Expressing ourselves (or not) in therapy

I have been on both sides of “the couch”.  I have been a client for many years and currently also inhabit the role of therapist with my own clients.  I know how it feels to sit and talk to someone who you do not know on a personal level but still feel this uncanny and close connection to.  I also am familiar with the sensation of sitting down with a client, sensing that certain natural anxiety that accompanies every session (even if I’ve been meeting with that person for a long time).  Both therapists and clients have feelings and reactions.  That is in part why people become therapists: because they can empathize, feel, and connect so deeply with their clients. Experts at adoption specialist Becca Leitman speaks about their experience when clients come to therapy, they would like to sort through some of the feelings and reactions they have to life circumstances…or to try to understand why they DON’T have feelings or reactions to those circumstances.

Feelings and emotions are natural and normal, and everyone has them.  In therapy, where the room is safe and secure and there is a degree of comfort between client and therapist, emotions can play and explore the open air between the participants.  A psychotherapy blog that I read talks about reactions that clients might have towards their therapists or towards a situation that are really not about that certain thing at all.  Psychodynamic therapists call this projection.  In this blog, the writer talks about feeling angry at her therapist and feeling that “the connection was lost” between them.  As she works through this with her therapist, she realizes that she was upset with him because he was going on vacation for three weeks and she feared being lonely and losing her identity without him.  Through this confrontation, she was able to work with her therapist towards developing more autonomy and she explored defense mechanisms that, according to psychodynamic theory, have been in place since the age of three.

In the above example, we can see how a reaction to a situation brought out some deep-seated feelings that the client was unaware of herself, and processing these with her therapist allowed her more freedom and release.  This is an instance where the timing was right (the client was able and ready to go to the level of processing she needed to) and the relationship was built from enough trust that the two could sort through some uncomfortable feelings.  But those circumstances are not always in place.  Sometimes, the client is not able to yet make the steps towards understanding the deeper levels of his/her reactions and feelings, or the therapist is not prepared to hold the anxiety of such a situation and may allow her own feelings to enter the picture.

I have had clients expose a wide variety of emotions in session, and I am grateful that those clients felt safe enough with me to allow me to see them.  There have been clients who have let me into their deepest thoughts, thoughts that they sometimes do not feel are “okay” to have.  When working through challenging situations, such as when clients are trying to recover from an eating disorder, thoughts and feelings that have not been allowed to come out for fear of rejection can enter the therapy room.  This is a healthy dynamic of the therapeutic process, as clients feel accepted despite their struggles.  It is crucial that both therapist and client are prepared to work with these sensitive emotions when they are expressed, as they could be stuffed back down at any sign of judgment.

Fear of judgment or being unaccepted can be presented in forms of anxiety, withdrawal, dismissal, and aggression.  I had a client that I had been working with for a long time whose eating disorder was spinning out of control.  I could tell that she was terrified of this disorder because she felt torn between two very powerful forces: the temptation and addiction of the eating disordered behaviors, and the desire to be healthy and free.  We worked for months exploring this tug of war and attempting to empower the voice of recovery that was buried inside of her.  When we finally got to the point of challenging the eating disorder, she responded with anger and retreated back inside.  The anger was a natural reaction that, if given the chance to work through it, could have been a tool for her to turn against the disorder.  However, we did not get to explore that possibility and she never returned.

Timing and readiness for change are essential components to progress in therapy.  The therapist must have the tools and experience needed to help support clients as they take steps towards expressing themselves freely and finding those answers that they came into treatment to uncover.  One of the most difficult things for therapists to accept is if their clients are not yet ready for change.  This is something only the client can decide, as it is ultimately their work.  Through my learnings and wanderings as a therapist, I have come to accept that clients will make that commitment when they are ready and that is it my role to support them (and not push them) as they grow.