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I would first strive to develop a connection that communicates my caring for him as a person and my emotional attunement to his sadness and isolation. I would then try to balance this support with challenges to his negative self-concept, encourage him to share difficult personal material, or structure anxiety-provoking situations to confront some of his social fears. In our discussions, I would alternate challenge and support, all the while encouraging both the experience and articulation of emotion to help him increase his ability to tolerate higher levels of stress (with less distress).
the evocation of emotion coupled with the client’s ability to put feelings into words is most likely to result in emotional growth, insight, and symptom reduction.
It is a hollow victory to end up with a detailed psychological explanation for problems that remain unchanged.
Regardless of orientation, therapists will encourage clients overwhelmed with their feelings to think their way to solutions and help clients who are emotionally cut off to experience and express their feelings.
As most people go through the process of therapy, they steadily reevaluate their beliefs with gentle, strategic, and well-timed doses of reality.
I’ve found that encouraging clients to review their past accomplishments, positive relationships, interests, hobbies, and passions will actually lift their spirits.
Asking these questions requires the courage to experience the negative feelings in us and to tolerate the possible negative reaction of our clients.
The stronger my feelings became, the less I discussed the case with my supervisor. I felt confident that I knew what I was doing precisely because I had such strong feelings about it.
The first would have been to take my strong feelings as an indication that I was having a countertransference reaction.
Strong feelings can indicate countertransference. • Discuss feelings about a client in your supervision (and therapy). • Think about how your client’s problems and conflicts may relate to your own.
stance of not knowing. While practicing not knowing, keep these points in mind:
Without words and discussion, thoughts and feelings remain embedded in our unconscious.
how some of their behaviors or symptoms are seen and understood by their family and understood within their culture. People from minority cultures are often so accustomed to being misunderstood
Try asking your clients some of the following questions to explore these areas:
that you accept your ignorance, find the information you need to do a good job, and continue to test what you have learned.
Doubt, if not taken to a paralyzing extreme, is a sign of an active mind and can keep us experimenting with new approaches.
A therapist who is absolutely certain he or she is doing the right thing is a dangerous therapist.
Did I: • Show up on time, rested, centered, and prepared for the session? • Review the relevant case notes before the session? • Communicate a sense of caring and concern for my client? • Listen actively? • Allow my client to express him-or herself without interrupting? • Deal with any emergency concerns appropriately? • Establish an emotional connection? These basic elements are the heart and soul of the therapeutic
Why Didn’t I: • Say more? • Say less? • Ask certain questions? • Say certain things? • Keep quiet? • Not interrupt?
Control is the enemy of exploration.
The role of a confused and befuddled detective can be far more effective than that of a brilliant spy (think Columbo rather than 007).
I’m confused. • Help me to understand what you mean. • What do you mean when you say that? • Could you say that again? I didn’t quite follow.
If an issue is important, it is bound to return. Seeing an issue repeatedly emerge will provide you with more confidence for a future interpretation.
Donald Winnicott described the “good-enough mother” as one who is available, empathically attuned, and caring enough to help a child grow and thrive. He used “good-enough” to acknowledge that a mother need not be perfect to be a good mother.
Following are some things I try to keep in mind when I am confronted about making a mistake and have confused and defensive feelings:
If your client feels that you appreciate the reason for his defenses, he will be more willing to explore alternative ways of being.
Choosing your client’s needs over your own emotions is an important moment in the therapeutic relationship. It presents the opportunity to demonstrate your skill, wisdom, and compassion.
If you find yourself arguing with your client, you have already lost. Remember, psychological defenses get stronger when under attack. Stop and rethink your strategy.
“What does silence evoke for my client as well as me?”
Neither you nor your client needs to be charming, entertaining, or witty. Take the performance pressure off of both of you and try to create a context for self-reflection and mutual discovery. Sometimes the best strategy is no strategy at all.
When you do not know your personal devil, he usually manifests himself in the nearest person. —PAULO COELHO
I never anticipated clients’ being angry with me or sleepless nights wondering if I had done the right thing.
Ask yourself if the labels you are using with your clients are truly helping you to help them.
When you recognize stagnation in the therapy, it is time to become curious, ask questions, and seek answers.
Why would individuals who needed protection from their own parents take your competence and good intentions for granted? They will keep their needs secret, and try, as best they can, to nurture, soothe, and support themselves in private.
Get a sense of your clients as people and don’t start out with both feet in your abnormal psychology textbook.
Rewards, or negative things that get to be avoided because of symptoms, are called secondary gains.
“Can you help me?” or “Can I trust you?”
They provided him a lifeline to me between sessions, a way to act out how painful his life felt, and an opportunity to exercise his power and feel a sense of control-although he had chosen to come to therapy, he still felt I controlled him.
Creating their own abandonment is a way to gain control over what they experience as a painful inevitability.
The very feeling generated in you—your anger and wanting to fire him or her—is the feeling the client needs you to withstand. It is a test of your centeredness, maturity, and availability.
Successful therapy is a “safe emergency” that depends on a continual balance of support and challenge.
With one hand we hold onto our clients to give encouragement and strength; with the other, we sword fight with their defenses. The
Interpretations attempt to make the unconscious conscious by challenging beliefs, naming resistance and defenses and adding new and challenging information to the client’s conscious awareness. Because
THE EYE OF A STORM is a place of calm at the center of chaos and confusion. You become the eye of your client’s storm through the calm and centeredness you carry within yourself.
Imagine this type of shuttling as going from yourself across to your client and back again.
Empathy is a hypothesis or educated guess concerning your client’s internal state.
often means that I have colluded with the client’s defenses by allowing his or her words to keep me at an emotional distance.
Depending on your theoretical perspective, these repetitive interpersonal dynamics could be called attachment schema, repetition compulsion, or implicit memories.
The more the client’s drama resonates with your own (and the less insight you have about your own unconscious processes), the more vulnerable you are to participating in a regressive interactive reenactment of your mutual childhoods.
