I sometimes use self-disclosure with my patients; however, I avoid answering direct questions when a projection may be occurring. Lindsay suffered with depression and suicidal ideation. She placed an emergency phone call to me stating that she was suicidal. In our conversation, she was willing to contract for safety. In our next session, she came in looking defensive and somewhat angry. She asked, "Were you mad at me last night - I know you were." This was tricky because while I was more than willing to take her phone call, I also was frustrated at having been awakened. I am human. Lindsay was projecting onto me her expectation that people would not care about her while simultaneously needing to be dependent and therefore taken care of. My first inclination was to reassure her that I was not bothered by taking her phone call and that she was worthy of my time. Although it would have been comforting in the moment, she was unlikely to truly believe this because it conflicted with her narrative that people don’t care about her. It my have even decreased her trust in me if she didn't believe it. The other option would have been to say something authentic in an attempt to let her know that even though a small part of me was bothered, I was still more than willing to take the call. However, the likelihood is she would have only focused on the small part that was bothered and be wounded by that. Answering her question was a no-win situation. Therefore, I sidestepped the dilemma as follows:
Me: Hmm, before I respond to that, can I ask you a couple of questions?
Lindsay: Okay.
Me: What would it mean to you if I was mad about the phone call?
Lindsay: It’s okay because I’m used to it. I know I shouldn’t bother you and should be able to take care of myself.
Me: Is there any small part of you that would feel anything else?
Lindsay: Well, it would seem just a little unfair because I was feeling really bad and thought I might hurt myself.
Me: Okay, so you would both expect me to be mad and also feel that it was unfair. So, what would it have meant to you if I wasn’t mad about the phone call?
Lindsay: I’d be glad but I wouldn’t necessarily believe you. No one likes getting awakened in the middle of the night, especially me.
Me: If I were mad, would it remind you of anything else?
Lindsay: Sure. My mom always acted like I was too much for her. I’m used to it.
Me: So you make the assumption (the projection) that I was mad, based on how you felt with your mom, and that’s totally normal as long as you continue to believe the things that you told yourself back then. I would think this makes you really ambivalent when it comes to needing help or even connecting with people for that matter.
We then spent much of the session talking about times when she felt neglected by her mother. She recognized that she alternated between feeling shame and anger (just like she had with me). We explored the wisdom on both sides of her dilemma. We never got back to whether I had felt mad. It didn’t matter anymore. My next post will share how I went on to help Lindsay learn how to identify what she needed from herself in these types of situations.
My book A Clinician’s Guide to Pathological Ambivalence: How to Be on Your Client’s Side Without Taking a Side can teach you how to avoid this and other common therapeutic mistakes by developing skills to work directly on resolving ambivalence. I would love to hear from you. Please scroll down to the bottom of this page (past the banner of recent posts) to leave a comment.