In Psychotherapy: What is the Therapist’s Role?

I heard this story first in Gestalt Therapy Training, some 30 years ago: Snakes live in the forest. Their daily travels take them over rough stones, branches, and uneven ground. Every Spring the snake sheds her skin. The outer, older skin loosens and gets tugged at as the snake makes her way around her world. But the outer skin never leaves until the new, baby, inner skin gets tough enough to handle all the rough stuff the snake will be going over.

It’s never the therapist’s job to rip the skin off a snake.

Your therapist sees your vulnerability/your baby skin, that you probably don’t show in normal situations. I feel this is a privileged position and one that absolutely requires respect and compassion if I am to be of use.

Couple Counseling: What is the Most Common Problem?

Couples Therapy

The problems couples face are often caused by what is actually normal growth in their relationship. Couples grow through stages in a relationship, and when it happens that each partner is at a different stage, the result is often pain and confusion.  It is at these times that couples most often come to therapy, and it is often the biggest problem for couples. Couples therapy can help by guiding both partners to an understanding of what is going on between them and helping them both grow together.


I am certified by the Couples Institute in California in couples therapy. I use the Developmental Model of Couples Therapy to help many of my clients. This is an approach to relationship counseling and therapy developed in the 1980s by Ellyn Bader and Peter Pearson, of the Couples Institute in California.

This approach focuses on the development and growth of each partner individually in addition to the development and growth of the relationship. It identifies a number of stages in the evolution of every couple’s relationship. The first two stages of couple growth are Symbiosis and Differentiation.

Symbiosis – The Initial Stage

All couples start out here – feeling romantic, delighting in their newfound similarities, wanting to spend all their time together. This brings about important bonding, your becoming a couple.

Differentiation – The Second Stage

As time goes on, usually within the first two years, Differentiation begins: one person, or both, need to identify themselves as who they are as an individual person. Now is when you recognize that you have differences in feelings and thoughts than your partner, that you don’t always agree.  You may want to go out and explore their world, have time with old friends or start a new hobby.

When Stages Happen at Different Times

If this isn’t happening at the same for both people, the one not moving into this second stage often feels hurt or abandoned. “Why am I not enough for you anymore? Why can’t we be together all the time like we were when we were so happy?”  The resulting confusion, unhappiness, and stress is the most common time for couples to seek couple counseling.

A Real Problem Caused by Normal Growth

There’s that common problem I was talking about: the normal growth of one person moving to the second stage of the relationship while the other is still in the first stage. The person feeling left and hurt is in the first stage, Symbiosis, and the other has moved into the second stage, Differentiation. It would be so much easier if both people moved from the first stage to the next, but it often doesn’t always happen that way. So they show up in a therapist office, wondering what went “wrong.” Actually, nothing went wrong, they are growing as a couple, but unevenly.

Understanding What is Happening

Learning about these normal stages of growth helps enormously in understanding and normalizing what is happening for both people, and these are taught without judging either person.  There are lots of reasons why people go through these stages at different times, and that can be understood by looking at their relationships with their important childhood caregivers, usually their parents. For our purposes here, suffice it to say it is normal, but when one person is at one stage and the other moving into another, it’s a stressful time for the couple. There are more stages to normal couple growth which I can explain elsewhere.

Learning the Skills

In couple therapy, you both can learn the skills of the second stage: Differentiation.  These skills include you each acknowledging and stating your own feelings, needs, thoughts, and preferences even when they are not the same as your partner’s.  You learn you can maintain your own perspective and not attempt to change your partner’s to match your own. You can agree that as a couple you really are two different people. Being heard and being understood as a separate but still loved and accepted person is a wonderful experience, different than the first stage, but equally bonding.  It brings you two together in a new way, with new respect and clarity of who your partner really is and being seen as you really are. It can be exciting and enhance intimacy.

Of course, there can be conflict, and learning how to deal with conflict rather than being afraid to face it is another skill of living in an honest and vibrant relationship.

What does the therapist do in couple therapy?

  • Provide a safe environment where both people are able to speak  and be heard, and  where both sides come to  be understood and validated
  • Show how your backgrounds  (yes, your baggage) are being triggered and affecting the present, and what to do about it.
  • Help each person explore their feelings and thoughts without being blocked by taking their partners’ opinions. Learn to do this at home without the therapist being present.
  • Get clarity about what is going on so the couple can understand themselves and progress.
  • Discover patterns that are destructive or at least not productive.
  • Provide ideas about what to focus on between sessions.
  • Specific advice and guidance for your particular relationship

Would a Therapist Ever Give Up on a Client?

