Category: Blog

When the Therapist Shares Too Much 

Posted on by Elizabeth Scozzari

Claire was working on her licensure, and she asked that I supervise her throughout the process. I’ve been lucky to have strong clinical mentors across my career, and so it felt like an honor to be asked for help. I was surprised to receive a text message from her first thing on Monday morning, “Can we touch base soon? I think I really messed up.” 

My stomach tightened. I wondered how badly things could have really gone. Claire was a new therapist, but she had strong clinical skills. I hadn’t expected the urgency of this request. Soon after, she came into my office holding back tears. “I’m too close to one of my clients,” she spoke in low volume. “I don’t know how it happened. It’s not romantic, but I’ve told him about my family and my own problems. Now when we talk… it feels like a friendship. He’s been giving me advice. I screwed up and I don’t know what to do.” 

I took a breath, “You made the right choice.”  

“I know,” she said. She mistook my response for sarcasm. “I don’t know how I let this happen.”  

“No. That’s not what I meant. You had a choice between embarrassment or secrecy. To share this with me or keep it to yourself. It’s a hard choice, but you made the right one.” 

We explored the reasons why the relationship with her client had changed and what to do next. Her willingness to feel embarrassed, and to admit her mistake, was the first step towards repair. It was the first of many such conversations I’ve had since, both with new therapists and advanced ones, too. It’s also a conversation I’ve had with myself. 

Leaving Our Post: Why Unskillful Self Disclosure Occurs 

Unskillful self-disclosure is common; probably more common than we think when considering how many clinicians choose the path of secrecy over embarrassment. Choosing embarrassment by admitting our mistakes means walking against the wind, and so many therapists choose to have the wind at their back.  

But how does this happen? Despite our good intentions, why do we leave our therapeutic post? There are probably many reasons, but the first is that the rules of healthy relationships are broken in good therapy. These are the rules of give-and-take, or reciprocity. When reciprocity is absent in our personal relationships, we tend to conclude these relationships aren’t desirable. Whether giving without receiving, or receiving without giving, these are usually signs that something has gone terribly wrong. If someone talks about themselves but never asks a question in return, we notice it. Somewhere in the back of our mind there’s an accountant who keeps tabs. And if this accountant doesn’t count every penny, they help us determine if our relationships are in general balance. 

In therapy, our job is to fire the accountant. While reciprocity is beneficial in personal relationships, in therapy it undermines our ability to maintain focus on a client’s problem. So, we learn new conversational habits. We temporarily adopt a non-reciprocal style of relating to help our clients. It’s strange to acknowledge, but dysfunctional behavior outside of therapy is useful behavior within it. 

Of course, some therapeutic approaches do emphasize mutuality and appropriate therapist disclosure. But even within these frameworks, disclosure serves therapeutic goals, not the therapist’s emotional needs. This distinction matters. If good therapy requires temporarily implementing this imbalanced dynamic, it shouldn’t be surprising that we struggle to make this adjustment. We’re asked to do something that, at its core, just feels wrong. Our inner accountant balks.  

A second reason unskillful self-disclosure occurs is connected to the first, and it can relate to the problem of therapist loneliness. We are not like other professionals and therapy is not like other jobs. While our individual temperaments vary, most of us become therapists because we’re drawn to people for one reason or another. This draw towards others might seem like a good fit for a career in therapy, and sometimes it is, but other times, therapy can be a lonely place. Back-to-back appointments in empty office buildings or remote work from available bedrooms can bring with it a great silence. 

And this silence isn’t only environmental. In our conversations with clients, we’re required to strategically deprioritize many of our reactions. This doesn’t mean these relationships are insincere, but that large parts of ourselves don’t participate in our discussions. When personal reactions aren’t in service to a client’s goals, we do our best to restrain them. We ask them to hide. 

While we all have a strong interest in human connection, we’re met with more environmental and relational silence than expected. Loneliness is what happens when longing meets absence, and in therapy, there can be a great amount of both. 

Returning to Our Post: The Art of Repairing Unskillful Self Disclosure 

Understanding how unskillful self-disclosure happens is only half the task. The harder part is knowing how to return to the therapeutic framework without damaging the relationship. Once we’ve come to the realization that a clinical relationship has lost its professional shape, what can be done? This problem is difficult because while solving it, we simultaneously introduce three new risks into the therapy. 

The first is that many clients enjoy having insider knowledge about their therapist. They may feel this is the basis of their rapport. To have insider knowledge is to feel special, and to lose access means losing this feeling of specialness. With open doors now closed, the sound of turning locks can create feelings of rejection. Feeling pushed away can damage the therapy, even while we’re trying to repair it. 

Another risk is introduced when clients are more comfortable with the reciprocal dynamic. They may prefer to share the spotlight rather than feel its bright circle pointed at them alone. Reducing self-disclosure will increase the number of empty spaces in the conversation. There will be more silence, and with more silence, more discomfort. When we start walking back to our clinical post, new intensity emerges. 

The last risk is that a client might decide that they’re to blame. They might conclude there’s something uniquely wrong with them if their therapist behaves differently with them than with other clients. Sensing that they lie at the center of their therapist’s dilemma, they might experience shame. It’s a shame that tells them that somehow, they’ve hurt their helper. 

Whatever steps allow us to walk back to our clinical post, it’s important to think about managing the risks of rejection, new intensity, and shame. There’s no perfect script for this conversation, each therapeutic relationship requires its own approach, but one framework I’ve found useful centers around four steps: 

Step 1: “I haven’t done a great job protecting your therapy…” 

Expressing this step demonstrates that our aim is to protect their therapy, and to implicate ourselves at the heart of the problem. To name that we’ve failed to guard their therapy lessens the chances the client will blame themselves. 

Step 2: “and so I’m going to pull back on how much I talk about myself…” 

This signals the incoming adjustment. This statement is directive in nature as we’re not asking the client for permission with this new course of action. We’re telling them it’s happening. This is the first act of stepping away from the reciprocal dynamic, and instead, returning to the clinically imbalanced one. 

Step 3: “but I want to let you know how to interpret this change.” 

This step is particularly important because it helps reduce, though not eliminate, the new intensity that can emerge in the therapy. The client is being prepared to understand what new interactions mean, but also what they don’t. 

Step 4:  “The truth is that my enjoyment of our work hasn’t decreased, but my investment needs to increase.” 

This final phrase reiterates that our adjustment reflects a stronger commitment to the client, not a weakened one. We’re disengaging in the wrong areas and reengaging in the right ones. We’re subtracting non-clinical interactions to deepen the clinical purpose. By expressing that our enjoyment hasn’t lessened, we maintain the appropriate degree of specialness that exists in every meaningful relationship. 

Conclusion: The Ongoing Practice of Returning 

Addressing unskillful self-disclosure isn’t a single moment but an ongoing practice. After we’ve initiated the repair, it’s important to continue monitoring our own pulls toward reciprocity. The loneliness that may have contributed to the initial drift doesn’t disappear simply because we’ve named the problem. 

This is where consultation, supervision, and our own personal relationships become essential. We need spaces where we can acknowledge our humanity: our loneliness, our need for connection, our own vulnerability to unskillful self-disclosure. When Claire came into my office, she made the right choice because bringing it forward made the repair possible. 

