Trust: The High Hurdle of Therapy

512px-Spinsel_op_het_weiland

All relationships are either therapeutic or non-therapeutic. Or perhaps I should say, sometimes therapeutic and sometimes not. A relationship with a counselor is not exempt from this complication. Bloggers in treatment suggest that no other topic so unsettles the soul.

The heart is easily torn. A therapist tries to get inside a patient in a way more intimate than most sexual encounters. The client is expected to strip down before the healer in a metaphorical sense. Remember, our custom of shaking hands derives from the need of two souls to prove they are unarmed — that to be near is not to risk injury. Even without weapons, however, danger is there.

Partners in friendship, love, and therapy make assumptions. Sometimes these unstated beliefs undermine the possibility of understanding and trust. Trust is like a garment made out of words and expressions; actions and expectations. In the space of less than the 50-minute hour, the fabric is woven, unwoven, and back again. By a shift in the body and a smile. By a raised eyebrow and a word well-chosen, poorly chosen, or misunderstood. By silence or its lack. By whether the counselor recognizes the tiniest of tears in the corner of an eye. By whether the patient — gaze downcast and terrified — misses the same evidence she would otherwise observe in the healer.

Too often we expect the impossible of people to whom we are close: that if we are cared for, the other will know what we are feeling and thinking automatically. “He should be able to tell,” we say to ourselves. This belief shifts the responsibility for the achievement of trust and understanding to the other; whether a parent, a spouse, or a psychologist. Sometimes it is reasonable, often not, especially when both parties are adults.

Part of what makes understanding hard (even if we do not assume the other owns a crystal ball) is a question of access. No one else can get inside our head. We have knowledge of ourselves, or what we think we are, in the bright light of the mind. We possess an internal and effortless but utterly precise grasp of our own meaning. Yet for all the clarity available on the inside, our counterpart is in the dark, far from the possibility of direct observation. He cannot see within us, only the outer disguise and armoring. He may consult the dictionary meaning of our words and interpret our expressions and movements, but not more. Relationships die when the other is obtuse and insensitive, and also when too much is expected.

512px-MAGIC_CARPET

No one is a mind reader. The job of comprehension leading to trust is a duet, not a solo performance. Like all good performances, it takes rehearsal. Repeated rehearsal.

Therapist and patient, when they are well-matched and both working hard, spin a spider’s web as the session begins. The fibers are fine, almost invisible. With time, the net grows. If strong enough and recreated session after session, the strands thicken and better bear the weight of personal disclosure. Yet they still can be torn and retorn.

This is not necessarily a bad thing. All of life must be tested and resilience can only grow out of disappointment. We live in a world of unreliability. Nothing is permanent and yet we seek permanence. So we weave the web — together. With familiarity, the strands are more easily rewoven when a rift develops. Confidence grows. A safety net seems possible.

Remember, this is an act of becoming, not of being. There is no “one and done” here. Repetition, persistence, and continued effort despite the fraying of hope are required.

Nothing above absolves the therapist of the need for finely tuned sensitivity, laser-like focus, and dedication. He must do his best to recognize messages often disguised; must take care not to injure. Nor does this free the patient from taking incredible risks to reveal herself, even though her history says revelation and vulnerability will result in a terrible end. Tearable of the thing we call trust, and terrible to the heart and body.

The most damaged of clients want to be known, but are afraid to be known. They are frightened to show themselves to anyone. Thus, their coded messages are misunderstood. Nonetheless, courage is essential. The unfairness of having to take one more risk carries no weight. They must do so repeatedly. Their healing is otherwise impossible.

Perhaps therapists should recite a disclaimer to the most damaged patients at the outset of treatment:

I want to understand you, but I am imperfect. I will not make a clean catch of everything you say. You might have to repeat or rephrase. You will test me, but I am helpless without your willingness to trust — to help me help you. This is asking a lot. I apologize, but there is no alternative. I will disappoint you, but I am earnest. We must keep trying to weave a beautiful fabric, like a magic carpet. One that will help carry you until you can fly without the support of a tapestry to bear you aloft.

The careful reader will be struck by how many visual metaphors I have used in this essay. I’ve tried to achieve your understanding by reference to what can be seen. In so doing, I have also been underlining how difficult it is to express oneself by abstract words alone. Put differently, how challenging is the therapeutic task of achieving understanding.

In the fairy tale, Rumplestiltskin, a miller’s daughter is said to be able to do the impossible — spin straw into gold. Such is the goal of therapist and patient, both at the wheel. They too must weave. Without even straw. They hold only the memory of pain on one side and a strained, always imperfect empathy on the other. Gold of a different kind — understanding, trust, and healing — can come of their teamwork.

Is this only a fairy tale, too?

Not if you have seen it happen.

The top photo of a spider web on a pasture is the work of Nijeholt. The second image is a Magic Carpet created by איתמר סיאני. Both are sourced from Wikimedia Commons.

