Therapy Can Work

Katherine Rabinowitz, LP, M.A., NCPsyA

Licensed Psychotherapist & Psychoanalyst
Union Square, Greenwich Village, New York, NY

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Therapy Can Work

Katherine Rabinowitz, LP, M.A., NCPsyA

Licensed Psychotherapist & Psychoanalyst
Union Square, Greenwich Village, New York, NY



“The easiest way to solve a problem is to deny it exists.”

~Isaac Asimov

Many (or possibly most) people think of “denial” relating to substance abuse, as in “I don’t have a drinking problem,” when it’s clear to everyone else that there is a problem. It reminds me of a t-shirt I saw once that read: I don’t have a drinking problem. I drink, I get drunk, I fall down, no problem!

While this humorous take is certainly true, it’s useful to understand the broader purpose of denial and the three variations of its basic premise. Denial is a coping mechanism.  A kind of armor, or defense we put into place to protect ourselves from the ramifications of a situation we can’t accept, or the unacceptable emotions that situation elicits. Often guilt, shame and self-loathing play a big part.

There are times when denial is helpful, and normal in its protective function. It gets us through some necessary or difficult situations that would otherwise render us unable to manage them, and helps reduce the overwhelming anxiety. An example would be some distressing news about a friend or family member. In the short term, a healthy form of denial helps us adjust to the pain and stress the situation has caused.

A personal story about a good friend who died recently of cancer metastasized throughout her body. She found a lump in her neck in November. Various diagnoses and treatments at the best cancer hospital followed, but she died at the end of April. It hit all who knew her like a ton of bricks. Rationally I know she’s gone. But some part of me still doesn’t want to believe she’s not here. There are reminders everywhere. And that’s denial. I know it and I will come to accept it.

But if denial does not diminish over time when the facts are irrefutable, it’s unhealthy. Eventually we must come to terms with the truth of the situation, and if we can’t, and don’t take appropriate action, there may be serious consequences. A good example is warning signs of your own health issue. At first we ignore our migraines, saying “it’s just stress,” they will go away and in the meantime we just have to live with them. But if they don’t abate, and we continue to play ostrich and stick our heads in the sand, insisting that “nothing’s wrong” rather than consult a physician, that’s an unhealthy form of denial.

The three forms of denial, as originally posited by Freud, are

• Simple denial – where we deny that something unpleasant is actually happening
• Minimization – where we downplay the seriousness of the situation
• Projection – where we accept the reality of it, but blame someone else for it

A common, unhealthy form of denial is when people engage in the same self-sabotaging behavior, over and over, and are then surprised that the outcome isn’t different. (In AA they call this insanity.)

If you embark on a new relationship that sooner or later fails, you might look for similar patterns in all your past relationships – the red flags you were blind to, or saw but ignored. If you continue to refuse to accept responsibility for your role, however minor, in its demise and blame your ex instead, you are in denial. A fitting quote here that has roots in similar phrasing in various books in the Bible, but can also be traced in English more directly to the 16th century:

There are none so blind as those that will not see.

There are many instances of unhealthy denial that look different, but they all play the same role of rejection of reality.

 • Living outside one’s means: overspending, then tossing aside the unpaid bills to
“deal with them later.”

• Refusing to acknowledge that the time has come to put an infirm or elderly person in an
appropriate facility better equipped to care for them.

• “Lending” money to someone who clearly has an addiction when they swear  they’ll
pay it back, and some part of you knows perfectly well they won’t – they never have
before, why would they now? You aren’t helping, you’re enabling.

• Ignoring the signs of an oncoming heart attack, an asthmatic attack, a diabetes or other
medical condition and delaying getting medical help, which could lead to more
permanent disability or even death

The situation with an alcoholic or drug abuser comes with a twist. Some of them do not deny, in fact, even willingly admit that they have an addiction, but their bodies have become so dependent on the substance that simply stopping cold turkey could send them into a deathly spiral. This calls for professional help to get them into detox and rehab (if they truly want to quit, but remember that relapse is part of recovery).

So what do we have here? Denial: a coping mechanism that can be helpful in dealing with painful emotions or difficult situations in the short term, unhelpful and surely unhealthy when it has become habitual over the long term, and ultimately does not mitigate or relieve the anxiety it initially successfully suppressed. It just doesn’t work over the long term.

So if you are the subject of denial (as opposed to an enabler of someone else’s addiction, whether to a substance or the racetrack or the mall) it’s time to take a good hard look at your choices, and take ownership of them. Do you really want to be dating someone who regularly becomes wasted every time you go out (but always has an excuse or “explanation” why it happened again)? Do you really want to get to the point of ruining your credit rating and having to declare bankruptcy? (It happens more often that you would think.) Do you really want to come home to find your loved one sprawled out on the floor when help would have been a buzzer away in a facility? And you declare these things are someone else’s fault? My guess is probably not.

Time to recognize your role in these behaviors and say yes, this is me. I’m doing this. And I’m going to make the changes I need to turn my life around. If it’s too hard to do on your own, seek professional help.

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