“Who am I?” Erica asked, sounding weary. “When will I ever feel good about myself. Why does it seem so easy for everyone else?”
Erica had been coming to therapy for about a year, reporting depressed mood, anxiety and relationship difficulties. In our early sessions, her narrative remained superficial. She talked about the tribulations of her daily life. But even when describing stressful situations, her telling lacked any emotional depth.
We’ve all been met with resistance. We all know that we must honor the patient’s need to remain safely where they are—that we must build ego strength and create curiosity. So, this was how we worked in the beginning. I listened. She talked. And we didn’t go too deep. But eventually, I realized that her need to remain on the surface and the lack of emotional vitality went deeper than anxiety about what she’d uncover.
Erica was alienated from her real self as a result of the cultural climate. As clinicians, we know we must remain vigilant of the impact of the social environment. Symptoms of individual psychology don’t happen in a vacuum. They emerge within a context.
Today’s societal atmosphere is filled with filtered photos and personal branding, where everyone is trying to be seen, where significance is slowly being equated with the amount of “likes” and the reaches of social media posts, where there’s a decline in meaningful interactions, where people are increasingly vulnerable to becoming someone they are not in order to receive validation. Pride and self-worth are slowly dissolving. What’s missing is being searched for in the very place it got lost. That is, validation is being sought from the outside, from “likes” on social media posts, something to give a brief dose of emotional validation. But that sense of validation doesn’t last.
Karen Horney talked about the tyranny of the shoulds. For her, these were unrealistic demands placed – I should be this, I should do that – on our self to become what she called the idealized self, an image of perfection that could never be attained, a paragon that squelched the ability for the real self, the spontaneous self, the vital self, to pursue natural personal growth.
The idealized self disables the real self and stops it from flourishing. It also blocks the individual’s ability to realize and use what Karen Horney called constructive forces, (our unique strengths and endowments) to go towards what would offer a sense of meaning and pride, a sense of aliveness.
In a world filled with personal branding and contrived social profiles, in a world where how we look can be altered—people are shrinking their bodies, contouring curves, brushing out normal expression lines on their faces. We’re slowly losing the ability to know who anyone really is. How are we as clinicians to help our patients, particularly our younger ones, to remain connected to their real selves? Karen Horney’s theories, I believe, give us a window of hope.
Patients most likely won’t come into the office saying, “I’ve completely lost who I am in order to be who I thought I should be. I’ve become who I present to the world. I’ve been faking it for so long, I don’t know what’s real anymore.”
Like Erica, many times the symptoms are much more general, but there will be indications in the narrative that there’s an absence of true connection and vitality, of integrated personal significance.
Real pride will be lost and instead we may hear of many frustrated and unrealistic aspirations. Sometimes we may hear inflated ideas about the self that are vacant of any real accomplishment or emotional connection. We can’t take pride in something we aren’t. And authentic pride is revealed not through self-aggrandizement, but through reverence and humility, by remaining awed by life and by others, and by having the emotional strength to doubt oneself.
The real self is the thriving self, the spontaneous self, the part that exists within all of us that’s real. This is where true self-worth, efficacy, a sense of competency, pride, and meaning come from.
Sometimes we have to help patients “unbecome” who they’ve been conditioned to believe they needed to be. One of Horney’s main ideas about therapy was to unblock the constructive forces. She believed that psychological distress occurred when our natural strengths became blocked, rendering us unable to use them.
So, this is where I began with Erica. I looked for her innate strengths and dynamic forces and then worked with her to uncover them and nurture them. It took a while, but I was able to help Erica recognize her strengths.
We can’t coddle patients by saying nice things to make them feel better, either. If we want them to find what’s real inside, then we need to listen closely and help them discover it. What makes this person unique? What are their personal endowments? Who is buried, alive, deep inside?
Erica was artistic. She played piano, sang, wrote music and painted. She also was very good with numbers. She did all of her own accounting and even did some for her friends. Piecing together meticulous details was something she was not only good at, but also enjoyed. She loved organizing. She hadn’t even considered these as endowments.
She also was quite athletic but felt that she was not as toned as many other women, especially the ones she looked at on the internet. We talked a lot about the psychological aspects of exercise and feeling strong and healthy and finding a true sense of pride in completing difficult workouts.
We spent months discussing her feelings about her strengths, about who she was underneath all of the “shoulds.” It became clear that she didn’t recognize her endowments, because she kept aspiring to reach an idealized self, an unattainable image that matched the imagined lives of people she saw on social media.
But as we continued to explore avenues for her to feel her talents and endowments, where she could gain true confidence, she showed more spontaneity in her choices. She decided to go back for a graduate degree in public health. She wanted to do research, a pursuit where she could combine her creativity with her love of meticulous details. She wanted to contribute to the world.
This process was two steps forward one step back. It’s challenging to help patients maintain strengths while still immersed in and affected by the world. But with every step forward, she was one more inch toward who she was and one more step away from who she thought she “should” be.
Perhaps, it’s time for all of us to revisit the brilliant contributions of Karen Horney. For those not familiar with her work, I highly recommend Neurosis and Human Growth where you will find the aforementioned ideas elaborated.
*Erica’s information was changed to protect her anonymity.
