Jeff Levy, LCSW
Mental Health, Relationships, Trauma, Identity
Jeff Levy, LCSW
(originally posted on Branching Out: The Live Oak Blog, August 2014)
Abby shot up from her seat and ran out of my office. I asked her to stop and tell me what was wrong, but she left without saying a word. I quickly called her cell phone but she didn’t pick up so I left a message. I tried to reach her later that evening and I still got her voice mail.
I had an urge to continue to reach her throughout the week, prior to her next regularly scheduled weekly appointment, but I also had an inkling that she’d only feel more pressured and anxious. She’d never left my office like that before and I was fairly sure I had unknowingly said or done something that triggered her response. I decided to wait until our next scheduled appointment, hoping she would attend as she had done in the past.
Zane was the last person to check-in as part of the beginning ritual for the group I was facilitating for male survivors of childhood sexual abuse. Despite having agreements about the check-in being limited to 1-2 minutes, some of the men would occasionally talk longer.
On this particular evening, Zane’s check-in was closing in on the 7-minute mark. When he finished, I realized that I hadn’t been paying attention for the last few minutes he was speaking. When I asked if anyone had any follow-up related to the check-in before we moved on, Zane looked directly at me. “Jeff,” he said with rising volume, “I don’t think you were listening to a word I was saying!” I literally felt myself gulp.
Faye had scheduled her first appointment shortly after I returned from vacation. She was referred by a colleague who couldn’t accept new clients at the time. Although availability was tight for me as well, when I spoke with her, she had already contacted three other therapists. Not wanting to send her to yet another therapist, we scheduled her first appointment.
Several days later, I was in session with a client for about 10 minutes when there was a knock on my door. It’s unusual for someone to knock when I have my “in-session” sign showing, so I went to open the door a crack. Standing there was a woman I didn’t recognize until she introduced herself as Faye. She said she had an appointment with me, and had been waiting for awhile before she decided to knock on the door. I went to get my appointment book and walked into the hallway where she was waiting, closing my office door behind me.
“I have you down for this time tomorrow,” I said gently. I saw her eyes begin to tear as she scrolled through her phone, eventually showing me the e-mail I had sent confirming her appointment for right that minute. I was embarrassed and hopefully apologetic when I told her “I’m so sorry I wrote this down for the wrong day. Can you come back tomorrow at this same time?” She nodded her head yes, but by then, tears were streaming down her face as she walked quickly out of our waiting area.
I called Faye that evening to confirm our appointment the next day and she picked up. It sounded difficult for her to talk to me, but she confirmed our appointment for the following day. I thought there was a 50-50 chance she would attend.
When We Rupture Unexpectedly
I could share many other examples when I have done something that has created a rupture in my relationships with my clients. I like to think of myself as someone who attends to detail and is attuned to my clients throughout a session. Still, no matter how attuned I am and no matter how much I think I attend to detail, sometimes something slips through the cracks. I miss an opportunity to validate someone’s sadness or anger. I say something that resonates with something historically painful, or in my busier moments, I schedule two people for the same time slot.
In over thirty years, it hasn’t gotten easier for me to know that I have done something to cause someone pain. Almost always, I have an immediate urge to correct my mistake. I want to call someone after a difficult session to check-in or I want to rush to apologize. I don’t want to cause anyone pain and I don’t want anyone to be angry with me. People come to therapy to deal with other people hurting them, not to deal with how much their therapist hurts them!
At least that’s what I used to think almost all the time. Now, although I don’t want to create a situation that is painful for my clients, I know that it’s bound to happen. I’m not superhuman and I’m not perfect. Realizing that it’s ok not to be superhuman or perfect has been liberating. I’ve reframed what it means when someone experiences pain because of something I have done. I’m more able to see it as an opportunity.
While we don’t come to therapy to experience pain at the hands of our therapists, many of us do come to therapy because we are dealing with the scrapes and scratches from past relationships. Sometimes the wounds from our past are deep and even as adults, they still haven’t healed. When salt from the present finds it’s way into wounds of the past, we’ve created a window for repair in our therapeutic relationship. If we can find a way to mend past pain that arises in the present, we can become more resilient. We get stronger at repairing current hurts. We don’t let them fester.
Repairing Rupture With New Relationship Paradigms
Laurie Kahn, Evanston therapist and Founder/Director of Womencare Counseling Center, in an article she wrote in 2006, talks about the power of creating alternative responses to betrayal traumas that have occurred in our clients’ past which may be activated in the present. Although every hurt we create in our present relationships with clients isn’t necessarily around betrayal, the principles Kahn identifies for responding to times when our clients have experienced us as hurtful are relevant.
She specifically writes about creating a new paradigm for love in our relationships with our clients. Creating this new paradigm involves teaching our clients about boundaries, mutuality, permission and protection. The main point Kahn makes in her article is that we can create new relational patterns when we respond to our clients’ pain in ways different than past relationship experiences. When there is rupture, we seek to repair.
There is a long history of rupture and repair in the study of psychotherapy, which is still relevant in our work today. If we never make mistakes or create pain in our relationships with our clients, there is never an opportunity for our clients to experience the true nature of repair in our work. And through experiencing rupture in relationships and then through experiencing the repair that follows, we build the skills to repair troubled relationships outside of those with our therapist.
