Rupture and repair in psychotherapy
Once we both make a commitment to the psychotherapy process, it’s a committed relationship. It’s legally binding that I am your doctor and you are my patient. You are under my care. I can help you in times of need including but not limited to medical leave and higher levels of care.
I’m making a commitment to being there for you both in the normal course of the therapeutic relationship and in times of crisis. We’ll decide together what the expectations are in terms of frequency of appointments and contact in between sessions. You have to hold up your side of the relationship. To facilitate a productive working relationship, you need to attend those appointments and work together with me to help you cope and recover from your symptoms.
That said, rupture is a normal part of the therapeutic relationship. I may say something that doesn’t resonate with you, challenges you, or feels painful to you in some way. My underlying feeling is not one of judgment towards you. I’m not trying to criticize or hurt you. I believe everyone is doing the best they can all the time. How you’ve learned how to cope with your thoughts, feelings, and circumstances is a combination of your biological vulnerabilities and your environmental opportunities. It is not my role to judge you, but rather to understand you, to help you understand yourself, and to help facilitate more effective ways of relating to your experience.
When you have painful feelings towards me, it might be the consequence of something that happened between us and it may be transferential feelings from the past that are becoming placed on me. Everyone is triggered by a combination of dynamics that are happening in the external world plus their interpretation of what’s happening. Your interpretation is colored by all of the experiences you’ve had in the past, especially those that happened when you were very young that formed your emotional template for how relationships go.
With that in mind, the therapeutic way through painful feelings that are directed at me is to talk to me about them.
As an example, many people become anxious towards the end of sessions. You might not be able to articulate what is anxiety-provoking about it at first, but as we talk about it, you may find that it’s uncomfortable to not have control over the next time we talk. In reality, we’ll have another appointment scheduled, but in your mind, there may be some anxiety about me suddenly deciding to end our relationship and you having no control about that.
It's important to talk about feelings like this so that I can clarify what’s really happened now – that is, I’m committed to you unless and until you are not engaging in therapy in the way that we have decided on together or you decide that you no longer want to be part of a therapeutic relationship with me – and the anxiety you feel is a transferential feeling towards caregivers in your past.
When we talk about how you feel, we’ll be able to discriminate between the parts of the situation that are problems for us to solve and the parts of the situation that are based on a painful memory or a painful interpretation of what is possibly happening.