, inclusion calls for the therapist's more complete imagining of the other's experience than does empathy. Inclusion is more than a cognitive, intellectual, or analytic exercise; it is an emotional, cognitive, and spiritual experience. It involves coming to a boundary with the patient and joining with the patient's experience, but it also requires the therapist to remain aware of his or her separate identity and experience. This allows for deep empathy without confluence or fusion. Inclusion, or imagining the patient's reality, provides confirmation of the patient and his or her experienced existence. It involves accepting the patient and confirming his or her potential for growth. Such confirmation does not occur in the same way when the therapist needs the patient to change and thus aims at a conclusion rather than meeting the patient with inclusion. A dialogic approach requires genuine, unreserved communication in which the therapist is present as a person—-that is, authentic, congruent, and transparent—-rather than as an icon of seamless good functioning. The therapist cannot practice this kind of therapy and also be cloaked in a psychological white coat. He or she must be present by connecting with the patient's feelings as well as by acknowledging his or her own flaws, foibles, and mistakes. The dialogic therapist must trust in and surrender to what emerges from the interaction with the patient rather than aiming at a preset goal. This approach recognizes, centers on, tolerates, and stays with what is happening as the therapist practices inclusion and thus focuses on present experience and moment-to-moment, person-to-person contact. In a sense, progress is a by-product of a certain kind of relating and mindfulness rather than something that is sought directly. The therapist relinquishes control and allows himself or herself to be changed by the dialogue just as the patient does. As a result, truth and growth emerge for both.


Attitudes are often communicated not by the text of what the therapist says, but by the subtext or how things are said. Nonverbal cues have an especially powerful influence on schizoid patients, even if neither they nor the therapist are consciously aware of them. For example, a gesture, tone, or glance will often trigger a shame reaction in a patient without the therapist intending to do so and without either the therapist or the patient being aware of the process (Yontef, 1993). And even when this operation (i.e., the effect of the subtext) is in awareness, it may not be expressed or commented on. Although they may appear to be distant and only vaguely present, schizoid patients (and many other patients as well) are exquisitely sensitive to nuances of abandonment, intrusion, pressure, judgment, rejection, or pushing—-in fact, to any message or subtext that says they are not OK as they are. Such messages are not only contrary to the paradoxical theory of change, but they also trigger unfinished business from painful childhood experiences of rejection and/or intrusion. Sometimes I have tried to encourage a patient to feel better, to convince the self-loathing patient that he or she is not loathsome. By doing so, I inadvertently sent the message that the patient's feelings and sense of self were so painful that I as a therapist could not tolerate them. This was a repeat of the message the patient received from infancy: You are too needy, too much of a bother. When you as the therapist have a view of the patient that is more positive than he or she has, the thing that you hear the most from the patient is, "You don't understand." I still hear that occasionally, and I have been working with these dynamics for along time. In such cases, good intentions create disruptions in the contact between therapist and patient and an impediment to working through. (For a poignant example of this process, see Hycner & Jacobs, 1995, p. 70.) I find it agonizing when patients I like hate themselves and describe themselves as loathsome, something totally contrary to how I and others (e.g., group members) experience them. For example, I have a bright schizoid patient who makes excellent comments in the group, comments that other patients appreciate and from which they benefit. But his self-description is, "I'm stupid," which for him is an untouchable reality. Attempts to induce him to take in the views of others and thus modify his view of himself have proved predictably futile. When people say they like him, think he is smart, or appreciate his remarks, his response is usually, "You don't understand." I eventually said, in effect, "You're right, I don't understand, your reality is that you are stupid." As I stopped fighting with him about his negative sense of self, deeper work started. Instead of pretense, I began to see more continuity of thematic work. In general, when the patient tells me that I do not understand, he or she is right. As the therapist you do not have to agree with the patient's viewpoint, but it is important to realize the patient's reality is as valid as the therapist's. Moreover, you cannot talk the patient out of his or her reality even if you believe it is acceptable to do so. Rather, the task is to connect with and tolerate the patient's experience so that he or she can learn to tolerate it—-and then to grow beyond it according to the paradoxical theory of change. The "friendly" message of persuasion is actually an attempt to get the patient to change his or her perception, belief, experience—-that is, to be different. If the patient is in despair, and the therapist works to get the patient not to feel despair, whose need is being served—-the patient's or the therapist's? Can the therapist stand to stay in emotional contact as the patient experiences despair, depression, hopelessness, shame, and self-loathing? If the therapist cannot or will not stay with the patient's experience, he or she gives the patient the message once more that the patient's experience is too much to bear. This is like demanding a false self, and it triggers shame and reinforces the childhood script. The most important thing the therapist can do with schizoid patients is to work patiently and consistently to inquire about and focus on the patient's experience, on what it is like to live life with the subjective reality of being stupid and loathsome. This approach is most useful when combined with careful attention to subtle signs of disruptions in the contact between therapist and patient. Although schizoid patients will not tell you about them, you can see subtle signs of connection and disconnection if you are observant. Often the latter indicate that subtext (nonverbal signs from the therapist) have triggered a shame reaction. This is rich material if the therapist is willing to take the initiative to explore it. The same holds true when the patient has a different view of you, the therapist, than you have of yourself. If you honor the patient's experience as one valid reality, not the reality, you can explore the discrepancy between your "reality" and the patient's "reality" and thus be consistent with the principles of dialogue, phenomenology, and the paradoxical theory of change. Working with this attitude offers growth for both patient and therapist.


