A Loneliness that Entangles

A couple of years ago I treated Nick, a young man of twenty years old. I think his is an interesting case because it shows very clearly that the key in the early stages of treatment is not to diagnose a specific pathology —such as depression— but to allow the subjective positions to appear and to listen to the patient, to make room for their sorrows and their fears.

This difficulty in distinguishing between normal struggles in life and the beginning of something more serious appeared in the first thing Nick told me: “Look, it’s not easy to explain, it’s nothing concrete, but it’s sad… it’s sad what’s happening to me, it’s kind of stupid and childish. I came because I feel alone… for a long time now. It’s not that I don’t have friends, though I don’t have many, but it doesn’t have to do with that. It doesn’t matter if I am with a lot of people or not… I feel alone either way, like it’s something coming from within.”

Hearing what he said as I established my first idea of what he was dealing with, I noted that what was happening to him was not new, that it had been happening “for a long time.” When I asked him about his loneliness, however, he replied explaining it didn’t feel the same way as before: “I know that in fact we’re all alone, in an existentialist sense I have always known that, but it feels different now… as if the loneliness has become sticky, gooey… it’s harder to endure, but at the same time, it’s becoming more and more comfortable not interacting with people.”

While he had felt some of this “for a long time now”, it also clearly appeared that there had been a change: his usual loneliness had turned into something else, something difficult to endure. I asked him to explain what he meant by sticky. Why? Because in contrast to the daily loneliness he referred to at the beginning of the session, which seemed like a personal preference from his existentialist comment, when he talked about loneliness becoming thick or gooey, his worry appeared.

“Yeah, sticky… like it catches me and I get stuck in that. When I feel alone, each time I feel more alone… I study marketing, where we have to do group assignments, and that is getting harder, it’s hard to tolerate people… it’s not that they bother me, it is that they bore me… I don’t know if I am making myself clear.”

The tension between two subjective positions appeared there once again. First, he talked about this new feeling related to loneliness as something that catches him, and then he downplayed it saying it was simply about boredom.

Without a doubt, this fluctuation between those two positions was partially explained because of his fear of what was going on with him. Many times at the early stages of depression the person feels something akin to what Nick was describing, that is, we feel something strange, as if the depression has a strength of its own that takes us, even overwhelms us. It is crucial that as psychotherapists we do not attempt to downplay what is going on with the patient, reinforcing for example in this case the position that there is nothing else but his natural tendency to be alone.

 

On the contrary, it was key to emphasize that he was talking about something different from what was happening to him before, that is, there was something going on beyond his natural tendency. The intervention I therefore chose was direct: “It seems it’s not just your natural tendency, but something else. When did you start feeling like this?”

After we had explored this new sensation more extensively, I shifted subjects to get to know more about Nick’s individual context. I wanted to find out what could have caused this worsening in his feeling of loneliness. When he spoke about his family some issues appeared that were going to be important for the following sessions:

“Before sitting at the table you have to know that you will hear a series of complaints and problems… we never talk about anything positive. I’m not an optimist, but if we’re going to talk about problems, let’s talk about the big ones, real ones. I’m not going to sit and tell my mom ‘I feel alone’, because I would feel like a crybaby, and there is nothing she can do about it, so I would only bother her.”

There we found two possible approaches to the case, that is, to focus the session on his feelings of loneliness, or to explore in more detail his family situation. I chose the latter, mostly because I thought it would raise less resistance in a first session, but I was also attempting to discover what could have produced the change in Nick.

When I asked him more about his mother, he replied: “She can’t handle anything else because she always has problems. If she knew that I felt alone, she would get upset, because she is always telling me to do more things that people of my age do, that I should go out more, that I should meet some ‘girls’. Maybe she realizes I am lonely, more alone than I would like, and she is pressuring me to be different. She always has people invited for tea and things like that, my sister is the same… I am the loner of the family.”

