Tag Archives: countertransference

Leaving Therapy

By Will

I will always remember these words from my first therapist “You begin to live when you leave therapy.” I like to think that you can also live when you are in analysis as well, but if you are like me, you may carry your therapist around in your pocket some of the time. So how does that enable you to be free? Having this little thinking and reflecting ‘action man’ with you at all times can be both comforting and irritating. If you have experienced some extremely emotional situations with your therapist, and you have felt comforted by him, you may tend to elevate your analyst to a God like status as they become the Master, the Knower or the Buddha. This can put you in a juxtaposition and in day to day situations you may be influenced by your therapist, and you may judge many of your actions and thoughts with him in mind.

The thought of leaving therapy can be daunting. What will happen to me when I leave? Will I be able to cope? Is our work really finished or is my ego forcing me to end the relationship? Is my therapist trapping me? You may be reluctant to leave therapy as you do not want to hurt your therapists feelings. These are vital issues that require working through and together you both may reach a better understanding. It is almost impossible for both Therapist and Patient to collectively feel that therapy is over simultaneously, so one person as in all relationships, may feel at a loss. When we leave therapy knowing we have not addressed all our problems we may be mindful that we will always have problems and issues to solve as this is part of being human. We can cling to all sorts of illusions and justifications in regards to ending the theraputic relationship but I guess the obvious reason for leaving therapy is that you want to.

We may sometimes loose sight of the fact that therapy is self-centered and your therapy is about what is good for you. After all, your therapist has worked on themselves and should be able to digest the loss and work through it alone or with supervision.

“Intimate knowledge creates vulnerability. Where intimate knowledge is asymmetrical, vulnerability is also. Whoever is known most about is usually the vulnerable one, for multiple reasons. In psychotherapy, this vulnerable one is the client.”

*Quote by ~ http://sleightmind.wordpress.com

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The Guessing Game

By Will

Orthodox confession is the only relationship that I can think of that mirrors therapy in as much as we have no concrete evidence regarding our analysts or our priests personal life. Are they married, are they straight, do they have children? Even your thoughts about their life are projections from the self waiting to be interpreted. It is both peculiar and familiar that after 3 years I still, very occasionally, ask a direct question. The questions I ask are hinged with sarcasm and knowing as I may say “Well I have worked out that you are straight by now.” These feeble attempts always bring a wry smile to my therapists face and the enjoyment for me is studying my analyst and watching him trying to hide any evidence. It feels very child like but I think he enjoys it just as much as I do. It’s as though we both secretly and humbly get the gig.

So all we are left with is our own projections regarding our therapists life. This in itself is so crucial and the lesson can be applied to so many relational situations we encounter every day. The example that leaps out at me is “I can’t believe he/she has done that”. “I” being full of  preconceived notions of how things should be done. “Can’t believe” My beliefs are fixed and different from yours. Taken to an extreme we can be continuously surprised and angry at how others behave, think or even feel.

When this lesson has been understood we can then apply this concept to the different parts of our own psyche which may enable us to be more kind to ourselves. “I can understand why that part of me would feel threatened by this or that situation” or “I am not surprised I have kicked myself in over this”. This kind of empathy shown to oneself can be simply put as learning to laugh at yourself but I think that it is more complex than that. It’s being able to laugh, cry or be anxious at yourself. The important thing is that you are there for yourself.

Believe nothing, no matter where you read it, unless it agrees with your own reason and your own common sense ~ Buddha

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The Depth of Wounds Vary

By Will

“I think his symptoms are likely to be stress related. He has no typical symptoms of colon cancer, though of course, colon cancer often has no typical symptoms.”

As I sit and read this letter, from a digestive specialist to my doctor, I am once again struck by the severity of the power of thought and matters of the heart. Was my body able to produce the same symptoms as my Father who died from this cancer nearly 2 years ago. Can stress really do that?

