The most untherapeutic therapists create more avoidance than they relieve by offering themselves up as substitutes for real relationships. A therapist who needs to fill his or her practice and bring in enough money to live on might unconsciously discourage “outside” relationships in very subtle, almost creative ways. For example, one therapist, advised by a patient that she planned to marry a man her junior and stop therapy, replied, “Men that much younger than you are only interested in your money”—in this case, clearly a projection.
DO NOT BE OVERLY INTELLECTUAL AND IMPRACTICAL
What some avoidants really need is a directive, nuts-and-bolts lecture on what the therapist believes constitutes being avoidant and how and why to change that. Therapists who avoid “lecturing” their avoidant patients, whether they do so by overanalyzing; overcorrecting thinking; overmodifying behavior; overgiving drugs on the assumption that the problem is biological, not psychological; or doing bio, instead of giving positive feedback, should consider the avoidant’s cry of “I’m afraid of rejection” as an opportunity to say something trite but true, like “it’s better to have loved and panicked than to have never loved at all.”
DO NOT DO FAMILY THERAPY WHEN INDIVIDUAL THERAPY IS INDICATED
With avoidants, the advantages of family therapy are often outweighed by the disadvantages. In particular, in family therapy, it is difficult for the therapist to take the family’s side, even when indicated, since avoidants regularly misinterpret the therapist’s in any way siding with family members in interfamily disagreements as a criticism of or an abandonment of them, the primary patients.
DO NOT BECOME IMPATIENT WITH AVOIDANTS
Some therapists find avoidants frustrating. Perhaps therapy is going too slowly and the therapist is tempted to lower expectations in a rush to see some movement and terminate. Perhaps the patient is deliberately being stubborn in order to provoke the therapist to declare, “Impasse, let’s take a vacation from therapy” or “Let’s quit, I’ve done all I can do for you.” The therapist suggests marriage is the goal and the patient counters that he or she instead prefers a long-term committed relationship because marriage isn’t right for everyone; or the therapist suggests a long-term committed relationship before, or instead of, getting married, and the patient counters either that all he or she wants is a circle of friends and acquaintances, not anything more intimate, or that marriage is his or her goal, and that by suggesting otherwise, the therapist is trying to humiliate and defeat the patient. Impatient therapists at best cut corners, cow patients into saying they feel better, dismiss ill patients from therapy before they are better, or, at worst, as happened in one case, essentially “throw the patient out of treatment” without notice, and in the middle of a session, because “we aren’t getting along very well and it’s better if we cut our losses and I don’t waste your money; but I will ask you to pay for this entire session since I can’t fill the time on such short notice.”
DO NOT TAKE AVOIDANT NEGATIVITY PERSONALLY
Too many therapists come to dislike and become overly critical of avoidants as their response to taking the patient’s negative transference personally. Patients who, with very little justification, complain, “You are criticizing me” make some therapists uncomfortable because they make them feel like a critical parent or an errant child. Patients who disagree with everything the therapist says, damning it into oblivion by responding with faint praise, foot dragging, or lack of movement to brilliant, apt, insightful, and decisive formulations, make some therapists feel like misguided fools wasting their time and the patient’s money. At times, avoidants’ guilt about their sexual instincts arouses like feelings in the therapist, enhancing the therapist’s sheepishness about having a body and sexual desire. Some therapists feel that all avoidants are too distant and remote for their taste; and I have even spoken to therapists who view the avoidant patient as a “cry baby” because “most of them are unable to suck it up and tolerate even a little social anxiety.”
Therapists often act out their feeling critical by using deep interpretations to hurt, as in “You are as hostile to others as your mother was hostile to you.” They blame the patient for actively causing every rejection he or she in actuality experienced passively. Too often, they refer to avoidant “misanthropy” when it would be less confrontational, and truer, to refer to avoidant “fear.”
DO NOT BECOME OVERLY SYMPATHETIC TOWARD THE AVOIDANT “PLIGHT”
Overly sympathetic therapists view avoidants solely as the innocent victims of less than ideal inner and outer circumstances and even conceptualize the patient’s avoidance as a “disease over which you, the sufferer, has no control.” They should instead ask avoidants to take some responsibility for themselves and their actions. Blaming early trauma exclusively for the avoidant’s present plight is common, but it has the effect of excusing avoidants for being avoidant. That, in turn, supports their desire for the world to change when they are the ones who need to work on making many of the changes in their world.
CHAPTER 17
Hel ping Avoidants O vercome Their Fear of Criticism
As the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, suggests, avoidants hesitate to look for interpersonal intimacy because of an extreme sensitivity to criticism that leads them to fear being “exposed, ridiculed, or shamed” and subject to “mockery or derision.”1
Avoidants do not feel criticized only when they haven’t been; they also deny that they have been criticized when they have been. In the latter case, instead of registering criticism consciously, they perceive it, but subliminally, or suppress it completely, thus allowing it to fester to the point that it leads to unmanageable, seething anger, and stuck just below the surface, it causes ongoing divisive resentment, ultimately outing to wound or destroy their interpersonal relationships.
It helps if avoidants recognize that so often, when it comes to being criticized, the problem lies not with something that they, but something that their critics, did wrong. To this end, avoidants can profitably understand what motivates their critics to be criticaclass="underline" their presumptuousness, their prejudice, and their distortive cognitions, all of which render their criticism too impersonal to be taken personally. Thus most critics
• are judgmental people prone to getting easily upset and, when upset, to hurling random epithets that predictably hit avoidants, individuals already guilty and hypersensitive, particularly hard
• are in an irrational transference to their subjects, mistaking them for a prying mother, controlling father, or competitive sibling
• have identified with their own shrill, harsh, hurtful parents and now are abusing people in the present the same way their mothers or fathers abused them in the past
• are basically talking about themselves, that is, criticizing themselves in the act of criticizing others. For behind all criticism of others lurks a self-criticism as critics routinely project onto, then humiliate and demean, others for traits they dislike in themselves. Therefore avoidants should reframe the negative things critics say about them as negative self-statements on the part of the critics, displaced outwardly, with criticizing another being just the critics’ way to criticize themselves, with the “you” being a “for example,” and so the formulation “it takes one to know (and criticize) one” here holds a special truth.