September 2021 - Kate Gegg, AM, LCSW

September 20, 2021March 27, 2023

The “Rules” in Therapy

There’s a lot of popular notions about what therapy’s “supposed” to look like, but often when a client starts to have reactions to or about their therapist it goes unspoken between them
When any of us are in treatment we bring with it our expectation of how we’re “supposed” to be in relationships. Those expectations are formed by our prior relationships, prior therapies, and our culture.
Those expectations can leave us feeling like there are implicit “rules” between client and therapist. Can I ask about ____? I didn’t like what my therapist said, is it ok to tell them? I’m feeling like we’re stuck in treatment, is it ok to talk about it?
If you start withholding, or keeping something from your therapist, it can actually interfere with the speed and effectiveness of the treatment; now there are whole sections of your internal world that are off limits.
Sometimes we don’t bring things up because we feel like we’re not supposed to, the therapy is helpful enough, we are afraid we’ll hurt the therapist’s feelings, or perhaps we assume “they’re the professional, they know what they’re doing, right?”.
Even if the therapist DOES know what they’re doing, that doesn’t mean how they are working with you feels right at any given point in time. When it doesn’t feel right that can leave the client feeling less safe. Without safety and trust we can start to withhold more and more.
For some of us, the “rules” we intuit in therapy are closely tied to social “rules” we feel in life. Rules that are sometimes so strong we don’t question them, and rules that effect how much we ask or expect of others, and how much we take on for ourselves.
In therapy, and in all relationships, we can get stuck in that space between “how we feel we’re supposed to be” and what we actually need.
Therapy is a GREAT place to have that first experience of exploring and challenging that “supposed to” by working to unearth and talk through those expectations and how they effect you. The opening path to that is talking to your therapist about your expectations or concerns of your work together.

It’s not uncommon, in my personal life, for a friend or acquaintance to ask me about “the rules” of therapy. Am I allowed to ask about my therapist? What if I’m bothered by something my therapist does, is it ok for me to give them feedback?

The answer to these types of questions is somewhat nuanced, because each individual therapist will hold different boundaries for their practice – but – the overwhelming answer is – YES – bring what you are thinking about or concerned about to your therapist.

“But I don’t want to hurt her feelings”, “I don’t want to seem like I’m prying” or “It just seems like this is how he is”, are common responses I hear. So yes, on the one hand you want to be considerate of your therapist’s person-hood, but on the other hand, it is your therapist’s job to help you understand what you are experiencing with them in the context of what brings you to treatment. Feedback, questions, or concerns you have for your therapist can become barriers to you being comfortable in the room, and therapy works best when you feel at ease, and able to be open, vulnerable, and honest.

Additionally, (and here’s where it gets interesting) what you are experiencing with your therapist may be a microcosm of what you experience in other relationships. A skilled therapist will be able to help you think about how your feedback applies to both your relationship with them, as well as other relationships in your life and the themes you are discussing in treatment. A skilled therapist will also be able to help you process through how it felt to give feedback and your experience in life outside of therapy speaking up in ways that both get you what you need and take care of your relationships.

If you ask a question about your therapist you may or may not get a direct answer, but you should learn something about yourself in the process. When it’s working well therapy is a collaborative process, which means the therapist will do his or her best to intuit what you need and what will be helpful, but they won’t always get it right. So, take a risk, and talk to your therapist about what you’re not talking to them about.

Notes:

1. . My post on Cyclical Psychodynamics covers more on how we can inadvertently and unknowingly participate in creating dynamics in our relationship with others that don’t work for us.
2. Often times when we have “rules” hard wired into us about “how we’re supposed to be in relationships” we find we have a hard time balancing our needs and the needs of our relationships. Sometimes when we’re trying out new ways of being with others we quite literally feel like we don’t know how to say what we want to say in a way that feels honest, open, and kind. See this post on how to find the balance between yourself, your goals, and your relationships.
3. This is a multi-part series that will aim to help you get the most out of your treatment. See the first part in this series “Tips for selecting a therapist”.

