PubMed · 4407634
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S Lesse. 1974. Depression masked by acting-out behavior patterns.. https://doi.org/10.1176/appi.psychotherapy.1974.28.3.352
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We hypothesized that anger repressors would show discrepancies between self-reported anger and cardiovascular and behavioral responses only during harassment. Subjects (N=102) were assigned randomly to condition. In the nonharassment condition, subjects told stories about eight Thematic Apperception Test cards without any harassment. In the harassment condition, subjects told four stories without harassment, and then told four more stories with harassment. Words connoting aggressive behavior and angry/hostile affect were coded from story content. Subjects were classified into low anger expressor, anger repressor, high anger expressor, and defensive anger expressor categories based on median splits of the Anger-Out Subscale and Marlowe-Crowne Social Desirability Scale. Results showed that harassed anger repressors reported anger comparable to that of low anger expressors but less than high expressors, whereas their heart rate (HR) reactivity was comparable to high expressors, but greater than low anger expressors. Increases in anger words did not distinguish repressors from other groups. Repressed anger may represent a distinct anger management style characterized by a discrepancy between acknowledged anger and cardiovascular reactivity--effects that become fully manifest only during interpersonal provocation.
This paper describes the interactions of a patient and her therapist in the course of psychoanalytic psychotherapy, during which there occurred two significant impasse enactments. At first sight, each resembled a classical impasse. On further review of the case, the interactions took on a different texture that we have described as a pseudo-impasse in the course of the therapy. The enactments took the form of an abrupt cessation of the therapy in which the patient terminated and then later returned, thereby giving a more intense rhythm to the therapy. The patient, described as a sexually inhibited novelist with symptoms of panic and anxiety, said at the outset that she was never able to express strong feelings for fear of criticism. Central issues included a number of conflicts: the manner of referral in which her friend (who was also a friend of the therapist) was instrumental; the grief for her dead mother and her lost sister; and overt conflict with her critical father. These conflicts became re-enacted within the interactions between herself and her therapist. The stages of therapy could best be described as at first wishing her therapist to be her "sin eater," and, subsequently, her idealized, loving, nonjudgemental parent. We understand the pseudo-impasses to represent psychotherapeutically framed developmental steps.
The pressure toward enactment is investigated in terms of the threats that primitive, pre-thinking states of mind exert on attempts to know and understand. Clinical material and a review of the literature suggest that when the analyst confronts (by thinking) rather than complies (by action) with the hidden demands of omnipotence, he or she triggers and is then subject to the pre-thinking mental realm of concrete sensory bombardment, which can penetrate and obliterate his or her separately thinking mind. One important pressure driving the analyst toward enactment derives from a defensive response aimed at avoiding the threat of such concrete projections.