How Psychotherapy Works (continued…)

Turning-Passive-Into-Active Testing

Whereas transference testing places the therapist in the parental or authority role, turning-passive-into-active testing places the therapist in the patient’s childhood role. The patient then takes on the role of the parent. Once again, the patient does not actually believe she is the parent nor is she consciously attempting behave like the parent. Instead the patient is simply behaving in ways that she has seen other important figures from her life behave. It is simple learning and it is carried out automatically and unconsciously.

When a patient turns-passive-into-active, the patient is giving the therapist a taste of what it was like to be the patient as a child, and is testing to see if the therapist will be able to tolerate this in a healthy and assertive way. In the previous example of the woman with the narcissistic and controlling father, turning-passive-into-active testing would involve the patient attempting to exert control over the therapist in some way. For example, if the therapist disagrees with something this patient has said, the patient may respond by feeling very wounded and hurt. This might prompt the therapist to feel guilty and to want to agree with the patient in an attempt to make the patient feel better. However, to do so would be inauthentic on the part of the therapist, because the therapist is only agreeing with the patient to make the patient feel better, not because the therapist actually truly agrees. By respectfully, and yet firmly maintaining his or her own opinion, the therapist is modeling how to cope with and how to handle the narcissistic and controlling behavior experienced by this patient during her own childhood. This interaction conveys to the patient that it is acceptable to have one’s own views and that the it is not one person’s responsibility to agree with another just to make him feel better. Another way to put this is that the therapists respectful assertive behavior models a new way or responding for the patient. This “passed test” is a small step towards ultimately disconfirming the patient’s pathogenic belief that she must adjust herself, her views and her opinions in order to avoid harming others or provoking their anger.

Regardless of whether the test is a transference or a turning-passive-into-active test, when a therapist passes a patient’s test, the patient experiences an increase in psychological safety. This is because the patient has been reassured that 1) the therapist will not treat the patient as the patient has been previously treated, and 2) the therapist knows how to handle and respond to the ways in which the patient has been previously treated. It is not enough to simply tell or explain this to the patient; it is a process that must be experienced and re-experienced again and again. The psychological safety of continuously being in the presence of somebody who will not hurt them and who also knows how to protect them, allows patients to explore, discuss, and face ideas and topics that may have previously been too painful, confusing, or frightening to address. The result is that patients begin to gain a greater sense of control and mastery in their lives allowing them to pursue previously elusive goals and dreams.

Conclusion

The above description addresses the process of psychotherapy in general. I have not addressed specific issues of concern (substance abuse, anger management, depression, sexual abuse, etc) The reader can find more specific discussion of such issues in the Specialties section of this website.

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