What Four Decades of Practice Has Taught Me

In my early days as a therapist, I wish I’d known that the other side of counterdependence is the cling response. I was a parent when I started practicing, so maybe I should have known that, but I didn’t. Instead, I’d spend countless hours encouraging counterdependent clients to rely on me, only to find that their only other option was to emotionally cling to my knee and beg me not to abandon them. Now I know that, for some clients, counterdependence might be the only protection they have against enormous vulnerability and emotional flooding. Today, I name counterdependence as a resource and encourage clients to recognize it as part of their story. Even better—I offer collaboration instead of just presenting myself as someone to depend upon.

I wish I’d known that when a client says they want to die, they’re often trying to articulate their wish for relief—the relief of not feeling, of having an exit plan, of feeling some semblance of control in the face of overwhelm. I wish I’d known that suicidal ideation alone is not dangerous. Impulses are potentially dangerous, but not fantasy. In my work today, I teach clients that wishes and fantasies, even wishes to be gone, are normal and natural. Still, we often forget this when it comes to a client’s suicide fantasies. 

I wish I’d known enough to accept that it’s a client’s right to be stuck, to be afraid of emotions or memories, to refuse to believe they have worth. It’s their right to resist what I offer or resist hope or fight self-compassion. After 39 years in practice, I’ve finally made my peace with how hard and frightening it is to change. I’ve finally let go of my need for my clients to change—which may be the most important thing I’ve ever offered them.

I wish I’d understood the neurobiology of human beings. I wish I’d known about the autonomic nervous system’s role in emotional and physical experience. Knowing that emotions and impulses and even beliefs are driven autonomically has lifted a burden from my clients and myself. I no longer view the inability to feel or the inability to manage intense emotions as an intentional choice. We can’t avoid how we feel unless our brains and bodies cause numbing or disconnection. I wish I could apologize to former clients who felt the pressure to feel emotion when they could not, simply because I didn’t know that “the body keeps the score,” as Bessel van der Kolk famously said.

I wish I’d known that the therapist’s commandment, “Thou shalt not interrupt,” was potentially harmful. How could I have believed that it was helpful to let clients disparage and condemn themselves over and over while I just listened sympathetically? Or to let clients rage at their loved ones or at me while I tried to empathize with them? I wish I’d known the power of therapeutic interruption, the attuned and empathic interruptions that disrupt self-hatred or prevent clients’ emotions from overwhelming them as well as others. It would’ve been helpful to learn how to use interruption to facilitate a collaborative dialogue. But in the psychotherapist’s world, it’s usually left to us to discover what really works for those who entrust us with their care.

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Janina Fisher, PhD, is a licensed clinical psychologist and instructor at the Trauma Center in Boston, a senior faculty member of the Sensorimotor Psychotherapy Institute, and a former instructor at Harvard Medical School.

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