This blog is for mental health professionals:
I have had more than one person come into therapy saying they left their last therapist because he or she was too passive and non-responsive in therapy. “All they did was listen, but they didn’t offer me any feedback.”
This therapeutic style is taught in graduate schools of psychology, based on the works of people like Carl Rogers, who advocated for non-judgmental acceptance and unconditional positive regard.
As someone who writes about the value of decreasing judgments and improving acceptance of self and others, I can certainly agree this concept is a worthy one.
Many therapists still believe the old-school adage that they should show no expression or reaction and be a blank slate in session. We certainly don’t want our emotions or opinions to take over a session. (In contrast to the disconnected therapist, I have heard stories about clinicians who talked endlessly about their own problems to clients, including their daughter’s suicide! Yikes!)
However, many therapists take this idea of merely being an empathic listener too far. They are so uninvolved and distant that the client senses this passivity. It becomes an abnormal relationship if one person is so non-reactive. I can imagine scenes where the client narrates about severe child abuse and the clinician stares blankly and nods passively. That doesn’t seem like an empathic response!
I take a much more active stance in therapy. I react with words and facial expressions and use this to very good effect. These reactions can often be extremely helpful to clients. If a client tells me about their traumatic history of child abuse I show concern and sadness and I express that in words.
I base my clinical interventions on my own experience in therapy years ago. My most evocative experience in therapy was after I had matter-of-factly told about how my parents had never said they loved me or shown any real affection throughout my childhood. They never hugged me that I could recall or exhibited very much warmth or joy. My therapist stated bluntly: “You do realize that is a form of child abuse.” Up to that point, I had thought my family was quite normal. Her very direct statement was a major turning point in my personal growth, allowing me to see how distant and disconnected my parents had been and how this had led me to also adopt a very arms-length relationship with people. (And with myself, but that’s a blog for another day!)
A recent case of mine is another example of how even small reactions and comments by a clinician can be very powerful.
I had one gentleman who was very fearful of any conflict with his wife to the point that he avoided telling her about events he planned to attend. Then when it came time to go to the event, she was angry about not having heard about it beforehand. We worked on getting him to realize that his fear of conflict was filling him with panic and avoidance. One day in therapy he stated he “dreaded going home to his wife,” not because she was an unlikeable person, but because he dreaded having to tell her about a golf outing or business trip. His fear had formed into a habituated response that kept him from communicating normally or connecting warmly to his wife.
I chose to react to his statement of “dreading going home to his wife” with an expression of surprise. I commented on his words: “Wow, listen to yourself, Gary. You are saying you ‘dread’ going home to your wife. Does that sound like a healthy relationship to you? Do you want to continue in that pattern?”
The next week he said that experience of me reacting and calling out his “dread” was revelatory. It really switched on a lightbulb for him that his fear had taken over to unhealthy levels. We had talked for many months about how fear was driving his behavior, but when I reacted forthrightly, he “got it.” In psychology, we call these “emotionally corrective experiences” and they can have far more effectiveness than endless intellectual and insight-based talk therapy.
I believe that mirroring or reflecting a person’s words can include amping up my response to highlight the emotional content, the feelings that the person is expressing. Rather than just blandly say: “You are dreading going home to your wife,” it may be more helpful to show surprise or shock in your face and actually express that with words, as well.
This more direct and emotionally evocative approach is successful in many types of cases.
When working with victims of abusive or narcissistic partners or parents, I often comment very directly on a person’s reporting. Victims of abuse will often nonchalantly report being the target of very hurtful words or behaviors. This indicates that they have learned to accept these actions as normal and acceptable. They will say their abuser calls them “stupid” or “crazy.” Or they will report that the abuser has a very different set of rules: He can spend hundreds of dollars on his hobby, but she can’t, or he can go on two-week vacations by himself, but she is forbidden from doing so and must stay home with the children during his trips.
I have an immediate and very emotive response to these reports. Someone will note something that their parent or spouse said that is cruel and I will wince and make a face. My reaction provides the speaker with a response that indicates the emotional pain that this comment would have caused the average person. She may pause to consider that she had no such reaction, but accepted the abuse as OK.
At other times I may look very concerned or confused — playing the “Columbo” style of therapist. “Wait, I’m confused. You say he can go out to the bar any time he wants, but you have to stay home with the kids all the time. Help me understand. That seems like there is a different set of rules for each of you.”
Many people who are the victim of narcissistic abuse often have learned poor boundaries and to tolerate verbal or emotional abuse as normal. One intervention is to have the person slow down and do a deeper experiential processing of the statement that they so nonchalantly tossed out: “Crazy. Hmmm. That’s a pretty strong word. How does it feel to be called crazy? Can you slow down and think about what it is like to tell me that? To be crazy. To be called crazy by the person who says he loves you.”
With extremely passive people who have minimal sense of indignity and self-protection, I may even get angry to model for them this reaction: “Wow, I have to tell you that hearing that your husband calls you ‘crazy’ makes me a bit ‘crazy.’ Crazy mad. Does that name calling sound like a kind, loving comment to you? Cuz it sure doesn’t sound like it to me.”
Too many people are disconnected from their sense of self-protection and boundaries, often because of a childhood where they had to over-focus on the needs of a parent. Narcissistic, addicted, abusive or neglectful parents have their needs come first, which trains a child to accept very unhealthy reversals of relationships.
This type of self-absorbed parent also does not know how honor a child’s experiences and emotions, but instead often dismisses them or even shames the child. As a result, the child does not get an accurate response to their experiences, and so does not learn normal responses.
I also provide lots of brief tidbits of education for clients about many topics, including:
- the physiology of the fear/threat response
- toxic blame-shifting relationship patterns
- the traumatic effect of narcissistic parents
- attachment patterns and their effects
- the falsities of the DSM and disease model of “mental illness”
- the impact of shame on mental health.
Many people also come into therapy saying they have never heard about these topics, which is mind-boggling to me, because this information is essential for clients to work toward self-improvement.
I’m sure many therapists engage in an overly passive style of “listening” because they are afraid of making a mistake. It probably seems safer to sit and nod than to say anything too “judgmental.” In contrast, I believe very strongly that clinicians should act as “witnessing professionals” who should react to a client’s words normally, expressing appropriate emotions at appropriate times.
One of our most important jobs as therapists is to be an attachment figure for the client, to be a person he or she can connect to emotionally and find comfort in. A blank slate clinician is certainly not going to provide the emotional attunement essential for a warm, healthy relationship.
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