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.

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.

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.

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.

Is it useful to see more than one therapist at a time?

This is a question I’ve been asked many times, by clients who come to me and on Quora.  Here’s my answer:

I don’t recommend seeing more than one therapist at a time.  In fact I won’t see a client who has another therapist, they have to choose.

There is the obvious reason that the two therapists are different people with different ideas and may disagree or take the client in different directions, which could be confusing. But a deeper problem has to do with transference:

If the client had a parent who was abusive or just inadequate, that same parent was probably occasionally functioning well as a parent also. The child, to deal with this uncertainty about what they are going to “get” from the parent often does that the psychiatric community calls “splitting.” In the child’s mind (s)he divides the parent up  as “the good Mommy” and “ the bad Mommy” even though the parent is one person. So if the client starts having a negative transference with one therapist that one becomes the “bad Mommy” and the other the ‘good Mommy” which makes it very difficult if not impossible to help the person work through the negative transference. Working through transference problems is often the most important work of therapy.  Allowing two therapists is a  set up for “splitting,”and it is totally counterproductive to that person having a successful therapy experience. I think it is a bad idea even with clients who appear relatively well; the “walking wounded” successful adult who comes in with a minimum of problems. An exception can be that the primary therapist encourages the client to go to a specific kind of therapy for a specific amount of time for a specific reason,  and it is something that the primary therapist doesn’t offer. Examples might be joining a group or going for EMDR therapy.

There are sometimes particular reasons for a client to want two therapists. One not so good one that I have encountered is that  having 2 therapists  keeps the client from getting close to either therapist. That might not even be conscious for the client, and that avoidance of intimacy won’t be dealt with if they are allowed to have two therapists.

Transference in Therapy

What is transference and why is it important?

Transference can be an aid or a hindrance in  therapy. It can also complicate any of our relationships.

Transference is the phenomenon of transferring feelings from a significant person in your childhood to someone else. It is unconscious and it happens all the time to all of us. For example: you meet a woman and she reminds you strongly of your older sister who you were very close to. You will probably like this person and wish for a close friendship even before you know her very well.

In therapy, there can be positive transference, negative transference, or countertransference.

Countertransference occurs when the therapist is transferring feelings about their important people on to the client. It’s very human of the therapist but it is imperative that the therapist is aware of it and keeps the transferred feelings in check. Otherwise the therapist’s therapeutic judgement and reactions to the client can become clouded and compromise the quality and progress of therapy.

Positive transference is common at the beginning of therapy when the client is wishing for a “super person” who will “save them”. Someone with all the wisdom and skill needed to succeed at giving the client everything the client needs.
Positive transference is helpful to the therapist as the client is open to what they say and compliant to requests. When asked people in positive transference will often enthusiastically characterize their therapist as “Wonderful!”

Negative transference occurs when the client transfers negative beliefs and feelings from someone who was hurtful to them, onto the therapist. The client may say to the therapist: “you are out to get me and make me feel wrong all the time, just like my father,” or “you are judging me just like my mother did” or “you’re angry but you cover it up.”

Great work can come from “working through” negative transference. A profound change can occur when a client sees the therapist as they are and then realizes how much negative transference influences the way they relate to other people in their lives. It’s eye opening! Some “people their world” with their hurtful parents and find it such a relief to stop.

Too much positive transference can be a problem because the therapist is bound to “fall from grace” at some point. Often when a client’s “wonderful therapist” disappoints them the transference turns negative.

Bringing this phenomena of transferring feelings and beliefs to conscious awareness gives the client access to reality.  Then they can see the actual positive and negative attributes of the person who has been the target of their transference. It often has the effect of moving the person forward in personal growth and maturation.