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This is an archive site for the blog Behind The Couch.

As it is an archive, comments are not enabled however you can access the majority of old posts from here.

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Protecting the therapist

Many clients grew up with dysfunctional or mentally ill parents. By “mentally ill” I refer to and include all abusers, manipulators and other psychopaths who are allowed to procreate willy-nilly without any thought of what fucked-up little progeny they are likely to send out into the world.

One of the effects of this, and one of the things that often emerge in therapy is the belief that “grown ups” cannot cope with anything remotely emotionally difficult and must be protected. Parents and subsequently other figures of authority (including, inevitably, therapists) are not seen as reliable or safe and this appears can appear as transference in the therapeutic relationship.

How many client readers have withheld something because they think that their therapist will not be able to cope with it? Or will reject them?

Internalising emotional responsibility
One of the things that crap parents are particularly good at is making the child responsible for the emotions and actions of the parents. This kind of boundary transgression at an early developmental stage results in ill-defined emotional boundaries – and confusion in the sense of “me” as a separate entity to “you” particularly in terms of who owns and takes responsibility for whose emotions.

Example (fictional). My mother is depressed therefore I internalise her depression. I feel everything she feels and she does nothing to prevent this (and may even encourage it) because she has no sense of her own personal boundaries or the needs of her child. This means that in order to tolerate her pain I either have to close off the part of me that feels anything or do everything in my power to protect her from further emotional pain in order to protect myself.

Emotional boundaries
One of the things that we should ideally be able to experience in therapy is a stable relationship with clear boundaries between client and therapist. Of course, there needs to be attunement – the therapist needs to be aware of the clients emotional experiences but must at all times retain a sense of self so as not to be drawn deeply into the clients pain. This is something I believe is taught under the header of “self-care”. I’m sure therapist readers will elucidate in the comments.

By demonstrating the ability to empathise without literally sharing the pain the therapist allows the client to experience and model a new type of behaviour – where boundaries are respected but not at the expense of a close emotional relationship.

This is reason #24,561 why boundaries are important.

Letting go
It is still one of the hardest things to accept that we cannot damage the therapist with our pain. Logically we know that they are trained to deal with the material, that they have supervision and personal support networks etc but emotionally we cannot separate their emotions from our own.

We fear damaging them so that they reject us or, and perhaps more accurately, we fear accessing our own emotions and destroying ourselves.

As always, emotional change takes time and a lot of patience but therapy is so much easier once you get over that initial hurdle. Realising that the therapist is competent and emotionally strong is one of the most liberating experiences that a client with this kind of history can have. But without this realisation, the work is destined to go round in circles and both client and therapist likely to become stuck and frustrated.

It’s so much easier said than done – get over it! just trust someone already! But you can’t trust the therapist until they have proven themselves trustworthy and they cannot prove this unless you give them a chance.

It takes a pretty brave client to break these patterns and move the therapy forward, but a good therapist will be with you every step of the way.

 

Eye contact in therapy

This is a tricky one.

We know that the therapist has to engage the client through eye contact to reinforce attention, empathy etc but really, how much eye contact is necessary?

There appears to be a belief among some therapists (in my experience) that constant eye contact is reassuring for the client and makes us think we have the therapist’s all-important attention.

This is a fallacy.

It’s great to have someone else’s attention, it’s true, especially for those of us whose emotional needs and even existence has been ignored for much of our lives but too much of a good thing is an utterly bizarre experience and quite off-putting.

Do we really need another thing to make us feel embarrassed and awkward or to make therapy more difficult?

A normal level of eye contact is apparently 30-60% of the time in “normal” conversation. More importantly, in normal conversations people do not look each other in the eye.. they look around the room, to left or right when thinking and most importantly, at the speaker’s mouth. Looking someone directly in the eye actually means that you are seeking permission to speak – so what good will a therapist maintaining constant eye contact do a client who is scared to speak in the first place??!!

The only thing I can think of is that it’s a backlash from the traditional Freudian couch setup, some new client-centred approach, or perhaps therapists finally have superpowers.

I have interviewed potential therapists in my therapeutic career who have attempted to nail my head to the wall with their eye-stare superpowers. Anyone who does this is not the therapist for me.

