Transcript: Episode 292
292. In Session, Part 3
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Okay, everyone. We are still talking about In Session: The Bond Between Women and Their Therapists, a book by Deborah Lott. A listener wrote into the podcast and told us about this book, and it has been a game changer. And I'm so grateful for it. And I'm so grateful it was shared. Thank you.
So the third chapter talks about the therapist power. The author says, “Women enter psychotherapy with great hopes and high anxiety. They long for comfort and support, insight and understanding, to feel better, and to make fundamental changes in their lives. They suspend disbelief and put their trust in the therapist’s presumably superior knowledge.” And then it goes on to talk about how therapists are supposed to know so much, and about how therapists are supposed to be such experts. And yet, all of them are trained differently, and there's lots of different kinds, and the licensing boards are all different, and all of these are different in every state, and that is the most overregulated and underregulated industry of all. And it was a fascinating discussion about that. And what we know from what we've learned from dissociation is that even in that context, when we get specific to trauma, it's even worse because so many programs, and so many educational venues, and so many licensure programs and supervisors, and all of this, so many do not even talk about dissociation, or are even anti-understanding it so that many clinicians don't really understand what dissociation is, or trauma for that matter. Which is horrifying because it's really the biggest chunk of almost every diagnosis, even if it's not specific to dissociative disorders.
She also said, “Some have used suggestive—even coercive—techniques to gain compliance, modify behavior, or convert a client in their way of thinking. They have directed therapy towards goals that were not disclosed, let alone negotiated with the client, seemingly under the assumption that the therapist knows best. I think that survivors with relational trauma are especially sensitive to this. And that clearly it's a discussion in the online community right now anyway about therapists goals versus client goals, and whether therapists talk to clients about that or not, and integration and functional multiplicity, and all of these kinds of things about how clients should have a choice in what their treatment looks like. So she talks this whole chapter about power, and the right to know, the right to understand what's going on in treatment, we should understand what to expect, and the obligations of the power.
She said, “The client should never feel that it is her job to satisfy the therapist’s needs.” And that's an interesting thing. That's an interesting thing because it goes back to what we talked about before in earlier chapters about countertransference, and about their issues getting transferred on to you. And I can think of all kinds of things. Our very first therapist that we ever had that moved us into her house and was like, “We can adopt you. We’ll be, you can be our daughter.” And that was our therapist who said that and we moved into her house. Well, do you know what else was going on? At the same time, her daughter had called children's services on her and had moved out to live with her father instead of her mom, who was my therapist moving me in to be her daughter. And I didn't know any of that at the time. So that was its own layer of trauma of like, was she caring for me because she cared for me? Or was she caring for me to get back at her daughter? Or was she caring for me to meet her own needs to have a daughter? Like how, despite what like other people may know of her or her heart or her intentions, how was I supposed to know any of that or sort through that with the trauma filters that I had on me? It was very confusing.
The other example that we share in the book is how we had a therapist who wanted to transfer us to a different therapist so that she could do trainings with us, because she wanted to learn how to make money putting on trainings, like to develop the business of her therapy practice. Okay? What's not in the book is that the therapist she sent us to, when we talked about this, about how we were going to go into business and do trainings, and we were already doing trainings, and how we that therapist wanted to start a company with us? Our new therapist then started a new company with her friend to do trainings. And while that was not at all, like, isn't that wild, just the energy of that and how it transferred to here to transfer to there to transfer to there? Like it's dizzying.
We had a therapist who asked us how to set up a podcast. And so we only saw that therapist two times because on the second section she wanted us to teach her and show her how to set up a podcast. And it's not that that's a bad thing. But it becomes about their needs, not about your needs. And for us because we've been through this several times, it's a retraumatizing of what we've already been through of therapist ruptures in the past where they wanted to take something from us instead of help us. Or wanted us to meet their needs instead of meeting our needs. And if it's going to be a mutual thing, then we need to be colleagues. Or if it's going to be an edifying thing, then we need to be friends. But don't say we're not friends and we're not colleagues, and that we have a therapist-client relationship, and then asked me friend things or or colleague things. Do you see? It gets so tangled.
