Sensitivity to Therapist’s Mood

Recently a reader shared this lovely insight into times when she knew something was up with her therapist. She gave me permission to pass on her words. (Photo, Flickr: Dennis Jarvis  CC BY-SA 2.0)

From a Reader:

“I have had several therapists over the years, and there have been a number of times when I have walked into the therapy room and immediately become aware that something is bothering or distracting the therapist. I can’t always explain how I know; it seems to involve a set of non-verbal signals.  I tend to ask either, “how are you?” or “Are you OK?” Almost invariably the therapist will answer, “I’m doing fine.  How are you?”   It would be extremely rare for the therapist to actually answer this question with much thought or honesty, and I think that’s true for most therapists.  The response really means, “we’re here to focus on you, not for me to tell you about myself.”

For a more withholding therapist with more strict boundaries it might also be motivated by an awareness that this question, asked sincerely, is inappropriate as it violates the boundaries of the therapy.  At the same time, the response shuts down further inquiries.  If I have a strong sense that something is wrong, I may ask, “no really, are you OK?  You seem off.”  A particularly astute therapist or one with a lot of experience with me may recognize this as a “therapy issue” and pursue how I am affected by what I perceive, but most of the time the therapist will reiterate the initial response (reinforcing the boundary) and then ask what (else) I want to discuss today.

I think therapists have very legitimate and appropriate reasons NOT to disclose personal problems, and ultimately that type of disclosure is not what the patient needs.  On the other hand, denying that the therapist is distressed in some way can create a repetition of the dysfunctional and mystifying communications of an abusive home in which children may be told of an abusive parent, “Daddy loves you and is proud of you” or “You’re lying.  Mommy would never hurt you” or “Your arm doesn’t hurt.  You are just acting like a baby” or “Mommy is fine.  There’s nothing wrong.”  The effect is to convey to the patient (as the parents may have conveyed) that the problem is in his or her perceptions rather than in his or her dysfunctional expectations about the effects of other people’s emotions or dysfunctional behavior in response to other people’s emotions.

The most therapeutic responses I have gotten have generally been honest statements that either something outside the therapy is affecting the therapist or that the therapist isn’t aware of anything but recognizes that it’s still significant that I perceive that something is off, followed by a discussion of how this impacts the therapy that day. If the therapist either feels it’s inappropriate to share details or is uncomfortable doing so, it can be very helpful just to hear that it’s not about me and that the therapist doesn’t expect the issue to affect the course of my therapy, if those things are true.

The least therapeutic responses have been ones that convey either directly or indirectly that the therapist is unwilling to engage with me around my perceptions of the therapist’s affect. In those cases the dysfunctional pattern of fear and avoidance in response to another person’s affect tends to be reinforced and I see the therapist as a direct threat. Then I either dissociate completely, try to placate the therapist to avoid perceived potential violence, or stumble along getting very little done and then use that as an excuse to leave the therapy session early (all counter-therapeutic avoidance behaviors). I’ recognize the possibility that I am misperceiving the situation, but both of my long-term therapists have acknowledged that usually I am correctly picking up on something going on with the therapist.”

Some Thoughts:

First, she raised the issue of patients who have suffered early relationship trauma being particularly sensitive to the moods of their therapists. Absolutely true! I realized this a long time ago, and came to the conclusion that for those patients, I was quite transparent and should relinquish any thought of my emotional state being private. It’s no wonder. For children, emotional needs are as necessary for survival as the physical ones. These children understandably develop an exquisite ability to read others’ moods and emotional states. And the sensitivity is all the more intense in relation to a therapist, instinctively seen as one who might fulfill those needs. This sensitivity may cause some difficulty, but really it is an asset. Being sensitive to others is a burden, but also a skill that can help a lot in delicate interpersonal dealings. Someone once pointed out that many therapists come from a family with a depressed parent.

This situation happened recently in my practice: Some time ago, I had abdominal surgery. It went well, and I was proud of coming through with flying colors and going right back to the office for a few days before leaving on vacation. My very sensitive patient e-mailed while I was away, just to keep a feeling of connection. I responded, and added a sentence that I realized I had been more affected by my surgery than I had known when I saw her.

