Therapy Session with Vince(nt) van Gogh (Estrangement Technique)

Uploaded 8/18/2022, approx. 16 minute read

Yesterday's video with Van Gogh, my patient, created some confusion. I'm using a technique borrowed from Cold Therapy, a technique called estrangement, where I address my patient with the name of someone who is meaningful or significant in the patient's life, particularly someone with whom the patient has a dynamic of merger and fusion.

This is intended, first of all, to elicit an outsider's point of view, force the patient to adopt someone else's identity in a way, and on the other hand, provoke the patient, resentment and anger, because it's like negating the patient, like invalidating the patient.

This aggression reduces the patient's resistances, the patient's defenses, and allows me to access the raw material, so to speak, the direct emotions and cognitions that are involved in the internal processes, psychodynamics of the patient.

So this is a technique, actually, estrangement, but it created a lot of confusion among you, and I apologize for that.

The patient's name is, of course, Vincent Van Gogh, his brother is Theo. His brother is such an important figure in his life that sometimes he's hard-pressed to tell the difference, hence the use of estrangement.


Hi, Theo.


Van Gogh, do you hear me?

Yeah, hi. Where are you now?

In Aal?

Still in Aal? I just came back from Romania yesterday. I had about a week or ten days there, clients and so on. How are you doing? Still in the yellow house? Okay. Is Paul with you? Not with you? What happened? Oh my God. Why did you do that? The entire ear? Just the earlobe.

But why did you cut yourself? What happened?

But Paul joined you. He left Paris for the, but he left Paris and he came to be with you. I think he is your good friend. I think he's a good friend because he left his life behind and he came to join you at your request.

What do you mean abandon me? Don't just use words. Don't just use words. What do you mean specifically? What do you mean abandon me?

Neglected me?

What do you mean?

I don't think going to have drinks in the evening is abandonment.

Do you?

You do. Let me ask you this. How many hours on average each day did you spend together? Six is a lot. Six hours is a lot.

I know you could have spent three times as much with him, but you realized this need to be together 24 seven is both unhealthy and is very onerous, pushes the other party away from you.

Theo, Theo, I told you repeatedly, you have this need to merge and fuse with a meaningful other. When you merge and fuse with someone else, someone who is your friend or your intimate partner, you feel more stable. You feel more safe. You feel more regulated.

So this is merger and fusion.

You wanted to merge and fuse with Paul, but Paul wouldn't have it because he has his boundaries. He is also very independent minded.

You're right. He has problems with attachment. He has probably an insecure attachment style judging by at least judging by his public history.

I never worked with him. So maybe you were not compatible to start with.

You had, you wanted to convert the yellow house into some kind of artist's colony. And I don't think he likes to be in crowds and herds.

You know, I wouldn't be surprised if he would just pick up his things and go and live in some island somewhere for the rest of his life.

I wouldn't be surprised if you were to do this.

So I think you put too much pressure on him because he wanted him to lose his autonomy, his separateness, his independence, and become one with you. And he wouldn't have it.

But still, I think that he sacrificed quite a lot for you. I think it means he loves you, at least as a friend.

But why did you cut your ear? I don't understand. Whom did you want to punish? You felt self-loathing, having been rejected. Did you internalize Paul's view of you as unlovable? You felt unlovable.

So you cut your ear.

And then what did you do? You went out on the street. It's a cry for help. You realize this. You are crying for help. You're trying to attract attention to your condition. I think you've been crying for help all your life, actually.

No, I don't think you're a narcissist. I know, I know it's a hype word. I'm responsible for this. I've made this happen.

Yeah. But no, I don't think, I don't think it's your narcissist. I do think you are. I do think you have mental health issues. Of course you do. You've been depressed many times in your life. I think you have, if you push me to it, I think you have borderline personality disorder.

Yes. I would love it if you were to come to my seminar. It's in Touno, Severin. It's a beautiful city by the way. It's in Romania. 19th September to the 25th of September. You can paint there, sure. You can paint me. You can paint the seminar. But you may have to ask permission from people. You may have to ask permission if you want to paint them. I don't know. But you're more than welcome. Of course, it's free.

Now, can we go back to you? Can we go back to you?

You raised the issue of a seminar in order to avoid the difficult conversation.

You haveto my mind, and I haven't diagnosed you properly. I haven't, you know, we haven't even met yet. We haven't even met yet. It's important to meet here because, you know, you can see body languages.

But to my mind, you have borderline personality disorder.

Yeah, I'm perfectly willing to explain why I think so. But you know, Theo, you would need to listen. You're a poor listener. It's all monologues with you. I mean, we would need to have a dialogue here. You would need to listen to what I have to say. You don't have to agree. No, you don't have to agree. I'm not saying I'm God. You don't have to agree. I didn't say you have to agree with what I say. I said you have to listen to what I say.

