We all know the importance of being present in the room with our patients, even in the face of overwhelming suffering and struggle. The work we do is hard, and it’s understandable, expected even, that we would employ tactics to distance ourselves from the pain we encounter in our patients from time to time.
It isn’t always obvious the ways we’re creating this distance. Subtle things, including some of the things we’re trained to do, like interpret and intellectualize, can be the source of separation in sessions. At best, these tactics can lead to missed opportunities to gather data or forge a secure bond with our patients. At worst, they can rupture the relationship and break trust.
The following are just a few of the ways we unconsciously distance ourselves from patients.
1. Playing the Expert
Falling back on the “healthy healer,” and “wounded client” dynamic has the potential to alienate, isolate and even humiliate a client. In fact, clinging rigidly to the expert role is one of the most effective ways to distance and ensure that authentic connection cannot occur. It is also a missed opportunity to establish a therapeutic relationship that models mutuality and respect.
Dropping the expert role doesn’t mean that you relinquish the responsibility of guiding the session according to what you know is best for the patient and his or her therapeutic goals. It simply means that you be willing to show up in the room as a human being, not above or somehow immune to the same human conditions as your client.
2. Interpreting or Intellectualizing
Most of us in the helping professions are here because somewhere along the line we decided that we wanted to help people.
But let’s be honest: Many of us are also in this field because we find behavior and psychology fascinating. We like intellectualizing and understanding. We like to analyze the things people do and say and come up with stories or discover theories about why.
Patients are courageous to walk into therapy and share their inner worlds with total strangers. If we are lucky enough to experience the moments in which they feel safe enough to open up about material that is deeply troubling or painful for them, it’s important that we respond in a way that communicates that they are safe, seen and understood. Interpreting and intellectualizing are two quick ways to do the opposite.
Just imagine how you would feel if upon sharing an intimate detail of your life, the person you shared with responded with some jargon and theory that you had no knowledge of or interest in. Would you feel safe, seen and understood?
3. Being Emotionless
The alternative to intellectualizing the client’s experience is being emotionally present and allowing yourself to be attuned to what it is that the client is feeling. This ability to hold space for a person who is experiencing something terrifying, excruciating or deeply disturbing without absorbing or becoming overwhelmed by it is a skill that takes practice.
The therapist must strike a balance between mirroring a patient’s distress enough for them to learn about the client’s sensations, but not so much as to increase the individual’s level of fear as in contagion panic, wrote trauma expert Peter Levine in his book An Unspoken Voice: How the Body Releases Trauma and Restores Goodness.
It is natural to respond internally to stories of horrific abuse or deep emotional hardship with feelings of shock, astonishment, sadness or anger. Finding a way to share these responses skillfully is an important part of helping a client better understand their own experience or simply making them feel less alone. You may need a moment to process what’s been shared before you’re able to be present again with the patient and that’s okay.
4. Leaving the Room
Leaving the room doesn’t always mean getting up and walking out the door, though it’s safe to say rapid exits are a no-go for anyone hoping to create a safe space for healing.
You also leave the room when you allow your mind to wander in session; perhaps you’re preoccupied with something you may have forgotten to do or even judging what the client is saying, spacing out and thinking “I’ve heard this before.”
In therapy, every moment contains rich information about where the patient is at and how they view the world, even if it’s that they repeat the same story 10 times over the course of a month’s worth of sessions. This practice, too, contains valuable data about the client’s experience and an opportunity to attune your work to his or her needs.
5. Projecting Our Own Experience Onto the Client
In what feels like a move to connect with the experience of the client, when we overlay our own experience onto theirs, whether aloud or internally, we’re re actually creating more distance, not less.
When a patient shares something, you may recall how a similar situation felt for you, what it brought up or triggered in you. If you’re able to defuse from your own story, you can listen for the ways this experience was for the client, rather than making assumptions based on your own experiences.
Notice when something the client has said resonates with your own personal experience. Take a moment to observe that thought train and then gently release it, returning to the client’s unique experience and perspective.
Now that you have a better idea of what distancing looks like, you may want to think about some of the other ways that you may be subtly disengaging or moving away from clients in sessions. If you start to notice distancing tactics, remember to practice self-compassion. We all make mistakes. It is the willingness to notice and take accountability for them that creates the possibility to do better.