|Clinical Mastery Mary Jo Barrett Mindfulness CE Comments Wendy Behary Trauma The Future of Psychotherapy Symposium 2012 David Schnarch Anxiety Clinical Excellence Narcissistic Clients Couples Therapy Diets Men in Therapy Gender Issues Couples Attachment Challenging Cases William Doherty Future of Psychotherapy Brain Science Mind/Body Great Attachment Debate Linda Bacon Community of Excellence Ethics Etienne Wenger Alan Sroufe Attachment Theory|
|In Consultation Jan/Feb - Page 2|
1. Instead of assuming that withdrawn, distancing, sullen, un-forthcoming clients are being "resistant," consider the possibility that emotional experience of any kind makes them uncomfortable and anxious. Or: it's not about you.
Clients' emotional distance may have nothing to do with your skills, but may reflect longstanding personal difficulties and family-of-origin issues. The emotional chilliness may be interesting in itself. Go with the flow! Engage your own curiosity about this dynamic without implicitly shaming clients for being "resistant" or "self-defeating." Explore clients' behavior with questions about its origins. Is the discomfort more related to issues of trust, feelings of vulnerability, rejection, or a need to be independent and in control? What does this say about their upbringing, previous relationships, or prior therapy? Your tone should be casual, respectful, and curious. "What's it like to have nothing in particular to say?" you might ask. "Does this happen in other areas of your life?" "What impact does it have on you?"
2. Carefully observe clients' reactions to your manner of relating and respond accordingly.
This may seem obvious. Aren't we all on the alert for our clients' emotional reactions to the ongoing process of therapy? But here I'm talking about looking for delicate, usually nonverbal, cues about the "temperature" of the session—largely an intuitive process.
Joseph was a young man referred because of his serious substance abuse, depression, and suicidal thinking. As we talked, he described a lifelong history of feeling that he'd had "difficulty fitting in," along with tirades about the evils of "society": people were "sheep," who allowed themselves to be herded around by venal, self-serving politicians; people selfishly thought about meeting their own needs, with little concern for the greater good. My attempts to search for personal connections consistently met with argumentation. It was too painful for Joseph to acknowledge that his childhood with insensitive parents didn't reflect the whole of society. I'd ask him in what way these "social" issues personally impacted or reflected his life, only to be assaulted with his criticism that my question proved his point—that I wasn't concerned with the overall good of others, but was only selfishly interested in the individual. Whenever I spoke of my concern that just engaging in tit-for-tat dialogue made it difficult for me to help him, or said anything that indicated I cared for him, Joseph became visibly uncomfortable and responded with cynical and sarcastic remarks.