Interpersonal Patterns in Group

This chapter briefly introduces the theoretical concepts on which the patterns are built.

Healthy Capacities

First some basic definitions. Human beings have the potential for a variety of healthy capacities. This theory focuses on interpersonal capacities such as connectedness, safety, and autonomy. These capacities are present to a certain extent in young children, but most of them must develop during childhood (and to a lesser extent also during later life). For optimal development of these capacities, a child requires the appropriate parenting and other influences (from siblings, relatives, peers, teachers, and the culture at large) that support and nourish these capacities. Each capacity includes both inner experience and behavioral ability.

Understanding Psychological Health. I believe that healthy living derives primarily from healthy capacities using flexible schemas (see next section) for guidance. Most object relations theories and self-psychology take the stance that health derives from healthy psychological structures. These theories don’t include any concept like healthy capacities. Healthy capacities are not structures; they are the actualization of innate abilities. Let me explain further.

Human beings have an innate potential for healthy living and relationships, which requires the right environment, especially the right parenting, to be actualized. In genetics, the “genotype” is the actual genetic endowment and the “phenotype” is the physical characteristic of the organism which will be realized under the influence of an appropriate environment. For example, a man might have the genes to be muscular and strong, but he would need good nutrition and the right physical activity in order to actualize this strength. The genotype is comparable to a person’s innate potential for psychological health and the phenotype to the actualized healthy capacity.

To the extent that a person has an adequate environment, he[1] will develop healthy capacities for interactions and relationships, characterized by his ability to creatively initiate and respond in the moment, taking into account both his desires and the needs of the person or group he is relating to. His response will be flexible in the moment, not rigid or stereotyped. He will expect things to go well but be prepared to handle the situation if they don’t. When a child develops a healthy capacity, it is not just a structure in the psyche based on the good parenting he received. It is his real self, an actualization of his innate potential, enabled because of good parenting but not simply an internalization of it. In other words, psychological health derives from the actualization of our human potentials, made possible by a favorable childhood environment. It is not simply based on psychological structures (object relations or the “self”) that represent the interactions in such an environment. My ideas on this are consistent with Gestalt therapy (Perls et al. 1951) and humanistic psychology in general (Rogers 1951; Maslow 1971), but since I differentiate psychological health into various capacities, I am able to develop a theory with more clinical detail. In chapter 9, I will discuss further the advantages of this way of conceptualizing psychological health.

Central Capacities. There are four healthy capacities that are especially important for psychological well-being which I focus on in this book. These are connectedness, autonomy, safety, and value. They are described later in the book when we cover the patterns that are related to each one.

Schemas

A schema is a structure in the psyche based on past events that influences the way people see and feel about themselves, relate to others, and act in the world. This influence can be conscious or unconscious. A schema is a way of coding memory so that it can be used in future interactions with the world. Schemas are the internal basis for transference reactions. A schema can include a representation of the self, other people, and other aspects of the world. Because of my clinical interest in therapeutic change in group therapy, I focus on schemas which consist of either self-representations or representations of interpersonal relationships (Safran & Segal 1990). These representations involve more than just beliefs and images; they also include emotion, perception, motivation, body sensation, expression, and action.

Let’s look at an example of a schema. If a girl, Marcy, was consistently rejected by her father, she might develop a schema with an internal representation of the self as needy and unlovable, and a representation of the other as desirable and rejecting. This schema would likely influence her self-esteem and the way she relates to men.

Rigid and Flexible Schemas. If the influences that create a schema are traumatic, painful, pervasive, and/or dysfunctional, then the resulting schema will likely be rigid. This means it will be applied inappropriately, will block the exercise of the person’s healthy capacities, and won’t be modified according to experience. For example, if Marcy’s rejection by her father was severe and pervasive, then the resulting schema will tend to be rigid, and Marcy will fear rejection from all men regardless of how they actually treat her. She will probably also feel negatively about herself. Her healthy capacities for intimacy, self-esteem, and the ability to reach out to others would be blocked by this schema.[2]

A flexible schema is held more lightly, applied more appropriately, and allows the creativity of the person’s healthy capacities to be used. It will also be modified according to what happens in the moment. For example, if Marcy had a more flexible rejection schema with men, she would be able to discern when a particular man really liked her and enjoy his warmth. With enough reassurance, she might be able to reach out to certain men. She might not need to defend against her desire for men, or if she did, the defense would be less extreme and more easily relaxed. After meeting some men who clearly respond well to her, her “men” schema would change in a positive way to reflect this new reality.

Activity. I will use the term activity whenever I want to refer to either external, observable behavior or internal experience, such as feelings, self-image, and motivation. Problematic activity[3] is activity that derives from rigid schemas, producing psychological pain or symptoms, problems in living, or harm to others. Healthy activity enhances the well-being of self and others. It means that a person feels positively about herself and trusting of others unless there is evidence to the contrary. It means that a person can get what she wants from others while respecting their needs. With healthy activity, a person can have close, intimate relationships and also be a separate, self-directed individual. Healthy activity results when people live and relate primarily from their healthy capacities with guidance from flexible schemas. The goal of psychotherapy is then to make rigid schemas more flexible and to develop and liberate healthy capacities, thereby promoting healthy activity.

Painful and Defensive Schemas. Schemas that are rigid tend to be of two types: (1) Painful schemas are those that reflect the original traumatic or dysfunctional relationship (or aspect of a relationship). In this book I also use the work core issue to refer to a painful schema. For example, Marcy has a painful schema that is based on her rejection by her father. (2) Defensive schemas are those that are used to defend against the awareness or experience of a painful schema. For example, Marcy might develop a schema in which she sees herself as superior to men and therefore not needing anything from them. This schema would protect her from experiencing the low self-esteem and fear of rejection that derives from her rejection schema with her father. Defenses derive from defensive schemas. For example, Marcy’s acting aloof from men would be a defensive reaction.

Three Classes of Activity. To summarize, most interpersonal behavior can be divided into three broad classes: (1) Healthy behavior comes from healthy capacities with some guidance from flexible schemas. This is the goal of therapy. (2) Some behavior is a living out of a painful schema or core issue. This is problematic, of course, but if the person can experience and understand the pain, it becomes an important step toward healing. (3) Defenses are an attempt to escape the pain of painful schemas. These must be softened or relinquished for the change process to proceed. In addition, much activity is comprised of mixtures of these three.

The Change Process

Access. The client explores those feelings and memories that are buried deeper in the psyche behind defenses. This includes uncovering pain or healthy capacities that have been blocked.

The most common kind of access involves experiencing the pain of the underlying painful schema and exploring its meaning and possibly its origin in childhood. Through this process the person accesses the painful schema, both experientially and cognitively, in a way that opens it up for therapeutic change. The greater the client’s emotional presence, interpersonal involvement, transference, and insight, the greater the access, and therefore the deeper the change that is possible. For example, in the access phase, Marcy might let herself experience her fear of being rejected by Ben and allow this to show in the group. For even greater access, the leader might encourage her to connect this fear with her rejection by her father and to feel this childhood pain. The more fully she can experience this and the deeper her insight, the greater her access. This opens up her psyche to inner healing in the subsequent steps. Access is not always necessary, and sometimes not possible, but when it occurs, it increases the degree of therapeutic change that can result.

Clients can also access healthy capacities that have been blocked because of the fear of negative responses. For example, Marcy might have blocked her experience of needing contact with people because of her father’s rejection of her. The access process might open up Marcy to experiencing her need for a connection with Ben. This need is part of Marcy’s healthy capacity for connectedness. A later step could be to experiment with expressing that need.

Healing Response. The group member receives something which redresses and heals the original painful, traumatic event or relationship. This is usually a parenting-like activity that comes from another group member, the leader, or the group-as-a-whole. We can think of it as reparenting, though it need not come in a parent-child form. The most common healing response is caring, which includes empathy, identification, compassion, acceptance, appreciation, or understanding. For example, after Marcy explored the pain associated with her father’s rejection, Ben might tell her that he appreciated her openness and courage. This would be the kind of response that she needed to receive from her father, and would be a step in healing the wounds from that relationship.

Other healing responses may also be necessary, depending on the original trauma. Sometimes protection is needed, sometimes closeness without harm. Sometimes a healing response must come after experimenting. With certain types of painful schemas, the person is afraid of a negative reaction to her healthy behavior. When she experiments with this forbidden behavior, she will need to receive acceptance or even appreciation instead, which is a form of healing response. For example, if Marcy was rejected or ridiculed for reaching out to her father, she will likely be frightened after reaching out to Ben. She will need to receive a clear response from him indicating that he appreciates her reaching out and (ideally) that he likes her, too. (This, of course, can’t be faked.) This appreciation can also come from the group and/or the leader. These healing responses would disconfirm Marcy’s negative expectations and reinforce her healthy activity.

A healing response doesn’t always have to come from outside, from another person; sometimes it comes from the group member herself. For example, Marcy might learn to be loving and accepting of herself. This often happens over time as a person’s work advances. In fact, sometimes the later steps of healing must come from within.

Experimenting. Experimenting means trying out new, healthier behavior. Experimenting has two purposes—to bring up material to be explored and to develop more functional behavior. For example, suppose Marcy likes a group member, Ben, and she has been keeping a distance because she’s afraid he doesn’t feel the same way toward her. Marcy could experiment with the healthy behavior of reaching out to Ben by telling him that she likes him. If she is able to do this, it may lead to healing (see below). If she even tries to do this, the attempt may bring up pain or defense, setting the stage for the next step in the change process, access. Experimenting can be planned out with the client or it can happen spontaneously. Experimenting may also happen later in the change process as described below.

Inner Healing. This is the actual internal therapeutic change, often brought about by a healing response. The person takes a step toward experiencing herself and the world differently. There is an internal restructuring, changes in schemas, and liberation of healthy capacities that can be directly experienced by the group member.

There are three specific effects: (1) A painful, rigid schema becomes more flexible. In Marcy’s case, her painful schema with men will not be held so tightly, and she will be more easily able to recognize when a man feels positively about her. (2) The painful schema is modified in a positive direction. Marcy’s schema will begin to reflect the possibility that men can like and appreciate her. (3) The healthy capacities that were blocked are liberated and developed, or existing capacities are extended to new situations. Marcy’s self-esteem would be enhanced, her ability to reach out would be extended to men, and her capacity for intimacy would be developed.

Once a healthy capacity has been liberated and developed, it is helpful to exercise the capacity through experimenting with new healthy behavior. This leads to additional inner healing by developing the capacity even further. By engaging in healthy activity, the group member furthers and consolidates the healing by integrating it into her behavior. For example, in Marcy’s reaching out to Ben, she is developing her capacity to initiate contact with people, or if she already had the capacity to reach out to women, she is extending its range to men.

In addition to the healing that can occur in a momentary interaction, the deepest healing comes through inner reorganization over time. Often this comes through developing a healing relationship with a person in the group who relates to the client in a different way than her parents[4] did. For example, if Ben and Marcy develop a relationship in the group that involves mutual respect and liking, this could have a profound healing effect on Marcy’s father schema, especially because Marcy’s father transference with Ben provides a significant level of access. Longer term healing also happens as the group member integrates her healing experiences from the group into her life over time.

These four aspects of the change process can occur in different sequences and inter-relate in various ways. They can happen in one session or over a period of months. They can occur inside or outside of the group.

PART 2: CONNECTEDNESS PATTERNS

Preview. Part 1 deals with those patterns that are related to connectedness, perhaps the most fundamental and important healthy capacity. We cover the needy, need-denying, and insecure patterns, and the underlying core issues—deprivation, abandonment, rejection and punishment-for-need. At the end are tables that summarize the information about these patterns and issues.

Connectedness

Connectedness is characterized by feeling close to important others, connected with people in general, and accepting and loving toward yourself. It means being in touch with your need or desire for connection with other people, including needing others to care for you and needing help from others. Connectedness includes the ability to care for and express affection toward others; this ability is important for developing group cohesiveness, promoting vulnerability, and responding in a healing way to others. Connectedness also includes the ability to receive love and caring from others and take it in.

A connected person expects that most people will like her, value her, and want to connect with her, and she has the ability to reach out to others in a confident, contactful way. Such a person can feel a sense of belonging to a group. Connectedness also includes the ability to commit yourself to a relationship, group, organization, or community, when that is warranted. It also means the ability to feel secure when you are in a stable relationship.

Most people have some deficiency in connectedness. Since connectedness is such a fundamental human need and one that starts from the moment of birth, deficiencies in it can thwart the development of other central capacities as well. Connectedness is important in developing a positive sense of value and also forms a base for the later development of autonomy.

chapter 3: the needy pattern

Clients with the needy pattern have underlying deprivation and abandonment issues. We will discuss these first.

Deprivation

When the core issue is deprivation, the child didn’t receive sufficient nurturing. The child was not given enough love, emotional nourishment, touch, and caring. This lack is especially important during the early years, especially the first year and a half. In extreme cases, this can include a lack of simple physical care-taking, such as feeding and cleaning. This deprivation can produce a schema where is self is seen as needy and unlovable and the other is seen as desirable and not caring or unavailable.

This issue tends to block connectedness in general. More specifically, it can block the ability to receive from others, because the person is so used to not getting what she needs from others that she doesn’t feel worthy of love. This prevents her from allowing love in despite how much she wants it. This issue can also make it difficult for a person to love herself, because she intensely needs caring from others and didn’t received enough love as a child so she could internalize it. This issue may produce the thought, “No one loves me or cares for me.” As with most of the cognitions associated with issues and patterns, this can be conscious or unconscious. A client with this issue feels deficient in basic nurturing and caring, and her behavior is driven by this need and defenses against it.

Notice that here “needy” refers specifically to a deficiency in early nurturing, not to a lack of other kinds of parental caring or support; other deficits are covered by the other types of issues to be discussed in the next four chapters. Today many people have some deficit in nurturing and therefore some form of this issue. Especially for the baby boom generation, who were bottle and schedule fed, deprivation is very common, though there are still wide variations in its degree.

Value. In addition to a deficiency in connectedness, this issue can also produce a deficiency in the feeling of value. However, this is not unique to this issue, virtually all core issues tend to produce value deficiencies. This is because when children are deprived or abandoned, abused or judged, they tend to assume that this has happened because of something wrong with them. In their attempt to make sense of their world, this may be safer than seeing the parents as flawed. Even when children become old enough or smart enough to realize that there is something wrong with the parent for treating them this way, they usually persist in feeling (at some deep level) that there is something wrong with them, or their parents would have treated them better, would have loved them in the way they needed. Therefore, even though deprivation has primarily to do with connectedness, it also has an effect on the person’s sense of value—not as strong an effect as those issues that specifically relate to value (see chapter ?), but a significant effect nonetheless. And this is true for all core issues.

Clients who primarily act from deprivation, rather than defending against it, exhibit the needy pattern. Those who defend against the issue by denying their need or avoiding intimacy may exhibit the need-denying pattern or the isolated pattern. Those who attempt to induce others to meet their needs may use the charming, victim, controlling, or intrusive patterns.

Abandonment

The abandonment issue can originate when a child loses an important person (or people) in her life, permanently or temporarily, due to death, illness, or abandonment. This also includes the situation where a parent (or other person) emotionally abandons the child at times through withdrawal or use of alcohol. It can also include the experience of severe losses that happen later in life. Abandonment is clearly related to deprivation, but includes the sense of having something that can then be lost. A person with deprivation may not feel that she ever had love, and conversely may not be so afraid of losing it once she gets it. Abandonment tends to block connectedness, especially the ability of a person to feel secure in a relationship because of the fear of impending loss. It may also cause a person to be afraid to open up and receive love because then it may be taken away. This issue may produce the thought, “I can lose those I love at any minute.”

Abandonment can coexist and overlap with deprivation. The difference is that abandonment has to do with having love and then losing it, while deprivation is an experience of never having had enough of it.

Needy Behavior

Clients with the needy pattern are those who act primarily from deprivation. They don’t employ much in the way of defenses against the underlying sense of need but rather show their neediness and dependence in their behavior. Clients who act from abandonment also exhibit the needy pattern.

Needs. Needy clients usually feel an intense need for connection with others and a painful lack of this connection in their lives. This may be because they actually lack satisfying relationships or because their need is so great. This may also be due to their difficulty in taking in the caring and love they do receive. Needy clients want not only connection but specifically caring and nurturing, especially when they are in pain, which is fairly often. They have an on-going need to talk to others about the difficulties in their lives and receive support. This is a common activity for them in a psychotherapy group. It can lead them to call other group members frequently on the phone and get together outside of group for help and comfort. They can become dependent on family, friends, and other group members.

They frequently put a good deal of energy into making connections with other group members and helping the group to bond. Some needy clients do this by being nice and pleasing to others, by being friendly and supportive and suppressing any negative feelings. Needy clients can be relatively easily hurt if their interest and affection for others is not returned or if their need for support is not met. Some needy clients express considerable anger when this happens while others don’t.

Loneliness and Relationship Addiction. It is difficult for needy clients to be alone, both in the moment and in their lives. Being alone at any time brings into painful relief the deep underlying sense of deprivation and abandonment, and therefore they often attempt to fill their lives with connections with others, even those that aren’t very rewarding. This is a compensation for the internal connectedness that is lacking. It is also hard for needy clients to be without a love relationship, actual or potential. They always need to have someone with whom they are involved romantically, even if the relationship is just beginning or is troubled. When they are in a relationship, they usually become quite dependent on their partner. In the absence of this, they may rely on sexual addiction or obsessive romantic fantasy, also forms of compensation. They also have a tendency to continue a relationship even after it is clear that it has become destructive for them. This behavior is called relationship addiction.

Defenses. Though clients with the needy pattern don’t act primarily from defenses, they do use some, such as relationship and sexual addictions. They may sometimes block themselves from feeling or expressing the pain in their lives for fear that it will lead them deeper into their early pain. In addition, needy clients often defend against really taking in caring from others even though that is what they most want (see Taking in below).

Gender. Though both men and women show this pattern, it is more common in women because men are often taught to suppress or deny their needs, leading to the need-denying or isolated patterns.

Conditions. The needy pattern might be activated with everyone, or it may only be activated by people who show some promise of meeting the person’s needs. Since women tend to be more nurturing than men on the average, clients are more likely to show this pattern around women. It may also be activated by people who are older than the client or who are naturally nurturing. For example, it may be activated around people who have the codependent pattern. The needy pattern especially gets activated when the client is in a love relationship, because this is often the place where people have the best chance of having their needs for nurturing met. In fact, this pattern is frequently activated when a love relationship is becoming particularly intimate. Sometimes only then will a person’s defenses relax and allow her needs to come out. This hopeful activation often happens without any awareness of the reason and can be quite frightening. It sometimes seems to the client that she is regressing, but it is really a sign that the relationship is now close enough for the needy pattern to emerge.

Levels of Functioning. Like all issues and patterns, the needy pattern includes a wide range of functioning. A client is included in this pattern because of the kind of relating and underlying pain, not the degree of it. For example, at the low end of functioning, this pattern would include a person with borderline issues who is extremely needy and forms intense relationships which soon blow apart over his desire and fear around merging and his rage over imagined rejection or abandonment. At the other end of the spectrum, this pattern would also include a relatively healthy person with a stable, successful marriage, who nonetheless has unresolved dependency needs which come out in her difficulty in being alone when her husband is away on business trips. Any pattern includes all levels of functioning, from the most disturbed to the relatively healthy, from the situation where the pattern dominates the person’s life to where it appears only occasionally in minor ways.

Related Concepts and Patterns

Related Concepts. Depression is a common symptom for needy clients, though it can have other roots as well. The needy pattern is similar to the traditional Freudian concept of the oral character. Extreme neediness is also related to the borderline personality disorder (see chapter ?).

Related Patterns. The insecure pattern is similar to the needy pattern in that both involved not getting important forms of love and caring in childhood. However, the insecure pattern comes from a deficiency in acknowledgment while the needy pattern derives from a deficiency in nurturing. The most important issue for needy clients is their degree of need, while for insecure clients, it is their fear of rejection.

Combining Patterns. Each person is likely to show roughly five to eight patterns in their interpersonal life, and even more if you consider patterns that show in minor ways. This means that we can examine combinations of patterns. For example, when a person has both the needy and insecure patterns[5], he tends to be both needy and afraid of having those needs rejected by others. When a person combines the needy and entitled patterns, he feels that he deserves to have all his needs met, no matter how extreme they are, because, of course, he doesn’t see them as extreme. When a person has both the needy and controlling patterns, he tends to be demanding about having his needs met. When a person is both needy and self-judging, he tends to feel bad about having needs. When a person has the needy and brittle patterns, he can be devastated if his needs aren’t met or if there is even a hint of judgment about them. A person who combines the needy and codependent patterns will try to get his needs met by taking care of others. Someone who has the needy and compliant patterns will try to mold himself to others’ desires in the hopes that they will take care of him. An extreme form of this produces the dependent personality disorder.

The Change Process

Responsibility. Many needy clients are not aware that their needs are excessive by adult standards. They are aware of their needs but often think that their problem is not being able to get them met. Therefore an important step in working with a needy client is for him to own his neediness so that he becomes interested in exploring its origins and healing it. Be careful that this doesn’t encourage the client’s inner critic to shame him for having too many needs. Your goal is to help the client understand his needs with compassion and acceptance.

Accessing Pain. Each time a client has a deprivation schema activated by a life event or by an experience of hurt in the group, this is likely to bring up the old pain. For example, Susan was drawn to Marie but felt that Marie wasn’t paying much attention to her and didn’t seem to like her. When Susan brought this up in the group, the leader helped her to explore her feelings about this, and she discovered a deep sadness that was out of proportion to the degree of her involvement with Marie. This sadness came from on old deprivation schema. It is very helpful for a needy client to access and relive her feelings about the lack of nurturing in her early life. The client may only be able to begin this access work after the group is fairly established and cohesive. This work can be very intense, and therefore it often needs to proceed slowly. The client may need to go into this deep pain gradually, one step at a time.

Healing Responses. Each time a client with a deprivation issue accesses the underlying pain, it is helpful for her to receive a healing response involving some form of caring and support, which is what she failed to get as a child. Fortunately many of the generic healthy responses in a good therapy group provide this kind of healing. These include empathy, compassion, identification, understanding, appreciation, and acceptance. The client might also need healing in the form of mirroring, nurturing, and the expression of liking and affection. These will come up naturally in the other group members, and if they don’t spontaneously offer this, you can encourage it by asking for feedback from the group. Make sure, however, that the group members are offering genuine responses rather than simply being nice because they think it is expected or needed. There is enough real caring in a group that it doesn’t need to be manufactured. In the rare case that the group members don’t seem to feel caring, the leader can provide the appropriate healing response (or explore what is stopping the members from wanting to).

When a truly needy client accesses her pain in a genuine, vulnerable way, our hearts open to her. Most group members feel touched and close to her; they want to give to her. And if she is able to take in what is given, this is very satisfying for the whole group. It is one of those special moments that make group therapy fulfilling.

