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Monday, March 30, 2020

Undoing Aloneness: The Client's and Therapist's Parallel Experience of a Crisis

In a prior article, I began a discussion about undoing aloneness and what that means (see my article:  Undoing Aloneness: Staying Socially Connected Even Though We Are Physically Disconnected).

In the prior article, I suggested ways that individuals could remain socially connected to loved ones, even though they are physically apart. I also discussed how therapists could maintain meaningful connections with clients through online therapy or phone therapy while they are out of their offices.

In this article, I'm focusing on the fact that therapists and clients are having parallel experiences of the COVID-19 crisis and how these parallel experiences can enhance therapists' ability to provide a safe therapeutic environment, which includes helping the client to feel that he or she isn't alone with the experience.

Undoing Aloneness: The Client's and Therapist's Parallel Experience of a Crisis

The Therapist's Clinical Judgement About Self Disclosure to Clients in Therapy During Parallel Experiences: Undoing Aloneness
In a prior article, I wrote about times when both the client and therapist are going through a similar crisis at the same time (see my article: Parallel Losses For the Client and the Therapist).

In that article, I discussed that therapists often find that a client comes to their office with a similar problem that the therapist might be experiencing at the same time.  I provided a fictional clinical vignette where a client, Lois, came to therapy because her mother was rapidly decompensating from Alzheimer's.

In this fictional example, Lois' therapist was able to provide both practical resources as well as clinical interventions to help Lois cope with her grief and fear about her mother's deteriorating condition.

Lois felt the calming and soothing holding environment that her therapist provided in her therapy sessions (see my article: The Creation of a Holding Environment in Therapy).  Even though Lois felt grief, she also felt her grief was being held and contained by her therapist and this was healing for Lois.

What Lois didn't know was that her therapist was also going through a similar experience with her own mother.  The therapist assessed whether it would be beneficial for Lois to know this and she made a clinical judgement call (to herself) that Lois needed to feel that her therapist was outside the world of Alzheimer's and nursing homes, so she opted not to tell Lois about her own situation.  She assessed that it wouldn't be helpful, so she didn't self disclose.

In another situation with a different client, the same therapist might assess that it would be beneficial for the client to know that the therapist was having a similar experience.  Self disclosure of this nature is, of course, done with much forethought and might even involve consultations with other colleagues.

The other consideration that must be kept in mind when the therapist and client are having parallel experiences is that, even though there might be similarities, there are also differences in the client's and therapist's situations.  This isn't a situation where there is "twinship" between the therapist and client.  Although similar, each of their situations will be unique and they will experience differences based on each of their particular situations and who they are as individuals.

The therapist has to make sure that any self disclosure, especially on this level, is for the benefit of the client and not for the benefit of the therapist.  This doesn't mean that the therapist might not derive some benefit or healing from it as a byproduct of the self disclosure, but the focus must be on what's best for the client.

Parallel Experiences During the COVID-19 Crisis and Undoing Aloneness For the Client
In the situation where a therapist is going through a similar personal situation to the client, the decision to self disclose or not, although not easy or done lightly, is easier to make, as compared to self disclosure in the COVID-19 crisis, because in the personal situation the client usually isn't aware of what's going on in the therapist's personal life.

But in the current COVID-19 pandemic, everyone is affected in one way or another, and most clients know this.  The therapist can't pretend that she's not affected by this crisis because the client already knows that everyone is affected, possibly in different ways and to a greater or lesser degree.

Similar to other situations where self disclosure is a clinical judgment call, during the COVID-19 crisis, the therapist must decide if, when and how much to self disclose on a case by case basis depending upon the needs of the client.

For some clients, any form of self disclosure or reminder that the therapist is affected is contraindicated because this reminder would be too overwhelming for the clients.  Even though, of course, they know, on some level, the therapist is affected, beyond knowing that the therapist is in good health and available to them, they don't want to be reminded that the therapist is experiencing the same crisis.