That sentence was the only one that mattered. In fact, during the session before I left, she was dealing with her own distressing medical issues. Sensing that I was not fully at ease with mine, she didn’t dare bring up hers. Any break in the connection needs to be repaired for therapy to go on. On my return, it took some more work to get to where she could feel confident that I was really ready to hear about her concerns.

Returning to the reader’s experience, it is so true that therapists usually do brush off questions about their mood. I think it’s a combination of professional reticence to burden the therapy with the therapist’s issues but also, being more at ease with giving than with receiving attention. Unfortunately, a light brush-off may be all it takes for a sensitive patient to shut down. I hope all the participants in this blog are ready to push themselves, like our reader, to insist on a real response. Being a little “pushy” gives a good therapist a better chance of realizing that what is happening is a “therapy issue.”

As for the therapist who thinks this is a matter of boundaries, it simply is not. The boundary issue, as she astutely points out, is about whether the therapist should share the cause of the mood. Giving that kind of personal information is rarely useful. Mostly it is distracting, making the conversation about the therapist, not about the patient. It is really no different than if the therapist abruptly came in with a big bandage on his or her head. Would it be a violation of boundaries to have a brief conversation about what happened? A minimal explanation would be all that was needed, then on to the real issue: whether and how it might affect the work. So if your therapist tries to insist on boundaries, please tell him or her that boundaries have nothing to do with it, you don’t need to know the details of your therapist’s life, not really.

What about the fact that my patient knew about my surgery? I made a judgment in her case and a few others that it was simpler and less mysterious to give a real explanation for my being out of the office. I think that kind of boundary judgment is a matter of balance between being secretive, which attracts as much attention as telling, versus revealing too much detail. I took pains to address the real question, making it clear that it didn’t affect my readiness to be there for my patients. The problem was that I was in some denial, myself, and my sensitive patient picked that up.

I think the most important take-home is that therapists do have moods and issues in their lives that have subtle effects on how they act in session. Sensitive patients will pick these up, and, predictably, will interpret them in the light of their own experiences. These reactions represent a huge opportunity if they are explored, and an unfortunate break in the relationship and the flow of the therapy if they are not. It is both the patient and the therapist’s shared responsibility not to miss the chance to pay full attention to the therapy issue and, in the end, to harvest a deeper empathic understanding.

23 Comments

  • Sometimes my therapist talks too much about his personal issues that it is difficult for me to share what is going on for me because I don’t want to burden him. It has been happening more lately and I am having a hard time with it. I am not sure how to address this. I am also very in tuned to my therapist mood’s and words. This goes back to childhood issues that I have had with trying to keep mom happy at all costs. Thank you for the wonderful information that you provide.
    Best,
    T

  • I love this blog. You make issues understandable, and help to shed light on therapy, the therapist, and ourselves! Question that has been on my mind lately: If a therapist did long term (9 years) trauma therapy (successfully) with someone (myself) recovering from childhood SA, (just having that known when her first granddaughter was born, age 59) and other multiple abuse, why would a therapist not invite the patient for a phone call, Skype, or visit just to say goodbye if they were dying ? The therapy ended about 4 months ago, and I knew he was dying. The relationship was very close because of the hard, painful work we had to do. This has for me been the most painful thing I’ve had to deal with, probably more so than the abuse and recovery process. Please shed some light on this for me.

    My Mom was the abuser, and after the age of three my Dad succumbed to Alzheimer’s and was hospitalized for 14 years, in a comatose state. So my therapist was really like a Dad to that little girl inside for awhile, and it just seems so cruel that this boundary would be put into place. Would you please explain it to me….

    • Dear Kimberly April, I wish I knew. I, and I’m sure all our readers understand your distress at not hearing from your therapist. I hope you had a chance to talk about his dying before you ended your sessions. That would have been appropriate in my view. The only thing I can say is that there might be many reasons other than some questionable notion of boundaries to explain not hearing from him. I’m sorry I can’t shed more light.

