Tag Archives: Patient

What’s Wrong with Me?

This question, and the accompanying statement, “there must be something wrong with me,” are those that I hear most frequently in the course of a working day.

In some ways, perhaps this isn’t surprising. People generally don’t come to therapy when they are thriving and full of joy.   And yet… are unhappiness, depression, feeling alone, etc. best conceptualized as something “wrong” with you?

I would say not, and that this way of thinking about things, and oneself, is pernicious and destructive, and more importantly, a kind of violence to the truth.

Let me try to explain.

Let’s say you hate being in groups of over three people. You feel anxious, bored, foolish, or very alone. Thinking of this in terms like “what’s wrong with me?” may come easily to you – it seems to come awfully easily to most of us.

[Do take a moment now to substitute your own version of this – the kind of situation where you think: “something is wrong with me.”]

It may seem to you that thinking “something is wrong with me” adds something new to the original observation. But what exactly? What do you know now that you didn’t know when you noticed you were bored or anxious?

Nothing, I would say. You don’t know any more, but you have the illusion you do. You “know” that this bored/anxious person is defective – morally/ genetically/spiritually/psychologically, take your pick.

Why does this feel like knowledge? Why do we go to this place so easily?

I tend to locate the answers to these questions in our earliest thinking/feeling. I think the idea “there is something wrong with me” is a transform of one of the earliest proto-thoughts/feelings we have – “I’m not loved.”   In any normal, let alone abnormal, childhood there are literally thousands of moments where we might come to think this: when we’re terrified and crying during the night but no one comes, when we’re starving and there’s no mum/breast/bottle in sight, when we are overwhelmed by any feeling – love/hate/anger/aloneness/fear and there is no one there to hold us and help us digest the feeling. And of course these are just the earliest such moments where we might come to think “No one loves me.”  Later, there’s the arrival of a new sibling, the priority given to another over us at family gatherings and school, the lack of recognition of what we can offer to the world, etc.

I believe that thinking/feeling “I’m not loved” is just too painful, especially to our earliest consciousness. So we replace it with another, slightly less painful thought – “there is something wrong with me.” Initially, I imagine, this is also a hopeful thought – in that if there is something wrong with me I can discover and correct it. And then I Will Be Loved!

But as time goes on, the thought becomes more solid, and the hope fades. The link with its painful origin is forgotten. And, in the fullness of time, it becomes a part of our identity. There Is Something Wrong With Me.

At this point, the thought comes very easily, and gives a kind of comfort – that of “knowing” ourselves.   I believe that for my patients, and indeed all of us, thinking, “there is something wrong with me” stops the pain of feeling anxious/bored/alone and substitutes Bitter But True Self Knowledge. We have come to conceive of ourselves as a malfunctioning machine, rather than a human being in pain.

But of course, there is no self-knowledge here, no truth.   As I’ve shown above, there is nothing added by this strangely reassuring thought to the original perception that we are anxious/bored/alone in a crowd.

Quite the contrary: it helps us avoid the truth. It stops us in our tracks and prevents us from enquiring into what is going on that makes us anxious/bored/alone. It prevents us from seeking our reasons for feeling what we do. In other words, it takes away our power to look at ourselves as rational creatures responding to something in an environment in a way that makes a particular sense to us.

It has become so obvious to me that thinking “there is something wrong with me” is a defence that I’ve become increasingly puzzled about why my clients are so attached to it, to this negative proclamation/conclusion about themselves.

It can take months, years even, to get past this repeated assertion, to get clients to focus on the phenomenology (a fancy word for “what is happening”) of a particular situation that makes them anxious, or bored, whatever.  It’s as if they cling on to this idea “there is something wrong with me” for dear life.

Of course, any identification, even a negative one, is hard to give up. Giving it up means facing the pain that was avoided by it. When people stop telling themselves there is something wrong with themselves they have to face something – a loneliness or self-effacement, for example, that echoes painfully through their lives into their pasts. We are pain-avoiding creatures.

