Taking Things Personally

Lately, in our therapy groups, Elaine (my wife and co-therapist, an LCSW) and I have been considering the cognitive structure of "taking things personally" or "getting one's feelings hurt". Much of the conflict in close relationships seems to start with this issue. Some time ago we realized that we had taken this expression at face value and focused our attention on the conflicts and difficulties that followed, rather than on the starting point.

Let me begin with an example. Maxine has had a difficult day, and comes through the front door with a slam and a muttered curse, having just realized that she left some important papers at her office. Her husband, George, looks up and sees her angry face as she looks at him. Immediately he says "What's the matter? Have I done something wrong?"

Maxine, whose mind was on the missing papers, replies with considerable irritation, "No!". She goes into the bedroom to change clothes and prepare to drive back to the office. George, following her into the bedroom, feels defensive and on guard. "Are you sure?" he asks uncertainly. Now she is becoming irritated with George. "Didn't you hear me say so? Just leave me be!"

George is now sure she is angry at him, and he is not sure what he has done wrong, but he has been looking forward to her return and is now frustrated as well. "I'll leave you be, all right," he replies, and stamps out of the room. He retires to his favorite chair and sulks. Both George and Maxine are angry and primed for a fight.

It's interesting to consider in detail the thought processes involved in the initial stages of the interaction. Maxine is not even thinking about George as she enters the house. He sees her frustration and out of his anxiety constructs a worst-case scenario, i.e. that her anger is about him and some failure on his part. He adds a further extension to this catastrophe with his fear that their relationship is in trouble and that somehow it is his fault. His only plan is to ask Maxine to explain. At this point he becomes another frustration for Maxine, and her anger turns to include him. Her tone of voice confirms his fear, i.e. that she is angry at him about something. He responds with a veiled threat and retreats to sulk, since he has no idea what the "fight" is about. His "sulk" is intended to communicate to her that this is her problem and that he is ready to fight or to just withdraw.

Why does George assume that Maxine is angry at him? George is frequently anxious, which means that he is in the habit of "catastrophizing" every event, looking for the worst possible outcome so that he can prepare for it. For him, the worst case scenario he has constructed to account for Maxine's anger involves him. This particular scenario has at its core the fear that he is failing in some major way to be the partner Maxine needs and that the relationship will break or end. His readiness to believe this possibility is based on earlier failed relationships. He is ready to blame himself for any potential failure, and at the same time to defend himself against any such blame.

Nothing hurts us unless we are prepared to believe in its truth. No accusation or attack can wound us without our consent; we have to believe that there is at least some truth in the attack or we dismiss the attack as meaningless. Think, for instance, of the things that people could say that would hurt you, and you will note that they are all things that at some time have concerned you about yourself. Then think of some totally inappropriate and untrue accusation. In the first instance, the things that people could say that might hurt you are things you "worry" about, that you consider to be possibly true. In the second instance, you would experience the attack as basically futile, because you do not fear that it might be true. This kind of attack is equivalent to telling a Nobel Prize winner that s/he is stupid; the person would not be so much hurt as puzzled at the inappropriateness of the comment. But calling an overweight person “fatty” is guaranteed to result in unhappiness.

Our internal Parent/value structure is the gateway through which accusations have their power. For this reason, people who know us and our secret doubts and guilts can more easily damage us that strangers can. Attacks aimed at our known “triggers” are usually successful (in the sense that they result in our being hurt or angry). This is why battles between intimate partners are so likely to be taken personally. In a sense, we collude with the attacker in attacking ourselves, or we do not and thus take no harm. In the example above, George is ready to believe that he has done something wrong, and thus is vulnerable to the interpretation of her frustration as somehow his responsibility. She did not attack him, but in a sense, George attacked himself. Even in the instance in which the other person deliberately does in fact attack the other person in the relationship, the "consent" of the victim is required for damage to the ego to occur, and the damage, in a sense, is self-inflicted with the active encouragement of the other person.

It is instructive analyze an instance of taking things personally between you and a loved one. List all the actions, thoughts and behaviors that were elements in the conflict. Being careful to be as honest as possible, look for the moments of self-doubt and fear and the content of your thoughts.

“No-suicide decisions”

The problem with having an option to kill oneself is that it is effective in reducing anxiety without solving the basic problem. The suicide option is a plan of action, and like all action plans, functions to reduce the anxiety that arises from having a problem with no easy solution. A reduction in anxiety also reduces the motivation to find another and better solution. Making a “no-suicide decision” will sharply increase the anxiety-level. The increase in anxiety motivates us to find a new solution to life’s problems

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Recently a battered wife whose alcoholic husband regularly threatened her life told me she could stay in the marriage because “if it got too bad, I can always kill myself”. The thought of having a “way out” through suicide reduced her anxiety at the thought of being “trapped” and made it possible for her to continue living in that situation. The effect of making a no-suicide decision is fairly obvious: 1) her anxiety level is going to rise sharply since she no longer has “a way out”; 2) the rise in anxiety level should trigger other solutions that do not involve suicide.

