*** Now Available: Attachment to Your Therapist: A Conversation. This series of posts in expanded E-Book form, on Amazon.***
Cynthia writes: (slightly edited for clarity], I am in therapy. The philosophy seems to be that therapist is to bring out needs and wishes and then not fulfill any of them in order for client to feel frustration, anger, pain, sadness. Then somehow from understanding and being aware of these feelings healing takes place. This is cruel and unusual punishment for some clients and certainly for me. I am an adult but I equate my needs to that of an institutionalized orphan whose physical needs were met but social, emotional,attachment needs were neglected. I am at a child’s level of these needs. Should one recommend catharsis by provoking pain, sadness and anger for a child? That would be absurd. I can tell you that by being more revealing and open with me and willing to do what i wish for (like being read to) has triggered hope, love, along with fear, confusion, jealousy, unworthiness, pain and sadness. I believe closeness will trigger emotions in a much healthier way. My model is based on the necessary love/bond between mom and baby. My relationship with my therapist is the closest thing to healthy I’ve ever had. And I get to work through all the necessary emotions. I get frustrated that sessions are so short and only once a week but that is golden compared to no therapy at all! When I read the comment above by “Me”, I just had to reply. Some people have deficits that need filling. To do so is healthy. We follow the boundaries. Emotions come to the surface in close intimate therapeutic relationships. Self esteem can be developed. I can socially emotionally cognitively mature into my chronological age. I research psychotherapy and I only find philosophies like yours. I can’t believe it is 2014 and therapy is still so undeveloped! So many forums and blogs are filled with people not getting what they need in therapy! I’d like to find more information on what my therapist and I are doing!
Later: My analogy is of the institutionalized Russian orphan babies. Physical needs met but no emotional attachment to anyone. Some die, some become mentally disabled, and some are ok. I think it is a getting stuck and being in need of certain things to happen before one can move on. For me it is a stubbornness. I refused to move unless I felt some love. I had too much self hate. Unless I felt love from a significant person (therapist) I was gonna stay stuck. Not all people need the same thing but people need to experience being in a nurturing relationship as close to healthy mother/baby as possible in order to be able to have their own healthy relationships. Attachment. Thank you. Cindy
Dear Cindy, I really like your description of the therapeutic process. You just weren’t going to get anywhere without feeling genuine love. While your therapist respected boundaries, things like being read to gave you a real sense of being nurtured. That didn’t stop you from feeling many mixed and painful feelings, in fact it triggered them, but the relationship gave you a basis for working with those feelings, together.
What makes this topic difficult to write about is the fact that any action a therapist may take, especially those that go beyond traditional limits, can have very different results depending on the particular therapist and patient. What may be just right for you and your therapist could lead to trouble for a different therapist and patient. Given the real risks, almost any recommendation or suggestion can be mis-applied in a way that could do harm. That is the reason for so much caution and the reason why I can’t make suggestions for specific people in this blog. However, let me do my best to talk about the issues.
An easy but oversimplified way to look at the interaction you describe is a “deficit” model in which people with deprivation in their background, are seen as simply needing a “corrective emotional experience.” Not only is this idea appealingly simple, but it responds to our inner child’s wish to get right to creating a situation that will take away our pain. The problem is that the healing comes not from feeling good, but from working through defenses and painful feelings.
The part of this model that is correct is the re-creation (or creation) of a feeling of safety. As I recently wrote in my post on Mindfulness, one of the conditions for healing is a deep, internal sense of safety and connection that is re-awakened and reinforced by a positive relationship with a therapist. This feeling of relationship is something most of us have internalized around age three. Unfortunately, even if adequately internalized, it can still be vulnerable in stressful situations. For many, this feeling of safety may be even more compromised. When the feeling of safety is not available, healing cannot take place. This is why it is important in therapy to have a feeling that your therapist really does care about you.
A social worker friend once told me, almost in a whisper, “It’s the love that does the healing.” I think there is truth to what she said. But the purest form of love is empathic connection. That is the core of true intimacy. When that happens, unless there is a serious blockage, people can’t help but care for one another. This natural bond is a major part of what creates the safety needed for healing. What all patients need is genuine, accurate empathic connection.
