Slow and steady wins the race. Or, how psychotherapy doesn’t have to wipe you out for days after a session

I recently tweeted about how feeling wiped out for hours/days after your therapy session isn’t necessarily helpful.  In fact, in my experience it can be very unhelpful, both to the therapy process (as it makes clients understandably anxious and reticent about coming to therapy), but also because it temporarily stops them from living their life and can leave them feeling more, not less vulnerable.  Therapy should be about supporting people to feel more able to live their lives, not less so.  Sure, therapy is often about working through some deeply painful or overwhelming stuff, but it feels like a widely held belief (dare I say, myth) that to do therapy ‘right’ it needs to hurt – really hurt.  I think that’s a belief that needs to be debunked because it’s potentially toxic.

In my tweet I suggested if this is what therapy feels like for you, then it would be a good thing to talk to your therapist about it.  ‘Great advice’ came a response, followed by, ‘but what should a therapist do if a client raises this?’.  That’s such an important question that I decided to write this blog.

I think the ability to name this as an issue is an incredibly crucial step.  Because in my view, if it’s not identified and addressed it rarely, if ever, goes away on its own, and can derail the therapy.  So, the first thing I do is acknowledge that this is an important and brave thing for a client to say.  Clients might feel anxious that any expression of disappointment or struggle with an aspect of the therapy might lead them to be rejected by the therapist (perhaps as their childhood or later experience has borne out).    

Next, I work with the client to help them feel calmer in a session.  I might use a grounding exercise at the start and at various points in the session, enabling the client to feel safe, to connect to the room they are in and to themselves, perhaps via supporting them to slow down and deepen their breathing.  I might think about how the space between us feels – do they need me to move my chair back, or sit at an angle rather than opposite them (so they don’t feel stared at)?  As the session progresses, I encourage clients to tune into how they are feeling moment by moment – for example, what is happening to their breathing, what do they feel in their body, are they finding it hard to think or is their brain feeling ‘foggy’?  If I observe them becoming overwhelmed, I might say something like, “I notice your breathing has become really shallow so let’s pause and take a breath here”.  Sometimes clients feel able to go deeper into the material, but sometimes not.  If not, that’s absolutely fine – it’s vital to feel more in control of the impact of our ‘stuff’, and to go at a pace that is right for us.  Once we can do that, we naturally tend to go further into the material because we know we can control our responses to it.  

I work hard to manage the time in sessions.  I give a time check around 10 minutes before the end, so that clients can begin to manage their transition from the therapy space to the outside world.  It’s important for clients to be grounded when they leave – too often I have heard clients say they felt ‘spacey’ after a session or can’t remember how they got home.  So, I might end a session with another grounding technique, and/or encourage them to take a moment outside of the room before they leave the venue. 

All of this is the ideal, but I know how tempting it is to feel like you must get as much as you can out of a session (especially if your therapy is time limited for whatever reason).  If I recognise a client hasn’t left in a calm state, at our next appointment I would be interested to know how a client felt after the last session.  This can be an opportunity to open a discussion about all the above points.

Finally, I want to think about how attachment can inform this work.  Attachment-based psychotherapy often involves observing for indirect communications of distress or dis-ease with the therapy process.  Often clients come to me because they recognise they have an insecure attachment style and want to change this.  Insecure attachment develops because childhood caregivers have been unable to offer unconditional acceptance of emotional distress.  As a result, a child learns to either bury their distress (leading to avoidant attachment style) or ramp up their hurt to be seen by a caregiver who is inconsistently emotionally available (resulting in a preoccupied attachment style).  They learn that stating their needs doesn’t work, or perhaps can make things worse, so they innately learn to bury them.  But we rarely give up on communicating our needs – we just do it indirectly.   

A big part of my learning over the decade or so I have been a psychotherapist has been to really listen for these indirect communications.  Missed sessions and clients regularly turning up late might be two such examples.  I might wonder aloud if these are indirect communications that the work feels overwhelming to them in the ways I have described above, adding, “It’s a hunch, and only a hunch, but what do you think?”

If I am beginning to wonder if the therapy feels overwhelming, I listen for indirect communication via the material a client brings.  Listening for this, I might hear stories that suggest life feels out of control, perhaps precariously so.  For instance (and this is a fictional example), a client might report she was rushing to the bus stop, carrying heavy shopping.  She tripped, and the shopping went everywhere, but people only jostled her to get on the bus and no one stopped to help. 

I might wonder if the shopping is a metaphor for her emotional distress (which feels heavy, cumbersome and slows her down), and that our work is ‘rushing’ her along at a pace that makes her unsteady.  Perhaps I am like the people who don’t stop to help, unconcerned and perhaps irritated that her distress (shopping) is uncontained and getting under their feet.  Perhaps that I am only interested in my journey, not hers.  Again, I tentatively put these out as a theory, and I am prepared to be wrong.  But I think the aspects of a client’s week that they choose to share in therapy can be a powerful communicator and that we (the client and I) need to try and understand what is being communicated.

There is so much more that can be said on this topic, and I really interested to hear what people think. Perhaps you are a client in therapy, a therapist, or just interested in the subject, but do share your thoughts! 

Making ripples

Do you ever, in moments of quiet reflection, wonder how you will be remembered once you die? I don't just mean your physical characteristics, or your personality, but your impact on the world.  I have no doubt that many people feel they will leave no imprint on the world. Some of my childless clients seem to struggle with this more than those who are parents, but it is something we can all find ourselves chewing over from time to time. Perhaps the idea that you will have no lasting effect on the world is something that is more than just a fleeting thought, causing you much anxiety and perhaps even sleepless nights.

This is one of the main concepts Irvin Yalom tackles in his wonderful book 'Staring at the Sun', which I read recently.  I found it to be a life affirming read, and I recommend it to anyone/everyone who wants/needs to start to face the issue of their own mortality.

There is one idea that Yalom talks about in detail that particularly struck a chord with me - the idea of rippling.  Rather than try to paraphrase, I'll let Yalom's words speak for themselves:

Rippling refers to the fact that each of us creates - often without our conscious intent or knowledge - concentric circles of influence that may affect others for years, even for generations.  That is, the effect we have on other people is in turn passed on to others. much as the ripples in a pond go on and on until they're no longer visible but continuing at a nano level.  The idea that we can leave something of ourselves, even beyond our knowing, offers a potent answer to those who claim that meaninglessness inevitably flows from one's finiteness and transiency. 

So, whether you are 19 or 90, in the peak of physical health, or facing your own imminent demise, as Irvin Yalom says, it is never too late to change the ripples you leave in your wake. 

Go on, make some ripples!