Counseling Conversations with a Therapist

Oh, heavens to Betsy and land sakes alive, I do indeedy do! There's the usual anticipatory nervous excitement in meeting a new client, a stranger whom I know only through a cursory phone conversation. On the other hand, I don't want to make too much of this. I really don't expect to find Alex Forrest (Fatal Attraction) or Hannibal Lecter (need I say more) in my waiting room someday!

All kidding aside, the demands made on psychotherapists are uniquely challenging. From my perspective, I do my best to be emotionally grounded, in the present moment, and hopefully aware of clients' nuances, both verbal and non-verbal. I have to think on my feet, because I never know what issues will present.

In short, I have to be prepared to be unprepared!

And sometimes I say the wrong thing. But what hopefully happens is that my client will object (sometimes non-verbally), and then I can clarify, qualify, or if needed, apologize. Paradoxically, these misattunements can be the most opportune moments for a client. This is because we are both so intensely aware of our presence in the therapeutic relationship.

And, shifts that occur "organically" that is, spontaneously from within our interaction, are those that have a good chance of being long lasting!

For me, the most challenging and rewarding aspect of being a therapist is recognizing and attending to my own emotional limitations. Deficiencies in knowledge and skill can eventually be overcome by experience, but my ability to stay with my client, to be empathic, to be attuned to their emotional processes, can be won only through intensive work on my own issues.

Remember, we all have our stuff!

Here is one example of how my professional effectiveness will be limited if I am not on top of my own issues.

Shame is one of the most difficult emotions to feel. In fact, when we observe another person experiencing shame, it can trigger the same emotion in us. We might even want to turn away. Of course, if we do avert our eyes, this can leave the person vulnerable to feeling even more alone and disconnected.

Imagine you are a client...

Imagine you are a client telling me how you embarrassed yourself by using nasty words in an argument with your partner. As you relate this event, suddenly I'm flooded with my own sensations of shame. Instinctively, my eyes momentarily dart away as I attempt to manage it.

Noticing your shame had triggered my own, and my automatic (i.e. not conscious) response was to pull away. In that instance, I could not "contain" you. I failed to help you transition from a shamed emotional state to a felt connection with another human being--me. Bye-bye attunement!

While you may not have observed this shift in gaze, at another level you registered it. As you felt my withdrawal, you immediately changed the subject to avoid feeling discomfort any longer.

Here's a different scenario.

Imagine that I have sufficiently worked through my own feelings of shame in psychotherapy. This time when you talk about those "nasty" words, I am not easily flooded and can stay connected with you, helping you move through the shame. Maintaining an "attuned" gaze along with the non-verbal aspects of my body posture and tone of voice help make this a counseling moment.

With this added support, you were able to feel the shame and move through it rather than quickly dismissing it. In so doing, your nervous system learned how to contain this uncomfortable emotional state...because the best way to change how you experience an emotion, is to experience it. In other words, if you can't feel it, you can't heal it!

An aside: How change occurs

Over the course of your counseling, moments like these add up. Some are significant "aha" moments while others are fleeting. Cumulatively, they begin to change how you internally respond to your own emotions. You feel stronger.

So in this way, and in a hundred other ways, you see why it's so important that therapists continue their personal work throughout their professional lives.

Especially for therapists.

It's so ironic, given this is a personal growth business, that the care and development of our most important resource--ourselves--continues to be devalued!

This was such an interesting question I decided to consult with Dr. Carole. We were both in agreement that a therapist must "like" the client.

That said, we admit that some people are more "challenging" to like, which of course is why they have come to see us in the first place (whether they know this or not). In this instance, we feel that the therapist must find some essential part of the client that is valued or honoured in order to establish a therapeutic connection.

Sometimes it's a very small part, but that's all you need. You see, psychotherapy isn't about, nor does it require, therapist and client becoming best friends.

We also believe that if the therapist is not able to "like" the client he or she is vulnerable to unconsciously pushing the client away. Not surprisingly, the client will unconsciously (and sometimes even consciously) sense the therapist's negative attitude and feel that something is not right...with unsettling moments in the therapeutic relationship.

Speaking as therapists

Even at our therapeutic best with "unconditional positive regard", the process can still fall short. And we don't do this all by ourselves. You see, as a client, you have so much to contribute. In other words, you have the responsibility of "showing up". Walking in the door is not enough!

This is a tricky question. Dr. Carole and I both felt that if the fit isn't good a therapist should refer the client to another practitioner. However, we were not optimistic that some therapists would do this.

We recognize that a therapist's rigidity towards a particular treatment method and/or factors like ego, (for example, success is about "keeping" patients) can interfere with what is best for an individual client.

And, as you may surmise, not all therapists believe in the power of attunement. Some feel that while it might be nice to have a good connection, it's not essential for therapeutic change.

From our perspective, it's imperative that you feel the therapist "likes" you, that he or she gets you. Admittedly this is not easy to discern when you're stuck in the middle of emotional pain!

On the other hand, we both agree that you actually know more than you "know"--if you get our drift!

And handily enough, this is what MyShrink is about - helping you to decipher what works and, what doesn't.