Touch. Healing responses can even go as far as touching. Many clients have suffered some level of deprivation in the area of touch, so after appropriate access it can be healing to have another group member offer some supportive touch. There are rules against this in most psychoanalytic groups, and this comes from a legitimate fear of gratification which might prevent the client from accessing her pain. However if a leader excludes touch altogether, in the name of preventing acting out, you throw the baby out with the bath water. Under the right circumstances (after access), touch can be very healing. In fact, in some cases touch is absolutely required as a healing response. Anything else would be a pale substitute. In these cases, it is important that the client not be deprived once again. If a group member accesses an issue that involves early deprivation in the area of touching, it can bring up not only great pain, but powerful needs for touch and physical soothing. Once accessed in a genuine way, these needs should be met directly.

I suspect that the most important reason for my disagreement with the psychoanalytic position on touch is theoretical. The analytic view is that therapeutic change occurs by making the unconscious conscious, part of what I call access. Therefore it makes sense that they would see touch as a possible distraction from the access process and not recognize the importance of it as a healing response.

When a client accesses deep pain having to do with deprivation, there are usually group members who feel a natural urge to hold or comfort the client through touch. If they express these desires, you can encourage them to take action, after asking the client if this would be OK. If no one initiates or mentions touch, you could bring it out by saying to the client, “It looks to me like you really need to be touched right now.” When dealing with touch, make sure that the client receiving the touch is not being violated in any way. Her permission should be asked, and you should make sure that her answer is genuine and not just compliance before allowing any physical contact to happen.

Taking In. One of the reasons that needy clients remain that way is that many of them have difficulty really taking in caring and nurturing when they do receive it. Because they don’t really take in love that is available, they remain in a deprived state. This resistance is usually quite unconscious and happens despite how much they want it. They may not feel worthy of receiving love because of an underlying value deficiency. They may also resist because they are afraid to open up deeper levels of need and the pain involved. Their needs feel so enormous that no one could begin to fill them. Their needs seem unending and so it seems best to keep them buried. The client knows that the group meeting will end soon and doesn’t want to be alone with the full, heightened experience of need and vulnerability.

With certain clients who are more disturbed, these fears are warranted (see chapter ?). However, most clients are capable of dealing with the depths of their needs if approached gradually in a loving atmosphere. Therefore, you can work with the client on her fears of taking in. First help her to be aware that she is blocking taking in what she is getting from people. Then have her explore how she is doing this. Does she close herself emotionally? Does she feel unworthy? Does she distract herself with other thoughts? Then explore what the client is afraid will happen if she takes in the caring. This will gradually allow her to open up to the nurturing she receives so that the process of inner healing can be completed.

Healing Relationship. Even more important than receiving healing responses in the moment is for a needy client to develop long term relationships in which he is cared for and loved. These relationships can be with other group members, the leader, and the group-as-a-whole. This is especially important for clients with abandonment issues (see below), because they usually suspect any momentary healing responses, being afraid the person giving them will disappear. Within a healing relationship, the client comes to realize that the person he is close to (or the group) will be responsive and trustworthy, so he develops a positive relationship schema representing this relationship. Although there may be times when the other person is angry or distant, these are worked through (with the help of the group) and the bond is not broken, so the client learns to integrate this experience into the emerging positive schema. As a result, his sense of connectedness develops and also his ability to receive from others and to care for himself. The more deeply the client is involved in a healing relationship, the more profound the inner healing that takes place. This is one of the advantages of allowing clients to develop relationships with each other outside of group.

As the process of inner healing proceeds, the client begins to feel a new inner strength and groundedness. He feels connected and whole within, so he doesn’t need so much from the outside. He is more able to pursue activities and people for the fulfillment they bring rather than pursuing people to fill his holes.

If a client who seems needy and deprived is repeatedly given healing responses without there being any therapeutic change, the person may not actually have a deprivatoin issue but instead a shaped-dependence issue. When a child’s behavior is shaped by her parents in the direction of dependence, this can produce behavior that appears needy. However, such a client is deficient in autonomy, not connectedness, and needs encouragement for self-assertion, not nurturing. This issue is discussed in the next chapter.

Accessing Aggression. It can also be useful to help clients access their anger and aggressive responses to deprivation or abandonment. Since this also applies to the insecure pattern, it is discussed later in that section.

Potential Problem

There is a serious problem that can happen with a needy client in a group, when the other group members become turned off by the degree of her need. Sensing that she has extreme needs, and not wanting to be drawn into a relationship in which they are constantly the caretaker, many clients will hold back from connecting with a needy client. This is especially true of group members who deny need in themselves or who are just overcoming codependence or boundary problems. This distancing reaction can be very hurtful for the needy client. It is an example of a therapeutic mismatch. What this client needs for healing is a warm reception and response, to have her needs accepted and met. Instead some group members may avoid connecting with her.

Of course, this problem may already have happened in the person’s life, where people have rejected her for having too many needs. This may have produced a schema where the client fears rejection because of her needs (see need-denying pattern later in this chapter). The group setting provides an opportunity to turn this around, if it is handled correctly.

Solution. If the group seems to be responding poorly to a client’s needs, focus her group work on access. In doing intrapsychic work, she can fully express her pain and needs without putting them on other group members. They will also be more understanding and compassionate with her when they see and experience the origins of her neediness. If she is able to access her pain in a vulnerable way without playing victim (see chapter ?), they will probably feel close to her and want to respond in a healing way, at least in that moment.

You may also need to help her refrain from acting out her needs with the other group members. Explain that her needs are completely OK, but they are child needs that belong to the past, and she can’t necessarily expect others to meet them in the present. Focus on her developing inner support rather than looking for gratification in the group. As she heals and grows, her inner strength and sense of connectedness will develop and the intensity of her needs will diminish. Then when she brings her needs to others in the group, they will be more likely to respond in a positive way.

Example. Joseph grew up with an alcoholic mother who continually abandoned him. As a result, he struggled with depression, suicidal impulses, and sexual addiction as an adult. In the group, he showed his neediness openly. He showed his pain and his need for connection with others. He became upset whenever someone left the group and even when certain people went on vacation for a few weeks during the summer. He developed phone relationships with a number of group members in which he talked about problems in his life. Luckily he was a very open, supportive, and appealing person, so most of the group members liked him and wanted to connect with him despite his needs. One of the women, Georgia, had boundary problems and difficulties in standing up for herself, so she became resentful of the fact that their phone conversations seemed to revolve around him. She brought this up with him in group and stopped the phone contact. However, he was receptive to hearing what she had to say and they were able to work this through in group over a number of weeks. He was able to take in her feedback, and when they resumed contact on the phone, he gave her an equal amount of attention.

When Joseph went into deep pain in the group, the degree of his needs scared Georgia and a couple of other group members who were fighting against codependence. A few other members responded by wanting to give to him. By then Joseph had a good enough inner sense of connectedness that he could tolerate the fact that some members didn’t respond well to his needs. He could access his pain and receive healing from those who offered it without being too hurt by the ones who didn’t. This allowed his therapy to proceed, and eventually he was highly respected by the entire group and his therapy was quite successful.

Abandonment

When clients with a needy pattern have an underlying abandonment issue, the emphasis is on loss as well as deprivation. In this case, the client is afraid that any connection he makes, any nurturing he receives, may be taken away or lost at any moment. He feels helpless in the face of this possibility.

Clients with a abandonment fears tend to become upset when other group members terminate, when the leader is on vacation, or even when a group member is absent. In fact, each new termination presents such a client with another opportunity to deal with this deep pain he carries. A client with abandonment issues also may become upset at any sign of withdrawal of a group member he has connected with. This upset can take the form of rage or tears or depression. Such a client may also be afraid to connect with others for fear they will withdraw emotionally or because of the knowledge that they will eventually leave the group.

Healing Responses. Healing depends largely on the development of long-term healing relationships. Therefore it is especially important that a client with abandonment issues be in a therapy group that is reasonably stable. Any lack of stability will upset such a client; if there isn’t too much of this, it can be used to access the deep material. However, if there is too much turn-over in a group or if the group changes leaders, it may be too much for such a client to handle.

Working with Grief. For clients with abandonment issues stemming from losses, an important part of their work is to do the grieving that didn’t happen at the time of the loss. Grieving is a natural process that must be allowed to happen when there is a loss. If it is aborted or blocked for any reason, the person is left with incomplete grief, waiting to erupt at the next experience of loss. In the past, proper grieving may have been blocked by parental (or other) messages that grief wasn’t OK, by lack of parental support for grieving, or because the child was overwhelmed by the degree of pain and had to avoid it. Grief can also be blocked because earlier unresolved losses have generated defenses that now close off that ability. For a client like this, the work in the group is primarily to allow the grief to happen with the support of the leader and group. In those cases where the client was taught not to grieve as a child, she will also need to access and heal the resulting punishment schema.

Example

Shanna was drawn to Alan and kept trying to connect with him in the group. However she had underlying issues about deprivation and abandonment and acted them out by being needy and demanding at times. Alan reacted to this with a great deal of anger and distance because it triggered mother transference for him. Alan’s rejection of Shanna caused her to increase her demands, and they were caught in a defense cycle. They worked on their relationship over a period of months, achieving a fair degree of access but little resolution or connection between them. One session Shanna allowed herself to access deep pain about her inability to connect with Alan, taking it back to her mother’s emotionally abandoning her when she was in need. In the process she made herself quite vulnerable and let go of the usual behavior that activated Alan’s transference. He let her know that he felt very strongly for her despite the fact that he didn’t show it because of the rage that got triggered in him. This reaching out on his part really touched Shanna and she began crying deeply, partly in pain and partly as a response to this healing overture from Alan.

This then prompted him to go over and sit next to her on the couch. After asking her, he put his arm around her and held her, and she clung to him and continued crying while taking in his caring. This was deeply healing for Shanna with regard to the deprivation she suffered from both her parents. After this, their relationship took a wholly different turn, and though their defense cycle still occurred occasionally, they were able to work through these reactions and maintain their connection with each other. Over time this deepened into a strong sense of caring for each other.

Group Roles

Emotional Member. The needy client often plays the role of emotional leader in the group, the person who is willing to show her pain and express her feelings, the first one to go deep into access. Because of her intense need for caring and help, a needy client will often lead the way in this area. This can help to encourage others to do the same. The danger in this, as with any role, is that the client might take over this function for the other group members. They might avoid getting into their own feelings because she is doing that job for the group. Then she may end up containing the feelings of the other members.

Social Leader. The needy client can also help in developing group cohesiveness. Because of her need for connection, she may go out of her way not only to connect with others but also to foster connection generally in the group, by being supportive and caring, by looking on the good side of things, by helping people to understand each other. This can be especially helpful in the beginning stages of group. However, watch for a needy client promoting connection to the exclusion of conflict.

Countertransference

Countertransference toward the Needy Client. Group leaders sometimes find themselves with a strong desire to nurture and care for a needy client. This is only therapeutically appropriate if the client has done significant access first, so if your desire is too strong, you may go out of your way to be caring when other interventions might be better. Perhaps the client needs insight, or encouragement to take risks, or deeper access. Perhaps the caring should come from the group members, not the leader. Perhaps the client needs to learn that she can find her own inner strength. Be careful of too much desire to nurture a needy client.

On the other hand, some leaders may be repulsed by the degree of need shown by the client. You may be afraid of being engulfed by her intense needs. This may lead you to subtly reject her, be too tough on her, or not encourage healing responses when they are needed. If the client’s needs are very great, remember that you aren’t responsible for meeting them, you are responsible for helping her grow. You can be sympathetic to her needs and help her therapeutically while retaining your boundaries.

Countertransference of the Needy Therapist. Group leaders who have a needy pattern may have a tendency to become overly involved in their groups. You may unconsciously want to use a group to meet some of your own needs for caring and connection, and this may lead you to either share too many personal feelings or information or to focus too much of the work on you. The best solution for this problem is to make sure to get your personal needs met in your personal life so they don’t contaminate your group leading.

chapter 4: The need-denying pattern

The needy pattern involves pain-driven reactions to deprivation or abandonment. The need-denying pattern involves a defense against these same core issues, which seems to come into play when the child was punished for having needs.

Punishment-for-Need

In this core issue, the child was punished or received negative consequences for showing need or desire or reaching out for connection, especially for needing anything from the parents (or others). This is obviously related to deprivation but also includes the idea that the child’s needs are bad. The child’s needs may be seen as infantile, greedy, overwhelming, disgusting, or insatiable. This issue tends to produce thoughts such as, “My needs are bad.” When a person defends against this issue, it tends to block her ability to feel her need for connection with others.

Need-Denying Behavior

Clients with the need-denying pattern try to pretend that they have no needs or that their needs aren’t excessive. They often say things like, “I don’t need very much.” The underlying thought is, “If I show my needs, I will be shamed.” This underlying need and fear may or may not be conscious. In other words, some need-denying clients realize that they are quite needy, but try to hide it. Others really believe that they are self-supporting people who don’t need much from others. Still other clients realize that they have needs, but convince themselves that they don’t have too many. All of them feel that they don’t really have the right to have needs, that there is something wrong with needing things from others. They often believe unconsciously that their needs are excessive, and therefore consciously they try to minimize them. They ask for as little as possible from others believing they will be rejected and judged if they want much. Need-denying clients often make comments like, “I only need you to ...”

For example, Louise was very interested in finding a successful love relationship, and each time she began to go out with a man, she put most of her needs on hold. She assumed that she needed to win over a man in order to get him to love her, and to do this, she must not need much from him. She focused her attention on his needs and ignored hers. In fact, she was fairly needy, but the important dynamic wasn’t the degree of her needs, it was the fact that she suppressed them. She suppressed even a reasonable amount of need, and in each relationship, she eventually became dissatisfied that her needs weren’t being met, not realizing that this was partly because she had been hiding them.

In a group, need-denying clients are generally careful not to show too much pain or ask for much caring or help. If they reach out to connect with someone, they make it clear that they don’t need much from the other person. This protest is often the clue to this pattern.

Self-Sufficiency. A need-denying client may develop ways of caring for and nurturing herself that compensate for her underlying lack of connectedness, thus making it easier to pretend that her deep needs aren’t there. For example, Louise was proud of her ability to support herself and care for her children by herself. She also enjoyed it when she had time alone to spend on her hobbies. There may be some healthy aspects of this self-caring, but it nevertheless defends against the underlying sense of deprivation. Therefore for the therapy to be fully successful, the client must get past this defense and allow herself to feel her needs.

Sometimes a need-denying client puts an over-emphasis on competence and self-sufficiency, leading to statements such as, “I can take care of myself.” The need-denying client may also have a persona of being “together” where she appears to have neither psychological problems nor pain. She may unconsciously deny any difficulties that might lead her to need very much from others.

Origins. The primary origin for the need-denying pattern is punishment for need along with deprivation or abandonment. In addition, this pattern is reinforced if a child becomes prematurely self-nurturing because of his parent’s unavailability or because they rewarded the child for this. If the parents modeled need-denying behavior themselves, this could also contribute to this pattern.

This pattern is complicated by the fact that, because of the underlying deprivation or abandonment, many of the needs of a need-denying client derive from early childhood and therefore don’t fit in an adult world. In fact, clients who start out with a needy pattern often encounter negative reactions to their needs, especially from their lovers or spouses, and this can produce a secondary punishment-for-need issue, telling them that their needs are unacceptable and possibly contributing to the development of a need-denying pattern.

Related Patterns. The need-denying pattern is similar in some ways to the isolated pattern (see next chapter), in that both involve defenses against need. However, isolated clients not only deny their needs, but avoid relationships as well, where as need-denying clients are usually very interested in connecting with others but defend against their needs in the process. Though it may seem like a contradiction, a client can be both needy and need-denying. He may act out his needs in some ways or at some times and deny them at others.

Combining Patterns. When a person has both the need-denying pattern and the insecure pattern, he will be afraid of being rejected because his needs are unacceptable. A person who combines the need-denying and defiant patterns will become defensive and angrily deny that he has any needs if the issue is brought up. A person with the need-denying and prideful patterns will use whatever he is proud of in himself to convince himself that he is above having needs. For example, if he is proud of his being a loving person, he will think that loving people only give to others, they don’t need anything back. If someone has both the need-denying and charming patterns, he will try to draw others to him with his charisma, so that they will meet his needs without his having to acknowledge that he has any.

The Change Process

Awareness. The first step with a need-denying client is to help her recognize that she is defending against her needs. Such a client may have to be repeatedly challenged about denying her needs in order to bring out the pattern clearly.

The Punishment Schema. In addition, it will be important to access the punishment schema, to help the client remember and experience how she was given the message that her needs were unacceptable. For example, a client might remember how her mother was disgusted with her for wanting to be picked up. In the process of this work, the client will show (or at least talk about) her needs, and this is a good opportunity for the group members to provide a healing response. If they have become aware of her tendency to deny her needs, they will appreciate her for getting in touch with them. They may share with her their own neediness and help her to understand that it is normal to have needs, especially if one was deprived as a child.

Healing. Eventually the client will develop the courage to actually show her needs and perhaps ask for them to be met. She may talk about feeling hurt by another group member, or she may reach out to someone when she needs caring. She might express the pain of being lonely or feeling rejected and ask for comfort. When a client, who has been hiding her needs for so long, takes the risk to allow her vulnerability to be known, the group members are likely to be deeply moved. Their hearts will go out to her, and they will appreciate her for her courage in taking this risk. They will probably also feel good about being needed by her, so their caring, loving responses will come naturally, healing the punishment schema in the deepest way. Their responses will also provide healing for the underlying deprivation or abandonment. In fact, once the client has let go of her need-denying behavior, she is directly confronting these issues, and therefore the rest of the change process is similar to that described previously under the needy pattern.

It is frequently true that once a need-denying client lets go of that pattern, she shows the needy pattern directly. As she works through the defensive pattern, her behavior more closely reflects the core issue beneath and the pattern related to it. We will see that this is true for other patterns as well.

There usually isn’t a problem with group members being put off by the client’s needs, since she has been denying them and therefore not putting them on people. The exception to this is where a client consciously denies her needs but acts them out unconsciously in subtle ways. Such a client is exhibiting both the needy and need-denying patterns, and this may possibly cause group members to respond negatively, as discussed under the needy pattern.

Countertransference

Countertransference of the Need-denying Therapist. The danger of denying needs in yourself is that you may be unconsciously judgmental of others for having needs or envious of others for getting their needs met. If you have a need-denying pattern, you may have a tendency to not be accepting and receptive towards the needs of your group members, especially when those needs are directed toward you. You may also have a tendency to reject your clients’ desire to care for you or idealize you, because of your compulsion to deny that you have any need for this. The solution must be to recognize and accept your own suppressed needs.

Painful Patterns and Defensive Patterns

We have explored two patterns so far—the needy pattern and the need-denying pattern. They are both related to underlying deprivation or abandonment, but one involves primarily pain-driven behavior based on these schemas and the other involves a defense against these schemas. Though it won’t always be so straightforward, we can divide most patterns into two types—those based on pain and those based on defense. Those patterns that involve primarily pain-driven behavior derived from a particular core issue are called painful patterns, and those that involve primarily defenses against a core issue (or issues) are called defensive patterns.

Painful patterns are not totally defense-free, however. What makes a pattern “painful” is that the behavior is primarily an acting out of the painful schema, while the defenses usually don’t take the client far from the painful schema or core issue itself. For example, a needy client may defend against taking in caring from others. This is a defense, but not one that completely denies the underlying neediness and deprivation, whereas the need-denying pattern (and even more the isolated pattern) involve defenses that completely hide the underlying issue.

Keep in mind also that the surface behavior is not always what it seems. When a client acts dependent, it doesn’t always come from a needy pattern based on deprivation. The needy behavior could be a defense against another core issue or it could be shaped behavior. For example, if a client was punished for signs of independence, then she might develop a needy, dependent way of relating. However, this would not be part of the needy pattern because the needy behavior would be a defense against punishment for being autonomous. See shaped dependence in chapter ?. Any behavior can be used as a defense, even behavior that is usually derived from a painful schema.

chapter 5: the insecure pattern

The insecure pattern derives primarily from underlying rejection, so let’s examine this first.

Rejection

The rejection issue represents a situation where the parents (or others) weren’t sufficiently interested in the child, and she didn’t receive enough acknowledgment and appreciation. The child was not recognized and loved for who she really was. She was dismissed, rejected, or ignored, sometimes because the parent was narcissistically self-involved. The difference between this issue and deprivation is that the deficiency here is in a form of connectedness needed later in development. In early years, nurturing is probably the most important form of love needed, while later the child needs more recognition and appreciation. Therefore rejection usually involves a deficiency that is developmentally later than that of deprivation. In fact, rejection of considerable importance can happen at the hands of a child’s peers or teachers. They can also involve rejection by society at large in the case of prejudice due to racial, religious, class, or other differences (see chapter ?). This schema involve seeing the self as needing recognition, worthless, and undesirable and the other as desirable, not interested, and rejecting.

This issue tends to block connectedness, especially the person’s ability to feel confident in social situations. If it has to do with exclusion, then it can block the person’s ability to feel that she belongs to a group.

This issue can be limited to certain areas, such as career or profession. A person may feel confident in social situations but not professional ones, or vice versa, depending on what form the original rejection took. For example, if a child was appreciated for her cuteness but not for her mind or competence, she might develop a rejection issue that is activated in work settings but not social ones. On the other hand, if a child was praised for her performance in school but rejected by her peers, she might develop the opposite issue.

Rejection also blocks the capacity of value because the child feels that she isn’t being recognized by others because she isn’t valuable to them. As mentioned earlier, all core issues tend to block value, but rejection has a more direct and serious effect on value. It could just as easily have been placed in the chapter on value patterns. It may produce the following thought: “No one sees me or likes me.”

Clients who show rejection directly in their behavior are exhibiting the insecure pattern. People may also defend against the issue using the compliant, charming, or prideful patterns.

Related Concepts and Patterns

Related Concepts. The avoidant personality disorder from the DSM IV is an extreme form of the insecure pattern. Some insecure clients may be diagnosed as having a social phobia. It is related to Masterson’s (199?) concept of the “closet narcissist,” which refers to clients who don’t act out the prideful, entitled aspects of narcissism, but rather their opposite. Narcissism is closely related to deficiencies in value and therefore will be discussed in the Value Patterns chapter.

Related Patterns. Though the needy and insecure patterns are similar, needy clients can be distinguished by the degree of their need while insecure clients can be known by their fear of rejection.

Combining Patterns. When the insecure pattern is combined with certain other patterns, this influences what the person feels insecure about. The needy person feels insecure about the degree of her needs. The self-judging person feels insecure about whatever she judges herself for. The passive-aggressive person feels insecure about not performing well, the codependent person about being giving enough. If a person combines the insecure with the isolated or defiant patterns, she may distance herself from others or fight with them to defend against her fears of rejection. A person who is both insecure and suspicious will look for evidence that others are going to reject her.

It is common for a client to have both the insecure and needy patterns; they often are combined in the same person. The insecure pattern is also frequently combined with the self-judging or compliant pattern.

Origins

In addition to originating in rejection, a client is more likely to develop an insecure pattern if he is not only rejected, but also judged. If a parent (or other person) lets the child know that he is being ignored because he is seen as annoying, bad, uninteresting, or worthless, for example, this contributes to the development of an insecure pattern.

