CHAPTER l3
Interp
ersona
lTh
erapy
Sullivan places the focus of therapy on interpersonal anxiety1; that is, he studies old and new interpersonal distortive fantasies in order to correct resultant transactional removal behaviors that keep patients from getting close and developing anxiety-free intimate relationships. Frieda Fromm-Reichmann describes the goals of treatment as a “potential freedom from fear, anxiety, and the entanglements of greed, envy, and jealousy . . . actualized by the development of [the] capacity for self-realization, [the] ability to form durable relationships of intimacy with others, and [the ability] to give and accept mature love.”2 Millon and Davis emphasize having “a ‘corrective emotional experience’ with the therapist,” with the therapist serving as a mirror for everyday relationships and offering a positive experience that it is hoped would “generalize to [other] contexts outside of the therapy hour.”3 I focus on the dyadic unit as a way to understand one or both of its individual members. I identify avoidant interactive behaviors, bring them to the patients’ attention, and study their conscious and unconscious meanings. I try to learn about the special circumstances under which interpersonal withdrawal actions appear, that is, the “when,” or the exact moment, that the avoidant begins to pull back from others, and to learn about the “why,” that is, the reasons for the retreat. Do avoidants become anxious in some situations but not in others, and withdraw from some but not from all people? Do some feel comfortable with a person “of their own kind,” but withdraw from people who are significantly unlike themselves, for example, “beneath them” or “better than I am,” or of a different color, race, religion, or social status? Or is it just the reverse: do they feel uncomfortable with a person of their own kind and seek, almost compulsively, someone as much unlike themselves as possible?
I also correct interpersonal cognitive errors, for example, I suggest avoidants stop exaggerating relational dangers so that closeness equates to commitment, entrapment, and fatal smothering. I ask avoidants to stop overestimating the degree to which others are being negative to them, turning a cancelled dinner date into a catastrophic signal that all relationships will henceforward be troubled and doomed. I ask avoidants to try only to react fully positively in safe situations with family, chums, and potential or actual partners who are warm, yielding, permissive, and available, and to react with at least some caution in dangerous situations such as those where the possibility of fulfillment is weak. I especially warn them not to attempt to get close to others who are by nature distant, unfeeling, forbidden, and unavailable such as people who are already taken, like “almost divorced” men who promise to leave their wives but have no intention of ever doing so.
I teach avoidants specific interpersonal skills. In particular, I ask them to identify and reduce the contribution they make to the distancing process, where they create relational negativity by behaving in a way that others will predictably find off-putting, if not openly insulting.
I strongly suggest that avoidants routinely exercise their power of positivity—striving to be nice and generous to, and less overly demanding of, others so that they come to act in the same healing way toward other people that they would want other people to act toward them. Being nice is always good practice for avoidants, and that usually involves becoming less critical and demanding of, and more forbearing toward, others, and failing that, if they must feel and behave negatively about and to others, doing so in as restrained a manner as possible so that they can at least leave the door open to making amends—apologizing after the fact, then going back. Being nice also involves being generous—giving others something without expecting to get something in return. That often starts with reducing excessive expectations of others to avoid disappointment that can lead to punishing those who have done one a good-enough good deed.
A Case Example
A student wrote to me asking how he could get a copy of my book on writer’s block, which he wanted to read but couldn’t afford on his small allowance. I guided him, I thought graciously, on how to get the book out of the library, only to have him criticize me and the library as follows: “I’ll order a document copy mailed out (I don’t fully understand what the hell this is, to be honest; you’d think they’d make it clear, operating a service and all . . . I mean, they won’t loan me the book by mail order, but they’ll photocopy every page and mail them to me? I mean . . . seriously, who would do that?). I’ve read your book on paranoia, by the way, not because I’m paranoid. It just seemed interesting, and I like to read a lot, y’ know. I’m not really interested in self-help stuff, to be brutal, I tend to think things come and go, are what they are, so to speak, and if you’ve got a pretty good handle on yourself, you know when to turn a page—forward or back. Y’ know what I mean?”
I also suggest avoidants, such as the student I just quoted, be em-pathic: not getting sidetracked onto how others make them feel to the extent that they lose focus on how they make others feel, as they address only their own emotional needs and not those of the people around them. I advise avoidants that they can best be empathic if they appreciate the good in others, and they can do that by better understanding others’ feelings, needs, and motivations as well as by seeking benign explanations for others’ presumably bad behaviors, forgiving their small transgressions, and thus giving others an opportunity to save face, and themselves the opportunity to retain the possibility of making repairs.
Finally, I ask avoidants to give up their need for full identity maintenance. I remind avoidants afraid of relinquishing any aspect of their identity to a significant other that as the singer Joni Mitchell said, when it comes to love, “some loss of self is inevitable.”4 I also emphasize that new and often more pleasurable identities emerge in close, intimate relationships, particularly the identity of being a happily partnered/happily married individual. I also point out that avoidants can, if they like, compensate for any loss of personal identity they will probably incur in a relationship by developing a new and stronger professional identity independent of, and supplemental to, the personal identity that they are so often highly terrified of losing completely.
This page intentionally left blank
CHAPTER 14 Supportive
Th
erapy
Supportive therapy for avoidant individuals consists of what Benjamin calls “generous doses of . . . empathy and warm support . . . delivered without a hint of judgmentalism or rejection . . . providing] evidence of a safe haven” where acceptance rules. Benjamin also notes that in therapy, “the AVD’s [avoidant’s] pattern is an especially intense version of the ‘generic’ patient position. He or she wants to be accepted and loved, and ‘holds back’ because of poor self-concept and fears of humiliation. The ‘generic’ therapist position addresses this ‘generic’ patient position,” gradually helping the AVD share “intimacies and feelings of inadequacy or guilt and shame,” while the therapist’s “benign and nonjudgmental acceptance of the AVD helps the AVD begin to accept himself or herself [and] as the therapy relationship strengthens, the patient can begin to explore his or her patterns.”1