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When Therapy Isn't Helpful

4/15/2015

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There are three specific factors within the therapeutic arena that I believe, whenever present, greatly minimize the client’s ability to experience any significant, long-term results.  I doubt that these are the only factors that would minimize results but in my estimation, based on what I’ve observed and experienced, they are probably the most common and influential.

The first factor would be what the client brings to the experience. In past articles, I’ve touched on the understanding that everyone who seeks out this venue of support is going to have some degree of anxiety due to the awareness that they are embarking on a journey into the unknown and that their life, as they know it, is about to change. In order for this process to be successful, well-honed defense mechanisms will need to be surrendered in order to allow the therapist to take them to the places that they have resisted going for so long.  I’ve come to understand that the extent to which the client has been traumatized or ‘shattered’ correlates directly to the degree of resistance that the he or she brings to the therapeutic experience. Resistance is inherent in all defense mechanisms and is informed exclusively by fear. It is important for the therapist to recognize this because this understanding should be informing the style and pace at which the therapist proceeds in order to ensure that they do not overwhelm or further traumatize the individual. However, sometimes the fear and resistance is so great that the client is unable to move beyond their story and the need to tell it over and over again.
Part of their story always includes the need to continuously identify that the environment, and individuals within it, are responsible for their current, undesirable situation. Consistent with this orientation is an over-reliance on the therapist or the ‘expert’ to ‘fix’ whatever they've identified is wrong. Very little progress can be made as long as the client holds strong to this position.

Such a position is largely being informed by what has yet to be resolved from the original trauma(s) including the individual’s emotional age at the time they experienced the traumatic event.  It is this aspect, the younger version of his or herself, that has so much difficulty letting go and trusting that they are safe in the present moment.  It is this younger version that has so much difficulty letting go of the need to blame others for whatever it is that they are experiencing that is undesirable and unwelcome. So even though I may have a 48 year old high-powered executive in front of me; I am also aware that it is his 6 year old self is who is making sure we don’t move forward too quickly, if at all, into dangerous, unchartered, and forbidden territory.  My job is to increase his sense of safety and security so that he can relax and feel safe enough to begin to let go of his story and allow himself to be exposed, transparent, and vulnerable; to be truly ‘seen’, not as a victim but as someone who has the capacity to change his experience without fear or resistance.

The second factor that minimizes the potential for long-term, significant changes in the client’s life would be what the therapist brings to the experience.  In the article “Finding a Therapist”, I identified the importance of working with someone who is continuously giving attention to their own healing process in order to ensure that they bring the greatest degree of awareness to their practice.  This quality of awareness creates a resonance between the therapist and the client because it is inherently understood that the client is merely a reflection and the process that the therapist is facilitating is not unlike any other process they facilitate for any other client, including the one they facilitate for them self.  This awareness is what fosters empathy and compassion for the client; the absence of which ensures that there will always be a power dynamic between the therapist and the client. In the absence of working on the self or identifying that there is even a need to, the therapist will always be posturing unconsciously within an “I’m okay, you’re not” attitude which is always being reinforced by the need to be seen as the ‘expert’.  This style of posturing always goes hand in hand with a strong attachment, on the therapist’s part, to a particular outcome. After all, they are the ‘expert’ and how much progress the client does or doesn’t make will be perceived by them as a measure of how good they are as a therapist. The problem with this approach is that it has as much, if not more, to do with meeting the therapist’s needs as it does the client’s. 
Another measure of this dynamic being present is when the therapist insists on pathologizing the client’s behaviors because as the ‘expert’, it now becomes their job to 'fix' whatever they have identified is wrong. When present, this dynamic will always serve to reinforce the client’s victimology because once again, as in childhood, they are in engaged in a relationship with an ‘authoritative figure’ who has complete control over their experience. Within such a relationship dynamic the client will never be able to resolve the
trauma(s) that continue to inform their beliefs, their behaviors and their relationship patterns.


The third and final factor refers to the style of therapy being proffered.  I am aware that the style and manner in which I acquired my clinical training that has informed my practice will always carry an inherent bias on the subject of “what works”. However, my identification of “what doesn’t work” is largely being informed by my own experiences as a client and what my collective clientele over the past ten years has shared with me. As a result, I would have to conclude that most of what is being proffered as therapy doesn’t result in any long-term significant changes for the client.  I also believe that this collective experience further reinforces the on-going stigma associated with therapy as not being a reliable or meaningful venue for any significant healing, but rather a place where people can go to vent and project blame onto other family members, or talk in great length about what it isn’t about. The majority of clients whom I’ve worked with and who span the full range of demographics have experienced significant frustration and even some trauma within the therapeutic realm. Over time, I came to understand that this was not an anomaly but rather an experience more common than one would imagine given the inherent oxymoronic nature of such an experience.