Schizoid patients are amenable to creative approaches that center on their experience, on contact, and on what emerges in the therapeutic relationship rather than on programs that try to get the patient somewhere. This can be maximized by identifying schizoid themes as they emerge rather than trying to formulate them according to a preset plan. If you show interest and inquire about the themes as they emerge, you do not need elaborate formulations to explain to the patient
about his or her process or life script. Insight will emerge from the interaction when the therapist follows these basic principles. Although this may seem to take a long time, in the end it is more effective, safer, and no lengthier than approaches that appear to obtain a quicker cognitive understanding. Working through—-that is, destructuring and integrating core processes—-requires identifying and staying with feelings as the patient explores his or her experience. It involves feeling the affect and is, of necessity, more than cognitive and/or verbal. The therapist must be able to experience with the patient the feeling of the empty shell, the core self, and the critic and to work with these feelings as they emerge and naturally evolve. It means feeling the inner child's painful hunger, terror, and need for the defense and how, when, and why it worked. It means feeling the experience of being an alien. Such working through requires more intensive work over time than therapy that is only palliative. Any cognitive identification of a theme before the patient can feel it is, at best, preparatory for deeper work, work based on the patient's felt sense of self and others. An interpretation is only valid when it is confirmed by the patient's felt sense of it. A cognitive identification before the patient can feel it lacks the patient's felt sense as a means of confirming or disconfirming the therapist's interpretations. The cognitive focus is often a barrier to deeper work based on a felt sense. The schizoid needs the therapist to be able to contact the hidden core self without being intrusive. This requires much sensitivity and awareness of the process so that openings can be found where the therapist and patient can discover a way to symbolize the very young, primitive, preverbal sentiment of the inner core self. It also requires that the therapist be willing and able to admit errors and counter-transference so that breaches in the therapist-patient relationship can be healed. A woman who wants to marry and raise a family but who relates to men using the schizoid compromise is not likely to benefit from either an emphasis on contact skills and relationship discussions that prematurely consider themes before they emerge in the therapy or a therapy in which the therapist does not understand the schizoid process. A man who says he wants intimacy but is always unavailable, critical, busy, or too impatient is in the same predicament. Treatment must proceed step by step by exploring issues as they emerge with a therapist who is informed by an understanding of the schizoid process. For example, a man in a relationship keeps asserting that he wants his freedom. Inquiry and mental experiments start to clarify the situation. He is asked to describe in detail what happens when he is at home and to imagine what he would do if he were free. What emerges is a relationship pattern in which there is no movement into intimate contact and no movement to separate while maintaining the sense of emotional bonding. This eventually links to early childhood experiences of being emotionally isolated within a troubled family, with freedom only coming by being away from the warring family situation. These isolating defenses were necessary in childhood, but subsequent exploration led the patient to discover other solutions for himself as an adult. For most schizoids, resistance to awareness and contact were necessary for survival in childhood, and they often still play a healthy function in adulthood. My advice is to treat resistance as just another legitimate feeling state of the patient, something for you and the patient to experience, understand, identify with, and make clear. It should not be treated as something to be gotten rid of. It is necessary to bring together the parts of the self that the patient has kept isolated from each other. This can be done by bringing the split off parts into the room at the same time—-the desire and the dread, the active and the passive core selves, the attacker and the core self. By bringing into awareness both parts of a split self, the parts are clarified and a dialectical synthesis or assimilation can begin. Certain techniques, such as the gestalt therapy empty chair and two-chair techniques, may be helpful, but the techniques are less important than the attitude of bringing the separated parts into some kind of internal dialogue. With regard to groups, schizoid patients often attend regularly and are important to the group process, although they may not be very active. They often come to group for a long time and may feel ashamed about this. When schizoid patients do work in group and even manifest some change, they can become discouraged by their own shame over how long it is taking or over how the group process is not encouraging them. At such times they need support for understanding that it is legitimate for the therapy to take that long. This is particularly the case when other group members come and go more quickly. If growth is occurring, they need help to see themselves as other than defective for still being in group and encouragement to stay and continue their work.

The Course of Therapy

The schizoid compromise in therapy.

The schizoid patient is often emotionally neither in nor out of therapy, just as he or she is neither in nor out of other relationships. In therapy this is accomplished by an infrequent but stable schedule, by being present without being intimately connected or allowing strong affects, and/or by being in a group but not working. Schizoid patients will often be "untouchable" in the sense of putting up a mask or wallor showing other signs of lack of intimacy, defense, resistance, or retreat from contact. However, they are usually not otherwise controlling or manipulative. These individuals usually focus on wanting something fixed or external regulation, on "How do I change this?" rules, fix-it approaches, and shoulds (especially for other people) rather than on affects, needs, or deeper understanding. Expressing emotion is difficult, delayed, or restrained, and they often react to narcissistic injury with painful, prideful, withdrawal. Isolating is easier for schizoids than feeling despair or injury.

Underlying pattern.

In the active core self mode the patient longs for love, and the therapist becomes the avenue of hope. Since it is difficult for schizoid patients to feel desire or need fully, they often show pride in renouncing need and shame or fear at becoming aware of need. This can take the form of total denial, acknowledging but trivializing, or intellectualizing the need without feeling it. These patients project hope onto the therapist but then fight it. They are usually unaware of this process and continue presenting problems to work on while stubbornly fighting. Although the fighting is ostensibly about what is being discussed, actually it is about core shame and terror. So, how does the therapist know how meaningful the therapy and the therapist are to the patient? It usually shows subtly in behavior: For example, the patient keeps coming, and if the therapist does something that injures the therapeutic relationship, the patient reacts, often strongly. However, when the patient does become aware of his or her attachment to and need for the therapist, the immediate reaction is often anger: "I don't want to need you, to depend on you. It makes me so angry!" The schizoid patient fears loss through abandonment. "If you really knew what I am like . . ." is a frequent comment of schizoid patients, even late in therapy. The inner schizoid world is characterized by a constant fear of desertion and feelings of being unwanted and unlovable, all of which may remain out of awareness until they emerge well into the therapy. The fear of abandonment relates to the patient's attitude toward his or her own intense hunger, and even if the hunger itself is not in awareness, it colors the schizoid patient's adult functioning. The schizoid patient wants to ensure the therapist's or lover's presence, to "possess" the other. This is most often represented in fantasy (e.g., using sadomasochistic symbolism). One aspect of this is an antilibidinal attack on the needy self. There is also a disguised dependence and or oneness (e.g., bondage can symbolically ensure connection or oneness with the significant other). Generally, schizoid patients are not demanding or controlling of the therapist, except for the isolating defenses. However, it is usually a long time before the patient is aware of these underlying processes. No therapist can completely satisfy the schizoid patient's intense cravings. When the therapist inevitably fails in his or her response, this supports the patient's projections that the therapist is intrusive and/or abandoning—-or as useless as the patient's parents were in meeting needs. This is reinforced even more if the therapist actually is controlling, intrusive, or abandoning, which makes the patient's perception not entirely inaccurate. This is true regardless of the therapist's rationale or good intentions. Even ordinary reflection or simple focusing experiments can be controlling or intrusive depending on how they are done and how the therapist relates to the patient. Schizoid patients often oscillate between hungry eating and refusal to eat. This is true both literally and figuratively, although more the latter. Mostly they isolate, occasionally approaching out of need and then isolating again. This is not surprising in light of the basic pattern of approaching in need and withdrawing in fear and dread. In the regressed, hidden, passive mode, schizoid patients regard others as too dangerous, intrusive, devouring, subjugating, and smothering. They want to escape from this danger as well as to find security, which leads them to long for the womb or temporary death as a relief from an empty outer world and an attacking inner world. Relationships are too dangerous, so part of the self is kept untouchable even when the patient recognizes cognitively what is happening.