Unresolved issues bubble underneath unnoticed, often for decades like a volcano, until one day when they finally erupt. What also struck me is the term “typical symptoms” as with the mind and the body we are all so different. According to Freud’s early theory, “painful memories and feelings were repressed by the unconscious and found expression in patients physical symptoms.” Although I have suffered panic attacks and depression in the past, my current physical symptoms seem more physical than mental. These intense emotions and feelings that were repressed may have something to do with my movement around my analysts room, from one ‘place’ or ‘space,’ to another. It is as if I am unable to stay in one place or rather unable to stay with the pain and the wounds for too long so I have to move around.

My therapist was speaking today about Masud Khan who had  fifteen-years of analysis with Winnicott and mentioned the phrase “A hard nut to crack” and that “All nuts can be cracked eventually” and I immediately thought that he was refering to me and our 3 1/2 years of analysis. Whether this was actually intentional or a Freudian slip or even transference from my therapists own analysis, it did not matter. I knew my own interpretation very well which is a belief that I should have worked things out by now, that I should be sorted and more aware of my unconscious drives and desires. It, whatever that is, takes as long as it takes.

Robert S. Boynton wrote “Is the aim of psychoanalysis to “cure” or merely to comfort? Should analysts maintain a clinical, professional distance and respect the “boundaries” between themselves and their patients (as classical analysis insists upon)? Or should they strive for a so-called “real relationship,” eroding the boundaries in order to heal the patient?” I liken this to the earlier phrase “typical symptoms” as I believe that in Psychotherapy there aren’t any, it depends on a multitude of complex factors but mainly on what suits the patient and therapist. For me, the relationship is paramount, for others a more clinical relationship may be what is required. I am unsure if I will ever be “cured” but I am sure of my need for some more of that beautiful connectedness and truthfulness that penetrates deep inside, as these wounds are deeper than I thought.

My sense of identity broke down and was replaced by something that is very hard to put into words ~ Eckhart Tolle

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My Therapeutic Introduction

Jade

By Jade

Training to be a therapist is a hard job, especially when your as young as I am. Being 19, carefree and a rebellious teenager is alot of hard work. Training to help people in worse situations is even harder. Having to think and act like an adult sometimes has its advantages, you get taken seriously and people see you for you and not some silly little kid. I found out from my course that I have to have 40 hours of therapy. I immediatley felt sick, what on earth can I take to therapy, I dont want to talk to a stranger about my problems. Then I sat back and laughed at myself, how can I expect clients to come and talk to me if I cant even take myself to a therapist.

I booked myself an appointment the next day for the following week. Every day went by so quick and before I knew it the day was here. All day I thought about what I could say and remembered to try and act “normal”. I walked up to the building (it looked normal enough), the sign was small so no one knew I was going in for therapy and I didnt even get a chance to knock on the door when I was greeted by a small plump lady with big rosey cheeks. I felt the colour come back into my face.

We walked up the stairs and into a cosey beige room with a big red sofa. I plonked myself down and tried to get comfortable. The therapist was called Helen, she looked like such a lovely person, even sounded like one. She sat down on the other sofa and got a book out of her pocket, this was for taking notes. Next thing I knew I was getting bombarded with questions.

Age, date of birth, sleep patterns, eating, sex drive, health problems, family health, mental health, suicide, self harm, drugs, what i’d have on my grave stone ect. This felt like way too much for a first session. I noticed that I zoned out of the room and ended up going back to having counselling in secondary school with a women who would constantly ask me questions and then judge me. Helen clicked her fingers and I came back into the room, I apparently zoned out for about 5 minutes staring at a painting. I explained to her about my past history with counselling sessions that werent even real, how it felt, how it’s impacted on me now ect. It was really strange being there and I felt very uncomfrtable after that.

My OCD kicked in with the room once I got agitated and I cut the session short and left. I havent been back to her since. It wasnt that she was a bad therapist, I just felt that it was too much too soon, she did ask quite alot of me.
I have now found myself a new therapist whom I know as she was my tutor in university. I trust her 100% and i’m sure I will be able to write something interesting from her therapy. Im quite excited about this journey with her… I shall let you know.

