- In active passivity vs. apparent competence, the patient fluctuates between appearing able to handle life issues and being completely incapable or unwilling to do so.
- Be alert to the risk of over- or underestimating the patient’s true capacities in order to avoid invalidation.
- Synthesizing the idea of helplessness and competence (being capable and incapable) is the task of therapy in this dilemma.
Active passivity versus apparent competence.
When the dialectical dilemma of active passivity versus apparent competence is in play, the patient and the therapist may have difficulty understanding what the patient’s true capacities are because their behavior fluctuates dramatically between seeming to have it all together and seeming to fall apart completely.
The patient may appear on the surface to be able to handle even complicated situations with ease such as successfully working as a nurse in a neonatal intensive care unit but then paradoxically melts down when deciding on simple things such as choosing a paint color.