When a major crisis happens in the world at large-whether it’s a pandemic, a devastating attack or invasion, or a contentious election- it can feel, as a therapist, like steering a ship through a storm. The impact on all of us, regardless of our baseline level of functioning, can be profound. As psychotherapists, we often witness dramatic fluctuations in psychological stability, with primitive defenses reemerging and an increased risk of harm to oneself or others.
The week of the election in the United States was a profoundly charged time. While the winning side experienced intense relief and joy, the psychological stress of defeat was palpable on the losing side, filling the room with heavy, almost overwhelming energy. Navigating such emotionally intense situations can make it hard not to feel incompetent. Balancing my own reactions, creating space for my patient’s emotions, and simultaneously guiding them toward stability and self-regulation was no small therapeutic task. This challenge was further amplified by the pervasive external messaging of panic and despair, which only heightened the emotional stakes.
Jonathan Shedler, the esteemed professor, psychologist, and all around beacon of light for “good therapy” in the age of quick fixes, proved to be that light again. In the midst of the chaos, he wrote, “Ideology and psychotherapy make poor bedfellows. Ideology traffics in simple narratives with good guys and bad guys. Real psychotherapy reckons with the contradictions and messy complexity of human experience.”
This reflection helped me anchor my own thinking and steady my psychological ship. It prompted me to ask: How can I be truly useful to my patients without getting entangled in the weeds of ideology? How can I move beyond ideology to uncover the deeper currents of fear or despair driving their emotions?
In times of crisis or intense psychological stress, it is not uncommon for people to revert back to what Melanie Klein described as “the paranoid-schizoid position”. Klein associated this with early infancy, a stage of life when overwhelming feelings of threat lead to the deployment of primitive defense mechanisms. These defenses include- splitting: dividing the world into “all-good” and “all-bad” categories that simplify complex emotional experiences into manageable extremes, projective identification: projecting unwanted parts of ourselves onto others, compelling them to feel or act out those feelings and denial: an outright rejection of bad experiences or threats.
Understanding these mechanisms in ourselves can help us grasp the emotional undercurrents that surface during moments of heightened fear or despair, offering a pathway to deeper empathy, connection and healing.
While these defenses are essential for managing overwhelming feelings during infancy, as we mature, we develop more sophisticated ways of handling psychological distress, learning to tolerate greater complexity and nuance. However, in times of crisis, adults can revert to the paranoid-schizoid state of mind, with profoundly negative consequences. Relationships become distorted, reality is misperceived, and difficulties and anxieties often intensify as a result. One individual decided not to speak to certain family members again because of the way they voted. This is a tragic example of the inability to tolerate others as multifaceted individuals with both good and bad traits and in doing so lose them from your life completely.
One of the essential tasks of therapy is to guide patients towards what Klein termed the depressive position. It’s “depressive” because it requires confronting the discomforting truth that our primitive defenses are out of sync with reality. Aggression, threats and bigotry are not merely external forces but also exist within us. When we fail to recognize this and externalize these feelings instead, we alienate ourselves from our own grief and emotional depth.
Paradoxically, though it can feel “depressing” there is great relief in learning to tolerate ones own aggression and complexity. When these feelings are no longer expelled or denied but instead processed and integrated, we are better equipped to relate to others with greater compassion and realism. Recognizing the complexity in ourselves allows us to see it in others. Relationships become more tolerable and fulfilling as we forgive the faults of others, just as we begin to accept our own. It brings to mind one of my patients who remarked after the election when talking about his own uncle, “Funnily it was my uncle who took me in when I was homeless, he’s not a bad guy, we just disagree on what’s actually going on in the world.”
In therapy we move back and forth between the paranoid-schizoid and the depressive positions, always aiming to help patients shift toward the latter. This shift is a cornerstone of therapeutic work, as Jonathan Shedler aptly emphasizes. Helping someone move toward a more depressive position allows them to live a richer, more grounded emotional reality, free from the oversimplifications of primitive defenses.
Today’s rapidly changing world only heightens our vulnerability to these psychological regressions. From the disruptions of Covid-19 and lockdowns to shifting political landscapes, technological upheavals, and climate changes, we often feel collectively “lost at sea”. Such uncertainty makes us more susceptible to reverting to primitive defenses, underscoring the importance of fostering psychological resilience and emotional integration in ourselves and others.
Klein, M. (1975) Envy and Gratitude and Other Works 1946-1963. London: Hogarth Press and the Institute of Psycho-Analysis