This eSingle is about 6,000 works in length, comparable to an article you might read in the New Yorker or The Atlantic. It sells for $.99, less than a cup of coffee at Starbucks. If you do decide to give it a read, I hope you’ll take the time to leave a review on Amazon. Many thanks.

Now that I’ve been practicing via Skype for over a year now, I’m also understanding one important way that it differs from conventional face-to-face work: psychotherapy relationships via Skype tend to be much more transient. I suppose it’s a feature of many “virtual” relationships that are quickly formed and easily ended. Despite all the caveats in my disclosure statements, no matter how clearly I state that I don’t do short-term work and believe it takes time for a psychotherapy bond to develop, I still have clients who come for a few weeks and decide to quit because they don’t feel they’re making sufficient progress.

Even more surprising to me has been the way some clients simply disappear. No final session, not even an explanatory email. I was working with a physician, prominent in her field, who disappeared without a trace. I knew I was doing good work with her. Our final session stirred up significant anxieties about the state of her marriage, so when she sent me an email cancelling her next appointment, I viewed it as understandable resistance. But my follow-up attempts to reschedule received no answer. She vanished without a trace. Another client recently terminated therapy with no warning, also because of anxiety stirred up during session: concerns about unconscious rage and violence had come to the fore in our prior session.

When you work in one specific location, the clients referred to you often know your colleagues or other people with whom you work. Another therapist may send you the spouse of a client, or one of your former clients might refer a friend to you. Such connections usually inhibit people from simply disappearing, as some Skype clients seem to do — at least in my experience. Over the years of my practice, I almost never had a client no-show and then fail to return my calls. Someone who lives in another state with no personal or professional connection to me doesn’t worry about what other people might think if they decide to disappear.

Still, over the last year, I’ve been fortunate to develop strong bonds with a growing number of Skype clients. In a way, it reminds of when I first began in the profession: many people started treatment but most of them didn’t continue for long; over time, I formed strong relationships with more and more of them until I finally had a stable clientele. Maybe it’s not simply due to the transience of virtual relationships but a function of building a virtually new practice.

Online therapy photo available from Shutterstock

I hope you’ll consider buying the book and joining our discussion group going forward. I expect to open a new topic thread each week, one per chapter, so we’ll be working our way through the book together over the next few months. I hope it will be a rewarding experience for everyone who participates. I’m not sure I’ve ever heard of a self-help book that you can tackle in the company of its author and other readers. Online group therapy anyone?

PRINT VERSION:

KINDLE VERSION:

Please help me make my book’s launch a success! There’s a detailed synopsis below.

WHY DO I DO THAT? Psychological Defense Mechanisms and the Hidden Ways They Shape Our Lives

by Joseph Burgo, Ph.D.

New Rise Press (October 2012)

242 pages

Psychological defenses are forms of self-deception we employ to avoid unbearable pain — that’s the starting point for my new book, now available in print and Kindle editions on Amazon, soon to be available on Barnes & Noble and in the iTunes store for other eReaders. It might seem odd for a psychoanalyst to write a self-help book; but after after watching psychiatric meds and cognitive-behavioral therapy increasingly dominate the profession over the 30+ years I’ve been practicing, I wanted to speak up for psychodynamic thinking.

On my website After Psychotherapy,I’m often asked by readers who can’t afford psychotherapy to recommend a book that might help them; up until now, I’ve never been quite sure what to say. Most self-help books rely on cognitive-behavior techniques that ignore the unconscious mind while the academic literature in psychodynamic thinking is too experience-distant and full of technical jargon. Now I’ve written a book that I think bridges the gap.

Why Do I Do That? adapts the basic strategies of psychodynamic psychotherapy to a guided course in self-exploration, highlighting the universal role of defense mechanisms in warding off emotional pain. With easy-to-understand explanations, the first part teaches the reader about the unconscious mind and the role of psychological defenses in excluding difficult feelings from awareness.