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An Interview with Peter Wilkin

An Interview with retired Psychotherapist Peter Wilkin.

During this interview, I have attributed my own gender to the ‘therapist’ & the female gender to the ‘patient’, purely & simply to try & reduce any possible confusion. I have also used the term, ‘patient’, to refer to the person in therapy, though neither this label nor any of the other common alternatives have ever sat that comfortably with me. However, ‘s/he who has come to explore & make sense of his/her difficulties’ is just a tad too cumbersome to repeat throughout an interview.

I once said, “I sense that Peter is one who has been fully analysed, and is therefore able to analyse others” A while after writing this I came to the conclusion that it is not possible to be ‘fully analysed’ or ‘fully enlightened’. What are your thoughts on this?

I agree entirely. I did enter into therapy before I began my psychotherapy training, purely to comply with the course requirements. Although I did not feel to have any huge issues that needed addressing I was aware of several recurring problems that I intended to share & work on with my therapist. You probably won’t be surprised to learn that those problems went a lot deeper than I had anticipated. My therapist, who worked psychodynamically, was a very astute man who always knew if I was avoiding facing up to difficult feelings and, although he was gentle enough, I knew there were no real hiding places.

Once the course of therapy had finished (2 years) I felt the benefit both as a practitioner and in general. However, I still experience difficulties in certain areas of my life, just like we all do – but if I were to enter therapy for the rest of my years I would never come anywhere near being ‘fully analysed’. Nor would I want to. There are certain little foibles and defence mechanisms that I would prefer to hold onto.

Do you believe that in order for a therapist to help someone, the therapist has to be ‘helped’ during the process too?

Yes I do. I strongly believe that to practice as a therapist without receiving regular supervision from an experienced and qualified supervisor is both irresponsible and potentially dangerous. All therapists are susceptible to reacting back to their patients’ *transference reactions (*transference in psychotherapy is an unconscious process where the attitudes, feelings, and desires of our very early significant relationships get transferred onto the therapist) and it is vital that there is someone whom they can trust who is capable of identifying and interpreting such reactions. As therapists, we all carry our own agendas & we are all susceptible to projecting them onto our patients. Additionally, we are also prone to accepting & carrying our patients’ projections. Supervision provides a safe and confidential space where the therapist can sit and analyse his work whilst also feeling supported.

How did you deal with frustration, in regards to the time spent with a client, where the client was unable or reluctant to change. Do you feel that your frustration should be voiced during the session, or does this depend on the person?

That’s a really good question. I think I learned to deal with such frustrations much better as the years rolled by. In a way, this question links to the previous one. In reality, there is no logical reason to feel frustrated if it is our patient who is resistive or reluctant to change. But, of course, we still do – which can result in us either feeling angry with our patients or, alternatively, over-sympathetic & desperate to ‘make things better’ for them.  All such feelings are fine if we remember to sit & work out where they are coming from – but we do not always do that. Instead, we fail to separate our own issues from our patients and become embroiled in a messy and unproductive relationship with them.

A good example is the patient who has brought an issue of loss to therapy but who seems to be avoiding and sabotaging all attempts by the therapist to help her develop insight and move on. The therapist begins to feel frustrated and begins to lose patience with the patient. Having taken the issue to supervision, the supervisor discovers that this therapist suffered a broken relationship that he had never recovered from. He had never managed to accept the break-up & still grieved for the loss of his partner. Consequently, he had been projecting his own frustrations at not being able to work through his grief onto his patient.

As for voicing such frustration during the session – yes, I think that’s fine … but, of course, there is a particular way of doing it. The rule of thumb is that any such frustrations should be aired in a way which is likely to help the patient develop insight. The other rule, just as important, is always be tentative – in other words, always give the patient a ‘way out’ if they are not ready or unwilling to accept your hypothesis.