26 thoughts on “Trust: The High Hurdle of Therapy

  1. It’s gone midnight here, and this post deserves so much more thought than I have yet had a chance to give it, and I want to reply properly within the next day or two. Right now, my response is purely emotional – I am crying because I think it’s one of the most important things I have ever read or am likely to read. It’s beautifully, exquisitely written and the message goes straight to where it’s meant to lodge. I am bowled over – I don’t even understand everything I’m feeling. Thank you for writing this and for doing it so illuminatingly and honestly – your ‘disclaimer’ paints a wonderful wonderful picture, and one I want to constantly remember. I will write more later – apologies I don’t have the wherewithall right now to reply more fully!

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  2. Love the “disclaimer”. Everything you say is so true. I’ve been there in therapy. Therapy tore my world apart and then ‘re built a better one. It was only through the disruptions with my therapist and the repair work we did, that I got truly healed. For anyone out there finding it hard it is worth the pain.

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  3. This post is beautifully written! Sometimes I think I expect a bit too much from my therapist but this reminded me that they too, are human. I should not expect the impossible and instead expect imperfections and some fumbling along the way. My therapist said this to me recently: seeking help is a two-way process which requires both to work hard in it. Thank you for sharing your perspective

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    • You are welcome. Both therapists and patients, at times, expect too much. Therapists are fond of saying there is nothing they can do if the patient is not working hard, etc. I have said it, too! While this is true, each person must make sure he is not apologizing for his own inadequacies in the effort to achieve what needs to be a shared goal and responsibility. In the counselor’s case, not only effort but talent, reliability, and knowledge are required.

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  4. All very true insights. I can also speak from experience that when a therapist is too incisive and x-rays his way through the walls too quickly, it can be deeply unnerving.

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  5. This is a great post, and one I really needed to read right now. I have such fear to go to my therapist with my anger. This post has reminded me that I NEED to be open.. otherwise I’m not letting either of us do our job. It also reminds me how we have worked through our difficulties and each time our relationship gets stronger and deepens. Thanks for helping me see the light a little more clearly today.

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  6. I apologise _profusely_ for what I’m about to do – if I could see an email address for you, I would use that instead! I started writing a ‘more considered’ comment following on from my initial response to your amazing post – and I appear to have written a post-length comment. This is not really what the comments box is for, but I’m afraid I got a bit carried away (and I sometimes have a problem with brevity 🙂 ). I hope these ramblings are of interest, and thank you again – immeasurably – for writing this.

    I am reading this again, and it still stirs tears inside me. There is so much to say, so many things it makes me think of, so many things that struck me. The need to feel safe, to know that ‘to be near, is not to risk injury’ – slightly ironic that therapy is one of the few settings in which due to boundary constraints (though I know many therapists _are_ happy to touch their clients), one cannot shake hands to prove one is unarmed. I know that it’s a metaphor in this case, but the question remains – how does one establish that one is ‘unarmed’ in therapy? Presumably one has to assume it and venture out as if that were the case, and then find it proven by experience (to echo another incredibly valuable suggestion you gave to me in response to another comment).

    Unstated beliefs – about both myself and my therapist – are constantly affecting our sessions. I’m sure the same can be said about my relationship with my husband. I absolutely adore your metaphor of trust as a garment, and I particularly love the composition of that garment – words, expressions, actions and expectations. In our weaving, how much emphasis do we place on each of the different types of strands; – how much attention do we give them, and how does that affect the type of garment that we weave and how easily it is unwoven and woven back together? I place an extremely heavy emphasis on words, whereas my therapist places much greater emphasis on actions. I have a huge number of unspoken expectations, and I interpret expressions very much according to how I feel about a person at the time. As for the expressions that I miss – there are many of them, as I spend so much time avoiding eye contact. As if to illustrate the point about unstated beliefs undermining a relationship – my first response to your comment about the patient missing the evidence of tear in the therapist’s eye, was to think that my therapist would never betray emotion in that way. I don’t _know_ that – I assume it. Why? Because at the moment I’m seeing her as holding back or emotionally unavailable. Because I’m ignoring past evidence and placing too much emphasis on _lack_ of words, and the lack of words is running up against my immense expectations and desires.

    As for ‘magical thinking’ and expecting someone to intuit our desires and needs and thoughts and feelings – this is at the core of so much intense emotion, turbulence and hurt in my relationships. I wrote about it a few months ago: http://lifeinabind.com/2014/08/03/are-you-receiving-me-bpd-communication-and-expectations/ . I know the problems this sort of thinking causes, and yet I persist in it because of the meaning I attach to magical thinking and how ingrained the beliefs I have about it, are. I expect ‘the other’ to know how I feel – and that expectation is so important because of what it _means_ if they don’t know, or what I have lost if I have to tell them how I feel, myself. I agree that magical thinking is often not reasonable, and I agree that that is particularly the case when two adults are involved. I guess the difficulty with BPD but also with therapy in general, is that ‘child’ comes out so often in that setting, and the child believes very strongly in magical thinking.