File under: The Art of Psychotherapy, Musings and Reflections
Erica had been coming to therapy for about a year, reporting depressed mood, anxiety and relationship difficulties. In our early sessions, her narrative remained superficial. She talked about the tribulations of her daily life. But even when describing stressful situations, her telling lacked any emotional depth.
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We’ve all been met with resistance. We all know that we must honor the patient’s need to remain safely where they are—that we must build ego strength and create curiosity. So, this was how we worked in the beginning. I listened. She talked. And we didn’t go too deep. But eventually, I realized that her need to remain on the surface and the lack of emotional vitality went deeper than anxiety about what she’d uncover.
Erica was alienated from her real self as a result of the cultural climate. As clinicians, we know we must remain vigilant of the impact of the social environment. Symptoms of individual psychology don’t happen in a vacuum. They emerge within a context.
Today’s societal atmosphere is filled with filtered photos and personal branding, where everyone is trying to be seen, where significance is slowly being equated with the amount of “likes” and the reaches of social media posts, where there’s a decline in meaningful interactions, where people are increasingly vulnerable to becoming someone they are not in order to receive validation. Pride and self-worth are slowly dissolving. What’s missing is being searched for in the very place it got lost. That is, validation is being sought from the outside, from “likes” on social media posts, something to give a brief dose of emotional validation. But that sense of validation doesn’t last.
Karen Horney talked about the tyranny of the shoulds. For her, these were unrealistic demands placed – I should be this, I should do that – on our self to become what she called the idealized self, an image of perfection that could never be attained, a paragon that squelched the ability for the real self, the spontaneous self, the vital self, to pursue natural personal growth.
The idealized self disables the real self and stops it from flourishing. It also blocks the individual’s ability to realize and use what Karen Horney called constructive forces, (our unique strengths and endowments) to go towards what would offer a sense of meaning and pride, a sense of aliveness.
In a world filled with personal branding and contrived social profiles, in a world where how we look can be altered—people are shrinking their bodies, contouring curves, brushing out normal expression lines on their faces. We’re slowly losing the ability to know who anyone really is. How are we as clinicians to help our patients, particularly our younger ones, to remain connected to their real selves? Karen Horney’s theories, I believe, give us a window of hope.
Patients most likely won’t come into the office saying, “I’ve completely lost who I am in order to be who I thought I should be. I’ve become who I present to the world. I’ve been faking it for so long, I don’t know what’s real anymore.”
Like Erica, many times the symptoms are much more general, but there will be indications in the narrative that there’s an absence of true connection and vitality, of integrated personal significance.
Real pride will be lost and instead we may hear of many frustrated and unrealistic aspirations. Sometimes we may hear inflated ideas about the self that are vacant of any real accomplishment or emotional connection. We can’t take pride in something we aren’t. And authentic pride is revealed not through self-aggrandizement, but through reverence and humility, by remaining awed by life and by others, and by having the emotional strength to doubt oneself.
The real self is the thriving self, the spontaneous self, the part that exists within all of us that’s real. This is where true self-worth, efficacy, a sense of competency, pride, and meaning come from.
Sometimes we have to help patients “unbecome” who they’ve been conditioned to believe they needed to be. One of Horney’s main ideas about therapy was to unblock the constructive forces. She believed that psychological distress occurred when our natural strengths became blocked, rendering us unable to use them.
So, this is where I began with Erica. I looked for her innate strengths and dynamic forces and then worked with her to uncover them and nurture them. It took a while, but I was able to help Erica recognize her strengths.
We can’t coddle patients by saying nice things to make them feel better, either. If we want them to find what’s real inside, then we need to listen closely and help them discover it. What makes this person unique? What are their personal endowments? Who is buried, alive, deep inside?
Erica was artistic. She played piano, sang, wrote music and painted. She also was very good with numbers. She did all of her own accounting and even did some for her friends. Piecing together meticulous details was something she was not only good at, but also enjoyed. She loved organizing. She hadn’t even considered these as endowments.
She also was quite athletic but felt that she was not as toned as many other women, especially the ones she looked at on the internet. We talked a lot about the psychological aspects of exercise and feeling strong and healthy and finding a true sense of pride in completing difficult workouts.
We spent months discussing her feelings about her strengths, about who she was underneath all of the “shoulds.” It became clear that she didn’t recognize her endowments, because she kept aspiring to reach an idealized self, an unattainable image that matched the imagined lives of people she saw on social media.
But as we continued to explore avenues for her to feel her talents and endowments, where she could gain true confidence, she showed more spontaneity in her choices. She decided to go back for a graduate degree in public health. She wanted to do research, a pursuit where she could combine her creativity with her love of meticulous details. She wanted to contribute to the world.
This process was two steps forward one step back. It’s challenging to help patients maintain strengths while still immersed in and affected by the world. But with every step forward, she was one more inch toward who she was and one more step away from who she thought she “should” be.
Perhaps, it’s time for all of us to revisit the brilliant contributions of Karen Horney. For those not familiar with her work, I highly recommend Neurosis and Human Growth where you will find the aforementioned ideas elaborated.
*Erica’s information was changed to protect her anonymity.
File under: The Art of Psychotherapy, Musings and Reflections