The Inner World of the Psychotherapist: Tuning In, Staying Present

By Veronica Kallos-Lilly and Richard Harrison who will be presenting Tuning In: Self of the Therapist  at Hollyhock in Sept.

The psychotherapy field has a long tradition of promoting therapist neutrality and ignoring the person-of-the-therapist.  In fact, in some approaches, therapists are actively encouraged to check their “self” at the door.  The reality is we bring ourselves into our sessions whether we intend to or not. When we do so out of awareness, we risk getting in the way of the therapy.

For instance, many of us will be able to relate to this scenario: Imagine one of your clients, Mark, coming in for his 5th session complaining and expressing discouragement.

Mark: I like coming to therapy, I find you really nice and all, but I still feel depressed and unmotivated. I don’t know if therapy is working.”

Inside a little panic button goes off. Your heart starts pounding and you feel a surge of anxiety. You say to yourself “…UH OH…He’s not getting better… If only he was seeing ___________ (insert your mentor’s name). I know she would know just what to do right now!  What was it that I’ve seen her do before?!!!  Oh shoot. I’m not getting it. I’m really second rate, at best. I’m failing Mark.” 

You feel upset and responsible for letting him down. All you can think of doing is anything to make him feel better about himself and therapy.

Therapist: Ohhhh, Mark, I wouldn’t say that… it was just last week you were telling me that you sent out three resumes and that was three more than the week before. That’s real progress even if you don’t feel the results right away.  The way therapy works is ….[now here comes a long explanation of the therapeutic change process you subscribe to. The more you talk, the more garbled it comes out.]

There is a long pause and your client looks perplexed. He then hesitantly agrees. Therapeutic exploration about your client’s discouragement has just come to a grinding halt and you try to figure out where to go next.

In this example, the therapist’s critical inner voice amped up her insecurities about her own competence and her concern for Mark. She began to work very hard at convincing Mark he is okay and smoothing down his (and her own) difficult feelings.  Her intentions are good: to help Mark feel better.  However, she may have inadvertently given Mark the message that his feelings and perceptions are not okay, which could amplify his discouragement that he’s coming up short. Exploration is curtailed and both of their insecurities may be fueled.

Moment-to-moment interactions like the one above send subtle yet powerful messages about the quality of the relationship.  Mark might be asking himself: How much room is there for my difficult feelings? Can I truly be myself with my therapist? What kind of response will I receive? Will I be accepted or rejected as I am, right here, right now?

Multiple studies over the past half century have shown that a strong therapeutic relationship is a major contributor to client change and facilitates exploration, cognitive flexibility, and growth.

Isn’t that what we want for all our clients (and ourselves)?  We foster safety and security by how we show up as therapists.

Our clients do not need us to be all knowing and all powerful. They need us to be present. They need us to be real. They need us to be comfortable with our own humanness and vulnerability so that we can securely hold theirs.

If we return to the scenario with Mark, how could it play out differently if the therapist tuned into herself with curiosity and compassion instead of self-criticism?  The therapist could slow herself down by regulating her breathing. She could notice her own anxiety about letting her client down and hold this feeling with compassion.  Her inner voice might say, “Yes, this touches that familiar raw spot I have about feeling incompetent.  It’s okay…It’s okay, I know this feeling of discouragement. I’ve felt it before. It’s a painful place.  I don’t need to be threatened by it and close it down.  I can be with Mark in this feeling.” In this moment, the therapist is feeling more calm and tender inside.  She might continue “I would like to help Mark make room for these feelings and explore them more.” With her balance regained she might say to Mark, softly “I sense your discouragement inside when you say this … can you tell me more about what has been going on to fuel your feelings of depression?” The therapeutic relationship is strengthened because Mark feels “met” right where he is at. Not only is the session back on track, but the connection created between therapist and client is strengthened and feeds back into Mark exploring and sharing his emotions more deeply.

Being present in this way for your clients necessitates attending to your own inner experience, with awareness and gentle compassion.  In the example above, we saw how the therapist’s connection to herself, as well as her connection to her client, becomes more secure and grounded, by virtue of her having tuned into herself.

When she listens and attends to her inner experience, she becomes more present. Then she is in a better position to help Mark know and be himself more fully.

Even if it were possible, checking ourselves at the door really is not helpful to our clients. We know from a half century of research that the therapeutic relationship and the person of the therapist are the most robust factors contributing to client change. These “common factors” are every bit as important as any specific technique or model of treatment. Clients can’t benefit from the therapeutic relationship if we as therapists are personally disengaged.  This is all the more reason to bring the caring and feeling person that you are into your sessions. By the same token, clients can’t benefit from the relationship when we are rattled and dysregulated. In order to be present in a way that is secure and centered, we need to attend to our inner experience and reflect on which aspects are therapeutic and ethical to share.

This work asks a lot of us. Part of our responsibility to our clients is to look after ourselves. This may mean seeking supervision with peers or a professional mentor, as well as other forms of self-care.  Taking care and attending to ourselves in this work is anything but selfish.  In fact, it is the therapeutic and ethical thing to do!

Veronica Kallos-Lilly and Richard Harrison will be presenting Tuning In: Self of the Therapist  at Hollyhock in Sept.

Join Veronica and Richard at Hollyhock on Sept 10-13, 2017  for Tuning In: Self of the Therapist . 

Dr. Veronica Kallos-Lilly is a Registered Psychologist in BC and Director of the Vancouver Couple & Family Institute (VCFI). She is a Certified Trainer in EFT and has recently co-authored a workbook for couples. As a clinician, supervisor and trainer, Veronica’s warm, genuine style will invite you to look inside and expand your growing edges.

Dr. Richard Harrison is a Registered Psychologist, Certified AEDP Therapist and EFT Supervisor. He maintains a full clinical practice at VCFI, teaches at UBC and has authored professional publications on self-care. Richard brings warmth and clarity as a presenter and delights in helping people grow and thrive in this important work. 

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Feature Photo: Photo by Nik Shuliahin on Unsplash   

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