    Access, access……one of the things that is so frustrating about therapy, one of the things I find ‘disconnecting’. The sense that I cannot have access to my therapist’s mind, anymore than she has access to mine. How often, when I have been disappointed in my high expectations, or in the fact that she has not said the words I wanted to hear, and she that is not working off ‘my internal script’, have I thought to myself ‘why does she not know, when _I_ know exactly what I need? I try to sidestep the obvious – that I have just told myself that either _I_ need to meet my own needs, or make them more explicit to others, but it can be such a challenging thing to do. Therapy, however, is the perfect ‘training ground’. I love your sentence about relationships dying also when too much is expected. I brought my husband to the point of saying he had given up on me, because I expected him and God to be around when this was all over, irrespective of how things were going in the meantime. It might be possible for God – but he is only human, and I didn’t expect him to react as a human would, in the situation in which he found himself.

    I play the piano, so I also like the analogy of the building up of comprehension and trust being a duet. One of the things I loved about playing with others, was the sense of being in tune and in synch with each other – connected. But as you said, that only comes with rehearsal, repeated rehearsal. And gradually the two players get to each other better, each other’s styles; they can read each other’s cues and hear their intakes of breath before the music starts. Do you play, by the way?

    With time the net grows – with creation and recreation. But how constantly must that process be sustained? How frequently can it be interrupted and what effect does that have? Does the process grind to a halt, or simply take place more slowly? At the moment I seem to be caught in a cycle of ‘good’ session/’bad’ session – flipping from one to the other with disconcerting predictability. It feels difficult to be ‘settled’ enough to let that weaving build up into a stronger net. I feel as though I need a solid period of weaving – I thought I had that for a while before Christmas. I’m not sure why things changed.

    I love ‘the act of becoming not being’; I love the ‘fraying of hope’. Yes, how often my therapist encourages me to keep going even when things don’t feel safe or I don’t feel connected – because they are, and I am. I _can_ still proceed even when the garment is frayed. The problem is that when it’s frayed, my compulsion is to pull at the strands and unravel it all –a bit like picking at my nail polish as soon as a tiny scratch appears. Once it’s no longer perfect, it has to be gone. Expectations again…..

    ‘Tearable of the thing we call trust, and terrible to the heart and body’ – yes, what a beautiful phrase, and how often, how _easily I seem to fall subject to being hurt in this way. And so often it _is_ because my messages are coded. Because I’m not explicit, because I know what I mean and I expect my therapist to know what I mean too. I can’t be more explicit because I’m afraid of rejection – please don’t make me say it, it’s too hard. But that just means that what gets said is unclear or misleading, making the perception of rejection more likely.

    I wish that I could have heard that disclaimer from my therapist at the beginning. Or that I could hear it now. It is so immensely to encouraging to know that you have seen this process ‘from the inside’ and you _know_ that a weaving of this kind is possible. What an immensely challenging and difficult task, but what a privilege to be part of it…..Thank you so much for writing this. Your metaphors are both immensely helpful and incredibly beautiful – there are so many key and memorable phrases in the text. And it is just so _important_ – it can make such a difference, I am sure it _will_ make a difference, if I can really take all these lessons to heart.

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    • Again, no apologies. I’m grateful for what you’ve written and think it will help others who identify with your words and the feelings they express. I assume your questions are rhetorical. You seem, in any case, to have many of the answers. The one that is clearly to me, I will answer. I do not play and came to music (classical) when I was quite preoccupied with other things, mostly academic and social. Thank you for writing this. Hardly ramblings. Your facility with words is impressive.

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  7. Reblogged this on Life in a Bind – BPD and me and commented:
    I believe that for me, this is one of the most important blog posts I am ever likely to read. The topic is trust – trust in therapy, but also trust in other relationships as well. It is a large part of what can make any relationship sometimes therapeutic, and sometimes not (to use Dr Stein’s phraseology).
    I don’t want to say too much about this post -it speaks volumes, about an immensely difficult and often painful topic. One of the things that makes it so extraordinary is that a number of metaphors are used to convey the nature of trust and how it is built up. The metaphors are both extremely illuminating, and incredibly beautiful.
    It’s a wonderful piece of writing; it’s an intellectually interesting and effective way of conveying a complex concept and revealing its core. But most importantly (and effectively) for me, it’s utterly emotionally convicting, and goes straight to the matter of my heart

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  8. Good post, thanks. Trust is one of the key things needing to be developed in the therapy of “Borderline Personality Disorder”, which I write about.

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  9. Reblogged this on Borderline Dissonance and commented:
    This is incredibly articulate, and is a crucial component of theraputic dynamics that has largely gone unaddressed. It’s really worth the read (that is, for any of you following me and have an interest in such).

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  10. Sounds like you’ve had some … “relationships”. Believe me, I have a complete understanding. It’s frustrating as the client. idk…. this was good to read. Thank you.

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  11. This is an amazing post and helps me with a particularly difficult stage of my own client-T relationship. Love the visuals, they help make it clearer 🙂

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  12. […] You can find Dr Gerald Stein’s amazing post here […]

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  13. Again, thank you. Ironically, my first thought on reading this was ‘must talk to my therapist about this’. She’s never far from my mind.

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    • You are welcome. The desire to talk with someone with whom you feel close and who you trust isn’t unusual or invalid. That’s part of what therapists are for.

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  14. Yes, DrG, I wanted a little more of what I got last time I read this post… I wasn’t disappointed, very helpful, thanks

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