by Frank Tallis
Psychotherapy is a kind of holding, a safe place in which to explore and grow. The relationship between a therapist and patient, when it works, replicates good parenting. It is a vehicle for encouraging transitions.
After seven weeks, Anita had acclimatised to psychotherapy. She was disclosing with less apprehension and I judged that she could cope with more probing questions. I wanted to excavate her jealousy; to plumb its depths. A useful technique for achieving this goal is what cognitive therapists call ‘downward arrow’. It is usually represented in diagrams as a vertical line of downward pointing arrows separated by questions that vary slightly but are actually the same, insofar as they are all inquiries about meaning.
‘Anita, have you ever thought about how you’d react if Greg admitted to having an affair?’
‘I’d be devastated. You don’t think that, do you? He hasn’t said anything, has he?’
‘No, not at all,’ I reassured her. ‘I’m just interested in what that would mean to you—if it were true.’
‘Mean?’ She looked puzzled for a moment and then said: ‘It would mean that he’d been lying all along.’ She shifted and looked at me with suspicion. I was asking her to state the obvious.
‘And what would that mean?’ I continued.
‘He can’t be trusted.’
‘And if that were true?’
‘Christ—if you can’t trust your partner—well, who can you trust?’
‘Okay. Let’s say you can’t trust Greg—or anyone else you might meet in future. What would that mean?’
‘That there’s no such thing as closeness.’
‘And if that’s true?’
Her words were given intermittent sustenance by a slow, tremulous breath. ‘I’m alone.’
She looked very frightened. The inner child had finally stepped out from her place of concealment; a child who had looked to a selfish mother for love—a mother who was as unfaithful to her children as she was to her husband—only to be ignored and rejected.
Evolution has ensured that we form a close bond with our parents, because on the plains of Africa, an abandoned child was a dead child. Anita’s rival—the woman who wasn’t there—was more than a sexy temptress. She was Death’s understudy. The prospect of betrayal terrified Anita, because betrayal deposited her inner child in the middle of an ancestral wilderness of lengthening shadows and predatory darkness.
Greg was sitting a short distance from Anita.
‘There’s no need to ask me about my past. It’s done—gone—finished. It’s the past.’
‘Why must you always be so cagey about it?’ Anita responded.
‘How can you say I’m cagey—I mean, really…’
‘I’ve told you everything.’ The heavily weighted pronoun made the sentence an accusation.
‘I know you have. But there was no need. Why should I care about how many lovers you’ve had?’
‘Openness—honesty? These things matter.’
‘Oh, come on… this isn’t about honesty and openness.’
‘Then what is it about?’
‘When you ask those questions… I feel like I’m being manipulated.’ The atmosphere chilled. Greg looked to me for assistance, but I simply revolved a finger in the air, encouraging him to continue. ‘It’s a pretext,’ he added.
Anita’s response was sharp: ‘What?’ Almost a shriek.
‘It’s a pretext. You say let’s be open—but it’s not really about that. It’s about getting more information—so you can compare and contrast—so you can trip me up. And the thing is, you’re always going to trip me up, because I can’t remember everything—not exactly. There are always going to be mismatches. It doesn’t mean that I’m lying. It doesn’t mean that I’m trying to mislead you. It just means that I can’t remember, because these things—my past relationships—they aren’t important to me any more. You are!’
The corners of Anita’s mouth had turned down slightly.
‘What are you thinking?’ I asked her.
‘Is it too much to ask?’ Anita’s question was addressed to the ceiling rose. ‘All right—I have a problem.’ She turned to Greg. ‘But maybe if you tried a bit harder…’
‘Me?’ Greg thumped his sternum. The impact made a loud thud. ‘Me—try harder? I’m not sure that’s possible. Besides, whatever I do will never be enough, whatever I say—whatever I do—you’ll never be satisfied.’
