Stress Response Syndromes: PTSD, Grief, Adjustment, and Dissociative Disorders by Mardi J. Horowitz & Mardi J. Horowitz

Author:Mardi J. Horowitz & Mardi J. Horowitz [Horowitz, Mardi J.]
Language: eng
Format: azw3
ISBN: 9780765708410
Publisher: Jason Aronson, Inc.
Published: 2011-09-16T04:00:00+00:00

Nuances of the Therapeutic Relatonship

Therapists should create a safe situation for the patients by remaining stable within their own clear boundaries (e.g., objectivity, compassion, understanding, concern for the truth, or whatever are their own personal and professional traits).

Patients learn the therapist’s limits within this frame. It gives them further that the therapist will react neither harshly nor seductively, and this trust will increase patients’ breadth of oscillation. They can express more aggressive ideas if they know the therapist will not submit, be injured, compete for dominance, or accuse them of evil. Harry could express more of his bodily worries when he knew the therapist would not himself feel guilty or overly responsible.

If the therapist changes with compulsives’ tests or needs, then they will worry that they may be too powerful, too weak, or too “sick” for the therapist to handle. Also, compulsives may use situations to externalize warded-off ideas or even defensive maneuvers. The therapist shifts, not they. This is not to say that such patients do not, at times, need kindly support after disastrous external events. But their propensity for shifting makes changes in the degree of support more hazardous than does a consistent attitude, whether kindly supportive, neutrally tough, or otherwise.

Suppose the therapist became more kindly as Harry went through a turbulent period of emotional expression of guilt over survival. Harry might experience this as an increase in the therapist’s concerns or worries about him. Or he might shift from the “little” suffering position that elicited the therapist’s reaction, to a “big” position from which he looked down with contempt at the “worried” therapist.

Similarly, if the therapist is not consistently tough-minded, in the ordinary sense of insisting on information and truth telling, but shifts to this stance only in response to the patient’s stubborn evasiveness, then the patient can shift from strong stubbornness to weak, vulnerable self-concepts. Within the context of this shift, the patient experiences the therapist as hostile, demeaning, and demanding.

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