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Embarrassment
Between Therapist and Client: The Great Divide
Therapists operate under constraints vastly beyond what most clients imagine.
Posted March 13, 2014 Reviewed by Jessica Schrader
For clients, perhaps the single, most valuable function of therapy is the unprecedented freedom of expression it affords them. Assuming that their therapist is both competent and conscientious (i.e., not needing to advance a private agenda), clients have full license to share themselves without fear of criticism or negative judgment. After all, most therapists recognize that for therapy to be successful, their appropriate role is to help clients feel richly empathized with and understood—hardly to evaluate how adequate, right, or justified they may be. And obviously, it’s essential that clients experience their therapist as safe and trustworthy if they’re to fully open up and divulge their deepest anxieties, or darkest secrets. In short, clients require a “protected space” to thoroughly explore, and ultimately resolve, what brought them into therapy in the first place.
Whatever guilt, humiliation, or shame clients might harbor about past behaviors; whatever baffling, fearful, or outrageous fantasies or obsessions they might be afflicted with; whatever anti-social or criminal impulses may plague them, they must feel sufficiently secure in the therapy relationship to “lay bare” their various concerns. It’s not only true that qualified therapists would never respond to such revelations by grimacing and wagging their heads. Clients can also be assured that, unless their disclosures are so perilous that the therapist is ethically and legally obligated to report them, all the information they share will be held in strict confidence.
Much of the time, such unrestricted freedom to let it all “hang out” is essential in enabling the client to significantly grow and alter self-defeating thoughts and behaviors. In such a relationship (till now probably unparalleled for them) they’re provided with the time and space, and clinical expertise, to begin confronting many of the things that previously had prevented them from confidently meeting life’s challenges. They can now address the issues that may underlie their problematic anger, anxiety, depression, or relationships—or harmful addictive habits.
And it’s not simply that they can now freely ventilate to the therapist what otherwise they may have felt compelled (and at considerable costs) to keep under wraps; that they can talk about beliefs and emotions which earlier they may have deemed themselves much too vulnerable to divulge. Through this singularly different and, frankly, rather extraordinary relationship—one that is, simultaneously, both personal and intimate and professional and detached—they can avail themselves of the opportunity to share what otherwise might feel “unshareable.” They’re finally at liberty to reveal their most frustrating and perplexing—even agonizing—problems.
In stark contrast to clients, it might be said that therapists are governed by an enormous number of constraints (only a few of which is there space here to discuss). To maximize their therapeutic effectiveness, they must function within unusually narrow parameters. The license they extend—and must extend—to clients (i.e., to facilitate clients’ spontaneously sharing whatever is on their minds, and in their hearts) is one they’re duty-bound to deny in themselves.
So why, exactly?
Well, for many reasons. Therapists, by definition, are performing a service—and a “paid” one at that. To fulfill their side of the bargain and devotedly serve their clients, they really have no appropriate “business” serving themselves. For example, if a client shares an experience that strongly reminds the therapist of one of their own, a powerful temptation may exist to share that experience as well. But therapy isn’t designed to be a two-way street. So before giving themselves permission to divulge what may have just come up for them, therapists must ask themselves such questions as:
“Will sharing my own experience possibly be too personal a disclosure at this point in therapy?” “Will telling this anecdote of mine actually be pertinent to the client’s goals and in keeping with my role as therapist?” "Might such a disclosure be advantageous in making me more ‘human’ and emotionally accessible to the client—or might it (on the contrary) be too 'intimate,' and so likely distract them?” “Might such sharing prompt them to regard me as more their friend than their therapist?” And, of course, the ultimate question—which, ideally, ought to guide every decision the therapist makes—“Do I honestly believe that what I’m tempted to say will move therapy forward?”
Whereas spontaneous communication (i.e., one that is unregulated or uncensored) is healthy for clients and at times outright “healing” for them, communication for therapists needs to be far more cautious and deliberative. So if the most scrupulous answer to any of the questions above is “no,” or “not really,” then the therapist ought to refrain from what then could only be seen as unwarranted (and unprofessional) self-indulgence. So at the same time that clients should have free reign to confide in their therapist, it’s generally not appropriate for therapists—reciprocally—to confide in them. Not that there aren’t certain exceptions to this rule—typically grounded in the therapist’s belief that such disclosure might help normalize, de-shame, or in some way productively alter a client’s negative assumptions about self. But broadly speaking, therapists need to refrain from personal sharing when their primary reason for doing so is merely that they feel strongly disposed to.