      Yours, Jeffery

  • I am definitely one of those very attuned to the others, especially the therapist, due to early vital need to be very aware of what was happening with my mother and having developed the survival trick to take care of her, a trick i am still unable to relinquish.

    Indeed people are “transparent” to me, especially my therapist, but there is a lot of projection too there. Sometimes I may be wrong in what I sense, and above all I have a strong negative bias, always anticipating the worse and imagining the worse, and being quite obsessed.

    Anyway right now I am struggling with the fact that it seems to me that my T. is hiding too much, never disclosing enough. Pretending to be just professional and untouched while I see a face and body langage (the nervousness of his feet) that tell another story.

    That triggers a lot of distrust in me. Like this is manipulation, or a proof of his lack of maturity.

    I wonder what to do with that. Seek another therapist? Or accept the imperfections of that one (utlimately lerning to accept my own imperfection), work through the frustration and distrust… on my own.

    As I said, he is unwilling (or unable?) to really discuss the substance of what is happening between us. It is all about me, and any doubt I have about him or question, he eludes, never aknowledges or denies (oh, yes denies.) That’s how it feels for now. He is sincere and kind and wishing me well but there is a limit to the authenticity I feel.

    I don’t like this rule that forbids self-disclosure. There is a whole lot right now about the need for therapists to come out and engage more fully with the patients, while being much aware of what they do, how and why they act the way they do. This is a catalyst, but of course it requires more work from their part and not all of them are able to do this.

    Left alone with the frustration for now.

    • Lol, Thanks for your comment. I happen to be in the camp of therapists who believe that “engaging more fully with the patients, while being much aware of what they do, how and why they act the way they do.” See my reply to jakethedog more recently. Jeffery

  • First of all, I’d like to thank the person who wrote in for her experience, and for articulating it so well! The following passage resonated in me, and this has been true for me as well.

    “The least therapeutic responses have been ones that convey either directly or indirectly that the therapist is unwilling to engage with me around my perceptions of the therapist’s affect. In those cases the dysfunctional pattern of fear and avoidance in response to another person’s affect tends to be reinforced and I see the therapist as a direct threat. Then I either dissociate completely……”

    As much as it pains me to read that there are others who went through the very issue I struggled, at the same time, it is also a relief that I am not alone in this and I was not crazy when I was experiencing therapist’s incongruent signals and words.

    In my case, my therapist and I became so good at reading each other’s signals and body language, my therapist stopped answering my questions to which he didn’t feel comfortable with in his effort to avoid giving away his true answers. He knew I could read him like a book, and if he said anything, I would know, and in return, he would know from my reaction that I knew the truth. So he kept my questions up in the air, and just switched the subject. Only option for me was to just give in when that happened.

    In my case, it never gotten resolved even after many attempts to solve the problem. I had to accept that he couldn’t respond to me in any other ways than he had been.

    • Echo, Thanks for sharing this. It sounds like a “therapy issue” that would have been good for both of you to explore. Sometimes it is hard to see beyond the immediate issue of the therapist’s mood and its causes, to the more important “meta” issues of what his mood and his refusal to answer meant to you.

  • This was interesting and helpful to me, and I want to thank the person who allowed you to share this with us. It is similar to some of my experiences in therapy and so it’s useful to have insight.

