Dear Patti,

My teenage son Gavin has been going through a rough emotional time over a relationship breakup and feeling depressed. He requested to start individual psychotherapy sessions about a month ago and this is his first time in any type of counseling. After a few sessions, the psychotherapist made requests of my son, such as asking him to take off his sunglasses, throw away his chewing gum, stop shaking his leg and foot or remove the pillow he’d picked up and placed on his lap. Gavin seems to like and trust this therapist and while I’m sure she has her reasons, could you shed some light on the therapeutic rationale? I’d appreciate it. I don’t want to interfere in any way. I just want to understand  

  — Claudia

Dear Claudia,

When your son first walked into his therapist’s office, chances are he had a healthy desire to open up and pay attention to his feelings, even if 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 of the self 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 his 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 son’s therapist is to challenge and push through the emotional barrier between Gavin and his buried emotions and support him to become stronger in his ability to experience feelings. One common way to ward off feelings is to discharge them before they get very strong. Your son’s therapist is confronting the defense of discharge by asking him to remove his chewing gum or by gently asking him to not shake his 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 Gavin is able to tolerate closeness without automatically putting up these barriers, it will become easier for him to go out into the real world and create close relationships. His therapist is confronting defensive responses against emotional intimacy by pointing out that Gavin 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 how 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 Gavin face his deepest feelings, establish a comfort level when intimate with another, so as to work together — without barriers — to make his 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 an office in Pasadena. Contact her at (626) 584-8582 or email pcarmalt@aol.com. Visit her website, patticarmalt-vener.com.