Thank you to everyone who responded to our October Clinician's Quandary. Here are some of the top responses! Submit to next month's Clinician's Quandary here.
October Quandary: My client has a lot of regret about past decisions he’s made. Although we've talked about them at length, he still can't seem to move on, and I'm not sure what more I can do to help him. What are some effective, creative ways to work with regret in a client's life?
1) Let Creativity Be Your Guide
I’m glad this therapist asked for creative ways to deal with this, because talking can have its limits. If you ask the client to respond to a creative prompt about the problem, it activates a different part of the brain and can offer important new insights that help them get unstuck. Here’s one approach I might use.
First, I’d give the client a piece of paper and some crayons, and ask them to draw a picture of their regret. When they’re ready to begin, I’d ask the following questions: What shape is it? (meanwhile, I’d encourage the client to be child-like and draw an outline of whatever shape comes—no judgements!) What color or colors is it? Is it in a particular setting? (encouraging them to add whatever background seems right) How many parts or appendages does it have? Last, I’d ask if there’s anything else they want to add to the drawing, and if so, let them add it.
You might respond to the drawing with a statement like, “Wow, there’s lots of red here. What does that color mean to you?” In other words, you have no judgements about the drawing, just curiosity about things like colors, shapes, the background, and the drawing’s simplicity or complexity.
From there, you can let the client talk about their regrets through the language of visual elements. You might be surprised by how much people enjoy being guided in new ways of looking at problems. It gets them out of their rut.
If your client feels resistant or is intimidated by drawing, offer to do one of your own at the same time. This puts you at an equal level of vulnerability, which is an excellent way to build trust and open new doors in the relationship. Tell them you’ll be drawing your own feelings of regret, and are as uncertain about what will come out on the page as they might be.
The key to working with clients in a creative way like this is to stay open to your own instincts and insights, and to trust them to guide you through the exercise. I can almost guarantee there will be laughs, too! Many of us tend to laugh when we’re doing something that makes us feel vulnerable, and laughter really helps dislodge feelings that keep us stuck.
Kathy Curtis, healing artist
Fort Wayne, IN
2) A Springboard to Something Better
What your client is going through is understandable. We all want to regulate our way out of the negative affect regret can bring. But simply trying avoid it could mean missing the opportunity to move forward with confidence that we’ll do better in the future. It might be useful to help this client distinguish regret from guilt, and explain the roles they can play in mental health.
Regret is useful for acknowledging a mistake and catalyzing an aspiration to do better in the future, whereas guilt can cause us to identify with our negative actions. It’s the difference between thinking “I’m not a bad person, but I did something a bit stupid” (which happens to everyone) and “I did something a bit stupid and that means there’s something inherently wrong with me.” The former is a healthy sense of regret and the latter is an attribution error that can set us on a trajectory to anxiety and depression.
In many Buddhist traditions, regret is seen as an integral way of moving forward from any kind of transgression or wrongdoing. It’s a genuine wish that we hadn’t said or done the action in question, combined with an acknowledgement that we were responsible for the negative outcome. This is usually augmented by a commitment to do better in the future and a heartfelt apology, when possible.
This combination of regret, acceptance of responsibility, aspiration to do better, and apology can transform a regrettable episode into a valuable learning experience. It’s a powerful way to make sure that the brooding type of rumination never gets a foothold to drag us down into guilt and hopelessness. More importantly, it increases our confidence that we can skillfully navigate the world’s complexities and inevitable mistakes.
So, next time this client asks about avoiding regret, maybe you can help them learn to use regret to spring forward with confidence in themselves and their relationships.
Corey Jackson, PhD candidate
Sunshine Coast, Australia
3) Try Speaking a Different Language
When clients become stuck, despite our best interventions, I’ve found that parts work can be very helpful. Often, this stuckness can mean one or more of the following three things is happening.
One, there may be an unnoticed protection mechanism, or protector part of the client, stuck in a fight, flight, freeze, submit, or needy attach state, working to block the positive change that may be perceived (subconsciously) as problematic, threatening, or dangerous—even though, logically, the client and therapist know this change is safe. In other words, although logical parts of the client understand the benefits of the change being sought, the defensive, protective parts of the client may not, and may continue to work to keep active the old ways of staying safe.
Second, the client’s nervous system may not be ready to tolerate and live within the change being sought. Although people ostensibly seek therapy to develop greater regulation in their inner and outer worlds, really living this change may be very new, and something the nervous system perceives as confusing, weird, boring, or even unsafe (common descriptions from clients on the verge of change) despite logically knowing otherwise. In other words, the client’s nervous system, now facing the real possibility of a more consistently balanced state, and all that this will bring, may feel overwhelmed, both from a practical standpoint and a felt standpoint.
