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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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    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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