That’s a very important question – in that it could be devastating to a client to be “fired” by his/her therapist. It’s tantamount to having your parent dis-own you, because of the transference.

After close to 40 years of doing therapy in private practice I think I have told a client I couldn’t keep working with them 3 times: once, the client was refusing to engage with therapy and only wanted to “use me “ much the way he used prostitutes – to feel better emotionally – and refused to have even have an area he wanted to improve himself about and ‘work on’. Another time it was very similar with a woman, and a third time I was seeing a man for the first time and intuitively felt in danger being alone with him in my office. I later heard he had attacked a female nurse in a hospital situation. In the first two examples I considered what I was doing to be therapeutic – in that the impact of having me refuse to continue seeing these people was my *final* BIG statement to them about the importance of dealing with their behavior.

All of which is to say – if you take someone on as a patient and you are not legitimately over your head with them – you have a moral obligation to them to work with them. It’s really OK to admit to a client that you don’t know how to help them and refer them to someone you think can help them. So yes, I think some therapists probably do give up on clients. Hopefully not often. It’s important for therapists to learn how to “size up” clients who show up at their door and decide if they want to work with this person or not.

Relationship Therapy

In the middle of war, people are still very preoccupied with the state of their love relationship. Love is so important, and it is so easy to mess it up.  Many people find maintaining a good relationship to be one of the hardest jobs there is. However –

There are skills you can learn to help you communicate honestly and productively with your partner; there are things to learn that better the satisfaction in your sex life. Good relationships make each person a better, happier and more successful version of themselves.  The opposite is also true, an unhappy relationship can and does hold you back.

I encourage you to try relationship therapy. Surprisingly, it pushes each person in the relationship to grow, to mature basically, sometimes even more than individual therapy does. I am particularly skilled and catching the small things that people do that affect each other – both positively and negatively. Recapture what it was that brought you together in the first place, and activate those feelings at the stage of development your relationship is at now.

How Can I Overcome My Fear of Being Vulnerable in Therapy/

You are absolutely right, you are vulnerable in therapy. Even when your therapist works to gain your trust, as she / he should, you can only know then that the therapist will do all they can to protect you from unnecessary hurt, and help you recover when you are hurting. You can get hurt during therapy in many ways, not only by mistakes the therapist could make with you, but by remembering things you forgot or never knew, or learning to see things that happened to you in a new light that is hurtful to you to realize. You may learn and grow from these new insights and understandings but initially they may hurt. So even the best therapist taking the best care of you can not shield you entirely from being vulnerable and experiencing hurt.

Maybe the only real answer to your question is to encourage you to be brave and deal with your vulnerability head on. Definitely don’t work with a therapist unless you can trust them to be both competent and caring. Know that things that are difficult and painful initially may be the very things that set you free from old alliances that aren’t worth keeping so steadfastly. Know that learning the deeper truths of your life will make it better, and that coming upon wounds that need healing is worth the work and the time. Pick your guide carefully and then take yourself, fears and all, into the fray. How wise of you to realize your vulnerability! Keep that wisdom with you and watch for all the other things you will learn as your wisdom grows. My best to you.

How is it for the therapist to have a client try to tell you about their attachment to you?

It feels touching,  just as seeing anyone say I matter to them would feel touching to me. Knowing that it is part of the ‘set up’ as a therapist, i.e. that if I do my job well my clients may well become ‘attached’ or have positive transference, doesn’t make it any less real a feeling to the client and thus to me when expressed. I would probably assure them that they are important to me too, but in a different way. I often say “ I am invested in you” – which means I am invested in their being OK in their lives and doing well, which is true. That seems to make things feel a bit more congruent, although they are not even at all. That’s why the therapist never takes advantage of the clients feelings towards them.

Re-parenting in Psychotherapy

I think therapists are re-parenting all the time they are in session with a client, and being keenly aware of that is part of using transference. Recognizing that transference is going on all the time in therapy allows the better therapists to be most effective. This is what is meant by “ It’s the relationship that heals,” not the particular therapeutic approach utilized.