I’ve learned that therapeutic work isn’t about being perfect. It’s about being honest enough to recognize when we’ve drifted and courageous enough to find our way back. Every time we effectively manage our need for reciprocity and our loneliness, we strengthen our capacity to help our clients. Even when we don’t prevent unskillful self-disclosure, if we practice repair, we remind ourselves that while we may fail at our post, we’re still worthy of returning to it. 

Measuring the Unmeasurable: How to Know When Therapy Is Working?

Posted on by Elizabeth Scozzari

Ever wonder if therapy is really helping? I’ve sat on both sides of the couch—first as a client, now as a clinician—and I’ve often heard the line, “Therapy isn’t working for you.” Usually, that says more about the person saying it than about the reality of what’s happening on the couch. 

Izzy’s Story: Healing on Your Own Timeline

This question came into sharp focus after a session with a 36-year-old client I’ll call Izzy. Not long ago, he shared that his mother had remarked, “You’ve been in therapy for two years and it’s not working.” Her words landed heavily. Izzy had come to me less than 24 hours after an unthinkable loss—his girlfriend had been killed in the middle of the night under tragic and complicated circumstances. The fact that he had the courage to seek help so quickly was impressive. 

Over the past two years, Izzy has navigated the raw terrain of grief. We’ve been bearing the unbearable together; slowly piecing together a life that no longer looks like the one he imagined while learning to grow around grief. His mother’s remark felt dismissive and were deeply wounding, as though the depth of his love and sorrow could be timed. Instead of compassion, she offered judgment, measuring his healing against her own expectations.  

I’ve discovered that what often looks like judgment is really a projection of someone else’s discomfort. Izzy’s story reminds me that progress isn’t always visible to others—and that’s okay. Healing doesn’t follow a stopwatch. 

Shayna’s Story: When Progress Can Be Quantified

Some gains in therapy are concrete and measurable. Shayna came to therapy with severe anxiety and somatic symptoms, many mornings she got physically ill from the stress. Driving felt impossible without taking alternate routes to avoid feeling unsafe on the highway, and seeing a doctor was terrifying. She was afraid that they would find something seriously wrong. 

As we unpacked her fears, validated and normalized her emotions, things began to shift. Shayna gradually stopped getting sick in the mornings. With courage, she went to her mammogram and colonoscopy. She even found a doctor she could trust despite feeling shaky and afraid. The hardest hurdle, driving, is still a work in progress, but she continues to show up and face the challenge. 

In Shayna’s case, progress is not abstract. She stopped getting sick. She faced the screening tests and doctors she once avoided. These steps were visible proof that healing can sometimes be measured in clear, undeniable ways. 

Concrete Wins You Can See

Other clients show measurable progress in different ways. One client, terrified of flying, eventually took a cross-country flight without panic. Another, who hadn’t cried after losing a loved one, began to access and release his grief. A 25-year-old moved out of his home after planning and executing steps used in therapy. 

These milestones are tangible, and important. They show that therapy can create results we can point to, celebrate, and even track. 

Subtle Shifts That Make a Difference

So much of therapeutic growth is quieter and harder to tally. Change happens beneath the surface—in noticing patterns, sitting with discomfort, and making different choices. Clients start recognizing which relationships drain them and which restore them, and which old beliefs no longer serve them. Many learn to nurture themselves with curiosity and compassion rather than judgment. Some become choosier about what they allow in their lives. 

These subtle shifts often manifest in daily life: responding more calmly in conflict, steadier self-talk, asking for help when needed, and seeing people—including oneself—with nuance. I see transformation in clients: behaviors that once triggered intense stress now pass with more ease, and moments of self-compassion come more naturally. 

For clients recovering from trauma, progress involves layers of insight, emotional processing, and coping skills. Progress may not appear on a chart, but it shows up in life: a disagreement that doesn’t escalate, a decision made from clarity rather than panic, a boundary held firmly, a quiet sense of relief in being kinder to yourself.  

What Progress Really Looks Like

So how do you know therapy is working? It isn’t about speed, neatness, or whether others notice. It’s about internal shifts that allow you to live more peacefully, confidently, and authentically. Some gains are visible: overcoming a fear, reducing symptoms, or achieving a milestone.  

Others are felt in small but profound ways: calmer reactions, steadier self-talk, greater ease asking for help, and the ability to hold complexity—recognizing that a parent could have loved you in one way and harmed you in another, less black-and-white thinking, and understanding that many things can be true at the same time. Every type of progress matters. 

If you’re wondering whether therapy is working for you or for someone you love, look for the small changes that ripple into everyday life: the subtle ease in reactions, moments of kindness toward ones self, or the ability to stay present with someone difficult. Even something as simple as using the word ‘no’ as a full sentence can be a quiet victory—one that often becomes the foundation for lasting change. 

Why Trauma Recovery Isn’t a Straight Line

Posted on by Psychotherapy.net Team

When clients begin trauma therapy many hold onto the hope that healing will follow a clear path. They picture a beginning, a middle, and an end. A moment where the past stops hurting, their relationships feel easier, and their bodies finally release the tension they’ve carried for years. But as therapists, we know it rarely unfolds that way. Healing is not linear. It comes in waves. Progress can be followed by regression. A moment of insight might be lost in a fog of overwhelm. A good week can lead to a hard month. It’s not a step-by-step climb. It’s a spiral. Clients return to the same emotional terrain again and again, but each time, hopefully, with a little more clarity, a little more stability, and a little more strength.

Clients Might Not Recognize Themselves at First

One of the earliest shifts I’ve witnessed in my trauma work is a client beginning to question long-held coping strategies, survival instincts, and automatic responses. These were the very tools that kept them safe in environments where safety was uncertain. They may start setting boundaries and feel a wave of guilt they can’t quite name. They may say no and spiral into fears of abandonment. They may feel anger surface for the first time in years and have no framework for how to manage it.

This stage can be disorienting. Clients often wonder if they’re regressing or doing it wrong. In truth, they are beginning to do something radically new. The nervous system often perceives unfamiliar experiences as potential threats, even when those changes are healthy. That is why growth frequently shows up as discomfort.

As a therapist, I have found it to be essential to help normalize this phase and support clients in tracking these shifts as evidence of progress. What once felt unsafe begins to register as tolerable. And over time, it begins to feel like safety. This is not failure. This is the nervous system recalibrating.

For clinicians interested in exploring the neurobiological foundations of this process, resources like Bessel van der Kolk’s work, and that of the National Child Traumatic Stress Network offer helpful frameworks for understanding how neuroplasticity supports recovery. I keep reminding my clients and myself that discomfort is often a sign of meaningful change. With time, what feels unfamiliar now can become a source of strength and stability.

The Nervous System Has a Story to Tell

Trauma doesn’t just live in your client’s memories. It lives in their bodies. It often shows up in the form of chronic tension, unexplained exhaustion, or a racing heart in situations that seem calm on the surface. I have noticed how a client becomes anxious in safe environments, withdrawn when connection is offered, or goes numb during moments that would typically bring joy. These aren’t signs of resistance or dysfunction. They are adaptive nervous system responses developed to survive past experiences.