Stages of Therapy

Ordinary, utilitarian therapy.

The beginning schizoid patient is often in search of relief of symptoms and ways to deal with practical situations. With therapeutic support and practical management of life situations comes relief and the possibility of either stopping therapy having gained some respite or going deeper and working with underlying issues.

The plateau created by the schizoid compromise.

At this stage the schizoid patient usually has a vague sense that something is missing, that something more in life is possible. Sometimes this follows work at the previous stage; sometimes patients begin therapy at this stage. There is often resistance to or fear of going deeper as well as fear of being more dependent on the therapist. The patient usually feels shame at his or her weakness and need and fears collapse if the self becomes too weak. Patients may stabilize at this stage and feel somewhat better. It is a stage characterized by the schizoid compromise, albeit with some beginning exploration into the twin fears of being more connected or more separate. However, at some point the patient must decide whether to stay in therapy and go deeper or leave. This depends in large part on how resistance fears are dealt with, how the relationship develops, and the supports available to the patient. Deeper work begins with the development of the therapeutic relationship and as the patient becomes aware of and deals with feelings about the therapy itself. If the patient stays with feelings and beliefs that arise, the fear and shame are usually too strong to support more intimate work immediately. But from the half safety of the compromise position, the patient and therapist can develop the relationship as well as greater awareness and centering skills. Gradually, the fear and shame will decrease enough to go step-by-step beneath the plateau.

Going below the plateau.

Some patients obtain enough relief by this point and decide to leave therapy rather than completing the deeper work. They are left living a half-in and half-out life, but perhaps with more comfort, connection, and connection while separating. Patients can survive here and perhaps even be thought of as leading lives of ordinary human unhappiness. Other patients at this stage will "take a break" from therapy and plan to return. Going deeper is difficult and time consuming. It means reaching the level at which the inner, regressed, core material is dealt with and real character reorganization can occur. However, even after the fear is relatively worked through, the remaining shame requires a tremendous amount of work while trust develops and the preverbal, infantile levels of the self are worked through. Interpersonal contact and intrapsychic work.

At each stage there is a correspondence between the interpersonal contact or relationship development between therapist and patient and awareness work on the powerful inner needs and terrors this contact arouses. The patient usually fears that these needs and feelings might be so intense that they will destroy the self and the therapist. The patient is also often terrified that his or her ego will break down as the self is experienced more fully. The experience of no intimate human relatedness and the accompanying experience of being utterly alone is understandably terrifying. It is often experienced as "black abyss." No one in the schizoid patient's past has understood the true, core self. Thus it is not surprising to find tenacious resistance at this stage. After all, maintaining bad internal objects may well seem preferable to have no internal objects at all. This is one reason that deep trust and foundation work must be done before deeper working through can be both safe and effective. Two related questions arise for the patient at this point: Can the therapist be of more use than the patient's parents were, and can the patient stand being aware of his or her early, core material?

Additional Guidelines


Build support for good boundaries and good contact. Provide a safe environment. Watch for the twin dangers of intrusion and abandonment. Do not do what the patient experiences as intrusive—-not even in a good cause. Needless to say, abandonment is not a good thing. Be contactful, emotionally direct and open, and easygoing. Let the relationship build with time, caring, and acceptance. Be inviting but not intrusive. The goal is contact, not moving the patient somewhere. Identify and validate the patient's experience using empathic reflections. Let it be OK that trust builds gradually and that movement is slow. Contact the hidden, isolated core self. The patient needs the therapist to contact the patient's core self so that he or she can feel like a person. The schizoid patient cannot do this for himself or herself. The trick is to do it without being intrusive or confrontive. This is done by good contact, experiments and reflections, and a steady, inviting presence. Cathartic release of emotions is not helpful with the schizoid patient unless expressed by the core self. Remember that resistance to awareness and contact was necessary for survival and may still be. Respect it and bring it into awareness as something to be accepted. With this awareness comes a choice that the patient did not have previously. Work on integrating parts of the self: desire and dread, active and passive core selves, internal attacker and core self. In group invite participation but allow the schizoid patient to play a passive role without being pejorative. Follow the patient's lead about timing. If the patient wants to continue and feels ashamed of how long it is taking, offer support by acknowledging progress (truthfully only), clarifying what is in process and what is next, and normalizing the lengthiness (truthfully only).

Sunday, December 14, 2008

Beethoven's Birthday

Today is Beethoven's birthday, by the way. Did you know that? At least most experts believe Beethoven was born on the sixteenth of December. The only documentary evidence is the composer's baptismal record. Of course, documentary evidence can be deceiving -- even inauthentic. We do know that Beethoven was baptized on December seventeenth, at least so the record shows. Some biographers maintain that Beethoven was born on the seventeenth, citing the fact that in the locale of Beethoven's birth, Catholics were customarily baptized on the day they were born. In any event, what we are left with is a few pieces of evidence, and an inference. As they say in the law, the question of Beethoven's birth date is a matter upon which reasonable minds can differ.

Tuesday, December 09, 2008

My Problems With The DC Government

Ms. Franssen:

Thanks for the information. About the rent increase, I have been paying the rent increase of $28.00 per month on my own since November 1, 2008 and will continue to do so. I assumed there would be problems, since there always seem to be problems with Housing. The rent increase is not a financial burden for me. I will be receiving an increase in my Social Security payment effective January 1, 2009 that will be more than $28.00 per month. So I'm OK as far as financial resources go.

About Dr. Abraha, I find that my interaction with him is a total waste of time. Let me tell you about yesterday's session. First, I didn't contradict or dispute him on any issues so as not to provoke any confrontation. The meeting was very cordial--but meaningless.

