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Tuesday, December 19, 2017

Developmental Trauma: The Client's Hopes and Fears in Psychotherapy

Clients often start psychotherapy with some degree of ambivalence--often a mixture of hope and fear.  The hope is that they will be able to work through their problems in therapy.  When clients come to therapy to deal with unresolved developmental trauma, the fear is that the psychotherapist might fail them, as they were failed in their earliest relationships with their parents, and they will be retraumatized (see my articles: Developmental Trauma: Living in the Present As If It Were the PastStarting Psychotherapy: It's Not Unusual to Feel Anxious and Ambivalent,  Clients' Fears About Being Abandoned By Their PsychotherapistWhy It's Important For Psychotherapists to Provide Clients With Psychoeducation About Psychotherapy, and Developmental Trauma: Developing the Capacity to Put Words to Feelings and Sensations).

Developmental Trauma: The Client's Hopes and Fears in Psychotherapy

As I've mentioned in other articles, it's always important for the psychotherapist to establish a rapport with the client.  This is especially true when clients come to therapy to work through developmental trauma where they might have been neglected, abused or betrayed in some way. These clients often expect to be retraumatized in their personal relationships as well as in their client-therapist relationship.

Even when there seems to be a good therapeutic alliance between the client and the therapist, this rapport can be fragile and subject to sudden changes depending upon how vulnerable the client feels in a particular session, so the therapist needs to be aware that there can be these sudden changes.

If the client develops a positive transference to the psychotherapist and there is some misunderstanding, the client, who is ever vigilant for possible betrayal, can suddenly develop a negative transference when he thinks that the therapist is behaving in a similar way to his parents.

Many times this fear is unconscious on the client's part, and he might not know that he is reacting to the therapist as if the therapist was the parent who abused, neglected and betrayed him (this assumes that the therapist is really not being abusive, neglectful or betraying the client).

These ruptures are usually reparable if the therapist understands what's happening between her and the client and the client allows for the repair (see my article: Ruptures and Repairs in Psychotherapy).

Let's take a look at a fictional vignette that illustrates these dynamics:

Developmental Trauma: The Client's Hopes and Fears in Psychotherapy

Agnes
Agnes was in her early-30s when she began psychotherapy. 

During the consultation, Agnes explained to the therapist that she felt like she was "just drifting" in her life without purpose.  She said she felt "dead" inside.  She had a history of several unhappy romantic relationships and many unsatisfying dead end jobs, including her current job.  

Coming to therapy was her first attempt to explore these issues.  In the past, she considered attending psychotherapy, but each time she would dismiss this idea because she feared being betrayed in therapy.

But lately she felt so miserable and her friends were tired of hearing her complain.  Even when they were willing to listen, she didn't find them to be helpful.  She thought they didn't understand what she was going through and their suggestions were simplistic.  So, she decided to try therapy, hoping that she would feel better, but dreading that it would be another bad experience.  

She described her family history as "a nightmare."  Her father was a severe alcoholic, and her mother was in denial about the severity of the father's drinking.  She described her mother as being in her own "fantasy world" where everything was "rosy."  Even when her father lost one job after the next because of his alcoholism, her mother blamed the bosses for firing the father.  

As the older of two children, Agnes felt she had to contain all her worries by herself because her mother was unable to talk to her about Agnes' concerns.  

Her mother would minimize Agnes' fears by telling Agnes that she was being "dramatic" or a "worry wort."  Agnes' brother, who was 10 years younger than her, didn't understand what was going on, so Agnes felt alone and she suffered from terrible anxiety.

From the time she was a child, she worried about things going wrong.  Even when things were going relatively well, she worried that there could be a sudden downturn and she would be devastated.

She was offered jobs that were commensurate with her education and skills, but she never felt confident enough to accept them.  Instead, she took low level, low paying because they didn't cause her to feel such fear and anxiety.

When she recently turned 31, she had a sudden awakening that she didn't want to just "drift" in life any more.  She wanted to get married and have a family, but she was afraid to date because her prior relationships were so awful.  

She also wanted to work in a more interesting job because she was bored at her current job.  Money wasn't an issue because her father left her a trust fund when he died, but she feared that one day when she was older that she would look back on her life and have many regrets because she was too afraid to take risks.

Recently, a family friend, who knew of Agnes' advanced education and skills, offered Agnes what she  considered to be her "dream job."  But she was highly ambivalent about taking it.  She feared that if she didn't do well, she wouldn't be able to face the family friend or her mother and brother.

So, her dilemma was whether she should stay in her current, boring job where she was underemployed or if she should take the risk and accept the family friend's job offer.

Agnes also talked about coming to therapy as being a "risk."  She chose her psychotherapist based on a recommendation from her primary care doctor, but she feared that the therapist would be another disappointment in a long line of disappointments throughout her life.

Given all of Agnes' fears about therapy, she and her therapist decided that they would take it slow.  Agnes' preference was to deal with the career issue first since she had to give her family friend an answer soon.

During their sessions together, Agnes went back and forth as to what she wanted to do about the job offer.  In one session, she said she planned to take the job.  In another session, she changed her mind and said she was too afraid to take the risk.

