Supporting the Symptoms
This is part 1 of a multipart blog entry, check back in a few days for the continuation.
Therapy takes time. Therapy needs to take time. And here’s why.
Some time ago I read a heart-rending article about the tragic and mind-boggling double suicide of a set of twin girls, age 33. Their story, in brief, was that as very young teenagers, they developed what would ultimately become a massively crippling, full-blown Obsessive-Compulsive Disorder. It was reported that their symptoms included extreme fears of contamination and preoccupation with cleanliness. They would go through five bottles of rubbing alcohol every day, disinfecting their skin until it burned. They hardly ever left the house. When they did, they would stop eating and drinking hours in advance to the point of dehydration to avoid using public restrooms. In their 20’s, their lives completely shut down. They neither finished school or obtained jobs, and never left their house.
At age 30, being a high-profile case that had been featured on television, they were offered a new treatment- deep brain stimulation, which involved the implantation of electrodes in the key areas of their brains, wired to battery packs surgically implanted much as pacemakers or internal defibrillators. The device sends electrical signals to the brain which largely prevented the twins from experiencing the extreme impulse to engage in their obsessions and compulsions. Over two to three years, the twins improved to the point that they began to interact with others, carry on lives outside the home, obtain jobs, even laugh and experience a full range of emotions for the first time. It was considered a huge success.
However, one day, at age 33, they were inexplicably found dead in their car, by dual gunshot wounds to the head, presumably by suicide pact.
What had happened? No one can answer why these two individuals with so suddenly a promising future and relief from the prison of their compulsions should be motivated to do such a thing.
To answer this, let’s take a look at one of my cases. I recently had a session with a woman who lost her mother a few months before. Only a few weeks into our treatment, we had been working on helping facilitate and unlock her grief process which had been stalled. In this session, we were discussing her desire to talk to her father, who was still living, about how she was feeling. They were in semi-regular contact, but not very frequently, and the patient felt her father doesn’t make time for her, to hear her out. She told me her father doesn’t have any interest in hearing about her ongoing emotional struggle with her mother’s death. (He, himself, had divorced the patient’s mother many years before her passing, and they lived separately).
But here is the key, as we turned to focus on what exactly she wanted her father to know or understand, she suddenly started crying in a way she never had before. I reflected that something about my question triggered a tremendous amount of feeling. After a moment of painful silence, behind hands covering tear-soaked cheeks, she haltingly said she wants him to know she can’t afford to lose both her parents. I thought to myself, was she implying that he should never die? At that point I recognized it was too early in the treatment to truly “go down that road.”
What had been revealed by her breaking down were themes of abandonment, existential crisis, loneliness and despair- all likely very core issues for her, covered over by years of personal rules, rigid boundaries and expectations, and patterns of “topic and relationship avoidance”—in other words: coping mechanisms. These were set up in order not to “touch” these sore and unresolved notions of abandonment, existential crisis, loneliness, etc.
So, I decided to redirect our discussion back to more concrete issues of the week, a more stable footing. I helped her back off from the edge of the abyss, as it were. In short, I supported her symptoms (for now).
Now, why did I do that? We should ask: Isn’t she in treatment to eliminate or at least greatly reduce her anxiety and depression? Why should a therapist support- or prolong– a patient’s symptoms?
Stay tuned for Part 2 of this article.