I told him about a young doctor, Brad Dolinsky, MD, who used to reside in my building. I said I admired him because even though he was just a resident, he had written a medical paper that he got published and that eventually won a national award for excellence in medical writing. I said I admired the fact that he went above and beyond the requirements of his residency training program. I told Dr. Abraha that I felt I would like to see someone like Dr. Dolinsky in psychotherapy: that Dr. Dolinsky was someone I could identify with. I told Dr. Abraha that I felt I needed "narcissistic mirroring." That is, someone who I could identify with--someone who represented an idealized version of myself. So Dr. Abraha said, "So you think you have a narcissistic personality disorder?" I said, "No. I don't think I have a narcissistic personality disorder, but I do think I have narcissistic tendencies." Then Dr. Abraha went off on a tangent. He said, "You know who has narcissistic personality disorder? Many of the dictators in Africa are narcissistically disturbed. They don't care about their people, they let them starve; they murder the people who oppose them; they rule their countries as dictators." So I just sat there listening to Dr. Abraha, not saying anything; but I was thinking, "what on Earth do African dictators have to do with my problems, specifically my perceived need for narcissistic mirroring?" It was as if Dr. Abraha had nothing to say on the need for narcissistic mirroring, so he just started talking about something he knew about without any regard for my psychological problems and needs.

Then Dr. Abraha started talking about something that he repeats at least once a month. He started talking about the neurotransmitters, such as dopamine, norepinephrine and serotonin. He repeats this speech again and again, and really it has nothing to do with psychotherapy: my thoughts, wishes, feelings, fantasies, and needs. Then he asked me about what medications I was taking (an issue that is really Dr. Barbot's bailiwick).

All in all I had an absolutely meaningless session with Dr. Abraha. It's as if he has nothing to contribute so he fills up the hour with irrelevancies that he feels comfortable talking about. I am not angry about this. I just feel extremely frustrated, and I feel a sense of futility and meaninglessness.

As I said, I'm willing to continue with Dr. Abraha, but the time we spend together is basically worthless.


-----Original Message-----
From: Franssen, Valerie (DMH)
Sent: Tue, 9 Dec 2008 8:08 am
Subject: RE: rent subsidy

Mr. Freedman,

Good Morning. I was writing to see how things went for you in therapy with Dr. Abraha. I am hoping it went well and you were comfortable throughout the session. Please let me know if you continue to have any problems.

As far as the rent increase goes, it sounds like DMH does not have any funding right now. I initially thought this was for new subsidies but apparently it also includes current ones (i.e. rent increase or income changes). I did ask Dr. Stewart when she thought the funding issue would be resolved and she was unable to give me a date. If you are able to make up the difference yourself, please do so at this time. If not, I can refer you to ERAP (Emergency Rental Assistance Program) and they can assist. However, with ERAP, you20have to have already been delinquent/behind in paying your rent. I know you have been able to make up the difference, but again if you are not able to do this please let me know. As soon as the Department has funding, they are supposed to let the managers know and then we will know ourselves. Please let me know if you have any questions about any of this. Otherwise, I will plan on seeing you tomorrow morning for the inspection.

Have a great day. Be safe and try to stay warm.

Valerie Franssen, MA
Mental Health Specialist
1125 Spring Road NW
Suite 304
Washington, DC 20010
(202) 576-8872

From: []
Sent: Tue 11/25/2008 12:44 PM
To: Franssen, Valerie (DMH)
Subject: rent subsidy

Ms. Franssen:

I received two receipts from the rental office at my apartment building
indicating payment to the landlord, WRIT, of two checks, each in the
amount of $430.00. As you know, WRIT imposed a rental increase on my
unit (136)effective November 1, 2008 in the amount of $28.00 per month.
At least one of the checks should have been in the amount of $458.00

The Housing Office check numbers are 49694 and 964213.

Thank you for your attention to this matter.


Saturday, December 06, 2008

Schizoid Processes: Working with the Defenses of the Withdrawn Child Ego State

Schizoid Processes: Working with the Defenses of the Withdrawn Child Ego State

Ray Little


This article examines the defenses of the withdrawn Child ego state as described by both transactional analysis and British object relations theory. The process of withdrawal is considered, and the principles of therapy from a relational perspective are explored.


Theoretical Views on Schizoid Processes

I will start by examining several theoretical descriptions of schizoid processes that have influenced my thinking in my work with the withdrawn Child Ego State.

The term “schizoid” has been used in the psychotherapy literature to describe both a personality structure and psychological processes.

Melanie Klein (1946/1986), from the British object relations school, employed the term both to refer to the splitting mechanism used by the infant to organize his or her experience and to describe a developmental position. In discussing what she saw as “the violent splitting of the self,” she highlighted the “excessive projection” (p. 187) that resulted in the other being experienced as a persecutor. She thus described the terror that some clients experience when they feel the whole world is about to attack them.

Fairbairn’s (1940/1952c) paper “Schizoid Factors in the Personality” described three prominent characteristics of schizoid personalities: (1) an attitude of omnipotence, (2) an attitude of detachment, and (3) a preoccupation with fantasy and inner reality. In a later paper, “Endopsychic Structure Considered in Terms ofObject-Relationships” (1944/1952a), he went on to describe an intrapsychic structure that consisted of the splitting of the ego and repression as a defense. He also pointed out that schizoid personalities may appear to fulfill a social role with others with what seems to be appropriate emotion and contact while in actuality remaining detached.

Guntrip (1968/1992) developed Fairbairn’s endopsychic ideas further and listed characteristics of the schizoid personality. He also elaborated on Fairbairn’s concept of the schizoid’s dilemma and spoke of the compromise that people engage in to manage that dilemma. He described a further split in the ego that he called “the passive regressed ego” (p. 144), which he saw as a retreat to an objectless world.

Ralph Klein (1995) built on the work of Fairbairn and Guntrip, and from the perspective of the Masterson (1988) approach, he used the term “schizoid” to describe another disorder of the self (in addition to borderline and narcissistic personality disorders). In taking an object relations view, Klein saw the schizoid as either in a self-object relations unit as a slave attached to a master or as a self-in-exile fearful of a sadistic object.

Horney (1945) described three “neurotic trends” (p. 42): moving toward people, moving against people, or moving away from people in a way that involves withdrawal from contact. She saw people who manifested these trends as estranged from themselves and others.

