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Telling the Client what they Don’t want to Hear

Clients come into counselling often due to some form of conflict (which some of us call the “Presenting Problem”).

The conflict may appear obvious (“My partner doesn’t like this about me…”), or the conflict may be at a deeper, as-yet-not-understood level (“I don’t seem to have any friends…”).

When I listen to a client tell their story ~ no matter if it’s at the beginning or during the work ~ I’m not just listening to the words of the story, I’m also listening to my internal responses to the story. I’m listening to how my emotions are reacting to the story, I’m paying attention to if my body is responding to the story. In addition to listening with my ears, I’m “listening” to how everything else apart from my ears is receiving the client’s story.

In other words, as a psychodynamic counsellor I’m paying attention to my counter-transference.

How does counter-transference help?

Some counsellors’ approach is to pay attention (only) to the client’s story, reflecting back (summarising, paraphrasing) portions of the story so that the client may gain some benefit from feeling understood. There is merit and rationale to such an approach.

However, by paying attention to how I am responding at different levels to the story, I’m later able to invite the client to go to a deeper level of understanding. To go deeper in understanding parts of the story that the client is not (yet) consciously aware of. I use the word “invite” quite intentionally, as invitations may be declined as well as accepted.

Counter-transference – an analogy.

For those who are unfamiliar with a counter-transference experience, I might describe the different parts of me that are responding to the story (my “counter-transference response”) as being like when a tuning fork is placed on a surface. Without the surface, the tuning fork makes nearly-no audible sound when it is thumped into life. But, when a thumped-tuning fork is placed upon a surface, the tuning fork begins to be heard quite clearly. In a way, to use counter-transference in counselling, the client is a tuning fork, I am a surface upon which the client touches, and I help the client to notice the client’s “sound” previously not heard by him… until he “touched” me.

 

Distinguishing Counter-transference from Personal Material.

In the past, I have heard some other counsellors express:

…the anger I felt was the client’s, not mine.

The counsellor is saying that they felt angry (whilst working with the client) but that the anger did not belong to the counsellor; they are saying that it was the client’s anger they were feeling (in Melanie Klein terms: the anger had been “split-off” and, through projective-identification, the anger had been dismissed from the client and “placed” within the counsellor).

…except (in this example) this form of explanation seems to dismiss the counsellor’s own role within the therapeutic alliance. Almost: “that’s his anger, nowt to do with me, guv!”.

It is my position, as a psychodynamic counsellor, that I must have something previously established within my mind that is available to resonate with the client’s (unconscious) material. So, tuning fork-like, the client’s stuff and my stuff combine to produce a “note” that, to my mind and/or body, seems to “sound” to me like anger.

Again, continuing with the example of anger, my struggle when I notice such feelings within me (and that the client appears not to be expressing or feeling) needs some thought:

  • could this anger that I’m feeling be my anger, and mine alone?
  • could this anger that I’m feeling be resonating with the client’s anger (counter-transference)?
  • a little from column A, a little from column B?

 

Feeding back the counter-transference.

Having received different shades of the client’s story: verbal (conscious), counter-transference / projective-identification (unconscious) , how might I use all of this together to assist the client.

Various authors have written about different approaches.

  • Some are subtle (eg a Donald Winnicott-style of leaving a spatula to be discovered):

…you say that women don’t find you attractive, but I imaging that some women do.

…suggesting that the counsellor is feeling an attraction to the client, but is not stating this overtly. The “spatula” technique is to place something (such as a verbal intervention) in front of the client for him to “pick up” and play with as he sees fit, or to not notice it or to even actively ignore it. It’s up to the client to decide what they make of the counsellor’s intervention (the “spatula”) – see Spatula Game

 

  • Some are more overt (e.g. Karen Maroda – relational style psychotherapy):

…you say that you’re feeling happier today, and you’ve asked me how I am, so I’d have to say that I can’t understand why I’m feeling furious; quite differently to you. Shall we talk about this difference?

…the counsellor has stated different feelings to the client, and is inviting both of them to wonder about the difference (possibly the counsellor is capturing a split-off emotion from the client).

