From One Therapist to Another - Potential Hazards in Individual Therapy: Part 2
“ I know you think you understand what you thought I said but I'm not sure you realize that what you heard is not what I meant”
Rod Coombs, Stealers Wheel album or Alan Greenspan
In Part 1, I talked about how a change, even a very positive change, can disrupt a client's relationships if the systemic or interpersonal consequences of the change are not considered. I gave an example where I totally failed to consider this with a client which resulted in the client's partner believing that therapy was hurting his wife. I'm not saying we shouldn't conduct individual therapy, of course, but I am advocating considering tenets from systems thinking when doing so.
Tenets of a Systems Perspective
•Individuals are only one part of system
•We live our lives through our relationships
•Sense of self is formed and maintained in the context of our relationships
•When relationships go wrong, powerful psychological processes arise and we may lose our sense of self
•Diagnostic problems (depression, anxiety) are often side effects of relationship problems
•When someone is in distress, look for relationships that have gone awry (Stratton 2010)
In this blog, I'd like to focus on the third tenet in that much of our sense of self is formed an maintained in the context of our relationships. Thus, the narrative that we develop about ourselves and others is developed primarily through early relationships and then usually maintained mindlessly and projected onto others throughout adulthood. Thus, another potential problem in conducting individual therapy is not fully understanding how a narrative may be operating when the person is talking with us in our individual sessions. The potential hazard is siding with a patient when they are talking about another person who is not in the room and you've never met. The hazard here is not being aware of which parts of the story that you are hearing are distorted. Notice I didn't say if, but which part, because we all have distortion in our perspectives.
If you are like me and most other therapists, you have sometimes done the following:
You allow your client to spend too much time talking about people not present during the session.
You offer an opinion about someone you haven't met, as in "It sounds like narcissim."
You express surprise about the other person's reported actions such as, "I can't believe you were treated that way."
There is a strong interpersonal pull to do all these things when someone is talking about others in their life.
Thus, another potential problem in conducting individual therapy is
not fully understanding how a narrative may be operating when
the person is talking with us in our individual sessions.
To guard against this, I suggest that you assess the scripts that a person has developed so that you can identify when they seem to be operating. I give my clients a list like the one below to assess the scripts which my client has developed so that I can identify when they seem to be operating. I ask them to check off the ones that they think they learned growing up.
_____ “I don’t make sense”
_____ “I’m important for what I can accomplish.”
_____ “I’ll sound foolish.”
_____ “I’m not likeable.”
_____ “I’m on my own.”
_____ "People will judge me.”
_____ “People won’t understand.”
_____ “People care only about themselves.”
_____ “People can’t be trusted.”
_____ “People always leave.”
_____ "Don’t show anger—they won’t like you.”
_____ “Don’t let people see you cry—they’ll think you are weak.”
_____ “Negative emotions are wrong.”
_____ “Showing emotions is being out of control.”
_____ “There is a right way to feel about things.”
For instance, Ashley talked in therapy about how she wanted to break up with her boyfriend. She would spend most of her session describing how he was not good for her because he said things that made her feel hurt and inadequate. Her therapist agreed with her perception that she would be better off if she broke up with him (you guessed it, without having ever met the scoundrel). At the end of several sessions, Ashley would decide to break up and even made plans as to how to carry it out. The therapist waited each week to find out how the breakup had gone, just to be told again that it had not happened.
Finally, the therapist confronted Ashley on her “resistance,” and Ashley began to state, shamefully, the reasons that she couldn’t break up. It is regrettable that she experienced shame for something that she wasn’t yet able to do simply because she hadn’t yet worked directly on her ambivalence.
As she spoke of the reasons that she couldn’t break up with her boyfriend, the therapist learned more about the relationship and about some of the positive aspects. Now the therapist changed her mind about supporting her to break up and began asking Ashley if maybe she should stay with him. Predictably, Ashley would then change the subject back to talking about how he didn’t treat her well. The therapist felt as though they were simply swinging back and forth and getting nowhere. Exactly!
In an attempt to avoid the fear on one side of the dilemma, Ashley would be thrown into the fear on the other. Contemplating breaking up with her boyfriend would highlight her fear of being alone and unloved, but the thought of staying with him would shift the focus to her fear of never being with someone who encouraged her. She was stuck in fear with nowhere to turn. The therapist unknowingly was participating in the swinging. If the therapist tried to join one side of the dilemma, it just pushed Ashley to the other. It is important to note that there is not a simple solution when someone is ambivalent regardless of how obvious the healthy path may seem.
I believe it is so much more helpful to our clients for them to become aware of how they may project previously held beliefs in relationships than it is for them to get the momentary sense of satisfaction that someone agrees with or validates their feelings. In Ashley's case, she began to see how she was projecting her belief that she wasn't loveable onto her boyfriend and interpreted his actions in light of this belief. It ended up being important to realize this before making a decision about the relationship as she may have been at risk of doing the same thing in the next relationship.
When our clients are complaining about others, it is helpful to address whether there is a global belief operating. If they've fillled out a checklist like the one above, they may be able to determine which part of any interpersonal situation is due to their own projection. An invaluable mindful process.
My book A Clinician’s Guide to Pathological Ambivalence: How to Be on Your Client’s Side Without Taking a Side can teach you how to avoid this and other common therapeutic mistakes by developing skills to work directly on resolving ambivalence and rewriting old narratives. I would love to hear from you. Please scroll down to the bottom of this page (past the banner of recent posts) to leave a comment.