"Generative Caring" Psychotherapy for Patients Who Are Reluctant to Talk

By Hassenfeld, Irwin N. | American Journal of Psychotherapy, Fall 1999 | Go to article overview

"Generative Caring" Psychotherapy for Patients Who Are Reluctant to Talk


Hassenfeld, Irwin N., American Journal of Psychotherapy


Patients seek psychotherapy for relief of symptoms and resolution ofproblems in living. Yet, they sometimes balk at the prospect of having to choose a topic without being prompted by therapist questions. This paper suggests that this apparently self-sabotaging behavior represents an acting out of a fundamental existential dilemma for many individuals, i.e., to be or not to be an adult.

Adulthood comes with the heavy burden of responsibility for making life choices, and the possibility of making the wrong choices. The psychotherapeutic situation, with its demand that the patient choose a topic, is a microcosm of the adult-adult relationship. The author proposes that the proper treatment for these patients is Generative Caring Psychotherapy, which promotes emotional growth and facilitates patients' transition from childhood dependence to adult responsibility.

When a patient refuses to work in psychotherapy, or attempts to sabotage the psychotherapeutic situation, it is thought that the patient's unconscious wishes or fears are working at cross-purposes with his conscious wish to be helped. The two most common explanations for what these unconscious wishes and fears might be are: 1. the fear of recovering unacceptable repressed memories, feelings, impulses (1), or internal objects (2), and 2. the wish to avoid change in order that everything remain predictably the same (3, p. 4). This paper proposes a third explanation which builds on and extends both of the first two.

GROWTH AND CARE

Emotional growth consists largely of movement from childhood dependence on caregivers to taking on responsibility for oneself. This process of growth varies from individual to individual; in some people it is very limited. Psychologically, separation from caregiver(s) starts at the moment of birth, perhaps earlier, and continues, mostly in spurts, throughout life, with a major spurt during adolescence and young adulthood. But even under the most propitious of circumstances, the child has lingering doubts about the merits of moving from childhood into adulthood. This is because taking care of oneself can be so burdensome, and being taken care of can be so pleasurable. Yet for many, the care and protection they received as children have, in actuality, been fraught with serious lapses, both intentional and unintentional. The recipients of poor, inconsistent, distorted, abusive, or incomplete care become adults, who are left with unconscious wishes to find proper care (in accordance with whatever their fantasy of care happens to be). These wishes are expressed in the repetition compulsion (3, pp. 22, 23) as reenactments of childhood primary relationships in current interpersonal contexts. Most often these reenactments take place in those relationships that most closely resemble the individual's early family situation, Marriage is a likely venue for these reenactments. Any "helping" relationship is fertile ground. Of particular interest to the readers of this journal is the relationship between psychotherapist and patient.

THERAPY AS A MICROCOSM OF FAMILY LIFE

The psychotherapeutic situation resembles that of the nuclear family. Patients find themselves locked in a struggle with internal representations of their parents and, transferentially, with their therapists. They feel caught between two contradictory wishes: 1. the wish to do the work of therapy and thereby increase their autonomy by becoming more responsible for themselves, and 2. the wish to remain a child and thereby attain the cared-for state about which they fantasize and for which they yearn.

After several years of therapy, this was clearly expressed by one of my patients. Mr. A., a practicing attorney. Mr. A. described how in his fantasy he sees himself lying in bed, being fed intravenously, surrounded by family who are all looking intently at him.

Another patient's statement illustrates how she played out both sides of her ambivalence about responsibility in one therapy session:

Ms. …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

"Generative Caring" Psychotherapy for Patients Who Are Reluctant to Talk
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.