Psychotherapy with the boring patient.

Abstract

Boredom is an unpleasant affective state which may be evoked by monotonous sensory input and reduction of an individual's internal instinctual and fantasy activity. Certain difficult patients have the capacity to evoke boredom in their psychotherapists and unless technical modifications are used, therapy quickly reaches an impasse and may be terminated on the grounds that the patient is 'not psychologically-minded.' Chronically boring patients have an impaired capacity for symbolization and can be identified by their non-symbolic communicative style. This reflects an inner struggle with primitive mental states due to fixation at, or regression to, the paranoid-schizoid developmental position. The patient may use projective identification to discharge unbearable psychic tension into the therapist whose boredom is partly a defense against this. Alternatively, the patient may create impenetrable barriers with language by making 'attacks on linking' which are tantamount to attacks on the therapist's peace of mind. The therapist should initially interpret the form and function of the patient's communications rather than the contents. In a manner comparable to a mother's interaction with her young child, the therapist can help the patient acquire a greater capacity for symbolization, including the ability to accurately label and verbalize different affective experiences. Careful analysis of the countertransference will identify the patient's projective identifications, provide valuable information about the patient's primitive mental life, and prevent anti-therapeutic projective counter-identifications. The patient will become less boring as he learns to use symbols and as his primitive anxieties are resolved.