The body carries what the mind may no longer recall. My client’s nervous system often reacts before their conscious awareness catches up. These responses made sense in the context of trauma, even if they seem confusing or disproportionate now. As a therapist, I can help clients begin to recognize these embodied patterns with curiosity and compassion. The healing process often starts with noticing—subtle shifts like shallow breathing, clenched jaws, or emotional distance in the room. These cues are the nervous system’s way of communicating safety or threat.

Rather than encouraging clients to override these sensations, I guide them toward listening to their bodies with gentleness. When I help create space between sensation and reaction, I offer a new way forward. That space is often where integration and healing begin. In learning about how the nervous system holds trauma and how regulation begins with awareness, I have found the Polyvagal Institute to be a particularly useful resource.

In one session, I have found that a client may speak with clarity and confidence. The next, they might come in feeling discouraged after falling into old patterns. Maybe they people-pleased, avoided conflict, or ignored their own needs. They begin to question whether any of their progress was real. It was!

Healing is not linear. The strategies that once helped a client survive can resurface, especially when they are tired, anxious, or uncertain. These moments are not evidence of failure. They are part of the natural rhythm of recovery. What begins to shift is their awareness. They notice the pattern more quickly. They pause before reacting. They ask themselves what they truly need in that moment. These subtle changes are meaningful. They mark the growth of resilience.

I have also found it important to help clients see these moments for what they are. Not as regressions, but as opportunities. This is where change begins to deepen. When someone catches themselves repeating an old behavior and chooses even a slightly different response, they are practicing something new. There is also something powerful that happens in these harder moments. Pain and struggle often reveal where care is still needed. They slow things down. They invite both the client and therapist to listen more closely to what is underneath the reaction.

This is where the deeper benefits of pain and suffering begin to emerge. These experiences have the potential to strengthen emotional awareness, deepen empathy, and reconnect a person with their values. Suffering, while never sought out, can become a guide that point to unmet needs, long-held beliefs, or unresolved grief that is asking to be seen. These moments help build presence, not perfection. Setbacks are not the end of healing. They are woven into the work. I have supported my clients in seeing these experiences not as detours, but as part of the path forward.

Healing Can Disrupt Your Relationships—And That’s Okay

As clients begin to heal, their relationships often start to shift. They may stop over-functioning. They may begin setting firmer boundaries or expressing their needs more clearly. Behaviors they once tolerated may no longer feel sustainable. These shifts, while healthy, can create waves. Not everyone in the client’s life will welcome or understand the changes. And that can bring grief, confusion, or even guilt.

Clients may feel lonely even as they move toward what’s best for them. They may grieve connections that once felt familiar, even if those dynamics were rooted in dysfunction or emotional distance. Letting go of old patterns often feels like loss, even when it is progress.

At junctions such as these, it’s important to normalize these growing pains. Healing doesn’t always feel good at the moment. It can challenge long-standing relational roles and bring uncertainty to familiar bonds.

These disruptions also signal movement toward something more grounded, more honest, and more self-respecting. Support clients in recognizing that discomfort in relationships is not a sign of regression and can be a sign of emerging authenticity. Healing doesn’t always preserve the old. Sometimes, it clears space for relationships that are built on emotional safety, mutual care, and respect.

It’s Normal to Feel Tired and Take Breaks of Healing

There have been moments in my clients’ journeys when the work feels like too much. They may grow tired of telling their story, tired of tracking every trigger, tired of examining old wounds. The weight of self-reflection can feel heavy. They might withdraw for a while. Maybe they spend more time scrolling, bury themselves in work, or cancel a session or two. These behaviors are not necessarily resistance. More often, they are signs of fatigue.

It is particularly important to name and normalize this part of the process. Healing is demanding. It takes emotional energy, and it does not always move at a steady pace. Help your clients understand that needing rest is not failure. Taking a break is not giving up. Slowing down does not erase progress. Sometimes the most meaningful work happens when clients step away and give themselves time to integrate what they’ve already uncovered. Growth needs room to breathe. It needs softness and space. When clients return, whether next week or next month, I acknowledge that return. Remind them that showing up, even imperfectly, is still showing up. That, too, is healing.

Clients often come into therapy carrying unspoken pressure. They want to get better quickly, move on from the past, and prove they’re strong by needing less. Some may feel shame for still struggling or frustration that their healing is taking “too long.”

There’s No Deadline for Healing

Therapeutically, it’s important to gently challenge this mindset. There is no prize for speed. No gold star for needing the least amount of help. Healing is not a race, and there is no finish line.

What matters is consistency, not perfection. It’s the willingness to return to work again and again, even after a setback. It’s the slow rebuilding of trust within themselves. I invite my clients to move at a pace that honors their body and nervous system. I help them see that slow progress is still progress. I let them know that taking the time they need is not only acceptable but it is wise. Therapy is not about rushing toward resolution. It is about creating a space where healing can unfold naturally, with patience, care, and room to breathe.

Postscript

If your clients’ healing journeys feel slow, confusing, or filled with setbacks, that doesn’t mean they’re getting it wrong. In fact, it often means they’re doing the hard, necessary work of integrating change. Recovery from trauma is rarely a linear process. It moves in spirals, detours, and pauses because that’s part of what makes it real.

As therapists, we can support this process by holding space for grief, for uncertainty, and for the parts of healing that take time. We can remind our clients that it’s okay to move at their own pace. That healing isn’t measured by speed but by presence, consistency, and the courage to keep showing up.

Insight into the Clinical Challenges of Adoption

Posted on by Psychotherapy.net Team

What does it mean to truly embrace the journey of families made by adoption? This question has both intense personal and professional significance for me. I am both an adoptive parent of BIPOC children and a play therapist who has taken the journey with many adoptive families as my practice has moved into the worlds of complex trauma and attachment issues. Adoption has long been seen as a solution—the miracle, that solves the problem of child abuse, neglect, and abandonment. During the era in which my husband and I were building a family, it was our solution to pregnancy loss and challenges to fertility. The miracle version of the story has inspirational, even profoundly spiritual overtones in many families. The idea of bringing together caring adults who want to be parents with children who have lost the care of their first parents through some version of tragedy and harm is an inspirational narrative. To the degree that it replaced the secrecy and shame of earlier decades’ approach to child placement and adoption, or overtaxed, harmful group institutional care, it represents a significant step forward in the lives of children and families.

Beyond Happily Ever After

Despite being a child mental health professional, I was not well prepared as a parent for the “what’s next” part of the adoption journey. However, neither was I alone. Many of the families that I have come to work with over the years have struggled to balance their own “miracle” language with the realities of the trauma and attachment loss for the child, even when placement and adoption occur early in life, before the so-called “age of memory.”

Thanks to Bessel van der Kolk and others, we are increasingly aware of the importance of somatic memories built implicitly in the earliest months of life, even in utero. When the preverbal or early in life trauma experiences compound with attachment loss and disruption, it make the realities of emotional and behavioral regulation deeply challenging. Parents, like myself, struggle to respond adequately to a day-to-day reality quite different from “the happily ever” after version of the adoption miracle story.

