When do we explore feelings toward the therapist? For most of us who were initially trained in other models of therapy, it can be a bit scary to ask patients about their feelings toward us. We are comfortable asking patients about feelings they have toward people in their current relationships or toward their parents. But when it comes to asking about feelings toward the therapist? Gulp. Ahem. Cough. Cough. It’s hard at first.
Of course, some of this has to do with our anxiety about facing such feelings. And this can be dealt with in our own therapy and supervision. However, it is useful to have some guidelines to know when and how to ask about feelings toward you. So we’ll look at the two most common cues that tell you to ask about feelings toward the therapist.
The first cue is when anxiety is in the forefront and it is discharged in the striated muscles. For instance, suppose the patient comes in, sits down, sighs heavily, crosses her arms and legs, and wiggles her foot. You haven’t done anything. You just invited the patient in the room and sat in your chair. Yet the patient has a rise of feelings and anxiety. Why?
If we take the analogy of the abused dog in a dog pound, if you approach it or I approach it, the same thing happens. The dog either barks or withdraws. Having been abused by one human, it feels anger and fear regarding all humans. We could call them dog ‘transference feelings.’ Likewise, the patient who has been hurt in previous relationships feels those same feelings when she approaches another human being. See the youtube video The Child of Rage to see the tragic consequences of these transference feelings in an abused child and how she acts out those feelings toward others.
Thus, when the patient presents with this anxiety in the striated muscles, this is a cue that she is having feelings toward you. In response, you can say, “You seem anxious. Do you notice that too? So some anxiety comes up as you come here to see me. So can we take a look at what feelings are coming up here toward me that are making you anxious?” Since the patient is having feelings, we want to offer a pathway for those feelings. Ideally, we can help her feel those feelings, so she won’t have to feel anxious instead.
Another important cue to ask about feelings toward you is when you notice the patient resisting contact with you. For instance, suppose you are exploring feelings the patient has toward her husband. Initially, she describes her anger, but as you ask about how she experiences her anger, she intellectualizes and rationalizes. But as you continue to point out her repressive defenses, something very interesting occurs. You will notice that she stops looking at you and starts looking out the window or at the floor. She starts to hesitate when you explore feelings. She withdraws. She becomes vague and hard to reach. Gradually, you realize that she is not avoiding feeling so much. She is avoiding you!
When this happens, it is fruitless to keep exploring feeling. The issue is no longer her avoidance of feeling, but her avoidance of genuine contact with you. So you need to shift your focus from her defenses against feeling to her resistance to emotional closeness with you. To do this, point out the defenses by which she distances from you.
“Do you notice how you are becoming vague?” “Do you notice how you look at the floor now?” “Do you notice how you go up in your head?” Having drawn her attention to these tactical defenses (tactics to avoid contact with you), you can point out the pattern. “Do you notice how you are avoiding my eyes?” “Do you notice how there is a barrier coming up here between us?” Having drawn her attention to the “wall”, you can ask, “I wonder what the feeling is here toward me that is making you pull back?” Then keep that focus on the feelings toward you and keep addressing the defenses against emotional closeness.
Sometimes therapists ask, “Is that the only thing you do? Ask about feelings toward the therapist?” No, of course not. There is no one intervention that we do “all the time.” To do any intervention all the time would not be therapy but an obsessive-compulsive disorder on the loose 😉 The only thing we do all the time is monitor the patient’s response to intervention. If exploring a feeling in a past or current relationship mobilizes unconscious anxiety and defense, we know we are in the right place. If exploring the patient’s feelings toward us mobilizes unconscious anxiety and defense, we explore there. Thus, no intervention or formula is our guide. Instead, the patient’s unconscious anxiety and defense always let us know where the unconscious feelings are. And that’s where we go.