There are many other situations demanding that therapists constrain their natural conversational, or sociable, impulses. Although discussing all of them would be impossible in a relatively brief post, let me at least provide a couple of additional examples.
At times clients can use language that may be decidedly offensive to the therapist. They might employ verbiage reflecting a prejudice toward someone of another race, religion, ethnicity, political party, and so on. Or they might use a disagreeable or discourteous obscenity in virtually every sentence (the much overused f-word very likely being their favorite). But here again therapists have to ask themselves whether directly commenting on what may be discomfiting (or possibly even distressing) to them will advance the cause of therapy. And even if in a particular instance a therapist determines that, yes, it would be beneficial to offer the client feedback on ways that their language could be detrimental to them, the question yet remains: Just how does this rejoinder need to be expressed so that it minimizes any chance that the client will feel affronted or attacked?
Harshly or condescendingly evaluating what the client says—or simply commenting unfavorably on where they’re “coming from”—may well make them less likely to speak in the unedited fashion the therapist has all along been encouraging. And if they have a fragile ego or are highly defensive, then even if the therapist thinks they’re being painstakingly careful in the tone and phrasing of their response, they may nonetheless be pushing the client’s all-too-reactive buttons. In which case their essentially benign intention may be woefully misunderstood. Finally, if the therapist’s communication feels to the particularly sensitive client to constitute a personal rejection, it’s quite possible that the therapeutic alliance—the prerequisite for all successful therapy—could be fatally compromised.
I’ll offer one more instance of the many constraints inherent in the therapist’s curiously dual role as fellow individual and professional. And this example will be exceptionally personal, taken directly from my own practice.
I once dealt with an extremely anxious client who desperately desired to change . . . but without actually having to do anything different. On my part, I did everything I could think of to help allay her many fears about trying out new behaviors. For she was one of those people who, almost literally, was intimidated by her own shadow. In addition, her self-esteem was somewhere below ground and her ego as fracturable as fine glass. However reluctantly, I realized our work would need to proceed slowly.
In our sessions we did role-playing exercises, behavioral rehearsals, visualizations, relaxation procedures, trauma resolution work, etc. etc. But not once was she able to get herself to follow up on any of the many suggestions or between-session “assignments” I proposed—and despite her regularly agreeing to do so. Becoming increasingly frustrated with her inaction, I yet tried as hard as I could to be as patient and compassionate, as encouraging and supportive, as possible. I certainly didn’t want to hurt her tender feelings and “spontaneously” let myself negatively react to her seemingly endless refusals. And my efforts to be forbearing did in fact enable me to keep in check a strong impulse to—well—scold her.
But what in this instance was so interesting to me was that though I did everything I could to maintain her sense of security in the relationship (so as not to undermine her potential for change), my keeping faith with my professional role was in fact taking its toll on me. As much as I tried to deny it, my rational understanding of the snail’s pace at which therapy was moving—and probably had to move—didn’t really prevent my patience from wearing thin.
It was during this time that I had the most flagrantly revealing dream (and one that was almost absurdly easy to interpret). In it, I was giving unbridled vent to all my frustrations with this client— unconstrainedly yelling and screaming at her at the top of my lungs. I remember waking up with a broad smile on my face. My patience had become overextended and my unconscious mind (in its infinite mercy!) was allowing me to “get out” what I knew, in reality, I needed to hold in.
As an addendum, much later in this client’s therapy, when at long last she’d begun to develop the internal resources to make some crucial changes in her life, it was actually appropriate to share this so-exasperated dream I’d had about her. And we were able to share a laugh over it—further strengthening (rather than weakening) the therapeutic bond I’d initially labored so hard to maintain.
So one final point that might be made here is that therapists, even while protecting their clients’ anonymity, may regularly need to air out with friends or colleagues frustrations they’re obliged to keep inside during the therapeutic process. That way, they’ll have all the more reserves to suppress any self-expression that—if it came out—could injure their personal/professional relationship.
For, in effective therapy, the self-expression double standard must always be honored. But outside this “sacrosanct” setting, therapists have every right to assert their freedom to share what they were compelled to forbid themselves earlier.
© 2014 Leon F. Seltzer, Ph.D. All Rights Reserved.
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