September 18, 2021March 27, 2023

The Power of Validation

When we validate another’s emotion, we validate them; we communicate that their perspective is valuable and important and as such they are valuable and important to us
The experience of repeatedly having your emotions validated helps bolster self-esteem and self-worth. It teaches us to trust ourselves; that others trust us; and that we are knowable, relatable, and understandable.
Validation is affirming someone’s perspective or reaction as understandable and legitimate. You can accept someone’s reaction, empathize with it, and still not agree with it.
It’s important that we learn how to validate others while maintaining our limits, and honoring our perspective. We can validate someone’s emotions and perspective and still challenge them and hold our boundaries.
Validation involves a degree of acceptance; acceptance of a perspective, and acceptance that feelings and reactions are what they are, whether you like them, think they’re justified, or not.
When we ourselves don’t share the perspective of a person, when we’re confused by what they’re feeling, or it feels irrational to us we are more likely to invalidate.
When we invalidate, we deny someone’s experience and teach them not to trust themselves or their intuition. Invalidation communicates that what they feel, or how they understand something is wrong.
Maybe sometimes you feel someone’s reaction is wrong. Remember: A reaction can be disproportionate to a situation, and still a valid reaction, given the cumulative experience of one’s life. At any time we are reacting to more than just the moment we are in.
Repeated invalidation can cause someone to question their capacity to hold a valid perspective on the world, can heighten anxiety and depression, and can have devastating impacts on someone’s sense of worth.
We can further this troublesome cycle by invalidating our feelings and our perspective, which can leave us alienated from our emotional world and constantly looking for external validation and approval.

Validation is a powerful and important part of parenting, being in a relationship, and working with others. When we validate, we communicate to someone, “I understand you, and I understand your feelings in the context of your experiences”. Validating does not have to mean that we agree with or share the feelings (or perspective) being communicated, but it does mean that we treat their take on a situation as reasonable in the context of their current and prior experiences.

Sometimes, in our efforts to cope or help another cope with an overwhelming situation we can accidentally invalidate by trying to reassure another (and ourselves). Saying “you’re ok” and “It’s not that bad” are examples of how we can accidentally invalidate by expressing our desire for someone (or ourselves) not to struggle. Other times, we can overtly invalidate; we deny the expressed experience of another person for the experience we believe they “should” be having, or the experience we want them to be having.

For many of us, if we ourselves wouldn’t have the reaction a person is having it becomes tough for us to validate their perspective or emotions. This can be made easier by working to trust that feelings arise for a reason, and that at any given point in time all people are responding to both the situation they are in, and the situations that preceded it (that inform how they understand what is happening). If we can accept all emotions as valid, we can still work to challenge perspectives without alienating (and invalidating) another or ourselves.

Many of us think invalidation is necessary when we don’t agree or need to hold a boundary. We can validate AND challenge. Our emotions can be a valid response to our current read on a situation, AND we can validate someone’s emotional experience while offering a different perspective. This is often a FAR more useful way of getting through to someone, and it allows us to support someone’s sense of self while sharing a different perspective.

See notes for further information on how to accept other’s perspectives, and for examples of how to validate while challenging and holding boundaries.

Notes:

Read more about how our difficulties facing the pain of something can lead us to react in ways that try and keep our sense of safety intact, but can alienate others and reduce connection.
Invalidating the facts as someone sees and understands them, especially facts about the difference between what they experience and what is told to them about what is happening is called gaslighting. It causes you to undermine your ability to trust yourself, your reality, and your ability to perceive reality in manner consistent with what is happening in the external world.
It can be helpful to think of our knowledge of why someone reacts the way they do like an iceberg – consider that what you think of as “too much” or “too big” is based only on what you know of a situation. Try and trust that there is probably much more beneath the surface of a “big reaction” that you don’t know about. This can be true of both others reactions and our own. A reaction can still be disproportionate to a situation, and a valid reaction, given the cumulative experience of one’s life.
Do you find you often question the validity of someone else’s reactions? Or you often find yourself feeling like others around you are over’-reacting? See this post to help you think through it.
I mention in the post we are all, in some ways, responding to both the present situation and past situations that inform how we perceive the current one. Sometimes how heavily the past “weighs in” can be disproportionate. Learn more about this here.
If you find that you are often effected heavily by the past informing your current reactions grounding and mindfulness can help you reduce that tendency and stay more in the present.
Ways to validate while holding a boundary, “I hear you, and I know. You’re really upset by this and I get it. We’re still not going to change our plans”; “You are really angry, this is not what you wanted to be happening right now. If it were up to you this isn’t what we would be doing, but this is what I’ve decided and I know you don’t like it”.
Ways to validate while challenging someone (and remember that your tone matters), “it sounds like you’re not comfortable with this situation. I get that, if I weren’t comfortable with something I wouldn’t want to proceed either. Though, in all honesty I don’t share your perspective. I see it this way ___”; “Wow. Ok, so it sounds like you feel really strongly that _____ is a problem. When I think about that same situation I see it really differently”
If you struggle with chronic low self-esteem or low self-worth, consider your prior experiences with emotional validation, there may be a history of invalidation. that has effected your ability to trust yourself.
If you’re a parent and you’re struggling to validate your children Big Little Feelings offers online courses on this, as does Dr. Becky at Good Inside.