Recently a client came to me for issues related to grief brought on by the recent passing of her cat. The first thing she identified was that she was referred to me by a friend when the therapist that she had been seeing for the past thirteen years retired. My immediate response was to identify that if we were still working together thirteen years from now then that would be evidence of me not doing my job very well. As it turns out, her previous therapist had allowed her to come in every week for thirteen years and essentially talk about what her issues weren’t about. I understood this to be the case because by our third session I was able to identify that her grief issues had very little to do with her beloved cat and more to do with her significant history of domestic violence, abuse, incest and subsequent removal from her family of origin as a young child. She acknowledged that this was not an area she had ever been able to explore with her previous therapist despite having seen her for weekly sessions over a period of thirteen years. After our third session she contacted me to let me know that she had decided instead to work with an animal communicator to help her work through her unresolved grief. I had no judgement regarding her inability to journey down a path that at this time would have required her to let go of the story that the overwhelming pain and suffering she was experiencing was from the recent demise of her 14 year old cat. However, I also believe that she had been strongly conditioned by her previous therapeutic experience to avoid the difficult trauma material and that a large part of this conditioning was evidenced by her over-reliance and extreme dependence on her therapist during the course of their long-term relationship.

Creating a co-dependent relationship with the client is not an uncommon occurrence and a perfect example of when therapy has become the problem. Becoming the problem is something that a therapist would want to avoid as much as possible all of the time in order to ensure that the therapeutic framework in which they are operating from is not reinforcing the client’s or the family's trauma and resulting dysfunctional patterns.  Only then is it possible to facilitate an experience for the client that might actually result in significant, long-term changes which would include moving them beyond their victimology and into a more aware, coherent, and empowered expression of the self.

 

 


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The Therapeutic Relationship

4/2/2015

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I believe that the relationship between a client and a therapist is sacred. It is not unlike what an individual would expect to experience when seeking wise counsel from a pastor, a priest, a rabbi, a shaman, or any spiritual teacher.  And yet, in my opinion, it involves so much more.  In addition to being a trusted confidante, one of the therapist’s roles is to create a safe and sacred space that allows the client to connect with and excavate difficult, threatening, and traumatic material in a way that does not overwhelm or further traumatize them. This takes incredible skill and intuitive abilities on the therapist’s part which, ideally, is being expressed with tremendous reverence and compassion for the process at hand. I believe that very little long-term, significant change can occur for the client if the therapist is not able to express from the heart.  And because of this, I believe that what makes this relationship the most sacred is that in order for it to be dynamic and effective,  it requires a great deal of intimacy.

 

Now I added an extra space between these two paragraphs to let my readers ponder a little longer on what it was I just said. I did this because I suspect that it will have set off some ethical alarm bells in a few folks.

“Surely, she didn’t mean intimacy?”

Yes. She did.

“Perhaps it’s a typo.”

Nope. It’s not.

I learned many years ago when studying with my indigenous, wisdom teachers that the highest frequency through which any of us can express while in this physical body and engaged with ourselves or another living being, is the heart. There is much research to support this claim. None of which, however, we’re going to discuss in this article. But suffice to say, it is my premise that very little healing can occur in the absence of a space or a relationship filled with heart. We’ll explore these ideas further in subsequent articles entitled: “Compassion Fatigue”, “What’s Love Got to do With it?”, and “The Dance of Relationship”.

Let’s start by identifying that intimacy does not infer the absence of boundaries. When studying to become a mental health counselor and when taking the examination in your respective state to become licensed, much of the material is devoted to learning what the ethical guidelines are that govern the therapeutic relationship. However, in order to become a truly effective ‘agent of change’; it is important to develop the ability to hang out very close to the edge of these guidelines without crossing over into forbidden territory. I credit my success in being able to do this with the fact that I am one of those therapists who is constantly working on themselves in an effort to bring as much awareness to the moment regarding how I might be getting in the way of the client’s process in order to ensure that I don’t.

