Clinician's Digest

Clinician's Digest

By Garry Cooper

Your Inner Therapist

Research suggests that therapists have a long half-life and remain inside their clients for years, a fact we tend to forget in these days of problem-focused, symptom-based therapy. Writing in the April 2007 Psychiatric Times, psychiatrist Barbara Young reported on her personal project asking former clients how they'd internalized their therapy. A client from 20 years before, who told Young that she checks in daily with God about her decisions and feelings, suddenly looked at Young and exclaimed, "He talks to me just like you used to!" Another revealed that two years after therapy had ended, in the middle of hanging himself, he recalled her advice about doing little things to make things better, and he saved himself at the last second.

In the December 2009 Psychotherapy Theory, Research, Practice, Training, James Mosher of Miami University reported on a study about how former clients who've been in therapy for varying periods internalized their therapists over time. One client, who'd had eight sessions, described her therapist as a protective shell. "It was like being on Who Wants to be a Millionaire and using a lifeline," said another short-term client. After a while, however, clients experienced the therapist's presence as being inside. Therapy, said one longer-term client, became "something that was deepening in me." A recovering addict, who'd relied on his therapist to keep him clean, reported, "Earlier, I needed to call on specific memories of things he said, but now they're kind of in me." In the final stage of internalization, Mosher speculates, the therapist's voice may introduce new ways of thinking and act together with the client's other internalized voices.

Psychotherapy researchers and theorists have contended that clients who internalize their therapists' voices make more progress. Because this internalization takes place as therapy progresses, however, it isn't clear whether clients do better because they internalize their therapists, or whether clients who can develop this capacity tend to stay in therapy longer. Because therapists who solicit regular feedback from clients generally have better outcomes, Mosher suggests that periodically asking clients whether and how they experience you between sessions may provide useful feedback about the nature of the therapeutic relationship and the client's progress in therapy.

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