Despite spending years in my own therapy, attending graduate school, receiving excellent supervision, and working as a therapist for the past couple of years, I am still in the process of discovering what exactly people find so healing about therapy. Is it the experience of empathy and unconditional positive regard? Perhaps it’s the space to express repressed thoughts and emotions? Then again, some people say it’s the reparative attachment relationship. Others feel that it’s the wisdom and insight of the therapist that’s paramount.
In my previous post, I shared my belief that clients heal most when they can express themselves fully without fear of judgment and retaliation. So, when a friend expressed that her most pivotal moment in therapy occurred when her therapist expressed helplessness and despair, I was intrigued. Didn’t she want her therapist to be strong and confident? How could my friend feel safe to be herself if her therapist was so reactive? To me, this sounded like an unethical experience of countertransference. I needed to understand more.
Her therapist helped Ella to check the facts, reflected on the possibility of transference, and continued to offer a reparative attachment relationship. Ella knew that her emotions were irrational. She would lash out and her therapist would not retaliate. What more proof did she need that her therapist was not going anywhere?
About a year and a half into their course of therapy, Ella’s therapist informed her that she would be taking two weeks off for a vacation. Ella expressed fear and worry and accused her therapist of abandoning her. Her therapist listened to her nondefensively, validated her experience, and helped her cope forward.
Ella worked through object constancy and knew intellectually that her intense emotions were a reenactment from her childhood. While her therapist was away, she used every strategy from self-compassion and acceptance skills to reframing her thoughts. She engaged in distress tolerance skills and tried to keep herself busy. She reminded herself repeatedly that a temporary break does not mean the relationship is over. But her emotions got the better of her and she texted her therapist with a suicide threat. Luckily, despite being on vacation, her therapist noticed the text. She contacted Ella’s emergency contact who was thankfully able to deescalate the situation.
Upon her therapist’s return, Ella and her therapist met for a session. As soon as Ella walked into the room, her therapist burst into sobs. Through her tears, she shared that she was overwhelmed and unsure if she could help Ella, who was expecting therapy to save her from herself. Although she had wished to help Ella, the burden was too much for the therapist to bear.
After hearing this story, I was perplexed. How could Ella have found this experience to be so therapeutic? I thought the therapist had been way too honest about her feelings. She sounded judgmental, hurtful, and perhaps even a bit self-centered. What right did she have to hijack the session with her own fears? I would’ve been devastated if my therapist were to react this way.
Ella, however, was relieved. She had experienced the tears as a piercing jolt of reality that cut straight through her debilitating insecurities. She had been unable to synthesize her rational thoughts with her internal emotional experience. While she “knew” rationally that her therapist cared about her wellbeing, she had never been able to “feel” it. She could not get herself out of the insidious loop of doubting and testing. She had been heading towards a self-fulfilling prophecy and the reaction of her therapist stopped her in her tracks.
After this incident, Ella’s behavior shifted dramatically. She and her therapist had a meaningful repair and they continued to work together for another couple of years. She shares that although she continued to struggle with doubts, both in and out of therapy, she learned to accept her intense emotions while also choosing more effective ways to navigate them.
File under: The Art of Psychotherapy, Musings and Reflections
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In my previous post, I shared my belief that clients heal most when they can express themselves fully without fear of judgment and retaliation. So, when a friend expressed that her most pivotal moment in therapy occurred when her therapist expressed helplessness and despair, I was intrigued. Didn’t she want her therapist to be strong and confident? How could my friend feel safe to be herself if her therapist was so reactive? To me, this sounded like an unethical experience of countertransference. I needed to understand more.
Countertransference or Therapeutic Transparency
Ella (not her real name) had been questioning her therapist’s care and commitment relentlessly. Despite many conversations and ongoing reassurance, Ella continued to doubt that her therapist had her best interest in mind. While she repeatedly challenged and tested her therapist, they would continue to show up unconditionally without judgment.Her therapist helped Ella to check the facts, reflected on the possibility of transference, and continued to offer a reparative attachment relationship. Ella knew that her emotions were irrational. She would lash out and her therapist would not retaliate. What more proof did she need that her therapist was not going anywhere?
About a year and a half into their course of therapy, Ella’s therapist informed her that she would be taking two weeks off for a vacation. Ella expressed fear and worry and accused her therapist of abandoning her. Her therapist listened to her nondefensively, validated her experience, and helped her cope forward.
Ella worked through object constancy and knew intellectually that her intense emotions were a reenactment from her childhood. While her therapist was away, she used every strategy from self-compassion and acceptance skills to reframing her thoughts. She engaged in distress tolerance skills and tried to keep herself busy. She reminded herself repeatedly that a temporary break does not mean the relationship is over. But her emotions got the better of her and she texted her therapist with a suicide threat. Luckily, despite being on vacation, her therapist noticed the text. She contacted Ella’s emergency contact who was thankfully able to deescalate the situation.
Upon her therapist’s return, Ella and her therapist met for a session. As soon as Ella walked into the room, her therapist burst into sobs. Through her tears, she shared that she was overwhelmed and unsure if she could help Ella, who was expecting therapy to save her from herself. Although she had wished to help Ella, the burden was too much for the therapist to bear.
After hearing this story, I was perplexed. How could Ella have found this experience to be so therapeutic? I thought the therapist had been way too honest about her feelings. She sounded judgmental, hurtful, and perhaps even a bit self-centered. What right did she have to hijack the session with her own fears? I would’ve been devastated if my therapist were to react this way.
Ella, however, was relieved. She had experienced the tears as a piercing jolt of reality that cut straight through her debilitating insecurities. She had been unable to synthesize her rational thoughts with her internal emotional experience. While she “knew” rationally that her therapist cared about her wellbeing, she had never been able to “feel” it. She could not get herself out of the insidious loop of doubting and testing. She had been heading towards a self-fulfilling prophecy and the reaction of her therapist stopped her in her tracks.
After this incident, Ella’s behavior shifted dramatically. She and her therapist had a meaningful repair and they continued to work together for another couple of years. She shares that although she continued to struggle with doubts, both in and out of therapy, she learned to accept her intense emotions while also choosing more effective ways to navigate them.
***
I’ve learned a lot from Ella’s story. Sometimes the most powerful tool that we have as therapists is simply our own feelings. We can be the first person to be brave and honest enough to reflect on their impact. Others may have responded with anger and accusations towards them but that’s not the same as honesty. That’s defensive and retaliatory. I’m suggesting that sometimes, what a client needs is a chance to see themselves in a mirror. And when we are certain that we have built enough safety in our relationship with them, I think being vulnerable and honest enough to share our feelings may be the biggest gift we can give them.
Questions for Reflection and Discussion
Do you agree or disagree with the notion that honesty is more important in therapy than empathy?
What are your limits of expressing your feelings with a client?
How did you address a challenging situation in therapy around expressing your feelings?
File under: The Art of Psychotherapy, Musings and Reflections