How Therapy Trumps Politics

In a paper with the curious title, “Mr. Trump: How I learned to stop worrying and love the patient-aggressor,”1 Sidney Coren, relates his psychoanalytically informed treatment of a middle-aged white patient with a history of sexual abuse. Complicating the treatment is that the patient happens to hold political views opposite to that of the therapist.

Where does Coren himself stand politically? Well, this is how he begins the article:

I woke up on the morning of November 10, 2016, in a piercing state of sadness and despair. We the American people had elected a businessman who used angry, bigoted rhetoric to heighten divisions amongst Americans into our highest political office. This is real. Donald Trump is our President. This is real.

His patient, on the other hand, happens to be unreservedly pro-Trump.

As a therapist, Coren initially finds it difficult to see past the patient’s (and his own) politics. Shortly after Trump won the US elections, for instance, the patient “struts” into Coren’s office, saying “I can’t believe it happened. The American people finally woke up. I’m elated.”

The author’s reaction to the patient’s announcement is “visceral, angry, and aggressive.” Why? Because Coren feels that within the patient’s “genuine ‘elation’ there is also a hostile, self-satisfied” message that Coren’s “side” has lost.

The author is also bothered by the fact that the patient “identifies with and idealizes aspects of Trump’s character, most notably his grandiosity, narcissism, and ‘truth-telling.’” What other aspects of Trump the patient might identify with, Coren ponders anxiously.

The author notes that his therapeutic relationship with the patient is shaped by “sadomasochistic dynamics,” with struggles for control and power.

At one point Coren even refers to his patient as “my Trump” because the patient projects negative aspects of himself onto the therapist, just as Trump displaces his aggression onto, say, minorities—and sees them as hostile and dangerous. That is, Coren views his patient’s political identification as a kind of projective identification.

In projective identification, a blurring of boundaries occurs: One disowns intolerable internal parts of…

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