In Principles of Group Treatment Eric Berne (1966) used the term “schizoid” to describe one of the four life positions, which he called a “futile and schizoid” position (p. 270). A game typical of that position would be “Look What They Did To Me.” In describing clients who occupy this position and who are at the limit of their endurance, Berne wrote that the schizoid position “leads ultimately to thechoice of aesthetic or spiteful suicide” (p. 271).

Paul Ware (1983) developed a classification of personality types or adaptations that described psychopathology and maladjustment and listed various driver behaviors and injunctions that were typical of each type. He described the schizoid adaptation as characterized by withdrawn passivity, daydreaming, avoidance, and detachment and people who exhibit these characteristics as shy, overly sensitive, and eccentric. Their driver behavior is “Be strong,” “Try hard,” or “Please others.” Vann Joines (1985), further developing Ware’s work, viewed individuals with the schizoid adaptation as creative daydreamers, referring to their highly developed capacity to think internally.

In talking about three styles of the Adapted Child—compliance, rebellion, and withdrawal—Vallejo (1986) described withdrawal as “the adaptive behavior that accompanies despair and resignation after loss, deprivation, destruction, abandonment, or the failure of something, whether it be a person, thing, or situation” (p. 116).

The schizoid character is a defensive position that results in a detached interpersonal style. Johnson (1994) viewed character structure as existing on a continuum. At one end is the personality disorder and at the other is a higher level of functioning that he calls a “character style” (p. 11). He saw schizoid personality at the disorder end and avoidant personality at the style end (p. 11) of this continuum.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association, 1994) lists the diagnostic criteria for the schizoid personality disorder:

A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

neither desires nor enjoys close relationships, including being part of a family

almost always chooses solitary activities

has little, if any, interest in having sexual experiences with another person

takes pleasure in few, if any, activities

lacks close friends or confidants other than first-degree relatives

appears indifferent to the praise or criticism of others

shows emotional coldness, detachment, or flattened affectivity. (p. 641)

The DSM-IV focuses on behavioral manifestations, whereas Fairbairn and the British object relations theorists focus more on intrapsychic dynamics. In my view, the various behavioral and descriptive elements of the DSM-IV need to be supported by a developmental and intrapsychic perspective.

Defenses and Processes

In my reading of the aforementioned authors, it became clear that certain defensive processes are common in relation to schizoid phenomena. One of these is splitting, a “process by which a mental structure loses its integrity and becomes replaced by two or more part-structures” (Rycroft, 1968, p. 156). Several writers also speak of repression or the process of rendering something unconscious. A further defense, projection, is highlighted by a number of authors; it consists of “viewing a mental image as objective REALITY” (Rycroft, 1968, p. 125). Withdrawal and detachment from the world, coupled with self-reliance, may create an impression of aloofness. This may be seen as a defense against the perceived dangers and anxieties that inevitably accompany reliance on others and is supported by a lack of affect and coldness (noted by several writers). Regression, a further defensive process, is characterized by a flight inward and backward, even to the point of contemplating suicide. Schizoid personalities are often introverted and live primarily in an internal world. They may experience themselves as lonely, which may be felt as a longing for contact and love. In contrast to this longing, a common feature is terror of destroying others and of being destroyed by others. Often these people may appear outwardly contactful but are, in fact, emotionally withdrawn. Overall, there is a sense of futility and emptiness and a lack of integration (J. Klein, 1987, pp. 171-172).

Case Example: Some of these processes are demonstrated by Sebastian, who usually startsthe session by feeding me something that we can talk about or “chew” on but that does not reveal his vulnerability. In so doing he is checking to see whether he recognizes and can trust me this hour. Sessions seem to be isolated experiences for him, without continuity. He often seems to have forgotten the previous session and to have wiped out his experience of connecting with me.

During sessions, Sebastian often withdraws and seems to be watching me. It is as if he is on the inside of his head looking out of his eyes watching my every move. He has described having retreated into a castle, in the dungeon where he feels safe. He leaves a guard on duty. The drawbridge is down but can be raised at any time. If I see an expression of emotion on his face and respond, he is moved at having been seen but feels he cannot call out. He feels it would be dangerous and frightening to do so.

Sebastian has retreated from the world and is detached from interpersonal relations. He has numbed his emotional responses to people and events. Initially, when we explored his feelings about our breaks, they did not mean anything to him. Now he seems to have some feeling about our endings, and more recently when we spoke of my going away, he acknowledged that he will miss me. This indicates that he is beginning to emerge from hiding into a contactful relationship with me.

The Process of Withdrawal

Attachment: Various authors have described our need for others (Bowlby, 1969; Erskine, 1989; Fairbairn, 1952b; Guntrip, 1968/1992) and suggested that we are relationship- and attachment-seeking from birth. Berne (1966) referred to this need for others as “recognition hunger” (p. 230) (for a detailed overview, see Erskine, 1989).

The helpless infant needs a holding, containing environment to make sense of his or her experience as well as an attuned response to his or her feelings and relational needs. An attuned holding environment enables the infant to emotionally attach to the other (Bowlby, 1969; Fairbairn, 1952b). A bond forms between the unitary ego of the infant and the attachment figure, and these fulfilling experiences of contact become memories.

Johnson (1994) described research that shows that the infant is “ ‘hardwired’ at birth for social interaction” (p. 21) and is attuned to the social responses he or she will encounter. He suggested that the infant “will be able to track the affective tone with which he is handled and the attunements, or lack of it [sic], to his needs, emotional states, etc.” (p. 22). Chamberlain (1987, p. 58) cited experiments in which the mothers of infants were asked to be silent and “still faced” for just three minutes. The infants tried to influence the mother within 15 seconds, as if to elicit a normal response. If they were unsuccessful, they withdrew. D. Stern (1985, p. 73) also found that when a parent does not respond appropriately, a baby can become disturbed or withdrawn.

Disruption and Withdrawal: A contactful attachment to another is the basis of the development of the self for the growing infant (Kohut, 1977; D. Stern, 1985). When the infant experiences neglect, impingement, or lack of attunement accompanied by a lack of reparation, the child may go into hiding with his or her feelings and relational needs. This painful disruption in the relationship may halt or slow the process of integration (J. Klein, 1987, p. 171) and the ego may fragment. Fairbairn described the infant’s response to this disruption as taking the relationship inside where she or he divides the experience into tolerable and intolerable elements (Fairbairn as cited in Gomez, 1997, p. 61). The tolerable self-object experiences are projected out onto the world and the intolerable are kept inside. This is the first phase of withdrawal and splitting. A coping/everyday self is left to maintain a relationship with the world while the withdrawn, vulnerable self goes into hiding (Figure 1).