  • Just want to say thanks for sharing this post! The reader’s story resonated so much with me. I’ve had a couple of sessions where I felt something was ‘off’ as soon as I walked into the room. Sometimes it was after the first ‘How are you doing?’ but other times it was before anything was even said. I couldn’t quite explain what it was but something felt different. Sometimes I thought it was me and perhaps that I was just anxious about stuff I was hoping to talk about. Other times I thought that maybe I was just imagining it. I didn’t realize until the second or third time it happened that during these particular sessions I would retreat into myself. I remember being a bit bothered after them as I felt that they weren’t very productive at all as I would only really talk about surface level stuff. My therapist even asked about it once or twice. Reflecting after these sessions I started to realize that although I wasn’t consciously aware I was doing this subconsciously I had been telling myself that ‘it was me’, ‘it was something I had done wrong’, ‘maybe they were annoyed with me’ or that ‘they weren’t happy to see me’….I decided to bring it up in session and I was glad I did. My therapist responded well and we were able to explore it more. She didn’t elaborate specifically on whether I was right about what I was feeling which I do think might have been helpful but we did talk about my sensitivity to other peoples moods and how those who experience childhood trauma are often highly sensitive to other people which I guess implied that I was. It was a good moment for me as realized that I had been doing this ALOT in my everyday life. I would often pick up on other peoples moods and if they were ‘off’ and pretending not to be I would start to feel off and that perhaps I had done something wrong or that they were annoyed with me. This would then cause me to retreat and would affect the building of the relationship. I am now working on changing that mindset and now that I am aware of it I am trying to change the conversation in my head when I do realize this is happening. I haven’t had it happen since bringing it up but will be interested in the next time it does.
    On another note whilst doing some reading on this, I came across a lot of articles on empaths (as opposed to empathetic people) and their traits/abilities. Do you have any thoughts on empaths would love to read them if you did?
    Thanks again for a great post and all the others that you do.

    • Dreamer, Thank you for your comment. I think many people have had these experiences, and sadly many have thought it was them. I am aware of the topic of empaths, but haven’t a lot of knowledge. I’m think that body of awareness may focus more on the tendency to want to manage others’ moods, as opposed to exploring and healing the sources of the sensitivity. Does anyone have more direct information?

      • “I would often pick up on other peoples moods and if they were ‘off’ and pretending not to be I would start to feel off and that perhaps I had done something wrong or that they were annoyed with me. This would then cause me to retreat and would affect the building of the relationship. I am now working on changing that mindset and now that I am aware of it I am trying to change the conversation in my head when I do realize this is happening. I haven’t had it happen since bringing it up but will be interested in the next time it does.”

        This sounds very familiar to me, too. It didn’t occur to me to look at the problem from the context of empaths although I think the concepts I came to adapt are similar. I think that people with complex trauma often have highly developed Social Cognition Network that Lieberman talks about and very active mirror neurons because it was crucial for our survival to accurately read others’ intentions and motivations on an intuitive level at any given moment. Social rejection causes us the same pain we experience when we get physically hurt. No wonder we become super sensitive to social injuries. But I knew that after reading Dr. Smith’s blogs on “the Black Box Motivation” and “How to Overcome Shame”, the more important issue was on how to change our reactions to perceived threats, not so much about how we are so sensitive to others’ mood.

        The way I came to solve the issues of BBM and Shame is by understanding neuroplasticity and the polyvagal theory. I started to practice self-compassionate mindfulness.

        I agree on Dr. Smith’s thought on the body of awareness that it may focus more on the tendency to want to manage others’ moods as opposed to exploring and healing the sources of the sensitivity. My very first introduction to body-based approach to regulate my symptoms was over 15 years ago. But body based approach had very little impact on my healing, and that only added to my shame and reinforced my belief that there was something fundamentally wrong with me until I discovered the self-compassionate mindfulness approach.

        It’s been proven that our brans can form new neural pathways. What wire together fire together. What I was practicing before I discovered self-compassion was plain judgement. I was practicing self-judgement and criticism. I was only strengthening my old beliefs! No wonder I didn’t get better. Some of you might have heard of the Tania Singer’s research on compassion vs empathy and effectiveness of “Loving-Kindness Mindfulness” practice or “pro-social” meditation.

        What I’ve found particularly helpful in my continuing healing journey with that understanding in mind are:

        -The Self-Compassion Skills Workbook by Tim Desmond
        I like this workbook because he incorporates parts work. I’ve never come across with any other mindfulness practices that do that.

        -Brene Brown’s TEDx talk on shame and books
        I learned how universal shame is, what it really is and how to rise above it.

        -“Wheel of Awareness” practice by Daniel Siegel
        What I like about Wheel of Awareness practice is that it systematically incorporates and works through all parts of brains that are usually left out from typical mindfulness practices. I found engaging in interoception part of Wheel of Awareness practice, particularly when going through the body parts governed by vagus nerve to be extra challenging, but when I could go though it successfully, I gained the kind of connectedness and security I’ve never had before within me.