There is nothing wrong with being a perfectionist, but if internal standards are too high this otherwise commendable trait can interfere markedly with general functioning. It is associated with several psychiatric conditions, most notably anorexia nervosa, OCD and depression. Opinions differ widely concerning the nature of perfectionism. At one end of the spectrum are the views of psychoanalysts, who understand perfectionism as a defence against harsh parental criticism, and at the other end are those of cognitive scientists, who understand it as a set of largely unmotivated preferences that arise directly from the brain (like an instinctive need to line things up, for example).
Anita’s mother was not only neglectful, but highly critical. In a previous session, Anita had said: ‘Mum was constantly finding fault. I might have become an artist—like her—if it wasn’t for her remarks. She was always being negative.’
I was inclined to view Anita’s perfectionism as motivated rather than unmotivated; a defence, rather than a property of her nervous system—although these contrasting approaches are by no means mutually exclusive. Sometimes, a single characteristic can be overdetermined, the result of several causes.
Anita would continue ruminating about Greg’s past and asking questions, because he could not supply her with perfect answers. As someone conversant with coding, Greg would have recognised that Anita was caught in a ‘test-operate loop’ with no ‘exit’.
Anita was looking miserable.
Greg had more to say: ‘Even when I’m just sitting quietly you act like I’m doing something wrong.’ He turned to face me again. ‘At home, sometimes I’ll be a bit preoccupied—you know—just thinking about stuff, and Anita will get agitated and say: “What’s the matter? Why aren’t we talking?”’ He took Anita’s hand and moved his thumb backwards and forwards over her knuckles. She raised her head and looked into Greg’s eyes. ‘I want us to be happy together,’ he said. ‘But what you do—it’s oppressive.’
The taproot of Anita’s jealousy was a child’s terror of abandonment, a primal fear selected by evolutionary mechanisms and amplified by early learning experiences. Ultimately, it was this fear of being abandoned that made her vulnerable to developing a psychiatric illness. But what does this mean, to be psychologically vulnerable? It’s relatively easy to think of physical vulnerabilities as weaknesses attributable to vitamin deficiency or brittle bones. But what is the psychological equivalent? What do the causes of psychological vulnerability look like?
Cognitive psychologists refer to ‘schemas’ or ‘schemata’ when describing connected beliefs that influence the way we see, understand and react to the world. They are created by learning experiences.
The idea of a schema might be quite difficult to grasp because it is a hypothetical construct and cannot be observed directly; however, one might think of a dysfunctional schema as a metaphorical lens through which the incoming light of experience is refracted by flaws in the glass. The subsequent distorted image is inaccurate and arouses strong emotions. For example, if the distortions make the world look as though it is full of monsters and dangerous, we will experience irrational fear.
Aaron T. Beck—the American psychiatrist who developed cognitive therapy—has suggested that dysfunctional schemas store knowledge in at least two ways: first, as conditional propositions or assumptions, e.g. ‘If I am not loved then I can never be happy’; and second, as unconditional statements such as ‘I am unlovable’. The latter is an example of a ‘core belief’. Core beliefs are more defining than assumptions and are buried deeper in the psyche.
Many important learning experi
ences precede language acquisition, so some schemas are either entirely non-verbal or they incorporate non-verbal elements. In the absence of language, learning is embodied. When our bodies ‘remember’, we experience physical symptoms, such as an accelerated heart-rate, hyperventilation or butterflies. Perhaps this is why we frequently say things like ‘I can feel it in my bones’ or ‘I have a gut feeling’. Elusive perceptions seem to register not in the brain but at any number of other sites around the body.
Schemas exert their influences from below the awareness threshold. When activated, pre-verbal schemas will reproduce the powerful, raw emotions of infancy. A trigger, such as jealousy, might activate an ‘abandonment schema’, and the vulnerable individual will then be overwhelmed by a sense of terrible isolation. This happens automatically with very little cognitive mediation. The principal task of psychotherapy is to make the vulnerable individual aware of his or her schemas and to modify them by correcting dysfunctional assumptions and harmful core beliefs. The therapeutic relationship—which frequently requires the therapist to act as a surrogate parent—can be an important catalyst for change at the pre-verbal level; however, such change is extremely hard to achieve and usually requires a long-term commitment from both therapist and patient.
