Unconscious Ambivalence About Therapy

In an earlier post, I discussed the difficulty of dealing with consciously ambivalent feelings. But now I would like to focus on a more pernicious type of ambivalence — unconscious ambivalence.

People who seek out psychotherapy to resolve their unconscious ambivalence do not know it. There are those who do not want to see some aspect of themselves and start psychotherapy hoping it will help them to get rid of it, to exorcise it. Other people begin psychotherapy because they are depressed or anxious but do not want to feel something, often anger toward someone they love, because they don’t want to lose that person.

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In both cases, paradoxically, psychoanalytic psychotherapy will not help the patient remain unconscious of their ambivalence; it will make it conscious. Hence, the patient may become ambivalent toward the treatment and leave precipitously.

An example of unconscious ambivalence

Tina is a 35-year-old accountant who was referred to me because she was depressed and had a history of panic attacks. On the phone, she asked me if I was the kind of therapist who didn’t talk. She didn’t want that kind of therapist. Would I talk? I assured her that I am not a silent therapist and she decided to come to a first appointment.

Clearly, Tina was ambivalent about beginning therapy before she met me. But she didn’t want to experience the ambivalence. Instead, she talked about “the good kind of therapy” and “the bad kind of therapy.”

When Tina came to the first session, I could not talk without interrupting her. She talked for 45 minutes nonstop. She said, “My mom is the greatest mom in the whole world. We are buddies. She’s my best friend. I can talk to my mom about anything.”

Tina’s idealization of her mother signaled a problem with ambivalence. Later in the session, Tina told me that her father had an affair and her mom wanted to confide in her about it. Tina did not want to know the details of her parents’ sexual relationship and asked her mother not to talk to her about it. Tina told her mother, “I’m the daughter, please don’t tell me about this.” So, it seemed, that Tina’s mother being her best friend was not entirely positive. But Tina could not integrate the mother who is “the greatest mom in the whole world” and the mother who had no boundaries and spoke to her about things that were inappropriate.

When the session ended, I told Tina my fee and asked her to pay for the first session and informed her that in the future I would bill her at the end of the month. She said she did not bring a check and could not pay me, but she would bring a check next session.

For the second session, Tina came a few minutes late and said she went to the wrong address and that was why she was late. She added that she was so rushed she forgot her checkbook. It was clear to me that Tina was ambivalent about being in psychotherapy. She did not bring a check to our first consultation, she went to the wrong address, and she “forgot” her checkbook. I asked her if she thought her confusion might reflect some feelings about beginning therapy. Tina insisted that she was “just forgetful.”

However, she began to tell me that she was upset that I had not talked in the previous session. She said she wanted a therapist who talked. I said that I had not said anything because she seemed to have a lot to say, and I didn’t want to interrupt her. She insisted she wanted me to talk. Then she proceeded to talk non-stop for the rest of the session.

Tina told me that her boyfriend had broken up with her while she was on a business trip. But she is seeing him again although he is living with another woman who is pregnant. At the end of the story, she said, “He’s a really good person.” I asked, “Do you think it’s curious that you feel he’s a really good person despite his behavior?” She said that was interesting and the session ended.

At the third session, Tina brought a check for two sessions. I thought that was strange because it was neither the payment for the first session as I had requested originally, nor was it the total she owed for three sessions. She said she liked what I said last time and wanted me to talk more.

Then, she started to talk about her father. She said, “My dad’s a really great guy.” She told me that he was a traveling salesman during most of her childhood and she was left alone with her mother. When her father came home, he expected them to change everything to the way he liked things. She felt angry at him for being both absent and controlling. She spent the whole session talking about how angry she was at her father.

Before our next session, I got a phone message from Tina: “I’ve decided not to continue seeing you. I don’t want to do this kind of therapy.” I called her to ask her to come in and talk about what it was that was bothering her about “this kind of therapy.” She refused.

I thought about what she meant by “this kind of therapy.” In her first session, she told me that she had been in therapy a few years ago to help her deal with panic attacks. That therapy focused on the symptom—panic attacks. She learned to talk herself out of the attacks, but she never learned what was causing the extreme anxiety underlying them.

Unconscious Essential Reads

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I think Tina did not want to experience the hurt and anger she felt at her mother and father but found that she kept expressing it in her sessions with me—it came pouring out of her like a torrent as soon as she sat down. She didn’t want to do that. She wanted me to talk so she would not get in touch with her anger. But then I pointed out that there was a disconnect between how her boyfriend treated her and how she described him. She wanted to keep her boyfriend “a good person,” her mother “the greatest mom” and her dad “a great guy.” She wanted some other kind of therapy in which she would get over her depression and panic attacks without having to experience painful feelings toward people she loved.

Tina was full of ambivalence—both consciously and unconsciously. She was consciously ambivalent about beginning psychotherapy as evidenced by her question to me on the phone before she came to the first session. She had already been in the kind of therapy that deals only with symptoms. On the one hand, she knew this was not that kind of therapy and that was why she was calling me rather than her old therapist. Part of her wanted to find out what was causing her panic attacks and depression. On the other hand, the unconscious part of her ambivalence about psychotherapy was her fear that understanding the cause of her anxiety and depression involved dealing with disappointment and anger at her mother, father, and boyfriend. She did not want to lose them and was afraid exploring her negative feelings would result in that.

Tina’s conscious ambivalence about psychotherapy reflected her unconscious fear of experiencing ambivalence about the most important people in her life. If she had been willing to come back and discuss her ambivalence with me, I might have been able to explain that allowing herself to experience hurt and anger would not necessarily result in giving up the people she loves. However, Tina’s anxiety about her ambivalence was so intense that she had to end the treatment immediately.

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