The insecure pattern can also derive from deprivation or abandonment. These schemas can also contribute to a child feeling insecure about his value to others. Even if a child is recognized and appreciated by his parents, if he has had an earlier experience of not receiving enough care and nurturing, this can contribute to the development of the insecure pattern.

Reaching Out

When I speak of a person reaching out, I mean any behavior that invites another person to connect with him. This includes expressing need or pain, since that invites a caring connection. It also includes general warmth, giving positive feedback, making eye contact, greeting people, and so on. And of course, it includes direct statements of liking another person, wanting to get to know her, and invitations to talk outside group.

Avoidance of Reaching Out. An insecure client may defend against reaching out by a straightforward avoidance defense. He may be too frightened to act, and sometimes this even causes him to forget that he had any interest in connecting with people. He may be withdrawn in social situations where he is faced with his fears or he may avoid them altogether. For a client like this, the group work often begins with experimenting. You can suggest that he reach out explicitly to someone in group that he wants to get closer to. This should at first be someone he feels relatively safe with. Another possibility is to suggest that he bring up an outside issue that is causing him pain and ask the group’s help with it. For some people, this can be a big risk. These suggestions could be set up as contracts in a consultation (see chapter ?).

When the client tries these experiments, the work can move in two different directions: (1) It may trigger his rejection issue more strongly, giving you an excellent opportunity for work on access. (2) It might be relatively successful in that the person (or the group) that he reached out to responds positively. This then provides the client with a healing response.

Receiving or Asking. When a client who is afraid to ask for help gets into pain and needs a caring response from the group, you have two options. (1) You can allow or encourage the group to give him the support he needs without his having to ask for it. (2) You can arrange it so he has to ask for support explicitly (or work on his difficulty in doing that). Which option to use should depend on how much growth he has already made on this issue. If he is just beginning to work on it and is quite frightened, let the group give to him without being asked. If he is further along, it may be best to focus the work on his asking, so he has to face that hurdle.

Similarly, with a person who is very afraid of reaching out for contact, it helps to let the other group members reach out to him first. This may provide enough healing that he gradually becomes strong enough to begin initiating it himself.

Example: John started to talk about feeling uncomfortable in the group, but he was rambling and confused and it wasn’t clear what the problem was or what he needed. Eventually I helped him to realize that he was feeling vaguely rejected or judged by the group. At that point, I could have just let the group members tell him that this wasn’t true, but instead I asked him what he needed from the group. This was very difficult for him to formulate, and in fact, his confusion had been a defense against recognizing his needs. He was terrified to verbalize any needs, for fear he would once again be rejected, and he was able to access some of this fear. This work brought him to the point where he was able ask for something. He wanted to know if the group members thought he was weak for being needy and in pain. This allowed them to give healing responses to this, since they actually admired his openness. This wasn’t, of course, all that he needed, but it was a step for him to ask for this.

Insecure Reaching Out. Another possibility is that the client may reach out, but in an insecure way. Healthy reaching out is done with confidence; the person expects to get what she wants. This attitude makes it more likely that she will, because she is assertive and people respond well to self-confidence. Insecure clients often expect to be rejected, and therefore reach out in tentative, awkward, or self-denigrating ways. They may act shy and self-effacing. This pain-driven reaction can sometimes actually make them less appealing to others, resulting in a self-fulfilling prophecy.

Insecure clients can also go out of their way to be supportive and friendly to others in the hopes that they will be liked because of this. This can even be successful in eliciting positive responses in others without healing the client’s underlying feeling of insecurity.

On the other hand, insecure clients can also be sullen, withdrawn, or even hostile without having any idea that this is happening. They may not engage in the less obvious ways of connecting that naturally happen when not defended against, such as smiling and giving compliments. (If this distancing behavior is the client’s main way of relating, this may belong under the isolated pattern. See chapter ?.) This lack of warmth can also produce a self-fulfilling prophecy, where a client who defends in this way creates indifference or even resentment in others. However, the client can learn about this through feedback from the other group members. They can tell her exactly what she is doing to put them off. It can be useful to set up awareness and feedback contracts (see chapter ?) dealing with this issue so the client gets repeated feedback and understanding.

Conditions. An insecure client tends to have this pattern activated by two types of people: (1) People who are likely to reject her. This means that a client may feel insecure with people who are judgmental or aloof. She may also feel insecure around people who remind her of the parent who rejected her, especially people of the same gender. A person may have an insecure pattern activated by authority figures, especially people who are supposed to evaluate her in some way.

(2) People who she is attracted to or wants approval from. This is especially true for sexual attractions. Many people are perfectly at ease with others until they meet someone they are sexually or romantically attracted to. Then the insecure pattern is activated and they become awkward, tongue-tied, and bumbling. An insecure pattern can also be activated when the client is with authority figures whom she wants to think well of her, and it can be activated around people the client finds appealing and would like to become friends with.

Clients who have exclusion issues (see below) will have their insecure pattern activated by group situations.

Showing Vulnerability. In a therapy group, vulnerability is appealing, so if the insecure person is helped to access her fears and be vulnerable about her insecurities, this is likely to engender a positive, healing response from the other group members. Once the client has received this kind of healing sufficiently, she will begin to feel more connected and confident and have less need to defend. Then she can experiment with expressing this confidence in reaching out to people in the group.

For example, Elena tried to reach out to people by complimenting them and subtly putting herself down by comparison. Eventually one person told her how uncomfortable it made her when Elena denigrated herself. This led Elena to discover how insecure she felt in connecting with others. In exploring further she realized that she thought people might like her better if she wasn’t a threat to them; this was the reason for putting herself down. In revealing these feelings, she made herself vulnerable in an appealing way because there was no self-degradation, and the group members responded with appreciation. Over time this helped Elena to feel better about herself and drop the self-effacing behavior.

Experimenting. Another way to work with difficulties in reaching out is to suggest experiments in which the client reaches out in a more vulnerable or contactful way. For example, if a client talks about pain without showing it, you could suggest that he allow the group to see his sadness rather than just asking for practical help. With a client who defends against desire, you could suggest that she make eye contact with a group member she is interested in and tell him that she likes him. Remember that these suggestions aren’t just for behavioral training. They are to be done with awareness, which can also lead into further fears or defenses and more access.

The Silent Group Member

Some insecure clients have a difficult time speaking in group. They are so self-effacing that it is difficult for them to feel they have the right to take the group’s time. They frequently feel that what they have to say isn’t valuable or that others have more pressing needs. They are usually afraid of being judged and rejected if they do speak, and often being the center of attention of the group is terrifying.

Technique. In the early stages of group, it may be necessary for the leader to call on such a silent client to help him to participate. The group members may also ask to hear from him. Sometimes this is enough, and gradually the silent client feels more comfortable speaking in group. If, after a time, a client doesn’t improve his degree of participation, then you must work directly with him on his fears. A good way to do this is to help him explore what it is like to have the group’s attention. What is he afraid of? What does he imagine the group members are thinking of him? What feelings does this bring up for him? This work can then move into accessing the origins of his insecurity. For example, the client may have been consistently ignored as a child or even punished for asking for attention or making noise. Then the client will be open to receiving healing responses from the group. Frequently the other group members will tell him how much they value what he has to say, and how much they appreciate his sharing himself with them. The tricky thing is how to start this work if the client is being silent. I will take the initiative if necessary so that this work can be done. I often discuss this whole problem with the client in a consultation when he is less anxious. I explain the work we can do in group and get his permission to initiate this work myself.

If the client is too frightened to agree to this, then the exploration may have to be done in consultations at first until he has gained enough insight and developed enough trust to tolerate doing it in the group. You can also encourage the client to process his fears on his own silently during the group.

Occasionally there will be a client who has fears of initiating work or speaking in the group, but once he gets started, his fears vanish and he can speak easily. In this case, the work can’t be done by the leader calling on him, because once that has happened there is no work to do. The work is specifically related to initiative. Then you have no choice except to work with the client on this in consultations or have him do some exploration silently during group.

A member may be silent not because of an insecure pattern but because of a passive-aggressive pattern. Then this approach won’t work until you deal with the client’s unconscious anger and need to defeat you. This pattern is discussed in the next chapter.

Bottleneck Issue. Notice that this is an example of a bottleneck issue because it blocks the client from working on any other issues until it is resolved. Bottleneck issues always must be given top priority. A silent client may have to work on this issue a number of times before he reaches the point where he can participate sufficiently to make good use of the group.

Dealing with Rejection

If a person’s desire for someone is not reciprocated or his need not responded to, and he has a healthy degree of internal connectedness and social confidence, he will not be easily hurt. If he is in need and support is not available, he can support himself. He can respond to rejection with curiosity about the reason and ask for feedback so he can learn more about himself. Occasional rejection doesn’t prevent him from continuing to reach out in a confident way.

For an insecure client, even small signs of rejection can trigger intense pain. This can also cause him to withdraw and feel even more insecure in reaching out to others. He may even feel hurt by behavior that isn’t really a rejection at all, because he is projecting his rejection issue onto the situation. This is an opportunity to move the client toward access, first understanding that he feels hurt by the perceived rejection, then perhaps seeing that this is a pattern of his. After that the client might be able to experience the pain of the issue directly and take it back to its childhood origins.

Healing Response or Therapeutic Mismatch. Once an insecure client gets to the point of reaching out, it is important that he get positive feedback that disconfirms his fears. If there has been access first, it will be clear to everyone that this is a big risk, and therefore it is very likely that he will get a healing response. If there is a therapeutic mismatch and the other person doesn’t respond positively, this must be handled delicately. If you think it is the other person’s issue, work with her on her rejecting stance. If you think it is because of the quality of the client’s reaching out or other problematic aspects of his relating, then have him get feedback about this. In either case, you may first have to help the client deal with his hurt. This rejection in the group could be a confirmation of his underlying core issue, so it is important to handle it in such a way that he gets support rather than re-injury. He will most likely get a great deal of support and sympathy from the group for having the courage to reach out, and this will help him to weather the rejection. He may also become angry at the rejection, and this could be healing. If possible, you should sense beforehand whether or not he is likely to get rejected, and if he may be deeply hurt by a rejection, try to avoid it if possible.

Over time, as an insecure client experiments with reaching out and receives healing responses, this gradually leads to inner healing for this pattern. The person becomes more confident and self-assured with others. He starts to expect to be accepted and liked, and this shows in his warmth and ease with people. An occasional rejection doesn’t affect him as deeply as before. He becomes more relaxed and spontaneous in social settings.

Access and Healing

One of your goals for a client with a rejection issue is to help her reveal her insecurity about others’ responses to her. This then allows the group members to give feedback about how they do feel toward her. In most cases, the group members will feel more positively toward her than she expects, and this will be healing. If she accesses the pain of her early rejection first, this makes people even more receptive to her, and the healing will also go deeper.

Taking In. Like needy clients, insecure clients often have trouble taking in the positive responses they get from others in group. Many feel that they don’t really deserve to be liked or appreciated. They feel bad about themselves and find it hard to believe that someone else likes them. Even if they believe the other person means what he says, they may block it from having any emotional impact on them. They should be encouraged to say it if they don’t believe a compliment and to engage in a dialogue with the other person. This often yields more information about why the other person feels positively and this makes it easier for the client to take this in.

If an insecure client can take in another person’s positive feelings, it may set up therapeutic dissonance (see chapter 4) with the client’s negative schema and self-image. This will result in a positive change in the client’s view of herself and her sense of value.

Accessing and Supporting Anger. In addition, a client who was rejected as a child will have an aggressive reaction to this, which can be part of the healing process. Frequently the rejection or lack of recognition made the child feel bad about herself; she was left with a poor sense of personal value or self-esteem. She felt that the rejection was because of something wrong with her, rather than with the rejecters. This reaction also happens with deprivation and abandonment. If you can help the client to access her anger about the rejection, this tends to put the responsibility back where it belongs, on the parents or others who rejected her. The feeling and expression of the client’s anger and the assertion that she deserved better treatment is very helpful in re-establishing a better sense of value. This is especially important for client whose aggression is blocked.

Aggression can be supported in two ways. (1) If someone in the group is actually being rejecting toward the client in an unkind way, so that her anger might be justified, then you can encourage her to express it to that group member. For example, Joel told Sarah that he was disgusted with her for being so whiny and wimpy. She was devastated because it activated a schema having to do with her mother’s rejection of her. Of course, anyone would be upset at receiving such a cutting remark, but it was especially hurtful for Sarah because of the rejection issue. At first she collapsed into tears, but also showed signs of anger in her voice and gestures. The leader pointed these out and asked if she was in touch with resentment toward Joel. She realized that she was, and the leader helped her to express it to him, working with her on her fear of his reaction. When he did react with disdain to her anger, she worked on being able to stand up to him. Eventually she was able to sustain a certain degree of aggression in the dialogue, and she felt much stronger and better about herself afterward.

(2) If the client’s feelings of rejection are largely transference or if the rejecting person handled the situation tactfully so that anger is not appropriate, then you must help the client take her reaction back to its origins and express the anger to the people who rejected her in childhood, using role playing. For example, suppose Joel approached Sarah in a concerned, responsible way and told her that he had difficulty with her tendency to complain about her life and disempower herself. If she was hurt and angered by this rejection, it wouldn’t really be appropriate for her to dump the anger on Joel. Therefore the best approach would be to help her to access her anger toward her mother and express this to her through role playing.

Accessing Aggressive Desire. Clients who have been rejected (or deprived or abandoned) usually block their natural aggression of wanting and desiring to connect with another person. Because of the pain of not getting what they wanted, they close off the full force of the wanting. It can be helpful to access this buried aggression so they will be able to reach out in more powerful and confident ways. Here the aggression you want to access is not anger at rejection but rather the power of desire. In the safe setting of the group, you would like the client to be able to feel the full passion and fire of her wanting, even if she doesn’t get what she wants. This can be very empowering.

Valuing Oneself. You must be careful that a client dealing with rejection doesn’t become dependent on healing responses to feel OK about herself. In the beginning stages of someone’s work on this issue, healing from the group is very important. After she has accessed important new insights or feelings, it is also valuable to have healing responses. However, after a client has worked on this issue for a while, if she is still feeling insecure and looking for reassurance from others, it may no longer be healing for her to receive this. At some point, the inner healing should progress to the point where the client feels an inner sense of connectedness, self-love, and value. She should begin to feel her own sense of worth and goodness at a deep level, without needing validation from others. If this doesn’t happen spontaneously, and the client keeps needing to hear from others, ask her to focus inward instead of on other people and help her to access her own sense of value. This comes not from valuing specific attributes of herself, but by being present with herself and following her process. See the Value chapter for a further discussion.

Exclusion

Exclusion Triangles. Rejection often includes a sense of being excluded from an interaction between two other people. The insecure client feels that the person he desires has chosen another person over him, and he feels devastated because this proves that he really isn’t lovable or worth much to others. This feeling can be triggered by simply observing two people interacting without any communication being directed toward him. He feels that he has lost the competition for the acceptance or attention of the one he wants, and he usually withdraws in pain. This is, of course, related to the classic psychoanalytic oedipal complex and often brings up feelings of jealousy or envy. When this happens, it is sometimes helpful to get the client reality feedback that he hasn’t been excluded, the other two people are simply connecting. Then he can be helped to access the origins of this issue.

For example, whenever Dee Dee observed a man she liked connecting with another woman, she felt worthless and unattractive. She assumed that he found the other woman more appealing. She would withdraw and make no attempt to connect with him. This, of course, would sometimes create the very situation she feared, a self-fulfilling prophecy. Once she was able to reveal this when it was happening in the group, she got feedback from the man that he was also interested in getting closer to her. This was a total surprise to her and helped to loosen the hold of the schema. We also explored how this went back to her rejection by her father and his intense preoccupation with his relationship with her mother.

Exclusion from the Group. An insecure client can also experience being excluded from the “in group” or from the group-as-a-whole. This may derive from a rejection issue having to do with exclusion from the family group. A person like this will often feel excluded even when the group members are completely accepting of him. This can even be a contributing factor in a client’s decision to leave the group without his realizing it consciously. If you suspect this, it is especially important to encourage the group members to express directly their liking for the client and their desire for him to stay in the group. This often helps to convince the person to stay. In any case, it is important to help the insecure person to express to the group his feelings of exclusion, so that he can get explicit feedback to the contrary. For this feedback to be truly healing, you may have to work with the client on access. The client may also need help in taking in such positive feedback when he expects the opposite. For example, after three months Denny said he was leaving the group because of money and a vague dissatisfaction with what he was getting. As we explored this, it became clear that he felt that the group members didn’t particularly like or accept him. They responded by telling him how much they liked him and how upset they would be if he left. This was completely shocking to him, but he was able to take it in and decided to stay.

Just as clients who expect rejection from individuals often create it by being insecure, distant, demanding, or hostile, clients who expect to be excluded from a group often create that in similar self-fulfilling ways. This can cause the person to play a scapegoat role in the group. This is usually best handled by feedback from the group members. They can give him clear detailed feedback about what he is doing to cause them to avoid him. Then the client can access his fear of exclusion and its history and proceed with healing and experimenting as discussed before. If the client seems to be too fragile to handle confrontation from a number of group members at once, it may have to come from the leader, perhaps even in a consultation.

Countertransference

Countertransference toward the Insecure Client. A danger with insecure clients is to simply focus on helping them obtain reassurance that they are desirable to others. This can be a part of the healing they need, but be careful of focusing on that to the exclusion of access and experimenting.

Countertransference of the Insecure Therapist. Group leaders with an insecure pattern may need too much reassurance from their group members that they are liked and seen as competent. If you have an insecure pattern, you may be overly hurt when clients challenge you or express negative feelings toward you. This is especially true if your rejection issue includes problems of insecurity about professional issues. Then client attacks can undermine your professional confidence and make it hard to lead effectively. See chapter ?. You also may have difficulty making interventions that won’t be so popular with you clients, such as setting proper boundaries or pointing out destructive behavior.

Summary

Relational Healing. Through the work described in this part with clients who are deficient in connectedness, they develops relationships with others in group, with the group-as-a-whole, and with the leader in which they:

1. Feel safe to experience their needs and desires.

2. Learn to reach out in healthy ways and discover that this is safe and rewarding.

3. Learn to take in the nurturing and loving responses they receive

4. Get their developmental needs for nurturing and mirroring met

As a result of this, they develop their capacity for connectedness.

A person with a healthy sense of connectedness is less likely to contribute to the objectification and dehumanization of other people. He will value his relationships and also value other people for themselves rather than only for what he can get from them. Therefore, he won’t be inclined to oppress or exploit other people. He will be capable of loving and giving to others and participating in healthy community. He will be more likely to feel connected with people around the world who are different from him. He won’t have much need to compensate for a deficiency in connectedness through power, status, money, or possessions. In short, he will have some of the personal qualities needed for being a citizen in a healthy society and culture.

Other Patterns Related to Connectedness. In addition to the patterns described in this chapter, there are a number of others related to connectedness. The isolated pattern involves a defense against connectedness. The victim pattern involves an indirect, unconscious attempt to heal a connectedness deficiency by coercing others into nurturing the client. The compliant pattern is sometimes an attempt to indirectly achieve connectedness.

Core Issue and Pattern Tables

The following tables summarize the information from this chapter. Since I will be using this type of table throughout the pattern chapters, let’s clarify the meaning of each column:

Core Issue Table. Table 18.1 summarizes the information about the issues discussed in this chapter. It is organized according to the left-hand column, “Core Issue.” The next column tells the type of that issue. There are two important types of core issues that affect the types of defenses clients use against them. Harm issues include violation, domination, attack, deception, shame, and exploitation. These produce a fear of being harmed or controlled, and clients may respond with either compliance or defenses against this. Deficiency issues include deprivation, abandonment, rejection, shame. These produce a deep feeling of being deficient or inadequate, which clients compensate for in various ways. In addition to this two types, punishment issues originate when a child is punished for a certain healthy behavior, and shaped issues originate when a child is rewarded for a certain behavior or it is modeled by the parents.

The “Origin” column briefly describes the childhood origin of the issue. The “Thought” column depicts a typical thought that characterizes this issue, conscious or unconscious. The next column, “Capacities Blocked,” lists the capacities that tend to be blocked when this schema is activated. The “Painful or Shaped Pattern” column names the pattern that occur when a client acts more or less directly from this issue, without defense. This reflects the fact that this pattern can be either of these types depending on the type of the issue. When this column contains the word “none,” it means that people don’t tend to live out this schema directly; they almost always defend against it in one way or another. The “Defensive Patterns” column lists those patterns that may be used as a defense against this issue.

Patterns Table. Table 18.2, the patterns table, is also organized according to the left hand column, “Patterns.” The “Similar Meaning” column contains other words that could be used to describe a client using this pattern. “Related Technical Concepts” list concepts from the psychotherapy literature that are related to this pattern. The “Behavior” column briefly describes the behavior of a person exhibiting the pattern. The “Core Issue” column lists those issues they typically underlie this pattern.

The “Conscious Statement” column contains explicit statements that clients with this pattern would make about themselves and the world. For painful patterns, these statements may be identical to the thoughts associated with the underlying issue. Defensive patterns also have an “Unconscious Thought” which is kept of our awareness because it is defended against. When this column is blank, it means that the conscious statement captures the pattern in a fairly accurate way, and nothing deeper is needed. The “Group Roles and Positions” column lists those roles and positions that are typically taken by clients using this pattern. “Countertransference toward Client” refers to countertransference reactions that therapists typically have towards client with this pattern. These are often elicited countertransference reactions. “Countertransference of Therapist” refers to personal countertransference reactions that are typical of group leaders who have this pattern. Any of these columns can be blank for a particular pattern, which means that I am not aware of a typical role or countertransference reaction for that pattern.

Change Process Table. Table 18.3 summarizes information about the therapeutic change process for the various patterns. It is organized according to the five aspects of the change process delineated in chapters 3 and 4. There are two columns for “Access” because one can access both painful schemas and healthy capacities. The last column shows “Potential Problems” that can arise in working with a client who has this pattern. If any of these columns are blank for a particular pattern, it means that that aspect of the change process is not prominent in working with clients using this pattern.

PART 3: AUTONOMY AND SAFETY PATTERNS

In this part we continue our exploration of the pattern system by looking at those patterns related to autonomy and safety. Because there is considerable overlap and inter-relatedness in the patterns that tend to block autonomy and safety, we will study them together. First we discuss the core issues related to autonomy and safety—domination, shaped-dependence, punishment-for-aggression, violation, and attack. Then we explore seven patterns related to autonomy and safety—the isolated, compliant, defiant, passive-aggressive, codependent, victim, and suspicious patterns.

Autonomy and Safety

Since this chapter deals with autonomy and safety, let’s review their meanings.

Autonomy. An autonomous person is a powerful, self-activating individual who can be herself without being unduly influenced by who others want her to be. To the extent that a person has autonomy, she trusts her feelings, perceptions, opinions, and desires; she feels she has the right to them and the power to act on them. She can take care of herself and reach out for what she needs. She is interested in actualizing her unique potential as a person. She trusts in others’ respect for her autonomy, but can assert herself to maintain it if faced with attempts to control her. She feels autonomous when alone or in a love relationship or belonging to a group or organization. An autonomous person can take initiative to accomplish what she wants, including therapeutic change. She takes responsibility for her actions and their effects and is an active agent in the conduct of her life.

