NYC Psychotherapist Blog

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Saturday, November 25, 2023

Can You Learn to Trust Your Therapist When You Weren't Able to Trust Your Family?

A common dilemma that comes up for people who have been traumatized is how they can trust their therapist when they weren't able to trust their family as they were growing up (see my article: Dynamics of Adult Children of Dysfunctional Families).

Developing a Sense of Trust in Therapy

Traumatized Clients Have Good Reasons Not to Trust
Most trauma therapists know that it often takes a while before a client can feel comfortable enough to open up.  And this makes sense when people grew up in homes where they couldn't trust family members. They have good reason not to trust a stranger right away--even if the stranger is a licensed psychotherapist.  

As a trauma therapist, who has been working with traumatized clients for over 20 years, I recommend that clients who contact me for help start by talking to me for 10-15 minutes on the phone before they set up a 60 minute consultation.

The 60 minute consultation is for them to talk about what they want to work on in a general way without delving too deep into their problem. I also suggest that they use the session to ask questions about how I work, my education and training, and get a sense of whether they feel comfortable enough with me to book another session.

The reason why I emphasize talking in broad terms during the consultation is that I want the client to feel as safe as they can without making themselves so emotionally vulnerable that they feel overly exposed emotionally after the session.

My Own Experience During My Training to Become a Therapist
When I was in training to be a psychotherapist 20+ years ago, I was required to be in my own three-time-a-week psychoanalysis as part of the training process.  This involved having consultations with potential senior therapists who were part of the institute where I trained.  

Since I was aware that these therapists were part of my institute where they taught and supervised students in the program, I wanted to make a good impression and appear to be a worthy therapist-in-training who had enough life experience to empathize with potential clients but also the potential skills to merit passing the training.

But these consultations turned out to be a lot more stressful than I anticipated because these first session involved delving deep into my history and my deepest emotional vulnerability.  

So, never having experienced this before, I walked out of the first consultation feeling like I was in an altered state.  Walking out into the street I felt all my senses felt heightened.  Everything I saw was brighter and noises were louder than usual.  Even though I knew I was having this experience because I had opened up too much, I still felt unsettled.  It was only after I could take a few deep breaths that I calmed down.

I knew that part of this altered experience was a psychological "fishbowl effect" of feeling exposed as a therapist-in-training where I knew I would run into this therapist at the institute and now she knew so much about my early personal history.

Soon after a few initial consultations, I returned to the first therapist I met and told her about the experience I had in the consultation with her.  Just being able to talk to her about it helped tremendously.  She was sincerely apologetic and I felt a lot more comfortable with her.  

During the next two consultations with the same therapist, my experience was completely different.  I felt safe and comfortable with her, and I eventually chose her because we clicked so well in the second and third consultations.

My Consultations With Psychotherapy Clients
I never forgot that experience and I remember it each time a client calls me for help. I usually spend 10-15 minutes talking to them on the phone and then, if they're interested, we set up an initial 60 minute consultation either in person or online (see my article: How to Choose a Psychotherapist).

I want them to feel as safe, comfortable and in control of what they divulge in that initial consultation.  I also encourage them to ask me questions about the modalities I use and how I might work with their particular issue.  Since I have many different modalities that I use, I usually tell them what it might be like with each modality.

If clients choose to return, I check in with them to find out how they experienced the initial consultation.  If there is anything to process, we talk about it and I listen to what the client needs to feel safe.

During the next few sessions, I gather information about their history as it is relevant to their problem.  This usually includes family and relationship histories and, if they're coming to work on a sexual problem, their sexual history.

When I work with couples, after the initial consultation, I meet with each one individually for one or two sessions to talk about their individual histories.  I also emphasize that it's important for each of them to feel comfortable with me.

Preparation to Do Therapy
If clients come to work on unresolved trauma, after gathering information about their history, I help them to develop coping strategies to deal with whatever might come up in trauma therapy.  Depending upon the client, this could take anywhere from a few sessions to a few months of sessions (see my article: Developing Internal Resources and Coping Skills).

For instance, if a client already has good coping skills and they have a regular meditation practice or they practice yoga, that they might not need as much preparation as someone who is having panic attacks.  Specifically, the person who is having panic attacks needs help to overcome them before working on trauma.  So, each client will have different needs.