An abandonment schema is activated almost exclusively during the course of an intimate relationship; a partner’s neutral remarks and behaviour are misinterpreted in a negative way and the affected individual overreacts. A panicky, highly aroused state is followed by a state of detachment and withdrawal, which can also serve as a means of punishing the unwitting partner.
Schema-focused cognitive therapy is an extremely good example of convergence among therapies. Although cognitive therapists and psychoanalysts have very different practice methods, the principal objective of both approaches is to reduce the power of influences emanating from the unconscious and increase awareness of the origins of self-defeating behaviour. The individual will then be able to make more accurate appraisals that will inevitably inform rational, reality-based judgements.
I was feeling relatively optimistic. Although treating jealousy can be challenging, we were making progress. Greg and Anita were communicating and they were both very motivated and emphatic about wanting their relationship to succeed. I had a formulation—a rather satisfying diagram in my notes—showing the proximal and distal causes of Anita’s jealousy, with arrows connecting core beliefs, assumptions and thoughts, circles showing how certain behaviours were maintained, and little boxes detailing modulating variables. Anita was a textbook case, conforming to the expectations of various psychological models and theories. It followed that therapy should be effective.
The next day Greg and Anita broke up.
I saw Greg first. A small plaster was stuck to his forehead, just over his left eyebrow.
‘On Friday night we met with some friends at my tennis club. Anita was relaxed and we were having a great time. We were messing about, laughing and joking. Anita can be really good in social situations. You’d never guess. You only see her when she’s in here—talking about our problems. But out there,’ he glanced towards the window, ‘she can be a lot of fun. There was a woman standing at the bar. She looked familiar and when she turned round I recognised her—it was Kate, an ex-girlfriend of mine. We were together four, five years ago—and not serious. I kept my head down hoping that if I ignored her she’d just walk past, but Richard, one of the guys we were with, called out her name and invited her to join us—she works for the same travel company. Anyway, I didn’t quite know how to handle the situation. Kate was friendly and it was obvious we knew each other, but no one was asking how we knew each other—and I think Kate sensed that things were a bit awkward because we didn’t talk for very long. She spent most of the time chatting to Richard and his wife. Thankfully, Kate left as soon as she’d finished her drink. From that point onwards Anita didn’t say very much. She was very quiet for the rest of the evening. I was expecting trouble and probably drank too much.’ He made an appeal for clemency with guilty eyes. I responded with an absolution sketched in the air with priestly benevolence and he continued: ‘I’d had a busy week and I wanted to have a quiet, uneventful weekend with Anita and the boys. I didn’t want to argue. Going back home in the car things were quite tense. Anita said: “How do you know Kate?” I told her that Kate was an ex and then she said: “So when were you going to tell me?” And I didn’t have an answer to that, because what I really wanted was to just forget it and go home and make love—like normal people. Anyway, I explained that it had been a very brief affair and I hadn’t seen Kate for years and Anita said: “What? You’ve never seen her before at the club?” And I said: “No, I haven’t.” But Anita was suspicious and I could see that she was getting more and more upset.’ Greg looked at the empty space next to him on the sofa, as if he had suddenly become aware of Anita’s absence.
‘We got home—I paid the baby sitter—and while we were still in the kitchen Anita started asking more questions, one after another—questions, questions, questions. It was relentless. And then she said something utterly ridiculous like: “Do you still find her attractive?” And I said: “Yes, I still find Kate attractive.” I was going to add—but I don’t love her—when Anita picked up a plate and threw it at me. She missed but it smashed against the wall and a piece caught me here.’ He touched the plaster on his forehead. ‘And I thought to myself—I just can’t go on. I just don’t need this. This is no way to live.’