There are at least two aspects to what he said that could be important for this case. First, the mother was always having problems. It would be interesting to know what kind of troubles Nick was talking about, to see if they were affecting him too. At the same time, he was putting himself in opposition to his family in the core subject of loneliness, stating that while his family is sociable, he is “the loner.” Because it was the first session and the time was almost up, I preferred to start inquiring about the first topic, because I thought it would raise less resistance in him. Besides that, if there was a serious family issue, it would also be important to know that as soon as possible.

It was, however, quickly made clear by Nick that the problems that troubled his mother were not connected to his loneliness, nor did they sound serious, at least according to his view. “She even gets stressed about what to wear the next day,” he told me.

Once the first session was over, it was clear to me that the core issue in this case was this new feeling of loneliness, and that it was going to be important in the following sessions to give him room to talk about that “sticky” loneliness, as well as opening for discussion the topic of the difference he felt between himself and his family.

In the second session I asked him about his statement of being “the loner” in opposition to the sociability of the rest of the members of his family. Nick got emotional and explained that his mother “doesn’t accept that I am just different… my parents work in marketing too, and they are always telling me about how they were the life of the party, that they always had people around them, doing stuff, that they find that healthy… so indirectly they are telling me I am sick.”

That appeared to be a key issue for Nick. He was not only different from his family, but he believed his natural tendency was seen as unhealthy by his parents. If we added to that his growing feeling of loneliness, we could understand his reluctance to accept that something was getting worse.

We kept talking about his family, particularly the differences between him and the other members. At the end of the session, he told me that his father had a similar opinion about him as his mother: “My dad usually tells me ‘you are not going to tell me that you prefer to watch a movie in your room than go out to a party, that is not normal.’ I just keep my mouth shut because I don’t have any interest in arguing with him, and at the end I do what I want either way. That’s one of the things that bothers me about people, that they feel they have the right to question me. Why do they have to care about how I live my life? I feel ok being how I am… if I come here it’s not to change that, but to avoid how the loneliness grabs me tight and I end up isolated from everyone… that is the only thing I am afraid of.”

After naming the fear, without giving me a chance to intervene, his subjective position oscillated again, “I wouldn’t like that because of a natural tendency of mine I ended up too far away from everyone… it’s a battle against the comfortableness of my loneliness.” As you can see, in that session the two positions kept alternating, creating that tension I already noted between differing perceptions on what was happening: considering his attitude towards his loneliness as a natural tendency or accepting that what he was feeling was not normal, that it was something different than the usual loneliness.

The key to helping Nick was clearly going to be to help him differentiate between those two positions, both valid but referring to two different things. Nick could have a natural tendency to enjoy loneliness more than his family and friends but, even if he was afraid to confront it, he had to accept that what was going on now was something beyond that. This new feeling was something moving dangerously towards the early stage of depression and, more importantly, was something that scared him.

How to intervene in a case like this? It was important to empathize with the fear he felt towards the experience he was living, but still encourage him by giving him space and time to explore it.

In the third session I focused on that, giving him the chance to talk about the sticky loneliness he was feeling. During that session Nick told me that he knew that “something is happening to me, and I don’t know what will happen to me,” and I could see this was a topic on which I would have to insist we maintain our focus.

His mother appeared again in his discourse, like in many sessions that would follow, mostly talking about how she keeps insisting that he needs to “have a life”. Nick also spoke about his dad saying that when he is “sad or mad, I just lock myself up in my room and that’s it. My dad knocks many times and asks what’s going on, but I know he is not going to understand. The few times I tried to explain my fears to him, he had reprimanded me for being bothered for such small things… the common phrase that ‘there are people that have it worse than you’ and things like that.”

Because every time his natural tendency to loneliness appeared this trait was rejected and misunderstood by his family, it was not surprising that he preferred not to share his new worry with his family, something he explained in his own words: “How can I tell them I am feeling worried because I prefer to be alone, without them saying I’m overreacting. If I tell them I’m worried because I like to be alone… their solution will be simply to tell me I should go out.”

I intervened there pointing to what he said, in a simple and direct way: “It’s not that preference that worries you.”

