"I'm sorry for canceling on such short notice, Dr. Daitch. Therapy was really helpful," Bill began half apologetically. "You taught me how to keep my cool when Denise criticizes me, instead of exploding at her, but it just isn't working. I know about active listening and validation. The problem is that when I'm home, I just can't do it: I can't stop myself from overreacting. She starts nagging, and before I know it, I'm screaming at her. It's not your fault. Therapy's just not the answer for my problem."
How could I argue with him? He was describing a common dilemma for clients: in the contained, nurturing therapeutic setting, it's relatively easy for them to learn rational reactions and rehearse intentional responses. But life comes at you fast, and it's extremely difficult for clients to transfer these skills to actual situations, when they're suddenly overwhelmed by their emotions. The stress, anger, and anxiety evoked by everyday confrontations and interactions can easily overwhelm our clients' best intentions, completely dislodging newly learned techniques for keeping their cool—no matter how much they practice these techniques in sessions. At that point in my practice, I had no idea of how to help emotionally overreactive clients take what they'd learned in therapy into their lives outside my office.
That was 10 years ago. Bill didn't resume therapy with anyone, and a year later, I heard that his wife had divorced him. The only good outcome of that case was that I determined then and there to develop specific techniques for helping clients do in their daily lives what they'd learned to do in my office. Today I not only teach emotionally overreactive clients techniques for calming themselves down, but include practice and rehearsal time in sessions and follow up with them between sessions to make sure they're practicing regularly at home. Without this kind of transfer of skills from therapy to daily life, therapy is futile.
Helping clients regulate affect and alter their own response patterns is enormously challenging because we're faced with the daunting task of intervening in the hardwired neural processes of the brain. The brain's 100 billion neurons are connected in extraordinarily complex ways and wired by evolution to react to upsetting external stimuli with behavioral responses based on fear or anger. That's why it's much easier to express negative emotions than to manage them with reason.