NYC Psychotherapist Blog

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Monday, January 22, 2018

Psychotherapy as a Co-Created Process Between the Psychotherapist and the Client - Part 2

In my prior article, I began a discussion about psychotherapy as a co-created process between the psychotherapist and the client.  I'm continuing this discussion to delve deeper into this topic, specifically about how the client and psychotherapist co-create the therapeutic relationship.

Psychotherapy as a Co-Created Process Between the Client and the Psychotherapist 

How the Client and Psychotherapist Co-Create the Their Therapeutic Relationship
As I mentioned in my prior article, the concept that psychotherapy is a co-created process is part of contemporary psychotherapy and it's different from how psychotherapy was practiced in the past.

There is now a recognition that each client-psychotherapist relationship is unique--just as any other type of relationship between two people is unique.

It's the psychotherapist's responsibility to provide the client with psychoeducation about psychotherapy and how she works in therapy.

If the psychotherapist uses Integrative Psychotherapy, as I do, she will explain the different therapy modalities that she uses, which can be used individually or in combination.

For instance, if the psychotherapist is trained as a contemporary psychoanalyst and she also does EMDR Therapy, she can explain how these two modalities can be used in combination (see my article: Contemporary Psychoanalysis and EMDR Therapy: A Powerful Combination to Overcome Trauma).

Most likely, she will also explain that if one modality doesn't work for this particular client, she can switch to another modality.

The relationship between the client and the therapist is also known as the therapeutic alliance.  At the most basic level, the therapeutic alliance is based on the therapist being able to provide a safe, trusting relationship, also called the "holding environment"  (see my article: The Creation of the Holding Environment in Psychotherapy).

Contemporary psychotherapy is a two-person therapy.  It's an intersubjective experience between the client and the therapist where the therapist is attuned to the client (see my article: The Psychotherapy Session: A Unique Intersubjective Experience).

Even though the psychotherapist is the one with the expertise in doing psychotherapy, most  psychotherapists also rely on feedback from the client about what's working and what's not working in therapy for the client (see my article: How to Talk to Your Psychotherapist About Something That's Bothering You in Therapy).

Ideally, the therapist will ask at various points in therapy and encourage the client to give feedback at other times but, even if your therapist doesn't ask you for feedback, it's important to give feedback to her.

Why is it important?  It's important for the therapeutic process and also for maintaining a good relationship with your psychotherapist that you provide her with feedback as to how the therapy is going (see my article:  Why Being Honest With Your Psychotherapist is the Best Policy).

Many people have problems giving feedback to their therapists because they were discouraged or even punished for giving feedback to their parents when they were children, so even as adults, they still carry that fear.

Other people don't feel entitled to give feedback.  They think of it as "complaining" and they don't want to "offend" their psychotherapist.

So, instead of giving feedback, they might pretend that everything is going well in therapy, and the end result is that the client doesn't get what she needs in therapy, the therapy is an "as if" therapy and nothing changes.

Many psychotherapists recognize when clients are hold back from talking about misgivings in therapy or that a certain aspect of therapy isn't working for them, so they will try to elicit feedback.

But there are times when the therapist doesn't see it, and the therapy becomes ineffective or, rather than express himself, the client leaves therapy prematurely (see my article: When Clients Leave Psychotherapy Prematurely).

The client's trust and sense of safety develop over time.  For some clients, it happens relatively quickly and for others it can take a while, especially if they've had early experiences where they couldn't trust their parents or other close family members.

The therapeutic alliance is also based on there being a good match between the client and the therapist.

Initially, you might not know if a particular therapist is a good match for you.  You might need a few therapy sessions to be able to discern if the two of you are a good match.  This doesn't mean that the therapist isn't skilled or that you're being "resistant."  It might just mean that, like any two people, the two of you aren't a good fit.

Some psychotherapists are better trained, educated and more skilled than others as well as more empathetic than others.

An empathic failure can result from a psychotherapist's oversight, but in a good therapeutic relationship, once the client provides feedback about an empathic failure or other rupture in the therapy, there is an opportunity for a repair (see my article: (see my articles:  Why is Empathy Important in Psychotherapy?What is Empathic Failure in Psychotherapy? and Ruptures and Repairs in Psychotherapy).

But if there are consistent empathic failures on the therapist's part, you would be wise to tell the therapist that you don't think the therapy is working for you and then seek out another therapist.

Even when you think the therapy isn't working for you, it's still important to provide the therapist with feedback rather than just leaving abruptly or disappearing from therapy.

Why?  It's not for the therapist (although it can be beneficial).  It's for your benefit to be able to assert yourself and speak up for what you need, especially if this is challenging for you (see my article: Ask For What You Need in Therapy).

So, if the therapy is going relatively well because you have a good therapeutic alliance with the therapist and you're starting to make changes in your life, does this mean that there will be all smooth sailing ahead?

Not necessarily.  There is the issue of transference, which is unconscious and which can change over time (see my articles:  What is Transference in Psychotherapy?,  Psychotherapy and the Positive Transference,  What is the Negative Transference? and Psychotherapy and the Erotic Transference: Falling "In Love" With Your Psychotherapist).

Having a negative transference at a certain point in therapy isn't necessarily a bad thing.  In fact, it can turn out to be beneficial.  Often, a negative transference is based on earlier relationships with parents where you weren't able to work out these issues with your parents.

But in a good therapy, you have a unique opportunity to work out these issues with a therapist who is receptive to working on issues in therapy that might have triggered earlier unresolved problems.  This can be healing to you and help you to resolve those earlier issues.

Getting Help in Therapy
It takes courage to admit that you have a problem and to ask for help (see my article: The Benefits of Psychotherapy).

Many people start therapy with a sense of ambivalence, especially if they've never been in therapy before (see my article: Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent).

Getting help in therapy starts with calling for a consultation.

The purpose of the consultation is to talk about your problem in a general way and to ask the therapist questions about her experience, training, history of helping clients with similar problems, and how she works (see my article: How to Choose a Psychotherapist).

Working through your problems in therapy can lead to your living a more fulfilling and meaningful life without the "baggage" from your history.

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

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 (917) 742-2624 during business hours or email me.