Safety. A person with a healthy sense of safety feels that she has the right to the integrity of the boundaries of her own body, physical space, inner life, and privacy in general. She feels safe from intrusion, attack, or violence when in situations that are objectively safe. She also has the psychological ability to protect oneself from harm, especially violation or attack. When she is relating with people who care for her, she can trust this fact.

chapter 6: core issues related to autonomy and safety

In part 1, each pattern had one or two associated underlying core issues. Here there isn’t such a straightforward correspondence between issues and patterns, so I will first discuss many of the core issues, and then afterwards present the patterns. The core issues in this chapter include not only painful schemas, where the primary issue is the pain of the original childhood relationship, but also shaped schemas, where problematic behavior is learned through internalization, reward, and punishment.

Domination

Origins. This issue derives from a family structure in which the child was excessively controlled. She was made to do what the parents (or others) wanted rather than what she wanted. Of course, children must frequently be told what to do, for safety reasons and because they need guidance. The domination issue results when this control is exercised for the parent’s good rather than the child’s, or when it is used despite the fact that the child is developmentally able to exercise her own will in a healthy way. This issue tends to block autonomy. It can produce the thought, “Other people are in charge of my life.”

Control, of course, can be exerted in many ways—direct command, reward, punishment, manipulation, and so on, but these all involve shaping the child’s behavior toward compliance, so this is a shaped schema. Control may also be exercised over more than just a child’s actions. The parent may also tell the child how to think and perceive reality. The child may be told what she is feeling and what she wants and needs. In fact, it is natural and healthy for parents to do all of this in teaching the child about the world and herself and in mirroring her. However, this can be done excessively or for the wrong reasons and the child can be given incorrect information about the world and her inner life. The parent’s ideas can be imposed on the child’s and her reality ignored. This is what can produce a domination schema.

Punishment for Autonomy. This core issue can also result from the child receiving punishment or other negative consequences for exercising any form of autonomy, especially for not being who the parents (or other guardians) want her to be. She might be punished for being assertive, taking initiative, separating from the parents, saying ‘No’, or in other ways being herself rather than complying with their plans for her. Of course, parents do need at times to punish a child for dangerous or destructive behavior, but this issue derives from a situation where it happened frequently and in ways that were not in the child’s best interests. The punishment could take the form of anger, judgment, ridicule, withdrawal, or abandonment; however, the most important issue here is the fact that it occurs in response to autonomous behavior. If this happens consistently, it causes the child to defend against and avoid such behavior and instead comply with the parents wishes. This can produce the thought “It is not OK to be myself.”

This issue can cause a person to have a fear of success because that is equated with autonomy. There is a fear that if she is successful, she will be alone; no one will want to be with her. This is particularly common in women who have been traditionally socialized toward homemaking rather than career.

Compliant Behavior. Clients who act from a domination core issue don’t feel that it is OK for them to do what they want. They frequently measure their desires and opinions against those of others and conclude that theirs are unimportant. They may even have a hard time knowing what they want, think, or perceive when this is different from others. When the domination issue is shown directly in behavior this way, this produces the compliant pattern. However, a client may defend against domination using the defiant, isolated, passive-aggressive, victim, codependent, or controlling patterns.

Shaped Dependence

If a parent, often the mother, is more comfortable when the child is young and dependent, she may unconsciously shape the child’s behavior toward dependence. She may encourage the child to need her and stay merged with her even after the child has developed to the point where separation is appropriate. The parent may punish independence and separation by withdrawing or becoming angry and judgmental. She might respond in such a way as to make the child feel guilty for separating. She might reward the child for dependence through praise and love. She may even model dependent behavior herself. All this encourages the child to stay dependent past the time when this is healthy for him. This may produce the thought, “It is good for me to be dependent.”

This issue can also result from a parent being overprotective toward a child. The child is given the message that the world is dangerous and difficult and he isn’t capable of handling his life, so the parent must do it for him. Of course, parents must often handle aspects of a child’s life in the normal course of caring for a child. It is only when they continue to do things for the child when he can do them for himself that this schema may be created, and especially if the child is given the message that he isn’t competent enough.

A client who acts out this issue directly may look needy on the surface, but this issue leads to a completely different pattern—the compliant pattern. Here the child is not necessarily lacking nurturing or deficient in connectedness. Instead his deficiency is in autonomy, especially his ability to separate and to take charge of his life. He doesn’t need caring, he needs encouragement to separate, be himself, and take responsibility for his life.

This issue may be instrumental in generating the compliant and victim patterns. A client may defend against this issue using the defiant, passive-aggressive, or controlling patterns.

Punishment for Aggression

Aggression is a healthy capacity that is related to both autonomy and safety. It is the psychological force or energy that allows a person to act in the world. It includes going after what you want and protecting yourself from what is not good for you. It includes the ability to feel and express anger and rage and also to move toward people and projects with passion. You can think of aggression as the energy behind the actions of autonomy and safety and the ability to reach out for connectedness. Aggression was discussed in depth in chapter 10.

Aggression can take many forms, but the one that is most difficult and threatening to others is anger, including variants such as resentment, rage, and hatred. Therefore when aggression is undermined in a child it usually has to do with anger. There are a number of ways this can happen:

1. Judgment. The child is judged or ridiculed for being angry. He is told that his anger is wrong or bad and he should feel ashamed of it. If this is done regularly, the child will suppress his anger to preserve some sense of value.

Self1: angry Other: judgmental of anger Self2: ashamed

2. Counterattack. When the child becomes angry, especially at a parent, that parent becomes even more angry (and perhaps violent) in return and frightens the child into silence. Since the parent is much larger and stronger, her anger can be very frightening. If this is done consistently, the child will learn to deny his anger out of self-protection and safety.

Self1: angry Other: attacking Self2: frightened

3. The parent may be unable to tolerate the child’s anger in that it may make her feel afraid or ashamed or hurt. She may become overly emotional or depressed. If this happens repeatedly, the child will defend against his anger so as not to cause a person he depends on to collapse. The child may also be made to feel guilty for being angry toward a parent who can’t handle it.

Self1: angry Other: devastated Self2: guilty, fearful of neglect

4. If a young child’s anger comes in the form of murderous rage toward a parent, he may be afraid to feel this for fear he will actually kill the parent who he is dependent on. Young children often can’t distinguish fantasy from reality. This may cause the child to defend against the rage to protect the parent.

Self1: enraged Other: destroyed Self2: fearful of abandonment

5. Ideally when a child is angry, he needs his parents (and others) to support his right to be angry and help him understand what he is angry about. If this is not forthcoming it can be hard for a child to continue to be aggressive.

If these situations occur often enough, the child will develop a core issue that says anger (and aggression in general) is not safe or acceptable because it leads to negative consequences. I will call this the punishment-for-aggression issue. It can produce the thought, “It isn’t OK for me to be aggressive.” The child will then develop a defense against his aggression, which may make it difficult for the child to assert and protect himself. The exact form this defense takes will influence the pattern the person develops. This could be a compliant, passive-aggressive, or victim pattern.

Attack

This core issue originates when a parent (or other person) repeatedly expresses excessive anger toward the child or abuses the child physically. It can also result from the child witnessing excessive anger or violence, even if it is not directed toward him. This issue blocks safety in general and especially vulnerability because the person doesn’t feel safe enough to allow herself to be vulnerable. It can produce the thought, “I am in danger of being attacked.” If the attack involves violence, it may also undermine the person’s sense of bodily integrity. If, in addition to being attacked, the child is prohibited from attempting to protect himself, then this may also undermine his capacity for self-protection.

Clients rarely relate to others directly from this issue because it would be too painful to live with that amount of fear, so they defend against it using the compliant, isolated, passive-aggressive, victim, or defiant patterns.

Violation

This core issue originates when a parent (or other person) intrudes on the child, especially at a bodily level. This can happen through force feeding, enemas, sexual or physical abuse, or other physical contact that happens despite the fact that the child doesn’t want it. The child’s body boundaries are violated. This issue can result from even a single traumatic incident of this sort, though, of course, it will be more severe if the violation happens repeatedly. This issue can also develop through experiences of rape or other traumatic experiences that happen during adulthood.

It often has the associated thought, “I can be violated at any moment, and I can’t do anything about it.”

This issue blocks safety and especially the person’s sense of bodily integrity. It often undermines the person’s capacity for self-protection because of her experience of being unable to protect herself from being violated. There is also usually a strong element of control and merging involved in the process of being intruded on, and therefore the child’s behavior is shaped toward compliance, blocking his capacity for autonomy. Thus this schema is both a painful (harm) schema and a shaped schema.

The client who acts directly from the violation issue exhibits the compliant pattern, because he has learned to give in to others, set no limits, and exercise no power. Clients can defend against violation using the isolated or defiant patterns.

Working with Violation

It will be useful to explore practical issues of working with violation here, in addition to what will be discussed under the patterns related to it.

Shame and Secrets. Clients who have been violated, especially sexually, usually feel a great deal of shame about it. The disgusting nature of such a violation is somehow felt as a reflection on the value of the child rather than on the perpetrator where it belongs. The child feels shame about herself rather than (or in addition to) rage at the perpetrator. Therefore an important part of the therapeutic change process is to heal this humiliation. The shame makes it difficult for the client to access any feelings or memories in a group because that means publicly acknowledging what happened, which intensifies the shame. However, if you work with the client explicitly on her shame about revealing the abuse, perhaps in a consultation, this can prepare her to be able to do it.

The positive side is that when the client is able to reveal her abuse to the group, she will most likely be received with caring and empathy, and outrage toward her perpetrator. This is crucial in helping to shift her inner response form shame to anger. This is especially helpful in a group setting because the client is receiving understanding from many people, not just from one special therapist. It is especially potent when other group members have also experienced violation, as is fairly common, even in general purpose groups. The identification and understanding from other group members who know what she has been through is very important. This is why specialized groups for sexual abuse are so valuable.

It is also common for children who have been abused sexually to be threatened with dire consequences if they tell anyone, or to be met with denial or dismissal if they do tell. This also makes it difficult to reveal this kind of history in group, but if you work with the client on their fears about revealing the secret, this can unlock the door. And when the person is able to reveal her secret, this can be wonderfully liberating, especially in a group. Now instead of protecting the perpetrator, she has the chance to publicly declare what he has done.

Access. Once the client is able to talk about her experience of violation, deeper experiential access will, of course, also be needed, and this is usually very gradual, delicate work. There may not be enough time to do all this in a group setting; the client may need individual therapy as well. However, the group also has an important role to play; the support of the other group members and their healing responses can be central to the healing process.

Rage and Self-Protection. It isn’t enough to access the pain, shame, and experience of violation. The client also need to feel and express her rage toward the perpetrator as a way of feeling her ability to protect herself from this experience. This is very important to the healing process in two ways: (1) The client learns to feel that she has the right to body integrity and protection from intrusion and harm. (2) She develops her ability to be assertive, autonomous, and strong, capacities that are often undermined by sexual abuse and other kinds of intrusion. This anger can be directed at the perpetrator or, in some cases, at another group member who is being intrusive. The other group members can contribute to this healing process by offering protection and parallel empathic feelings of anger.

Relational Healing. Another level of healing occurs over time when a violated client develops a relationship with another group member (or the leader or group-as-a-whole) in which she is cared for and her boundaries are respected, especially if she started out with negative transference with this person. This is particularly important if the client has a schema where attention or caring are paired with abuse. This occurs when the abuser is the only person who gave the child any positive attention. Then if the client can develop a relationship in which the other person not only cares for her but also respects her boundaries, this will be especially healing.

Of course, much more can be said about the healing of sexual abuse. See Scharff & Scharff (1994), [gestalt ref], and Herman (1992).

chapter 7: the isolated pattern

The isolated pattern is related to the capacities in both this chapter (autonomy/safety) and last chapter (connectedness).

Isolated Behavior

Clients with the isolated pattern develop powerful defenses against connecting with others. They usually do this by blocking their experience of need or desire for people. If a client doesn’t feel a need to connect with others or be helped by others, he can avoid closeness and the pain or intrusion he fears it will bring. This avoidance defense can take a number of forms:

1. Emotional block. The client blocks his emotional experience of need or desire. He feels mechanical and uninvolved with people.

2. Distance, independence. The client believes that he can stand on his own and doesn’t need caring or help from other people. “I don’t need anyone.” “I can take care of myself.” This can take the form of not needing the group members or the leader.

3. Judgment. The person looks down on other people as a way of defending against his needs or desires for connection with them. This can take the form of denigrating the group members, the group-as-a-whole, or the leader. This may or may not be stated explicitly.

Clients who use this defense not only avoid reaching out for connection or help, they often don’t show warmth or respond positively when others reach out to them. They avoid taking in warmth from others because this might cause them to feel their need for contact. Therefore they are often deficient in their ability to care for and nurture others. Caring is a healthy capacity, discussed in chapter 3, that is important for the promotion of vulnerability in groups and for being able to respond to others in a healing way. Isolated clients block not only need but also put up barriers to vulnerability, a healthy capacity that is crucial for the therapeutic change process. For a person who has been attacked, controlled, or intruded on, it is much too threatening to allow oneself to be vulnerable.

Compensation. The isolated client doesn’t trust other people to respect his boundaries, but he also doesn’t trust himself to be able to set and maintain his boundaries, reflecting a deficiency in the capacity for safety. His position of isolation provides a compensatory form of safety, by avoiding the dangerous situation, namely intimacy. In a similar fashion, isolated clients often don’t feel that they can maintain their autonomy in a close relationship, so they create a compensatory form of autonomy by making themselves completely independent of others.

Gender and Society. The isolated pattern is more common in men, though both sexes can have it. This happens because men are socialized to value their independence, and women are socialized to value relatedness. Men often believe they should be strong and self-sufficient and able to handle everything themselves. To feel his need for others can be a threat to client’s masculinity. Many of our societal institutions have the flavor of the isolated pattern, promoting distant, bureaucratic relationships rather than the aliveness of genuine contact and community.

Conditions. Clients with the isolated pattern often act it out it with everyone. However, in some cases it only comes out in love relationships, where the person’s intimacy fears are activated. It also may be activated by people who remind the client of the parent who harmed him. For example, if a man was harmed by his mother, he may keep a distance from women.

Origins. Clients with the isolated pattern usually have core issues that involve harm or abuse of some kind—domination, violation, or attack—especially when this harm came from a family member. Sexual abuse from a stranger is not as likely to produce an isolated pattern as when it is perpetrated by a parent (though it may produce other patterns just as problematic). The isolation is a defense against allowing the kind of closeness that is associated with the harm or abuse. This is associated with the thought, “If I am close to someone I will be harmed.” Sometimes the issue underlying an isolated pattern involves only deprivation or neglect but at a level that is so severe that it constitutes a threat to the child’s safety. This also seems to be capable of producing an isolated pattern of defense. More extreme versions of the isolated pattern, such as the schizoid personality disorder, tend to originate with a deficiency in safety caused by attack or abuse. Deficiencies in autonomy, caused by a controlling parent, are likely to cause less severe versions of the isolated pattern.

Group Roles and Positions. An isolated client may distance himself by becoming a silent member of the group with the problems that this entails (see chapter ?). If he is functioning at a lower level than most of the group, he may become a group mascot, being tolerated by the other members but not really connecting with them. On the other hand, some isolated clients are fairly attractive, physically or in other ways, and their reserve creates a sense of mystery and enticement. The other group members, especially those of the opposite sex, may become engaged in attempts to get an isolated member to open up and connect with them. This can especially be true of a woman who is enticed by a male isolated client, who represents all the men in her life who she couldn’t get to love her. The isolated man then becomes an object of pursuit for her.

Related Patterns and Concepts

Related Patterns. Clients with the need-denying pattern also block their need for others, but they don’t defend against connecting with others. In fact, they are often quite needy and interested in closeness, though they defend against recognizing or showing the degree of their need. An isolated client goes much further; his whole personality is constructed so as to avoid closeness, and denying his need is just a way of accomplishing this. The isolated and defiant patterns are both ways of defending against perceived attack or control. However, the isolated person does this by avoiding close relationships while the defiant person does it by fighting back and setting rigid limits.

Related Concepts. Isolated clients sometimes use dissociative defenses and may be diagnosed with a dissociative disorder. They also commonly use intellectualization as a defense.

Combining Patterns. If a person combines the isolated and compliant patterns, it means that his isolation is a defense against compliance in relationships, so when this person begins to heal his isolation and connect with others, he will be in danger of giving himself away. The person who is both isolated and codependent will relate to others exclusively as a caretaker and use this to keep himself safe from deeper emotional involvement. The person who is both isolated and controlling will only allow himself to be close to others in relationships in which he is completely in control. The person who is prideful and isolated may feel that he doesn’t need anything from others because he is above them. It is also common for the isolated pattern to be combined with the suspicious pattern or the defiant pattern.

Variations in Functioning. There can be a wide range of functioning within the isolated pattern, as is true with all patterns. Clients with more extreme versions of the isolated pattern are typically diagnosed schizoid. This includes people who lead very lonely lives, cut off from almost everyone and perhaps also from their own feelings. On the healthier side, there are people who have friendships and stable marriages but have arranged these relationships so that they are relatively independent and rarely need anything from others. For example, a person might be married but keep his heart closed so that he doesn’t let himself to show love or vulnerability with his wife. Almost anyone may exhibit a minor version of the isolated pattern in love relationships. This is illustrated as follows:

Needy and Isolated Patterns in Relationships. The isolated pattern is in some ways the opposite of the needy pattern. In fact, these two patterns exemplify the two common complementary fears in love relationships—the fear of rejection and the fear of closeness. These can also be conceptualized as the fear of abandonment and the fear of engulfment. Most people have some of each fear inside them, though one fear may be much stronger than the other. In other words, most people have some of the needy pattern and some of the isolated pattern in their personality structure. Some may have an intense version of one and a minor version of the other, and some may have them in more equal amounts. Sometimes a person is pushed into one pattern or the other depending on which is strongest in their partner. Thus if you get involved with an isolated person who intensely fears closeness, you will probably be propelled into dealing with your fear of abandonment because he will pull away. And in the opposite way, if you become involved with a needy person who very much fears distance, his neediness may trigger your fears of engulfment.

In fact, some people, rather than clearly exhibiting one pattern or the other, show both. Some borderline clients switch between the extremes of neediness and isolation, desperately clinging to a relationship and then pulling away out of fear of engulfment. Other people manage to create relationships in which they inhabit an in-between place, where they are involved enough to assuage their fears of abandonment but keep enough distance to avoid the fear of being engulfed. They have a mixture of neediness and isolation, leading to relationships that are bland, safe, and unsatisfying. In fact, many men in today’s society (and quite a few women as well) try to keep their marriages in this safe middle ground.

Primary and Secondary Deficiencies. In the last chapter we discussed deficiencies in connectedness that are the direct result of core issues that block connectedness. In other words, the deficiency came from the issue. However, clients who exhibit the isolated pattern have deficiencies in connectedness that are the result of defenses against core issues related to safety and autonomy. In this case, the deficiency comes from the defense as well as the core issue. The defense blocks connectedness, while the core issue blocks a different capacity. Since isolated clients have an underlying harm issue, their primary deficiency is in safety or autonomy, and they feel so strongly about needing protection that they are willing to forego connectedness to feel safe. So they develop a secondary deficiency in connectedness as a result of their isolated defense. A primary deficiency comes from the core issue, and a secondary deficiency comes from the defense.

Of course, things are often much more complex than this. An isolated client may have a primary connectedness deficiency as well, and there can be different degrees of deficiency for each capacity. The important thing is to recognize that both deficiencies exist and that the connectedness deficiency is at least partly a result of a defense. It is important to focus on both capacities in the work, but especially to start with autonomy/safety issues. If you work toward connectedness with an isolated client without understanding his safety or autonomy fears, his defenses will only harden.

The Change Process

Responsibility. Motivation may be the biggest problem to overcome in working with the isolated pattern. The client may be convinced that he doesn’t need people or that he isn’t interested in the people in the group. He may defend against his need for help by saying that only the group leader can help him, that the group members don’t have anything to offer. You may get past this defense by helping him understand how his lack of need or desire in group is related to his lack of satisfying relationships in his life (which is usually the case). If he seems not to care about this, try to make a connection between his lack of interest in relating to people and his presenting problems in joining group. For example, if he is depressed, you might explore how this might be related to his isolation. This is often best approached in a consultation because it might be difficult for the client to say indifferent or negative things about other group members in their presence without evoking anger and hurt. Ultimately your goal is to get the client interested enough that he is willing to see his lack of need as a defense and explore what is behind it. If he doesn’t eventually reach this point, the group isn’t likely to work for him.

Protection. It’s very important not to push an isolated client into connecting with other group members or asking for help until he wants to do so. You may feel like suggesting that he get more involved in the group, but any pressure from the outside can be experienced by an isolated client as control or intrusion. When another group member reaches out to an isolated client for contact, this can also be experienced as danger, leading the isolated client to react in a defended or angry way. The group members may feel annoyed at him for his indifference to them or his barriers to contact, and they may pressure him to relate to them. They certainly should be allowed to express themselves, but try to protect the isolated client and support his boundaries. He needs this so he can take the time to uncover and explore his fears. Eventually he will work them through and feel safe enough to experience his needs and desires. You can protect an isolated client by explaining to the group why he needs to keep distant, by supporting his ability to stand up for himself, or by working with a group member who attacks him to uncover that person’s issues.

The isolated client originally cut off his needs because he was excessively intruded on or controlled as a child, and you don’t want this pattern repeated in the group. In fact, your protection of isolated clients can be a healing experience for them, since they were often abused as children, and protection is the most important healing response for a harm issue. Similarly, if the client protects himself from others in the group, make sure to support him in this, even if his perceived need for protection is a distortion and his way of protecting himself is hurtful to others. Frame his behavior so all can understand its origin. The paradox of isolated clients is that often they present a very tough, angry, or distant exterior, and yet they need a great deal of tenderness and protection.

For example, when Penny expressed hurt that Don wasn’t more available emotionally, he felt she was being needy and trying to suck off him. A couple of group members became angry at this and defended Penny. The leader suggested to Don that he had a strong need to keep his boundaries clear, especially with women. At first Don was resistant to this idea, but after a few weeks in which he got similar feedback, Don was willing to explore himself. He began to realize that he had a core issue that led him to worry that a woman would take him over with her need. Don was sexually abused by his nanny as a child.

Access. When an isolated client reacts with anger or judgment, it is very helpful if he can get in touch with the underlying harm issue. This not only gets to the origins of his isolation and anger, it also reveals this to the group, helping them to be more supportive and patient with him. For example, if Don accesses his experience of sexual abuse, the group members will be much more empathic and willing to allow him his barriers. Even just telling them that it happened will help. Patience is one of the most important things an isolated client needs—time to find himself, to feel his fear, to ultimately feel safe enough to allow himself to feel his need for connection with others.

In the process of accessing these memories, the client is likely to feel a great deal of anger, possibly rage, at the way he was violated as a child. This is an important aspect of the healing process. He may need to express this to his parent (or other perpetrator) through role playing. He may begin to experiment with setting boundaries in his relationships with various group members. This should be supported as much as possible even if he goes overboard at first. For example, Don decided that he didn’t want any outside contact with women in the group, at least for a while. When one of them felt hurt by this, the leader supported his decision and helped her to understand why he needed this. Over time, as an isolated client grows to feel strong enough to exercise his aggression and thereby maintain his boundaries, he won’t be so afraid of allowing people close to him.