        I’m so sorry for mentioning many theories that may not be very familiar to you all, and not explaining them at all. I wanted to be able to relate enough so that you’d know where I’m coming from, but not so much that it becomes to analytical and detracts from what I really want to share, which is what was helpful for my healing journey, and what might be useful for others who read this post. I’m sorry for not been able to keep it jargon-free. Dr. Smith has this incredibly super-power of explaining complex theories in a deceptively simple manner. I unfortunately don’t share his super-power.

        I hope Dr. Smith would add more to this. I hope I didn’t misunderstand the comments and am not completely off topic….

  • “I think that kind of boundary judgment is a matter of balance between being secretive, which attracts as much attention as telling, versus revealing too much detail.”

    If only my therapist knew how much his secrecy attracted my attention. I think he would be taken aback. He has revealed very little about himself, and I won’t ask because ‘boundaries’. Do I want to know about his personal life? Only the surface things that other therapists seem to talk about in passing, or display in their office, with no qualms (spouse, kids etc.). The difference in presentation between this therapist and other therapists is marked. I imagine that he is gay or single. I am probably wrong about that: he is most probably married with a minivan full of kids. Whatever his relationship status is, it’s his life not mine.

    I like the boundaries, they are necessary. Boundaries give me a sense of safety and code of conduct for reasonable behavior. Why the secrecy? I am not having that conversation with him. If he wanted to share those details, he would have. He is entitled to his privacy. I will continue to have my theories about him. Why do I want to know? Connectedness: I would like to know how he functions in the world to bolster my sense of safety with him, to know I have read him correctly.

    If I am wrong about him being gay, or single, or having a minivan full of kids, what else have I misunderstood about him? Is he worthy of my trust? Is he safe enough? Human beings are all about relationships, and the therapeutic relationship is very unique. Being in a therapeutic relationship is very challenging for me, I feel vulnerable and exposed.

    I thought I had put my curiosity behind me until I read your comment about secrecy. I realized that is me, obsessing about my therapist’s secrets. It doesn’t help that I’ve caught him out in a few half truths in an attempt to protect his privacy. His half truths hurt my feelings. It feels like he doesn’t trust me or feel safe enough with me. I’ve never let him know I knew more about him than he wanted me to know: I’m good at keeping secrets too. I found the information about him online, it was available to the public with a google search. He obviously feels the need to protect himself from me, or to protect me from myself.

    Before I understood why I was doing what I was doing, I attempted to cross boundaries, and he was not so good at maintaining them. I don’t cross boundaries anymore, because I understand my behavior. He is also better at maintaining boundaries. I feel shame and regret for my transference behaviors, because I am ultimately responsible for my actions. However, it is up to the therapist to maintain boundaries and educate their clients about appropriate behavior and the importance of boundaries. I learned about transference from your books and website because I was too shamed to bring it up. If your website and books mean I have a better therapeutic experience, I’ll accept it. Sometimes therapy is so hard! For better or worse, I am sticking with my mystery therapist because I am working through transference and attachment.

    The therapeutic world is a very interesting vocation. It is a very fine line to walk with some clients. As a client, it’s a fine line to walk with some therapists. Ugh!

    Thank you for your books and your website. I have learned a lot from you and your words have helped me heal.

    • Thanks so much. Freud’s original idea of anonymity of the therapist was based on a nineteenth century notion of the “objectivity” of science. Since then, the field has mostly recognized that the blank screen is an impossible fiction, as is complete objectivity. I do agree that knowing some basic things about the person you are working with helps with confidence that you have read the person right. Nor does that require detailed revelations about the other person’s life. Incidentally, this asymmetrical relationship reflects the experience of a small child. There is so much about the parent’s life that the child doesn’t know or understand. I don’t think that is a coincidence. Jeffery

