Reaction Formation and Long Term Care

The fifth article in a series written by LTC Tree Advisor, Joe Houston, M.Ed., LPC, CRC Reaction formation is a defense against threatening thoughts and feelings.  The person handles these by first striving to repress them, pushing them down into the subconscious, effectively eliminating them from his everyday life.  When this attempt at repression doesn’t work, or his personality suggests a different method of coping, he may compulsively think and feel the opposite, usually to excess. 

Reaction formation is manifested with exaggerated, compulsive behavior, designed to keep the psychic “beasts” within locked up in their cages.  This method of denial is a common practice with people as they age when it comes to planning for needing long term care.  Even though the statistics say that if you make it to age 65 you'll have about a 48% chance of needing long term care before you die, most choose to ignore the risk because it's uncomfortable. I once had a client who was a compulsively generous man toward people he liked.  He would shower them with expensive presents, expensive dining experiences and excessive attention.  He often told other people what a very generous person he was.  But this was a cover-up for repressed ego-centricity and self-absorbed selfishness.  He had just a small circle of friends, and spent most of his time obsessively analyzing the rest of the world’s people’s many faults and deficiencies. 

Thus, I concluded that he didn’t like most people, but selected a small group of people around him to cater to, which allowed him to think, “What a good boy am I!”  I call this the Little Jack Horner syndrome. Another client was a lady who was over protective of her children.  She did all she could to keep them away from all situations that had any potential at all to cause them harm.  She reluctantly allowed them to attend school, but did not trust them to ride the school bus, for fear of an accident. Instead, she drove them to school herself.  All this possessiveness with the children was causing much difficulty in her relationship with her husband.  After extensive counseling she and I concluded that she did not want her children to grow up—she was afraid they would reject her when they became teenagers.  She had rejected her parents as a teenager, arising out of anger at the way they treated her, and he she was repeating the cycle with her own children.  She was unable initially to recognize that this inappropriate behavior with her children was a reaction to the repressed anger towards her parents, but with the counseling, she was eventually able to let go of her anger, which led to her being more trusting with her children and husband.

A typical example of reaction formation regarding the need for long term care insurance—or any other type of insurance or health care, for that matter—is illustrated when a person convinces himself that he doesn’t need it, and counters the arguments that there’s a 48% chance that he will, by convincing himself and others how vigorous and strong he is.  And he can prove this by telling all that he’s never had a major illness, exercises vigorously every other day, and can do things that most 20-year-old can’t.  And he’s telling the truth, because all who know him observe that he does all these things.  Basically, he is denying that the normal process of ageing ultimately gets to us all, and he is obsessively engaging in opposite types of behavior to the extreme. 

This behavior can have severe consequences because an average long term care stay of 3 years can cost easily $250,000 and if a person develops cognitive problem such as Alzheimer's then they could be faced with $500,000+ if care lasts beyond 5 years.