In my last two blogs I talked about the Freudian concept of the Id, the Ego, and the Super Ego as personality constructs. The theory is that there are three component parts, each of which has a function and role to play. The ideal situation is when all three are doing a good job. I like to picture it as a three-cylinder engine. When all three cylinders are working properly, the engine just hums along perfectly. However the machine can get out of balance due to many different causes, and, according to the theory, this is when pathology occurs.
As a clinician, you may encounter a situation with a client who has become dominated by a single one of the three cylinders, their engine is running rough and seems as if it may implode. Their lives and relationships are out of balance and they are unhappy. It is also possible that they come to you because some person of authority in their lives makes them come. They may not feel like there is anything wrong but their wife, their boss, their principal etc., may say if you do not work on this then your life will be a bed of pain and loss. These clients are resistant and hard to work with because they are there under duress. Part of the challenge in working with them is to engage the Ego so that it can reality test the situation. If you can get that part of the personality co-opted to work with you, then things will go more smoothly for both you and the client.
When you have a client who is forced to come in because others are demanding that they change, it is important to help them look as objectively as possible at the available data. Why do others feel this way about them? What evidence is there to consider that can be measured in terms of cost/benefit ratio? Is it possible to evaluate the circumstances and predict alternative behaviors and their outcomes? Can the individual then make those changes in a rational, reasoned, measured way in order to reality test the situation and the changes?
While it is important to engage the rational choice making part of the Ego, it is also necessary to spend time listening to the feelings that the person has. Not in a judgmental, dismissive or condescending way, but in a validating way. Their feelings must be uncovered and validated, even if they are then asked to consider changing their behavior because of what the current situation costs. Or, as Dr. Phil used to ask his guests, “How is that working for you?” The client must realize that even if it hurts or angers them, there is still a need to objectively look at the cost of the situation and estimate and or plan for alternative strategies so that changes can be made. Ultimately, the client has the option of leaving the job or the relationship because he determines that they are toxic for him, though the cost of leaving may be high, the cost of staying and attempting to be disingenuous may be too high to bear.
When you get a client that comes in of their own volition and you spend time with them observing how they present themselves, you may determine that their system is out of balance. The constant flow and interchange between and among the three disparate parts of the system will become obvious and you will begin to make some assumptions about what is out of whack and why. Depending on your theoretical orientation and your beliefs about change in therapy, you will choose a manner of response that will encourage and invite the client to a healthier life choice pattern. As a therapist, you will need to remember two basic tenants: The client has the right to make their own choices. The client has the responsibility to do the work. Our job is to invite them to live a more ego syntonic life than they previously have.
Let’s consider the presentation styles of the three possible kinds of cylinder malfunctions. We will begin with the Id. The Id is the part of the personality that does not reality test, has no moral values and does not consider consequences. It is all about immediate gratification. The vocabulary of the Id is, “Yes! Now! I Want (or don’t want) it!” The Id never sleeps or rests and is always monitoring conditions of want and need in the organism. It will immediately suggest solutions to any perceived state of need. It seeks resolution of the imbalance immediately and continually, without regard to appropriateness or cost. When you have a client that is imbalanced in the direction of the Id, the client will present with major impulse control problems. They will have a history of anger outbursts and acting out, they will have lost jobs and relationships for “no good reason.” They will resist any effort to get them to anticipate cost and consequence, they will say they “felt” that they had to do something and that it was not their fault, others are to blame. It is common for them to say, “Something just made me do it, I don’t know why and it just happened.” When they lash out in anger at others or lose their tempers it is all about what the other people made them do because the others were unreasonable in not letting them have or do what ever they wanted at the time. It is never about “fair,” “reasonable,” “turn taking,” “social obligations” or “self control.” They do not require themselves to have self -control.