Imagine yourself for a moment in her position. You can find the situation barely tolerable by reminding yourself that if the situation “gets too bad” that you can always kill yourself. Your counselor tells you that if you make the no-suicide decision, you may have another 30 years in that situation.

The counselor then asks “Can you imagine enduring your situation another thirty years or so?”

You reply “Absolutely not!”.

This vignette illustrates the power of the no-suicide decision to provoke a new decision to change things.

The no-suicide decision has been described in other articles by myself and others, and is quite simple to describe technically, if somewhat more difficult to put into practice. A person who indicates their willingness to make such a decision is asked simply to read the following words from a piece of paper or from a blackboard: “I may feel like killing myself AND I will not.” The person making the decision should be told not to change the wording. Note that the statement deliberately separates feelings from behaviors. It is important because patients frequently feel they are unable to control their emotions and thus would be making a “false promise”.

The therapist then points out that only the client can tell whether or not the statement is true. The client may be asked to read the statement without meaning it, in order to clarify the difference between commitment and insincerity. The person can be invited to “Say it again and mean it”, but more often the patient will spontaneously carry out this action. I always ask the patient if they felt “solid” with the decision or if they were not sure if they meant it. If they indicate uncertainty, I suggest they spend some time thinking about it and discuss it with family, and at a later time with me. It is not useful to bring pressure to bear on the patient, since inducing some kind of insincere compliance is counterproductive.

It is important to emphasize that this decision is NOT a contract of some kind. It is not an agreement between client and counselor. It is not a “promise”. Contracts and promises can be broken. The no-suicide decision is not between the client and anyone. It is not dependent upon anything. Sometime their heightened anxiety causes them to look for “loopholes”. I suggest they add the following: “If I find a loophole in my decision, I will not take it”.

I am intrigued by the fact that making such a decision is so difficult without the presence of another person. Why can’t I tell what I mean when I’m simply thinking to myself, or even talking aloud while driving alone? I do know that the moment such thoughts are expressed to another person actively listening whose opinion I respect, I can tell whether I am being truthful or just playing with thoughts.

Bear in mind that the no-suicide decision is not for the benefit or reassurance of the therapist. It is to allow the patient to force him/herself into a position in which s/he will be under pressure to make changes rather than continue temporizing. Patients sometimes want to engage in pseudo-philosophical discussions rather than actually make a commitment. These tend to be the same patients that talk and talk in therapy without actually doing anything. “Talking about” for them is instead of taking action, rather than preparatory for action. I have been known to suggest suspending therapy for a period of time to “give them time to think things over”.

I strongly believe that patients in therapy with open suicidal options will do very little except talk. If therapy is a place in which people wish to change, an open suicidal option precludes that possibility. In early stages of therapy clients are often involved in philosophical exploration, rumination, self-examination. They are not ready to change; they are in what Prochaska calls “pre-contemplation”. I want to be clear that no-suicide decisions are necessary only in the stage of therapy in which change is the goal.

A more serious technical difficulty is in the timing of suggesting a no-suicide decision. Very early in the therapy, when the relationship of therapist and client is still new and tenuous, it is easier for the client to terminate rather than face the anxiety and discomfort of change. By suggesting the no-suicide decision too soon, the therapist may be asking the patient to give up a tactic that for some time has provided the only “way out” of a difficult or impossible life. Why should the patient believe the therapist is competent and has something to offer that is better?

Clients would not come to therapy if they were simply and purely suicidal. They would be dead. They are in therapy because, whether or not they know it, they are significantly ambivalent. They want to have a life but fear it. They fear they won’t be competent to solve their important problems. They fear that a solution to their problems may require a radical rethinking of their values and beliefs. They may not be ready; they may not be able; they may lack the courage.

A caveat: Therapists who have open suicidal options themselves will be generally ineffective in getting no-suicide decisions from patients.

Suicidal Life Styles

Some suicides happen impulsively. Some suicides are deliberate and result from a rational decision to end physical suffering and pain. Many people have occasional suicidal impulses and do not act upon them, and some people endure physical pain and suffering for lengthy periods of time without seriously considering suicide. In this article I want to examine the frame of mind in those for whom suicide IS an option, whether or not such people actually kill themselves.