You rightly suggest that your situation may be different from that of other people. When the inner battery pack of connection is less well formed or more vulnerable, and trust has been broken, there is probably more need for literal indications of caring. Those who have more reliable access to their own internalized feeling of security can handle more austere styles of therapy. It is often recognized that a depriving style of therapy does not work well for trauma. It does appear that sometimes tangible indications of the therapist’s personal caring can make all the difference. Still, even with tight limits, it is natural for therapists to care and feel real connection with their patients, and it is natural for this reality to be conveyed in some way.
As you say, what different people need can vary greatly. I remember a patient who had been in psychoanalysis in Europe. When she came to the US, she began to fall apart. What had been holding her together was the quiet, reliable, sphinx-like demeanor of her analyst. For her it was opposite to the loud, dangerous chaos she had grown up with.
Pitfalls and Reasons for Concern:
As you point out, the field of psychotherapy has long been wary about overt expressions of caring and nurturing. It may be because a therapist is afraid of closeness or is guided by Victorian precepts, but let me describe some of the real problems and risks.
First, if boundaries are blurred, which you have indicated is not the case in your therapy, it is all too easy for the therapist’s needs to compromise the patient’s. Therapy is for the patient. What is special about the therapeutic relationship is that a therapist is there for one reason, to help you heal and grow. Boundary violations often start with a rationalization that they are for the patient when they are really not. The end result can be disastrous and very sad, with loss of a good therapy, damage to the patient and damage to a career.
The second problem is that true closeness, that which comes from revealing your deepest feelings and vulnerabilities, the bedrock of any good therapeutic relationship, is often scary. Real intimacy, in the sense of accurate empathic connection, is well known to be one of the greatest challenges to humans. So it is that, in many instances, patients and therapists may prefer more obvious and concrete indicators of love over pure empathy. In this way, gifts, extra time, and other unusual exchanges can be a way of avoiding real closeness even when they seem quite genuine.
Going back to what I said earlier, in cases of severe deprivation like yours, something more overt may be needed to allow you to feel safe and connected, the problem is that telling the difference between a simple genuine gesture and a subtle avoidance of real empathic connection is very hard to distinguish. The same act can mean so many different things.
The third problem is the one that, I think, lies behind many of what seem like prescriptions for hurtful and even sadistic withholding on the part of therapists. We all seek to escape pain. When deprivation in the past has been a source of pain, there is naturally a strong motivation to undo that pain by finding a new relationship where deprivation and abuse will no longer happen. The inner child’s idea is to escape from the pain by undoing it, rather than going through and healing the anger, hurt and other feelings that are the legacy of abuse, neglect, and deprivation. A “Yes” from a therapist will awaken young wishes in full force. Since they are usually pent up wishes from early life, it is often not long before those desires go beyond what even a flexible, caring therapist can do. Wherever a therapist sets limits, those limits will become the here-and-now embodiment of hurt from the past. As you describe, with a trustworthy and empathic partner, one will be able to process painful feelings and heal. Your therapist’s giving to you “triggered hope, love, along with fear, confusion, jealousy, unworthiness, pain and sadness.” Working with these feelings is what therapy is really about, while awakening a feeling of being cared for is what allowed you to dig into the work with confidence that you were not alone.
A fourth common pitfall is that therapists may have trouble saying “No” and, by not setting limits, may imply promises they can’t and won’t keep. The more they give, the more their patient expects. Sooner or later, this pseudo-generosity will create a problem that is much harder to disentangle because the therapist has been an active participant. The other side of the coin is that a therapist’s patient and firm insistence on limits may be what shows true caring and creates a safe framework for growing.
Therapists and good mothers are not that different. They have to deal with the impossible job of always knowing when to say yes, when to say no, and how to keep empathy when the relationship is difficult. Even if the interaction is more governed by rules or a formula, there are subtleties where humanness shows through, hopefully for the better.
You have a fine way of exposing the problem and not leaving room to wriggle out of a straight answer. I hope I have clarified why the issue you bring up is so difficult for all of us.
Next post in the Attachment Series: Shame and Attachment.