September 18, 2021March 27, 2023

The Myth of Exposure Therapy

Many of us wrongly believe that “exposure therapy” is repeatedly putting ourselves in a feared situation in the hopes it will decrease our anxiety in that situation.
I.e. “If I get on the plane enough times my fear of flying will go away”.
While low-level anxiety often dissipates with repeated exposure, higher level anxiety is made worse or stays the same with this tactic.
That’s because what makes exposure therapy effective is that the therapist exposes someone to a feared situation AND helps them have a different set of internal responses
It is that repeated experience of being in a situation and having a DIFFERENT internal experience that can shift our relationship with the situation.
An exposure therapist would NOT advocate for white knuckling your way through
Exposure therapy isn’t the only way to deal with fears of this nature, but the key for any and every individual to be aware of is that exposure therapy is not simply putting yourself in the situation time and time again and “pushing” through it.
If you want to work on a feared situation I’d encourage you to work to increase your awareness of where that line is between “high” and “low” anxiety situations
In low-anxiety situations – sure – expose yourself. You may just need to get the hang of it.
You can address high anxiety situations in a variety of ways including formal exposure therapy, standard therapy, working to build insight into what’s under the anxiety in an effort to help it dissipate, and increasing your mindfulness and grounding skills (info on those two in the comments).

I can’t tell you how many times a client has walked into my office talking about a struggle in a particular situation; a fear of flying, anxiety with public speaking, difficulties with crowds. Often, they tell me about how they have “white-knuckled” their way through this situation time and again in an attempt at “exposure therapy”. More often than not, they find it doesn’t work.

This is when I tell them that’s not how exposure therapy works. When a therapist is helping a client with an exposure the therapist is both EXPOSING the client to the situation they struggle with AND helping them have a DIFFERENT internal experience while doing so. It is that repeated experience of being in the situation and having a DIFFERENT internal experience that can shift our relationship with the situation.

For most of us, if we knew how to have a different internal experience while in the situation we would have done that long ago. What may feel intuitive to us in those moments (and perhaps not in our control) is to have the reaction we’ve always had.

Getting on the plane 35 times in an effort to expose yourself to a feared situation in the hopes it will neutralize (or numb) you to it can work with situations where you feel anxiety in a low intensity manner (i.e. think about performance anxiety where we are jittery the first few times, but with repeated experience we get more and more comfortable). With higher intensity anxiety you may actually be reinforcing (i.e. strengthening or making worse) the anxious response by exposing yourself to it without having built up coping strategies or skills for how to manage your internal world while you are exposed to the situation.

What I can do with my clients, and what you can do too, is work know ourselves well enough to know where that line is between the “low(er)” anxiety situations and the “high(er)” anxiety situations. When our anxiety is lower we often just need to stick with it and get the hang of it. You should notice yourself feeling less and less anxious over time. When anxiety is higher, the anxiety doesn’t change or get worse with repeated exposure. That’s a cue not to keep going without a different set of internal responses.

Notes:

How much anxiety we feel in a certain situation can vary based on a variety of factors. I.e. one day a situation might be “low intensity” and the next day the same situation might be “high intensity”. The key here is to work to pay attention to knowing your own anxious cues and responding to what they tell you.
I am not a specialist in exposure therapy, and in fact when I have clients in need of this type of treatment I will send them to a specialist for a series of sessions to work with someone in the situation they are struggling with to come up with strategies specific to their situation and their needs. This is often short-term work and it can be done alongside a longer therapy.
One tactic you can try if you want to try building that different set of internal responses is strengthening your grounding based skills (those help combat anxiety by keeping you in the present) and mindfulness skills (those both keep you in the present and help you increase your ability to control your attention. Both Mindfulness and Grounding will help you “tame” your anxiety in those moments, though there are many more skills and techniques that an exposure specialist could work with you on (sometimes in as little as 4-6 sessions) if you’re really stuck with something.