In this space, a trauma and attachment-focused play therapist who enters the family system can have such a profound impact. We have to be ready to challenge the miracle narrative and, in its place, use the best clinical tools we have to help the child feel supported in the unfolding of their own true and three-dimensional story. This story includes a recognition of the emotional, and often cultural, dislocation and disruption that is at the core of this adopted child’s life journey.

It also must address an understanding of the messages from the most fragmented parts of the self that are communicated through the body. Attempts to deny, dress up, or over-soothe these losses and disruptions can land badly. When loss and adversity are left unprocessed and unresolved, this can lead to the intense emotional dysregulation some children display, and for others, can lead to a ticking time bomb for a crisis of worthiness, belonging, and the capacity to form deeply satisfying attachments over the life span.

For children with multiple disruptions as they moved through the foster care system, the complicated wounds to their attachment exact a painful and complex cost, as there are so many missed opportunities for adults to keep their part of the attachment bargain—that every little human born into the world deserves to have their basic needs met, to be enjoyed and nurtured. By the time the adoption happens, these forever caregivers may have a lot to prove and the negative energy they get from the child is the cumulative effect of others’ failures.

Many of my clients’ parents with whom I’ve worked have despaired that their efforts to connect with, and shape, the behavior of their dysregulated and insecurely attached adoptive child(ren) are met with rage and rejection, instead of responsiveness. Often, I have felt those impulses as well, during struggles to make the child’s response make sense in a cause-and-effect, logical consequence version of the parent-child relationship. For a child who missed out on the basic building blocks of the serve and return part of secure attachment, consequences are perceived as threats, and may work to grow the most defensive and rageful parts of the child’ personality.

A Layer Cake Metaphor for Adoption-Based Therapy

One of the attachment concepts I find so useful in these moments is based on the notion of mentalization, and the ability of caregivers to create and sustain an attuned mental map of what is going on inside the child. Peter Fonagy and others have been writing for many years about mentalization and the impact on reflective functioning in the attachment between parents and children. In my own experiences, I have come to realize that clinging to the “miracle” narrative can sabotage mentalization.

Why does this happen? So often the impulse to spare children the hard parts of their own story or soothe away uncomfortable information leads to a real phobia of their own child’s distress and the resulting failure of mentalization. The answer to this challenge is for therapist—and the adoptive parent—to help the child make sense of their story, including the hard parts; expand the family system’s capacity to hold the distress without minimizing it, and do this work with the parent as an active participant, with support from the therapist.

In attempting to teach a group of clinicians about weaving together of all the things that seem important in therapy with families, I came up with the metaphor of the layer cake. Play therapy, trauma/attachment work, dissociation theory/parts work and family therapy are all a part of this multi-layered work, even as we try to help our clients eat the “whole thing,” bite by bite.

I think of my work with a child who was adopted from an orphanage in the developing world as a preschooler, and the complicated, but beautiful layers of how the therapy unfolded for him a few years after his adoption in the US.

Play Therapy Layers

Like many children, offering open and child-centered play in the playroom, led to the emergence of post traumatic play narratives, giving clues or hints to the preverbal experiences. One example was many narratives around characters fighting over scarce resources, as well as abandonment stories played out with dinosaurs, video game characters, and superheroes.

Dissociation/Parts-Work Layer

Dissociation is the infant/child’s solution to the unbearable threat of betrayal by the original caregiver whether through overt abuse, neglect, sexual exploitation, or attachment loss. To fragment and isolate that chain of painful associations and emotional/somatic stress is a very adaptive way to cope. By the time this child entered therapy, these dissociative patterns had resulted in some fragmentation, including rageful episodes and “baby” parts who were almost incapable of receiving soothing from the parent. The parent admitted to a lot of dysregulation herself in the early months after placement and compounded the effect with threats, yelling, spanking. It was clear that we needed to playfully befriend these dissociated parts through some expressive work. Using a lot of drawing and flexible sand tray creations, we involved the parent experientially in play scenarios apologizing to the hurt parts of the child that she had frightened.

The EMDR/Trauma Protocols Layers
Bridging from trauma content held implicitly in play into first person narrative work, while staying grounded in the present is a tricky business. I used a flexible and playful approach to adding EMDR processing in the playroom for short periods, especially when the adoptive parent was able to support and bear witness to that work. This often served an additional purpose of shifting angry and embittered caregivers into empowered and compassionate ones.

As they come to see their child’s story through their eyes, it increased their reflective capacity and attunement. This parent struggled at times with her own impulse to soothe—she and I talked of her desire to “put a bow on it” and keep the child from feeling the intensity of his losses and rejection as he grew older, and became more aware by following my lead in the playful EMDR sessions.

Anti-Racist, Anti-Bias Icing on the Cake

This is an area of great challenge for adoptive parents who may have limited experience with the day-to-day realities of being Black or Brown, especially in the White majority spaces where many adoptive kids are growing up. In this case, the parent had really minimized the impact of cultural dislocation for her child, but as I insisted on broaching the subject directly, we discovered a lot of distress for him around looking different from her, navigating racial/cultural groups of peers, and as we began to work through the hard parts of his own story, anger at the birth country for “throwing away children” arose.

Permission to feel big feelings was needed throughout that work, and collateral work with the parent on her own biases and perceived need to soothe and minimize these experiences of microaggressions was crucial. Given the polarization and negative narratives in the wider culture, this work will likely be ongoing throughout his development, but the work so far has helped them both to have a framework in which to stick together, and build the parent’s capacity to move past the “miracle” of coming together into the power of growing together through adversity.

***

As my own children have moved from adolescence into young adulthood, I continue to marvel at how unfolding layers and the expanding capacity hold the hardest parts of their stories. I never cease to be humbled by my own invitation to that process, in my own family, as well as in my psychotherapy work, and even the potential to act in a wider culture that needs that capacity now more than ever.

A Therapist’s Guide to Breaking Free from Impostor Syndrome

Posted on by Psychotherapy.net Team

Two years ago, I released a song called Imposters, which explored my feeling of not belonging, especially in relationships. Fast forward to today, and I find myself still wrestling with the same theme. However, my perspective has evolved. I am no longer speaking just as a musician, but also as a therapist, a writer, and a human being actively living through this experience.

