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.

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.

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.

How do you know when it is time to leave therapy?

When you are ready to go it on your own, and you don’t want to keep going to see your therapist. You don’t have to be ‘completely done ‘ with growing and changing, or with therapy, you will learn and grow living your life without therapy too, and it is often very useful to do therapy in “chunks.” By that I mean , do a “chunk’ of time with a therapist and then leave and live on your own,. Then, when a need arises that is obvious to you, go back and do another “ chunk.”

I often suggest a few options to people that aren’t sure they are ready to leave : they can space out a few appointments to get a feel for what that is like, they can make an appointment a month or two into the future, knowing they could always call and get back in if needed, or they can say good bye for now, and know I will be there and they can always call. Often leaving therapy feels a bit like leaving home, and it’s important to know you can always come back, stop in for a little visit ( and support) or whatever feels right to you.

Psychotherapy as a Spiritual Pursuit

I think it is everyone’s job, everyone’s spiritual job, to clean up the human mess your parents left you and not spread any more dysfunctional hurt around to any other people. So I think it is your job to do your own personal therapy so you don’t continue the mistakes your parents made with you – and I mean this not only with your own children, but first and primarily with your own children. Then with everyone you have contact with in your life.

Another way of saying the same  thing is that I think  it is everyone’s spiritual job to be the best version of themselves that they can be.  I don’t (at all ) mean doing this at every minute of every day, with a perfectionist pressure, but rather to become the best person you can be. That creates  another very competent, moral, high functioning person (in whatever way that is for you), so that you are making your personal best contribution to the world around you. You might  then be the best man in a construction crew – doing very good construction work and  being a good human being, kind, honest and decent, to those around you. Or perhaps you are a lawyer and could be unscrupulous and out to make the most money you can, or you could be  touching people’s lives, or a corporation’s life, with integrity that profits everyone involved. The world and all the people in it, need those of us who are in  the lucky enough position of having the money and time to indulge ourselves in personal growth – to do it.

I realize that doesn’t have to take the form of psychotherapy. But it is one path.