Boundary exceptions

“Rules” are values which prescribe or prohibit certain behaviors. We grow up with rules, but as adults few of us follow them rigidly. For the most part we follow our rules, but we sometimes allow ourselves to break them under certain conditions and engage in behavior that we might not normally condone. Of course, such exceptions determine the actual boundary of the rules.

Even in the law, rules are never completely rigidly enforced. Instead of mechanically imposing a consequence on a breach of rules, a human being such as a judge can consider the particular circumstances. For instance, we have a rule forbidding murder. Courts have held, however, that under certain conditions the consequences of breaking the rule can be modified or an “exception” made. Such a condition might be that the murderer was experiencing a strong emotion, such as passion, anger or fear. While we may punish a premeditated or "cold-blooded" murder to the fullest extent, a murder based on strong emotion might be assessed a lesser penalty. The rule forbidding murder may be granted an exception under these circumstances.

I chose this particular example because the “strong emotion exemption” to laws is based on a common to many cultures. We tend to excuse to some degree an otherwise illegal act if it was motivated by sufficiently strong emotion. We believe an emotion that is strong enough may justify a temporary exception to our rule. The “strong emotion” exception is of particular importance in understanding human behavior.

It's as if we said to ourselves "I will never do X", and then privately to ourselves, we add "…unless I'm very angry/frightened/depressed/sexually-aroused”. As a result, the test of all our rules is whether there is a hidden or at least unspoken "exception". As a psychotherapist, I want to know the exceptions to someone's rules and boundaries; I want to know under what conditions they are willing to make an exception to a rule they espouse. Often people are unaware of their own exceptions to their rules, or they may take it for granted that “strong-enough” emotion” automatically grants an exception.

We talk about strong "justifying" emotions as if they were something that "comes over us", that overwhelms our judgment, as if they were something outside of our control. There are truly moments like that, such as in catastrophic events or in combat, but these are fortunately rare. Other than in such emergent or catastrophic situations, much of our extreme emotion is self-induced. We increase or sustain an emotion by going over and over a series of thoughts justifying our emotions. We call this tactic “ramping”. With each repetition of these thoughts our emotion grows stronger until we stop it or until we allow it to reach the level of intensity that "justifies" breaking the rule.

A patient of mine, "Fred", who was driving on the highway was "cut off" by another driver, in what Fred felt was a rude and inconsiderate way. He was outraged. He followed the driver almost sixty miles, all the way "steaming" over his mistreatment. He pulled in behind the other driver in a parking lot, went over to the man's car, opened the door and pulled him out, with the intention of "teaching him a lesson". However, the man obviously didn't even know what Fred was talking about, and was frightened. Fred suddenly recognized the inappropriateness of his own behavior, let the man go, went back to his car and drove off. Later, in my office, Fred said "I drove 60 miles, enraged, ready to hit this guy, and he didn't even know he had done anything! That's just crazy! I don't know what's the matter with me. I would never hit another person."

Of course Fred would hit another person. His rule against hitting has an exception in it. He doesn't mention the exception because he doesn't like to think of himself as a person who hits others, but his exception is clear. If Fred feels sufficiently wronged, he goes over and over his “wrong” thereby becoming increasingly “righteously angry”. When angry enough, he allows himself an exception to his "no hitting" rule. A more precise description of what occurred shows that at the time of the “infraction”, Fred decided almost immediately that he was angry enough that he was justified in hitting the other driver. While he was driving, by going over and over his grievances, he was keeping his anger “ramped up” so that his anger could overcome his rule and allow him to strike a blow. It took a lot of energy to keep his anger going for an hour.

In the parking lot Fred realized that the offending driver was totally unaware of his driving infraction.. Another of Fred’s rules which conflicted with hitting someone popped up: "It's not right to hit someone who doesn't even know they've done anything wrong". His anger dissipated as he recognized that he had been wrong in his thinking. He no longer felt “justified” in breaking his rule. As a result, he stopped ramping his “righteous anger” to the exception point.

We can increase any emotion by ramping up in this way. Whatever the thoughts we have which create or renew our feeling, we can continue cycling through them over and over. Sometimes the rule we are considering breaking simply doesn’t fit our self-image. Someone who is normally proud of “self-control”, for instance, might mentally ramp up sadness in order to justify wallowing in self-pity or simply withdrawing for a while. In a more extreme (but not unusual) instance the self-pity might justify substance abuse or a suicidal gesture. A person who thinks of himself as “brave” might ramp up fearful thoughts in order to justify running away or “backing down”.

We might conceal our unspoken exceptions in order to hide our real intentions or plans. A depressed patient, for instance, might state that he would "never kill himself", but when pushed to state the "exceptions", said "… unless my wife left me... I couldn't stand that". Sometimes the exceptions are so clearly dishonest that the person doesn't admit them even to himself until after the exception has occurred. A married patient admitted to having sex with his wife's best friend, but commented that he "had had too much to drink, and besides, I didn't think my wife would ever find out." He would never have admitted his rationalization PRIOR to the unfaithfulness. It’s interesting to speculate what a marriage service would sound like if the prospective partners had to announce the exceptions to their vows.