The Evolution of an Imposter

What exactly is imposter syndrome? The dictionary defines it as “the persistent feeling of not deserving one’s success and of being a fraud despite a history of accomplishments.” With that definition in mind, it is important to ask: why is this experience so seemingly common? Is it because we live in a world where personal successes are only validated when they align with rigid societal standards? Or is it because we are so emotionally, mentally, and spiritually undernourished that we struggle to affirm ourselves, making it almost impossible to acknowledge our growth, even when it is right in front of us? Over the past year and a half, these questions have become personal; I turned 30, became a business owner, assumed the role of lead psychotherapist in my mental health practice, and launched a podcast called Do We Have Your Attention? (shameless plug—go listen). On paper, it appears that I am thriving. In reality, much of this growth has felt out of my control. It was during this significant transitional phase that imposter syndrome resurfaced more intensely than ever before. Despite having extensive training from one of the top clinical training programs in the country, a license to practice, and a growing business, I found myself doubting my competence. The number of accomplishments did not seem to matter; when the feeling of unworthiness sets in, it can easily overshadow everything. This brought me to a deeper and more critical question: how do we measure worthiness? To truly understand imposter syndrome, I feel compelled to examine the standards against which we compare ourselves. Isaac Prilleltensky describes worthiness as the feeling of being valued and the ability to give value to oneself and others. Based on that definition, I should undoubtedly feel worthy. After all, I have dedicated my life to helping others heal and thrive. Yet, despite these tangible contributions, the voice of self-doubt has persisted, highlighting the disconnect between external achievements and internal validation. Why, after reaching these professional milestones, was the voice of my imposter syndrome louder than ever? Tracing this back led me to my childhood. I was the student who struggled academically, often hovering between average and below average. At one point, my parents even considered having me repeat a grade. Reading and comprehension were significant challenges. I could study an entire chemistry textbook and retain almost nothing. Instead of encouragement, I frequently received criticism, particularly from teachers, reinforcing the belief that I was incapable. Slowly, a damaging internal narrative formed: I am incompetent. While not everyone’s experience with imposter syndrome originates this way, identifying the root belief system has been an essential road stop on my healing journey. Given my academic struggles, and the subtle, but consistent, feelings of disappointment from important figures in my life, it makes sense that success now feels undeserved. Early narratives, once embedded, have clearly shaped my self-perception long after I have outgrown the environments that created them. Understanding this, it has become clear that addressing my imposter syndrome is not solely about recounting achievements; it is about confronting the reflection I meet in the mirror each day. It is about understanding why I so often meet my reflection with shame, criticism, and doubt, instead of acceptance and worthiness. Could healing imposter syndrome be as simple as identifying its roots? The answer, unfortunately, is no. Recognizing where it started has certainly been essential, but it is only part of the work. We must also contend with external reinforcements—failed relationships, rejected opportunities, academic struggles, and the perpetual comparisons fostered by social media, where others’ curated successes are constantly on display. These external triggers have continuously reinforced my feelings of inadequacy.

A Remedy to the Imposter Syndrome

A tool I have found incredibly helpful in managing these feelings is a mindfulness practice called RAIN, developed by Tara Brach. RAIN is an acronym that stands for: Recognize, Allow, Investigate, and Nurture. It is a framework that guides individuals in meeting difficult emotions with both compassion and clarity. Recognize, the first step. For me, it often involves recognizing the feeling of incompetence resurfacing, particularly as I step into public roles—building a business, launching a podcast, and exposing myself to real-time visibility and judgment. Vulnerability is inevitable. Allow, the second step. Allow the experience to exist just as it is. This has been difficult for me, and can be especially so for those who habitually try to control outcomes. The goal here is not to fix or suppress the emotion but simply to sit with it. Investigate, the third step. This means approaching your experience with curiosity and compassion, rather than judgment. Asking questions such as: What beliefs are fueling this feeling of fraudulence? How is this emotion manifesting in my body? This step invites gentle exploration rather than critical analysis.   Nurture, the fourth and final step. Here, you meet the pain with kindness. Ask yourself: What do I need right now? and then offer that, whether it is reassurance, forgiveness, comfort, or patience. This is the space where healing begins to take root. RAIN is not a magic fix. It is a practice that demands consistency, patience, and kindness. Each person’s process of nurturing may look different, and that is not only acceptable but necessary for true self-compassion. Today, I continue to navigate imposter syndrome. I am learning to balance building a new life while tending to the younger parts of myself that need validation and reassurance. My focus now lies in disciplined self-care: wellness routines, prayer, nervous system regulation, and practicing RAIN.

Case Application

In my clinical practice, I’ve worked with numerous individuals grappling with the weight of imposter syndrome, particularly those from marginalized communities where societal expectations often clash with personal realities. One client, a Black woman in her early thirties, offered a vivid example of how imposter syndrome can intersect with perfectionism, anxiety, and culturally constructed definitions of success. Despite being high achieving by many standards, she struggled with persistent feelings of inadequacy, often comparing her life trajectory to that of her peers. These comparisons left her questioning her worth and accomplishments, particularly because she had not followed certain conventional milestones such as pursuing a postgraduate degree, or attaining what she perceived as a “stable” professional identity. Complicating her experience was a long-standing history of Attention-Deficit/Hyperactivity Disorder (ADHD) and Generalized Anxiety Disorder (GAD), both of which amplified her self-doubt and made it difficult for her to feel grounded in her successes. As our work progressed, it became increasingly clear that her internal narratives of success were not organically her own––they were shaped by broader societal pressures and cultural messaging about what it means to be accomplished, especially as a Black woman expected to “excel” in all domains. Together, we began the process of deconstructing these inherited belief systems, and rebuilding a more authentic, internally defined understanding of success and happiness. A key part of this work involved using the RAIN framework (Recognize, Allow, Investigate, Nurture) as a tool for emotional regulation and self-inquiry. We began by Recognizing the core distress: the belief that she was “unsuccessful.” This belief stemmed from her decision not to pursue further academic credentials and from taking the bold step of starting her own business, choices that felt right to her but conflicted with societal norms. Next, we practiced Allowing, making space for the emotions that accompanied this belief, rather than trying to immediately fix, change, or suppress them. This allowed her to begin cultivating a compassionate relationship with her inner experience. As she became more comfortable with allowing these emotions to exist, we moved into Investigation, exploring questions like: What do I believe being “unsuccessful” says about me? Where did this belief come from? How does it show up in my body? This phase helped her connect with the somatic experiences of anxiety and perfectionism, allowing for deeper insight into the ways these beliefs were embedded in both mind and body. Finally, we moved into Nurture, supporting her in meeting herself with compassion and care. This included grounding practices, affirming internal dialogue, and honoring her needs for safety, validation, and emotional rest. Over time, she began to recognize that success is not a fixed or universal standard, but rather a deeply personal and evolving concept. Through this reframing, she was able to cultivate her definitions of what it means to live a meaningful, successful life free from the limiting expectations that had previously governed her self-worth.

Hide & Seek: Evoking Desires to be Seen, Heard, and Found

Posted on by Psychotherapy.net Team

Separation and Reunion

Hide-and-seek is a universal game enjoyed by children across different cultures and ages. It reflects the ongoing interaction of separation and reunion that begins in infancy. As children develop emotionally, they transition from infancy to toddlerhood and eventually to childhood, engaging in various play activities such as peekaboo, chasing, and hide-and-seek. These games help children navigate developmental challenges, allowing them to experience loss and learn how to manage the dynamics of separation and reunion while forming close relationships with others. Playing peekaboo and hide-and-seek help children transition from relying on the physical presence of their caregivers to developing mental representations of them that they can recall when the caregivers are not around.

Play allows a child to make sense of their experiences. Play Therapy provides a therapeutic environment in which children can explore the unconscious independently. Children inherently strive for growth and healing. Our role as play therapists is simply to create the right therapeutic space and setup, enabling them to express and address what needs to be transformed or resolved. This is why play therapists don’t have to actively introduce concepts; children naturally initiate hide-and-seek themes on their own in the playroom.

Attachment and Loss

The presence of repetitive hide-and-seek in play therapy suggests the child may have experienced an inability to master the developmental task of emotional constancy, had (or has) a break in attachment where the child did not feel wanted or desired, or weak attachment bonds.

