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November 17, 2014
by Dr. Chloe Carmichael, PhD

How Much Fire is OK in Therapy Sessions?

November 17, 2014 05:55 by Dr. Chloe Carmichael, PhD

How much passion should a psychologist have for clients' issues to get resolved?  Personally, I can get absolutely tenacious when it comes to helping clients stick to resolutions, meet goals, or keep a promise to themselves to stay away from an ex who mistreats them.  Generally, my enthusiasm is considered a plus.  But what if the client says they want to back away from a goal, or give their ex "one more chance"?  Should I support them, or would that actually be failing them in some way if I'm really supporting the very waffling that they came to therapy in order to change? 

I think sometimes my clients benefit from "borrowing" my enthusiasm for them to stay on track when they feel like giving up - in fact, it's probably especially when they feel like giving up that my steadfast commitment to their goals is most important.  On the other hand, I really do support clients if they genuinely wish to change or revise their original goals.  As humans, we shape our perspective partially from feedback we get from others - so my shock at an ex's behavior, or my belief in a client's ability to succeed even when they doubt themselves are helpful, as long as the client feels secure that his or her feelings about which goals to pursue and which to revise are really the most important feelings in the room.  So perhaps fire is desirable, so long as I'm able to keep it somewhat contained!

Feeling Pressured During Therapy?

If you're feeling like your therapist is being "bossy" or trying to force an agenda on you, I would encourage you to speak up.  It could be that your therapist needs to refine their understanding of your therapeutic goals.  Sometimes clients struggle to find the words to stand up to their therapist.  This can come from a people pleasing nature, or tendency to view the therapist as a more of an authority figure than as a trusted guide.  Please be assured that it is actually a healthy part of therapy for the client and therapist to discover and explore different points of view.  You might even find that there is a part of you that agrees with what the therapist seems to want for you, while another part of you feels differently.  Giving voice to all of these internal pieces actually helps you to become more insightful, and to make decisions with awareness.  If you discover that a part of you agrees with your therapist's goals, but a part of you feels differently, that's actually a wonderful thing!  Therapy should be a place where you can discover different sides of yourself, and then work with your therapist to make sure that your needs get met in a way that makes space for diverse feelings.  We've all had moments where we feel different things- even opposite things- at the same time.  If it is a supportive and collaborative environment, therapy can be a great place to discover and make peace with different sides of yourself so that you can move forward in an integrated, self-aware manner.

How to Discuss?

The success of therapy often depends on the therapeutic alliance, which includes how well you and your therapist get along.  This is why it is very important that your therapist welcomes discussions about how you're feeling about the support your therapist is trying to provide.  If you decide to share with your therapist that you're feeling ambivalent about whether you and the therapist seem to agree on what's best for you, it is extremely important that your therapist welcomes this conversation.  Your therapist may not agree with you, and you might even feel some ambivalence yourself.  If you and your therapist discover that you have different ideas about what your therapeutic goals should be, or if you have the same goals but different ideas about how to achieve them, then it may be worthwhile to revisit whether the relationship is working.  This is a two-way street.  I periodically ask clients to review their goals with me, so that I can make sure we are on the same page. 
Many clients find it anxiety-provoking to initiate discussions with their therapist about how the treatment is going.  As a client, know that it is nearly always appropriate to say something like, "I've been in therapy for x weeks/months now, and I was hoping we could talk about what my goals are."  Your therapist will likely respond by asking you to share your feelings about that question first, and that's actually okay - after all, your feelings about why you're in therapy are actually the most important.  If you need help defining the goals, you might say, "I've been in therapy for x months/weeks now, and I find it helpful-- and I think I'd get even more out of sessions if we spent some time in session to explore and define a few goals."  Don't hesitate to be open with your therapist if you feel concerned that he/she might see things differently than you.  For example, it's okay to say, "Sometimes I feel like you want me to _____, and what I really want to do is _____.  Is that true?  Are there times when I give you mixed signals about what I want?".  Conversations like these should feel rich and collaborative.  One of the great things about therapy is that it gives you a chance to say and hear things that we don't normally get to voice in everyday life.

Goals and Pacing

In addition to having the same goals, it is helpful if therapist and client have similar timelines for change.  I think it is important to be able to talk openly about this, from both the therapist's and the client's perspectives.  Change happens in stages.  The Stages of Change model outlines 5 basic stages of change.  The first few stages are actually not as action-oriented.  They include a lot of contemplation, as well as going back-and-forth about whether you're really ready to make the big changes (i.e. quit taking calls from your ex or absolutely commit to spending particular blocks of time working on graduate school applications).  It's okay to be in those early stages, and your therapist should respect if that's where you are.  On the other hand, it is important for therapists to facilitate clients' transition through the stages of change, and not let them get "stuck" at any one stage.  To help clients move past procrastination, therapists often need to challenge clients' reasons for not completing homework, or ask them to examine if they're really "fine with" having taken back their ex for a fifth time.  This is not always comfortable for the client, but it can actually be exactly what the client needs.  Clients often tell me how much they appreciate that instead of just smiling and nodding, I will give frank feedback and keep pushing them to find ways to overcome obstacles instead of giving up.  However, sometimes the best thing is actually to slow the timing of action-oriented goals if a client is actually more in the contemplative stage of change.  This is where it gets tricky.  When the client wants to be in an action-oriented stage but isn't yet ready to take action, the therapist needs to find a delicate balance between being patient with the client while avoiding complacency.  These are the times when it is very important for the client to reflect on their therapeutic goals, as well as their sense of pacing in meeting those goals.

Opportunities for Growth 

Therapeutic conversations to clarify goals and pacing are almost always productive.  If you and your therapist are able to agree on the goals and pacing, the conversation serves as a roadmap and keeps you both focused.  It also gives your therapist a framework to explain why he or she is pushing you sometimes during session.  When the therapist and client are in agreement about goals and pacing, "fire" in sessions is usually experienced as an intense but positive feeling - much like working with a personal trainer who gives you an intense workout that pushes you beyond your comfort zone in a way that feels productive.  On the other hand, what if you and your therapist have a discussion about goals and pacing, and discover that you're not on the same page?  It's actually a great learning opportunity if this happens.  If the therapist is generally supportive but ultimately sees your goals differently, it gives you a chance to practice positive endings.  You still learned something valuable about yourself, and the conversation may have helped you to clarify your own goals by discovering where you differ from your therapist's goals; and you know exactly what you're looking for in the next therapist.  Even if you initiate a discussion and end up feeling like the therapist is being dismissive of you, it's still a good thing that you discovered that this therapist is clearly not a good fit for you; and you can practice good self-care by finding a more supportive therapist.
What if you never feel fire or intensity in session?  That could actually get pretty boring- So next time you find yourself feeling fiery in session, I encourage you to become curious and ask yourself why- and perhaps ask your therapist too.  
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