As they talked about her need to make a decision and how difficult this was for her, Agnes' therapist helped Agnes to see the connection between her early history and her fear of taking what she perceived to be a big risk.

Agnes began to understand how overwhelmed and emotionally neglected she was as a child since neither parent was able to be emotionally supportive.

It was understandable that Agnes, who felt so insecure about most things since she was a child, would also be fearful of making a change in her career.  She had little confidence in her decision making process in part because she was so invalidated as a child (see my article: Growing Up Feeling Invisible and Emotionally Invalidated).

After a few weeks, Agnes expressed feeling comfortable in therapy.  She felt that her therapist understood her and was emotionally supportive.  

Soon after that, Agnes told the family friend that she would accept the job.  At first, she was relieved that she made a decision and she was no longer going back and forth in her mind.  

But shortly afterwards, she was overcome with anxiety and fear:  Was she taking on more than she could do?  Would she disappoint the family friend?  If she didn't succeed, would she feel like a failure in front of family and friends?

Whenever Agnes spoke with her therapist about her decision, she felt better.  She was almost defiant about "showing" her mother that she could do better.  She also knew that she could leave the job if it didn't work out and no one needed to know what happened.  

But she continued to ruminate about her decision, going back and forth in her mind even though she had already told the family friend that she accepted the position.  Her rumination caused her to lose sleep because she was so worried.

One day, Agnes showed up at her psychotherapist's office on the wrong day.  When her therapist saw her in the waiting room, she called Agnes into her office to talk to her for a moment and to let her know that her appointment was for the next day.  She explained that she couldn't see Agnes today because she already had other clients scheduled.

At that point, Agnes became furious.  She insisted that her appointment was for that day, and she blamed the therapist for being confused, "I knew I couldn't trust you.  You're just like my parents--so unreliable.  I knew you would betray me.  I don't think you're the right therapist for me" and with that she stormed out of the office.

Agnes' therapist called Agnes that evening after she saw her other clients.  When Agnes answered the phone, she sounded calmer.  She told her therapist that she realized afterwards that she was the one who was confused about the day, and she apologized.

During the course of Agnes' therapy, there were several more similar incidents.  Whenever an incident occurred, Agnes was sure that her therapist had betrayed her in some way.  

But when she calmed down and she and her therapist were able to talk calmly, Agnes realized that she had misjudged the situation and that her fear of being betrayed was always just under the surface waiting to erupt.

As Agnes and her therapist were able to repair their relationship after each incident, Agnes became more trusting of her therapist.  As time went on, these incidents decreased and there was more time between each incident.

In the meantime, Agnes was doing well at her new job.  This gave her more confidence, although she was still afraid sometimes that she would fail.  

When Agnes was ready and she felt more stable in her relationship with her therapist, she and her therapist began to work on her developmental trauma using EMDR therapy (see my articles: What is EMDR Therapy? and  How EMDR Therapy Works: EMDR Therapy and the Brain).

Developmental Trauma: The Client's Hopes and Fear in Psychotherapy

Over time, she was able to work through her traumatic childhood so that the trauma didn't continue to get played out in her adult life.

As she felt more comfortable and secure, she also started dating again, and she felt more hopeful about being in a long-term relationship.

Conclusion
People who have experienced developmental trauma often expect to be abused, neglected, disappointed or betrayed in some way in their adult relationships.

Many people, who have unresolved developmental trauma, tend to be vigilant so they won't be caught off guard when the disappointment comes.  Even when things are going relatively well in their life, their fears can dominate their emotions.

Clients with developmental trauma usually come to therapy hoping that they will find relief from their problems, but many of them also dread that their therapist will betray them in some way.  

Even if the client with developmental trauma develops a positive transference with the therapist, even a minor misunderstanding can cause the client to regress to feeling suspicious and fearful again.

Under these circumstances, there can be many incidents of ruptures and repairs between the therapist and the client--if the client will allow the repair.  Some clients just leave therapy precipitously and never allow for the repair (see my article: When Clients Leave Psychotherapy Prematurely).

But if the client and therapist can work on repairing the relationship, this is healing for the client because her childhood experience was usually that there were no repairs, only ruptures, so seeing that ruptures in therapy can be repaired is healing for the client.

Over time, if the client stays in therapy, a consistently positive relationship can develop between the client and the psychotherapist and can create an opening to develop other positive relationships.

Getting Help in Therapy
One of the most difficult things for many clients with developmental trauma to do is to come to therapy (see my article:  The Benefits of Psychotherapy).

For these clients, balancing hope and fear can be challenging.

Clients with developmental trauma often come to therapy when the emotional pain they're experiencing is greater than their fear.

Over time, if the client and the therapist are a good match, these issues can be worked through in therapy and the unresolved developmental trauma can be gradually resolved (see my article: How to Choose a Psychotherapist).

If the issues that I've described in this article resonate with you, you owe it to yourself to find a skilled psychotherapist who has experience working with developmental trauma.

Once you are free from your traumatic history, a huge emotional burden will be lifted from you.  It can improve how you feel about yourself, your outlook for the future, and your relationships.  

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article:  The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

I have helped many clients to work through their traumatic experiences so they can live more fulfilling lives.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.





























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