For example, the therapist might say: ‘I’m very aware that, whilst you were explaining to me about your partner’s reluctance to talk about his illness, I began to feel my stomach tightening … I can actually feel a huge knot of tension in it … right here *points to his stomach & taps it with his fist* … you know, I could be entirely wrong about this, but … I wonder if I’m feeling some of the frustration that you felt when your partner refused to let you in … you being unable to tell him how that made you feel?”

If the patient is ready to hear the tentative interpretation, a response might be: “I desperately wanted to let him know how frightened I was about losing him … but he just didn’t want to hear. I used to feel so angry with him (begins to cry) … & so wound up that I couldn’t eat.’

What are your thoughts on individual and creative therapy, which may be quite unorthodox, in terms of extending the 50 minute hour or adults taking part in play therapy or even switching seats with the therapist?

Ah! Well, if the therapist is practised in such ‘alternative’ techniques (e.g. in Gestalt therapy) & the patient has been fully briefed about the mode of therapy, then I am all for it. I used to employ similar strategies myself when working with families. I remember a specific session of ‘couples’ therapy when I asked one person to turn her chair round & direct all her answers to the wall. She was baffled at first, until she realised that this was how it felt for her partner when he tried to talk to her, as she never seemed willing to listen to him.

So such creative switches in therapy can work well, although I’m not sure about extending sessions beyond the agreed ‘hour’. For me (working within a very structured timetable) it would have caused problems & inconvenienced people with later appointments. And I believe an hour is ample time at one sitting to address the issues that need to be discussed. Giving a time boundary helps to contain a session by informing the patient that she has a specific amount of time to go wherever she needs to go. If the patient is inclined to wait until the last few minutes before ‘dropping a bombshell’ then this needs to be addressed by the therapist, as it most likely represents a ‘boundary’ problem that needs working on in therapy.

Do you feel it is necessary to share your personal experiences with the client, or again do you feel that this would depend on the person?

Generally speaking, no. I believe the more a patient knows about her therapist, the more that information is likely to pollute the therapy process. To illustrate, if I were to disclose a particular faith or religion, that might prevent the patient from sharing a negative feeling towards that faith or religion. Or if I was to highlight a particular personal difficulty (an illness, a relative’s struggle, an anxiety), that might generate concern & worry for the patient. I know that some person-centred counsellors do share certain personal experiences as a way of empathising but, for me, I think it is inappropriate to do so. There are surely better ways of demonstrating empathy as opposed to revealing personal details.

How important were your initial instincts on first meeting with a client?

Extremely important for two reasons:

Firstly, I trust my instincts. Almost thirty years of clinical practice has honed them to a point where they are pretty sharp at forming an accurate profile of a person.

Secondly, they are a wonderful source of counter-transference for me to explore, either on my own or with my supervisor. Instincts always surface from the unconscious and, on occasions, I will be unwittingly projecting my own beliefs onto the patient. If the therapist is able to identify these counter-transference reactions it can provide him with a rich source of information about himself and his patient.

For example, I may feel inexplicably cool towards a patient in the first assessment session. The reason might be a very simple one, in that she reminds me of someone I know – & if that’s the case I will surely work that out quickly. But at the other end of the spectrum there may be no discernible reason why I should harbour such a negative feeling. So, I would have to explore my instinctual feelings until an explanation surfaced.

A possible explanation might go something like this: the patient lost her mother when she was only a child. She had no father figure to turn to & this caused a multitude of problems for her. Throughout her adult life she has had a string of very brief relationships & only one longer relationship that lasted just over two years. Whilst she insists that she yearns to be in a loving & caring relationship she is also frightened of ‘losing’ any figure that she may get close to. Consequently, she unconsciously projects a rather austere persona that is inclined (& unconsciously designed) to deter people from trying to get close to her.