Individual chapters in the longer middle section explore the primary defense mechanisms one by one, with exercises to help readers identify their own defenses at work. The final part offers guidance for how to “disarm” those defenses and cope more effectively with the unconscious feelings behind them. Psychological defense mechanisms are an inevitable and necessary part of the human experience; but when they become too pervasive or deeply entrenched, they may damage our personal relationships, restrict our emotional lives and prevent us from behaving in ways that promote lasting self-esteem.

Throughout Why Do I Do That?, I use clinical vignettes from my practice, examples from daily life, and personal accounts of grappling with my own defense mechanisms to illustrate the discussions. Here’s a more detailed outline of the book.

Part I – Understanding Our Psychological Defense Mechanisms

Chapter One introduces the reader to Freud’s notion of an unconscious mind, using everyday examples to show how his views have been incorporated into our shared understanding of human nature. Psychological defense mechanisms are then explained as the means by which we exclude parts of our experience from consciousness; they are defined as “lies we tell ourselves to evade pain.”

Chapter Two examines “our primary psychological concerns”: what it means to experience need and dependency in all our relationships, how to manage intense emotions, and the drive for feelings of self-esteem and a sense of personal worth in relation to others.

The final chapter in this section explores the broad range of emotions all human beings experience in connection with their primary psychological concerns, adopting the view that certain emotions usually considered “negative” are in fact inevitable. Defense mechanisms typically come into play when we experience these painful and socially undesirable feelings.

Part II – Identifying Your Own Defense Mechanisms

The long middle section takes a look at the most important defense mechanisms individually and shows how our culture has incorporated many of Freud’s insights about them into our shared understanding of human nature. For example, we regularly refer to defense mechanisms such as denial, displacement and projection in everyday speech. Each chapter includes a section that explains how readers may recognize that particular defense mechanism at work in relation to their primary psychological concerns – Need and Dependency, Emotions and Self-Esteem – concluding with a set of exercises to help them identify the potential role played by that particular defense in their emotional lives.

Chapter by chapter, the defense mechanisms discussed are grouped as follows:

Repression and Denial (Chapter 4)

Displacement and Reaction Formation (Chapter 5)

Splitting (Chapter 6)

Idealization (Chapter 7)

Projection (Chapter 8)

Control (Chapter 9)

“Thinking” – i.e., rationalization and intellectualization (Chapter 10)

Defenses against Shame – especially narcissism (Chapter 11)

Each chapter concludes with a section entitled Now What? that briefly summarizes what has been learned and suggests ways to make use of new insights going forward.

Part III – Disarming Your Defenses

Unlike most self-help books, Why Do I Do That? does not offer a cognitive-behavioral set of techniques for changing behavior or thought processes but instead emphasizes the necessary mindset for change (Chapter 12) and the role ongoing choice plays in authentic growth and development (Chapter 13). The final chapter, The Future of Your Defenses, presents a realistic view of “mental health,” emphasizing that defense mechanisms don’t simply disappear but play a continuing role in our lives. While struggling with our defenses remains an ongoing challenge, increased self-knowledge and the ability to make better choices leads to a richer, more satisfying emotional life, deeper relationships and the kind of self-esteem that lasts.

Since beginning to read Tomkins on affect and emotion, where he defines affect as a built-in physical reaction to a stimulus which tells us that we need to pay attention to that stimulus, I keep wondering: but what if we don’t pay attention? What if the physical response occurs but we don’t notice it? In my view, this possibility connects with Bion’s understanding of certain psychotic processes: when someone finds a fact or feeling too painful to be tolerated, he or she may attack the means of perceiving it — e.g., the capacity to see, hear, pay attention, etc. It also connects to my developing thoughts about defense mechanisms as the means of diverting attention away from psychic pain, and about the group project I want to do on pain and distraction.

I’m fairly confident that depersonalization (dissociation?), for Carl, is a defensive means to escape from his painful internal world, particularly the experience of profound shame. It isn’t only dissociation from memories but disengagement from the places in his body where he might register emotions. When I brought up mindfulness, suggesting he try to focus on his breathing and center his awareness on those places in his body where he might detect emotion — face, eyes, chest, belly — Carl seemed resistant. I think he’s afraid to come back into his body and thus into contact with the pain from which he fled. This whole issue of attention and where it’s located is fascinating to me.