No, I don't think you know best. I don't think you know best about your mental health. I don't think, frankly, that I think there are long stretches of your life where you are incapable of judging properly your mental state.

Yeah. Yeah. So, okay. Start with your grandiosity.

Grandiosity is a feature common to narcissistic personality disorder, borderline personality disorder, and so on. So, the fact that you're grandiose doesn't mean that you have narcissism, that you are narcissist. However, it does support my contention or my impromptu diagnosis that you're a borderline personality disorder.

Yes, I do.

No, I think you are grandiose. No, I don't think this is a realistic assessment of who you are.

Let me challenge you. Did you or didn't you tell me on multiple occasions that you are the greatest living artist in the world? Right. Didn't you tell me that after your death, you would be recognized as possibly the greatest artist who have ever lived? Don't you find these two statements? Don't you find these two statements counterfactual? Don't you consider your self-perception as a great artist to contrast with reality?

Reality doesn't support these contentions, doesn't support these. Reality doesn't support your self-perception as a master artist, as the greatest artist who have ever lived.

I'm sorry. How many paintings, how many paintings have you painted? A few hundred. How many of these paintings have you seen? One.

Okay. How many good reviews have you received throughout your career? Three.

Okay. Now, please try to be objective for a second. Do you think these numbers support your self-image as the greatest artist ever? No, I don't. I don't know what's going to happen after you die. And you don't know what's going to happen after you die. And frankly, your performance hitherto as an artist, as a painter, doesn't give me great hopes that you will mysteriously and suddenly be recognized as a great artist after your death.

It's a fantasy defense. Theo, it's a fantasy defense. You fantasize about being a great artist. It's your way of avoiding reality. You don't want to cope with the exigencies and demands and vicissitudes of real life. You're escaping from real life into this fantasy, into this paracosm, into this artificial virtual reality where you are the greatest artist who have ever lived.

And if this were not to happen in your lifetime, you comfort yourself that you will be recognized, that you will be accepted as a great artist after your death.

It's a little like the afterlife in religion, you know? Life on earth sucks, but the afterlife is ample compensation.

Do you truly, when you're alone with yourself in bed near the green shutters of your window in the yellow house, do you really believe in this? Is there a conviction, a self-conviction, that after your death, you'll be recognized as, after your death, you will be the greatest artist ever? That you believe that.

You firmly believe this.

Oh my, no. I don't think it's a good idea at all. I don't think it's a good idea to off yourself, to shoot yourself in the head.

You think you have to kill yourself in order to be recognized? I don't think it's a good idea.

Don't you love life? Don't you love the riot and explosion of colors? You know, yellows and blues and everything?

So, this is life. Colors are life. Light is life.

Why would you want to give this up? This is who you are, you claim to be. You claim this is who you are. So, why would you give it up? Just for recognition? That's grandiosity. The wish to kill yourself or to sacrifice yourself in order to obtain narcissistic supply. That's grandiosity.

But I don't think you are. I think you're borderline.

Look, have an objective look at your life. Let's review your life.

You've always been itinerant. You've always been unstable. You change professions. You change locations. You change lovers. You've been all over the place. You've been a salesman. You've been a religious minister. You've been, I mean, you've been in the coal mines. You've been in small towns all over France and Belgium and Netherlands and the United Kingdom. You've been painting.

Then you stop painting. Then this kind of instability, this kind of itinerancy and desultory existence, this is very typical of borderlines because borderlines don't have an identity. They have an identity disturbance.

I don't think you have an identity core. I think you know what you love. You love colors. You love light. You love painting. There's no question about this. You love people.

For example, I think you love your brother.


I called you Theo on purpose.

Yes. I know. I called you Theo on purpose because I wanted you to adopt your brother's point of view.

I wanted to contrast your point of view with his point of view. I wanted to speak in his voice, so I kept calling you Theo.

Did it work? Did you feel a bit removed, a bit detached, a bit alienated? Did you feel strange? Did you feel that you're one step removed from yourself? Calling you by your brother's name was my way of forcing you to see yourself from the outside.

So now we can talk about you. Now we can talk about you. So Vincent, you are itinerant. You're unstable.

I mentioned this. You change professions and locations and so on. This is common in borderline. We also established your grandiose and this is also common. Your self-harm. Just cut off your ear. I think your lack of, you don't take care of yourself. You don't eat well. You abuse substances. This is all a form of self-harm.

Vincent, you hate yourself. You loathe yourself. Should I call you Theo again to remind you of this?

You have violent outbursts. You don't harm others. You harm yourself. You have violent outbursts. That's true. You're aggressive. That's also very common in borderline.

When they face rejection and humiliation, they tend to transition to a psychopathic self-state and they become very violent and aggressive.

But you never hurt anyone ultimately. You hurt yourself. Even with Gauguin, even with Paul, even with Paul, you chase him with a knife.