She says, “The client is not in therapy to please the therapist, flatter the therapist, amuse or entertain the therapist, or make the therapist feel smart, important, valuable, sensitive, lovable or needed. It is sometimes difficult for women in therapy to recognize this fact because they are so used to feeling responsible for satisfying everyone else's needs in their personal lives.” Which really, that's appeasing, which we call fawning, which is a trauma response. So then the therapeutic relationship—in this example, I don't mean every therapeutic relationship—but in this example, the therapeutic relationship becomes a reenactment of the trauma. And so then what happens is that we get trauma responses in the therapy experience. Either starting to fight with the therapist, or to get away from therapy or quit therapy, or we shut down in therapy altogether, because it's a trauma response. It's a reenactment of what we have already been through.
So naturally the next chapter, chapter four, is about boundaries. And she talks about a guy named Arnold Lazarus. And she tells the story of when the APA was first setting up their first code of ethics and how some people felt it was in response to litigation and trying to protect themselves, rather than actually setting boundaries for clients to keep clients safe. Now, it depends on what stories you listen to or what you read as to how much of what is true. But a little bit of both, really, is true, right? But Lazarus was not having it. He wanted things to be open and more flexible. Remember that Lazarus was one of the guys that moved therapy from psychodynamic or psychoanalytic into behaviorist, and trying to make that be more scientific. He said that therapy should be more humane than just the boundaries that the code of ethics were trying to lay out. And he gave this speech about the code of ethics and how things needed to be more flexible. He said, “With some clients, anything other than a formal and clearly delineated doctor-patient relationship is in advisable. But with others, a willingness to step outside the bounds of a sanctioned healer will enhance treatment outcomes. Thus, I have socialized and partied with some clients, played tennis with others, and taken long walks with some. At times I have learned more at different sides of a tennis court or across a dining room table than I might ever have come to light in my consulting room.” So he was saying, he was saying that boundaries needed to be more flexible, including where you see a client, when you see a client, and in what context you share time and space and activities with a client.
So the author goes all the way back to the Anna O. story in the time of Freud to kind of give a history of boundaries. And in response to some of the things that came out with the analysts and all of the recounting that some of them did. Because no one wanted all that abuse and trauma out in the elite circles, right? Like that kind of had to be suppressed or avoided. And that became this community dissociation where Freud recanted his theory, and instead of saying that these were trauma survivors he was treating, he changed what he was saying about all that, right? That's a whole different podcast. But in response to that, and to show that they were not going to give attention to any of these stories about women and their pain and the traumas they had been through, this whole stance of therapy having this neutrality and abstinence developed. So in that one shift, in that one shift, therapy moved from something that was about presence and connection, and healing through relationship, into something very distant and cold. She says, “Neutrality and abstinence became the by-words of analytic demeanor. Neutrality meant that the analyst was to take no sides in the patient's internal struggles. Abstinence meant that the analyst would not get caught up in trying to gratify the client's longing, and would refrain from using the patient to gratify his own as well. To do so he had to guard vigilantly against gratification to the point of depriving the patient of even the usual human warmth. So at this point, like, the pendulum swung the other way to where that distance and coldness was the structure and framework of therapy instead of the relationship. And this lasted for a long time.
But at the same time it was ironic. And the author points out how Freud took patients with him on vacation, how Freud analyzed people that he had social and professional relationships with, how he treated friends and family, and even his own daughter. There's records of that. So one of his students countered this, saying that healing came from a genuine loving relationship. Because that was more natural, and the actual human expression is what was curative. And so he started experimenting with authenticity, warmth and compassion, and develop to those is necessary elements of the therapeutic relationship. And then Franz Alexander, who had been a patient of the other guy’s, who was a student of Freud, said that, the author says, “Declare the curative agent and psychotherapy to not be insight, but corrective emotional experience in a positive relationship with the therapist. The therapist only needs to do the exact opposite of what the patient's parents had done to reverse the consequences of their faulty parenting. Where they were critical, the therapist should be approving. Where they were rejecting, she should be accepting.” But then traditional psychoanalysts said “No way. They objected and said that trying to be a good parent-figure carry too great a risk of gratifying infantile fantasies and encouraging transference reenactments.”
