Individual Therapy

One to one therapy with one client and the therapist

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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.

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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.

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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.

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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.

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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

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The Therapist’s Job

I’ve been asked how much therapists really ‘get it’ about how much they effect their clients’ daily lives with what they say and do. I say it depends on the quality of the therapist. It doesn’t hurt if the therapist has been in therapy themselves and experienced the power of transference.

Good therapists know very well how significant they are to their clients, certainly want to avoid their clients’ losing them, and pay attention to what they say and do. Good therapists put themselves into a “good parent mode” when they are working, and are careful about balancing nurturing and challenging interventions that are intended to promote growth.  Even the way a phrase is delivered can make an important impression.  It’s part of the therapist’s job not to be overly tired, and certainly not irritable, from their own life.

I often feel as it I have the ‘client’s life in my hands’ knowing full well how powerful my words and actions can be for them. Doing therapy is not a casual business. That’s why therapists are tired after a day of sessions. They have been working hard, mentally and emotionally, to give each client their best.

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In Psychotherapy: How to deal with your therapist and your feelings.

I have been asked by clients what to do with their feelings of attraction to their therapist, past or present.

It’s an uncomfortable feeling usually, and often makes a client feel one down –  because an ethical therapist won’t reciprocate and the client feels alone in their attraction. The therapeutic relationship is a natural place for clients to sometimes develop romantic feelings for the therapist. After all, the client is being listened to deeply, possibly understood more fully than ever before, and hopefully truly helped.

The informed therapist doesn’t take the client’s feelings personally, and is most concerned with treating the client respectfully about their feelings, and also reassure the client that the relationship will always remain therapist/ client. It’s important for the client to know that the therapist will never take advantage of the client’s feelings and allow any other kind of relationship to develop, besides therapeutic, in session, either during therapy or afterward.

Feeling  attracted to your  therapist is often a part of positive transference.

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Your Imperfect Parents

Most people want to believe their parents are good people and were good parents to them. To keep this belief is to keep your world stable and good.    If your parents were normal people they made mistakes that have affected you. Some parents are so injured themselves that they, for the most part, weren’t good parents at all. Some parents are downright destructive and their children are lucky  ( or marvelously resilient) to come out of their childhood relatively intact. Some children don’t.

The truth  is there are no perfect parents. There really aren’t.  People not willing or able to see their parents’ limitations and mistakes lose out in understanding and forgiving themselves for their own limitations, and often feel bad about themselves.   They make excuses for their parents, seeing them so much as victims of their own situations and therefore not ultimately responsible for what they did – or didn’t do – to their own children. So the adult child inwardly makes themselves bad to protect the parent from responsibility for their own behavior. For these people the parent must remain good, or at least not as  faulted/limited  as they were. When in therapy, these adults lose out on what they might learned about who they are and why they are the way they are.  They can’t overcome the  mistakes or cruelties from their parents; you can’t fix something that didn’t happen. And you can’t find out what did happen if you aren’t willing to  be open to what you find when you look.

People who protect their parents and lose out for themselves are often relying on the parents to make them feel OK, instead of taking it on themselves to make themselves feel OK. This is a growing up process that many times people resist. Of course we all want our parents to love us, but if they screwed up and our self esteem is lower than it could / should be, it’s time to take on the work of finding out how to validate and love yourself. That’s therapy.

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Communicating with the Child Within: Part 1

One way to do inner work is to have an ongoing conversation with your child self. It’s tricky to really do it correctly, though.  You can’t decide what you want the child to say, you have to “let it happen”.  If you do, you will find remarkable insight into your own unconscious, because it is from the unconscious part of your mind that your imaginary child self will speak to you.

So how do you “let it happen”? Some people can do this easily (and some people are probably best off doing their inner work another way, because it is virtually impossible for them to allow their mind to flow as is needed here – which is fine since there are other ways to do internal work).  But when you can let it happen – it is comparable to a day dream that is progressing on it’s own, without an agenda, and can be very useful.

So here’s an example of “letting it happen”. In a fantasy, go to your childhood home and look for your young self in your old bedroom. When you open the door, look around, is there anyone there? Is it a younger you? About how old is this part of you? (Here’s where you don’t decide – you look to and see.)

One person I know looked everywhere and couldn’t find her child – the room was empty. (That was a perfect message from her inner child – she had no relationship to herself in this emotional way). Eventually the person found the child hiding under the bed – backed away and facing the wall. By the time she had eventually gently coached the child away from the wall – she had learned a great deal about how frightened she was of her abusive family, even at a very young age.

Another example is a person finding a young teenager self in the backyard by her old swing set. She tried extending to the young girl self, only to have the teenage self blow up at her, furious, “If you don’t stop pushing me and making me work all the time, I’ll go kill myself. Then you’ll be sorry! You never let me have a any fun. All you care about is money!” The adult in this situation did over work and rarely gave herself  down time, no less time for fun. The adult was running from emotional self, and her internal pain with over work and busyness. The wisdom she needed came from her teenage self.

The goal of this kind of work is to get in close touch with your feelings and if possible, re-parent yourself. I have said to men clients “You be the good father  that your inner little boy never had, and if you get into places where you don’t know what to do or say, you can always check with Grandma. (That’s me, therapist and Grandma.)

Hurtful self talk is revealed here – as the adult may not know what is nurturing and supportive, if they rarely got caring or supportive words from their real parents. “Grandma” can intervene and teach the adult how to be a good parent.   Learning how to be a good parent to yourself can lead to positive self talk. You can practice it intentionally during these sessions with your inner child self, and kinder, more useful self talk will start to happen naturally.

A very powerful conversation with one’s inner child can occur after a relationship has been formed through several sessions of work. At this point the adult can ask the child to leave the hurtful, often abusive home “and come and live with me.” It is often very touching how gratefully and enthusiastically the child responds to this offer.  Some people make elaborate rooms for the little child in their imagination,  others prefer to simply visit the child in their new, safe environment and re-parent  him or her.

Some of my clients have picked up on this approach and done a wonderful job of learning much about their family of origin and what needed to be learned and unlearned in order to have a satisfying life as an adult.