  • Jeffrey wrote:”Incidentally, this asymmetrical relationship reflects the experience of a small child.”
    Amen. Perhaps I am particularly cantankerous, but I would probably push a therapist who had particularly restrictive boundaries to be more specific about the idea of “boundaries.” Who is the therapist protecting and how? (Note that this is a bit of a leading question – I would hope that a therapist who doesn’t take a superior or patriarchal stance toward patients would fight back a little on the idea that they are “protecting someone”). If the therapist is “protecting the patient,” what is it about these particular choices of boundaries that makes them right for me as a patient with my specific set of characteristics and problems? If the therapist in any way seemed to convey an attitude of “I know what’s best for you,” or if the therapist didn’t seem able to reflect on these questions and answer them thoughtfully but just gave me a pat or overlearned answer, it would make me nervous. I’m fine with, “I need to think more about that, let’s talk about this next week.” I’m not fine with a stance that the therapist’s job is to “fix” me rather than work collaboratively with me to help me heal. I’m not saying this is your therapist’s stance, jakethedog, just that ultimately these kinds of conversations have often helped me understand myself and my therapist better and have strengthened the relationship.

    Jakethedog, I can definitely relate to shame about transference. I really hope that your therapist isn’t in any way suggesting that you SHOULD be ashamed about it, though, or shaming you for “breaking the rules” and asking about him. Part of the idea of the “blank screen” is that it makes transference more likely (with the idea that this allows you and the therapist more insight into your issues). I guess I’m saying that I agree with you that it takes two to tango, and I think that transference isn’t something that YOU have or do as much as something happening in the relationship BETWEEN you.

    About Googling your therapist: I read an article about this a while back and was struck by all the therapists who thought this was an invasion of privacy or a horrible thing. My first thought was, “Are these people completely out of touch with anyone under 35?” How do they think the younger generation FINDS a therapist? I haven’t seen a Yellow Pages in years. Since I was starting out looking for a therapist through my insurance company’s list of providers and Psychology Today’s “therapist finder,” I Googled all the potential therapists I was considering. I intentionally looked for compromising photos and information that they had control over releasing. Anyone with a public Facebook page who was posting indiscreet photos of their own behavior was someone I didn’t trust to be discreet with my private information. Anyone who was making claims that I thought were wacky or were really out of touch with the standards of their profession I also ruled out.

    I also found some stuff about the therapist I ended up working with (nothing that was a problem, but enough that I knew some things he didn’t know I knew). I eventually “confessed” this to him and said I was ashamed about it and he totally normalized it. He said,”EVERYONE googles their therapist!” (His caseload is heavily slanted toward people 25 and under, so this might be somewhat more true for his patients than for the general population, but I think he’s probably pretty much right).

    I agree that a therapist is entitled to privacy, but there’s also a fair amount of research that indicates that patients’ values tend over time to become more like those of their therapists. I also think that it’s impossible for therapists to be unbiased or value free (nor would it be useful if they could). In this respect it seems like there may be times when it’s fair for a patient to ask and expect to get some idea of the therapist’s values or experience, particularly when those have some bearing on the patient’s case.

    For example, I was abused in a religious context as a child, and some of that abuse was carried out under the pretext that it was “God’s will” or that people were acting on behalf of God or by threatening that God would kill me or send me to eternal torment if I didn’t do as they said. My experience has been that only one of the six therapists and psychiatrists that I have talked with extensively about this has been able to avoid interjecting their own beliefs into the process. Somehow there just seems to be something about religious abuse and the resulting damaged spirituality that really seems to trigger people’s biases. One psychiatrist prescribed an anti-psychotic when I admitted I “talked to God” (prayed) and clearly stated that although God never “spoke to me” audibly I couldn’t categorically deny the possibility that in some way God might answer my prayers by giving me impressions or ideas about how I might respond to problems of life (to her credit, after I pressed her on why she felt I needed an anti-psychotic she called my therapist to say she might have made a mistake about this and asked more about the normative practices of my religious group). One therapist and one psychiatrist, both religious themselves, have argued with me that “God isn’t like that” when I have described the abuse and its aftereffects. Probably all these people would argue that I have no right to ask them about their own religious biases. To some extent I agree with them, but on the other hand, in almost all of these cases their strong reactions to my experiences (and attempts to change/convert my religious beliefs or behaviors by persuasion or drugs) have come unexpectedly after I had worked with them for some time. And the thing is that I really don’t care what they believe or don’t believe. What I care about is whether they have the ability to manage that themselves and keep it in check enough to maintain a safe and supportive container for my emotions and conflicts about religion and abuse. This isn’t something you can just ask someone (e.g. Can you manage your own biases and beliefs about religion well enough to let me experience and explore what I think and feel without trying to convert me?). I think all of them would have said yes. I do think in some way, though, it would have been so much better if I had been able to have an open conversation with each of them early on that gave me some way to assess this. It probably would have felt to them like I was in some way “invading their privacy” by asking about how they think about religion. On the other hand, it would have been well worth it if it helped avoid some of the toxic situations I have gotten into. At this point I only tolerate my current psychiatrist, who spends much of our time together trying to get me to think about religion the way she does or read one of her favorite religious books. I tolerate this because I think she is reasonably competent at prescribing, and I’ve come to accept this as the lowest common denominator. My current therapist recognizes and acknowledges his own religious biases, but is fair in his work with me, and I only see his occasional frustration with my beliefs because I can read him so well.

