December 14, 2008

Blocking Therapy vs. Therapeutic Mismatch

Posted in mental health, therapy, Therapy and Counseling, Trauma tagged Approach, Assistance, Attachment, Attacking, Block, Boundaries, Challenging, Change, Claim the Issue, Clash, Client, Conflict, Conflict in Therapy, Dissociation, Distract, Emotional, Family, Family Dynamic, Father, Feelings, Gain, Harmful, Healing, Health Professional, Heart Wound, Homework, Infallible, Kathy Broady, Limit, Limitation, Misinterpreting, Mistake, Mother, Need, Painful, Positive Change, Projection, Reasonable, Responsible, Restriction, Rule, Sabotaging, Skill, Style, Talking, Therapeutic Alliance, Therapeutic Attachment, Therapeutic Gain, Therapeutic Mismatch, Therapeutic Process, Therapeutic Relationship, Therapist, therapy, Transference, Trauma, trauma therapist, Trauma-Related Issue, Unmet emotional need, Wound, Your Therapy at 4:36 pm by Kathy Broady

Castorgirl’s comment to the article “Therapy for Trauma Survivors, Part 1″:

Hi Kathy,

An interesting post. It raises many issues that have been a struggle over the last three years of therapy…

The question whenever things don’t seem to be going well in therapy always seems to come back to – “Is this our fault?” Are we sabotaging our own recovery, misinterpreting what has been said or meant.

It always brings forward the issues from the past about the health professionals being infallible and beyond questioning. We’ve just tried to question our therapist, and it hasn’t gone well. Our first foray into challenging a health professional has pretty much come crashing down around our ears…

In a rather rambling way, we’re trying to ask what indicators can you use to see whether it’s a block from us, or a therapeutic mis-match?

Great thought provoking blog…
Take care…

Thank you, Castorgirl, for asking such a great question.  I wish there was an easy answer.  This is actually a very big question with lots of layers to it.  I could probably make several different posts from this question, each with a different approach.

I have a response for you, but please remember, there are just my thoughts, are cannot be taken as medical advice nor are they to replace or usurp the recommendations of your therapist. (Please see my disclaimer.)  For the purposes of this post, I am going to write it from the perspective that the therapist is not making any grave errors.  Addressing therapeutic blunders is a big topic, and will reserved for another day.

I want to commend you for talking with your therapist about the issue at hand.  You have taken an important step in talking to your therapist about it, and that’s excellent.  Even if it didn’t go as well as you wanted it to, you initiated a conversation about it, and I strongly encourage you to keep working on it.  But do your homework – meaning… explore your feelings on your own as well, and see if you can move yourself forward through it.

Actually, I don’t think for a second that health professionals are infallible.  We all make mistakes and that very fact makes therapists’ human too.  However, when we have our “Therapist Hat” on, we make a conscious shift in our heads and our thinking to put our energy and attention on the client.  We’ve also been given rules, guidelines, boundaries, and restrictions to follow from our employment agencies, training institutions, educational facilities, and theoretical perspectives that highly influence our thoughts and our behavior.  We may very well approach conflict in therapy different “in the office” than we do in our personal lives.  Remember that the point of therapy is to be about you, the client, and even in rough patches of the therapeutic process, therapists will tend to keep that mindset in the forefront.

I’m guessing that most therapists examine the interaction between themselves and their clients with the greater focus on their client, what the client is doing (or not doing), saying (or not saying), expressing (or not expressing), etc.  Part of keeping the therapeutic process about the client is by keeping our thoughts and interpretations on the client, while keeping our thoughts about ourselves more neutral or in the background.  Otherwise, the therapy process becomes about us, and that becomes a boundary issue.  Particularly complicated problem points are when the client does something that is actually harmful or damaging to the therapist, or vice versa.

Keep in mind that all relationships have simple misunderstandings and small pockets of confusion.  Little mistakes are not the end of the world.  If you find yourself blowing normal miscommunication issues up into huge conflicts, then chances are, you are adding other personal issues into the situation.

You would probably be surprised to see how many conflicts with therapists are actually directly connected to projections / transference issues related to the client’s painfully unresolved mother- father-family-trauma issues.  As cliché as it sounds, the biggest portion of therapeutic conflict can be seen in the “this is actually about your mother” context.  The therapeutic relationship, while it is a current-day professional relationship, becomes the battleground for all the emotional hurts and deep heart wounds of the years past.  Because an element of caring and emotional attachment builds between the therapist and client, all too often conflicts arise when the client expects the therapist to fulfill too many of their unmet emotional needs.

