Dear Patti,
My wife started individual therapy about two months ago and this is her first time in any type of counseling. At a number of sessions, her psychotherapist has made requests such as asking Lea to take off her sunglasses, throw away her chewing gum, stop shaking her leg and foot or remove the pillow she’d picked up and placed on her lap. My wife likes and trusts this woman and I’m sure she has her reasons, but if you could shed some light on the therapeutic rationale, I’d appreciate it.                             
— Neal

 

---

Dear Neal,
When your wife first walked into her therapist’s office, chances are she had a healthy desire to open up and pay attention to her deepest feelings, even if intensely painful or difficult. When patients reach out for professional counseling to help them face and resolve their problems, it’s because they realize that the cost of suppressing and avoiding hidden impulses or disowned emotions is no longer worth the adverse results they’re having — such as mood disorders, anxiety and relationship conflicts.

 

Unfortunately, once a patient is actually in therapy, an unhealthy part that is afraid to be open and is vulnerable, due to emotional trauma from the past, invariably emerges. This harmful aspect of the personality surfaces in two ways: (1) by trying to keep intense feelings pushed down due to a powerful fear of them and (2) by preventing the therapist from becoming too close because of a fear of intimacy. These two walls of resistance —the one between the patient and her feelings and the one between the therapist and patient — trigger defensive maneuvers that the therapist needs to discourage.  

A major role and responsibility of your wife’s therapist is to challenge and push through the emotional barrier between Lea and her buried emotions and support Lea to become stronger in her ability to experience feelings. One common way to ward off feelings is to discharge them before they get very strong. Your wife’s therapist is confronting the defense of discharge by asking Lea to remove her chewing gum or by gently asking her to not shake her leg and observe what feeling is trying to come up.

It’s also a professional counselor’s job to help patients overcome their fears of intimacy by confronting any emotional walls that obstruct the therapist-patient relationship. Once Lea is able to tolerate closeness without automatically putting up these barriers, it will become easier for her to go out into the real world and create close relationships. Her therapist is confronting defensive responses against emotional intimacy by pointing out that Lea placed a physical barrier between them (the pillow) and asking her to remove her sunglasses to confront her avoidance of eye contact.

A skilled and competent therapist is able to recognize and identify each patient’s particular road map of defensive maneuvers, very different from patient to patient. For example, one person might avoid feelings by clamming up and not talking. When the therapist urges the patient to be more verbal, the patient’s flow of words allows her to get in touch with deep emotions. Another patient might engage in rapid talking and, when coached to slow down and not talk so much, will start to experience emotions she was previously unaware of.

A therapist might point out specific defenses by saying, “Do you notice you repeatedly look away when feelings of sadness come up?” or “Can you see you begin to speak rapidly when discussing how, as a child, you rarely saw your father?”

Verbal and nonverbal “cues” can convey a lot to a therapist. Patients, for instance, may use a lot of minimizing words when speaking (i.e., “I’m kind of angry” instead of “I’m angry” or “I guess I’m lonely” instead of “I’m lonely”). Another example of defending intense feelings is by expressing the exact opposite emotion (i.e., laughing or smiling when sad, folding hands calmly and setting them limply in one’s lap when furious).  Another defense is constricting and tensing muscles (like tightly crossing arms and legs) when strong feelings arise.

In summary, the therapist’s requests are designed to help Lea face her deepest feelings, establish a comfort level when intimate with another, so as to work together — without barriers — to make her symptoms disappear.

Patti Carmalt-Vener, a faculty member with the Southern California Society for Intensive Short Term Psychotherapy, has been a psychotherapist in private practice for 23 years and has offices in Pasadena, Santa Monica and Canoga Park. Contact her at patticarmalt-vener.com or call (626) 584-8582.