Man sitting photo available from Shutterstock

Later in the session, Melissa told me she felt bad about the chaos in her life: the uncertainty as to where she’s to live, the loss of her debit and health cards, etc. When her friends tease her and say, “You’re such a mess,” she laughs in the same light-hearted vein but it really upsets her. It makes her feel ashamed but she doesn’t know what to do about how disorganized and undisciplined she feels. This is the flip-side of contempt and indifference: underneath, she feels a hopeless kind of shame about her difficulties. She talked about the many things she needs to take care of, at home and at work, feeling overwhelmed by them, with no idea about where to begin. I found myself thinking in practical terms — making lists, for example — but didn’t say anything about it at that point.

She went on to talk about her finances and how she would often spend $30 at a bar, knowing on some level that it would mean she might not have enough money to pay her cellphone bill the next week; when I asked her if had a budget, she blushed and said “No, not really.” She added, “It makes me feel so ashamed, admitting that I don’t even have a budget.” At that point, we talked about the fact that she could actually make one for herself. I’m not usually so directive, but I explained how to go about it, then brought up the idea of chore lists, as well. Sometimes Melissa brings out the pragmatic father in me. We talked about her sketchy family background, how little her unreliable parents had prepared her for the adult world.

Toward the end of the session, I linked up the idea of step-by-step growth that leads to real mastery with preparation of a budget that would allow her to make better and informed choices. In both these ways, she could develop authentic self-esteem, instead of the false kind (arrogance) that grows from scorn and superiority. It’s actually possible for her to grow up, little by little, into a person she will respect.

Businesswoman photo available from Shutterstock

Janice began the session by talking about her husband’s almost complete inability to read her body sexually and to identify what gives her pleasure. The way he had been touching her the night before felt completely unrelated to her own responses; it distressed her so much that she began to cry in the middle of sex. When they talked about it afterwards, he told her he felt there was a very narrow pathway of acceptable behavior and that if he deviated from it, he’d upset her. Janice acknowledged that there was some truth to what he had said. She next talked about how he doesn’t pay much attention to his intonation when he plays saxophone, that he often sounds shrill and off-pitch but doesn’t seem to notice. Her mother had been like that, too — interested in music but unable to carry a tune.

Janice went on to talk about her chiropractor. She described him as a very empathic man in terms of the needs of her body. She didn’t know how to describe what happened in his office, but whatever it was felt to her like “heaven.” At that moment, my cellphone began to vibrate on the desk and I briefly glanced toward it. In an agitated tone, she said, “What? What is it? What are you looking at over there?” She sounded distressed. I thought about her husband and her mother — insensitive, out of tune. Then our session from Monday came to mind — the way her yoga teacher had noticed that Janice seemed out of sorts during class; in order to help “ground” her, the teacher held onto Janice’s feet during Shavasana. This had calmed her. The yoga teacher resembled the chiropractor. Her husband, mother and I did not.

I put it together in this way: now that she’s coming “out of boxes” — the way we describe her emergence from the set of autistic defenses she has relied upon to protect her vulnerable self — she feels incredibly raw and needs others to show a very close attunement to her feelings and needs. Anything other than a highly sensitive touch feels unbearably hurtful to her; even my brief distraction by the cell phone felt painful. I linked it to her mother’s almost complete inability to empathize with baby Janice. It struck me that what normally goes on between mother and baby is a kind of musical attunement, reminding me of the way members of a tight band are “attuned” to one another. I told her that, in ways I didn’t fully understand, her autistic escape into music was a kind of substitute for her mother’s inability to be attuned.

Janice felt the truth of all this and it reminded her of the way her mother used to hum in the kitchen, how much Janice had liked it, even if her mother didn’t have a good ear. Because her mom would usually hum the tune she’d most recently heard, Janice would intentionally hum a different tune that she, Janice, preferred, in order to get her mother to switch. This usually worked and her mother would echo the tune that Janice had just hummed.