‘What did Anita do?’
‘She started crying and then Brad woke up and Anita had to get him settled again. When she came back I told her that I thought it would be best for all of us if I moved out.’
‘How did she react?’
‘She just went into herself. She became—I don’t know—blank—frozen.’ Greg brushed away a tear.
‘It’s okay…’ I said, placing the tissue box on the sofa.
He looked at it for a few moments and then snatched a tissue. ‘She’s so beautiful. I mean—amazing.’ He blew his nose and stuffed the tissue into his pocket. ‘Whatever we had is buried under so much shit now. I hope the boys are going to be okay. They’re great kids and I’ll miss them. But if Anita and I stay together and she gets as mad as she did on Friday night—that isn’t going to be good for any of us. Brad and Bo, they shouldn’t see their mother behaving like that—they just shouldn’t.’
We discussed options: a temporary separation, more intensive therapy. But Greg was sure. The relationship was over.
‘You might change your mind,’ I suggested.
‘No,’ he said firmly. ‘I want my life back.’
I saw Anita the next day. She entered the consulting room with an air of brisk efficiency and business-like purpose. Her hair was pulled back with an Alice band and she was wearing more make-up than usual. It had been applied skilfully, but the effect was of unnatural smoothness—artificiality, the complexion of a mannequin or a doll. She sat down, crossed her legs and recounted her version of events.
‘I was suspicious the moment I saw her. There was something… something going on between them. I could just tell.’
Greg had been shifty—he’d refused to answer her questions—and yes, she had lost her temper—but his behaviour had been unforgivable.
‘If I hadn’t asked him about her, he wouldn’t have said a word.’ The whole episode had been utterly humiliating. She had been obliged to sit at the same table as Kate, ‘watching her catch his eye—watching her flick her hair.’ Anita did an extraordinarily good impression of a manipulative woman capturing a man’s attention while feigning innocence. ‘How could he have done that to me?’
There was a slender possibility that Greg had decided against ending their relationship and I thought it wise to remain silent on the matter—at least until I knew what had actually transpired.
‘You saw him yesterday—didn’t you?’
I felt a little duplicitous. ‘Yes. I did.’
She set her jaw defiantl
y before saying: ‘We’re breaking up.’
‘I see.’
Somewhat breathlessly, Anita added: ‘He’s leaving me.’
She didn’t make a sound at first, but slowly, sobs came, and then a great, heaving cry of anguish, which made her snap forward as though she’d been winded by a hard punch. Tears coursed down her face, leaving vertical trails of mascara. With the unguarded, careless urgency of a child, she slid the back of her hand under her nose to wipe away the snot. I tried to engage her, but she had regressed to some pre-verbal state where horrors are necessarily unspeakable, where words cannot be interposed between a chaotic world and the self, where language isn’t accessible to give despair a name and thereby contain it.
When I was an undergraduate, I was discussing my ambition to train as a clinical psychologist with one of my lecturers. ‘So,’ he said. ‘You fancy the misery game, do you?’ He was being purposely provocative. ‘A life in misery…’ His intention was to make me give proper consideration to the potential effects of spending the rest of my life in enclosed spaces observing people suffering. Spectacular grief can be cloying—hard to shake off.
The only time I have ever come dangerously close to crying in a therapy session was listening to a boy recounting the circumstances of his mother’s death. What had started off as an exciting day out for his family had ended in disaster. They had found themselves caught up in a series of events, the outcome of which was a national tragedy. Hundreds were injured and many people were killed. It wasn’t pity aroused by the boy’s distress as he described screams and disfigured corpses that moved me, but rather his courage, his dignified efforts to remain composed because he wanted to give an accurate account of his mum. He wanted to affirm her character and kindness, to give her short life meaning by telling others about her.