 

  • Some are positively challenging (e.g. Habib Davanloo – Intensive Short-term Dynamic Psychotherapy)

… you keep saying “I don’t know” to my questions, but I think you really do know, otherwise you wouldn’t be sitting in front of me waiting for me to tell you what you already know.

…suggesting that the counsellor is inviting the client to address a defence (denial?) by challenging a real experience between them both.

 

My own approach to using counter-transference varies between these examples depending on such factors as:-

  • The strength of the therapeutic alliance (early days I may take the subtle approach, later days I may take more overt approaches).
  • If I unsure that what I am experiencing may be more counter-transference or more my own personal material. This would be a discussion to go into supervision.
  • If the client has made an overt request to learn about their behaviour and impact upon me. I no longer entirely hold to the psychoanalytical tradition of saying nothing about myself (at least in the context of the therapeutic alliance).
  • How active are the client’s defences. Use of Patrick Casement’s internal supervision & trial identification concepts can be useful here.

… a deciding factor can be: can the client “digest” this “food” that I’m offering (and if he “spits it out”, what might he and I do with the regurgitation).

And even that (the regurgitation) is grist for the mill; worthy of a conversation:-

You asked me to tell you how I experienced what you’re telling me; when I did, you rejected the experience. What do you think may be happening between us just now?

 

When the client won’t hear…

A supervisor once suggested I offer an intervention to a client, and I responded: “But I’ve already said this”. Her response was: “What makes you think you offer it only the once?!”

The point of this exchange was that in counselling (we hope that) the client is growing, and at later times may hear what he has been unable to hear before (or heard in a different way to before).

So, when I offer back a counter-transference-informed intervention, the likelihood (being that the intervention is formed from unconscious material) is that the client may not be ready to hear it if my delivery it too early or misjudged. And that’s OK.  An inability (or a refusal) to hear may be import to keep the material “outside of the consciousness” right now. Should such a rejection occur, I’ll consider whether to look at the rejection or shelve the intervention for a later stage, and may not make this decision by myself; each client’s needs and each therapeutic alliance will be different.

The client may not wish to receive back that which they’ve dismissed into me (for safe keeping, perhaps).

 


 

In short, counter-transference is a process which a psychodynamic counsellor may use to help a client understand parts of themselves that, through their internal defences, they are unable to consciously appreciate.

The choice in technique of counter-transference interpretation will depend on any combination of the counsellor’s skills & empathy, the therapeutic alliance between counsellor and client, the client’s (in)ability to tolerate what they hear, and the counsellor’s respect that sometimes the client does not want to hear what they have just been told.

 

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About Counselling Articles

Absorbing People’s Emotions

This article from The Mind Unleashed talks about how to prevent yourself from absorbing other people’s emotions: http://themindunleashed.org/2014/06/stop-absorbing-peoples-emotions.html

Those of us therapists who include notions of counter-transference & projective identification/introjection in our therapy work actually make use of clients’ emotional affects upon us…

psychodynamic therapists use these phenomena to effect change in the client. We digest what unconscious emotional signals we “receive” from client (or what of our own emotional makeup may be triggered by the client’s story), try to understand it, then offer it (discretely) back to the client if the client is able tolerate it (and postpone further offers if the client rejects it).

This way of working comes from theoretical works published by Melanie Klein, Wilfred Bion, Donald Winnicott and others.

But – with the more skilled therapists – as a client you’d not be aware of this process going on, other than maybe noticing just how much your therapist seems to “get” you.

Categories
Christmas

‘Tis the Season of Projective Identification – Fa la lah!

A brief hypothesis on the painful loneliness experienced by some as a hypothetical result of projective identification from others.

‘Tis the season to be jolly.

Fa la la la lah, la lah, lah, lah.

As I said a pre-Christmas farewell to a colleague last week, he referred to this period as the ‘nonsense’ season.  It got me thinking: if this holiday season could be nonsense … to whom might this period make no sense?