But we are also fed in a powerful way by recognizing the truth. And getting past the empty identification “there is something wrong with me” can put us solidly, if temporarily painfully, on the earth, in our bodies and in our lives. It can give us the future this empty self-knowledge has deprived us of.

A price worth paying?

Failing in Therapy

Ever tried.  Ever failed.  No matter.  Try again.  Fail better.  Samuel Beckett

There are three impossible professions:  governing nations, raising children, and psychoanalysis.   Sigmund Freud 

The list of things we expect of ourselves as therapists is long:

  1. To be “present” and emotionally available throughout every hour that we’re seeing clients,
  2. To be “neutral,” that is, not to take sides in the client’s story – either with respect to the roles that partners, parents, and co-workers play in their lives, or in relation to favouring one outcome or possible future over others,
  3.  To remember everything we’ve ever been told and have it easily available to make connections,
  4.  To treat resistance and even attacks on the therapy/therapist in a “positive” way, that is, to be concerned with the interpretation of what such attacks mean, rather than defending oneself or smarting with (and reacting out of) hurt, (In this light, I remember a cartoon in the New Yorker. A therapist is returning home at the end of the day, his clothes torn and his face gashed.  He’s smiling grimly and saying, “My patients are really getting into their negative transference.”)
  5. To not act in any way that is driven by one’s narcissism, defensiveness, or needs for confirmation and satisfaction (emotional or physical),  and
  6. To be open-minded, open-hearted, gentle, understanding, flexible and spontaneous.


I could go on, but I think this is good enough for starters.  It makes clear why psychoanalysis is an impossible profession.  And why every therapist’s experience of working is one of failure.  Because these expectations, like those our patients have of themselves, are irreconcilable with being human.

Of course, it’s very human to have impossible expectations of oneself (and/or others), and it’s at the heart of our experience of life how we deal both with these expectations and with our failing to meet them.

As a therapist, I believe it’s the unconscious expectations of oneself (that often have their origin in the unstated/stated expectations of significant others) that produce the most conflict, pain, and despair.  These are the expectations one tries to fulfil without any great confidence they will be met, or even if they are met, that this will make any difference.

Being able to articulate such expectations, however disloyal, difficult, painful, and halting this may feel, is the key to managing them, and our inevitable failure to meet them.   This is because failing when one has consciously chosen a course in full recognition of the possibility/inevitability of failure, feels quite different from a desperate attempt to satisfy an imaginary Other.

So, for example, while I am perfectly aware I don’t/can’t live up to my analytic ideal in moments (and sometimes more than moments), the fact that I chose to practice in spite of my recognition of the impossibility of the task makes my failure more bearable. Years of personal therapy also made failing more tolerable, by attenuating radically the harsh inner judgement on my human erring.  Through this process, I have come to appreciate Pope’s wonderful succinct definition of our humanity: to err is human.

I now recognize that my way of failing, which is unique to myself and different from the way other therapists fail, is actually what I have to offer to my current and potential clients.  In other words, I’m not a machine for producing perfect understandings/interpretations. Rather, I’m a very particular window on the world, someone who has erred and learned from their erring in their own unique way.

Like the swordsman in Seven Samurai, my goal is to hone my attention and skill — to fail better.

I thus resonated with the writers who wrote so revealing on their experience of failure in the Guardian article which inspired this blog: (http://www.guardian.co.uk/books/2013/jun/22/falling-short-writers-reflect-failure)

I have many favourite quotes from this article but I’ll end with one from Anne Enright:

In the long run we are all dead, and none of us is Proust. You must recognise that failure is 90% emotion, 10% self-fulfilling reality, and the fact that we are haunted by it is neither here nor there. The zen of it is that success and failure are both an illusion, that these illusions will keep you from the desk, they will spoil your talent; they will eat away at your life and your sleep and the way you speak to the people you love.