It’s the therapists respect, interest, affection, effort put out to help; all of this and more is apparent to the client consciously or unconsciously. And all of this is saying “you are worthy, you are of great value as a person.” Your thoughts are interesting, your feelings matter, etc. etc. These messages are the ones the person should have gotten as a child are now being expressed by the therapist, overtly and not so overtly, verbally and non-verbally. That’s re- parenting. Knowing how to do this genuinely is an important therapeutic skill.

When I am meeting a client for the first time, I look to see what I label to myself as the “beauty” of this person. If I don’t see it right away, I consciously wait, because I know I will see it soon. If I can tell I am never going to like a person, for what ever reason, I don’t work with them. It happens very rarely. I know each person deserves to have their therapist like them and find them worthy.

How Do Therapists Stay Calm When the Client is So Very Angry at Them?

I think there are a couple of reasons. One is that we (us therapists) forgive ourselves for mistakes, and two, is that often we haven’t really done anything wrong at all and the client is angry because of misplaced transference. By the first I mean having confidence in the fact that we are 99 times out of 100 doing what is useful and if we make a mistake, we are OK with ourselves for not being perfect. The second one is about when the client is perceiving us as acting badly because they are seeing us as a family member who did act badly (transference), but we ( the therapist) actually hasn’t. Clearing that all up is called “working through negative transference” and it’s a very useful part of what can happen in therapy.

To explain further: If the client is having negative transference, they are seeing the therapist as harmful, as their parent or some important childhood figure was. They are then transferring the perception that this person is also going to harm them, onto the therapist. They are almost always transferring that onto other people in their lives also. So it’s great when it happens in therapy, and they get to realize that the therapist doesn’t mean them any harm when the therapist says “X” or looks at them “Y” – just like their mother ( or father or someone from childhood did). They may be completely right that the childhood person did intend harm and created harm, but the therapist isn’t doing that now. The therapist can explain what they meant by what they said or how they looked, or whatever.

That is so helpful to clarify. It clears up a lot of bad feelings this client may have been assigning to others in their world. It’s often hugely important.

The therapist recognizes, when the client is angry at them, if they’ve actually done something wrong and the client deserves an apology – and it’s very therapeutically useful to apologize and admit you were wrong at those times. The therapist also recognizes when the client is transferring motive, or whatever, to them and it’s not accurate, and listening respectfully and then explaining what they did intend, etc. is very powerful for the client to hear, and experience.

It takes skill and an understanding of transference to do this well with clients. It’s a perfectly OK way to use the therapist. It’s their job to help you make sense of what you experience and treat you with respect the whole way though

Have Clients Ever Straight Up Lied In Session? Can You Tell ?

Yes, clients do sometimes lie in therapy, and I’ve had my share. Here are a few examples I remember:

An alcoholic says she stopped using when she hadn’t. I had no way of knowing except by hunch, and you can’t confront someone for lying because of a hunch; it could be very disrespectful if you are wrong. By the time the spouse was able to see the lies, the alcoholic client in this case left treatment with me.

An unfaithful partner tells me and his wife he has ended an affair when he hadn’t. The truth came out eventually and I was able to say how it felt to me, and how much time and effort I had wasted, because of the lies.

A Narcissistic Personality Disordered person told me how useful I was being to him so he could tell his wife he had “been to therapy” and in hopes of keeping me from confronting him. It didn’t work, because this one I could see through.

I’m not very patient with devious people who waste my time. I usually ask them to leave, or offer a “one more chance” proposition when I think fear is the dominating motivation rather than straight up manipulation to avoid growing.

Do therapists ever get annoyed at or tired of their clients?

Yes, I think so.

The job of the therapist is to use yourself as an instrument, and be aware of how you ( your instrument) reacts. If you feel angry, irritated or bored with a client, very likely other people would also. So you use the information you’ve received, by your own reaction, in some manner that would be helpful to the client. The trick here is note your feelings to yourself, think about why the client is probably acting the way he is, and not express them as they are felt, for example – not speak angrily. The therapist’s job is to find a way to explain to the the client, so he can understand, how he is creating this reaction in another person without sounding critical. Then it’s the therapist’s job to help the client understand what is going on within himself.

Similarly, if, as therapist, you are “tiring” of your client, or getting bored, it is a signal (to me anyway) that the client is not being authentic, or is not going anywhere useful, i.e. being repetitive. This too can be communicated to the client without judgement and in a clarifying way to help the client in self awareness.

This takes skill, more than simple self control, because you as therapist have to know how to reach that particular client.

What you say may be experienced by the client as a confrontation but one that includes having the therapist’s arm around you, metaphorically.