Beating Self-defeating Psychological Resistance
Dear Dr. Trausch,
I have two questions regarding coaching and patient responses I was hoping you could answer.
First, how do you respond to a person that tells you about all their losses. Outside of listening....which I know I do very well. A prime example: My friend talks about how much his life has changed. How he does not even feel the right side of his scapulae or thoracic area anymore (after a stroke). He is stunned by the loss. I feel for him because it is like he has just started to recognize the full scope of the stroke.
You must have heard stories of loss a thousand times in your work.
What behaviors do you see that tell you a person is willing to resolve their losses and move forward? What is the best thing you are able to offer people in this regard?
I don't let people tell me about all their losses, even in a session. I let them give me representative lamentations, complaints, or legitimate concerns. There is a place for needing to be heard, and it is good for someone—a friend, a therapist—to listen. But, within a reasonable time, I stop the flow of what turns out to be a nowhere-going string of grievances. I then move them to another mode--that of action. If they are not interested in that next step—and together generating specific interventions and actions they will take, or learn to take—I am not interested in continuing the session, or listening to my friend.
In this way, I model a proactive life, and only have relationships with friends, as well as clients and students, who appreciate those values enough to move themselves in that direction. Even when a person is only gradually realizing the extent of their troubles, I still ask for initial steps in making changes within those parameters. This builds power, and together we create a strong ego/mind. One example is a well-educated, highly intelligent but resistant and narcissistic woman who would not in any way take charge of her caregiver dilemma, although she prodded me for answers that she was then not willing to hear, and which she discounted. I stopped seeing her since she was making no progress, her resistant attitude blocking creative options for meaningful and gratifying change. That was a year ago. Then, she contacted me with a grief-generated readiness. She had endured much pain. She began to take my directions, and actually see their value. Since I had not judged her in our initial encounters, or damaged our original relationship by pushing her away or abandoning her, she felt comfortable in returning to me. The insights I provided her with originally finally “took” and she became open to more insights.
Secondly, I am working with a family in Michigan that is caring for a young person with dementia. His 80 year old Mom is working hard to care for him. My concern is that she will burn out. Why do families or family members wait for the burnout stage? You have helped people with the problem of taking on too much responsibility. Please address this issue. What do you do for them?
She will likely burn out, and that will manifest in a variety of ways. Many caregivers who burn out don't even know they have burned out. They often fade into a kind of semi-present “functional” catatonia. These people are not waiting for the burnout to happen. They are living in an increasingly narrow world of guilt, little information, poor coping and communication skills, boxed-in fear of risk; poor tendencies toward self-care, etc.). They slowly deteriorate and find themselves in dire mental and emotional circumstances. Others see it coming, and try to head it off. Those still healthy enough to seek guidance can forestall and even prevent burnout. The wisest people do not wait for information to come to them, but rather seek it out themselves, sensing that they are in trouble and need help. Those who do not do that seem to "need" the secondary gains that come from complaints and resistance more than they need the relief of real, proactive change. All too many people will actually rebel, or even punish you if you try to enter their dysfunctional burnout system. Their guilt, sense of pride, etc. keep them locked into the scheme. They need to have help in exposing the resistances to the light, acknowledge them, and make gradual small, doable changes in strengthening their motivation and their will, which they will then apply to challenging their own faulty perceptions about their situation. Unless they grant that there may be such defective thoughts, no change will likely occur. There are, after all, genuine ways of coping with such dire life sitations!