Okay. Did you use it? Could you have used it? Were you close enough to him? You didn't. You cut yourself. Self-mutilation and self-harm is a major diagnostic criterion of borderline.

Your painting is a form of obsession. It's compulsive. You paint the way other people drink glasses of water or change socks.

How many paintings, how many a day, one painting a day, do you find reasonable?

You churn out canvases. You self-medicate with painting because it fits in with your fantasy that you're the greatest of them all.

I wanted you to see it through Theo's point of view, through his eyes. It was as if Theo was talking to you. Exactly. Yes. No, I don't think you're right. I think you took over Theo's life. It's very parasitic. You appropriated his life. You cluttered his every physical space that he has ever owned with your paintings. You take money from him on a regular basis. He finances your lifestyle. It's parasitic, and I'm not quite sure that he loves you.

You showed me some of the letters. He loves you. There's no question. Yes, but there's a difference between, yeah, but you can love someone and still resent them. I think he resents you. His wife definitely does. I think it's intrusive and invasive.

Yeah. I don't know if he shares your point of view that you're the greatest painter ever. I think he believes in you, and he believes that you may be a good painter.

But, okay, even if you're right, it's only his opinion against the opinions of hundreds of others. Art critics, other painters, no one thinks you're genius. Only you think you're a genius. Are you serious? These are prostitutes. What qualifies them to judge art?

You're having dysfunctional relationships. That's also very common in borderline personalities.

Vincent, it's very common. Vince, listen. All your relationships are with broken, damaged women. They have a big heart.

Yeah, but prostitutes are not known to be very well regulated, and you need a centered, grounded partner, not someone who would add to your anxiety and dysregulation.

It may be a good idea to check in. If you can find an institution somewhere, check yourself in for a few months, under the supervision of a doctor, under the supervision of a doctor for a few months, I think it's a great idea. And go on painting.

I'm not advising you to not paint. I'm just telling you, don't invest your painting with grandiosity, which is fantastic and drives you deeper and deeper into a delusional disorder.

Because, Vince, you're delusional. You're delusional about yourself, about your painting, about your life, about your relationship, about Theo. Precisely why I called you Theo at the beginning. I wanted to create this dissonance. Exactly. I think you're having a shared fantasy with Theo, and Theo is regulating you from the outside. He's an external regulator.

Brother lines often do this, and I think you've tried to replace Theo with Paul, with Gauguin. Yeah, Paul, and Paul simply wouldn't have it. There's no healthy person who would have it.

What you have with your brother is not a healthy relationship. He loves you in an unhealthy way.

Can you accept this? Where would you go? It's a family thing. It's a convalescence home run by a family. He's a doctor. I think it's a good idea. Yeah, I think it's a great idea. Go there, take time off, reconsider your life, your relationship with Theo, your painting, your emotional investment in your painting in a grandiose, fantastic way.

I think you need help. I think you need long term help. We can talk about the specifics, maybe dialectical behavior therapy, but right now, the first thing you need to do is let go of your life as it is. Just take a break, gain perspective, some insight, some introspection.

Okay, Vince, have you seen a doctor about your ear? You bandaged it yourself. That's even more grandiose than saying that you're a great painter. Go and see a doctor. He is a doctor.

Okay, so go and see him.

First thing, make it infected. Make it infected.

And what's with your eyesight? You said you were seeing all kinds of hellos and shadows. You need to see a doctor. You need to see a doctor about this too. You need to begin to take care of the real Vincent, the flesh and blood Vincent. The Vincent who is in reality, the Vincent who is not the greatest painter ever, but just a struggling, lovely young man.

You need to begin to have a life. Maybe find a job, maybe have a family. I don't know, a woman to love you, at least, to see you as you are. You are very lovable. Vince, you're very lovable.

What do you mean? You're very lovable. You end up with this kind of woman because you don't love yourself. You loathe yourself.

Theo loves you, so at least one person finds you lovable.

You really, really need to get rid of this bad object, this view of yourself. This view of yourself that you are lovable and bad and crazy. It's not helping you. It's not helping you. You're compensating by afterlife fantasies of being a great painter, which, honestly, I don't think would ever come to fruition.

Get rid of all this. An afterlife fantasy is religious. That's your religious strict upbringing. Your parents haven't been of help yet. They haven't been of help. They made you who you are. It's not a total loss. You're not hopeless.

Where are you getting these ideas from? Did I say any of these?

On the contrary, there is a great chance if you just let go of your delusions and start to confront life on its own terms, you can make your mark and leave a legacy in any number of other fields.

You don't have to stick to a doomed dream.

Okay, Vince, keep me posted. Let me know how you're doing, okay?

Okay, I want to read about you in the newspapers, but for the right reason. Give my regards to Theo and be well.

Okay, Vince, sure. As I said, you're more than welcome. And yes, you can paint me.

Okay, shoshanim, have fun.

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