  • I’ve experienced this many times and clam up and shut off because I feel he’s not going to be forth coming and I am an annoyance, so why bother. I am extremely sensitive to other people’s energy, that hyper vigilance I’ve had my entire life, which stinks. He tells me I study him, and he is correct, constantly watching his body language. It’s telling and kind of fun. As a matter of fact, today I will tell him that he seems different to me over the last several weeks; quieter and not much talking. I can’t tell if it’s my imagination or an excuse to pull away from him. Or, if he’s been pulling away from me. Or, maybe something is going on in his private life. One time I walked into his office and he looked super aggravated. I said, right away, “What’s wrong?” He did tell me he was very frustrated with the previous couple since he was giving his all the them to no avail. I thought, “great, I now get the leftovers for my session.” It worked out. One thing I notice every time he comes to get me is that he will look at me and then his eyes dart away. That always makes me think he is hiding something. Maybe it could be that he’s sometimes “afraid” of me because he never knows what’s going to walk in his office. Me loving him or hating him. Poor guy. Now I email him ahead of time with a warning if I’m going to be a handful. He always appreciates that. Interesting article, as usual. Thank you.

  • I’ve experienced this many times and clam up and shut off because I feel he’s not going to be forth coming and I am an annoyance, so why bother. I am extremely sensitive to other people’s energy, that hyper vigilance I’ve had my entire life, which stinks. He tells me I study him, and he is correct, constantly watching his body language. It’s telling and kind of fun. As a matter of fact, today I will tell him that he seems different to me over the last several weeks; quieter and not much talking. I can’t tell if it’s my imagination or an excuse to pull away from him. Or, if he’s been pulling away from me. Or, maybe something is going on in his private life. One time I walked into his office and he looked super aggravated. I said, right away, “What’s wrong?” He did tell me he was very frustrated with the previous couple since he was giving his all to them to no avail. I thought, “great, I now get the leftovers for my session.” It worked out. One thing I notice every time he comes to get me is that he will look at me and then his eyes dart away. That always makes me think he is hiding something. Maybe it could be that he’s sometimes “afraid” of me because he never knows what’s going to walk in his office. Me loving him or hating him. Poor guy. Now I email him ahead of time with a warning if I’m going to be a handful. He always appreciates that. Interesting article, as usual. Thank you.

    • Dear J, The two instances you report where you communicated with him, you had positive results. Perhaps your belief that he won’t be forthcoming and decision not to tell is premature. Maybe even based more on past experience. Even if he initially avoids answering it is possible to persist that there is a “therapy issue” to talk about. The therapy issue may also be more important than knowing exactly what is going on with him. However I notice that the one time you report his response in detail, he gave more than one might expect, even slightly crossing a boundary by talking about the previous couple. JS

  • Jeffery,

    Thank you for addressing this subject. I think when a patient senses a change in the therapist’s mood (and the patient’s perception is accurate), denying that anything is amiss is actually anti-therapeutic. In general, the therapist should help the patient with his or her reality testing and not sabotage it. And of course it can reinforce dysfunctional relational patterns learned in childhood.

