*** Now Available: Attachment to Your Therapist: A Conversation. This series of posts in expanded E-Book form, on Amazon.***
In a comment to the last post, M. asks whether she should be understanding of her therapist’s need to put his children first or focus more on her feeling of being neglected. Let’s get out our magnifying glass and look at just how feelings about your therapist can lead to positive change.
The part I haven’t really focused on in previous posts is exactly how the relationship leads to healing. Usually after an initial “honeymoon” period, as you both settle into the work, the therapeutic relationship begins to bring up feelings. As time goes on, they hopefully get stronger and more explicit. Eventually, you get to the point where M. is. You are invested and involved enough to have real feelings, such as M’s of upset when her therapist takes care of his children’s needs ahead of hers.
Why the gothic image? In therapy, as in life, healing and growth happen at the cusp of two feelings. The original use of the word was to describe those points in gothic tracery where one curve meets a different one. It is where your tracing finger must abruptly change direction. The simplest and best studied example in therapy is trauma, where the therapeutic situation is set up to help you get in touch with painful feelings associated with trauma. What is special is that this time, the painful feelings intersect with comfortable and safe feelings associated with the therapist and the therapeutic situation. At that point or “cusp” when both feelings are active and intense, an amazing transformation takes place. I call this transformation “catharsis” because that’s what Freud called it and, to my knowledge, he was the first to describe it in any scientific way.
Current scientific thinking is that, at such moments, each of the two feelings is represented by a neural network, that is, a number of interconnected nerve cells that tend to be activated as a group and represent a certain mental content. In this case the content consists of feelings associated with memories or facts. Conscious awareness tells us that, simultaneously, two neural networks are strongly activated, one for the painful feelings and one for safety and empathic connection with the therapist. Science tells us that when two neural networks that were previously not associated are both activated at the same time, they become associated or “wired” together. This process takes only a few seconds to initiate, though it may take some hours (and perhaps sleep) to become permanent.
Can the same process of catharsis take place at other cusps of feeling? Of course. Let’s go back to the complex moment when M’s mixed feelings might intersect. Her therapist calls to say she is canceling a session because of a family emergency. I am guessing that M. feels sudden pang of disappointment, hurt and anger. At the same time, she feels concern for her therapist. Is she OK? Has something terrible happened to her child? Will the child be OK? Will she be available to help me? Unfortunately, this is not a therapeutic moment. Again, according to my guesses, two things take away the possibility of transformation. First, there is no time or place for M. to linger with her feelings, even for the few seconds that catharsis takes. It it time to make the best of the situation and move on. Second, M’s conscience comes in to spoil the opportunity. Her conscience says she should “be a good person” and suppress her selfish feelings when someone she cares about is in need. Quite automatically, M. shuts down her feelings and copes with her disappointment.
At their next session, let’s say M’s conscience has relented enough for her to feel her feelings all over again. She is feeling intensely hurt and angry at the same time that she is feeling empathy for her therapist. Suddenly one of them realizes that this mix of feelings is not new. The many times her parents had to attend to her sick sibling while she was neglected (for example) come to consciousness. Now the intensity of the hurt and anger are there for a reason. It is not that she is selfish and immature in wanting her therapist all to herself. Rather, the therapy has brought to the surface some important unfinished business from her past, the inevitable result of her sibling’s illness.
Let’s focus on the anger. M. feels anger towards her therapist at first. But it doesn’t really fit, because the therapist really did no wrong. This is what we call “displaced” feeling. It is the right feeling directed towards the wrong person. At least the feeling is active, but without the original context, it can’t heal. Then, with the realization that she has felt this before, M. is able to connect the feeling with the right context. The therapist now provides a safe context in which to feel the anger of a child who has legitimate needs independent of the sibling’s illness. In this new context, the feeling can heal in the same way traumatic memories do. The neural network of anger at parents gets “wired together” with the one representing that it is safe and OK and understandable to feel such things, even when a sibling is sick.
The same goes for the feelings of pain and loneliness when the therapist disappoints. That pain heals by catharsis just like the pain from trauma.
This is how the therapeutic relationship heals. At first the feeling is towards the therapist, and may be uncomfortable and threatening. As the therapist encourages exploration of what is happening, the feeling heals a little and becomes more safe. With safety, the mind is able to furnish the original context involving the parents and sibling. By that time, the therapist is able to serve as a comforting and empathic witness. Those are the conditions for catharsis: Feelings with their original details in a safe and empathic context.
There are still a few important points to clarify. First, there is some misconception in therapist circles that just having a healthy relationship with your therapist constitutes a “corrective emotional experience” and will heal you. Having a nice therapist who doesn’t have children or conflicting needs is not enough for healing and growth to take place. The reason is that “niceness” tends to reinforce our suppression of shameful, immature or problematic feelings. When feelings are suppressed, catharsis can’t take place. The troublesome moments in therapy, whether they involve feelings about the therapist or not, are the ones that can bring us to a cusp with important issues.
Second, let’s not mix up intellectual clarity with empathic understanding. “Mindfulness” doesn’t mean gaining an intellectual perspective. It refers more to an emotional sense of being understood and accepted. It is true that the therapist often has some wisdom about the situation and can share that with us, but the thing that makes for catharsis is the fact that the therapist is in tune with our intense feelings but not overwhelmed by them. It is the therapist’s empathy that activates neural networks representing safety. Intellectual understanding alone doesn’t necessarily mean empathy. Furthermore, “intellectualization” can and often does facilitate suppression of feeling, which, as stated above, means catharsis can’t take place.
Finally, what about feelings that come up when the therapist actually does something wrong. Therapists can make mistakes and do have counter-transferences. They can be caught unaware of their own emotions and can say or do things that are not in the patient’s best interest. If the error is not so grave as to end the therapy, then there is still work to do for both therapist and patient. This is the same as in other relationships where hurt is done. Forgiveness requires that the therapist address the event in some satisfactory way, as well as understanding the hurt done to the patient. Forgiving, too, involves the process of catharsis, whether we are forgiving a therapist or anyone else. Once again, there is a cusp between the feelings of hurt and anger that have been aroused by the error and feeling the therapist’s empathy with our hurt.
Now the complicated part. Much of the time, when the above scenario takes place, it also arouses feelings associated with unfinished business from the past. Just because the therapist has participated in creating the problem doesn’t mean the feelings all stem from the present. It is likely that there are also feelings from the past “piggybacked” on top of the present ones. How can you tell? When the feelings are out of proportion to what has happened in the present, it usually means that something from the past was activated as well. Unfortunately, in situations like this when the therapist’s role is not “clean” it is much more difficult to sort out which feelings come from where. The rule is this: Therapist and patient will first have to sort through and heal the present issue between them before clarifying what comes from the past. Only then, when present feelings are no longer so intense, is there a chance to identify and address what comes from the past. If clarity is not possible because of the murkiness of the situation, dealing with feelings from the past may have to wait till they are activated again under circumstances that are less confused.
Look at the SPSE (Scarsdale Psychotherapy Self-Evaluation) on this website. It will help you evaluate your therapist’s effectiveness in helping you. The cleaner your therapist’s work, the easier it will be to experience those feelings that belong to you on a cusp with safe and empathic feelings associated with the therapy. Then catharsis will happen and you will progress.
Be sure to check the other posts in this series. See categories. Go to the next one