In a therapy session a couple months ago, a friend who I’ll call Suzy repeated a log of complaints her live-in boyfriend had filed against her that week. “He told me that I’m too needy and jealous,” she said. For good measure, he added that she was not a talented stand-up comedian—he’s a comedian as well. Her therapist supported her, stating that her boyfriend’s claims were unfounded.
“But she’s my therapist,” Suzy later said to me, rolling her eyes. “She thinks I’m perfect.”
Suzy’s dismissiveness of her therapist’s encouragement was painful to witness. First, I worried her relationship with her partner was transitioning from tense to verbally abusive, and wondered if, in comforting her, my words were sadly being buffeted away, too. I realized further that Suzy’s insecurity was so formidable she found it impossible to think her therapist would genuinely respect and appreciate her, in spite of her paying for the sessions.
But this is something I’ve pondered in therapy as well. Those who enroll in psychoanalysis are often seeking a caring presence, someone to help them cobble together a more sound self-esteem that will carry them toward a life of greater emotional awareness, balance, and perhaps joy.
That care sometimes manifests itself in soothing praise of the patient. I can’t count how many times in therapy I’ve been told, in one form or another, that everything’s going to be okay because I’m smart, hard-working, and talented, and that my character fabric has carried me this far, so there’s little foundation for doubt. Decades of believing otherwise have been difficult to cast away, which has meant I’ve also sometimes contemplated whether or not my therapist supports me or takes my side simply because I’m the only other one in the room, I’m her client, and it’s part of her job.
I’ve made progress since I started therapy four years ago, generally feeling more secure about myself, my work, and what I have to offer the world. However, these shows of faith in myself have not proliferated simply because my therapist has proverbially patted me on the back. With her guidance—teaching me to sit with all my emotions, good and bad, so I can process them, for example—I’ve also confronted fairly unpleasant aspects of my life, and dutifully examined how I interact with others, how I can self-sabotage, and how I can take steps to better my life. This has not been easy.
So how do therapists know when to challenge clients versus when to champion them? Like much in psychoanalysis, it’s tricky.
“There’s an expression in therapy, which is called ‘rent-a-friend,’” says Scott Dehorty, a licensed social worker and executive director of the Maryland House Detox treatment facility, Delphi Behavioral Health, where he counsels individuals in recovery. With rent-a-friend analysts, Dehorty continues, “You’re just kind of hanging out and talking.” Patients don’t get into anything of real therapeutic value, he says, and the therapist is there as a “buddy,” to support you and build you up.
Dehorty says that there’s a fine line between that practice and what is referred to as “strength-based perspective,” which, according to Psychology Today, is counseling that “focuses more on your internal strengths and resourcefulness, and less on weaknesses, failures, and shortcomings.” Strength-based perspective therapy appears to play out kind of as a therapeutically heightened “rent-a-friend” with deeper psychological analysis happening in-session.
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Dehorty says that, often, if a patient has a history of trauma, “then it would be very therapeutic to begin by building them up…because they will have beaten themselves up so much that they don’t have a clear view of themselves.” Their off-center perspective of self can be reinforced over years because they’re more accepting to negative feedback—either real or perceived—and disregard positive appraisals.
In the therapist’s seat, strength-based perspective helps cultivate a rapport with the client and establishes greater comfort and trust in-session, which opens up the floor for the exploration of beneficial life changes.
“I’ve had clients who, every session, there’s always a problem with everyone else; the world is against them,” says Celeste Viciere, a Boston-based, licensed mental health clinician and cognitive behavioral therapist. “I’ve realized that they haven’t been challenged in their lives, and they’ve been coddled.” She says, too, that sometimes, when people have truly been traumatized as kids or even adults, “they will maintain that victim mentality.” And that’s not very empowering.
Once a connection between her and a client has been established over time, based on trust and ease in the room, Viciere looks to “put the ownership on the client, in a way that’s compassionate, caring, and challenging.”
Viciere’s methods call for phrasing like, “I hear what you’re saying,” which may lead into, “I can tell that this is really bothering you, but how can we have done this differently?” She may also ask the client how they might think they “played a role” in the way an inauspicious situation unraveled.
“You have to take into account their life story, any mental health issues, trauma, their current social and family issues, addiction issues, everything,” Dehorty says of his brand of treatment, especially when working with people with addiction. Throughout, he must gauge the patients’ needs and whether or not they’re “ready to change.”
Speed bumps in treatment may pop up when someone with substance use disorder is not totally forthcoming or is disingenuous with his or her therapist. The act of abusing drugs and alcohol is, in a way, inherently dishonest—a lie to oneself that they’re all right, at least for a stretch of time while they’re high.
“Just because they’ve come in for treatment, doesn’t mean they’ve changed as a person,” Dehorty continues. “Those symptoms still exist; all they’ve done is put down the drink or drug.”
In facing off with a client where there’s proof of deception, Doherty says that, depending on their position in treatment, he may ask them what the motivating factor behind the infraction and lie was. “We have to look behind the action, and get to the emotion,” he says, “because that’s what’s driving it.”
Abusive relationships also see embedded deception. “We all manipulate to some extent in the beginning of a relationship,” says Sara Stanizai, a cognitive therapist in Long Beach, California, who specializes in domestic violence trauma. Early on, such manipulations are usually harmless, like doing things you might not want to, but a new partner might enjoy: going camping or handing over the TV remote.
However, abusers use that beginning to find out what’s important to you so they can subsequently use it to control you, Stanizai cautions. For example, if one has a close relationship with their sister, gradually an abusive partner will figure out ways to keep them from seeing her. “They might say, ‘Oh, you can go see your sister, but I’m not going,’” Stanzai says. Before their partner knows it, they don’t want to see their sister anymore either.
In dealing with relationship abuse victims, Stanizai takes a similar approach to the one Viciere outlines: reflecting their history and actions back to them. Stanizai might say to a client, “Hey, this is the same thing you told me last week” or “This sounds like your last relationship.” Then they call themselves out, Stanizai says, instead of her having to say, “What the hell are you doing with this person?”
“I would do them a disservice if I just let them sit and talk and not offer ways for them to be more solution-focused,” Viciere says of her clients, adding that, on occasion, she’s lost patients due to the fact that her “style didn’t work for them because they just wanted to be listened to.” Still, there’s room in therapy for unadulterated, “there-there” tidings.
“As much as I’m challenging, I’m also soothing,” Viciere says, especially when a patient has had a recent emotional disturbance. “If it’s a fresh situation, I’m not challenging them. I’m listening, and I’m validating their feelings.”
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