In the process of accessing the original way in which he was harmed, the isolated client may also allow some vulnerability. For him to feel this and show it emotionally in group is a big step. It requires a considerable degree of trust in the group and leader for an isolated client to reveal the fear and pain associated with the way he was harmed as a child. This may occur only much later in his therapy process. When it does occur, it will help the client to develop more trust when he discovers that people in the group respect his vulnerability and respond with caring and appreciation. For example, when Don was eventually able to feel the pain and fear of his abuse, it was a sacred moment in the group. The members were profoundly touched by his courage and openness.

As a client softens his defense of isolation, his work begins to follow more closely the underlying harm issues. This is described in the next section on working with the compliant client. The previous discussion of working with violation may also be relevant.

Experimenting. When an isolated client begins to open up his needs or desires, he may first share them in a consultation, where he doesn’t have to worry about the group’s reaction. He may feel a need for help from the group or a desire to belong to the group. The need might first emerge after the person has been received well in the group, so that he feels safe enough to feel it. His first step may be to respond positively to someone who reaches out to him. His need for connection might first be directed toward the leader, because you are the safest person or the one he feels most comfortable with.

It is a tender moment when an isolated client first begins to risk feeling and showing his vulnerabilities and needs. The group will probably be very supportive, but make sure they don’t overwhelm him in their enthusiasm to connect. Continue to protect him from anything that may be experienced by him as harmful.

Fear of Closeness. As the isolated client begins to develop relationships with people in group, he will repeatedly become frightened and pull back from the closeness. Often this will happen unconsciously. He will turn off emotionally or fail to take in love that is expressed to him. He may become judgmental or distant without realizing why. It is a major task for him to become aware of those moments his fear of intimacy is getting in the way. Then he can experiment with feeling the fear and allowing the closeness, or he can use these opportunities for deeper access into the origins of his fears.

Healing. Over time, the isolated client will gradually make deeper connections with other group members, with the leader, and with the group-as-a-whole. He will develop relationships in which he is vulnerable and yet is not harmed the way he was as a child. This constitutes the deepest healing for this pattern. He will learn to feel his need for people, open his heart, and let go of his intense need for boundaries and protection. He will become able to feel his emotions and make satisfying and lasting relationships with others.

Fear of Commitment

In the Person’s Life. In a variant of the isolated pattern, some people are quite able to reach out and connect in the early stages of a relationship, but once it reaches a certain level of intimacy or commitment, they have to run or push the other person away. Their fears of being controlled or abused become too great to allow the connection to continue. This is especially true in love relationships, but it can also happen in other close relationships. The fear of being controlled is sometimes related to the client’s own desire for merging and being taken care of.

This defense can be acted out in various ways:

1. Losing interest in the relationship.

2. Becoming judgmental or angry at the other person.

3. Becoming involved with other people or activities to dilute the intimacy or push away the other person.

4. Ending the relationship.

This pattern is more common among men, but women use it, too.

For example, Carl had been involved in numerous love relationships, but each time, after three months or so, and especially if the woman wanted more from him, Carl would begin to feel less excited about her. Increasingly, he would find fault with her. Before long he would become involved with another woman, effectively ending the chance to go deeper into commitment with the first partner.

In Group. In a therapy group, this defense is most frequently activated by the person’s fear of commitment to the group, even when the issue isn’t a group-oriented schema. When any member has been in the group for about two to four months, and the group is working for him, there is a natural point where he makes an emotional commitment to the group. (See the chapter on Developmental Stages.) With an isolated client, this is often the time when his fears of commitment come up intensely, and if not dealt with, he is may leave the group precipitously. An effective way to handle defense is to predict it. Once you realize a client has an isolated pattern, it is wise to predict that he will probably want to quit group after a few months when he is starting to feel close to the other members. This is usually enough to remind him to bring up this fear to explore rather than acting on it. If your prediction is wrong, you have lost nothing.

In addition to actually leaving, the client might act out his defense by becoming judgmental of the group (or leader) or losing interest in it. This should be explored to determine if it derives from commitment fears. Once the client recognizes that his defense is because of a fear of closeness or commitment, you can work with him on accessing this fear, and his work will go to a new depth.

Countertransference

Countertransference toward the Isolated Client. Be careful of the urge to try to get through to an isolated client, the desire to help him open up and connect. This can lead you to act in ways that feel intrusive or controlling to him, and he will simply close up even tighter. It is also easy to be fooled by the seeming toughness and rigidity of an isolated client or his angry distant exterior. When such a client gets into a confrontation, especially with someone who shows her vulnerability, you may forget that the isolated client is also vulnerable. He hides it well, but in his past he has been injured very deeply. He needs just as much support and protection as someone who cries easily.

Countertransference of the Isolated Therapist. A group leader who has an isolated pattern may not allow enough connection with his group members. Even though your primary job isn’t being friendly toward your clients, a certain amount of warmth is necessary for helping them feel comfortable with you and developing good therapeutic alliances. All group members must feel that you care about and understand them. At times, a client may need warmth and compassion as a healing response from you. A leader with an isolated stance must be able to break out of it enough to form real bonds with each of his group members and with the group-as-a-whole. Your group members also need to interact with you when they are feeling hurt or angry and when they need to explore their positive feelings toward you. There is a danger that you may unconsciously discourage them from bringing up these issues and working on their relationships with you.

chapter 8: the compliant pattern

The compliant pattern can come about in two ways: (1) The client may be acting out of an issue where her behavior was shaped to comply with control or intrusion. This means that the core issue is a shaped schema and therefore we call the compliant pattern a shaped pattern. (2) The client is defending against a core issue in which she expects to be attacked or punished for being aggressive or autonomous. In this case, the compliant pattern is a defensive pattern.

Compliant Behavior

The compliant client’s aggression and assertiveness are blocked. She has a difficult time expressing anger or activating herself to get what she wants. Often she doesn’t even know what she wants, and her anger may be completely submerged. For example, a client was being very quiet and when the group asked her what was going on, she only knew that she was feeling distant from the group and not involved that night. Eventually with help, she realized that she felt upset by something that was said the week before. As she began to interact with the person who said it, she began to realize that, in fact, she was quite angry at him.

The compliant client tends to go along with what others want her to do. Her conscious statement might be, “I am a nice person.” Her stance is especially designed to prevent people from reacting negatively to her. This goes along with the underlying thought, “It isn’t safe to exert power.” She often accepts another person’s view of her without any inner reflection to see if this fits with her experience. For example, John told Jody that he thought she was avoiding speaking in group because she was afraid of looking foolish. She quickly agreed that this sounded right without checking inside. Later it turned out that she was actually afraid of something else but simply assumed that John knew better than she.

A compliant client may actively attempt to figure out what others want from her and who they want her to be. She may try to understand what would make them feel most comfortable and happy. The client then tries to provide this for them without considering what she needs. This often takes the form of being nice and caring with everyone and making sure that she doesn’t offend or hurt anyone. For example, Sandra is consistently friendly and supportive to everyone. She goes out of her way to say complimentary things to new people in group and to people in pain, even if she has negative feelings toward them.

Conditions. Compliant clients are often this way with everyone. However, they may be especially compliant with people who are powerful, intimidating, controlling, or in authority roles. They may also tend toward compliance with people who remind them of the parent who harmed them. For example, one women who was sexually abused by her father was quite assertive in every area of her life except in sexual situations with men, where she was very compliant.

Group Role. A compliant client sometimes plays the role of social leader in the group, making everyone feel safe and cared for, smoothing over conflict, promoting understanding and agreement whether genuine or not. This can be helpful for a group that is dangerously overloaded with anger, or for a client who is new and fragile. It can also be problematic for a group that is avoiding confrontation.

Related Concepts and Patterns

Related Patterns. On the surface the compliant pattern looks similar to the passive-aggressive pattern, but the latter pattern has an unconscious twist (see next chapter). The compliant and codependent patterns have in common that the client focuses on caring for others rather than herself. However, a codependent person is concerned with taking care of others and may even do this from a controlling place, while a compliant person is concerned primarily with being what the other wants, not caretaking. And a compliant person generally gives control to others.

Related Concepts The compliant pattern is very similar to the well-known behavior patterns of adult children of alcoholics. Alcoholism can lead a parent to be attacking or intrusive or otherwise frightening when drunk, and yet sometimes the parent provides loving care when sober. This inconsistency often leads the child to attempt to foster the positive state through pleasing the parent, leading to a compliant pattern. When a client is compliant in order to maintain dependence, this can produce the dependent personality disorder, which is a combination of the compliant and needy patterns.

Combining Patterns. When a person is both compliant and insecure, then she may try to please others in order to avoid rejection. A person who is both compliant and codependent will try to take care of others by giving them exactly what they want. A person who is suspicious and compliant will give in to others on the surface but secretly be looking for the ways he will be hurt. A person who is both self-judging and compliant will give in to others needs and opinions because he feels that his are wrong or worthless.

Society. Though clients of both genders exhibit the compliant pattern, it seems to be more common with women because of their socialization. Frequently members of oppressed or exploited groups in society are trained toward this pattern. Until the last generation, blacks, women, working-class people, and other minority groups were socialized to be submissive and “know their place.” With the advent of the various liberation movements of the last thirty years, this compliance has turned to defiance (discussed later in the chapter) in many cases.

Origins

Unlike previous patterns, the compliant pattern can have a variety of underlying issues, and frequently more than one is involved:

1. Control. The client may have a shaped schema which involves being controlled by others. This includes domination or violation discussed previously. It could also come from the exploitation (see chapter ?), which means that the parents used the child for their own ends rather than being interested in the child’s needs.

2. Punishment for Autonomy or Aggression. If a child is punished for autonomy or aggression, she may squelch her power and become compliant instead.

3. Shaped Dependence. If a child is shaped toward being dependent on a parent, she will tend to act in a dependent, compliant manner to keep the parent’s love.

4. Opposite Reaction. A client often becomes compliant as an opposite reaction to a parent who was attacking or abusive. The child often hates the way she was treated by this parent and swears she will never be like that. Therefore she becomes the opposite—pleasing and compliant. (This may or may not be conscious.) However, her view of healthy behavior is so distorted by her experience with the abusive parent that she believes her compliance is really healthy behavior.

5. Shaped Compliance. In addition to the above, the child may have been rewarded by the parents (or others) for being compliant. When she complied with their wishes, she got attention and approval. This means that her compliant behavior became a successful defense in childhood. She was able to ward off punishment or withdrawal by pleasing them. Thus her compliant behavior was rewarded and this made it even more entrenched in her developing personality. The compliant behavior may also be internalized from one of the parents. It is especially common for daughters to internalize compliant behavior from their mothers.

6. Fear of Attack. Children who live under the fear of anger or physical abuse often try to figure out what actions are most likely to please the abuser and prevent an angry outburst. They attempt to comply with whatever the volatile parent (or other person) wants of them and even try to anticipate what is least likely to trigger an outburst.

The Change Process

Awareness. The first step in working with the compliant pattern in a group is to point out the compliant behavior so the client begins to be aware of what she is doing. In the case of obvious compliance, there is something concrete to point to, and most compliant clients are interested in becoming more assertive. For example, Charlotte starts to speak at the same time as Dawn. She immediately backs off so that Dawn can go ahead. This compliance on Charlotte’s part is obvious enough that when it is pointed out, she will probably be interested in working on it. Be on the lookout for a client being compliant with you. This is often harder to see because you assume that the client simply agreed with you because you were right, rather than that she complied with you.

In the case that the compliance takes the form of avoiding certain behavior, such as anger or self-assertion, it may be more difficult for the client to see her compliance. You can point out the fact that she never seems to get angry or set limits, for example, but then she will need further help. Notice when you might expect her to be angry or assertive and help her to be aware of her experience at those moments and see what is stopping her. For example, Joanne was sharing some of her issues with a new person in the group without mentioning that she had been sexually abused, which the rest of the group knew. Marie interrupted to make this explicit. Joanne appeared to take this in stride, but I suspected that she felt violated by this, so I asked her what she was feeling toward Marie at that moment. This helped her to realize that she felt angry at Marie.

Motivation. The next step is to help the client become aware of the function of the compliant or avoidant behavior. Does she assume that others are in charge of her life or that they know best? Is she trying to get someone to like her or prevent someone from judging her? ‘For example, Charlotte may just assume that other people’s sharing is more important than hers. Is she trying to prevent someone from attacking her? Is she afraid of asserting herself? If so, is she afraid of anger, judgment, abandonment? For example, Joanne might have been afraid that Marie would explode in rage if Joanne expressed her anger at Marie’s violating her confidence. This kind of exploration helps the client to understand the unconscious motivation behind her actions. Now if she is ready, she can choose to experiment with different behavior or access the core issue.

Discovering the Hidden Feeling. It is also important to help a compliant client get in touch with where she really is—in other words, to know what she thinks, perceives, feels, or wants. For example, a silent client may want the group’s attention but be afraid to even know this. The client may also need help in feeling her anger, as with Charlotte above. This work is often more difficult and must proceed gradually. The autonomous part of this client may have been so thoroughly suppressed that it will only come back slowly and with much encouragement and reassurance. She may get glimpses of anger or desire and then become frightened. She may be so used to looking to others to define her that she doesn’t know how to reference her own inner experience. For example, Della often lays a problem of hers on the table and then elicits other people’s views of her and advice on how to proceed. She tends to see the rest of the group as experts who know more about her than she does. To break this pattern, the group leader encouraged her to examine herself first and see what she thought. It was novel for her to trust her own feelings and perceptions.

Access. At some point the client may need help in accessing her fear of being punished for being autonomous, angry, or separate. It is useful to take this back to its origins in childhood, if possible. For example, the client may realize that she is afraid that if she expresses anger, her father will hit her. If the client grew up in a home with constant rage and violence, she may have a general fear of anger, and this fear must be accessed, in a gentle, caring environment. During this work, it is helpful for the client to feel that the group members are supportive of her. This includes empathy with her pain, but also outrage at the anger or abuse she received (or witnessed). If group members feel protective of her, this can be healing, too.

In addition to accessing pain and fear, there will also be anger, resentment, and rage at being controlled, attacked, or punished for being herself. This anger may be deeply buried, but it is quite healthy, and when the client is ready to deal with it, any hints in this direction should be supported. The anger can be directed toward the parent in role playing or toward another group member, if appropriate. Of course, if the client was originally punished for anger, expressing it in group may bring up more shame or fear, but the members will support the client through this. If she repeatedly gets stuck at this point and is unable to make progress, she probably has a passive-aggressive pattern rather than a compliant pattern.

Experimenting. A central goal of this work is for the client to progress to the point where she can experiment with asserting her desires and opinions, expressing anger, acting on what she wants, and protecting herself from what she doesn’t want. These experiments may be successful, or they may bring up more shame or fear, leading to further access. The client needs to have the experience of taking the forbidden action and discovering that nothing catastrophic happens. If she is afraid of setting limits on someone she experiences as intrusive, she must experiment with that. If she is afraid of doing something that might provoke someone’s anger, she must risk that. For example, Joanne can experiment with expressing her anger toward Marie for revealing her abuse history without her permission.

Healing. When a compliant client takes such a risk, the group usually responds positively, which is quite different from what she expected based on her core issue. When a client who has been disempowered for so long finally stands up for herself, the whole group usually feels excited and pleased. They have been rooting for her to do this, and everyone feels a sense of completion and release. Therefore the client usually receives congratulations from the group for taking this important risk. There is also the intrinsic satisfaction that comes from setting limits to protect herself or from getting what she wants. For example, the group will support Joanne for taking the risk to express her true feelings. In addition, Marie may realize what she has done and apologize to Joanne, giving her an important validation of her right to protect herself.

Let’s look at this process from the point of view of a shaped schema. If the compliant pattern was shaped during childhood, through punishment for autonomy, reward for obedience, and perhaps internalization of compliance, then the experimenting and healing discussed above will reshape the client’s behavior in a healthier direction, because the new healthier behavior is being rewarded.

The compliant client will, of course, need to experiment repeatedly with various aspects of autonomy, perhaps in increasingly difficult situations as she becomes stronger and less afraid of being herself. Over time, as inner healing progresses, she will develop the courage to confront others when necessary, to state her opinions when they differ from others, and to go after what she wants. She will dare to be herself, even if others may not always like it. And, of course, she will discover that most people like it even better when she is really herself.

If the client was punished for aggression as a child or if her parents weren’t strong enough to receive her aggression without crumbling, then the client needs to interact with people in the group who can tolerate her aggression and perhaps even appreciate it. She needs to have the experience of having conflicts with other group members who neither fall apart nor retaliate, but instead use the conflict to further their connection with her. Of course, this is more likely to happen in a therapy group, because the clients have the leader’s help in doing this. Many clients have had the experience in their families of origin that conflict always led to destructive fights or painful distance, never to anything positive. One of the most important benefits of the therapy group is learning that when conflict is handled properly, it can lead to increased understanding and closeness.

Opposite Reaction. In the case that part of the origin of a compliant pattern comes from an opposite reaction, such as wanting to be the opposite of an aggressive parent, then becoming aware of this can help to loosen the pattern. For example, Ben became compliant partly because he never wanted to be like his explosive father. To Ben, being aggressive meant being a beast like his father. He opted instead to be pleasing and nice. When he became aware of this, he was more open to experimenting with healthy aggression. Usually there is no chance that the client would really be as extreme and hurtful as the parent, and by experimenting with the parent-like behavior, he can discover this. For example, Ben realized that even if he allowed his anger to be expressed, he didn’t have a tendency to be explosive and demeaning like his father. Even if the client has a tendency to be like the parent, he will find out that he can control it.

Difficulties. When a compliant client begins to assert herself, she may need help with the following difficulties:

1. If she is interacting with a powerful group member and they are disagreeing or in conflict, there is a danger that he will overpower her and she will quickly retreat from her new, fragile autonomy. In this case, the leader and group must support her in repeatedly standing up for herself in the face of a powerful adversary. She may need this support so she doesn’t feel that she has failed in her attempt to be assertive, or worse, that asserting herself was not a good idea.

However, it is also important to make sure that the group member she is interacting with doesn’t feel that you (or the group) are siding with her against him. Your support of her aggression should not necessarily be based on thinking that she is right and he is wrong (or she is being healthy and he is being problematic) in the content of their conflict, but it may be easy for him to think so. It is a good idea to explicitly and reassure him that you are supporting her aggression, not the content of her position, and you support him, too. For example, suppose Julie and Peter are in conflict because she wants more softness from him and he wants more directness from her. I feel that they are both right, but I support Julie in her assertion because she has a tendency to collapse and just agree with Peter. I say to Peter, “I want you to know that I believe you have just as much right to ask Julie to be direct as she has to ask you to be soft. I am only supporting her assertiveness because it is so hard for her.”

2. Some clients with a history of compliance go overboard when they begin to assert themselves. They have anger accumulated from all the years they spent subordinating themselves to others, and when their aggression is freed, it may temporarily become excessive, like a pendulum swing. In this case, it is important to support the client’s newly found power, even if it is exaggerated. The best way to do this is to frame this situation clearly for both the client and the group, so they understand what is taking place. For example, if Joanne went overboard and became nasty and hostile with Marie, you might say, “I imagine that Joanne’s anger is so intense because it has been bottled up for so long, and it is new for her to express it at all.”

3. When a compliant client confronts you with negative feelings, she will often do it tentatively even though she may be feeling quite angry. It is important to support the expression of this anger. Don’t focus only on the transference that may be behind the anger. This might undercut the client’s tentative foray into assertion. Ask what it was like for her to confront you, and help her explore any fears about your reaction. Check to see if she has expressed as much anger as she feels toward you and encourage her to be more powerful with you if she is ready to take that risk. If appropriate, tell her that you had no problem receiving her anger.

Countertransference

Countertransference toward the Compliant Client. The biggest danger for the group leader is that you fail to see that a client is complying with you. She may accept all your interpretations without learning anything from them because she is doing it to please you. She may try all the experiments you suggest without getting anything from them because she is only going through the motions. If you don’t realize what is happening, this may be a repeat of the client’s experience of being controlled as a child—never asserting her own view and never challenging yours. It is easier for a group leader to see compliance when it is directed at someone else.

Countertransference of the Compliant Therapist. A compliant group leader may have difficulty challenging his clients enough. You may find yourself always wanting to be empathic and understanding with your clients and rarely being able to help clients confront problematic behavior of theirs. You may be afraid of hurting clients and having them become angry with you or withdraw from you. You may even have a tendency to avoid dealing with conflict in your groups. Therapists who are uncomfortable with conflict can subtly discourage it in their groups without realizing that this is happening. You also may find yourself backing down in the face of angry, judgmental, defiant, or controlling clients, thus undermining the power and authority you need in the group.

chapter 9: the defiant pattern

A defiant client usually has roughly the same core issues as a compliant one, but his behavior stems from a defense against them. He was probably controlled or abused as a child, but he dealt with it by rebelling, either then or as a teenager or adult. A defiant client will go out of his way to defy anyone who seems to be exercising power over him, especially if they are in a formal authority position. This pattern might be associated with the statement, “Don’t tell me what to do.” The underlying thought might be, “If I allow anyone else to be in charge, I will be harmed.” The defiant pattern tends to block cooperation because the defiant client is too frightened about giving up his power to allow him to be receptive enough to collaborate with or learn from another person. This makes it harder for a defiant client to establish and maintain a good therapeutic alliance with the leader.

Defiant Behavior

Opposition. A defiant client tends to be oppositional, in that he opposes suggestions based on power issues rather than the merit of the idea. Defiant clients can easily get into power struggles with people in authority. They have such a strong need to protect against being controlled or exploited that they tend to fight against initiatives from anyone in authority. They often don’t realize that their opposition comes from this source. They believe that, in each case, they simply don’t like the idea. For example, Morton was feeling that he wanted to connect with people that day in group, but wasn’t sure how to go about this. I suggested that he pick someone he wanted to interact with and talk to that person. Morton said that he needed to talk more to the group about his feeling distant. While this might have been true, Morton really just didn’t want to give me any power by following my suggestion.

A client’s defiance can extend to anyone who attempts to exercise power, even if they are not in a position of authority. This means it can also propagate power struggles between group members. Outside group, the need to rebel against authority is sometimes so strong that the person engages in activity that is illegal or socially unacceptable simply to prove that he can’t be controlled. This is common with adolescents, but people with the defiant pattern may carry this throughout their lives.

Anger and Arguments. Defiant clients can easily become angry, judgmental, or argumentative when they feel threatened. They often become defensive if someone challenges them or tries to get them to own a problem. For example, Richie often got intensely involved in judging other group members, especially if they weren’t being powerful enough or getting to their issues quickly enough. Whenever the leader asked Richie to explore why he felt such a strong investment in one of these judgments, he would only attempt to prove that his point of view was correct. Winning this argument was more important to him than self-exploration or, ultimately, getting anything from the therapy group.