To provide a sense of well-being and safety, the infant’s coping/everyday self attempts to maintain a tolerable relationship with the external object. To achieve this the infant must abolish negative experiences, which it does by splitting and later repressing the bad experiences so that he or she can control them. Tolerable experiences of the everyday self are repeated and internalized; this reinforces the repression of the vulnerable self. The infant thus upholds his or her sense of security by maintaining a relationship with the external object. However, this relationship is now impoverished. The vulnerable infant part of the ego is now split off and will be repressed and hidden from that part of the ego that maintains contact with the world. This coping/everyday self is similar to Winnicott’s (1965) false self as well as to the adapted Child described by Berne (1961, p. 69).

The withdrawn self splits further to create the internal saboteur (Fairbairn, 1952b), which turns against the vulnerable self. The internal saboteur serves to keep the vulnerable self hidden and repressed. It is the anti-wanting self that is contemptuous and despising of neediness and ensures we neither seek nor get what we want (J. Klein, 1987). The vulnerable self is repressed further and splits off from the coping/everyday self that maintains a relationship with the external world (Figure 2). As a defense against an attack from the external world or an attacking and rejecting object, the internal saboteur may launch a preemptive strike against the vulnerable self to forestall such an attack. This has the effect of shutting down the vulnerable self to prevent an attack.

This process of withdrawal describes a defensive retreat from the world of rejecting objects and painful experiences, with a subsequent withdrawal from contact and taking inside the important and precious parts of the self to protect them from the unresponsive world.

Fairbairn (1944/1952a) described a psychic structure that he saw evolving out of this disruption to the early relationship with the primary caretaker (Figure 3); he called it the “endopsychic structure” (p. 82). In this structure, each aspect of the self is attached to an object by affect. Thus we have three basic self-object representations. First, the coping/everyday self was described by Fairbairn as the central ego, which is attached to the idealized object. I prefer to call this the “preserved object” to distinguish it from Kohut’s (1977) idealized selfobject and because it is more descriptive of the everyday self’s attempt to maintain and preserve the nature of the relationship. Often the countertransferential response to this representation is feeling controlled and limited by the attempt to preserve the relationship. Second, the vulnerable self/libidinal ego is attached to the exciting object, which is inevitably disappointing; therefore, I call it the “exciting/disappointing object.” J. Klein (1987, p. 161) described it as the frustrating exciting object for similar reasons.

Third, the internal saboteur, which Fairbairn later called the antilibidinal ego, is attached to the rejecting object, which may also be experienced as an attacking object. The coping/everyday self uses aggression to keep the rest of the structure out of conscious awareness, and further aggression from the rejecting/attacking object and the internal saboteur maintains the repression of the vulnerable self. Although the structure is repressed, it is there all the time, overhearing the process of therapy even if it is not active or manifest in the therapeutic relationship.

Ego States: In Blackstone’s (1993) excellent article, “The Dynamic Child: Integration of Second-Order Structure, Object Relations, and Self Psychology,” she suggested that the introjected object of Fairbairn’s theory is analogous to the Parent ego state. She quoted Berne (1972) as stating that “Fairbairn is one of the best heuristic bridges between transactional analysis and psychoanalysis” (p. 134). One of the points Fairbairn made is how the self is bonded to the object/Parent ego state by affect, and it is the affect that keeps the two glued together to form a self-object representational unit.

Therefore, the three self-object units of Fairbairn’s psychic structure represent three introjected units in the second order of the Child ego state. These units are archaic states of the Child ego state resulting from “developmental arrest which occurred when critical early childhood needs for contact were not met” (Erskine, 1988, p. 17). When the contact is need fulfilling, the experience becomes integrated and assimilated as memory (R. Erskine, personal communication, August 1999). These self-object representational units may simply be relics of a relationship that once existed. However, if, for example, the infant projected onto the other his or her rage at not being met, then the other is imbued with that rage in addition to whatever anger the person was expressing toward the infant. The self will then be depleted and impoverished, and it is this relationship that will be introjected in the Child ego state.

In Exile: In developing Fairbairn’s theory, Guntrip (1968/1992) suggested that the infant may feel so persecuted by internal objects that there is a further split in the ego that results in the infant making a second retreat deeper into his or her mind to avoid the internalized world of self-object representations (Figure 4). The repressed vulnerable infant self is thus further split as it once again leaves part of itself to deal with the internal bad objects while the rest retreats into its “citadel.” This is a fantasy of a retreat to an antenatal existence in a symbolic womb. Security is, therefore, established through fantasies of enclosure in a womb-like state. “Womb fantasies cancel postnatal object relations” (p. 53) and represent a flight from life. As mentioned earlier, Guntrip described this aspect of the ego as the “passive regressed ego” (p. 144), which I describe as the “hidden vulnerable self.” At each stage of the withdrawal, defenses are employed to protect the self from further humiliation, attack, or injury. The regression may also be the self’s flight from its own murderous rage and hatred of the object; therefore, the self is retreating not only from the aggression of the internal objects, but also from its own aggression. Repression and withdrawal prevent further normal development of the self.

R. Klein (1995) described this position as being in exile—-a retreat from being in prison with others to being in an objectless world. While being with others entails a loss of self, being in exile entails a loss of others. Therefore, the retreat may represent safety, but it also encompasses the fear of objectlessness. The womb-like state may be described by clients as a citadel, a castle, a fortress, or even a freezer. The state of being in exile has been described as being adrift in a boat without a rudder or a sail on an ocean a long way from land with no wind. However, as several theorists have observed (Scharff & Fairbairn-Birtles, 1994; Seinfeld, 1996), describing this womb-like state as objectless may be confusing. The retreat is not to an objectless state but to an antenatal state where there are no demands or attacks and there is no need to adapt. “An objectless state remains something the individual dreads” (Seinfeld, 1996, p. 14).

In addition to a client presenting as having gone into hiding, Seinfeld (1993) also described a retreat and regression in therapy as the client relaxes his or her defenses. This retreat is in response to a holding relationshipand the seeking of a psychological rebirth. As the client relinquishes his or her defenses, he or she may allow regression to an earlier self-object relationship.

