Being consistently present with other people’s suffering is one of the hardest parts of clinical work. Being present is a prerequisite to engaging with patients, validating them, and helping them heal interpersonal traumas that may make the act of connecting with other people difficult or scary.
Needless to say, our ability to engage and stay present is crucial to therapeutic success.
Of course, because we are human beings, there will be times when we will disengage from the patient in some way or another. Our minds may wander, we may put up an emotional wall, or something a patient says will trigger something from our own history that temporarily distracts us from what they’re communicating.
But there are also more subtle ways that we sometimes disengage from patients without knowing it.
We are trained to decode client behaviors because understanding why people do what they do is often an important first step in encouraging change. The meanings we are able to make out of the things they feel, do, and say is very often clinically relevant, useful for case formulation, and important to steering the direction of treatment.
But analysis has its limits. The meanings we come up with don’t necessarily need to be shared directly with patients, for example, but can be kept in our back pocket as a way to guide the kinds of questions we ask and the areas of focus in sessions.
Because most psychotherapists are naturally interested in understanding why people do the things they do and making meaning from internal events and behaviors, we are more likely than other people to intellectualize both our own problems and those of our clients.
But it’s important to recognize that the temptation to analyze is sometimes a defense against feelings things we’d rather not feel. A patient might bring up something that hits close to home or simply feels too intense to bear. In that case, we may fall back on analysis as a way to distance ourselves from what the client’s story brings up in us. Analysis is often important, but left unchecked, it can be just another way we subtly disengage from clients.
2. Maintaining a Poker Face
There are conflicting theories and beliefs in the psychotherapy field about how much personal information a therapist should communicate in sessions, and how much they should share through facial expressions and body language.
Some clinicians believe that any amount of expression is inappropriate, while others believe that sharing personal details about their own lives can be incredibly powerful in forging a strong, therapeutic alliance. Whichever camp you belong to, if you express as anything less than human—for example, emotionless, unaffected, unfazed by intense suffering—you may be creating distance between yourself and the patient that may hinder the process and make it more challenging to build an authentic connection.
Again, you can put yourself in the client’s shoes to consider why this might be important. Think about sharing a horrendous story from your childhood—perhaps something you’ve never told anyone before. You muster the courage to share it with someone and the person stares back at you with a blank expression. Even with verbal validation, a straight face appears to be untouched by the experience thereby risking the possibility of making the patient feel that his or her story was “not that bad,” after all.
3. Assuming You Know How the Client Feels
Many of us are in the mental health field because of our own experience with mental health challenges whether firsthand or secondary. For that reason, it can be tempting to think we know exactly how a client feels or have “been there.” But when we project our own experiences onto patients, we can negate or invalidate the details of their experience that are unique to them, dismissing important information about their circumstances that are crucial to their treatment or recovery process.
Overlaying our own “stuff” onto clients’ experiences is yet another way of unconsciously disengaging from what they’re truly expressing and what they need.
If you connect with some of what the client is saying, notice that. But also know that anytime that happens, you are at a heightened risk for projecting your own experience onto him and thereby distancing and disengaging from being present to the person.