Opting-out of Christmas.

“How do we opt out of Christmas gifting w/o being Scrooges?”
JenneySavings Advice Forum.

For many people, the approach of the season switches on certain automatic behaviour.  Behaviour coming from certain assumptions and certain expectations:

  • We must prepare to buy gifts for people.
  • We must buy the right sort of food.
  • We must write and sends greetings cards to people.
  • We must begin deciding with whom we will spend days like Christmas and New Year’s Eve.
  • We must remember people whom we’ve barely given a thought to during the year.

Notwithstanding this list comes from this author’s keyboard, there’s an interesting lot of ‘must’ in the list.

For most, preparation for the seasonal behaviour can be stressful and it’s a chore.  For some, this behaviour is natural and pleasant. For some, this behaviour (whether acted out by themselves, or observed in others) it is a painful reminder that there are few-or-no reasons to participate in this seasonal ‘must’ behaviour.

For those who are without families – whether biological or extended – or few or no friends, the holiday season becomes nonsensical. How easily it seems one can be forgotten whilst it seems everyone is running around preparing for a jolly season. Those not participating in the season can, perhaps, emulate the jolly behaviour of buying gifts for people, yet one may also be carrying a heavy heart suspecting that what few social contacts they have will disappear during the holiday season as people venture off towards their families-of-original loaded with tokens of ‘musts’.  One can emulate the behaviour or buying the right food for Christmas day, yet one knows that the food won’t be shared with anyone.  One can decided with whom they will spend holiday days, but it’s likely that friends and and those who are reasonably close will have already decided to attend family events – leaving others who are not family behind.

Rather than simply being ‘nonsense’ for some people, I’d offer that this seasonal period can be an extremely painful reminder of the solitude that some tolerate.  Solitude that is tolerated – even embraced – with pleasure during the counterpart of the year, but a solitude that borders on becoming unbearable loneliness during this  holiday season.

Year-Round Solitude versus Seasonal Loneliness.

“You’d like some other bears!”
Dr. Gina Toll – ‘In Treatment

A human being is a social being – he needs to not be alone.  So, how can it be that solitude (the state of being on one’s own) does not feel lonely (sad at having no friends/company)?

From an object-relations perspective (Wikipedia), our psyche grows in relation to our position with respect to others, and our experiences of them.  Good and bad experiences of significant people from our lives (parents, siblings, teachers, lovers etc), are stored within the psyche as mini-templates: in theory, they become ‘internalised’ objects.

One’s good & caring mother stored away in the ‘loving mum object’ gives some of us the sense that we are cared for, even when mum has passed away a long time ago. 

Conversely, those of us who were given the experience that we were not cared for, could be stored away in the ‘persecutor object’, remaining a reminder that as a human being we are someone who others will not care for.

I’d offer the thought that internalised objects can be a factor in how one approaches being on one’s own.  The word “solitude” is used to describe a choice – that in being without company one feels good.  Loneliness is used to describe no-choice – that in being without company one feels bad.  Solitude is pleasant because one does not sense being alone when accompanied by supporting internalised ‘good’ (or good-enough) objects, whereas perhaps loneliness is the lack of good objects/the presence of bad ones.

Object Relationships & Seasonal Nonsense.

“the self, exists only in relation to other ‘objects,’ which may be external or internal.”
New World Encyclopedia – Entry: Melanie Klein

It makes me wonder how in our society the change in social behaviour (eg the approach to Christmas) effects the meta-structure of the psyche’s internalised objects of participants, observers and affectees.

If, during the year, one can tolerate one’s place in social relationships (e.g. occasional social-meetings with friends, but primarily spending time on one’s own) there would appear to be something in the shift of social behaviour (“we must now prepare for Christmas”) that shifts the meta-organisation of the internalised objects for some (“I am in solitude” shifting to “I am lonely”).

Containment of ‘the loneliness’.

