In 1942, the psychoanalyst Helene Deutsch published a landmark paper in which she described a particular type of person who relates to the world and to other people in ways that appear normal but who, over time, comes across as inauthentic. “Every attempt to understand the way of feeling and manner of life of this type forces on the observer the inescapable impression that the individual’s whole relationship to life has something about it which is lacking in genuineness and yet outwardly runs along ‘as if’ it were complete.” Hence the term she coined to denote such people—the “As If” Personality.

When these individuals come for therapy, they often appear to engage enthusiastically in the psychotherapeutic process, though over time, no progress is made; a feeling of futility might plague the therapist. The challenge is to recognize and address a fundamental dynamic crippling the work: rather than being used to convey meaning, the words employed by the client instead conceal and ward off an internal truth felt to be intolerable. The personality enacted for the therapist’s benefit embodies a kind of performance, the simulacrum of an actual person with emotions and connections to other people, when in fact, the person feels empty inside and unable to engage authentically with anyone.

In the early years of my practice, one client (a highly intelligent and verbal young man) once asked, “If you tell me what you believe my unconscious is saying based on what you hear, how am I to know if you’re right? How do I know if some other formulation isn’t what’s actually true?” It’s ultimately up to the client to decide whether an intervention is accurate, of course, but this young man couldn’t connect my words with his inner world to assess their accuracy, largely because he relied upon language to obscure rather than to illuminate. He appeared to be a willing client, but the way he communicated instead made sure I’d never get anywhere near him.