I have worked with therapists who have maintained what they believe to be non-intrusive/non-aggressive attention and frankly it was almost as bad. In fact, I ended up having to ask challenging questions just to get a break from the eternal eye contact and give myself room to breathe and regroup.

(Incidentally, surprising therapists with weird questions makes them look away – they have to think about it and there’s no way they can do all that clever “what does the client want me to say and what is their motivation” double-think whilst maintaining proper eye contact – try it for yourself.)

My own therapist has achieved a bizarrely entertaining combination of eye-contact-when-important and eyes-wandering-all-over the-room-when-it’s-not which makes everything feel much more.. human. It also makes me feel that she is just as human and therefore just as fallible as myself, without us having to have some awful verbal power struggle to achieve this which I have gone through so many times before with previous therapists.

Laser-glare is not a superpower. Being human is.

 

Fantasies

This is an interesting one.

I read over and over, especially in psychoanalytic texts about the client’s “fantasies”. I’ve never quite understood what they mean by this unless they are talking about the occasional desire to defenestrate a previous therapist for being an idiot.. I guess that’s a fantasy.

Or are we talking about erotic fantasies?

Personally, having never been struck down by erotic transference (I think it would be far too complicated for my internal system to deal with) and I can’t quite get my head round it – and no, it’s not just resistance

Having talked about the therapist generally as a fantasised ‘other’ and the idea of creating a straw therapist I would imagine that the term “fantasies” in regards to the therapist are a wider concept than merely sexual fantasies.

There is a quite extensive definition of the term here although it is definitely written in shrink-speak. The upshot of a slightly confusing read is that “fantasy” = anything you imagine to be that isn’t and anything you wish to be that isn’t – whether conscious or unconscious.

Freud links fantasy with desire but he also links dreams with desire and we know it aint necessarily so. Freud’s approach to dreams as well as fantasies and the unconscious have pervaded popular culture and are now perceived as some part of the dark and perverted nature of psychotherapy.

Perhaps this is why, when a therapist asks a client “what are your fantasies?” the client’s first reaction can be to suck the couch up their own ass in a vacuum of paranoid humiliation. But this may be because some therapists lose sight of the connotations of the word outside of the therapeutic situation.

The therapist, when they say this, is (imho) thinking in shrink-speak, not in client-speak. And just as therapists are not psychic, neither are clients.

So what else are “fantasies” if not sexual?

Delusions, daydreams, desires
There are many non-sexual fantasies – even rather vague desires – that may consciously or unconsciously be experienced by the client during their therapy. For example, the client may experience in the transference a desire to be mothered (or fathered) by the therapist.

I’ve read a lot of client accounts and therapist-written case studies and some of the not-so-unusual client “fantasies” described have included wanting to be hugged, wanting to be held, wanting to curl up in the therapist’s lap like a child, wanting to be adopted or be part of the therapist’s “real” life, and generally wanting to be soothed and comforted beyond the simple sitting-in-a-room-together-once-a-week approach.

Now I’m sure that Freudians would say that all of these desires to be mothered are fundamentally sexual and would start bandying around terms such as “oedipal conflict” or “phallic stage” but I would have to disagree (once I’d finished sighing) and say that this is exactly why this kind of valuable material gets repressed by clients in session.

If a client could be educated and told simply that fantasies are not necessarily sexual and certainly not shameful then the embarrassment that these feelings create in the client which can cripple them from continuing the work and may even lead to clients terminating therapy could be reduced and the feelings and desires discussed openly and worked with.

This material, if expressed rather than repressed, would be incredibly useful to the process.

 

Shame and the psychotherapist

We’ve been talking a little about the shame a client feels in revealing past events or deep personal feelings and truths however, to move the conversation sideways a little, I randomly found my way to an article that talked of the shame the therapist feels, rather than the client.

Now don’t get freaked out client-readers, I’m not saying that therapists feel shame regarding your self-disclosure.. this is more of a political post about the perception of the therapist by media, society and themselves.

Many or even most clients are embarrassed to admit they are in therapy, but it seems that equally therapists are reluctant to admit to being therapists for fear of certain reactions.

