Therapy patients use defense mechanisms to avoid confronting the truth, and therapists must see through them. 4

from book Maybe You Should Talk to Someone: A Therapist, HER Therapist, and Our Lives Revealed

Some of the main complications of therapy stem from a couple of very simple facts about human beings. The first is that, generally speaking, we don’t like to feel painful emotions, and we’ll avoid them if we can. The second is that – again, generally speaking – we want to feel positive about ourselves, and we want other people to feel positive about us too.

But in therapy, patients are asked to dig deep into the most emotionally painful parts of their psyches and reveal the ugly, potentially unflattering wounds that are festering there. This runs counter to both of the aforementioned human tendencies. As a result, many patients put up defense mechanisms to try to ward off the threat that therapy seems to pose to them. For the author, fixating on her ex-boyfriend and his alleged misdeeds was precisely such a defense mechanism. By taking up all of the time of her initial therapy sessions, it prevented her and her therapist from addressing her real, underlying issues – the ones that made her breakup feel so traumatic in the first place.

To examine the truth concealed by such a defense mechanism, a therapist has to pick up on clues from his patient. For example, Wendell noticed that in the middle of one of the author’s rants about her ex-boyfriend, she made a passing lament about her life being “half over.” From clues like this, he surmised that she wasn’t just upset about the ending of her relationship. Instead, she was feeling anguish over a much bigger ending – indeed, the biggest ending of them all: death itself.

On a figurative level, she was grieving the death of the future that she had envisioned with her ex-boyfriend, a future in which they got married and lived happily ever after. But on a more literal level, she was also grieving for her own mortality. A couple of years before the crisis that sent her to therapy, she had begun experiencing a mysterious illness with a wide range of symptoms, including fatigue, hand tremors and an irregular heartbeat. She saw many specialists, but none of them could diagnose her. She feared the worst: whatever it was, perhaps it was slowly killing her.

Fears don’t get much more fundamental than the fear of death – but there are some other ones that can underlie a therapy patient’s presenting problems.