A surprisingly large number of people have an open “suicide option”. This option is a conscious willingness to consider death as a legitimate solution to a difficult problem. If you ask whether suicide is an option for such people, they can give you a direct answer, because it is always a conscious choice. They see suicide as a legitimate and reasonable solution to life’s problems, at least under certain circumstances. I have for a long time been interested in the developmental histories of people with suicidal options, and I have noted certain consistencies, both in their historical development and in their subsequent life styles.

To carry out a decision to kill oneself the suicide option has to be actually open. A close friend of mine, facing a certain and painful death from cancer, decided quite rationally to end his life. When the moment came, however, he discovered to his own surprise that he was quite unwilling to actually do it. Another psychologist friend (who had been in therapy for many years with little change) told me that “knowing I can always kill myself is the only thing that keeps me going.”

For a suicide to take place, there must be as a minimum an open suicidal option. Some people have this option, and others do not. Where does it come from? Many psychotherapists have asserted that the decision to die is made in childhood, when it is seen as a solution to an intolerable and inescapable situation (Haiberg, Sefness and Berne, 1963; Boyd, 1972; Drye, Goulding and Goulding, 1973). It is unfortunately not difficult to find instances of deliberate suicides carried out by children.

Children have a limited capacity to understand the real nature of death. They also have a very limited ability to deal with difficult or even unbearable situations, such as a brutal or sexually predatory parent or total abandonment. They have few choices in reality. They can’t move away or seek shelter from other sources; they are in fact helpless. Their resultant anxiety can be overwhelming when they see no way out of their suffering.

One way they may find of reducing anxiety is to make a plan that they can actually carry out. This decreases the feeling of helplessness that makes the pain so unbearable. When children discover that suicide is a choice they can make and actually carry out, their anxiety is relieved, though the subsequent depression and sadness is not. The price of that decision (which I will discuss later) is not obvious. It is important to note that the function of the suicidal decision/option is an immediate reduction in anxiety.

Holloway (1973) described the suicidal decision in children as an “escape hatch”. It takes the form “If things get bad enough, I can always kill myself”. People with this escape hatch frequently find this thought passing through their minds. It becomes something of a crutch, used consciously to decrease anxiety in a difficult situation. As such, it is reassuring and rewarding, a reaffirmation that the person is neither powerless or helpless.

It is necessary to understand how important the suicidal “crutch” is in decreasing anxiety. As an anxiety reducer, the suicidal decision is constantly reinforced, even in situations not in themselves critical. It is actively seen as a solution to many of life’s problems. There is a price, however. Keeping this option open requires that the person be able to see life as something that can always be left. To get too attached, to love too deeply, to become too successful, to be too happy, make leaving life more difficult.

Many times I see people (including clients) back away from positive experiences, avoid intimacy and love, sabotage success, but tolerate a mediocre and lackluster and “safe” existence. They do so to protect their “solution”, because reducing their anxiety is more important to them than chancing success and failure. They seem to live as if they cannot move too far away from the graveyard or the “safety” of the grave. To be ready to go on a trip, one must keep one’s bags packed. They seem to believe that real happiness would somehow leave them trapped, a thought they find unbearable. Death becomes a security blanket, a promise of escape. But it is also an escape from life, an avoidance of any passionate commitment to make things better.

Others allow themselves more happiness and success, but in their minds they attach a condition for continuing to live. They remind themselves that “if things go wrong”, meaning if they lose their money or their life-style or their loved partner, they can exercise their suicidal option. There is a tentative quality to their happiness and success; their willingness to continue in life is based on the chance that life will continue to meet their demands. No one with a suicidal option, placed in the situation of the Swiss Family Robinson, would have the endurance or will to create a good life from disaster. If life becomes overly painful, they neither make things better nor endure them with grace. People associated with them are frequently aware of the tenuousness of their commitment to life.

The result of this half-hearted life style is that the person with the suicidal “escape hatch” is very prone to depression. They are frequently aware that there is something missing, that somehow their happiness and love are incomplete and unsafe. Their marriages, their careers, their education, their therapy all have the mark of limited commitment. Because of this failure to commit, they have a sense of alienation from others, a distance from life that isolates them.

So we see four kinds of consequences for keeping the suicidal option open:

1) A general failure to commit wholly, to connect to others wholeheartedly;

2) A basic passivity toward the ills of life and an unwillingness to commit oneself to correct them;

3) An overall pessimism about life sufficiently intense to make the fantasy of death an effective reliever of anxiety;

4) A willingness to trade the anxiety over being helpless and abandoned for a general mild and predictable depression and alienation.

In the next part I plan to discuss how one gives up the suicidal option. The references cited in this note are available on request.