A major task of childhood is achieving emotional constancy. Emotional constancy is the ability to have an inner conviction of being ‘me and no one else’ while also respecting and valuing the separateness of others. Achieving emotional constancy enhances one’s ability to manage emotions during change or in response to anger, disappointment, and frustration. Hide-and-seek is essentially the child’s attempt to overcome and work through the earlier developmental need to understand that people can disappear but then return.

Boy who wanted to be found

Jeremy is an 8-year-old boy who faced medical complications at birth and continues to live with a rare heart condition. He was separated from his mother and spent several months in the Intensive Care Unit before his parents could bring him home from the hospital.

As we entered the playroom, he looked at me with the biggest smile on his face. I looked back with glee.

“You’re excited to play today,” I said.

“Yes. Because I am going to hide now, don’t look,” he shouted! “Close your eyes,” he added as he ran toward the other end of the playroom.

With my eyes closed and my hands over them, I waited while he hid. After some time, I softly walked around looking for him.

“Oh, where are you,” I asked. “Where did you go?”

Before I could make my way around the playroom, he popped out.

“Here I am!”

“Oh, there you are. I was wondering where you went.”

He shook his head in agreement.

“Again, find me again,” he quickly directed!

Jeremy played variations of hide-and-seek with me, and also in the burying and unburying objects in the sand during our time together in the play. He often struggled to stay hidden during the process, popping out or revealing himself before I could find him (or the object) suggesting he struggled with the tensions of aloneness and deep down feared no one would notice or “find him.” Across time and throughout the sessions, he was able to spend more time hidden and eventually developed confidence in sitting with tensions of oneness and separateness. I was careful to attune to his desire to be seen, heard, and found.

***

For Jeremy, and others his age and developmental level, hide-and-seek symbolizes the universal human desire to be seen and heard. Play therapy allows children to explore, restore, and practice the concerns that occupy their inner world. Engaging in hide-and-seek with me helped him to manage anxiety, while also fostering a sense of mastery and reinforcing his self-worth.

Questions for Thought and Discussion

What childhood games have you effectively utilized in therapy?

What are your impressions of the way this author used hide-and-seek?

Given the child’s presenting issue, what might you have focused on in the playroom with him?

A Supervisor’s Guide on How to Create a Culture of Support

Posted on by Psychotherapy.net Team

My entry into the workforce began, and has remained, in 24/7, high-paced environments be it call centers or residential treatment. These fast-paced settings taught me the importance of resilience and self-care, but it was not until I transitioned into private practice that I could begin to slow the pace. However, the demands of a high-risk caseload meant that even in private practice, I maintained extended office hours. Throughout my career, I have had the privilege of supporting many mental health professionals who regularly engage with trauma survivors or those in active crisis. Understanding the toll that vicarious trauma takes, I developed strategies to support the well-being of and prevent burnout in professionals. I’d like to share three strategies that my supervisees found especially helpful in fostering their mental wellness in the workplace.

Creating a Supportive Supervision Model

As a supervisor, my role extends beyond overseeing the day-to-day tasks of my supervisees. I recognize that mental health professionals, especially those working with trauma survivors and high-risk clients, require both administrative and clinical support to manage their responsibilities effectively and maintain their well-being. I take responsibility for creating a culture where staff feel supported and equipped to handle the emotional demands put on them. To this end, I created a structure that delineated the roles of administrative and clinical supervision, providing a balanced, comprehensive support system.

In a typical supervisory relationship, the administrative supervisor is responsible for evaluating and supporting performance—ensuring that supervisees meet the operational and procedural requirements of the agency. However, the clinical supervisor focuses on developing psychotherapeutic and case conceptualization skills, providing professional development and emotional support to the supervisee as they navigate the complexities of trauma work. This division of roles ensures that each supervisor can specialize in their respective areas, offering targeted guidance that fosters professional growth and emotional resilience.

One of the most important aspects of effective supervision is fostering open communication about the emotional impact of trauma work, ensuring that staff feel safe to express their vulnerabilities without fear of judgment. I implemented a supervisory triad model, pairing each supervisee with one administrative supervisor and one clinical supervisor. This model allowed for an integrated approach to supervision: the administrative supervisor handles performance evaluations, time management, and task completion, while the clinical supervisor concentrates on therapeutic skills, case discussions, and the supervisee’s well-being. Additionally, the clinical supervisor, in keeping with the ethical standards of confidentiality in therapeutic relationships, ensures that any personal disclosures made by the supervisee regarding their emotional or psychological state remained private and were not communicated to the administrative supervisor. This clear distinction between the two supervisory roles allows supervisees to feel secure in discussing sensitive issues without fear of it affecting their professional standing.

In some cases, I oversaw a structure where six supervisors held both administrative and clinical roles, but never for the same supervisee. This arrangement provided the supervisees with consistent support from trusted individuals while preventing any potential conflict of interest. Supervisors were able to give well-rounded feedback and support while being mindful of the emotional and professional needs of their supervisees, ensuring that both aspects of supervision—administrative and clinical—worked synergistically to help the supervisees thrive in their work with trauma survivors and high-risk clients.

Peer Support Groups: A Collective Approach to Emotional Resilience

One of the most effective strategies I implemented to foster staff well-being was the creation of a volunteer peer support group. This group convened every other day, providing a dedicated space for staff members to offer one another support without the direct involvement of leadership. The peer support group primarily focused on emotional and practical support, creating a safe, informal setting for staff to share their experiences, challenges, and coping strategies. This allowed staff to connect with one another, offering solidarity and understanding in a way that was distinct from their regular work tasks.

By establishing the peer support group, I aimed to encourage a culture of mutual aid, where colleagues could provide emotional assistance without the pressure of leadership oversight. This structure empowered staff to manage stress and challenges together, without relying solely on hierarchical support structures. I made it clear that if the peer support group identified systemic concerns or common issues that could be addressed at a larger organizational level, those concerns should be brought to leadership’s attention in a collective, constructive manner. This approach prevented individual staff members from feeling burdened by problems that could be addressed more effectively at the systemic level, fostering a shared sense of responsibility for the emotional health of the workforce.

Creating this peer support network was an essential part of building a sustainable and compassionate work environment. It helped staff feel less isolated in their experiences, knowing that they had a space where they could seek support from peers who truly understood the emotional toll of trauma work. This group was not just about coping in isolation but about collectively sharing strategies, offering comfort, and validating one another’s experiences, helping to build emotional resilience across the team.

Self-Care Encouragement: Prioritizing Individual Well-Being

In addition to peer support, I strongly believe in the importance of self-care as a crucial component of maintaining long-term emotional and psychological well-being in trauma and crisis work. As a supervisor, I consistently emphasize the significance of work-life balance and self-care, especially in high-stress environments where emotional and psychological demands are prevalent. I encourage supervisees to establish clear boundaries between work and personal life to avoid burnout and preserve their mental health.

To promote self-care, I implemented several strategies. First, I set aside two hours each week for every supervisee to either engage in reflexive writing or exercise, ensuring that this time was a non-negotiable part of their workday. Reflexive writing offered a space for staff to process their emotional experiences and gain clarity on their work, while exercise provided an opportunity to release physical stress and re-energize. This initiative was intended not only to give supervisees a break from their caseloads but also to encourage habits that promote long-term resilience.