 

Nick got emotional and recognized that: “No, I am used to being alone… what worries me is what I’ve told you, that I started thinking ‘What happens if this get worse?’ and then I started feeling that it could indeed happen. If it remains at this level, okay, I’m just different from my family, different from most people my age… that doesn’t bother me, I have always been different from the rest, lonelier, I prefer to do things I can do by myself, I don’t like team sports, I don’t like to work in groups…”

Frightened about the possibility that his natural tendency to be alone might get worse, Nick again tried to seek shelter in examples about his preference, again trying to believe or make me believe that what was going on was the same as ever.

However, in psychotherapy we wouldn’t lessen the importance of what was happening. Nick had too much of that at home. I returned to the point, telling him: “It seems that what worries you is that something is changing.”

“Yes… something is changing,” he recognized, but immediately he downplayed it: “It’s a small change, maybe I am making it worse imagining what would happen if it gets worse.”

As you can imagine, I disregarded the second part, and I continued the dialogue with that part of him that was worried and anxious about what was happening to him. “What changes have you felt?”

 

“I have noticed something when I’m with my girlfriend. Now, after just a couple of hours of being together, I say to her that I’m going home, or take her home… because yeah, I like to be with her, but I also like being alone. Before I needed it less, and I was less forward with her about it, too. The current state doesn’t frighten me in itself, it’s the tendency that worries me. I get anxious thinking that I will isolate myself from everyone, that finally I will say goodbye, everyone can go to hell, and I will be alone, quietly alone.”

In that statement appeared clearly again what worried him. If what was going on was not just his tendency, if something else was going on, his fantasy was that he could end up completely isolated, something that frightened him. It was key to attend to that fear, exactly what he avoided, so we could face what scared him. To give it room to exist, and then to confront it together.

I intervened like this: “How would your life be, if this would be a tendency that in fact gets worse?” The goal was to get him to put into words that fantasy that lingered as a threat.

 

We kept working like this session after session, putting into words that sticky loneliness that frightened him. Thus, Nick started to speak more and more about the changes he felt, about why they scared him, and the causes he thought could be provoking them. Above all, he had a space to talk about his loneliness.

 

Since the treatment went on like this for a couple of months, instead of sharing every session that followed in detail, I would like to highlight two features of our work for you.

First, something he told me when the treatment was pretty advanced that showed the risk we went through in the first sessions: “I have to confess that if you would have downplayed my stuff like my family do, I think I would have killed myself… I haven’t told you but you were the third therapist I had tried to have therapy with.” As you can see, by giving room to his fears, helping him talk about them, and not downplaying them as the rest of the world had, I allowed him to confront his fears in his own words and eliminate them from his life.

The second thing is how the case ended. Nick kept his natural tendency towards solitude, preferring to watch movies rather than go out. However, he could do it with a peace of mind, without feeling that what he was doing was wrong or that he had to explain himself because he was able to free himself from that sticky loneliness he felt. How? He expressed it like this during one of the last sessions: “I think it had me trapped because I turned my back on it, but once I faced it, everything was alright.”

His statement showed that Nick stopped avoiding the possibility that what was happening to him was something other than his natural tendency. With the help of psychotherapy, he was brave enough to face the negative changes he was going through, and able to handle a situation that was overwhelming him.

Without a doubt, this case distinctly shows the fundamental difference between ignoring our subjective position and assuming it. Above all, how that produces a therapeutic effect. In the shadows of what we don't accept of ourselves —that is, the unconscious— our fears will only grow and we are not going to be able to do anything about them.

Assuming our subjective position and opening our eyes while standing in that vantage point to see what lurks in what we don't want to see will allow us to name our fears, transforming the unknown terrors into identified fears, named objects that can be acknowledged and understood.

Once they become words, part of our recognized symbolic world, these fears can be defeated by the same words that brought them into the light and make them real. This is why psychotherapy, even if it's 'just words’, can help people change.

Sometimes, that is all that is needed.

* I have modified the names, jobs, and other identifying information to maintain the confidentiality of the psychotherapeutic process.

 

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