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Monday, July 31, 2017

Psychotherapy Blog: A "Flight Into Health" as an Escape From Therapy

In a prior article, Overcoming the Urge for "a Flight Into Health," I discussed a particular dynamic that comes up with many clients as they talk about childhood abuse.  In this current article, I'm focusing on childhood neglect, which is often more difficult to detect than abuse, and how it can affect relationship choices as an adult (see my articles: What is Childhood Emotional Neglect?What is the Connection Between Childhood Emotional Neglect and Problems Later on in Adult Relationships? and As an Adult, Overcoming the Effects of Childhood Trauma).

"A Flight Into Health" as an Escape From Therapy

In psychotherapy, the term "a flight into health" implies that the client leaves therapy abruptly out of fear, telling herself that she no longer needs therapy.  This often happens when something comes up in therapy that the person is frightened by and not ready to deal with at that point.

This doesn't mean that the client is lying or trying to fool the therapist.  Usually, the client really believes that s/he is ready to leave therapy but, based on whatever came up just before the client decides to leave, the therapist usually knows that this is a defensive gesture on the client's part that comes from fear.

An astute psychotherapist will try to reengage the client to discuss what came up and what might have frightened the client.

If the therapist and client have a good rapport, the client might be willing to come back for another session to explore whatever might have come up to cause him or her to leave.

If the therapist and client haven't established a rapport, the client might not be open to exploring this further because s/he really believes everything is okay or, even if s/he knows things aren't okay, s/he might feel too emotionally vulnerable to explore it further.

A Fictionalized Scenario
Let's take a look at a fictionalized scenario, based on many cases, which deals with a "flight into health" involving a history of childhood emotional neglect:

Mary
Mary started therapy because she wanted to make healthier relationship choices (see my articles: Choosing Unhealthy Relationships: Bad Luck or Poor Choices?Falling In love With "Mr. Wrong" Over and Over Again and Choosing Healthier Romantic Relationships.

She attended a few sessions with a psychotherapist who was recommended to her, and told the therapist about her tendency to get involved with men who were in and out of life.

The relationships usually started out well.  With each relationship, Mary thought there was a possibility for a long term relationship.  But whenever she and the current man in her life would became more serious, the man disappeared.

Mary was very confused and hurt about these dynamics and wanted to stop choosing men who turned out to be so unreliable.

By the second session, the therapist asked Mary to share her family history, and Mary said she thought she had "a very good childhood."  But when she talked about her parents, she was very vague, and the therapist had to ask questions in order to understand the family dynamic.

A "Flight Into Health" as an Escape From Therapy 

As a result of the therapist's questions, Mary alluded to her father being around sometimes and not around other times.  But as soon as she said this, Mary looked uncomfortable and guarded.

She folded her arms in front of her chest, and said, "He was a very good father, even if he wasn't around all the time.  He had a rough childhood himself and I don't hold it against him that he would sometimes have to disappear for months at a time."

Having said this, Mary appeared upset.  She told the therapist that, until now, she never thought about how similar the dynamics were between her and her boyfriends and her and her father.

Since Mary was the one who made this connection, the therapist asked Mary what it was like to realize this.  But Mary was at a loss for words.

Mary remained quiet for a while, and then she said that she needed to leave the session early.  The therapist tried to help Mary to calm down, but Mary told the therapist that she was "alright"--she just needed to leave.  She said she would come in for her session next week.

But a few days before her next session, Mary left a message on the therapist's voicemail, at a time when she knew the therapist wasn't there, saying she was "feeling better" and no longer needed to come in.

Her therapist knew that Mary was bothered by what came up in the prior session, and she tried to reach Mary a few times, but Mary didn't return her phone calls.

Several months later, after being hurt and disappointed again by another man, Mary resumed therapy with the same therapist.

Initially, she was defensive, saying that she didn't want to talk about her family, "After all, my parents both did the best that they could."

When her therapist asked Mary why she left the last time, Mary didn't respond to the question.  She said she only wanted to focus on her current life and what she could do to find a man who would treat her well.

As soon as she said that, she began to sob and told her therapist, "I don't even know why I'm crying."

Her therapist realized that Mary wasn't ready to make any further connections between her father and the unconscious choices she was making about the men in her life.

She knew she had to develop more of a rapport with Mary.

The therapist also knew that  they would need to go slowly, and she would need to help Mary with the anxiety about these issues--otherwise, Mary would become too anxious again and she might take another "flight into health." And next time, she might not come back.

Her therapist suggested that they begin by working on coping skills and helping Mary to develop internal resources.

Based on their work together, Mary began to meditate for 10 minutes in the morning and at night.  She also started a beginners yoga class.  In addition, her therapist helped Mary to visualize a relaxing place so that whenever she felt anxious, she could imagine herself going there.

As the holidays approached, Mary talked about trying to decide if she wanted to go home to see her family or not.  She still maintained that she had "a very good childhood," but she also expressed her strong ambivalence about going home.