The "ramping up" process is a familiar one in cognitive therapies. We use it to whip ourselves up emotionally in order to justify our breaking a rule/boundary. When we do so, we manipulate our own emotions in order to “motivate” our own behavior, rather than making a more rational and cognitive decision. Such apparently impulsive decisions, being dictated by a more primitive and emotional part of ourselves, tend to be of more or less poor quality. We may find ourselves doing things that at a less emotional time we would find unacceptable.

Stopping ourselves from “ramping” is easy to describe: We simply recognize cognitively the cyclic pattern of our "ramping" thinking and choose to break it. By doing so we stop creating more emotion and thereby protect ourselves from arriving at the point where our boundaries have exceptions. Without using strong emotion as a justification for action, we must make behavioral choices based on intellect and logic. Unfortunately, for many if not most of us, intellectual and logical choices do not provide very strong motivation. We may not be so accustomed to making choices coolly by an act of the will. However, by acting on our more mature values we strengthen them and our own emotional maturity. Knowing and admitting our exceptions is an important step in limiting or eliminating them, and every time we are able to do this, we move in the direction of greater emotional maturity.

Self-deception

We can understand why people lie to each other. They lie for some sort of advantage, personal or financial; they lie to avoid disharmony or disagreement, to impress, to mislead. Why do we lie to ourselves?

As a psychotherapist, I spend a lot of time listening to people lie to and about themselves. Generally we lie to ourselves to maintain an image of ourselves more or less false to fact. We reassure ourselves that we are stronger, braver, more able to tolerate pain than we really are. We present to ourselves the image of ourselves we would like to have others see. We deny our age, appearance, weight, sadness, disappointment and grief. As when we lie to others, we lie to maintain a stable and manageable world, one in which we do not have to adapt nor change.

On a deeper level, we always know when we are lying to ourselves. It takes energy not to know what we know. Turning a blind eye to ourselves in spite of all the evidence is effortful.

I think it was Fritz Perls who said that change begins with who we are, not with who we want to be. We have to be willing to let go our fantasies of ourselves before we can recognize what we can or cannot change. So our conversations with others are full of dishonesty and pretense, as we try to present ourselves in accordance with our self-delusion. Others pretend to be deceived because it is easier, more comfortable, and certainly more socially acceptable to be dishonest. Besides, when we accept the dishonesty of another we have a sort of bargain that they, in turn, will accept our dishonesty in return. In this way our social and internal psychological systems remain stable and predictable.

People who promote instability and change in relationships do so by being honest and hopefully kind as well. Psychotherapists make a living by doing this, but loving friends can also serve this purpose. It takes a strong relationship to withstand much honesty, but any relationship that embodies honesty promotes change and growth. Kindness is optional in the encouragement of growth, but as I get older it seems to be a more and more important option.

Dreams in psychotherapy

Many therapists, trained in the psychoanalytic tradition, have regarded dreams as a "royal road" to the unconscious mind. Much time has been spent in the clever and creative analysis of the dreams of patients. Patient dreams are said to be the production of some inner unconscious and highly creative voice, whose stories and creations cannot be understood by the dreamer but which seem to be couched in language understandable by the therapist.

Interestingly enough, the dreams seem to be tailored to the therapy. For instance, the patients of Jungian analyists have dreams full of Jungian symbols; patients of Freudian analysts have Freudian dreams, and so on. It appears that the dream is a communication specifically aimed at and couched in the specific language most meaningful to the receiver/analyst. From whom is the meaning concealed? The patient himself. So the patient has found a way to provide information to the therapist without having to understand it him(her)self.

It's easier to understand a dream as a somewhat dishonest form of communication in which the sender does not have to recognize nor take responsibility for the content. Such deception results in the therapist knowing more about the patient than the patient knows, and the therapist is thus cast in the expert/parental mode in relationship to the therapist.

Transcripts of early sessions of dream-oriented psychotherapy leave little doubt that the therapist can eaily train the patient to speak the therapist's professional language. Patients then become extraordinarily able to express themselves without having to recognize what it is they are expressing, leaving the therapist to translate for them.

How is the patient benefitted by this indirect form of communication? By keeping the dream symbolic and indirect, the patient is in a position to deny responsibility and ownership of the content of the dream. The all-knowing therapist (like the Sibyl of Greek times) can explain the content, unscrew the inscrutable, and have his/her position of authority confirmed.

I think it better to discourage the recounting of dreams in a therapy session. The time is better spent developing a relationship in which patients can become comfortable with their own inner life and with the therapist, enough, at least, to be able to tell their secrets more openly. Honesty and directness are attainable goals, and they bring lasting benefits of increasing self-honesty to the patient. In a good therapeutic relationship, there should be no areas that are too uncomfortable to be discussed.

Therapeutic relationships

Back at the beginning of my practice as a psychotherapist, a patient once asked me why I was a therapist. I thought of several answers. Helping others is a good thing, I thought, an answer that would have pleased my grandmother. Bill, a therapist who was my consultant, laughed and said "Bullshit. It's an easy way to earn money sitting down". I thought at the time that his answer was both honest and clever. It certainly minimized altruistic and "helping" sorts of motives, both of which I was beginning to distrust. I now recognize that his answer was only partially true and in fact trivialized an important question: What does the therapist get out of doing therapy? Is it just money? Is there something wrong with enjoying one’s work?