Shame in a social setting
I hear so many “a therapist goes to a party” jokes that it is clear the last thing you want to do when meeting new people is tell them you are a psychotherapist. It seems the reaction is usually one of fear and suspicion or simply an awkward conversation stopper.

To me it seems this is the standard social reaction to anything where there is ignorance and misinformation. In this case I blame Freud and his big mysterious blank screen of pointlessness. Of course, when I discovered that my friend’s partner was a therapist they got a reaction they probably weren’t expecting and we had a very interesting discussion

Media representations
Firstly, I am not going to talk about ‘In Treatment’ because regular readers will know what I think about that and I have written about media representations of therapists before so I don’t need to repeat myself too much but there is a mystery surrounding the process and with any level of mystery or ignorance you are going to get both morbid fascination and inaccurate media representations. This happens with anything from representation of racial and ethnic groups to homosexual stereotypes and so forth.

Therapist as voyeur
There is a suspicion among the general public that therapists are a strange breed of person who get a kick out of hearing other peoples’ problems. The image appears again in the stereotype of the unresponsive therapist sitting there (e)motionless as a client pours his/her heart out. This is not a helpful image for client or therapist but it is a stereotype that even the most responsive, engaged therapist must acknowledge and work to overcome.

Governmental regulation
With developments in attempted government regulation of psychotherapy in the UK, the wider public is being made aware of the work of therapy but this awareness is tinged with a general suspicion of the efficacy of the practice thanks in great part to the role of the National Health Service.

The NHS offers CBT because it is results-oriented and appears to have a demonstrable return-on-investment for the bean-counters. Often for clients presenting with mental health issues the only “help” available is 12 sessions of CBT and then you’re back on your own. The waiting lists for clients needing more than this are, from my conversations with other UK clients, quite lengthy.

Although CBT may work for some cases of anxiety or depression, it is my opinion that this one-size-fits-all approach is totally inappropriate and ineffectual for many, many people.

For those in the international community who may not be aware, UK residents all pay a fair whack of their salary or earnings to “National Insurance Contributions” from any paid employment from 16 years old onwards. This ensures that people get treated when they get ill “for free” without the need for private health insurance or care plans. As someone who started work at 15 years old and has been paying since the second I turned 16 it’s interesting that I am paying for my own private therapy (as well as NI contributions and income tax) for something way beyond temporary depression. Can I have my money back please Mr Brown?

What does this mean for the client?
Clients are highly aware of everything the therapist gives out – body language, vocal intonation, emotions, vibes, feelings, impressions – and that doesn’t count the actual words they use. But that’s just ‘in the room’.

The client’s impression of the therapist is also a combination of the client’s own internal beliefs and emotional programming, the presence and behaviour of the therapist and of course (and most relevant to this post) the preconceived ideas about therapy that come from the world and society in which both therapist and client live.

Perhaps therefore some of the sense of shame the client feels about being in therapy comes from the shame the therapists feel themselves? Perhaps everything and everyone is connected.

Still, it seems to me that most of the miscommunication and “sense of shame” is around a lack of cohesive and coherent communication either within the various psychoanalytic groups and organisational bodies or with the world at large which is ironic given that these are the people who are teaching us clients how to communicate.

 

Homework – therapy between sessions

Note: I’m writing this to allow for the needs of different personality styles/ages etc because of my DID readership. Much of it may also be relevant for “the integrated”

I thought I’d have a think about the kind of work we can do between sessions. I’m not talking about taking care of yourself (that goes without saying) I’m talking about what some therapists call “homework” – the work we can do on our own to support and help progress the one hour a week of (what one could call ’supervised’) therapy.

Not all therapists set “homework”. It really depends on their training, experience and of course the needs of you, the client.

Even without “official” homework being set, every client and every therapist thinks about the therapy between sessions but for clients, there is a tendency to go round and round the same material in their thinking without getting anywhere – I say this because I’ve been there and as always I doubt I am the only one.

So let’s have a look at some of the things we can do to get this thinking back into a straight line that might lead us somewhere…

There are several ways we can express thoughts, feelings, ideas and so forth. These thoughts and ideas don’t have to be just about therapy, they don’t have to be horrible and triggering and traumatic – they can just be about anything that tells us more about ourselves, our lives and how we relate to the world around us – anything that tells us more about how we think and feel.