The most important boundary to be maintained involves the understanding of what happens when the therapist becomes ‘inducted’ into the individual’s or family’s dysfunctional patterns.  Text books teach us about ‘transference’ and ‘counter-transference’ between a client and a therapist and identify it mostly as a bad thing that the practitioner would want to avoid at all times. This is in reference to a client engaging with the therapist as if he or she were the individual whom the client has the most unresolved material with such as a primary care giver from childhood. When the therapist is unaware that these projections are occurring and unconsciously becomes defensive by responding with their own projections; it is at this point that the therapist has become ‘inducted’. The job of the therapist is to help the client identify their own dysfunctional patterns and change them. In order to do this it is important to ensure that the therapist not become part of the dysfunctional patterns.

One of the most common forms of ‘induction’ that I have experienced is in working with individuals or families that generate and feed off of a lot of drama and chaos. It’s very easy to get pulled into this because there is a very real and palpable energetic vortex around chaos and drama. It will touch in on and trigger all of our cellular imprinting around survival including when ours hung in the balance. So when sitting with someone whose adrenals become activated while telling their story about who did what to whom and why; it’s hard not to notice how easy it is for our adrenals to become activated. The trick is to just notice it without responding to it.  And this is one example of what I was referring to in the last article when I identified that the therapist’s shtuff is always going to be in the room. What’s important is that they know it and not defend that it’s true when engaged with the client regarding the client’s shtuff. After all, the client is paying you to focus on their shtuff. So a perfect example of the therapist maintaining appropriate boundaries in this case is to ensure that they are in control of the session by not allowing the client to continue to ‘spin’ in their vortex of chaos and drama.  This can be achieved with heart and loving kindness. Boundaries are actually evidence of heartfelt, loving kindness being expressed because they are, by their very existence, evidence that the self and the other are considered sacred and worthy of consideration.

In addition to practicing from the heart, intimacy requires that there be transparency in the relationship and transparency is best achieved when the therapist is able to be empathic. During the 1980’s and 1990’s, an Italian neurophysiologist, Dr. Rizzolatti, discovered mirror neurons in the frontal lobes of the brain which are neurons that ‘fire’ when we perform an action as well as observe the same action in others. Further research using fMRI’s has demonstrated that this mirroring system is the neural basis of the human capacity for emotions such as empathy. Empathy is feeling and experiencing what the other is feeling and experiencing while always maintaining focus on, and directing attention to, the other. Being able to do this allows you to acknowledge and affirm the other’s experience on a much deeper level than is usually achieved in a casual relationship.

Over the years, I have stopped counting how many times a client has unburdened a deeply held secret for the first time in one of our sessions. They could not tell their wife, husband, mother, father, best friend, pastor, priest, rabbi, shaman, or spiritual teacher but for some reason they were able to tell me. I’ve come to understand that this level of intimacy is only possible when the therapeutic ‘space’ that is being ‘held’ for the client is filled with heart and absent of any judgment as evidenced by my ability to empathize with what they are feeling in the moment which usually includes excruciating levels of pain, shame and guilt. It takes tremendous 'presence', 'strength', and 'stamina' to hold this quality of 'space' for any length of time. But, whenever possible, the results are deeply moving and profoundly sacred. I've come to understand that this is the space in which miracles happen and I never cease to be humbled by the courage and grace that my clients continue to bring to this experience.

Reverence, compassion, and heartfelt, loving kindness are all hallmarks of a sacred experience. Any relationship that occurs within this ‘space’ would be considered intimate. Maintaining this frequency along with appropriate therapeutic boundaries allows for the client to experience emotional safety in a way never before experienced in any other relationship. This renewed sense of safety lays the groundwork for the client to have a corrective emotional experience. Only when the client feels this degree of safety can they allow themselves to drop their defense mechanisms and become truly transparent. Only then, when the client allows themselves to be truly 'seen', can any significant, long-term changes occur.


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    Author

    Kate O'Connell is a licensed Child and Family Therapist with a private practice in Charlottesville, Virginia addressing the therapeutic needs of children, adults, adolescents, couples and families. Her extensive training in Intensive In-Home Services,  Addiction, Family Systems Therapy and Energy Medicine enables her to facilitate positive outcomes for her clients dealing with a variety of emotional and mental health issues.

    



    

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Copyright 2015 Kate O'Connell, LPC