Attunement.

Mother and baby photo available from Shutterstock

This got me thinking about relationship dynamics, and what happens when the person who’s supposed to be the one giving — in a kind of parental role, so to speak — becomes the needy (and exploitative) one. It stirred up thoughts about Jeff’s aged father who’s been calling him 10-20 times per day. It’s become clear to me that during Jeff’s childhood, his father was a highly anxious man who relied upon his children to help manage that anxiety. Jeff talks repeatedly about the pressure he felt growing up to become a lawyer as his father had wanted to do, and his feeling that he wouldn’t be loved if he didn’t do so. Yet Jeff always insists that he “for some reason” misinterpreted reality and came to the mistaken view that he wasn’t lovable.

Getting Jeff to question his parents, or think about them in a critical way, has been a challenge. Jeff insists he knows they love him unconditionally; he is a dutiful and devoted son. Whenever I suggest to him that his massive feelings of low self-worth, the inner feelings of shame and ugliness, must have their roots in his childhood, he agrees in theory but can’t seem to connect it to his experience. In in yesterday’s session, it felt as if we made some progress.

When we were discussing those feelings of self-hatred, and I once again pointed toward his childhood, he reiterated his belief that his parents love him unconditionally. I said, “Even if that’s true now, it doesn’t necessarily follow that they felt the same way about you back then.” I reminded him of his feeling that he wouldn’t be loved if he didn’t become a lawyer. “Maybe you didn’t just make that up. Maybe there was something accurate about what you perceived.”

“There must’ve been,” he said. Then he quickly added, “I feel guilty. I feel bad thinking like that about my parents.” Lightbulb moment. I put it together for him: as a child, he felt that he need to fulfill his father’s desire to have a son who would become a lawyer, regardless of what he, Jeff, wanted. Even now, in his own therapy session, he felt he had to protect his father, as if there wasn’t room for Jeff and his actual feelings. He seemed confused. He told me that none of the other therapists he’d seen had ever talked about these ideas to him before. He didn’t know what to make of them. “I feel guilty,” he repeated. We had to end on that note.

Afterwards, I was thinking about the way he always tells me how much he appreciates me. He is far and away the most grateful client I’ve ever known. I wonder if he feels that he has to make me feel good about myself, that his role in therapy is to bolster my ego rather than to get what he needs. Something we’ll have to explore.

Pastor photo available from Shutterstock

We went on to discuss the email he’d sent me over the break: the way he’d turned authentic upset over his aunt’s death into a facsimile of real feeling, how “performing” appropriate emotion took the place of his genuine response. I felt as if we were connecting some dots: his fear of strong feeling has led to a tendency to flatten everything, to take the life out of his emotions and reduce himself to a safe but passionless existence. I said to him that, contrary to the way he usually viewed himself as unemotional and detached, I think he’s actually a very sensitive person underneath; his apparent indifference is a defense against feeling unbearably vulnerable. He seemed quite touched and linked this to being bullied during his school years, how he strove so hard to appear “cool” as a response, as if he didn’t care.

At that point, I thought back to the beginning of the hour — the way Julian had questioned the value of our work together. I said, “This is just my hunch, by I think you very much missed having your session last week and you’re really glad to be back working today, but instead of showing me how you felt, you began by questioning the value of the therapy and seemed almost indifferent.” He laughed in that way he does whenever he feels fully “seen” and admitted it was true. There were several times during the week when he’d wished we could have had a session because of what he’d been going through and he had very much looked forward to our session today. I pointed out that this was completely invisible to me, as if he didn’t want me to know.

In talking about what he might actually do to put these insights to work, I gave him two suggestions: first, in his everyday life, to try to become more attuned to the ways he “takes the life” out of his emotional reactions and hides himself (his feeling self) from other people; second, in our work together, to reach out to me in our relationship and try very hard to let me see him, rather than concealing his feelings behind a show of indifference. At this point, Julian was struggling to maintain eye contact and not look away from me, as he usually does. He said, “That sounds really frightening.”

It was a very good session.

Anxious young man photo available from Shutterstock