This can include:
* Ideas about life in general
* Impressions on the world around us and how we see it
* Our relationships with others (friends, romantic partner, FOO)
* How we connect to people, places, things
* Objects of significance in our lives
* Likes/dislikes (foods, books, films, music)
* Memories, fragments, impressions of the past (not necessarily triggering)
* Dreams and streams of consciousness
* The relationship with the therapist (if you’re feeling brave enough to share!)

So how do we express this?

Writing
There’s something nice about old-school pen and paper but I also like just opening a word doc on my laptop and starting to type and see what comes out like a stream of consciousness – that’s how most of these posts start after all! I guess it also depends how good your typing is!

As someone with a stationery obsession (paper, pens etc.. not standing still..) I use everything from post-its (dangerous amount thereof) to CIAK Italian leather journals. Mmmmm.

Writing doesn’t have to be a re-creation of War and Peace- it can be anything. It can be a few notes on a scrap of note paper, a daily journal entry, a short story, a poem: whatever comes out.

For those who are feeling brave or strong, a letter to someone important can often throw out new material – of course these are not letters that ever have to be sent.

Blogging
I always encourage those with something inside that wants to come out to start a blog. Shit, start several – I have!. One for each subject you want to write about, one for each personality who wants to talk. Who cares if no one reads it? Who cares if you don’t want anyone to read it?

(WordPress has a “private” function so no one can see the nonsense you write as does Livejournal and you can switch off comments on all of them including Blogger)

It’s a great way to keep track of your thinking, observe themes that come up again and again and can be most… therapeutic. You might even meet some like-minded individuals.

Drawing
This is something that can be quite intimidating. Perfectionists and paranoiacs will be unwilling to put pencil to paper or brush to canvas unless they know they will create the next Impression: soleil levant (or should that be Guernica?!). But there is something very primal about humans and drawing – something free and creative that is sometimes lost or beaten out of us in childhood.

Give it a go – you don’t know what you might find out about yourself. Even if it’s just that you can’t draw for shit. Which you knew already, right?

Charts and diagrams
A big piece of paper and a pile of pens laid out on the living room floor can be great for mind-mapping but if your mind is anything like mine then it could become a big pile of scribbles very quickly.

Now, this can be quite therapeutic for those with “littles” who haven’t previously been allowed to ‘make mess’ but on the other hand, those with more of a neat-freak inside might prefer to use something like PowerPoint for clarity and flexibility when mind mapping.

My blog-writing alter approves of PowerPoint 2007 because they have tied links which allow you to create some more complicated diagrams. Basically you can move stuff around without making a huge mess or losing your connections.

Digital scrapbooking / collages
This is one I picked up on from a client on Kathy Broady’s website. Fotofusion is a great product for creating digital collages/scrapbooks and so forth. It’s also great for people trying to extract personalities from dissociative states
(As an alternative to Fotofusion you can of course use Photoshop or PowerPoint or even MS Word)

And although you have to buy the software (I’m sure there are free versions out there somewhere that someone can recommend) there are a lot of sites out there that “give away” digital scrapbooking images which are great for this kind of work. This site links to hundreds of these “freebies”

Music
Anything that helps you feel and express emotions is a good thing. For me, music and lyrics are a huge source of inspiration and there are plenty of places on the web that you can go to find music you like, music you might like, lyrics to songs long-forgotten etc. And any of the words or feelings brought up by music can be incorporated back into any writing, charts, diagrams or drawings.
Last.fm is great for listening to music and finding recommendations
Spotify is my current fave for listening to full free tracks
Pandora is great for song recommendations. They killed it in the UK (dammit) but US residents can still access the site.

(I’m sure there are things I have missed which will be important to clients whose brains work differently from mine so please put other ideas in the comments!)

Although many therapists don’t dictate specific homework tasks, I don’t believe there are any out there who would discourage a client from exploring any other creative or expressive avenue or from bringing that material to session as long as the client is willing to examine and discuss the material produced.