Additionally, I encouraged the cultivation of personal self-care routines, such as mindfulness practices, regular physical activity, creative outlets, and maintaining social connections. These habits allowed staff to recharge both mentally and physically, preventing exhaustion and helping them stay engaged and compassionate in their work with trauma survivors. By prioritizing these practices, I hoped to empower my supervisees to take ownership of their well-being, ultimately enabling them to maintain their capacity to care for others without compromising their own emotional health.

Conclusion

The integration of peer support groups, reflexive writing, exercise, and a culture of self-care was designed to not only prevent burnout but also promote long-term emotional health for staff. By fostering a culture where emotional support and self-care are prioritized alongside clinical work, I believe we can create a more sustainable and compassionate work environment where professionals can thrive in their roles, while maintaining their mental and emotional well-being. A supervisor’s guide to supporting well-being involves proactive interventions, such as reflective writing or exercise, that encourage staff to engage in practices that recharge both their bodies and minds. By establishing a peer support network within the team, I help cultivate a sense of shared responsibility, where colleagues support one another without the direct involvement of leadership, promoting autonomy and mutual care. As a supervisor, it has been crucial for me and my colleagues to not only offer guidance in clinical practice, but to ensure that the emotional needs of the staff are met, empowering them to maintain their compassion and professionalism in the face of difficult work.

Questions for Thought and Discussion

  • What about the author’s model of supervision do you find useful? Not useful?
  • How is self-care practiced at your facility? In your practice? In your personal life?
  • How has burnout entered into your own life and practice, and what do you find most effective in combating it?

From Darkness to Hope: Using Compassion-Focused Therapy

Posted on by Psychotherapy.net Team

The most authentic thing about us is our capacity to create, to overcome, to transform, to love and to be greater than our suffering – Ben Okri

“It’s a head-heart disconnect,” were the words of my supervisor when I asked her why my client, who seemed to ‘know’ or agree with our cognitive reframe of their traumatic experience, didn’t feel it. I’ve repeated those words countless times since—to clients, to colleagues, even to myself when reflecting on my own processes. The head-heart disconnect, when we know something intellectually, but don’t feel it emotionally.

As a newly qualified cognitive behavioural therapist at the time, I was still grappling with the difference between cognitive change at the head level versus the deeper, felt shift that happens when change touches the heart. When I encountered that disconnect in sessions, I felt helpless and confused.

Sarah: Freedom from Shame and Guilt through Self-Compassion

Many clients stand out in my memory. This is a fictional account inspired by them, but not representing any particular person in order to protect their privacy. Sarah was in her late twenties and had been grappling with intense self-blame following a traumatic online sexual experience. She would nod in agreement when we explored the lack of control she had over the situation and when we challenged the beliefs she held about herself as “naive and pathetic.” Yet, despite these rational shifts, her emotional reality remained unchanged. “I know you’re right,” she’d say, “but I still blame myself for what happened.” It was difficult to witness how much guilt Sarah carried, as though she were the perpetrator.

In supervision, I shared my helplessness, feeling as though I were missing something essential. It seemed like no matter what we did—whether we used Socratic questions, conducted an anonymous survey of other people’s opinions, or used thought experiments about whether she would judge anyone else who had been in the situation as harshly—Sarah’s guilt persisted.

My supervisor, with the same gentle wisdom she’d shown me before, said, “is it guilt or is it also shame? I think it is shame you are dealing with, and what do we do with shame? We bring compassion to shame.”

That statement, and what it helped me to learn, changed my practice and my future research interests all at once. Up until then, I’d understood compassion as an element of the therapeutic relationship, but I had not yet worked with it as a core intervention. I began to understand how emotional change requires more than cognitive insight; it requires an internal felt sense of warmth, safety, and connection.

Shame relates to how we see ourselves through others’ eyes, or a lens through which we view ourselves. It can create a powerful urge to hide, even when there’s nothing to hide from. Compassion helps counteract this by fostering a body-mind sense of safeness, belonging, and acceptance.

In the following sessions, I introduced Sarah to the concept of her compassionate self. We practiced guided imagery, inviting her to imagine a nurturing, wise, and courageous part of herself—a part that could hold her pain without judgment. At first, she resisted. “This feels silly,” she said. “Why would I give myself compassion when I caused this?”

Together, we explored that resistance, gently uncovering her fears about compassion: that it might let her ‘off the hook’ or make her weak. Over time, she began to understand that self-compassion wasn’t about denying responsibility or making excuses. It was about recognising her suffering and meeting it with wisdom and strength.

Compassion-Focused Therapy in Action

The shift didn’t happen overnight, but gradually, Sarah started to replace feelings of numbness and the extreme discomfort of shame with the underlying pain and the caring feelings she needed to heal. As part of this process, we introduced soothing rhythm breathing—a core Compassion Focused Therapy practice that activates the parasympathetic nervous system and fosters a sense of inner safety. Sarah practiced breathing slowly, finding her own soothing rhythm that settled and calmed her. This simple, embodied exercise became an anchor for her, helping her regulate overwhelming emotions and connect to a felt sense of stability.

One day, during an imagery exercise, we identified what fuelled Sarah’s shame was the isolation she had experienced at the time of the trauma. She had hidden what had happened to her from everyone close to her, while knowing that hundreds of people, possibly more, online, were aware and might be judging her. This isolation was, in part, the source of the intense shame she carried.

Together, we created a new image. Drawing on her knowledge that her close-knit group of friends did not blame her and would have surrounded her with solidarity and love if they had been there years ago, Sarah allowed herself to develop a felt sense of protection and connection instead of ostracisation and stigma. As she did so, the head-heart disconnect dissolved.

By shifting our attention away from guilt and blame toward shame and acceptance, Sarah was able to acknowledge that she had felt tricked and that it had been a painful experience. She learned to relate to her past self with wisdom, gentleness, and acceptance, replacing the internalised feelings of social danger and the urge to hide with an internalised feeling of social safeness and being deserving of care.

This experience profoundly shaped my clinical practice and research interests. I realised that, like Sarah, there may be more people who carry shame and hide because of online sexual experiences. I dedicated my doctoral research to developing a compassionate self-help programme and testing whether it might help individuals become more open to seeking support and relating to themselves in a kinder way.

There is still much work to be done in this area, but this experience taught me an essential lesson: the head-heart disconnect is not a sign of resistance or failure in therapy—it’s a sign that the heart hasn’t yet felt what the logical brain understands. Compassion is the bridge. And sometimes, we may find the work stems from the question “What would it take to feel safe enough to receive compassion?”

Transformation, creativity, love and the overcoming of suffering through compassion. This is what gives me hope in the darkness in my work at the Oak Tree Practice.

Questions for Thought and Discussion

  • Have you encountered a ‘head-heart disconnect’ with your clients? What interventions helped bridge this gap?
  • How do you distinguish between guilt and shame in your clinical work, and how might compassion help address each?
  • How might incorporating embodied practices, like soothing rhythm breathing, support clients in connecting with a felt sense of compassion?
  • Are you able to find compassion for yourself when you feel helpless at times? What helps you to do so?