During therapy, how important are the unconscious or the darker sides of the Psyche. For example, with my analyst, we have adopted a name for the part of me that seeks drama, darkness etc?

What a wonderful question! Very important, I would say. According to Jung the Shadow is an archetype that reflects deeper elements of our psyche. It is, by its name, dark, shadowy, unknown and potentially troubling. It tends not to obey rules, and in doing so may discover new lands or plunge things into chaos and battle. It has a sense of the exotic and can be disturbingly fascinating.

We may see the shadow in others and, if we dare, know it in ourselves. Mostly, however, we deny it in ourselves and project it onto others.

In therapy, if we face up to our shadow side it can help to vitalize our lives. Those fears & anxieties that we suppressed many years ago, when confronted & understood, can lead us to places that we would, otherwise, never have discovered. The negative messages we receive in childhood all contribute towards constructing our shadow sides. If a person is told that they are stupid, or clumsy, or even unlovable, those messages live on in the dark side of the psyche. Shining a light on them is usually perceived as a fearful & risky thing to do. However, exposing them to the light in therapy provides an opportunity to see them for what they really are (hurtful and inappropriate comments) whilst, also, unwrapping potential that, otherwise, would have laid dormant.

For those who would like to learn more about their shadow, there is an excellent article by Denise Linn entitled: ‘Facing your Shadow

Have you ever given a client advice?

Within a contracted course of therapy, never (as far as I can recall). For me, doing so goes against the whole ethic of offering the patient ‘cues’ (in the form of interpretations & hypotheses) so that she may find her own way through her difficulties. Offering solutions by way of advice disempowers the patient by taking away her potential for finding her own answers.

Of course, if the patient asked me: ‘Is there a train station nearby if I’m ever unable to travel by car?’ then I would answer their question. But suggesting various coping strategies runs against the grain of psychodynamic therapy & may even imply that you have no faith or trust in the patient to find her own way out of her difficulties.

Many thanks for giving me the opportunity to address such thought-provoking questions, Will. Having been retired for several years I had to put my thinking cap back on in order to provide what I hope will be satisfactory answers.

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Personal Reflections by Christine

Child

By Christine

When I first met my therapist he asked me why I wanted therapy. I had a list of things I wanted to achieve. I memorised them before I went. To be fair he kept a straight face. He was good at not laughing at me, always. I don’t think I realised how important the ‘not laughing at me’ part was until now. I thought he would be able to tolerate me and wouldn’t be over familiar with me.  That would make it easy for me to ‘ignore’ him and ‘use’ him to work on my issues and then go off and live in a more tolerable way.

It didn’t work like that. I think I did a lot of messing around. I was childish and that had nothing to do with my ‘inner child’. I was childish because I had never grown up emotionally. I just wanted to push the boundaries in whatever way I was able. I was fed up with being good. I was angry as hell.

I was always late, without fail. Sometimes 10 minutes, sometimes 15. He never said anything about it, ever. It annoyed me that he didn’t comment on it. I wanted him to be angry. He couldn’t win of course. Not with me. It was my game and I was going to win. If he had ever said “I wonder what you’re being late is saying” I would have stopped going. I can’t bear that type of phoney counsellor speak. It’s as though he knew. I left early too. Sometimes I left after 20 minutes. Once he asked me why I was leaving so early and I said that I was finding it painful. That was a lie. The truth was I can’t bear to be rejected. Saying ‘time’s up’ is rejection for me. Far better to reject him. It took me a long time to admit that. Maybe that’s because it took me a long time to realise that.

Quite often I could not speak. I would try to say something but the words wouldn’t come at all. It was like no other experience. I found it hard to deal with my emerging self. I felt embarrassed.  Ignoring Mr Boundary helped me to cope with that. I never cry in front of other people. Yet here I was crying all the time. Very undignified.

I hated him looking at me. I’m ugly. Seeing my tears. I wanted him to go away. I told him. He still kept doing it. I still kept going. Brazen, that’s what my mother would have said. He never said much. But he paid really close attention to me, all the time. I hated it. I’d sit there and the tears would keep coming. It was like being tortured. The silence was killing me.