It is a good idea to use this material in session, but I also believe that this kind of activity can be useful for a client to do just for themselves. Not every detail of every activity needs to be shared with your therapist and none of it unless you are 100% happy and confident in their support.

Who knows, as well as finding more out about yourself… you might even enjoy yourself

 

Why is trust important in the therapeutic relationship?

This is a topic that the site gets searched for over and over and I’ve never written about it because the answer(s) seems so darn obvious.

Today I thought to myself; start writing, maybe you’ll think of something new.

So here we go.

Five reasons why trust is important

1. Trust is important in any relationship
Trust is the cornerstone of all relationships because in a relationship we must give something of ourselves – something personal and emotional which is part of the essence of who we are as an individual and we are potentially exposing ourselves to emotional damage if the other person cannot be trusted.

In the therapeutic relationship, although it is an unusual relationship and more one-sided nature than others we will experience so much sensitive material is shared by the client, that issues of trust and safety are magnified exponentially in the client’s mind.

2. Many clients have difficulties trusting others – even/especially therapists
One of the things that takes many people into therapy is the desire for functional, close, emotionally fulfilling relationships which they are struggling to achieve. It is ironic that in order to examine why we cannot trust people enough to have this kind of relationship we must trust the therapist enough to do the work.

Every prior bad experience or disappointment adds to the wall of protection from further harm that is built up around the client and makes it harder for the therapist, or anyone who wants to be a part of the clients’ life, to overcome.

3. Many clients are afraid to trust their therapist
The role of the therapist is one where there is inherently an imbalance of power. The client may have experienced previous abuse of power by caretakers or supposedly “supportive” people in their lives. This suspicion and anticipation of failure of the relationship makes the therapist’s and the client’s jobs even harder.

4. The therapist might be the first person who could be safe to trust
This will make the client more fearful and hesitant to trust because the stakes are higher and further disappointment must be avoided at all costs. With clients, trust is hard to win and easy to lose.

5. Trust is what keeps the relationship going
The trust built in therapy, especially in the early stages (i.e. first 6 months) is the basis for all future work. It is how the client learns that, when an inevitable rupture in the relationship occurs, it can be resolved and healed in time because beneath it all the therapist can be trusted. This is how the client learns to balance their need for trust and security with the fallibility of human existence and not run away when the going gets tough. (NB. as said before there is a difference between a single rupture and repeated failures in the therapeutic frame).

Someone once said to me that therapy can be like a religious experience. As a confirmed atheist I scoffed appropriately however, if you think about it – the idea of creating a therapeutic alliance to do the seemingly impossible work of creating belief in humanity where before there was only betrayal or abuse or dysfunction – and that this should be based on a tenuous thread of trust, on a hope that you won’t be let down this time, on finding that corrective emotional experience that will prove that if one person can be trusted maybe others can in time – well, it has to be seen as something akin to a leap of faith.

 

Breaks in therapy – the benefits to clients

Following on from previous posts about breaks in therapy, (which strangely seem to come about when I have a break in my own) I thought I’d look at the whole thing another way. Just to see if it could be done.

I’ve talked about breaks in therapy and how to cope with them and longer breaks in therapy and how to prepare for them with your therapist and.. well.. just make it through.

I’ve talked about how sometimes you have to take a break when you don’t want to for example when the therapist is ill or has to take some personal time and I’ve talked about the effects of sudden termination.

In all of these posts I have looked at how difficult it can be for the client, how those with challenging attachment patterns can suffer from a kind of traumatic withdrawal and how generally shit it can feel.

However there’s one thing that I haven’t considered before – that when my shrink takes a holiday, I get some time off too!

Why do I get a break? Let’s look at some of the positives:

For the next X weeks:
* I don’t have to talk about stuff I don’t want to talk about
* I don’t have to worry about what I’m going to talk about next week
* I don’t have to worry about “making progress”
* I can spend some time with “real” people
* I can talk about utter rubbish with friends over coffee/beer that isn’t about therapy
* I can focus on work/writing/music/whatever makes me feel creative and alive
* I can forget for a couple of weeks that I might be.. just a little bit.. nuts

And the best bit? I can basically skive off for a few weeks in the knowledge that the therapist will be back and the work will start again.