When challenged, a defiant client will often retaliate by attempting to prove the problem at hand is really the other person’s fault. This is the source of many blame and defense cycles in groups. In a similar fashion, if someone becomes angry at a defiant client, he may feel a need to respond with even more anger to show that he hasn’t been intimidated, to prove that he can stand up to the other person. This can result in a useless power struggle. The defiant person has a natural aggressive reaction to the way he has been harmed in the past and uses it as a defense against this happening again. However, because his perceptions are distorted by his issues, he often uses his anger unnecessarily or has exaggerated reactions. A defiant client may also feel a need to fight to defend himself from being dismissed, misunderstood, or rejected. Whenever Melissa felt excluded by the group, she would angrily state that she had the right to be heard, too.

Rigid Boundaries. In an attempt to protect themselves from harm, defiant clients often have very rigid boundaries about touch, space, privacy, responsibility, and so on. They tend to have a very clear idea of what is theirs and what is someone else’s, and they will defend this in a determined way. They will go out of their way to make sure they are not taken advantage of, even if they must go overboard in the process. For example, one person will only allow touch in a certain way. Another becomes angry whenever he is interrupted during an interaction in group. A third will split hairs about who is responsible for a certain problem in group, using a style that is more appropriate for a court of law than psychotherapy. There can be an anal retentive quality to this attention to boundary details.

Group Roles and Positions. If a defiant client is quite extreme in his opposition he can become the group scapegoat. If he is less extreme, he can often help the group to break out of constricting norms by taking the deviant role. He will be the first member to challenge anything going on in the group that feels restricting. For example, if anger or sexuality aren’t being allowed in the group, he may bring it up. He will dislike feeling controlled and have enough courage to confront the group or leader on it. Since his aggression is available, he will also initiate challenging the leader or other group members if no one else in the group does. Since this must happen, he can play a positive role in initiating the power stage in the group. He is also likely to be the one to call people on insincerity or “niceness,” and to tell the truth as he sees it even if this is unpopular. However, if he is heavily invested in aggression as a defense, he may frighten the other group members into avoiding him.

Related Concepts and Patterns

Related Concepts. The defiant pattern is a form of the anal character from traditional Freudian psychology.

Related Patterns. The defiant and isolated patterns are both ways of defending against harm. However, the isolated client does this through avoiding closeness and the defiant client does it through direct aggression and rigid boundaries. The controlling pattern can also be a way of defending against harm, but here the client does it through attempting to control other people. The passive-aggressive pattern also involves defiance, but it is done indirectly and unconsciously.

Combining Patterns. When a client shows both the defiant and controlling patterns, he controls others in order to protect against being controlled by them. A person who is both defiant and suspicious may provoke fights in order to reveal the aggression he suspects is hidden beneath the surface. A person who is defiant and brittle will retaliate with extreme anger and judgment whenever he feels judged by others; this is to protect his fragility.

Society. Members of oppressed groups that are in the process of liberation often exhibit the defiant pattern as a reaction to their position in society. Political activists and others who are critical of our current social arrangements may also have a defiant pattern. They may have developed a defiant pattern in childhood, and this makes it easier for them as adults to see beyond the mainstream culture’s values. Therefore a small amount of defiance can aid someone in being a social change agent. However, if a person has an intense defiant pattern, this usually leads him into exaggerated and unproductive rebellion and a sole focus on fighting against injustice to the exclusion of offering creative alternatives. Defiant activists also have a hard time understanding or connecting with anyone who doesn’t believe as they do. This has been typical of many political radicals and is part of the reason for their failure to have a more lasting impact on society.

Origins

Defiant clients have core issues similar to those of compliant clients. They often have domination or exploitation issues derived from being controlled as children. Their defiance is an attempt to prevent anyone from controlling them again. They may have violation or attack issues, indicating that they were attacked or intruded on as children. In this case, the defiance is a way of protecting themselves from such boundary violations. Defiant clients were often physically or sexually abused as children, especially those with more severe versions of the pattern.

A defiant pattern may also be internalized from a parent who was defiant, or even shaped by growing up in a subculture that was defiant of the mainstream culture.

Defiant clients aren’t likely to have a punishment-for-aggression issue, unless mild, because they have learned to use their aggression to defend against compliance. They also aren’t likely to have shaped-dependence issues because they have fought against such shaping.

Compensation. For various reasons the defiant client has managed to retain his aggression and use it to protect himself, even if he does this in a distorted way. His defiance is a compensation for the true autonomy that he lacks. A person who is autonomous doesn’t need to fight against authority, unless that is truly in line with his needs and beliefs. Similarly, a person with a good sense of safety doesn’t need to have the rigid boundaries of the defiant client. He feels safe enough to have open, fluid boundaries. The rigidity of the defiant client is a compensation for his deficiency in safety.

Determination of Patterns. You may have noticed that the way a client was treated as a child doesn’t completely determine the resulting pattern that he develops. Though child-rearing has a significant impact on later developments, much is also determined by the child’s innate strengths and weaknesses and his own choices. For example, a child who is naturally strong and athletic and is innately endowed with a great deal of healthy aggression will be more likely to develop a defiant pattern of defense against being controlled, while a different child might become compliant or passive-aggressive. A child who was sick a lot during his early years might have excessive needs for care and therefore be predisposed toward a needy pattern, while a child who was innately self-sufficient might thrive under the same amount of parental care. One child may also make certain behavioral choices that will lead her toward a victim pattern as a way of getting her needs met, while a different child might decide to take care of herself and go in the direction of a need-denying pattern.

The Change Process

Defiance of the Leader and Countertransference. In a group setting, a defiant client is likely to rebel against the group leader because you are the authority in that setting. He is likely to be angry at various aspects of the way you work with him. He may refuse to take your suggestions or consider your interpretations. He also may object to the way you run the group or the way you work with others. For example, a defiant client might say that you are cold and distant and challenge you to reveal more about yourself. While you need to consider if this accusation is true, it might just be a way for the client to try to reduce your authority in the group. If there are a few defiant clients in one group, this can be especially trying for the leader. Their challenges can be unusually hard on inexperienced group leaders who are insecure about their abilities. Confrontations from defiant clients can easily put you on the defensive or throw you off center emotionally.

The first and most important thing is to welcome any and all confrontations, even if they are obviously based on transference distortions. In fact, some defiant clients are really just testing you to see if you can allow and handle their anger and challenges. Once they see that you can, some won’t need to do it anymore. You must respect the challenges and anger that a defiant client brings you, without allowing it to disrupt your conduct of the group more than is necessary. Respect him enough to take his dissatisfactions seriously, and respect yourself enough to retain your therapeutic stance and help him explore his issues. If a client repeatedly confronts you, then take this seriously. There is a problem in your therapeutic alliance, and even if this derives from a defiant pattern, it still must be worked through with respect and understanding. See Chapter ? for further discussion.

Problem Ownership. Eventually you want to help the defiant client to own his defiance as a problem to be explored. Many defiant clients think that other people really are being controlling or attacking, and their reactions are simply natural responses to this. They may think that their rigid boundaries are simply reasonable precautions that everyone should be taking. Feedback from the other group members is often the most useful way to loosen these attitudes. The client isn’t as likely to trust your perceptions since you are the authority, but he may be willing to listen to his peers. For example, a group member might say to a Morton, “You know, every time the leader makes a suggestion, you always find a reason why now is not a good time to try it. I think something else is going on.”

Access. With or without problem ownership, you may be able to help the client access the origins of his concerns with control and safety. Defiant clients aren’t quite so frightened of being vulnerable as isolated clients, because they know they can engage their defiant defense at any moment. The work of access with the defiant pattern is similar to what has been discussed before. For example, a client may remember how his father was always telling him what to do and making him feel inadequate. This made him vow that he would never let anyone do that to him again.

The Goal is True Autonomy. Ultimately the goal with a defiant client is for him to be able to truly know what he wants, independently of what others want. Most defiant clients have no idea that their ability to know themselves is compromised by their need to defy others. They see themselves as having true autonomy rather than a compensation for it. Once a defiant client can see that his autonomy is compromised, he may be more inclined to work to achieve it. For example, when the leader gives Morton a suggestion, Morton’s goal is to be able to evaluate it on its own merits and his inner sense of what is best, rather than automatically rejecting it. It is a big step forward when he sees that his rejection of suggestions is largely automatic and therefore actually decreases his autonomy.

Healing Relationship. A related goal is for the defiant client to trust others enough that he can let down his rigid boundaries and allow himself to be open to people and cooperate with them. It is especially important that he learn to cooperate with authority figures, and therefore his relationship with you as group leader is crucial. This involves long-term work, in developing a healing relationship where he feels safe enough to allow himself to collaborate with you and yet has the experience that you don’t harm him, that in fact, you care for him and help him. He may also need to develop healing relationships with certain powerful group members who activate his harm issues. As these relationships lead to inner healing over time, he will gradually let down his guard and feel free to be open and receptive with others without fear.

Countertransference

Countertransference toward the Defiant Client. In addition to feeling insecure and defensive, it is easy to become angry with a defiant client for refusing your help, questioning your competence, or disrupting your group. Remember that he is really frightened of being controlled or harmed even if this is not obvious. This will help you to be more sympathetic to him.

Countertransference of the Defiant Therapist. If you have a defiant pattern yourself, you may have difficulty with clients who exhibit the controlling pattern. This may activate your defiance and cause you to become angry at them rather than understanding their need to control. See chapter ?.

Chapter 10: the passive-aggressive pattern

While the compliant and defiant patterns are in many ways opposites, the passive-aggressive pattern is a mixture of these two, with the client being compliant on the surface and defiant underneath. The passive-aggressive client is just as concerned with control and autonomy as the compliant and defiant clients, but she can’t clearly go one way or the other. Her aggression is significantly blocked, so open defiance is not an option, but she has so much underlying anger that simple compliance isn’t either.

Passive-Aggressive Behavior

The surface behavior of a passive-aggressive person is compliant, and her conscious experience is that she wants to please others and be what they seem to want her to be. However, because of her unconscious resentment and defiance, she frequently fails to really comply. If she is asked to do something, she will often agree and then not follow through, or she will do it in a way that fails. In a therapy group, this plays out in the passive-aggressive client’s responses to the leader, especially the leader’s suggestions for experiments. She usually tries to follow them, but they seldom work. Of course, an experiment doesn’t usually have a “successful” outcome. As I have explained previously, experiments are done to see what happens, not to produce certain behavior (although sometimes there is a preferred result). However, the passive-aggressive client generally determines what she thinks the leader wants from her, tries to produce it, and fails.

For example, Dina appears to agree with Tad but subtly takes a different point of view. The leader points this out and suggests that she try making her disagreement explicit and direct. Dina says she doesn’t know how to do this. The leader, not realizing she is passive-aggressive, gives her a specific sentence to try. She says it to Tad and then looks blankly at the leader. He asks her what it was like to say that sentence. She says it was OK, nothing special. Dina is complying on the surface but sabotaging the work unconsciously. A client who took the suggestion seriously without sabotage might have a variety of interesting responses. She might be afraid to disagree directly. She might do it and then become afraid of Tad’s reaction. She might do it and feel more free or powerful. However, Dina is unconsciously defying the leader. Her real work at this point isn’t with Tad at all.

Performance Pressure. A passive-aggressive client often feels enormous pressure to perform properly, coupled with a conviction that she will be unable to do so. Like the compliant client, the entire focus for a passive-aggressive client is on what others want from her, but in addition there is a sense of others as powerful, judgmental people who expect more from her than she can deliver. This pressure is fostered by living in a society that is strongly oriented toward performance and evaluation (see the shame issue in the next chapter.) In a group, such clients often feel that they have to perform well as group members—say interesting things, have powerful insights, speak articulately, take important risks, and so on. Even if the leader makes no suggestions for experiments, a simple question such as “What are you experiencing right now?” can trigger performance pressure. The client’s response is often to go blank. She is so anxiously worried about performing that she can’t focus on anything else. Her nervousness about functioning adequately is so great that it blocks her feelings.

In some areas, such as sports, performance pressure can sometimes result in greater effort and greater success. However, if the area of performance is one’s inner experience, then a feeling of pressure will block the client from the task. Often the client’s failure also derives from an unconscious defiance of the therapist, but in many less-severe cases of the passive-aggressive pattern, it simply comes from self-consciousness about performance. If you ask a client what she is feeling and she seems unable to respond because of feeling pressured, this can be handled by asking the client to simply report on her experience of feeling pressured and going blank. After all, that is her actual experience in that moment, so in keeping with our interest in here-and-now awareness, that is what she should report. In that sense, she can’t do it wrong. There is no “right” experience to be having. Anything that is happening is appropriate to be reported, including the experience of feeling anxious and blank. Explaining this may help the client to feel less pressured.

Failure to Make Progress. Another common pattern with passive-aggressive clients in therapy is that they work well in group but fail to make any therapeutic progress. Their therapy looks like it is working, but there is no psychological change that makes a difference in their lives. This brings us to the most difficult aspect of this pattern. The passive-aggressive client has an unconscious need to defy people in order to preserve her autonomy, and this is especially directed at authority figures. In a group, this means the leader, who is trying to help the client grow and change. Therefore, in order to defy you, a passive-aggressive client sometimes feels unconsciously that she must defeat you in your efforts to help her. She will fail to make progress in therapy in order to accomplish this. She will harm herself in order to defeat you and preserve her autonomy. %For example, if you suggest an experiment, she will execute it in a way that is sure to fail. If you ask for awareness, she may become confused and blocked. A passive-aggressive client may also defeat the group leader by subtly undermining your work with other group members or your attempts to foster therapeutic group norms.

Sometimes instead of actually failing to progress, a passive-aggressive client will deny the progress she has made. A client may clearly make strides in becoming more open or assertive, for example, but when complimented on this by the leader or the group, she will claim that she sees no change at all. This might also be related to the client’s perfectionistic attitude which means that no amount of progress will be enough to satisfy her inner critic.

This lack of progress, of course, shows up in other ways in the life of passive-aggressive clients. They often fail at various projects in their lives for the same reason. Unconsciously they feel that they can’t exercise their autonomy directly or explicitly, so they resort to the only means they know, which is to subtly rebel against others, including people who expect them to be competent and successful. This may be compounded by a self-critical attitude that undermines the self-esteem of a passive-aggressive person and therefore her ability to succeed. Of course, not all fears of success are attributable to the passive-aggressive pattern; this may happen for completely different reasons.

Origins. The childhood origins of this pattern are similar to those of the compliant pattern, where the child was controlled, exploited, or intruded on. In addition, passive-aggressive clients were usually judged or humiliated as children and carry a lot of rage about this. Frequently they were also punished severely for being aggressive, which explains why they feel they can’t exercise their autonomy or express their anger directly as adults. Thus the underlying issues often include the domination, violation, attack, shaped-dependence, shame, exploitation, and punishment-for-aggression.

A child may also internalize the passive-aggressive pattern from a parent who exhibits it. In some cases, where the parent was brutally aggressive, the child may try to avoid being anything like the parent. This is an opposite reaction that leads her to be soft and compliant on the outside. However, she has such rage at the way she was abused that this comes out unconsciously in the passive-aggressive style.

Compensation. The child’s natural aggressive response to being controlled has been blocked, and the passive-aggressive behavior is a compensation for this. The ability to defeat an authority figure provides an indirect expression of rage and a kind of revenge. When passive-aggressive clients are exploring themselves deeply, they sometimes discover that they feel gleeful at defying people and making them feel helpless and incompetent (which is what the client feels). The passive-aggressive behavior is also a compensation for a deficiency in autonomy, because it provides a kind of autonomy from the perceived control of others, but at the price of competence.

Inner Conflict. This drama of compliance and defiance also gets played out internally with the client’s inner critic. The inner critic pressures the client to do something, such as dieting or studying, and the client unconsciously rebels against this injunction by avoiding the task or failing at it. Because of this, passive-aggressive clients are often prone to procrastination, indecision, stuckness, and a general feeling of being unable to progress in their lives. See chapter ? for a further discussion of working with the inner critic.

Conditions. The passive-aggressive pattern tends to be activated by situations where the client is expected to perform or where she thinks he is. This means that it is frequently triggered by authority figures or powerful, demanding people.

Group Role or Position. The passive-aggressive client can take on the role of the frustrating identified patient. She becomes the person that the group repeatedly tries to help, but the members ultimately feel frustrated and resentful because they can’t succeed.

Related Concepts

Related Concepts. This pattern is very similar to the passive-aggressive personality disorder listed in the DSM IV appendix, except that the pattern is broader, including clients who are healthy enough that a personality disorder diagnosis would be inappropriate. The passive-aggressive pattern is also closely related to the “masochistic character” in bioenergetics (Lowen ?). It is a form of the anal character in traditional Freudian psychology. Passive-aggressive clients are often depressed because of the severe blockage of their aggression.

Capacities Blocked. In addition to the capacities of autonomy and aggression that are blocked by the underlying issues, this pattern also blocks cooperation. The passive-aggressive person finds it difficult to cooperate with others because she usually experiences this as a form of being controlled, which she unconsciously defends against.

Related Patterns. The past pattern is related to the compliant and defiant patterns in that the passive-aggressive client looks compliant but is surreptitiously defiant. The passive-aggressive pattern is similar to the victim pattern in that both involve unconscious manipulation and helplessness. However, the passive-aggressive client is trying to achieve autonomy while the victim client is trying to elicit caretaking, and the passive-aggressive client feels overly responsible for her problems while the victim blames them on others.

Combining Patterns. When a client has both the passive-aggressive and victim patterns, her failures are an attempt to achieve autonomy and paradoxically to elicit nurturing from others. A passive-aggressive client is often self-judging as well, especially about performance. When a client is brittle as well as passive-aggressive, she will be devastated whenever she fails at something.

The Change Process

An important goal with a passive-aggressive client is to liberate his underlying aggression. In other words, if a client converts from a passive-aggressive pattern to defiant behavior, this is a large growth step. Once the defiance becomes active, this is usually just a transition stage on the way to healthy autonomy. However, often the defiance is deeply buried and the client is thoroughly invested in his compliant, incompetent exterior. However, this doesn’t mean that the defiant pattern is necessarily healthier or more advanced than the passive-aggressive pattern. Each pattern subsumes a wide variety of levels of functioning, from very disturbed to quite healthy, and therefore it would be possible, for example, to have a relatively healthy passive-aggressive client who was functioning at a much higher level than a severely disturbed defiant client.

One way to encourage aggression is to look for any signs of hidden anger and point them out to the client, hoping that this will give him permission to realize that he is angry. You can also look for any behavior that is a more direct exercise of autonomy, even if it is in a very mild form. Then you can support this and frame it as the important growth step it is. For example, when Harry got into a stuck place, the group members jumped in with advice, suggestions, and interpretations. He responded to the content of their suggestions, but almost always disagreed. Over time he began to make subtle remarks that indicated he didn’t really want suggestions at all when he felt stuck. I framed this as a healthy way for Harry to set limits so he could develop his own autonomy. This encouraged him to tell the group even more directly to back off.

It is also important to help the client achieve some awareness of his passive-aggressive actions and their underlying motivation. The client feels unable to succeed at anything, especially at being a good client. It is harder for him to see that he is actually invested in failing. His experience of “can’t” is really “won’t.” It may help to ask him to examine what he might be getting out of failing. Sometimes the feeling of glee will help him realize that he enjoys defeating others.

The Therapeutic Relationship. In addition to the question of how to achieve therapeutic change with a passive-aggressive client, there also can be problems in the therapeutic alliance. The passive-aggressive pattern can be a bottleneck issue, where any suggestions from the leader get interpreted as control and trigger the cloaked defiance, blocking the client’s ability to work with you. One way to work around this is to avoid using suggestions and questions and instead rely on empathic reflection of feelings and interpretations. If you do need to use a suggestion, ask the client first if he is interested in it. This may forestall a passive-aggressive response.

Another way to work with this pattern is to communicate to the client implicitly and explicitly that he is OK not matter what he does in group. It is very helpful for the leader to have the attitude that there is no such thing as success or failure in his work. You completely accept the client just exactly as he is under all circumstances. There is no way he can fail to please you. For example, suppose Harry feels lost and doesn’t know what he wants to do next in group. You can ask him what it feels like to be lost. You can empathize with how difficult it must be to get in touch with desires when he feels the group is expecting something from him. You can let him know by your whole demeanor that you don’t care if he ever comes up with an answer to this question. You are simply interested in his experience in each moment as he struggles with it. Of course, even if you communicate this, he may still feel that you are pressuring him to be a certain way, but this can be worked with. By the way, this accepting attitude can’t be faked. You really must feel that way. If you try to communicate this because you think it will be helpful, but you really want him to get on with it, he will pick this up.

It is fairly common for a passive-aggressive client to be unable to initiate movement because he doesn’t know what he wants. A compliant client tries to do what others want; a defiant client does the opposite. A passive-aggressive client doesn’t have such an easy choice, and this often leaves him feeling lost and confused. At these moments it is important not to offer a way out and to prevent the group members from doing this. If the client is given any suggestion, even a very sensitive, accurate one, he can get bogged down in being passive-aggressive about it. If however, you leave him to flounder and struggle on his own, he has a better chance of breaking out of this pattern and finding himself.

The Group. The group members may badger a passive-aggressive client with suggestions and advice and become frustrated with him when he doesn’t use them. He will engage in his unconsciously self-defeating behavior in order to ward them off. This is a vicious cycle. His obstructionism causes them to feel frustrated, and their frustration cause him to become more obstructionistic. If this happens, try to frame his behavior for them so they understand what is happening and stop them from offering him help that he doesn’t want. For example, I explained to the group that Harry experienced their attempts to help him as judgments that he wasn’t OK as he was. I also helped him understand how this originated in his relationship with his mother. I asked the group to refrain from offering Harry any help, and I backed this up by stopping people when they slipped.

If a client seems to have his passive-aggressive pattern activated more strongly by the other group members, you may need to take an active, protective role, as I did with Harry. If the client reacts more strongly to you and is more at ease with his peers, you may need to take a back seat and allow his work to unfold with the other group members without much facilitation from you.

The Leader’s Attitude. You need a great deal of patience in working with a passive-aggressive client. You must not become invested in any particular therapeutic outcome but rather just maintain an interest in the process. If the client senses that you need a certain response form him, he will try to give it to you and then defeat himself and you. It is very easy to become frustrated with a passive-aggressive client, but any time you do, it will disrupt your ability to work with the client. It is imperative that you adopt a therapeutic attitude that makes it impossible for you to become frustrated with the client. This means accepting whatever he does and not depending on his therapeutic success for your own sense of competence or comfort. A passive-aggressive client’s behavior is usually quite frustrating, for himself and for others. You must remove yourself from this equation so that he feels the full frustration himself.

Access. It is also important for the passive-aggressive client to access the original experiences of being controlled, violated, or humiliated, and also the ways in which his aggression was disallowed. It is important to re-experience both the original pain and also his aggressive responses to this. This sets the stage for healing responses and helps free up his blocked anger and assertiveness. It also makes it more likely that the client will become aware of the nature of his passive-aggressive behavior.

Since the passive-aggressive pattern so frequently involves considerable self-judgment, the client will probably also need to work with his inner critic (see chapter ?). Since the underlying issues for the passive-aggressive pattern are virtually the same as those for the compliant pattern, once the passive-aggressive client works through his passive-aggressive defense, his work may be similar to what was discussed for the compliant client in the last chapter.