    I recently read a really insightful book, Attachment in Psychotherapy, which combines attachment theory and intersubjective and relational psychotherapy. One of the central premises of intersubjectivity is that the therapist’s irreducible subjectivity affects therapy and the therapeutic relationship. Moment by moment, therapist and patient communicate via non-verbal channels, and the verbal conversation floats on top of this undercurrent of non-verbal communication. A shift in the therapist’s emotional state affects the undercurrent, and most patients will sense the shift whether they’re consciously aware of it or not. Denying the shift confuses the patient, creates an obstacle to progress, and damages the therapeutic relationship.

    The book’s author refers to this non-verbal communication as the “unthought known.”
    It’s a communication between limbic systems. For example, a dog can sense that its owner is sad and will cuddle up to provide comfort. If you try to describe your feelings to the dog verbally, the dog probably won’t understand what you’re saying, but it can sense how you’re feeling anyway.

    In the intersubjective framework, the undercurrent of non-verbal communication is co-constructed by therapist and patient. (In traditional psychoanalysis, everything is “made up” by the patient who is, of course, neurotic.)

    One of the goals of therapy is to help the patient learn to put these non-verbal feelings into words. Oftentimes patients are very bad at this because they didn’t learn it from their parents. Of course, you can never fully describe these feelings in words–so much of it is amorphous. But the more you can describe the feelings, the more you can bring your neo-cortex, the rational part of your brain, to bear on these primitive feelings. This is maybe what integration means–to open the communication channels between the neo-cortex and the limbic system so you can think about what you feel and feel what you think. I don’t know. Now I’m just making things up.

    Before I knew what intersubjectivity was, I saw my relationship with my therapist as a wave made up of two separate waves that interacted destructively at some frequencies and constructively at other frequencies. I would visualize the wave in a box (like particle in a box), bouncing off the walls. Depending on the shape of each of our waves, some frequencies are amplified while others muted. The book calls this reciprocal mutual influence.

    This non-verbal undercurrent is something I’ve been struggling with in therapy. I sensed that something was wrong in the undercurrent but couldn’t put my finger on it. It was amorphous, and I had no words for it. Because I didn’t have words for it, I couldn’t really think about it. (I think in words so without words it’s just…confusing.) For a while I thought I was going crazy. My intellect had never failed me this badly before. Then I read this book and realized this is simply a domain to which my intellect had no access.

    The “wrongness” was co-constructed by us. Some of my feelings and some of his, bouncing off the walls, amplified certain things that felt off. But I think the seed of this weirdness was started by him. I don’t know what it was–maybe he felt guilty about the way I found out he had cancer. I’m only guessing, but, certainly, if I picked up on his guilt, it would confuse me. My confusion would make things weirder between us, causing him to react in other ways that exacerbate the weirdness–a vicious cycle.

    Now, had I confronted him directly (I have not), and he denied anything being wrong, I would, well, I would probably (initially) think I’m crazy. That would be anti-therapeutic. Now I’m pretty sure I’m not crazy. I’m picking up on something real. If he denied it, I don’t think I could continue seeing him. That sort of lying to my face would irreparably damage our relationship.

    I don’t think he would lie to me though. I just don’t have the courage to ask him about it directly. I gave him the book, which is a start.

  • I want to add that I think it takes a lot of courage for a therapist to engage in this kind of self-disclosure (i.e., to tell the patient what’s really going on with them). It’s a lot of weirdness wrapped in awkwardness, and I get it. But if the therapist takes the initiative with this sort of self-disclosure, it helps the patient do the same thing.

    My therapist doesn’t seem to be aware that this is what’s needed. And I *wish* I had the courage to go first, but it’s too hard. I just can’t. I’m nudging him in that direction, and it’s going slowly. But it’s going. We’ll get there eventually.

  • I generally don’t ask my therapist how he is doing, but if I sense something is off, I will. He will give a brief explanation if I ask and we can carry on. knowing that it isn’t my fault that he is not feeling OK makes me more comfortable in sharing.

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