Now we know that most of the work of therapy is done by the client and we know that most of that work happens between sessions. As much as some therapists may like to think that it is their mighty interventions alone that lead to epiphany and miraculous recovery.. it ain’t so.

So how does this fit with the idea that the client should also take a break?

The thing is, we don’t have to obsess about therapy all the time just because we are “in therapy”. We don’t have to struggle and work at breakneck speed the whole time on a one-man/woman mission to “get better” single handed… on pain of death.. asap.. etc.

Why not?
The therapist is there for a reason. They are there to help us share the burden of all this crap until we make enough sense of it to deal with it on our own. Just because they take a couple of weeks off does not therefore mean that we are supposed to then take back the whole burden for the duration of this break.

What it actually means is that we too can lay down the burden for a couple of weeks and NOT work ourselves to death and NOT obsess and NOT stress about making no progress because, feck it, we’re on holiday too.

It doesn’t mean it’s not sad to be without this support system, it doesn’t mean that we won’t “miss” the person we perceive the therapist to be and it doesn’t mean we won’t have written down reams of material to work through with them when they get back but it does mean that we can take some time for ourselves, just as they have.

We can be kind to ourselves and our loved ones and spend some time building up those “real world” relationships that we are going to need when therapy begins again.

 

Toxic parents and role-reversal in therapy

Talking before about roles and responsibilities in the therapeutic relationship got me thinking about a recent session in which we discussed some experiences from a previous therapy, namely one where the boundaries were so chaotic and the environment so insecure that I spent most of my time protecting myself from the relationship and the therapy itself rather than doing any actual work.

One of the things I am struggling with now, possibly as a result of this experience, is accepting that the new environment is safe and that the new therapist does not have to be protected in order for me to feel protected. And it’s irrational, because I know that for once I couldn’t be more safe – that’s how I know it’s some weird kind of transference issue.

This previous relationship was, ironically, an example of history repeating itself.

And, more importantly, it was an example of the therapist engaging with the client in an abusive relationship – whether they meant to or not.

There are patterns that we take into therapy with us, usually from our primary caregivers. Part of the purpose of therapy for the client to have a corrective emotional experience – to experience what we should have had which would have allowed us to be functional happy people at the first attempt.

Let’s look at some examples:

* If your mother was controlling and manipulative then this is what you will expect from the therapist. You may develop paranoia about his/her intentions which will continue and intensify unless these things are talked about openly so that you can be sure that you’re imaginings and second-guessings are unfounded.

* If you were shouted at or criticised or ignored when you cried as a child then you won’t want to/be able to cry in session. It will take time to believe that the therapist will not behave in the same way.

* If your upbringing was unsafe and abusive then you will live in fear of the therapist until they demonstrate their ability to make you feel safe – over and over again until you actually internalise and accept it.

* If your primary caregiver was incapable of caring for you because of their own dysfunction then you will excuse this failure in other caregivers, professionals and relationships to your detriment because ultimately, you were (then) and are (now) forced to put yourself in the role of the caretaker.

Therefore, if your therapist repeats actions and activities that trigger your insecurities etc over and over without ever resolving this through effective communication then you are continuing the cycles of abuse and bad experience and you simply cannot heal.

It’s true that all therapists will make mistakes and will trigger things in you that they (and perhaps you) did not know were there but the job of a “good” client is to communicate how these events/words/moments are experienced and the job of a “good” therapist is to be open and willing to discuss, not to deny that something happened and to see it from the client’s perspective so that the therapy can be moved forward with increased understanding of each others’ needs in the relationship.

But there are times when this doesn’t happen, when the client’s appeals are not listened to and this only worsens the client’s trauma. This is particularly significant where a client is still influenced by the ongoing relationship with their FOO in the world outside of session.

An ongoing, damaging attachment to a toxic parent is one thing, but an attachment to a therapist who cannot see their role in repeating these behaviours is unacceptable.

I guess the message is this – don’t let attachment to a bad/less-than-wonderful therapist prevent you from getting what you need from therapy or from seeking help elsewhere.

There is no reason for history to repeat itself if you don’t want it to.

This may be the first time in your life where you have a choice.