Healing. As the passive-aggressive client progresses in his work, he begins to express more anger and assert himself more often. This tends to be satisfying for the other group members. By now they have seen how he blocks his aggression and have felt frustrated by his inability to assert himself, so they generally feel relief and appreciation as this log-jam breaks up. This provides additional healing and support for his path into aggression.

Like the defiant client, the passive-aggressive client ultimately needs to develop a relationship with the leader and the group in which his boundaries are respected and his autonomy encouraged, where he learns that it is safe to be assertive and autonomous. He needs to know that his initiative won’t be squelched, that his anger is allowed, and that he can be himself. Then he can gradually emerge as a powerful person who can take a stand and achieve his goals in the group and his life.

Countertransference

Countertransference toward the Passive-Aggressive Client. I have already discussed above the tendency of the therapist to become attached to specific outcomes with a passive-aggressive client. The resulting frustration can, over time, turn to anger at the client. For him, of course, this is a self-fulfilling prophecy. He expects others to control and subjugate him and his frustrating behavior often brings out the sadist in others, at least in mild forms. If you understand his dynamics and commit yourself to acceptance of him, this can be avoided. The other danger is that a passive-aggressive client can make you feel incompetent. His unconscious goal is to defeat you and, perhaps in some cases, even to make you feel as incompetent as he feels. And this frequently happens to therapists who don’t understand the client’s pattern, especially beginners. If you measure you competence as a therapist on the progress of a passive-aggressive client, you will feel terrible about yourself.

Countertransference of the Passive-Aggressive Therapist. Beginning therapists sometimes feel that they must make exactly the “right” intervention at each moment. This can be paralyzing because therapy is such an intuitive art that requires a relaxed open attitude toward the situation. If you have passive-aggressive tendencies, you may feel performance pressure about your therapeutic performance, which in a self-fulfilling prophecy will make it difficult for you to do a good job. It may help to recognize that there are many right interventions at any given time and mistakes are frequent and retrievable. Psychotherapy is an improvised dance, not a programmed science.

chapter 11: the victim pattern

In using the victim pattern, clients avoid taking responsibility for themselves and their therapy. Of course, many of our clients have been victimized in the past, either by their parents or by oppressive social forces, but the victim pattern has to do with the way they respond to harm (or imagined harm) in the present. When not playing victim, a client can acknowledge what was done to him, feel pain and anger about it, and then take responsibility for moving on with his life. This may include repeated access to the original trauma and victimization but it doesn’t include using this fact as a means of avoiding taking charge of his life now. A client using the victim pattern becomes stuck in blaming others for his problems or feeling helpless to do anything about them. He avoids responsibility for his life. This does not include people who really are helpless to change certain things in their lives or who are really being victimized.

The Angry Victim. There are two different flavors of the victim pattern. The angry victim blames other people for problems in his life and in group. He blames his spouse, his boss, his children, and others, and when there is a conflict in group, he always finds fault with the other person. The surface thought is “It’s your fault that I’m unhappy.” Such a client is primarily deficient in the aspect of responsibility I have called problem ownership (see chapter 3). Commonly in a therapy group, a victim client provokes other group members by being insensitive or intrusive, for example, and then when they confront him, he feels victimized. For example, Jane frequently got into fights with other group members, as did another group member. As a result, the group was frequently hostile and unsafe, for Jane and everyone. Jane would periodically complain about this and talk about leaving group because she “didn’t need all this hassle.” She refused to see that she was one of the main contributors to the combative atmosphere in the group.

Clients who don’t have a victim pattern may nevertheless blame others for problems, but this isn’t a pervasive pattern. A victim client finds it hard to accept any responsibility because he is so invested in seeing himself as a victim of others.

A victim client may blame others as a transference reaction. His anger is a natural aggressive response to the ways in which he was harmed or deprived as a child. He really wants to blame his parents for his difficulties but he blames people in his current life instead, who don’t deserve this. Even more importantly, he uses the anger as a way to avoid responsibility for his part in problems and therefore he doesn’t grow or change.

The Helpless Victim. The helpless victim feels that his situation in life is impossible to handle. He acts like he can’t take care of himself and doesn’t have the strength to make the changes in his life that are needed. He isn’t particularly interested in making therapeutic progress in group, unless others make it happen. He is more interested in complaining about his problems and eliciting sympathy. When involved in a confrontation, a helpless victim usually becomes devastated rather than angry. Such a client is primarily deficient in the aspect of responsibility I have called motivation. For example, Wendy was in a long-term marriage where she felt emotionally abused by her husband. She claimed she had tried to get him to change and had given up on the marriage ever being any good. However, she was making no move to get a divorce. She was frightened of various aspects of the divorce process and being on her own, and these fears were understandable. However, Wendy made no effort to use the group to work through these fears or to develop her strength so she could change her situation. She spent a lot of group time complaining about her marriage and other aspects of her life, but showed little interest in attempting to change them.

Unconscious Motive. It is important to distinguish between clients with a helpless victim pattern and clients who really feel helpless. Victim clients use their helplessness for effect; they are trying to compel others to love them or take care of them, though this is often unconscious. They feel frequently unloved and abused, and for many, this was real in childhood. However, they have learned a self-destructive, manipulative way of trying to get the love they need. The victim feels unconsciously that if he shows others how helpless he is, how much pain he is in, and how it is their fault, then they will take care of him and love him. This is different from a client who really feels helpless, such as a compliant client whose assertiveness was squashed as a child.

Victim clients often confuse love and practical caretaking. While these go hand-in-hand for young children, they don’t for adults. Victim clients seems to be regressed to that age where to be loved means having things done for them. They often unconsciously want others to make choices for them, handle their problems, and somehow make their lives work. And this is, of course, impossible for an adult. It is an attempt to compensate for the caring they didn’t get during childhood. Sometimes the victim directly asks for these things, but more often the need is subtle and hidden. The underlying thought is something like the following: “I will force you to care for me by blaming you and being helpless.” For example, Wendy’s sharing about her husband was designed to show us how bad he was and how helpless she was. Though she would never have consciously felt that she wanted us to fix her life, beneath the surface that was her wish.

Entitlement is usually an important aspect of the victim stance. The client feels entitled to caretaking from the world. He feels that the world owes him caring, help, and love, and that it is other people’s responsibility to make his life better. This feeling is sometimes attached to a lover or spouse. “Since you are my partner, you owe me love,” where love may mean constant caring, or never being angry at me, or making my life happy without my doing anything, for example. Of course, partners and spouses do owe each other certain things, but a victim client takes this much further, requiring more than any person should be responsible for giving to another adult. This attitude of entitlement can also be directed at his therapist, where he feels you owe him love and that you should solve his problems for him. This attitude ultimately derives from the client’s childhood, where he really was deprived or harmed and his parents really did owe him love.

Gratifying a Victim. If you try to give victims the caring they are unconsciously asking for, it doesn’t work. Some will reject it because the more mature part of them doesn’t really want to be treated like a helpless child. If a victim client does accept your caring, it won’t really be healing for him, because he didn’t access his genuine pain first and because he knows at some level that he manipulated you into doing it. Sometimes gratifying a client can even cause him to become more helpless. With more disturbed victim clients, trying to give to them can sometimes initiate a downward regressive spiral, where they function more and more poorly in their lives in an unconscious attempt to get you to parent them. For example, Faith was a well-functioning woman in her forties who had raised two children and completed graduate school. She started having anxiety attacks that made it difficult for her to handle work and her young-adult sons. She moved in with her parents for a while to get away from the anger her sons expressed at home. However, she had a victim pattern, and this move was an unconscious attempt to force her parents to give her the love she never got as a child. Consequently, her functioning became steadily worse while living there, until I confronted her on this and helped her to regain her inner strength.

Conditions. The victim pattern tends to be activated around people who are naturally giving or who might try to become the savior of a victim client, such as a codependent person. A victim-codependent relationship is often very appealing to both sides, but it is a match made in hell.

Group Role or Position. Like the passive-aggressive client, the victim client can play the role of frustrating identified patient, where the group members try hard to help him and end up angry at him because he doesn’t change.

Origins

Victim clients usually have a deficiency issue related to lack of nurturing, or abandonment. In addition, they have often been harmed or abused in a way where they were indeed helpless to do anything about it. For example, when a young child is sexually abused, it is often a horrible experience, and the child has no way out. As a result, the child develops a schema that says she is powerless in life; no matter how she tries, she can’t do anything to change things. As an adult, this issue persists, leading to the helplessness of the victim client.

However, these experiences, by themselves are not enough to produce the victim pattern. In addition, victim clients have usually been exploited, overprotected, or spoiled as children, undermining their sense of autonomy and responsibility. This can happen in a number of ways:

(1) Being Exploited. The child was treated as an extension of the parents (or others). He was valued only for those things he did for the parents or ways that he performed that bolstered their self-esteem. He grew up with a sense of being merged with others, of not being separate. As an adult, he will tend to treat others in the same way, feeling entitled to whatever he needs from them without considering their feelings. This leads to the victim’s sense of entitlement (see next chapter).

(2) Being Overprotected. Some victim clients were overprotected to the extent of having everything done for them by a parent. When this is combined with a lack of nurturing and love, they end up believing that love is expressed through care-taking. Therefore they yearn for care-taking and try to manipulate others into giving it, leading to the victim pattern. However, they are also afraid of the dependency and submission that go along with it, so many push away love or caring when it is offered.

(3) Successful Manipulation and Shaped Irresponsibility. When children aren’t receiving what they need, they sometimes try to get it through manipulation. If this manipulation is repeatedly successful in that it gets the child the caring he needs, he will incorporate it into a schema. For example, when a child throws a tantrum in order to get something he wants, the parents repeatedly give in. The child learns that this is a way of getting his needs met. This happens completely out of the child’s awareness. It leads to what is colloquially called “spoiling” a child. However, spoiling doesn’t come from giving the child too much, as is popularly assumed, but rather from rewarding manipulation and not expecting responsibility. As an example of the latter, when a child avoids helping around the house, the parents simply do the work themselves and allow him to get away with it. These interactive patterns from childhood can lead to the kind of manipulation that is characteristic of the victim pattern.

(4) Internalizing Victim. The helpless victim pattern can also be created when a child internalizes the behavior of a parent who acted helpless and irresponsible, in other words a parent with a victim pattern.

(5) Reaction to Blaming. If a parent repeatedly blames the child and consistently refuses to take responsibility for his own problems, this can produce a schema where the client reacts very strongly to any hint that another person is not taking responsibility. He becomes angry at the person and demands that she own her part. Taken to an extreme, this leads to the angry victim pattern, where paradoxically the client refuses responsibility in the name of making others take responsibility. In addition, of course, this blaming attitude is internalized from the parent.

Related Concepts and Patterns

Related Concepts. The classic term “help-rejecting complainer” refers to someone who repeatedly asks for help but refuses to take it. A variation of this is Eric Berne’s “Yes, but” game (19??). This is often enacted by a victim client who looks like he is seeking advice about his problems but really just wants to complain. Therefore he rejects the help that is offered.

Related Patterns. Earlier in the chapter, I discussed the difference between the victim and passive-aggressive patterns. A compliant client often has trouble taking charge of her life, but her helplessness doesn’t have a complaining or blaming quality to it, as with a victim client. A defiant client can engage in blaming, but this is usually just a defense of the moment, rather than a stance in the world. An insecure client may see his problems as revolving around others rejecting him, but he sees this as his fault, not theirs.

Combining Patterns. The victim pattern often goes with the entitled pattern, since the victim feels entitled to caretaking. It is also common for a helpless victim to also have the needy pattern. An angry victim often has a defiant pattern as well. The victim and suspicious patterns often go together because the suspicious client feels victimized by the hostility he imagines or creates in others.

The Change Process

Promoting Understanding and Motivation. The most important step with a victim client is to help him see that he is invested in the victim stance. His experience entering the group is that he really is helpless or that other people are really the cause of his problems. After a while it will start to become clear that he is showing no interest in taking responsibility for bettering himself or his situation. You need to point this out to him. Ask the client to consider what he might be getting from complaining and feeling sorry for himself rather than taking action to improve things. Eventually he may realize that he wants to be taken care of and hopes that his pain will elicit that.

Since responsibility is an important aspect of the therapeutic change process (see chapter 3), the victim pattern can make it difficult for a client to benefit from therapy, because he is often lacking the basic motivation to work seriously on himself. Therefore your first and most important task is to help him understand his pattern so he begins to be motivated in therapy.

You may have to repeatedly challenge the client on his victim stance, explaining each time how he is playing the victim rather than just sharing his pain. A victim client isn’t really helpless or powerless; this is an unconscious ploy on his part. (If a client really is powerless, then this is a different pattern.) It may be helpful to say that you know he can take charge of his life, you believe in him. You can suggest what options he has in that moment for being more powerful and taking responsibility for himself. However, don’t try to encourage the client to take power in his life; this will only lead to his trying to prove that he can’t. This responsibility must come from him. If necessary, you may need to take the step of not allowing him to indulge in playing victim by stopping him each time he does. Unlike the passive-aggressive client, who should be treated with total acceptance, the victim client will benefit from being challenged. It is helpful to be tough with victim clients; they were often spoiled and indulged as a child (as well as deprived or harmed). Of course, being tough doesn’t mean being judgmental or angry, the challenging must be done in a caring way.

For example, Wendy periodically got negative feedback from some group members about her taking up too much time and constantly complaining. At first she got devastated by this and threatened to leave group in a way that was designed to make people feel sorry for her. I explained the pattern I saw, even using the word “victim,” and stopped her from playing up her pain. She had also given clues that she was also angry at those who challenged her, and I encouraged her to express her anger instead of collapsing in pain. With my help, she really was strong enough to fight back, and this pulled her out of the victim stance, at least for the moment. Then I worked with her on taking responsibility for how she wanted to relate to the group about her pain at home.

Dramatization of Feelings. When victim clients are talking about painful situations in their life or their history, they sometimes over-dramatize their pain in a hysterical fashion. There can be a great show of emotion, but the clients actually feel little. The pain is trumped up unconsciously for effect, to make others feel sorry for them, as Wendy did above. This must be distinguished from genuine pain. For example, if a victim client tries to commit suicide, it will be a ploy to bring home to others the extent of his pain and thereby get them to care for him. He won’t really be wanting to die (though the attempt could still succeed). A client who really wants to die is not using a victim pattern.

Sometimes there seems to be a mixture of genuine feeling and victim dramatization. It is important to help a victim client open up to a genuine experience of pain before group members respond with caring and nurturing. Otherwise you run the risk of reinforcing the victim pattern. You can do this be asking the client to describe what she is actually experiencing emotionally, rather than just telling painful stories. If she tries to do this, it will become more apparent that she isn’t really in touch with her pain. Then you can work with her on feeling whatever pain is there or understanding her need to dramatize.

Challenging an Angry Victim. The angry victim will need feedback from the leader and the group on his part in his difficulties with other group members because he will tend to blame it all on them. This must be done carefully, however, to avoid making him defensive. The danger is that the group members will become so angry at the client’s repeatedly blaming others that they will attack him, thus confirming his victim stance. It is also important to help a victim client see his larger pattern of consistently attributing responsibility to others rather than looking at himself.

Access. It is always helpful for clients to access their pain about the ways they were deprived or harmed, and victim clients can do this pretty well. They will be happy to include their parents among the list of people who have wronged them and owe them restitution. In the case of the parents, this is often a justified feeling. However, with the victim client the most important access is related to the way the victim pattern was created. This might involved memories of being exploited by parents, being indulged or spoiled, or having dependence encouraged. These experiences are harder to access because the pain involved is more subtle and difficult to see. In fact, sometimes the work with a victim must proceed without this kind of access. However, when it is possible, it can help in unhooking the victim from his stance.

Reshaping Behavior. The victim client ultimately needs support for his sense of personal power and ability to take charge of his life. He needs to be reinforced for any small steps in taking responsibility for himself. Much of the work with a victim client takes the form of reshaping his behavior by challenging the victim stance and supporting responsibility. As he gradually learns that he won’t get anything in the group by playing victim, he can be encouraged to experiment with being an active agent in changing himself and getting what he wants in life. As he tries this, he will discover how satisfying this can be, and this will provide further reinforcement for his new found sense of power and responsibility.

Countertransference

Countertransference toward the Victim Client. The danger with a victim client is that you fail to see the pattern, and you buy into her helplessness. You try hard to give to her and to help her change without understanding her investment in passivity. The victim pattern is one of the most difficult patterns to work with, and victim clients can evoke intense negative countertransference. This following is one scenario about how this can happen:

The client is caught in the double bind of needing caretaking and love that she didn’t get as a child but being afraid of closeness because of the harm she experienced. Her defensive compromise is to demand caretaking from others while acting (unconsciously) in such as way as to keep them at a distance. This is often done through guilt, and some victim clients are masters at evoking guilt in other people, especially their therapists. The client asks for caretaking from the therapist, and initially you respond with some form of caring. However, it never seems to be enough for the client. She always wants more, or she doesn’t trust that you mean what you say. Moreover, the client has been demanding and complaining so much that you become annoyed and frustrated by her unwillingness to take responsibility and make changes. You don’t want to give to her wholeheartedly; at least part of you is reluctant to give her what she wants. The client senses this and feels hurt. She then challenges you on this, or indirectly implies that you are letting her down, and you feel guilty. As therapist, you think that the client needs a healing response from you and you don’t really feel like giving to her. In fact, refraining from gratifying the client is correct. She can’t get any therapeutic benefit from receiving caring until she deals with her fear of closeness and her avoidance of responsibility. She wouldn’t be able to take in caring at this point in her therapy process. Not seeing her victim pattern, you think it is your fault, and you feel inadequate for not giving this client what she needs. Eventually this guilt turns to resentment, and you feel even more guilty for feeling resentful toward a client.

The way out of this dilemma is to understand the victim pattern and to remember that your job as group leader is not to give the client what she needs, but rather to help her grow. What the client needs from you is clarity so she can see what she is doing, help in understanding her fear of closeness and her manipulative behavior, and challenge to take charge of her life and therapy. After she has worked through some of her fear of receiving caring and truly accessed the pain of her deficiency, then it might be helpful to be nurturing to the client. However, the main thing she needs is encouragement toward responsibility and power in her life. Outside of the group you should try to work through your anger toward the client, so you can challenge her in a caring way when that is necessary.

Countertransference of the Victim Therapist. If you have a victim pattern, you may have a hard time dealing with clients confronting you and expressing anger at you. You may be unable to look at any responsibility you might have for their dissatisfaction. You may try to turn everything back on the clients as their transference. Ideally you should be able to take responsibility for what is yours and also work with them on what is theirs.

chapter 12: the codependent pattern

Codependence is a concept that originated in the understanding of the alcoholic family, where the spouse of the alcoholic is often addicted to taking care of and enabling him. This has now been generalized and popularized to refer to any person whose sole focus is taking care of others while ignoring her own needs.

Codependent Behavior

The codependent person’s primary purpose in life is taking care of others. This is the only way that she can feel valuable. Other people’s needs always come first. The codependent person feels that other people’s needs are more urgent or important than hers. This pattern goes along with thoughts such as, “My role in life is caring for others.”

Since the codependent person is not allowed to try to get her needs met directly, meeting other people’s needs may be a compensation for that. The codependent person gets some feeling of contact and connection while caring for others. Even though this is not all she needs, it is the most she can hope for, since her needs are seen as unimportant. In some cases, the codependent person hopes that eventually the person she is caring for will feel grateful and give to her in return. This rarely happens.

A codependent person often becomes involved with people who need help, either because they are emotionally disturbed, disadvantaged, poor, medically ill, or young. The classic book, Women Who Love Too Much, describes the pattern of codependent women being attracted to men who need help. The codependent person often sees herself as the savior of a troubled person, and, in the case of a love relationship, she then expects to be saved by him in return. This also rarely happens.

In Group. In a psychotherapy group, the codependent client becomes the helper and caretaker for the other group members. She rarely focuses on her problems or feelings and instead is always available to help others. She asks them about their feelings, comforts them when they are feeling upset, and offers advice and interpretations. She would be quite happy to become your assistant group leader. If she does talk about her own feelings, it is usually in resonance with someone else’s feelings—empathy or identification—which is a way of making the other person feel understood and cared for. Even when she is interacting with someone and actually expressing her feeling reactions, these are often calculated according to how helpful they will be for the other person rather than how accurately they reflect her real emotional state.

For example, Jeannie tells Miranda that she felt hurt when Miranda ignored her in the waiting room before group. Miranda explains that it happened because she was preoccupied with a problem at work. She doesn’t even look deeper to see if there is any difficulty she has with Jeannie that might be part of her reason for ignoring Jeannie. She also doesn’t consider if maybe Jeannie is too sensitive to being ignored. Miranda’s only objective in the interaction is taking care of Jeannie and making her feel better.

Conditions. The codependent pattern tends to be activated by people who need help or caring from others. In fact, codependent clients are often drawn to such people without realizing why. In some cases, a client will act out this pattern only with her spouse. In other cases, a person may do it with everyone in her life.

Group Role. The codependent client is likely to take the role of caretaker, either in a nurturing way, or by becoming a member-therapist.

Gender. Women have this pattern more frequently than men because of the way they are socialized to get their identity through caretaking. In fact, it is fair to say that at least a mild form of codependence has traditionally been fostered in women.

Related Patterns. In popular use, the meaning of codependence has sometimes been broadened to include needy or compliant behavior, but I find this too inclusive to be helpful. The codependent client is usually needy, but this comes out in a specific way through caring for others. The codependent and compliant clients are both out of touch with their needs, but for different reasons. The compliant client is trying to please others and the codependent client is trying to take care of them.

Combining Patterns. The client who is codependent and insecure feels that it is her responsibility to care for others but is afraid that they don’t want her to. The client who is codependent and controlling will take over and tell others what to do for their own good. The needy and codependent patterns often go together.

Origins

The codependent client has usually been deprived, rejected, or abandoned as a child, and often punished for having needs, but this is not enough in itself to produce this pattern. In addition, the child was usually shaped in this direction:

(1) Shaped Codependence. The child is rewarded by a parent (or other significant person) for taking care of him. He may confide in the child inappropriately, telling the child his troubles and seeking sympathy or help. The parent may let the child know in various ways that she is responsible for the parent’s happiness. If the parent is depressed or mentally ill, he may blame it on the child and expect the child to make him feel better. Sometimes the parent will actually ask things that the child is capable of providing and then reward the child for the caretaking behavior. At other times, the parent may expect help that no one could provide or that the child can’t provide because she is too young. This makes the child not only feel responsible for helping but inadequate because she can’t do it successfully.

A child may also be shaped into caring for younger siblings. If the parents are uninvolved or inadequate, they may enlist the help of the oldest child (or sometimes another child) in caring for the rest of the children. Of course, a certain amount of this is healthy and even helps a child to develop a sense of caring and responsibility for others. However, if too much is expected of a child, or if this is only way she gets any praise or attention for herself, this is likely to produce a codependent pattern.

