Stage Fright in Psychotherapy

I WANT TO TALK ABOUT SELF-CONSCIOUSNESS as one form of shame, a form that emerges specifically in the encounter with the other. One of the major goals of most forms of therapy is to make the patient, in one way or another, more aware of himself. Our therapeutic expectation is, that becoming conscious of something is a way towards mastery and integration. However, this is not always the case, particularly when we consider self-consciousness. Self-consciousness is a way of becoming conscious that can lead to inhibition, paralysis and even the loss of the capacity for thinking. This is a problem that may bring people into therapy, but unfortunately it is also a problem that gets very much in the way of therapy. When a patient becomes extremely inhibited or avoidant in therapy, I sometimes think of it as a kind of stage fright, in which the patient functions as though he is afraid to perform. In this metaphorical sense, the dramatic term 'stage fright' may illustrate the force with which self-consciousness can paralyze the treatment setting. An illustration from fiction may illustrate the point.

In his 1810 essay, "On the Marionette Theater, " the German Romantic writer Heinrich von Kleist (1959) relates an episode in the life of a young man in which self-consciousness is dramatized in the context of a social interaction. After going for a swim with an older friend, the young man tells his friend about an observation he had made of himself. As he was drying himself by the side of the lake he had noticed in the reflection of the water his mirror image as it seemed to resemble the well known classical sculpture of an athlete pulling a splinter from his foot. The older friend who tells this story continues:

… Indeed at this very moment I had seen the same, but either to test the certainty of the grace residing in him or to tone down somewhat his vanity, I laughed and replied that he must be seeing ghosts. He blushed and lifted his foot a second time to show me.