So there became this struggle between should therapy be cold and distant, or should therapy be warm and authentic and connected. And in the middle of all this came psychologist Carl Rogers in the 1940s. He's the one who came up with unconditional positive regard and said that therapists should have a platonic love for their patients. He said, quote, “The therapist was not an object for transference projections, but as a real person and a genuine human bond. He urged therapists to be authentic and not to adopt an artificial therapeutic persona.” And then from there developed Gestalt therapy and Rollo May’s existential school. “And these therapies shared a belief that the real authentic supportive relationship between therapist and client served as the agent of change. They sought to equalize the power imbalance in the relationship, suggesting that absolute parody might be possible.”
The problem with this was that those things developed in the 50s and in the 60s during the movement towards freedom and liberation. And the focus on being that authentic carried things so far that people were acting out all kinds of things with almost no boundaries at all. And so because of that a lot of humanistic approaches really got dismissed. And there's less of it today because people behave so badly, really is what it comes down to.
So she moves from talking about the history of why we got codes of ethics, and where that developed from, and where the idea of therapeutic boundaries came from, and she explains how there's some common ones that everyone kind of agrees on. That clients should know when they can be seen, that client should know the boundaries of things like consent, of what you're going to do or what you're not going to do, what you can help with, what you can't help with. And clients should know things like the boundaries of confidentiality of like, what you can disclose to whom, and what you can't disclose, or when you will disclose, things like that. But other than those kinds of things, she says, quote, “Women in therapy feel as if they are moving blindly around in the dark, hoping not to bump into the sharp corners of the therapist boundaries.”
And they think that that is a place where misattunement can happen when things are not communicated explicitly, or when there are shifts or changes or transitions that remain unclear. Or worse, when there are boundary crossings which may be appropriate therapeutically, but are not appropriate when the boundary crossing turns into a boundary violation, or when boundary crossings are appropriate therapeutically but then the therapist panics about it, backtracks and then withdraws that care so that the experience is not a boundary crossing that's helpful, but a violation of the relationship and a rupture instead of attending to. Either way, those become violations.
So then the therapist talks about how sometimes boundaries for people who grew up in really chaotic households can feel helpful and structured and safe. But also how especially with trauma survivors, when there have been lots of secrets growing up, that boundaries that are not expressed or not consistent can be confusing. She said, quote, “She regarded the boundaries as being like all the locked doors in her childhood home. An impediment to intimacy. She imagined that if only the rules were relaxed, if only she and her therapist could go somewhere outside of the office, she could allow herself to feel more.” So then she works through that chapter and gives lots of different examples and stories of boundary crossings and boundary violations, and when boundaries were helpful and when they were not.
And then she gives an example of one with therapy trauma. Where there was a rupture that was unresolved in the past, and the person is seeking therapy again. So obviously that piece felt familiar just because we've had so many therapists in the last year, right. And she talks about how that adds pressure to the therapeutic relationship because there's so much power in it. She said, “One kind word from the therapist had a greater impact than a 1000 compliments from anyone else. Whatever the therapist said, the client believed. Their relationship became emblematic. This was the first time anyone really had heard or understood her. This was the relationship that would make up for all the hurts of the past. Like a dream come true.” And then she tells about that story which is just another example of what boundaries can look like when they're crossed or violated, and what it's like from the clients point of view. So these were powerful little stories and examples.
And then, so it was really a good chapter, and really put many things that many of us have seen or know, really put them out there explicitly. But also shared stories of other people's experiences of that show why boundaries are so important, but also the lived experience of what happens when they are too rigid or too flexible. The author wrote, “That said, good boundaries are not equivalent to good therapy. Boundaries exist to protect the therapy. They are not the therapy. It is quite possible for a therapist to keep the boundary and lose the patient by enforcing boundaries in a restrictive, legalistic, defensive manner. One of the complaints that I heard most often from women was how bad, how invisible, and how impotent their therapist’s lack of emotional responsiveness couldn't make them feel.” So boundaries were super important, but the flexibility of boundaries is what makes them healthy. But that doesn't mean that every boundary should be flexible.