(2) Being Needed. Sometimes a codependent pattern can develop even without much shaping from the parents. If one or both parents are absent or inadequate in caretaking, then there is an objective need for caring for younger siblings. Similarly, if a parent is unable to care for herself adequately, a child may be sensitive to this. Out of her own love for her siblings or parents, a child will often attempt to provide caretaking that is far beyond her ability and far beyond what should be expected of one so young. This also sets the stage for the codependent pattern.

(3) Opposite Reaction. The codependent pattern can sometimes develop as an opposite reaction to parents who were neglectful. The person is determined not to be like her depriving parents, so she becomes overly concerned with being giving.

The Change Process

Challenging Caretaking. The most important step with a codependent client is to point out her pattern of helping others and ignoring her own needs. Each time you notice a codependent client facilitating another group member, it helps to turn it back on her. Ask her what she is feeling, or what her investment is in helping the other member, or why she felt a need to come in at that time. Be careful not to derail the other person’s work, but give the codependent client the message that she is in the group primarily to explore herself, not help others.

Of course, not all helping behavior comes from the codependent pattern. When you see a consistent pattern of helpful behavior from a client who rarely deals with her own issues, that is a clue to codependence. You may have to repeatedly challenge the client’s caretaking behavior, since she can easily fall back into helping others. If after repeated challenges to her caretaking, she persists, you might even want to make a contract with her to refrain from all helping behavior. If she tries this, it may demonstrate to her how deeply ingrained her pattern is, encourage her to look at her reasons for it, and perhaps force her to consider her own needs. The trickiest situation is when you have a codependent client who is really helpful to others and does enough of her own work that it isn’t obvious that she is avoiding herself. The danger is that she will allow herself to exploited as a caretaker in the group rather than getting the help she came for. When you realize this is happening you may have to gently push her to go more deeply into her own needs and pain.

Caretaking the Leader. The codependent client may also try to take care of the group leader. For example, she may protect you from other client’s attacks. She may praise you when she thinks you are feeling down or insecure. She may avoid expressing any negative feelings of her own toward you. In this case, in addition to pointing out what she is doing, you need to provide her with a healing response that undercuts her codependence. She needs to find out that you are OK and can take care of yourself, that you can handle anything that is thrown at you without her help. This wasn’t the case with her parents. It is better in most cases to show this in your actions rather than having to say it explicitly, because this could seem defensive and therefore be suspect. However, in some cases while exploring the feelings of a codependent client, she may directly reveal her concerns about you. Then after asking if she wants feedback, you might say explicitly that you are handling the situation fine and don’t need her help. It is also healing for a codependent client to get this kind of feedback from other group members, when it is true.

Access, Experimenting, and Healing. The client should be encouraged to get in touch with her own needs and feelings in each situation. This may take some time and exploration, and it will probably bring up the underlying belief that other people’s needs come first. This can then lead to access, where the client re-experiences her deprivation and the way she was encouraged to take care of her parents or siblings, especially if this was a painful experience. For example, in the above example, the leader pushed Miranda to get in touch with her real feelings instead of taking care of Jeannie. Miranda realized that she very uncomfortable with the fact that Jeannie was hurt by her. In exploring this, she realized that her mother was frequently depressed and hopeless about life. She blamed this on Miranda and expected her to make the mother feel better. Now whenever someone feels bad, Miranda thinks that it is her responsibility to take care of this.

If the shaping toward codependence was more based on reward, then access won’t be particularly helpful. The client’s behavior will simply have to be reshaped toward self-care. As the codependent client gradually learns to feel her own needs and act on them, she will probably discover that the group is really interested in her, this will begin to heal the underlying issue. She will find out that it is OK to care about herself and even ask for help at times, and that others will usually respond in a caring way. For example, after exploring her transference, Miranda realized that she was ignoring Jeannie partly because of unresolved negative feelings toward Jeannie. Miranda had felt indirectly judged by Jeannie frequently in group, and this made her distance from Jeannie emotionally. The leader encouraged Miranda to ask Jeannie for what she needed. Miranda asked her to be more accepting of her and to state her judgments directly so that Miranda could deal with them. The group was very excited to have Miranda express a need rather than just taking care of others. Jeannie was interested in working on this difficulty in their relationship.

The codependent client may also have blocked her aggression as well as her needs, so it is frequently helpful for her to experiment with this as well. For example, if Jeannie became defensive when Miranda expressed her needs, Miranda might feel angry, and it would be valuable for her to experiment with expressing this, if she was ready.

Because codependence is a way of blocking a client’s needs and desires, in many ways the work is similar to that we have already discussed under the compliant and need-denying patterns.

Countertransference

Countertransference toward the Codependent Client. The biggest danger with the codependent client is ignoring her needs and issues. Be careful not to be taken in when she denies that she needs help. This is especially dangerous with a client who is not obviously in pain and is genuinely helpful to the other clients in the group. When a codependent client is interacting with another client, the work will tend to focus on the other client because the codependent client will ignore her issues and adopt a helping stance. If this happens, make sure to check in with the codependent client and ask her to share her feeling reactions as well, and be prepared to probe more deeply and turn your focus onto her when appropriate.

Countertransference of the Codependent Therapist. As group leader, one of your functions is to care for and protect your clients, but you have other functions as well, such as challenging group members and promoting awareness and insight. If you have a codependent pattern, the danger is that you will focus too much on nurturing and not enough on the aspects of your job that require you to take your clients into their pain or to be tougher with them.

chapter 13: the suspicious pattern

Clients with the suspicious pattern usually have an underlying betrayal issue, so we will discuss this first.

Betrayal

This issue can derives from a number of childhood situations:

(1) A parent (or other important person) is caring and loving toward the child at times, and this naturally encourages the child to open up to the parents, to be vulnerable and feel how much he really needs them. Then at other times the parent changes radically and becomes hurtful to the child. For example, the parent becomes explosively angry or ridicules the child or abandons the child. Of course, any parent has mood swings and moments of anger or distance, but with the betrayal issue, these are much more pronounced and the child is more seriously harmed by them.

(2) The child shares very sensitive or vulnerable information with a parent, and later the parent uses it against the child. For example, as Don was ridiculed by some boys for being effeminate, they called him “Cynthia.” He went to his mother in tears and shared this with her. Later when she became angry at him for being artistic rather than athletic, she shamed him by calling him “Cynthia.”

(3) A parent erects a positive persona for the outside world, and yet is very harmful to the child inside the home. People outside the family accept the parent’s false front. The child sees the parent being deceitful by hiding her true nature from most people, and therefore learns not to trust what people show to the world. This is common in alcoholic homes where the drinking must be hidden or denied and great effort is put into making things seem normal.

This issue can produce thoughts such as, “You can’t trust anyone.” It blocks a person’s ability to trust that others are benign and friendly when they appear to be. When this issue is activated by the group leader, it can disrupt the therapeutic alliance. It also blocks a person’s ability to allow himself to be vulnerable.

Suspicious Behavior

Mistrust. The suspicious client expects other people to be hostile, judgmental, shaming, or rejecting even when they seem warm and friendly. He may believe that people are hiding their negative feelings, or he may expect that at some point in the future they will change their minds and attack or reject him. For example, Lanie told Lev she felt uncomfortable and distant from him when he was new in the group. He got upset about this and they had a minor conflict about it which led Lev to access some mother transference. Then he abruptly thanked her for expressing her feelings so he was able to do this work. This seemed at little artificial to me, but not greatly so. Lanie didn’t trust him because he had become “nice” so fast. She felt even more guarded with him than before.

A suspicious client often looks for hidden motives behind seemingly benign behavior, expecting to be manipulated by others. Some suspicious clients even attribute malicious intent to other people. Clients with a less severe version of this pattern may believe that other people’s hidden motives are unconscious. Of course, sometimes other people are manipulative and do have hidden motives, and being aware of this possibility is healthy. This is especially prominent in institutional and political situations, and interactions involving prejudice. However, suspicious clients see this when it isn’t there or exaggerates it when it is. And they usually assume more evil intent than is really true.

As a result of these fears, suspicious clients are cautious, guarded, and mistrustful. They are reluctant to reveal much about themselves or to become close to anyone. It is common for a suspicious client to misconstrue things others say so as to confirm his suspicions. Suspicious clients are often hostile and demeaning toward others, the very things they are most afraid of themselves. In fact, projection is a common defense mechanism, and it seems that these clients often project their own negative feelings onto others, except that they tend to be direct with hostile behavior while they expect others to be harmful in a sneaky way.

Provocation. Suspicious clients are often provocative, especially eliciting anger in others. Since they expect hidden hostility, they can’t feel comfortable with someone who only shows their nice, compliant side. Therefore a suspicious client will try to provoke what she believes to be there, and when she has weathered it, she may actually feel safer with the person he provoked. For example, Lanie told Lev that she didn’t trust him. When I asked how this made him feel, he said that it didn’t bother him, providing an unconvincing rationale. This made Lanie even more mistrustful because he didn’t show the negative feelings she suspected were there. I suspected this, too. I think he was defending against his hurt or anger, but it didn’t make me mistrust him. She then proceeded to tell him, in fairly emphatic tones, that she didn’t like him. This was partially a genuine expression of her mistrust and partially an unconscious attempt to provoke him into acknowledging his negative feelings. A suspicious client is most afraid of trusting someone and then having him turn on her. She would much rather have an out-and-out war, because at least then she won’t be fooled into trusting someone who doesn’t deserve her trust.

Of course, this provocation is usually self-destructive, because often people don’t feel any hostility toward a suspicious client until she provokes them. Thus she creates the hostility she thinks is already there. Suspicious clients often have a tendency to annoy other group members with their constant focus on other people’s underlying motives, especially if they do this when they are in conflict with someone. No one likes having an adversary telling him what is going on beneath the surface. In fact, I teach group members that good communication consists of referring to the external behavior of others that one doesn’t like, not making accusations about motivation. Suspicious clients frequently violate this. For example, in chapter 8 in the transcript, Ralph accuses John of using his vulnerability as a weapon. Good communication would be for Ralph to say that he feels guilty when John is hurt and vulnerable. Instead Ralph accuses John of showing his hurt in order to make Ralph feel guilty. While this might be true, Ralph is not owning his own guilt, and in addition, he is telling John that he thinks John has a hidden manipulative motive. This is provocative for most people.

Origins. As I mentioned above, the suspicious pattern usually originates with betrayal. Suspicious behavior may also derive from the child internalizing suspicious parental behavior. Therapists frequently hear how a client was trained by a parent to never trust anyone outside the family. In addition, the suspicious pattern may also be created by childhood harm that is severe enough. In other words, if the child is abused, controlled, attacked, intruded on, or shamed in an intense, pervasive way, this may create the suspicious pattern even if betrayal or deception are not prominent.

Conditions. The suspicious pattern is often activated when the client is relating to people who are nice on the surface, especially when they aren’t forthcoming about their negative feelings. This is frightening to a client with a suspicious pattern. It can also be triggered by authority figures, powerful people, and people who have clearly erected a persona to hide behind. And it is more likely to be activated by people who remind the client of the parent who betrayed or deceived him.

Group Roles and Positions. The suspicious client can sometimes create a scapegoat role by constantly provoking other group members and being hostile and guarded. When relatively healthy, clients with this pattern can be very perceptive, often ferreting out underlying feelings and patterns that other group members might miss. Therefore if they don’t do this too often without other people’s consent, they can play the positive role of group sleuth.

Related Patterns and Concepts

Related Concepts. Clients with more extreme versions of this pattern would probably be diagnosed with a paranoid personality disorder.

Related Patterns. The suspicious and isolated patterns both make it difficult for the client to be close to people, but the isolated client is not particularly suspicious of hidden motives. The defiant client may be hostile and guarded, but this is directed at what others do directly rather than what the client fears is lurking beneath the surface.

Combining Patterns. The suspicious pattern is sometimes combined with the prideful and angry victim patterns in creating a paranoid style of personality. It is common for a suspicious client to also be isolated.

Change Process

The biggest issue with an isolated client is obviously trust. He should be encouraged to talk about the fact that he doesn’t feel trusting of the group members or the leader, if that is so. In no way should he be made to feel that he should trust anyone. His mistrust needs to honored even while you explore with him what it is about. He will only become trusting over a long period of time, as he sees that people don’t, for the most part, harbor malicious intent. In a therapy group, there is enough honesty and exploration of underlying feelings that the suspicious client will be able to see what is really beneath the surface after a while. He will also see that the group members are really interested in exploring their deeper feelings and their negative feelings, and that when a group member is hiding something or out of touch, the group will call her on it. This reassures the suspicious client that he is not alone in looking for underlying patterns.

The suspicious client often points out underlying anger and hidden motives that he perceives in others, and this may eventually become annoying to the other group members. You can help avoid this by encouraging him to talk about what he is afraid others are hiding, rather than just probing them. Revealing fears may be very difficult for him because it makes him vulnerable, but even if he can’t do it, your attempt will alert the other group members to his possible vulnerability. For example, you might say to Lanie, “I wonder if you suspect that Lev is still harboring resentment toward you, and if you trusted his saying ‘Thank you,’ you’re afraid he might clobber you later.” If the group members can begin to see a suspicious client as frightened and vulnerable, they will be more sympathetic to him. Of course, he will do his best not to admit any vulnerability at first, but as he begins to trust the group, he may be able to show some.

The Therapeutic Alliance. When a suspicious client has difficulty with the leader, he will often shun you, attack you, or ask you personal questions. The attack is often an attempt to provoke you into revealing the hostility he expects is there. The personal questions are also designed to get you to show more of yourself, so he can see what is hidden. It can actually be helpful to reveal yourself to a suspicious client, as long as you are comfortable doing that. It can be especially helpful to reveal any negative feelings you have toward him, as long as they aren’t too strong. A suspicious client is likely to provoke negative feelings in you with his constant provocation. Unlike most other clients, a suspicious client will trust you more after you have revealed a difficulty you are having with him. He assumes it is there anyway, and when you reveal it, he may begin to trust that are honest. For example, Gary had been attacking the leader and various group members for the last few weeks. He said to the leader, “I don’t think you like me very much.” The leader replied, “Well, I have felt annoyed at you sometimes when you have gotten into fights with a number of people. I worry that the group is beginning to feel unsafe.”

In deciding whether to reveal your feelings to a suspicious client, you must take in account the other members of the group as well. Even though this might be helpful for the suspicious client, it might be very threatening for others. After hearing your negative reaction to him, they might think, what does the leader feel toward me? As always, this is a difficult decision to make.

You will probably have to work continuously on your relationship with a suspicious client in order to develop a good therapeutic alliance. If he mistakenly perceives you as treating him badly, feedback from other group members can be helpful. For example, if he feels you are favoring others at his expense, the other group members might tell him they don’t see this happening. This will only be effective if the group has been going on long enough that he has begun to trust their perceptiveness. Keep trying to make a connection with the suspicious client without demanding that he change his feelings of mistrust toward you. Just keep exploring them, and make an effort not to be defensive when he accuses you of things that are not true. Make a special effort to admit anything that is true, even if only slightly.

Access and Healing. It is a great risk for a suspicious client to reveal any sensitive and possibly shameful material, because he expects it to be used against him. Therefore you must move him toward this very gradually having empathy with his fears. When a suspicious client is able to do this, the other group members are often deeply moved because they know how hard this is for him. This response is a healing step for him. However, the full healing will take longer; he will need to realize over time that they aren’t going to turn on him or use the information against him.

When a suspicious client is able to access the origins of his fears of being harmed and betrayed, this will be important, not only for his change process, but also because it will help the group members to understand the reasons for his difficult behavior and therefore be more sympathetic to him.

As he gains trust, the suspicious client will gradually reveal more and more of his fears and vulnerabilities and take the risk to connect with people. He will develop relationships in which he realizes over time that he is cared for and not harmed. He will learn that he can trust you and the group and, by extension, other people whom he wants to be close to. He will retain his ability to see through people’s surface behavior, but he will no longer assume that there is harm lurking beneath it, and this will allow him to develop relationships that are loving and intimate.

Countertransference

Countertransference toward the Suspicious Client. It is easy to become defensive and angry at a suspicious client who constantly accuses you of favoring others or hiding yourself or in other ways provokes you. It can help to remember that he is only doing this out of a need to protect himself.

Countertransference of the Suspicious Therapist. If you have a suspicious pattern, you are likely to put too much focus on looking for unconscious manipulation and projection in your group members and interpreting this to them. Of course, our clients do often have hidden motives, and these are sometimes manipulative or hostile, so sometimes this is appropriate. However, if you focus too much on this, you neglect your other therapeutic tasks, such as empathy, warmth, and acceptance.

Summary Tables

The pattern table here contains one additional column that was not needed for those patterns in the last chapter. “Additional Capacities Blocked” lists those capacities that are blocked by each pattern, not including those capacities that may be blocked by the issue that underlies the pattern, because these are already covered in the core issue table. This column is used only when the pattern itself, usually a defensive pattern, blocks additional capacities.

Pattern	Similar Meaning	Behavior	Conscious Statement	Unconscious Thought	Core Issues
Needy	Dependent	Needs much caring, over-reacts to loss	No one loves me or cares for me.	I am unlovable.	Deprivation or abandonment
Need-denying		Defends against feeling and showing needs	I don’t need very much. I can take care of myself.	If I show my needs, I will be shamed.	Punishment for need
Insecure	Self-effacing	Avoidance or awkwardness in self-expression or reaching out, easily hurt	No one sees me or likes me.	I am not interesting or desirable.	Rejection
Isolated	Distant, cold	Avoids relationship or commitment	I don’t need anyone.	If I am close to someone, I will be harmed.	Harm
Compliant	Pleasing	Tries to be what others want	I am a nice person.	Others are in charge of my life. It isn’t safe to exert power.	Harm, punishment for aggression, shaped dependence
Subservient	Masochistic	Seeks to be dominated or exploited (or otherwise harmed)	Your power is attractive.	The only way I can be loved is if I am controlled.	Harm paired with the only love the child received.
Defiant	Rebellious, oppositional	Rebels against power and authority	Don’t tell me what to do.	If I allow anyone else to be in charge, I will be harmed.	Harm
Passive-aggressive		Tries to please and fails in a way that indirectly expresses anger and defeats others	I want to please people but I can’t do it.	I am angry at being controlled, and I will fail in order to preserve my autonomy.	Harm, shame, punishment for aggression
Victim		Doesn’t take responsibility for his life	It’s other people’s fault that I’m unhappy. My situation is impossible.	I will force people to care for me by blaming them and being helpless.	Deprivation, exploitation, indulgence of weakness or blaming
Codependent	Caretaker	Cares for others rather than self	I care about people.	My only value comes from caring for others.	Deficiency, responsibility for others
Suspicious	Paranoid	Mistrustful of others, expects to be harmed	You can’t trust anyone.	If I trust anyone, I will be harmed.	Betrayal
Self-judging	Ashamed	Feels bad about self	I am bad/worthless.	same	Shame
Charming	Entertaining, charismatic	Charms people with force of personality, seductive	Look at me. Aren’t I terrific?	If I charm people so they like me, I won’t feel deficient.	Deficiency, shaped charming
Brittle	Fragile	Devastated by criticism or brittle defense against this	People don’t understand me.	I am terrified that they will see how deficient I am.	Shame, pride
Prideful	Grandiose	Overly invested in performance, condescending	I am special and better than others because of my performance.	If I impress people and feel superior, I won’t feel so deficient.	Deficiency, pride
Entitled	Self-centered	Self-absorbed, lack of empathy, intrusive, controlling	My needs are important.	Other people are extensions of me.	Indulgence, exploitation, pride
Negative transference*	Angry, judgmental	Reacts angrily to a certain behavior X in others	It is bad to do X.	I’m angry at my parents for doing X.	Parents did X.

Core Issue	Type of Issue	Origin	Thought	Capacities Blocked	Painful or Shaped Pattern	Defensive Patterns
Needy	Deficiency	Lack of nurturing	No one loves me or cares for me.	Connectedness	Needy, insecure	Need-denying, isolated, compliant, charming, victim, entitled, codependent
Fear-of-abandonment	Deficiency	Emotional or actual abandonment or loss	I can lose those I love at any minute.	Connectedness	Needy, insecure	Same as above
Insecure	Deficiency	Lack of recognition and appreciation	No one sees me or likes me.	Connectedness, value	Insecure	Charming, prideful, compliant, codependent, brittle
Punished-for-need	Punishment	Punishment for expressing need	My needs are bad.	Connectedness	none	Need-denying, codependent

Pattern	Similar Meaning	Related Technical Concepts	Behavior	Core Issues
Needy	Dependent	Oral character, dependent or borderline personality disorder	Needs much caring, over-reacts to loss	Deprivation, abandonment
Need-denying			Defends against feeling and showing needs	Punishment-for-need
Insecure	Self-effacing	Avoidant personality disorder, social phobia, closet narcissist	Avoidance or awkward reaching out, easily hurt	Rejection

Pattern	Conscious Statement	Unconscious Thought	Group Roles and Positions	Countertransference toward Client	Countertransference of Therapist
Needy	No one loves me or cares for me.	[6]	Emotional member Social leader	Desire to nurture, repulsed by need	Too much involvement
Need-denying	I don’t need very much. I can take care of myself.	If I show my needs, I will be shamed.			Rejection of client’s needs, or client’s caring for or idealizing therapist
Insecure	No one sees me or likes me.	³	Silent member, scapegoat	Desire to reassure	Needing too much reassurance. Hurt by clients’ negative feelings. Difficulty challenging clients or setting boundaries

Pattern	Responsibility	Access (Painful Schema)	Access (Healthy Capacity)	Experimenting	Healing Responses	Inner Healing	Potential Problems
Needy	Owning the degree of need	Being deprived or abandoned	Anger at deprivation		Caring, nurturing	Taking in nurturing	Members repulsed by degree of need
Need-denying	Understanding that needs are denied	Being punished for having needs	Needs	Showing needs	Acceptance of needs
Insecure		Being rejected	Anger at rejection	Reaching out, showing insecurity	Liking, appreciation,	Taking in liking, self-valuing	Therapeutic mismatch. Silent client doesn’t get time to work

Related Concepts

Definitions

Healthy Capacities

Schemas

Deprivation

Needy Behavior

Related Concepts and Patterns

The Change Process

Potential Problem

Abandonment

Example

Group Roles

Countertransference

Need-Denying Behavior

The Change Process

Countertransference

Painful Patterns and Defensive Patterns

Rejection

Related Concepts and Patterns

Origins

Reaching Out

The Silent Group Member

Dealing with Rejection

Access and Healing

Exclusion

Countertransference

Core Issue and Pattern Tables

Autonomy and Safety

Domination

Shaped Dependence

Attack

Violation

Working with Violation

Related Patterns and Concepts

The Change Process

Fear of Commitment

Countertransference

Compliant Behavior

Related Concepts and Patterns

Origins

The Change Process

Countertransference

Defiant Behavior

Related Concepts and Patterns

Origins

The Change Process

Countertransference

Passive-Aggressive Behavior

Related Concepts

The Change Process

Countertransference

Origins

Related Concepts and Patterns

The Change Process

Countertransference

Codependent Behavior

Origins

The Change Process

Countertransference

Betrayal

Suspicious Behavior

Related Patterns and Concepts

Change Process

Countertransference

Summary Tables