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This concept suggests that certain feelings are reasonable: it makes sense that we may want to find ways to steer clear of the past. When a client balks and proclaims "I'm not uncomfortable; it's just a waste of time," you can follow with: "It's not that I'm saying that your feelings are wrong or that you aren't being honest. It's just that I know that most of us feel uncomfortable with the experience of looking back at painful moments in our lives—even when we've done it before. There are many reasons for the discomfort: family loyalty, embarrassment, not wanting to feel our negative emotions. I wonder which of these might be true for you. I also propose that if these past experiences were truly resolved, you probably wouldn't be stuck in the self-defeating patterns that keep you from getting your needs met."

Here's another classic: "You just don't get me." This client may be characterized by a profound lack of empathy from caregivers during her childhood, along with a high degree of manipulation and control from them throughout her life. She's known to be a fighter when she feels misunderstood or used. So here you are, trying to be your empathic and caring self as she tells you, from her most vulnerable core, "I know I need to work on these issues. It's so hard (tearful). I just get so triggered when . . . ." You're sitting tall, clipboard on your lap, taking copious notes, while nodding, and "um-humming," and you say, "I'm beginning to understand how hard this is. I really get how when you . . . ." But, before you can finish your thought, she's grimacing with arms folded. "No you don't! You don't get me! No one gets me! No one ever will! Please don't pretend to understand and be nice to me."

This time, with arms comfortably resting on the sides of your chair, hands gently placed on each thigh, both feet on the floor, posture straight with face tilted forward a bit, you say: "I wonder what would make you feel the need to become so defiant and self-righteous with me just now. I'm aware that whenever I offer my understanding—the very thing that I know you long for—you seem to immediately negate and dismiss any empathy that may be resonating for me. Can you see that, too?" The discussion that follows can be very revealing. Links to fear of control or shameful exposure are among the themes that may be discovered.

This is hardly a complete list of examples. But, hopefully, it affords a glimpse of how to use expressive integration within the moment-to-moment challenges in the treatment room. In addition to competent assessment, interpersonal skills, and general therapeutic techniques, healing your own maladaptive life themes is an absolutely necessary component of effective therapy. This isn't so you won't feel the jab when a client crosses a line, but so that you can feel it just enough to be able to confront and correct self-defeating patterns, instead of becoming ineffectively numb or overwhelmed.

And remember—it's not just what you say. It's the way you say it!

Wendy Behary, L.C.S.W., the founder and director of The Cognitive Therapy Center of New Jersey and The New Jersey Institute for Schema Therapy, has been treating clients and training professionals for more than 20 years. She's the author of Disarming the Narcissist: Surviving and Thriving with the Self-Absorbed. Contact:; www.dis Tell us what you think about this article by e-mail at, or at Log in and you'll find the comment section on every page of the online Magazine section.

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