When her therapist asked Mary about this, Mary started getting agitated, so her therapist suggested that Mary visualize the relaxing place, do the breathing exercises she taught her, and then they could resume talking about her family--if Mary wanted to do it.  Her therapist made it clear that it was up to Mary if they talked about the upcoming holiday and her family or not.

After Mary relaxed a little, she said she didn't want to make it sound like there were problems in her family home.  She said, "Far from it..."  But she was unable to articulate why she had mixed feelings about going home to her parents.

By the next session, Mary brought in a dream:  She was five years old and she was waiting for her father by the window that faced the street.

In the dream, every time she saw a man walking towards the house, she got excited because she thought it was her father.  But each time the man got closer, she could see that it wasn't her father and she was disappointed each time. The dream ended with Mary waiting and waiting and her father never showed up.

After she told the dream, Mary burst into tears.  She remembered being that little girl by the window many times, hoping to see her father, but he didn't come.

Her therapist was listening and sensing what was going on for Mary and if she would be able to explore this further.  Rather than push her to go somewhere where she wasn't ready to go, she would take her cues from Mary (see my article: The Therapist's Empathic Attunement and The Creation of the Holding Environment in Therapy).

Mary seemed to be in her own world, as if she was back in the dream, "I don't understand why my father came and went like that.  I know he loved us, but he would just suddenly leave without saying a word and we never knew when he was coming back."

Her therapist remained attuned to Mary and stayed close to Mary's experience, reflecting back to her how difficult that must have been for such a young girl.  Mary nodded her head.

By the end of the session, Mary told her therapist that she felt supported by her and she was grateful for that.  She had never felt so supported in her life before.

During the next few sessions, Mary continued to talk about the dream and how it reflected her childhood experience with her father.  She went back and forth between feeling sad and defending her father vs. telling her therapist what a good man he was.

When Mary felt comfortable, they did "parts work" where Mary imagined her younger self sitting next to her and she spoke to her younger self to soothe and reassure her.

Then, her therapist asked her to switch roles and be her younger self and ask Mary for what she needed.  Mary said she felt soothed by these exercises.

When she came in the next time, she talked about a recent dream where she was sitting on the couch next to her five year old self, holding and rocking her.  She said she felt the sadness from her younger self, but her younger self also felt comforted, and Mary was happy that she could do this for her.

Several months later, Mary came in and told her therapist that she thought she felt a little more comfortable now exploring the connection between her relationship with her father and her relationships with the various men that she dated.

Her therapist said they could do this, but she wanted Mary to tell her if she began to feel like she wanted to leave therapy.  She asked Mary to talk about it, if she could, rather than acting on it.

Mary said she would try to do this, and she said she might feel like leaving, but she really wanted to stay and talk about it, especially now that she felt a stronger bond with the therapist.

A "Flight Into Health" as an Escape From Therapy
Gradually, over time, Mary was less defensive and she was able to express her sadness and anger about her father's erratic behavior when she was a child.

She also began to understand how she was unconsciously repeating these experiences in her current life by choosing men who would behave in a similar way as her father.  Unconsciously, she was repeating this behavior in the hope that there would be a different outcome.  This is called repetition compulsion in psychotherapy.

This was a big step for Mary, and it was the beginning of her healing process.

She admitted that talking about this felt a little anxiety provoking, but her anxiety was no where near what it had been.  She also felt good that she could say this, and it didn't feel nearly as frightening as it did when she first made the connection on her own when she began therapy.

Conclusion
A "flight into health" is a reaction that many people in therapy have when something comes up in therapy that causes them to feel anxious and they're not ready to deal with it.

This is usually an unconscious response.  At that point, the client is often convinced that whatever symptoms or problems brought them into therapy are now gone--they're "better" now.

If clients in this situation remain long enough for the therapist to help them to develop the skills to cope with their fear, they can eventually go back, when the client is ready, to explore together what was too frightening before.

When clients leave therapy, as in the fictionalized vignette above about "Mary," they often return at some point because they become aware that their problems aren't really gone.  It just seemed that way because they convinced themselves of it out of fear.

At that point, the client and therapist can strengthen the therapeutic alliance between them by allowing the client to set the pace.

Most skilled psychotherapists know that it's counterproductive to push clients beyond where they can go emotionally, especially if they're not feeling safe.

It's better to take a step back and help the client to develop the necessary internal resources so that if and when the client becomes ready, s/he can feel more confident to deal with whatever comes up, knowing that the therapist is there for them.

Getting Help in Therapy
It's often comforting for clients to know that if they've taken "a flight into health" that they're not the only ones who have ever experienced this.

If you recognize this dynamic in yourself, you can be assured that an experienced psychotherapist understands this dynamic.

Whether you return to your former therapist or decide to see someone else, you're not alone.  You can think of the"flight into health" as a temporary obstacle that a skilled therapist can help you to overcome.

Being afraid and ambivalent about exploring uncomfortable personal problems is normal.

It's also alright to tell a therapist that you're uncomfortable, and the two of you can work together to help you get to the point where you feel more comfortable.

The first step is making the phone call to get help.

Freedom from a traumatic history allows you to live a more fulfilling life.

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

One of my specialties is helping clients to overcome emotional trauma.

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

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




































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