Schizoid Dilemma: Retreating from contact leaves the individual isolated, lonely, and in pain. In some cases the longing for contact will reemerge and the person may move toward others; however, such movement also brings with it the anxiety of being close. Guntrip (1968/1992) described this as the “in and out program” (p. 36), an expression of the hunger for and terror of contact and closeness. Some individuals manage this dilemma by establishing what Guntrip called the “schizoid compromise” (p. 58), which is a way of keeping others around but preventing them from getting too close or becoming endangered. This may be achieved by keeping contact at an intellectual level, by being present physically but absent emotionally, or by looking away when expressing emotions.

Therapeutic Principles: Reaching the

Withdrawn Child Ego State

Working relationally with these processes entails working in the here and now with the client, working with the transference (both the needed and repeated relationship [S. Stern, 1994]), and working with the various defenses used to protect the vulnerable self from further pain. It entails the therapist being involved, being available to be impacted and affected by the client (Erskine, Moursund, & Trautmann, 1999), and offering a reparative experience.

Creating a Safety Zone: Therapeutic goals include creating a safe, holding environment that is both not wounding and unobtrusive and that will enable the hidden vulnerable self to reemerge. The therapist needs to understand why the client went into hiding and what his or her terror is about. In addition, it is important to comprehend how attempts at contact may be experienced by the client as intrusive. The schizoid compromise is the individual’s attempt to create safety and to manage the tension between isolation and being trapped or enslaved. The therapist needs to demonstrate an understanding of the schizoid dilemma and compromise (R. Klein, 1995) and offer an attuned interpretation. Ware (1983) adjured us to go slowly: “It must be remembered that the cure of Schizoids is a slow, painstaking process, taking only small steps at a time” (p. 15).

The therapist must track the relationship, noticing and responding to the vulnerable self as it reveals itself as well as monitoring the defensive interruptions to contact. The therapist needs to listen to and notice when the client withdraws or dissociates and to explore what behavior in the therapist prompted the client’s retreat from contact. In supporting the relaxation of defenses and the reemergence of the self, the therapist will enable the self to come out of hiding and to leave its fortress or castle. The therapist thus takes on the function of the defense. For example, with someone who uses intellectualization as a defense, the therapist might offer, “May I do the thinking, while you feel?”

As therapists working with these clients, we need to be available for connection by responding to the withdrawn Child ego state (R. Klein, 1995) and by offering an attuned empathic relationship (Erskine & Trautmann, 1996). We must also be available as an object, creating a space in which the client can use us until he or she feels safe enough to let us into the “citadel.” Then we can help the client out of hiding. This entails the client emerging into a relationship with the therapist through forming an attachment with him or her. The therapist then eventually supports the client’s separation by pointing out the client’s anger and thus disillusioning him or her. At times, we need to be as still as possible, to sit quietly and be willing to not know what is happening. We need to allow ourselves to wonder silently about them and about our countertransference responses. We need to shift between centering on the client and noticing our own feelings, thoughts, and fantasies. We need to be curious and offer reverie (Bion, 1962), and as we begin to understand, show them what they feel or want and create a space in which they can experience love and hate. Speaking of the schizoid personality, Joines (1985) wrote of the need to go “in after them and bring them out” (p. 48). Rather than “going in,” perhaps itmight be more appropriate to wait to be invited so as to avoid a reenactment as the intrusive object.

Defenses: In working with the schizoid’s defenses, the goal is for the client and therapist to discover the function of the defensive process and to move through the defenses to the repressed and hidden elements of the vulnerable self. Fixated defenses are an attempt to take care of the self in the absence of a reparative relationship but at the expense of some capacities, which results in the self being impoverished in some way. Manfield (1992) described defenses as follows: “Defenses are patterns of behavior or thoughts that people use to protect themselves from emotional pain or discomfort arising from present life situations usually linked to painful childhood memories” (p. 32). In his article on defense mechanisms, Erskine (1988) wrote, “It is because of the fixation of defense mechanisms that the archaic (Child) or introjected (Parent) aspects of the ego remain separate states and do not become integrated into the neopsychic (Adult) awareness” (p. 18). These defenses, therefore, keep the vulnerable self with its feelings and relational needs repressed. In addition to repression, splitting, and regression, other early defenses include avoidance, freezing, fighting, the transformation of affect, and reversal of aggression (Fraiberg, 1987). When talking about the defense of avoidance, Fraiberg cited Kaufman’s description of how an infant, when faced with danger, will feel helpless and “employ(s) a ‘flight-fight’ response(s), followed by conservation-withdrawal” (p. 191) to defend and sustain himself or herself.

The appropriate therapeutic response to such processes is to acknowledge, name, validate, and normalize the defenses and to understand their function, pacing movement through the defenses to the vulnerable self in such a way that the client can accommodate the change. The role of the therapist is to take on the function of the defense, thus leaving the client free to express vulnerability. Since defenses serve to offer the individual stability, consistency, identity, and predictability (Erskine, Moursund, & Trautmann, 1999), all these functions need to be taken over by thetherapist. However, care must be taken in working with defenses so that the client and therapist can handle the underlying affect. Offering a contactful relationship in which the therapist is inquiring and attuned may trigger memories for the client of not being met in the past and may be a challenge to his or her script. The client may therefore defend against the current contact to avoid emotional memories.

When working in an attuned manner with clients, they may begin to relax their defenses and cathect a part of their mind in which they feel terrified; they may then experience what M. Klein (1986/1946) described as “persecutory anxiety” (p. 182). The whole world becomes a dangerous place, and even the therapist becomes an attacking object. When this happens the client has cathected an early defensive split in the ego, and rather than the therapist being a helpful person, he or she becomes unhelpful and even dangerous or attacking. The client may feel he or she is in a torture chamber, and the therapist may be seen as the sadistic torturer or jailer.

Working within the Transference: Working therapeutically within the transference relationship with the withdrawn Child ego state involves creating an opportunity for the client to relive, in the present with the therapist, the emotions, conflicts, and relational longings of the past. The feelings must be reexperienced and expressed in the present toward the therapist, who becomes the focus for the old feelings. He or she must be willing to respond nondefensively (Gill, 1982) by offering a validating, attuned empathic response. Working within the transference allows the intrapsychic conflict to be expressed within the therapeutic relationship (Erskine, 1993). For the withdrawn Child ego state this means possibly experiencing both the fear of and the hunger for contact as well as the fear of isolation.