After a while Mr Boundary Man said to me “tell me what you need.”

How would I know?

“I need you ……….I need you to say more,” I said. “I need you to be more like a normal person.”

“What’s a normal person like for you?” he asked.

“They say more.”

I was furious with him.  He was saying that I’m mad. After that he started to say more. He never let me sit ‘alone’ again. It was like having a Dad. That made my cry too, lots. Mr Boundary Man became a person. I tried to ignore him, but he seeped in anyway. Sometimes I’d catch an expression on his face and I’d have to look away. It hurt too much.

I felt shy. But I hid it well. Sometimes I’d have nothing to say. The fact that I’d turned up at all was enough. It was nice just to sit there. I felt less alone. I remember, after a difficult time, I sent him an email saying that I needed a break for a couple of weeks. He replied and said “take as long as you need, I am willing to work with you.” I cried when I read it, long and hard. It was like having an arm put around me. I stuck it in my journal. Proof that someone cares.

I tried to stop messing around. I was surprised to hear myself talking about stuff. No agendas, just me. I tried my best not to worry about what Mr Boundary thought of me. I assumed he thought I was annoying. But he never said. Completely accepted. Endless patience. I realised that this was up to me. My responsibility. It took me ages to get that. I started to see things differently. It hurt, lots, physically and emotionally. I started to unravel. My dad became very ill. In my therapy I had come to a new understanding about my past. It was the first time I felt able to try and get to know my dad. It felt too late. It was hard to keep going.

I needed to sort myself out. I told my therapist. He was so kind it hurt. It was hard to face the loss, the enormity of it. How I’d got it all so wrong. I felt understood. He never forgot the important details. His antennae picked up on all the stuff that hurt me most and he gave it back to me when I could tolerate it. It was the first time that I was allowed to feel my feelings. No censorship.  No judgement.

I realised that messing about was only hurting me. I got angry. “There was a time when you wouldn’t have come back,” he said. It was as if he was me. I learnt what it was to have a proper relationship. To tolerate emotions, to repair damage. I felt the poverty of my past relationships. I started to stay to the end. I still couldn’t arrive on time. That would look like I needed him.  Needy me, greedy me. I felt really attached. I started to panic about having to end. “It sounds like you’ve finally separated from your mother,” he said. I felt ambivalent. I was stripped right down to my nothingness. I dug deeper. Voiced my fears. I met my therapist, face to face, adult to adult. I grew up. I didn’t need to learn my lines anymore.

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Dream Journal

dream

By Will

I was going through my dream journal and decided to share my first ever dream, which happened three years ago, when I began therapy for the second time. The dream was very short, but massively vivid and powerful; The dream took place after therapy one night.

I suddenly found myself in the bath with my analyst. At first, we smiled at each other in a surprised and innocent way. Straight after this exchange my analyst reached down below and started to touch me under the water. I refused the advances and my analyst began to paddy, thumping his hands and feet ferociously on the floor like a child. It was extremely disturbing and vivid and I remember thinking that I was more mature than him.

I knew from having therapy before that the dream had to be ‘aired and shared’ and I found myself laughing as I recounted the dream during our next session. We talked about the dream for most of the session and together we unpacked some possible meanings and realisations.

We discussed the meaning of the bath itself, which may be interpreted as a place where one literally washed oneself clean internally, shedding old ideas, opinions and negative patterns. We were in a tight place together where we could possibly remain stuck for some time. The initial smile we shared could be our true selves meeting for the first time. We discussed going to new places that are below the surface. Places we shouldn’t go. Down below; Should not be touched down there. Touching the darker shadow self would cause a huge paddy, huge resistance and the new beginnings of re-living a battle of previously held opinions and beliefs. Who knows more than who has been in control for so long. Of course ‘I’ am more mature.

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