Unburden What Has Been

Posted on by Psychotherapy.net Team

It was like most mornings; a brisk walk in the local nature preserve, downing the last drop of coffee, and heading off on whatever adventure I could create for myself before settling in for the day.

On the way out of the preserve is a very homemade road sign, one I pass so frequently it has blended almost imperceptibly into the surroundings. I remember questioning its purpose the first time I saw it, saying something to myself like, “gotta be a religious statement.” It checked all my boxes for a roadside reminder of God’s ubiquitous presence in our lives: simple statement, homemade sign, profound deeper meaning (if a passerby chose that option)—check, check, check!

Unburden What Has Been

“Unburden What Has Been,” it boldly proclaimed, standing out in sharp contrast to its brown wintery surround. For whatever reason, on that particular penultimate day of the year, I looked down (instead of up to the heavens), and boy howdy was I surprised by what was holding up that sign. A portable commode! A damn potty chair.

Unburden what has been! Donning my clinician’s cap, I thought, “so simple in theory, but so hard in practice,” regardless of which side of the couch you are on. Although for now, I’ll position myself on the clinical side of that couch and ask myself—and you—to look beneath the common factors that undergird successful psychotherapy for the ur-factor, that one therapeutic ring to rule them all. Yes, yes, perhaps a bit reductionistic, but no more so than that fateful sign that birthed this musing.

The goal of psychoanalysis is to penetrate the unconscious and its myriad of defenses to free repressed thought and emotion so the patient can have full insight into and resolve conflict. Unburdening in its fullest form.

The goal of Cognitive-Behavior Therapy is to release the client from the torturous grip of self-defeating thoughts and repressive behavioral patterns, so the client can finally achieve freedom (and dignity?!). Unburdening, once again.

The goal of Rogerian treatment is to use the presence and person of the therapist to close the gap between the client’s ideal and actual self so they may become more fully functioning. I imagine there is no better state of unburdened(hood) than that.

And what about the goal of Narrative Therapy? Isn’t it to unburden the client from the pre-scripted demands of their self-defeating stories that were often created in systems of oppression? And then of course, there are the Systemic Therapies, a more challenging venture, where the goal is to cancel out the noise, empty out the closets, and shoo away the ghosts, so couples and family members can peacefully, safely, and lovingly co-exist. A shared unburdening project.

I could go on. . . but in short, we clinicians, regardless of therapeutic orientation and methods, are all in the business of helping our clients, our patients, or in the words of Irvin Yalom, fellow travelers, to slow down, take a breath, look inside and around, and unburden themselves.

A worthy goal, not one so easily achieved, but definitely one worth the journey—one I’m reminded of every time I walk through that nature preserve.

Questions for Thought and Discussion

  • Can you think of an incidental inspiration such as this one that has impacted your clinical thought or practice?
  • What do you think are some of the common factors in therapy that drive your own practice?
  • Can you think of a client with whom you’ve worked that has deepened your appreciation for the power of unburdening in therapy?

Moving Beyond ‘How Do You Feel’ in Therapy to Release Client’s Pain

Posted on by Psychotherapy.net Team

“My granddaughter wants to spend Christmas with her other grandma.” Doris looked out the window while slowly chewing on a piece of gum. “She’d rather be with Fun Grandma,” she huffed as though trying to imitate laughter.

Armed with good intentions and extensive training in cognitive-behavioral therapy, I had been a therapist for just a few months. Doris told me during our first session that she hadn’t been truly happy since her divorce 20 years earlier, and she had spent every subsequent session describing how unimportant she felt to her children and grandchildren.

“And these are supposed to be the golden years,” she continued. I felt the need to change the direction of the session and asked if she had researched local meet-up groups, something we had discussed the week before. “I had trouble getting on the internet,” she said.

Doris, I believed, needed to take action if she was going to feel better, and I believed it was my mission to motivate her to take that first step.

“It’s just that I know you’re happiest when you’re with people,” I said, “and I think one of these groups could be part of the answer.”

“I don’t think I’m very approachable anyway.”

“Why do you say that?”

“I have an uninviting face.”

“I don’t think there’s anything uninviting about your face.”

“You’re very kind.”

“I’m serious. Has anyone ever told you that?”

“They don’t have to say it. I can tell.”

Moving Beyond ‘How Do You Feel’ in Therapy

I proceeded to initiate a detailed discussion about her face. I badly wanted to lead her out of her misery and to help her to evaluate her thoughts (helping her to recognize that her face was really not so uninviting and that others were probably not judging her as harshly as she imagined) seemed like the best path to take.

That intervention, like the others I had tried, proved to be ineffective, although I kept at it for the remainder of the session. Imagine Winnie the Pooh trying to cheer up Eeyore, Pooh making one reasonable point after another while Eeyore just keeps making excuses, the conversation finally ending when Eeyore realizes he has again lost his tail.

Later that week I discussed the session with Ari, my clinical supervisor. “I’m trying so hard,” I told him, “And I feel like she’s not doing her part. She’ll ask me what she should do to feel better, but when I offer an idea, she always has an excuse.”

Ari inhaled deeply as though attempting to fully absorb what I had said. “Sometimes,” he finally said, “our clients tell us they want one thing, but deep inside they’re pulling for us to do something else. When she made that comment about her face being uninviting, I think she was trying to tell you something important about herself.”

“I get that she’s unhappy.”

“There’s a depth to her pain. I wonder if she needs you to really understand that.”

“I think I do understand that.”

“You understand her suffering on a cognitive level, but I wonder if she needs more. I wonder if she needs you to understand it on a deeper, visceral level. What’s often most helpful to our patients is the experience of being truly understood.”

The truth of his words stung. I thought back to my own times of distress and how others had often told me to cheer up and look on the bright side. Rather than cheering me up, those exhortations usually made me feel like a burden. They made me feel that my distress was intolerable and that, as long as it remained, I too would be intolerable.

I now saw that, by being the Pooh Bear to Doris’ Eeyore, I had inadvertently given her the exact same message. “She must feel so alone,” I said to Ari. “She tells me that her children are always telling her to stop being so negative. And now I’m doing the same thing.” When I next saw Doris, I asked more questions and tried to more fully understand her. When she again complained that her granddaughter didn’t want to spend Christmas with her, instead of inquiring into what exactly the girl had said, I said, “Help me to understand what that feels like, being rejected like that.” As soon as those words left my mouth, I feared that I had set something dangerous into motion, as though I had given Doris permission to step into a black hole from which she would not be able to escape.

But she did not step into a black hole. What she did instead was describe what it felt like to be a nuisance to her granddaughter, and she then shared how she had felt like a nuisance to people most of her life. She continued to open up and share more associations. While our previous sessions had started to feel like repetitions, I was now learning new things about her.

Our sessions over the next several months were too complicated for me to summarize here, but I will say that exploring her most painful emotions proved essential to the gains we made. I would later discover that Doris had developed an attachment to certain aspects of her pain that would require additional interventions. However, before these interventions had any chance of succeeding, Doris first needed to feel understood.

Questions for Thought and Discussion

  • How do you resonate with the author in recounting the work with Doris?
  • Can you think of one of your clients who struggles in similar ways to Doris?
  • How might you have intervened differently with Doris?