Of course, a huge part of therapy is experiencing a correction of formerly wronged emotional experiences.  But there is a limit to how far a therapist can go in terms of meeting those unmet needs.  There will be a boundary line. It’s understandable that when this line is approached, and the client wants more from the therapist than the therapist can give within their professional or personal limitations, there will be a conflict.

That means many clients get their feelings hurts.  The therapist often becomes one of the very most important people in the client’s life, especially for trauma survivors who have poured out their heart and soul in their healing process.  Even being as critically important as therapists are, therapists can’t necessarily participate in the important social events for the client, or be emotionally or physically or therapeutically available as their clients want them to be.  Many times, therapists can’t even approach the client, or make the first phone call, or offer extra time.  While the professional opinions on proper therapeutic behavior vary greatly, the point being, to maintain proper boundaries, therapists have limitations to what they can do.  Many client requests will be denied because they go too far outside of the therapeutic box.

One of the very biggest blocks that clients can do that will harm or destroy their therapeutic relationship is to not talk about these conflicts with the focus on their own thoughts, feelings, behaviors.  Remember, the goal in your therapy is for you to learn more about yourself and to learn more about how to be personally responsible for your own health and well-being.  If you insist on defining the issues as “the therapist’s problems”, then you have missed the boat of what your therapy is about.  That doesn’t mean the therapist doesn’t have problems.  It means, you are trying to distract from your issues, and your therapist is not to be the focus of your therapy.  Keep the focus on yourself.  If you want to make gains in your therapy, talk about you.  Examine your wants and needs.  Examine your behavior.  Poke at your beliefs.  Keep it all about you, you, you.  And protect this time.  Treat it as precious for you.  Having the time to work on your healing is incredibly important, so don’t share the focus with anyone else.

Because it is your therapy, claim the issue as your own.  Attacking or blaming your therapist isn’t going to help you address your own issues, nor will it help your therapeutic alliance.  If you are really in therapy to address your own issues, then even in situations where there are potential conflicts with your therapist, first look at how the conflict relates to you.

Talk openly about how the painful conflict at hand affects you.  Be courageous enough to look at the painful historical roots for this issue.  Be willing to see how this current conflict has shown itself in your life, time and time and time again.  Look to old family dynamics and find the parallels.  Look at how this new wound is similar to previous wounds.  When you find those connections, you will be making progress.

Ask yourself: Why does this bother me? And what’s under that?  And then what?  And then what?  Peel the emotional onion, in terms of getting further down into the root of the issue.  Your therapist will be able to help you do this, but you have to be willing to look at it from that perspective.

If you are unsure if there is a therapeutic mismatch, use the same approach in tackling that issue.  For example, write out a list of the things that seem mismatched.  For each individual issue, ask yourself why that bothers you.  Take this first answer, and ask yourself why that bothers you.  Take your second answer and ask yourself why that bothers you.  Take your third answer, and ask why that bothers you.

Remember, there are many good therapists out there.  If your needs truly clash with the style of a particular therapist, then thank them for what they have offered you, and simply move on to someone else.  Don’t assume the therapist will or can change to be what you want them to be. It doesn’t mean the therapist is “wrong” or “bad” for not doing what you want them to do.  They are who they are, and they have their style of working in place.  I use this metaphor:

If you don’t like the food at a particular restaurant, then go to a different restaurant.  It would be unreasonable to throw a hissy fit in a Chinese restaurant, demanding Mexican food.  If you want Mexican food, just go on down the road till you find the Mexican restaurant, and leave the Chinese restaurant to do what it does best – serving Chinese food.

Too many clients expect the therapist to become what they want or need, typically based out of their own trauma-related issues.  Your healing isn’t based on making your therapist change to be what you need.  Your healing is based on your addressing your needs, and making positive changes with the assistance of your therapist.

If you want to do more thinking, here are some sample homework questions:

• What is a therapeutic mismatch?  How do you define that for yourself?
• Is your therapist challenging you to think / act in ways that are new or uncomfortable?  Are these harmful challenges?  Or, is your therapist encouraging you to develop new skills?
• List 5 areas you are mismatched, and for each area, list five reasons that feels upsetting to you.  What are the common themes, and what have you learned from this?
• What are you doing to encourage or enhance the mismatch issue?
• What do you want your therapist to do that he (she) is not doing?  Why is this so important to you?  What does it mean if your therapist will never do these things?
• Are these reasonable requests?  Do any of your requests take the therapist out of the therapy box?

I hope these ideas give you a starting place.

Thanks for the question.

__________

by:

Kathy Broady, LCSW

www.AbuseConsultants.com

www.SurvivorForum.com

Permalink 14 Comments