These individuals are very difficult to work with, it is like they are large children. Their Ego has not developed in its role of reality testing and problem solving. The voice of the Id is so loud that other voices cannot be heard. When you work with them, the sessions will be full of noise and pain and anger. You cannot take that personally and you cannot attack or punish the client for being an overgrown child. You must be persistent, gentle, matter of fact, well bounded and consistent. You are not the punishing parent or the critical parent. If you want to help you have to gently validate, effectively reflect, and invite them to consider another path. Lay the path out but take no ownership of it. Invite them to see it, to consider what might happen if they walked upon it, but be patient and gentle, but with good boundaries. You must not let them be inappropriate with you, damage things in your office, you or others. You must not take on their projection of the angry parent against whom they can rebel. This is a large challenge for therapists. If you work with the imbalanced Id, Good luck!
The second distorted cylinder you may encounter is the Super Ego. These individuals are highly moralized. They are extremely “shouldistic” and limited in their options of behavioral choice because so many things are “wrong” or “wicked” and not possible. They feel that the world is going to hell in a hand-basket and that by their “good living” they can model and demonstrate the true path to righteousness. I find this type of client to be the most difficult. In my experience they often turn my attempts to get them to look more objectively at their behaviors and world -views into efforts to proselytize me to their point of view and get me to see or attempt to justify the error of my ways. In these cases, therapy is often denigrated as the “devil’s work” and I am viewed as the tempter who tries to get them away from what is good and right. It is a challenge to find a way past their armor. One method for approaching this is to continue to ask them to explain to you their faith- based concepts of forgiveness. Invite them to consider that there may be more complex ways of understanding a phenomenon, that there might be a larger plan at work that they cannot see from where they stand. Invite them to focus on their own behaviors and the costs of those versus the rewards, while at the same time encouraging them to be compassionate towards the errors of others. They can still be clean and pure, but do not have to control or challenge others to follow their vision.
Many of them will resist all efforts to challenge their fanaticism. Their belief system will not allow it. This anchor of “truth” is all that holds back the abyss of fear and defeat. If you are working with a client that has the over dominant Super Ego, focus on helping them find out where it hurts and how to survive the hurts with minimum damage. How can their lives be happier or their relationships be more satisfying? Remember, you are there to help them feel better and function better, not to judge them or change them to your own point of view. Return to the safe holding environment and invite them to spend time there with you. If you work for small incremental steps of peace from that breathing room, change has an opportunity to occur.
Finally, the third distorted cylinder is the over -dominant Ego. These people are like machines, always calculating and manipulating. They play chess with all their relationships and always have multilayered strategies that leave multiple options for movement to them. They seldom get in touch with their feelings and are entirely logic and evidence driven. Pragmatism is their mantra. They constantly evaluate and cut their losses. They leave relationships behind that are full of wounded people, but they do not understand the complaints of those people. “Why can’t everyone just see that it was time to do X. Look at the data, it makes sense.”
The challenge of working with these individuals is getting them to get out of their head and into their bodies. What about the feelings? What about the feelings of others? One way to get them to look in this particular closet is to ask them to speculate and analyze about the feelings of others and to predict the outcomes of any strategies for change. While they think they are playing a higher form of chess, ask them to imagine the feelings. Ask them to pretend to feel themselves in the room with you. Point out that it is a safe place to experiment with feelings in an environment where they can walk away and deny. They can explore with no cost.
The problem for these clients is that you cannot unpeel the onion or un-break the egg. Once they begin to get in touch with their feelings their defense mechanisms are in trouble. You will need to be prepared for their anger and their flooding. You will have to help them bridge the gap of going from all machine systems to all feelings. The goal is to re-tune the engine so that all three component parts work at the same time and contribute what they are supposed to contribute so that the individual works in balance and harmony.
Remember as the therapist you have a job to do. Your job is to listen and observe so that you see accurately what is going on with the client. You make take the client into the safe holding environment and then you invite them repeatedly, gently to consider the possibilities for change. Then, you let them do the work. You help, you facilitate, observe and reflect. You do not judge, condemn, punish, or control. It is a challenging, yet rewarding process.