For instance, for some clients, who grew up with parents who were overwhelmed by one crisis after the next, these clients felt emotionally unprotected by their parents and had to fend for themselves as best as they could while feeling alone in their traumatic experiences.  They might even have had to function as parentified children to their parents where they took on the role of adults to take care of their parents--even though they were just children (see my article: The Roles of Children in Dysfunctional Families).

These clients often need to feel that the therapist can overcome any situation in order for the clients to feel safe in the therapy sessions.  This usually involves an idealized transference that the client develops for the therapist, which is an idealized view of the therapist (see my article: What is Transference in Psychotherapy?).

This is what undoes aloneness in the therapy session--the idea that, unlike the client's parent, the therapist is a competent adult who can handle any situation that comes up.

The resolution of the idealized transference will be determined by the client, and the therapist will take her cues from the client.  Over time, as the client's trauma begins to resolve and the client feels more empowered, s/he no longer needs to see the therapist as an idealized, powerful figure.

Converesely, other clients have a need to know that the therapist is also affected by a crisis that they're both experiencing, like the 9/11 World Trade Center attack or the current COVID-19 crisis.

For instance, during 9/11, many clients in New York City wanted to know if their therapist lost anyone at the World Trade Center.  Or, they wanted to know if their therapist experienced fear when the therapist heard about the attack.

Since both the therapist and client lived through 9/11, the therapist's willingness to discuss this as an experience that they each went through was often necessary and helpful. Obviously, the therapist needed to know each client very well to know what would be beneficial to help the client to feel less alone.

Another example is during the COVID-19 crisis a client might say that time feels distorted to her since the crisis began. In response, the therapist makes a clinical judgment as to whether it would be beneficial for the client to know that the therapist is having the same experience--with the same recognition, as mentioned before, that, although similar, each individual will have his or her own unique experience.

In addition, the therapist usually won't just end with self disclosure.  She would also talk about what the client can do to keep his or her perspective manageable.  So the therapist would provide the client with tools and techniques to accomplish this, so it's not just a shared experience but also an opportunity to learn how to manage emotions and maintain a perspective that's healthy for the client.

When the therapist self discloses, even if it's not a big self disclosure, it's always important for the therapist to metaprocess the experience with the client, which means asking the client what it was like to hear that the therapist was having a similar experience.  This helps to deepen the work and also helps the client to clarify the client's experience about the self disclosure.

In the event that the therapist made a clinical mistake in self disclosing, metaprocessing also provides an opportunity to repair that mistake (see my article: Ruptures and Repairs in Therapy).

Metaprocessing the experience of the therapist's self disclosure also helps the therapist to understand the client's experience.  This can lead to further explorations of the client's past, present and anticipated future.

The Therapist's Self Knowledge and Clinical Judgement About the Client
It's important for the therapist to know her own comfort level as well as knowing the client in order to make a clinical judgment call about self disclosure.

If the therapist knows that she tends to be reticent about self disclosure and that the client's question feels too personal for her, she needs to take this into consideration so that she's not uncomfortable with what she discloses.  At the same time, as mentioned earlier, she needs to know the individual client and what the client needs at any given time.  This is a balancing act.

At a particular point in time, a client might need to know something about the therapist's experience in order for the client not to feel alone in a situation.  However, over time, the client might have other thoughts and feelings about what s/he asked the therapist to self disclose.  All of this is grist for the mill and should be explored.

Undoing aloneness and self disclosure is an important and complicated topic, and one article isn't sufficient to address all the issues involved.  However, hopefully, this article gives you a sense of some important factors.

Getting Help in Therapy
As I've mentioned before, physical distancing doesn't mean that you can't connect in other ways to feel socially and emotionally connected.

If you're feeling overwhelmed, you could benefit from working with a licensed psychotherapist, who has the experience and skills to help you.

Rather than feeling alone and suffering on your own, you can get help from an experienced therapist.

Many therapists, like me, are offering online therapy while they're out of their office.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, Somatic Experiencing and AEDP therapist.  I also use EFT (Emotionally Focused Therapy) for couples.

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.













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