The other thing that she really emphasizes is how small moments are big things in the lives of the client. So small things that the therapist does or says are really impactful for clients in positive ways or difficult ways that are more challenging. So things that the therapist may not even notice or be aware of, may be really loud to the client, which they talk about more in the chapter about transference. So that's chapter five.
She kind of continues the history. Going again back to Freud, and how transference, quote, “also had the potential to distort or even completely block the light of reality. The illusion was not only unconscious, it could overwhelm all other perception.” It goes back to the other chapter where finding out the therapist is in real life not at all who you thought that they were because of this symbolic relationship within the four walls of therapy. And so the book gives the example of running into your therapist in the grocery store while they're in their regular like lazy day clothes. Right? So it was just interesting.
Then she adds to that the connection of developmental phases and how conflicts during that time, according to Freud's theory, could show up later. And what's interesting is this book was released a long time ago. And what we know now about developmental trauma really comes into play here, I think. She says, “Te-experiencing the past in the present and then realizing how the past experience was distorting perception, that could be curative. Transference could be resolved as the patient becomes conscious of her transference feelings, accepted their origins in early infantile strivings that could never be satisfied, and made a new peace with what was possible in adult life. For this to occur, the analyst had to be careful not to gratify the patient's irrational infantile longings and to offer dispassionate interpretation instead.” And so back in the day, therapists were not supposed to rescue the clients from those feelings of transference, because the feelings of transference meant something. And what we know now that she's not talking about here, is about relational trauma and how those wounds in the relationship are what make relationships so difficult. Because it's not possible until those until there is relational healing.
But again, that's where Carl Rogers came in. She writes about this and says, “Carl Rogers and his followers argued that the real relationship between a humane, authentic and collegial, as opposed to a cold and paternalistic, therapist would allow the client self-actualizing tendencies to flourish. By offering genuine support, encouragement and emotional responsiveness, therapists therapist would not evoke those same sorts of troublesome transference feelings.
And then she talks about how behaviorism turned into cognitive behaviorism. And that this sort of came to that pendulum swinging the opposite way where transference wasn't a thing at all. That they were aware that they had to have a positive relationship for the client to, quote, “do the work.” But that there was not any discussion of the relationship, of what was happening between them. Which is also why things like CBT, for example, don't always help people with trauma, when they're only talking about thoughts and feelings and behaviors, without any sort of trauma context.
The rest of this chapter was kind of interesting to read in a painful way because she's kind of predicting what actually happened. And how behaviorism was developing into cognitive behavioralism. And how therapy was shifting from the relationship and context of healing within the consulting room, to techniques and tools to correct thinking and behavior. Because that was a more hard science and could get funding. And that's really exactly how things played out. And it's kind of sad and scary both to know what we know now about the history of treatments since she wrote this book, and what that has done to people, and how poorly clinicians are trained now because most clinicians now are not trained in psychoanalyst at all, or even psychodynamic theory. They don't even know. And instead they do these fads of certain techniques or certain tools, but without that foundation of understanding the context of relationship, and relational trauma, and developmental trauma, and what that means. And that is doing a lot of damage.
But then in chapter six, it's fascinating, because she writes about how transference was really a term that Freud came up with to justify having time alone with a client. Because the women that he saw, even though they were his patients, that society at the time would not let him alone in a room with his patients. And so calling the relationship between him and his clients, his patients, calling that relationship transference made it something outside of himself or the patient, so that it became like the third person in the room. Almost like the transference itself became an escort to protect them both or as a witness to what their relationship was, creating what the author calls a privileged space. So that for the first time in what we have in documented history, there was an excuse and an cultural permission for the psychoanalyst to meet alone privately with the patient.
