Acting Out In Therapy

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Any acting out in therapy is a failure of the ability to speak, a situation when it is impossible to directly voice one's feelings and thoughts, there is no space to stop experiencing the experience, to twist it in interaction with another person. Therefore, many therapists tend to confront acting out. Offer clients not to do, but to speak. Do not release emotional tensions outside of therapy or into actions in therapy, but try to stop and face the feelings that prompt these actions.

And this, in general, is very understandable and logical, because the goal of therapy is just to make as many experiences and states of the “I” as possible available for transferring to the border of contact with another person, and therefore, as a consequence of this, available for comprehension, living and, ultimately, transformation.

However, in practice, things are not so simple. This kind of logic of confrontation of acting out comes from the opposition of “say or do”. As if only one thing is possible, either, or.

Those. situations where this opposition arises also happen.

The first is acting out, which is destructive in itself. For example, come to a session drunk. Or be late by 40 minutes. It is clear that if this kind of behavior is regular, then therapy is hardly possible. There are also more cunning ways of destruction, for example, the client can complain to the ethical commissions about his therapist (while continuing to visit him) or in some other way try to influence him indirectly through third parties. This also includes suicidal behavior, and this is not necessarily a direct threat of suicide, it can be a whole range of a wide variety of self-destructive scenarios.

All these are actions that should be stopped and should be stopped. Some of them - completely exclude the possibility of therapy as such, some - very difficult and make it difficult and not particularly effective. It is clear that the therapist does not have the magical ability to say "stop it", but the systematic confrontation of this kind of behavior is a natural and understandable choice. The boundary where the possibility of therapy as such ends is drawn individually and on its own, but this is undoubtedly the pure truth: a therapeutic relationship can not accommodate any behavior. And if the client himself cannot cope with this and stop himself, then this can exclude the therapy as such.

Secondly, in my opinion, it is worth stopping acting out, which release tensions to such an extent that there is nothing to talk about. Actually, this is the most common argument about why the dilemma of saying or doing arises. If the client, with the help of an action, achieves sufficient relaxation and pacification, then the passion for discussing and living the meanings that prompted this action can disappear completely. Why talk if the condition is already quite normal? If emotional regulation came about through action? Here, of course, a logical question arises, if the client is already normal, then why interfere with this? The catch here is that until the experience enters the zone of relations with another, it is doomed to remain unchanged for the rest of its life. And if there is something that from time to time is compressed into action and remains sealed inside it, then this means that there is a certain part of the self, which from time to time is compressed into the usual rituals, and from that it remains as if in a life prison.

And then the therapist can quite reasonably ask the client to change the signal. Tell about yourself not by deeds, but by words. To fantasize about what this is happening, and use the voltage of the stopped action as an ignition spark to be able to start talking about it.

This does not work, in my opinion, in two cases.

The first is the case when the voltage is oversupplied, it floods. When traumatic affect is packed inside the acting out. It can be driven into action like a genie in a bottle, but as soon as it breaks free, it will be very difficult. It's like opening a Pandora's box or an atomic burial ground. You can't push it back, or you can push it with a very difficult struggle and consequences. There is so much seething inside that an attempt to stop the actions leads to an overflow of the possibilities of the psyche, to the flooding of the unconscious with seething affects. It is good if the containment capacity of therapy is enough to digest all this, but this is not always the case. The client's inability to deal with such content at the moment, and the therapist's inability, and simply so far insufficient strength and prescription of the relationship, insufficient knowledge of each other, can play a role here. Some things can only be touched if the therapeutic alliance is already strong and sealed by the trust of a long-term relationship. And before - in any way, it will simply lead to separation and destruction.

Yes, if we talk about deep and serious therapy, then sooner or later it will have to be done. But, in my opinion, not every client is ready for this. And to receive help with less intrusion into his own unconscious, the same client may well be ready. Here, it seems to me, it is still worth remembering at times that psychotherapy, like diplomacy, is the art of the possible.

And finally, there is, in my opinion, another option. A little higher, I suggested a situation when a traumatic affect is packed into acting out as a knocking wave of experiences, as a sympatho-adrenal response, hit-and-run. But if the trauma is even deeper, then there is a “freeze” response. If we are talking about a rather massive relational trauma, this is a total reaction of inhibition, shutdown, apathy, and the fading of life. These are clients who are chronically lacking in vitality. They complain of eternal lethargy, apathy, derealization, that they do not cope with their duties at all or that they cope with a huge effort, mechanically and lifelessly. These are clients with vitality that is rolled inward like a snail in a shell. And if such a client makes an attempt to act out, then stopping it = stopping him is the only way to somehow stick out. This is a situation when actions are not a capsule that isolates experiences, but the only possible way to convey a message about yourself. Let it be indirectly so far, without too close contact, but still say something inside. This is a situation when the client's mental world is inhabited by non-embodied ghosts of experiences that take on flesh only for a short time and only at the moment of doing. It is impossible to talk about it simply because there are no words to express it. And only immersed in action, only having played a lot next to someone who understands and accepts this, and is able to decipher, there is a chance to connect with these states of oneself. And here not only the opposition of saying and doing does not work, here a completely opposite situation arises: only in the flow of free doing (of course, within the therapeutic framework) there is a chance over time to start and talk about it.

Of course, it is easy to separate this only in theory, in practice, it is far from always clear what kind of acting out the client brought. Moreover, one and the same client packs some states of selfhood into habitual actions, as in imprisonment, and some - under-embodied - as messages and the only way to say about himself. And it's not always possible to immediately figure out where what. Some things can only be understood after a series of mistakes. And sometimes these mistakes can be fatal to therapy.

But I am absolutely certain of one thing: strict rules about confrontation of acting out or, on the contrary, a chronically liberal attitude towards them - very much limit the possibilities of the therapist, narrow the field where he can be useful. And every time you need to look at the context, and make decisions based on the current moment. Not hiding behind a rule that obscures the real person opposite. Although in this case, the therapist becomes more vulnerable to countertransference and already his acting out. And you have to take risks.