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Attunement and Love in Psychotherapy

Therapists lay like a bridge over troubled water.

Source: @eelnoslva/Canva Pro
Source: @eelnoslva/Canva Pro

This was “one of those weeks." Almost all my clients had a difficult time and one experienced an episode with family and caregivers with consequences that will play out for months, perhaps years.

In this kind of week, I have a lot of work of my own to do. Some of it is my own countertransference. In one particularly challenging situation I experienced a lot of Projective Identification, a defense mechanism recognized to operate in a therapeutic relationship. The client unconsciously projects intolerable aspects of the self onto the therapist, and the therapist internalizes these aspects onto herself. The result is that the therapist feels within herself the feelings/emotions/sensations of the client, as though they were her own.

This week I was on the phone, in long discussions with the client and caregivers, helpless to make things work out as they should. For hours afterward, I felt a deep sense of sadness and pain.

I have my own share of life pain, but this was different. I knew it belonged to my client. It felt like an unfamiliar weight within that pulled me down. It took me a few hours to figure out that this was projective identification, and then I decided to take action.

As an expressive psychotherapist, I know the usefulness of artistic response for my client's therapeutic process. In student days, one of many ways I was taught to use it was, following a session with a client, to understand the client's therapeutic process better. I learned a sequence to put myself in my imagination in the role of the client and then create an artistic response to what was going on with the client. It could be a body-sculpture, a drawing, a movement, writing a poem, singing, etc.

So this week I listened to songs and experimented with allowing my body to move in a way that might somehow reflect the pain I felt in relation to the experience of this client. It felt like the depth of Hades. Eventually, the playlist brought a familiar song, and as I listened a very slow movement passed through me that somehow seemed to embody the words.

I felt like I was being stretched, almost beyond my ability, to lay as a bridge over troubled water for this client. I recognized that stretch was the embodied movement that I needed to physically create to shift how I felt at that moment. Rather than being a stagnated weight, I became the embodiment of a long bridge over troubled water.

We become such a bridge as therapists by bringing a presence as a “good enough” caregiver, able to hold things that feel intolerable for our clients and bridge them. Clients in certain moments feel surrounded by pain wherever they turn; the pain is so overwhelming that they feel unable to hold themselves together and function. As therapists, we accompany our clients in encountering this overwhelming pain, and we do not disintegrate when we do so. In this way, we become a sign of hope in the possibility of integration.

But for this to work, our client must feel that we truly “get” the pain they are experiencing and that we are true “with” them. This happens only if we put our client in the center of our attention and heart. Over and over again we offer caring messages, sometimes with words, but always with eyes, body posture, and tone of voice: I see you, I hear you, I care, I am here with you, we are doing this together.

Bridging with love and attunement as building blocks
When we offer those messages of care, we provide the most important basic element of support for trauma survivors. We give attunement, a nonverbal process of being with another person in a way that attends fully and responsively to that person. Attunement is interactive and provided with supportive eye contact, vocalization, speech, and body language.

Attunement is the primary vehicle for parents to communicate love and safety to small children. The loving eyes and kind voices of parents repetitively assure a child: you are seen and noticed; we love you and will keep you safe; you can explore and engage with difficult or strange things because we are here for you. We unfold as human beings in the presence of early caregiving attunement, and we unfold further if we are fortunate enough to receive it in later relationships.

The supportive, loving, predictable, attentive, presence of an attuned caregiver is the building block of the ability to feel safe in the world, engage in relationships, and claim our space in society.

However, in our own way, we have all experienced deficits of attunement in our lives. We all need someone else at times to embody the bridge over troubled water for us. For some, this is provided by a close loved one, or a mentor able to embody that role. For others, the bridge is a therapist.

Either way, we cannot do it on our own. This is a process that requires reciprocity. Somebody must embody the bridge for another until the unsteady one is able to rely on that embodiment and slowly stretch and grow these parts, and eventually become steady enough to embody integration on their own.

The genuine care and fondness of a therapist for a client is a make or break dynamic in the process of therapy in general and trauma therapy in particular.

Recent years have brought a lot of attention to trauma, and developmental trauma and its role in individual and communal healing. This is a blessed step in the right direction. But, an unhelpful aspect of this new awareness is a focus on stress symptoms mitigation instead of trauma integration and an all-wellness approach. Many therapies and therapists promote modalities that aim to address stress symptoms and their impact on clients. Therapists become narrowly focused on techniques on occupying time and redirecting distress instead of staying in moments of distress and pain as part of the therapeutic process.

There is a time in the therapy process to focus on addressing stress symptoms. (Read more here.) But it’s important as therapists to recognize that treating stress symptoms is preparatory; it is not an end in itself.

In working with trauma survivors we need a broader lens, focused on all aspects of wellness. The survivor’s overall well-being should be at the center of your time together, and often outside of your time together. (Read more here.)

We serve as a bridge until things shift and the client is able to bridge these parts on their own. This usually happens first as part of the therapy process, but eventually, it continues when they are on their own. With all of our heart, we labor for that time when the client is able to sustain the progress and ready to continue without us.

Our clients need to know from day one that we care for them, that we are fond of them, that over time we come to love them in a way that protects them and maintains boundaries. Gradually they come to trust us as a bridge among the painful experiences they carry. When this is achieved, we are able to help them invent and connect to their own resources as building blocks for their own bridge over troubled water.

To find a therapist, please visit the Psychology Today Therapy Directory.

More from Odelya Gertel Kraybill Ph.D.
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