But this chapter, of all things, is actually about gaslighting. And she says that this happens in therapy because of the transference bind. She says, “The transference bind goes something like this. A woman perceives something about her therapist. Perhaps that he or she is inattentive, or that he has a bias against her in some way, or perhaps she suspects that the therapist is thinking or feeling something about her. She conveys her suspicions to the therapist, who promptly attributes them to transference. In effect, the therapist is saying, ‘this is about you and your past, not about us right now.’ And that experience in itself leaves the client with virtually unanswerable questions. ‘Are my feelings rea or are they transference.’ For a dizzying moment, the therapist office turns into a house of mirrors with a client unable to tell which surface offers accurate reflections and which distort. If she can't trust her own perceptions, she must be crazy. And if she can't trust the person she's relying on to take care of her, then she has been abandoned.”
That I feel like was our crisis two years ago, and last year, of why we could not fix what we were going through, and we were stuck. Like, drowning and scrambling and falling. I don't know all of the words to talk about how devastating it was. This is what it felt like. If we couldn't trust our own perceptions. Because we were wrong for feeling this and this and this, or noticing this or this and this, or for this and this and this happening, then it's on us. But if we can't be helped with that, or if those things are because of what happened in therapy, or what didn't happen in therapy, then Now Time is not actually safe, and we were abandoned and betrayed and violated. And that's a terrifying thing to even consider. How do you sort all of that out?
The author says that the answer is both, that the client is experiencing accurate information that she can sense from the therapist. What we know now from research, even just in the last few years, is that that's called neuroception. And she's responding to things that therapist doesn't even know that they are presenting. Right? But it's also true that there are patterns of interactions that reflect back to and reenact early childhood experiences.
So, in the chapter, she talks about how to sort of walk through this situation, and about how “the therapist more important role as provider of a safe haven for the client is to explore these projections. But the therapist who becomes authoritarian or dogmatic, who blames the client, who insist on an all or nothing real or transference world, threatens this safe haven.”
So then she talks about congruence or congruence that, like authenticity, is the term that therapists use when describing how much the therapist should reveal of his or herself in therapy. That to be congruent, or congruent, is to maintain some essential match between the person inside the therapy room and the person outside the therapy room. She says, “When client and therapist are trapped in a bind, it is easy for the client to believe that the only way out is to determine definitively ‘is it real or is it transference?’ But the stories in this chapter have shown that the answer is always that it's both. It's real, and it's transference. The relationship between therapist and client is a fine balance of the symbolic and the real. The way out of a bind is through an appreciation of the subtle complexities of that balance. That shared reality that client and therapist create is fragile. It lacks the trappings of day to day life and social support to sustain it. Client and therapist may need to negotiate and renegotiate this reality over and over again throughout the course of therapy.
So that's what pulls psychodynamic theory full circle, and so relevant to complex trauma and relational healing. Because it is about the present, and it's also about those patterns and relationships. The two chapters after that are about mother figures, which I don't want to talk about right now because we talked about it on mother hunger already and kind of updated in that way. But you can look in those chapters for more information. And then it has a chapter about erotic transference, or feeling like in love with your therapist, which seems horrifying to me. I don't know that we've had that experience. But I can see why feeling that would be such a struggle. And then it also has a chapter of actual violations and sexual abuse in therapy, and, which we have also not experienced and so we're not going to talk about today. But if any of that is interesting to you, or more important to you, you're welcome to look up the book. It has some really good stuff, helped us put some words to things, and was interesting for us to explore. And we'll definitely be talking about it in therapy.
So I just want to give a shout out to the people who recommended that book in their email telling us about it. We really appreciated it and it was very helpful. And we will definitely be talking about it in therapy. We've already sent a picture of the cover of the book to our therapist so that she can get it ordered. And it will be some good discussion as we get into things a little more in depth. Thank you so much for sharing with us and for helping us find words as we sort of climb out of this black hole that we fell into two years ago. It has been a long hard journey. But I really feel like we are crawling out of it, and that helps to stabilize us in other ways too. And I am so grateful because it feels like there is air again for the first time in so so long. So really that helps so much. Thank you so much for listening. And the book again, if you want to look, is called In Session: The Bond Between Women and Their Therapists by Deborah Lott. Thank you so much.
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