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All relationships place different demands on us. Each relationship invites us to play a particular role, a way of being that is co-created by both parties. Think, for a moment, of the different relationships you are in — i.e., spouse/partner, parent, sibling, friend, colleague, teammate — and note how each requires something different from you.
The therapist-client relationship is no different. This relationship, however, is unique in that the client (and his/her needs) are the priority. And this prioritization centers on the therapist nurturing a healing therapy space for the client.
Each client’s healing space must be created anew by the therapist so that each individual client has the room to shape the space as s/he needs.
The essence of the therapy process
The healing foundation of psychotherapy involves a conversation that requires a unique form of listening on the part of the psychologist or counselor (while one of Freud’s early patients called psychoanalysis a “talking cure,” the psychoanalyst and essayist Adam Phillips looks at the other side of the therapeutic coin and aptly calls psychotherapy a “listening cure”).
The therapy engagement that unfolds should do several things: It should deepen the connection between client and therapist so that the client feels less alone in his/her pain/suffering. It should make the client feel understood and “seen.” It should invite clients to consider other perspectives that they may not have recognized on their own. It should help clients move into emotional places that are difficult and that they might typically avoid on their own.
And these therapy conversations should unfold within each session and across sessions— in other words, there shouldn’t be any “agenda” (spoken or otherwise) on the therapist’s part that blocks the client from going where s/he needs to go or that prods or steers the client when s/he feels frozen in ambivalence. In these sometimes-pivotal moments, therapists need to offer our full presence as we allow the client the important space to find meaningful direction and to develop the capacity to find us, and find themselves again.
Clients may need to get to know and feel comfortable with the psychologist/counselor before meaningful trust is established; initially, s/he may be cautious, testing the waters, so to speak, by slowly becoming vulnerable (or by challenging what the therapist has to offer) and assessing how the therapist responds. This building-trust process varies considerably across individuals.
When therapists impede the therapy space
Therapists are human (in other words, fallible), and with this humanness comes emotional blind spots and, sometimes, therapist-related-agendas that can create hurdles to the therapeutic process.
Two ways therapists can impede the therapy process
1) Problematic emotional reactions
Countertransference is the term used to describe the therapist’s psychological-emotional vulnerabilities that may be triggered by certain issues the client is struggling with in therapy.
While there are different forms of countertransference (some which can be beneficially used to enhance healing), the focus here is on the countertransference reactions that can impede client growth.
Here’s a brief example of a therapeutically-constricting countertransference reaction:
Let’s say that a therapist has struggled at different points with not feeling in control of her life. During a therapy session with a new client, the client expresses a profound sense of feeling hopeless. He is convinced that nothing he does will make his life better.
Unaware of her emotional reaction to what the client is sharing in the moment, the therapist gives the client practical advice and suggests that they should “focus on solutions rather than sinking into despair.”
Feeling unheard and unseen, and feeling like his hopelessness is “too much” for the therapist (or he might feel like he’s “not enough” because he has the feelings of hopelessness in the first place), the client shuts down emotionally during the rest of the session and at the end of the meeting, he tells the therapist he will give serious consideration to her suggestions.
The morning of the next session the client leaves a message canceling the session and states that when his schedule slows down, he’ll give the therapist a call to reschedule. In supervision with another counselor, the therapist recognizes that her premature dispensing of advice was an attempt to undo her own discomfort in the face of the client’s despair. In essence, moving from an empathic-listening stance to an advice-giving stance was the therapist’s unconscious attempt to undo her own helplessness that was triggered by the client’s.
Countertransference reactions are often unconscious and it’s important for the therapist to reflect on his/her emotional reactions and ways-of-being with different clients. All therapists should be doing this type of ongoing self-examination.
2) Blinded by theory
Most therapists enter into therapy relationships with theory-driven agendas as well as third-party pressures to “get the job done.”
It is a therapist’s theoretical orientation (e.g., psychodynamic, attachment-relational, cognitive-behavioral, somatic-focused, mindfulness-based) that guides the listening/witnessing process, moving us to prioritize certain client-experiences while overlooking or giving less attention to other in-session phenomena.
Behind every question a therapist asks during a therapy session there are many questions that are unasked in that moment. It can be no other way. The problem isn’t that psychologists and counselors are guided by a particular theory (or set of theories). Rather, it’s how rigidly we hold onto our theories that can make us myopic.
Our clients lose out when we become zealots to a particular way of doing therapy, rather than remaining open to what the individual client in the therapy space at the moment is needing (and even that can change, with the same client, across sessions).
Flexibility, not rigidity, is key. No matter how well-acquainted a therapist may think s/he is with a particular issue, there is no one-size-fits-all approach to helping clients.
Rushing to reach therapy goals (and how this contaminates the therapy space)
Our clients come to us to feel better about themselves or to feel in greater control of their lives. Implicit in the therapy process is that positive strides will be made. This raises important questions and, depending on who is in control of the answers, the therapy space can be enhanced or diminished:
- Who determines what is beneficial for a particular client?
- Who determines the best way to get a client to a better place?
- Who determines how long this process should take?
The ideal, of course, is that client and therapist discuss these questions throughout the therapy and that the client’s voice is central in guiding the therapy’s direction.
Increasingly, however, it is the insurance companies or the agency paying the therapist who ends up determining how therapy should proceed. The mandate to pin down the number of sessions it will take to reach treatment goals isn’t the language spoken by the suffering. It’s the language of profit and the bottom-line.
Too many therapists are subtly and not-so-subtly pressuring clients to formulate their emotional struggles in ways that are cartoonishly categorical. When third-party pressures to be efficient (or when pressure to be a good therapist by dogmatically adhering to the latest research finding that demonstrates that condition “X” can be addressed in “Y” number of sessions) infiltrate the therapy space, there is little room for clients to authentically unfold in ways that allow for healing.
Clients sense this artificial pressure, even if they cannot consciously articulate what is happening. In these instances, if they are compliant, they will contort themselves in an effort to please the therapist (they will become the “good” or “obedient” client in ways that may parallel negative childhood relational patterns), or they will drop out of the therapy altogether. (And sometimes, sadly, people don’t realize it’s the individual therapist that was the problem, and not therapy in general, and therefore they don’t bother seeking another counselor.)
Therapists, while acknowledging their own humanity, should always be guided by clients’ pain, not by any external pressure or theoretical framework.
We should be continually asking ourselves, “How can I help this person create a safe space?” A space that will allow the client to find a way out of the pain that brought him/her to therapy. A space that the therapist will continually work not to impede but to nourish on the behalf of the client.
These (and similar) considerations can help therapists remain diligently mindful about the many things that can prevent us from protecting the healing space of therapy.
Additionally, though, it can be beneficial for the clients themselves to be aware of what the therapist’s priority should be so that if it becomes clear the counselor is not on the right therapeutic page, the client can seek another practitioner.
Wishing you safety and healing,
Dr. Rich Nicastro
Richard Nicastro, Ph.D. is a licensed psychologist in private practice in Georgetown, Texas where he sees individuals, couples and runs therapy groups.