In addition, clients need to feel enough of a sense of trust and safety before they can begin processing trauma (see my article: Trauma Therapy: Why Establishing Safety For the Client is So Important Before Processing Trauma).

Empowering Clients in Therapy
I also let each client know that they are in control of the trauma processing no matter what type of therapy we're doing--whether it's EMDR Therapy, Somatic Experiencing, AEDPEgo States Therapy or any of the other modalities which I use (see my article: What is a Trauma Therapist?).

Developing a Sense of Trust in Therapy 

This is important because people who were traumatized weren't in control of their experiences, and new experiences in therapy can make them feel vulnerable.  So, it's important for them to feel empowered during the therapeutic process (see my article: Empowering Clients in Therapy).

I try to work with each client within their window of tolerance, and I'm usually good at tracking how clients are doing in session. But some people are so good at hiding their discomfort (they had a lot of practice since childhood) that they might hide it from me in order to appear to be a compliant client.  So, I encourage clients to tell me, to the extent that they know, before they get to the point of overwhelm, and I teach them how to detect these feelings.

Helping to get clients back to their window of tolerance could mean that the trauma processing stops temporarily in a session so we can do some grounding or containment  exercises and then return to processing the trauma in that session.  Or, it could mean that we stop and debrief for the rest of the session about what might have come up that was so disturbing.  It's up to the client how we proceed (see my article: Riding the Waves From Trauma to Transformation).

When You're Looking For a Therapist, Take It One Step at a Time
The following steps can be helpful when you're looking for a psychotherapist:
  • Referrals: Get a referral from a trusted source--like your doctor or personal friend or you can read therapists profiles online on a professional therapist directory.
  • Verify License: Make sure whoever you're considering is a licensed mental health professional. You can do this by looking up and verifying their name online in your particular state's professional licensing website (therapists are licensed by state).
  • Look Beyond Location: I know a lot of people choose therapists based on geographic location these days and, while I understand the importance of convenience, I would encourage you to look beyond location.  As long as the therapist is licensed in your state, you can choose anyone, but looking up therapists based on whether they are walking distance from your home or office shouldn't be the sole criteria for choosing a therapist.
  • Talk to Them: Take the time to speak with the therapist on the phone for a few minutes to find out if s/he has the expertise for your presenting problem.  You also might want to know how long they're practicing and what professional training they have.
  • Do a Full Session Consultation: Do at least one initial consultation with the therapist and get a sense of whether you feel comfortable. This doesn't mean you're necessarily going to feel completely comfortable since, after all, you're speaking to a stranger.  It might take a few sessions to know if you feel a connection with a therapist.
Once You Begin Therapy: Tell Your Therapist If There's Anything That's Bothering You About the Therapy
Once if you've begun therapy, let your therapist know if anything has come up that's bothering. you (see my article: How to Talk to Your Therapist About Something That's Bothering You About Your Therapy).

Many people feel too intimidated to talk to their therapist about things that make them feel uncomfortable in the session or they don't know how to do it.  They're afraid the therapist will take it personally or that it might damage the therapeutic relationship.

This problem often originates in clients' history where, as children, they couldn't tell their family about things that made them feel uncomfortable. Back then, it might have been emotionally and/or physically dangerous to do this.  So, being able to talk to your therapist about misattunements or an empathic failure is an important part of your personal growth.

Once clients and their therapist work through any misattunement or other rupture, they often discover that the therapeutic relationship is enhanced when these ruptures get repaired in session (see my article:  Ruptures and Repairs Between You and Your Therapist).

If a therapist is unwilling to talk about a misattunement or rupture, this is often an indication that this isn't the right therapist for you.

Also, remember that not every therapist works well with every client, so even though the therapist might come highly recommended to you by someone you trust, you have to trust your own sense as to whether the therapist is the right for you.

Getting Help in Therapy
Getting help in therapy can feel like a daunting process, but it's less daunting than continuing to suffer with unresolved problems that are having a negative impact on you now.

Rather than struggling on your own, seek help from a licensed mental health professional so you can lead a more fulfilling life.

About Me
I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex 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 (917) 742-2624 during business hours or email me.