As the work develops, the focus may shift to decisive archaic scenes. The therapist then functions as the “secondarily longed-for, receptive, and understanding” (Stolorow, 1994, p. 51) other, who, through attuned responsiveness, offers a reparative relationship. For example, in the case ofinhibited aggression, the therapist might support the undoing of the inhibition and the expression of fighting back.

The Needed and Repeated Relationship: In the transference relationship clients will invite the therapist to repeat old experiences, but they are also longing to be exposed to new experiences. For therapy to be effective, the therapist needs to be experienced as both someone new as well as someone from the past (Cooper & Levit, 1998). If the therapist tends to focus exclusively on repetitions of the past in the form of games (Berne, 1966), he or she may overlook how new capacities for relating are emerging out of the old. On the other hand, the therapist using a relational model may too quickly offer a new relationship, therefore defensively welcoming aspects of the new while seeking relief from the old, repetitive, problematic relationship with its games. We need to balance staying with the old while offering the new so that the new may emerge out of the old. Therapy is the search for the transformational experience (Bollas, 1987) that enables the repeated relationship to be understood and the needed relationship to be experienced.

Negative Therapeutic Reaction: As the therapist attunes to the client’s withdrawn vulnerable self, the latter will probably relax his or her defenses, and in doing so, the endopsychic structure will be disrupted. Attunement mobilizes the withdrawn self’s relational needs, particularly if the therapist takes on some of the functions of the defenses, thus leaving the client to experience the vulnerable self. In other words, this process disturbs the equilibrium of the psychic structure, and elements of that structure will probably react against the disturbance. The “gang” of the rejecting object, the coping/everyday self, and the internal saboteur will attack the previously repressed self. This is the essence of the negative therapeutic reaction.

This defensive process was described by Freud (1923) as the most serious obstacle to psychotherapy. It comprises the client’s lack of “receptivity to an alien, unfamiliar positive experience” (Seinfeld, 1990, p. 13) with a therapist, reinforced by the client’s activerejection of the need for the experience “in identification with the original external rejecting object” (p. 13). The negative therapeutic reaction describes the mechanics of juxtaposition as identified by Erskine and Trautmann (1996), and the internal saboteur is similar to Erskine’s (1988, p. 17) self-generated ego state.

Activation of the internal saboteur and the rejecting object serves to protect against the emergence in the relationship of the vulnerable self’s relational needs. Attacks from members of the “gang” may result in the client shutting down, annihilating self or other, and forgetting. More serious attacks may lead to drug abuse and self-harm. I think this is similar to Bion’s (1967) observation that psychotic clients attack the link between self and object. The “gang” may attack the link the therapist forms with the repressed self and its relational needs. The therapist must work with the attacks on the link between self and other, exploring the aggressive denial of need. The client must also experience the therapist as the exciting object in order to separate and individuate. The client’s inevitable frustrations and disappointments with the therapeutic relationship require a nondefensive response from the therapist. In fact, therapeutic efforts by either the client or the therapist to avoid regression and dependence in the transference may be an avoidance of the exciting object transference.

The hidden vulnerable self may be experienced as deadened, and an attuned, understanding attitude from the therapist may lead the client to feel like the deadened self is being brought back to life. It is as if the therapist is giving mouth-to-mouth resuscitation to the client, who may fear an attack if he or she does come back to life. These individuals may also be frightened of their own aggression and hatred of the other, which in the past may have been projected onto the attacking object so that the other became a terrifying monster. At one time, survival may have depended on being dead to the world, so the therapist’s attempts at resuscitation may be resisted because the client fears what might happen if he or she camealive. A lively infant may have not been welcome in the client’s family of origin, and the infant’s angry reaction to the unwelcoming response may also be experienced as a danger to existence.

If the rejecting object and internal saboteur are activated in the transference, the therapist has the option of interpreting the attack (Seinfeld, 1993), thus differentiating these two parts from the vulnerable self. For example, the therapist may say, “What we’re seeing right now is how, as we form a bond, the attacking part of you becomes critical.” Therapist and client can then work to understand the reason that an aspect of the person would reject efforts to activate the self and to invite the rejecting object/Parent ego state (Erskine & Moursund, 1988) to express itself directly to the therapist. The therapist can also interpose himself or herself between the rejecting object and the vulnerable self (p. 191). Therapy with the internal saboteur, however, may consist of echoing its statements in order to mobilize the energy of the vulnerable self so that it can emerge and fight back.

Therapy needs to combine an attuned, empathic, involved relationship; a holding, containing environment; and interpretation and transformation of the bad objects. Attuned interpretations that breach the closed system allow clients to incorporate a good object relationship with the therapist (Seinfeld, 1993).


The purpose of the type of therapy described in this article is to create an opportunity for the client to reown his or her repressed, disavowed, hidden capacities and to integrate these into here-and-now functioning. Further, it is an opportunity for the client to reemerge from withdrawal, to integrate the split and fragmented ego, and to resolve the conflicting pulls between a self that seeks predictability, continuity, and safety and a self that seeks spontaneity, authenticity, and contact.

The capacity for growth and development may be hampered by the prior reinforcement of the closed system, and, like a muscle that is underused, it may have become wasted and will require exercise and support to rebuild it. Thisinvolves rebuilding the attachment-seeking behavior that may have atrophied over time as a result of not being sustained in earlier relationship (Sutherland, 1994).

Therapy needs to combine an attuned, empathic, involved relationship; a holding and containing environment; and interpretation and transformation of the bad objects. Attuned interpretations that breach the closed system allow clients to incorporate a good object relationship with the therapist (Seinfeld, 1993).

Ray Little is a Certified Transactional Analyst working as a psychotherapist in private practice in London. Please send reprint requests to Enderby Psychotherapy & Counselling Associates, 16 Hatfield Road, London W4 1AF, United Kingdom.


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The author wishes to extend special thanks to Richard Erskine for his support in the development of the ideas presented in this article and his encouragement to write it. The author also wishes to thank Shirley Spitz for her comments and support in the development and application of these ideas.


This article was first published in the Transactional Analysis Journal, Vol. 31, No. 1, pp. 33-43. Reprinted with permission of the ITAA

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