Third, the therapist could be using left-brain, cognitive, or logical language to create the sought-after change, when lower right-brain language is needed. Many therapists and clients don’t understand that there’s a way of speaking other than the left-brain language of logic, concepts, and reason. So when a protector part is actively fearing and blocking change, the therapist can begin to speak with this part using right-brain language, orienting to sensations in the body, mental images, the body/behavior, and affect—SIBA, as it’s called in somatic experiencing. This noticing allows us to more fully process stuck material.
When we can invite our clients (and ourselves) to conceptualize these impasses as the work of protector parts with their own unique language, we de-shame and normalize these old adaptations that still seek to protect the client. This allows us to approach them with curiosity rather than frustration, confusion, and hopelessness.
Jenifer Freedy, MEd, RSW, CCC
4) Rewrite the Narrative
As an existential therapist, I see regret as one way we grapple with the grief of the reality that time runs in a single direction. Regret concerns the loss of the life we think we might have had, and the loss of the person we’d hoped to be. As Irvin Yalom says, we’re left struggling with the natural wish for a better past.
Losses cannot be unlost. Decisions made cannot be unmade. These regrets, these losses, will be with your client for the rest of his life. But that’s okay. It’s normal. And it’s important your client understands this. The challenge is to find meaning in the losses, decisions, and regrets. Your challenge as his therapist isn’t to help him get over or move on from these regrets. It’s to help him rewrite the narrative by incorporating the regret into it in a way that gives meaning.
One thing that might help you is to encourage him to empathize with the younger version of himself that made those decisions. He’ll probably still ask himself “What the hell was I thinking?” But trying to empathize with that younger self might help him step back, understand things better, and get a better perspective on how the regret fits into his larger life narrative.
Above all, normalize the regret. It often seems as if the overriding social narrative is that regrets are somehow “bad” or “unhealthy,” or that one should “live a life without regrets.” My view is that a life without regret is a life barely lived. A life without regret is one lived by skating on the surface in an attempt to avoid the inevitable losses that accompany life. Try to help your client see that his regrets are a testament to his deep investment and engagement in life, and that they can be a powerful tool to make that investment and engagement even more meaningful.
Michael Morad-McCoy, PhD, NCC, LPCC
5) Schedule a “Worry Time”
If I was this therapist, I’d do a collaborative functional analysis with the client about what’s reinforcing his dwelling on these guilty feelings. Together, we’d try to find out what need this behavior is meeting. We might find there’s some belief that feeling an “appropriate” amount of guilt fulfills some moral obligation for remorse. Or we might find there’s a belief that this mental review will prevent future bad decision making. Mental review of events from the past is, occasionally, a sign of OCD, so I’d assess for OCD as well.
I’d want to help this client see that although this mental review makes sense in certain contexts, it also has negative consequences, such as frequently feeling dysphoric, being preoccupied in moments when he’d rather be fully engaged, feeling inhibited in relationships due to shame, and having an avoidant interpersonal style due to seeing himself as unappealing.
Next, I’d assess this client's motivation for change. If he’s not ready to stop dwelling, I’d work on helping him develop more self-compassion. If the clients says he’s ready to accept his mistakes and stop self-blaming but doesn’t know how, I’d work on worry inhibition, assigning a daily time-limited interval during which he’s allowed to ruminate, and asking him to only think about the guilt-inducing decisions during that time. I’d advise that if the thought comes up outside of worry time, he should try to commit to trying not to solve or decide anything. I’d add that although he can jot a note about the regret when it comes up outside the allotted worry time, he’s to postpone completing that thought until worry time.
When worry time arrives, if he cares to worry about it, then he’s free to do so. If worry time comes and he doesn’t care to worry then, even better. I’ve found that, with exercises like these, people eventually stop ruminating and learn to accept uncertainty, as they’ve done by postponing the thoughts until worry time. If we really want to get creative about rumination inhibition, I might even advise that the client place some notes around the house with reminders about the regret so he can practice rumination inhibition in response to external forces in addition to internal ones.
Jeremy Shuman, PsyD
St. Louis, MO
Next Month’s Quandary: Sometimes I feel therapy getting a little bit dry. I consider myself a funny person, but I don’t know if it’s appropriate to showcase my sense of humor in the midst of clients’ clinical issues. Is there a way for me to bring play and humor into the work? How else are people using play and humor in therapy?
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