 

The desire to punish the therapist

Following previous discussions about the role of acting-out and resistance I thought I’d take a look at how we (the clients) can use these behaviours as a way of punishing our therapists.

Now as I’ve said about a squillion times, despite its reputation amongst therapists, resistance is not futile it’s there for a reason and its part of the process of therapy. Resistance is how we identify what really matters, what our frustrated needs are and how we behave in a less than functional manner – all the things that need to be worked on in therapy so that we don’t make a self-destructive prat of ourselves in the real world.

There are many things about the therapeutic relationship that can be frustrating for the client, many of which remain in the subconscious and only emerge through our reactions and interactions with the therapist. These are the frustrations and disappointments that can be expressed as resistance and a desire to punish them. But in many ways in this relationship we are as powerless (or rather feel as powerless) as a child – perhaps as we did ourselves as a child. And how can a child take revenge on a parent? Why by acting-out of course.

What might remain unspoken?
There are so many things that we as clients don’t feel we have the right to complain about. Sometimes it’s true we don’t have a right (i.e. when it relates to the therapist’s “real” life) and sometimes we do have a right to express our dissatisfaction (i.e. when it relates to our own therapy). The difficulty for the client is knowing when complaint is permitted and when it is not. This is something we will ideally learn with the therapist in time as we begin to express our needs.

Some of the events that occur within the relationship that may result in these needs being frustrated and the ones that are least likely to be raised by the client are:

* An inappropriate/inaccurate/poorly timed intervention
* A poor/emotionally unsupportive reaction from the therapist
* The therapist taking a break from the therapy (e.g. a vacation)
* The therapist cancelling or rescheduling sessions
* The existence of the therapist in the “real world” (e.g. having a life, a family)
* The client’s awareness of other clients
* The therapist’s availability (or lack thereof) between sessions

These are all things that happen in the relationship and in the “real world” because the therapist is a real-life human being and, if they are a good therapist and a well-balanced individual, they will have other commitments, a real life and take vacations from time to time.

Any or all of these factors can trigger needs in the client. They can stir up a client’s anxieties, frustrated attachment needs, or jealousies. These emotions can often leave the client feeling (rather ridiculously and embarrassingly) like a small stroppy child. This makes it even harder for us to acknowledge or express our feelings about the relationship.

What are the types of resistance that manifest?
There are things that clients may find themselves doing that are totally out of character, especially if they are normally a rational, sensible human being in the “real world”.

This can include:

* Extended silences in session
* Inability/unwillingness to do the work
* Skipping sessions
* Late attendance
* Bouncing checks / late payment
* Avoiding certain subjects entirely
* Refusal to talk about the relationship between therapist and client
* Hostile reactions/overreactions to the therapist and the work

It is natural for the client to use any or all of these methods to “punish” the therapist for their inability to meet our needs; “natural” in terms of the therapeutic process but not acceptable in the longer term.

This is partly because these kinds of passive-aggressive punishment behaviours are not worthy of us (they are worthy of our manipulative, controlling parents!) and partly because by missing sessions or even quitting altogether we are in fact not punishing the therapist – we are punishing ourselves. And we know this deep down, we just have to admit it.

These are all things that will be seen as acting-out which of course they are – because in all of these examples the client is breaking the agreement of the therapeutic relationship. Naturally, some behaviours are more difficult to accept than others (to be a little controversial I’m sure the therapist would prefer a silent client to a non-paying one…) but these actions all need to be identified and discussed… as generally unpleasant and cringeworthy as the experience will be.

Clients and therapists both need to look on this behaviour as a different means of communication, rather than the client being “resistant” and troublesome or childish and regressed. Admittedly many of these are not very constructive means of communication but they are an attempt at least – even if they have something of the pre-verbal about them.

For many clients these behaviours are the first step on the path to actually being able to verbalise needs and explain in a more functional way to the therapist and eventually to other people in their lives exactly what it is they need and find a way by mutual discussion in which a compromise can be reached and everyone’s needs can be met.

The first step though is for the client to work with the therapist to develop an awareness of their own reactions (as embarrassing as they may be) and to try and communicate their needs – otherwise both therapist and client are working in a vacuum.