Why had I learned to distrust altruism? Painful self-examination in my consultant’s office showed me how often other more selfish and personal motives were concealed behind the altruistic label. When I gave the "helping others" answer, I was concealing from the patient AND from myself the pleasure I got from imagining myself in a "superior" and knowledgeable position, of being the helper to a less wise person than myself. I liked the idea of being admired, of being thought of as wise. One of the problems with being paid off with admiration and humble gratitude is that there is no way to enforce being paid in that coin. My self-worth was entwined with the patient rewarding and reassuring me with gratitude. So the patient would gradually become aware that he or she owed me more than money, and that our contract had been somewhat dishonest from the beginning.

Bill's point, poorly made but valid, was that the patient owed us no reward of any kind other than money He meant we had no right to exploit patients who rely on us. The idea that the patient owes us something besides the fee, such as gratitude or admiration or even love, is a betrayal of the trust we rely on for conducting therapy. But we're not just in it for the money; Bill was wrong when he said that it was easy work. It's hard work, in fact. There are many easier ways to make money, but there are intangible rewards for me in addition to the money, even though those rewards don’t come directly from the patient.

On a surface level, it's important to me to believe that I help people, that in some way I help them diminish their suffering. On a more primitive level, I am rewarded as well by having the opportunity to gratify my interest in solving puzzles. Every time I see exactly how a patient’s previous life experiences, choices and thoughts give rise to present puzzling and complex behaviors, I have a sense of satisfaction. I see once again that there is after all a logic in human behavior. Behaviors that appear to be puzzling and even self-destructive are meaningful, sometimes in a primitive way, but they can be understood. No matter how irrational or even bizarre, they are not random. They are the direct outgrowth of decisions and choices the patient has made in the past. When the patient and I recognize this we have a sense of things falling into place and making sense. The patient recovers his sense of autonomy and power and feels less controlled by forces out of his awareness.

Patients begin the therapeutic relationship experiencing much of their own behavior as puzzling, illogical and painful. They have lost some of their sense of autonomy in their lives, and yet they do not see how they can behave differently. They experience important aspects of their lives as out of their control, and their self-deception conceals from them their own responsibility and their power to change. I often feel frustrated and alienated from them as their friends and families must be. I feel distanced by the apparent impossibility of understanding their behavior and feelings. Intellectually I am curious, then frustrated by their unwillingness to behave “reasonably”. The conflict appears to be initially between the patient and me, but is really inside the patient even though not clearly a part of their awareness. I struggle to understand them; they struggle to communicate with me more clearly, and in that struggle issues begin to clarify and emerge. The need to be honest, as honest as we can be with each other and ourselves, and at the same time to be understood by another human being, makes the therapeutic relationship more intense than others.

As time goes on and as the struggle continues, I begin to understand the patient more. Their behavior begins to make sense to me and to them. As we begin to see how the previous habitual and only partially conscious choices the patient has made have led them almost inescapably to where they now are, they begin to feel the freedom to make new choices. At the same time, I see increasingly how much alike we are, how human and essentially simple we are, and I feel re-connected to both the patient and the human race. Our struggle and attempt to be honest with each other reinforces and teaches us how to be connected.

I was recently re-reading Irv Yalom’s excellent book of therapeutic vignettes, Love’s Executioner. In particular I was struck by the recurrence of one theme: his finding a way to like and show liking to people who were not easily likable. More and more I notice that the patients who do the best in therapy, who make the most profound changes in their lives, are exactly the ones I find that I like. My liking for my patient grows with my understanding of the patient’s life. I wonder frequently if this capacity to find a way to like difficult people is something that characterizes competent therapists. Perhaps people only feel the freedom and confidence to change in an atmosphere of genuine liking and mutual respect.

In therapeutic relationships there is a built-in imbalance that is not tolerated in regular (i.e. not paid-for) relationships. In normal healthy friendships and within the intimate conversations that accompany them, there is a certain balance in the flow of revelation and honesty. We expect to share thoughts. We expect to take turns listening to one another. We need to experience mutual respect and equality of power or status in the relationship. The flow of help, understanding and tolerance must generally be two-way and over time it also must be in balance.

Therapeutic relationships, by their nature, are unbalanced. We need to find balance and reciprocity in our relationships, and when they are more one-sided, where the flow is predominantly one way, they can become toxic. Partners in unbalanced relationships experience increasing resentment and feelings of exploitation or alienation. The money or other value that changes hands serves an important role in maintaining the balance in therapeutic relationships, without which they eventually become toxic.

So Bill’s clever response has an important element of truth in it. What the patient owes me is only money. Money is an OK thing, but there are many ways to get it. What I get from the relationship (not the patient) is the chance to practice my craft well, the opportunity to grow in understanding, to solve riddles, and to become more connected to my own humanity and that of others. And it feels good to like people.