“projective identification may unconsciously aim to get rid of unmanageable feelings but it also serves to get help with feelings”
Patrick Casement – Further Learning From the Patient (cited in Wikipedia Article)

It would be my hypothesis that those who are capable of tolerating, even enjoying, being on one’s own become those who, hypothetically, are capable of holding the fear of loneliness that rest of society must split-off and discharge in order to participate in Christmas.

It’s not uncommon to read Twitter and Facebook posts that many people complain of the commercialisation of the season.  Minor, barely-heard protests from some people about feeling caught-up helpless in the season.  I’d offer that in order to participate in this season – that one must not be alone during this holiday period – that wish for non-compliance must be temporarily blanketed.

From the works of Melanie Klein, and later Wilfred Bion, we have come to understand that the mechanism of ‘projective identification‘ (Wikipedia) intolerable pain within the infant is, unconsciously, sent out to another person ( a care-giver ) who will contain the projection, maybe process it into something more tolerable, and hold it until the infant psyche is able to take it back later.

This meta-process allows something that is very painful – or in conflict with other mental demands –  to be sent away from the psyche that cannot manage it for now, placed into a psyche that can manage it better for the period.

This process is made use of in most psychotherapies (psychoanalytical, psychiatry, psychodynamic counselling) where the therapist may become aware of ‘containing’ or ‘receiving’ something on the patient’s behalf.

A patient revealed some news that the therapist believed he was meant to find worthy of congratulations; whilst the patient sounded excited about the news the therapist, instead, felt huge waves of rage that he was not able to associate with the apparent glad-tidings.  The therapist pondered that he may have been ‘containing’ something split-off that the client could not manage; could not manage at the same time of holding onto the thought that this news was good. 

Notwithstanding other explanations (such as the therapist’s own personal constructs: possible jealousy about the news), the therapist used this experience to inform his questions: gently wondering out loud with the patient about the news and its implications.  What later appeared in the work was the patient’s terrible fear about the responsibilities this news would require of him; that the patient was terrified of the implications and responded to his fear in a very angry manner.

Hypothetically, therapist had experienced the patient’s split-off and unconsciously communicated rage.  The therapist had found himself in a state of conflict:  being expected to reply ‘congratulations’ but filled with something quite opposite.  The patient – without the rage – was able to participate in a normal celebratory appearance whilst delivery the news. The therapist appeared to have been left holding the unacceptable part until the patient was able to take it back.

During this time of the year for Christian-based societies, people either have to participate in the ‘jolly season’, or be able to tolerate the shadow-side of not-taking-part. Those who do not follow the masses have to have huge courage to go it another way.

After all, we still refer to ‘Scrooge’ as a warning to all who do not participate in this meant-to-be-jolly time.

A Seasonal Hypothesis.

  • The holiday season approaches and folk are filled with ambivalence: good times ahead / bad times ahead.

  • To be participating in this holiday season, the psyche may need to split-off the more ‘horror’ parts that would interfere too much taking part in Christmas.  The need to be away from the celebrations (to be on one’s own) are split-off.

  • Via projective-identification, others who are more capable of tolerating ‘be on one’s own’ can hold the ‘horror’ during the season. 

  • Result: a part of society is able to participate in seasonally-expected behaviours, is able to cast off the parts of one that would wish to recognise the nonsense of the period for what it really might be (commercial etc), and others in society who are, perhaps, more used to the pain of non-participation will contain the seasonal-pain until the holiday season dies away for another year.

In Closing.

This is not a jolly hypothesis.

But it is intended intended to offer a thought – perhaps a rescuing thought – to those who are subject to massive-yet-unexplained changes in their feelings during such holidays seasons as Christmas (and as it’s author, I’m aware that this brief essay turns a blind eye to other hypotheses in order to focus on this one).

Perhaps, whilst you are enjoying your holiday season and a moment of ‘Oh I wish I wasn’t here…’ creeps into your thoughts, maybe that might be your Jiminy Cricket moment.  Perhaps someone might enjoy a thought or a message sent their way.  After all, someone may be suffering extra painful loneliness, tolerating in order for you to be able to participate in what you must consider as a Happy Christmas.

Nonsense?

Comments welcome.