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Thursday, March 14, 2013

The Therapist's Empathic Attunement Can Be Emotionally Reparative for the Client

In my prior blog article, I began discussing the therapist's emotional attunement in the therapy session.  In this blog article, I would like to continue to discuss emotional attunement by focusing on how the therapist's attunement to the client can be emotionally reparative.


The Therapist's Empathic Attunement Can Be Emotionally Reparative for the Client

The following vignette, which is a composite of many cases, will help to illustrate this point:

Jane
Jane grew up in a household where she was the youngest of 10 children.  Her mother worked cleaning people's apartments, and her father worked in a factory during the day and as a taxi driver at night.  Both of them were exhausted when they came home, and they relied on Jane's older sister, Ruth, to help them with the children and the household chores.

Jane was very different from her siblings.  While they liked to go out and play in the yard, she preferred to stay in and read books.  She loved using her imagination to make up stories and do artwork.  But Ruth, who was 12 years older than Jane, had little patience for Jane.  Ruth was often irritated and resentful that so much was expected of her and she became very impatient with Jane at times, especially when she thought Jane was "wasting time" playing, reading or drawing.

All of Jane's basic needs were taken care of in terms of having a roof over her head, food to eat, and clothing to wear.  But she often felt lonely in her home.

Jane had lots of fantasies about what she wanted to do when she grew up, but she had no one to talk to about it.  Her parents' attitude was that when she graduated high school, she should be happy to find a job, any job.  It didn't matter if she liked it or not.  Liking your work seemed like too big a luxury to Jane's parents.

So, when Jane decided to go to college, her parents and older siblings were flustered and confused.  None of them had gone to college and they couldn't see why she wanted to go.  Her parents warned her that they didn't have the money to send her, so she had to rely on scholarships and part time jobs throughout college.

When Jane graduated college, she was surprised that she didn't feel good about it.  She felt like something was missing, but she didn't know what it was.  She knew, at least on an rational level, that graduating college was a significant accomplishment. But she didn't feel it.  Her family came to her graduation, but they seemed self conscious, guarded and out of place.  Jane watched her friends' parents swell with pride about their children's graduation, and she wished her family could do the same.

Throughout her 20s, Jane continued to feel that something was missing inside of her, but she couldn't put her finger on what it was.  So, when she was 24, she began therapy.

No one in Jane's family had ever been to therapy, and she didn't dare tell her family.  She knew they wouldn't approve of it and they would think she was wasting money.  They would never understand if she told them that she felt something was missing in her.  They would probably laugh and tell her she had too much time on her hands to think about herself.

Initially, Jane felt self conscious and anxious in therapy.  On some level, she felt she didn't deserve to be there:  Maybe her family was right--maybe therapy was an indulgence that was for other people, not someone like her.  Whenever she had these thoughts, she burned with shame.  And yet...she knew there was something of value for her in therapy.

The Therapist's Empathic Attunement Can Be Emotionally Reparative for  the Client

Over time, Jane began to sense that her therapist cared about her and wanted to hear about what she felt.  At first, this was uncomfortable because Jane wasn't accustomed to this.  When she was growing up, she would normally keep her thoughts and feelings to herself.  Or, she would write stories about young girls like herself, never quite realizing at the time that she was writing about herself.

During the first few months of therapy, Jane felt ambivalent about the therapy process.  On the one hand, she was grateful to have a place where she could speak uninterrupted and have the therapist's undivided attention.  It was a new experience for Jane to be heard in this way.

On the other hand, Jane felt a deep hurt because she realized what she was missing when she was growing up.  As a child, she never allowed herself to feel the pain of the emotional deprivation.  But she felt it now and it made her feel very sad.

One day, when she was feeling particularly undeserving, Jane decided to make up an excuse about not being able to afford therapy.  This wasn't true because Jane had very good out of network benefits that paid for 70% of her therapy.  But Jane couldn't bring herself to tell her therapist that she felt she didn't deserve all this attention.  So, at the next therapy session, she went in looking outwardly cheerful and confident and told her therapist that she had to end therapy because she could no longer afford to come.

Jane was especially good, even with her close friends, at convincing people that she was happy even when she felt very sad.  She had a lot of experience pretending that she was okay when she really wasn't.  She was sure that she would convince her therapist.  But to Jane's surprise, her therapist, who was empathically attuned to Jane, mentioned that she sensed there was something else going on, and she wondered if Jane would be willing to discuss it.

What followed in that session was an emotional breakthrough for Jane and a breakthrough for her therapy.  Jane took an emotional risk and opened up.  She cried a lot during that session for everything she didn't get as a child and for how undeserving she felt now.  She spent many sessions after that one focusing on these issues while her therapist remained empathically attuned to her.

If Jane's therapist had not been empathically attuned, she might have accepted Jane's excuse on face value.  And Jane would have continued to feel emotionally deprived and undeserving.  More than likely, this would have had consequences for both her personal life and her career.  But, being empathically attuned, Jane's therapist sensed the underlying issues going on with Jane and let Jane know.

Overall, Jane's therapist's empathic attunement was an emotionally reparative experience for Jane.  It was the first time Jane felt genuinely cared about and understood in this way.

Empathic Attunement and Therapeutic Rapport
In order for there to be empathic attunement in psychotherapy, there needs to be a good fit between therapist and client.

A good fit means there is a rapport between the client and the therapist.  Often, this develops over time.  But when it doesn't  happen, when clients don't feel a rapport with the therapist, I recommend that they discuss it with their therapist.  And if it continues to be a problem, they can find a therapist where they can feel this rapport.

A good therapeutic relationship between client and therapist is one of the best predictors of a good outcome in therapy.  And, just like anything else, some therapists are more empathically attuned than others.

Getting Help in Therapy
No therapist is going to be 100% attuned all of the time.  Therapists are human.  But, overall, as the client, you deserve to have a therapist that you feel is empathically attuned to you most of the time.  As a client, the most important thing is to trust your instincts when choosing a therapist.

And if you're with a therapist, who is usually attuned to you, but who may have lapsed into an empathic failure by not hearing you or misunderstanding you in some way, your therapist might be unaware of it.  Tell her or him.  Often these kinds of situations in therapy can be repaired and it can lead to a breakthrough in therapy and an emotionally reparative experience for the client.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist.  I work with individual adults and couples.

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: josephineolivia@aol.com






























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