Abby: Validating Feelings
When Abby returned the following week for her session, she started by apologizing for leaving, but before she got too far into her apology, I asked if there was anything I might have done that resulted in her leaving so quickly. She said she had left my office because she detected a smile on my face, which she inferred was mocking her in some way. While I was not aware of the smile, I wanted to explore the power behind feeling mocked and soon got my answer. “The whole time I was growing up, I watched my father beat my mother and when I tried to intervene, even when I was little, he would make fun of me and belittle me. Even as an adult when I try to talk about those times, he makes fun of me for not ‘getting over it.’”
I was so glad that I stopped Abby from immediately apologizing for leaving. I’m sure that when she was belittled in the past, she learned to apologize for having the feelings she had. We were able to explore how, whenever she felt wronged, her reflex was to apologize rather than to share what had troubled her. I was able to invite her to explore slowing down her reflex to apologize and to, instead, share what had troubled her. If she couldn’t yet do it in relationships outside of ours, I at least wanted her to continue to practice in sessions.
Zane: Listening and Acknowledging Pain
When Zane called me out on not listening to him, my only choice was to tell the truth. “You’re right, Zane. I found myself drifting as you were talking and that must not be easy to hear.” Zane’s typical response to being wronged was to become immediately enraged and this situation was no different. “I can’t fucking believe my own therapist doesn’t listen to what I say to him,” he screamed. I watched other men’s eyes glaze over in the group and felt myself wishing I could leave the room.
I reminded myself to breathe (and to continue breathing). Slowly and quietly, careful to not match Zane’s volume and pitch, I responded: “Yes, I can only imagine how much that hurts. I wish I had paid better attention.” This was not enough for Zane. He continued to raise his voice and continued to challenge me, goading me to yell and respond to him in the same attacking manner with which he was responding to me.
With help from the group, Zane and I continued to talk. He shared that his mother had denied the sexual abuse he experienced as a young boy. In fact, despite Zane’s disclosure, she remained married to the man who abused him. Over time, his anger and resentment grew and when wronged in any relationship, he became enraged. He alienated almost anyone with whom he had a relationship. They were either afraid of his rage and left, or responded to his rage with further rage, and he left. “I’m not going to fight with you, Zane,” I continued. “I should have listened to you and I’m sorry. I think the challenge now is to decide if you can still have a relationship with me, knowing I am imperfect and may not always respond the way you’d like me to.”
Faye: Acknowledging and Valuing
Repair with Faye was more complicated because I didn’t yet have any kind of relationship with her. When she did come to her first session with me, it felt like we had skipped all the preliminaries of relationship building. We started the session with her sitting down on the couch while crying softly.
I stayed quiet and sat with her as she continued to cry, eventually slowing down and wiping her eyes as she looked up at me. “I don’t know why I’m crying. It started when I left your office yesterday and I’ve been crying off and on since then, she confessed. “I can’t stop.” Luckily, Faye saw her reaction as an opportunity. She knew something was happening with her but she didn’t know what yet. She decided to come back and see if she could make sense of her reaction.
Over the next weeks and months, Faye shared that she had been abandoned by her mother and lived in the foster care system until she was adopted. The woman who adopted her wanted Faye to meet her needs more than she wanted to meet Faye’s. Unfortunately, where Faye’s biological mother left off, her adoptive mother picked up, providing only the basic necessities for her. She dated numerous men during the years Faye was growing up, often leaving Faye alone for hours at a time. Once, when she was 11 years old, she reported she was left for over five days.
When Faye graduated from high school, her mother told her she was on her own. In the 30 years since then, Faye had married and had children of her own. Still, she reached out to her mother on several occasions to try to repair their relationship. In each instance, her mother canceled at the last minute. As we continued to explore her growing up, it wasn’t long before we understood that me “forgetting” her first appointment resonated with deep feelings of abandonment. Faye quickly understood that often, when she cried, it was because she felt alone.
Rupture and Repair
I often tease the students I teach about the case examples used in the texts we read. “Isn’t it interesting that every intervention shared in the text is always successful?” And my students laugh, often adding they wish they’d hear about the times something didn’t go well or didn’t go as planned.
I’m reminded of that now because I’ve written about three people where there was rupture and there was repair. I wish I could say that’s always the case in the work I do. There have been times, even when I believe the relationship is solid, that a rupture occurs and the repair has not been easy or hasn’t occurred. I’ve found that the more time and space I allow, the greater the likelihood for repair. That’s not easy for me. I don’t like sitting with the pain and discomfort, but I’ve learned over the years that if I don’t allow the pain, I’m much more likely to respond in a way that reinforces old relationship patterns rather than creating new ones.
It’s been a few years now that Faye and I have been working together. When we reminisce about how our relationship started, she’s able to joke about it now: “Something tells me that all happened for a reason.”
Love moves, responds, touches, and returns the unwanted pieces of your life.
All AIDS Anger Apologizing Asking Questions In Sessions Authenticity Beginnings And Endings Being The Expert Boundaries Boundary Crossing Boundary Violations Breaks From Therapy Collaboration Between Therapists Coming Out Compassion Fatigue Contact Between Sessions Continuity Between Sessions Courage Crying Death Depression Disclosure Disclosure And Technology Dogs Email Emotional Support Animals Emotions Empathy Ending Psychotherapy Endings Expectations Experiments Failure Finances Forgiveness Framing Therapy Fraudulence Gifts Goals Grief Happiness Healing Rituals HIV Holding Back Homework Honesty Hope Human Animal Bond Identity Imposter Injuries Interpersonal Neurobiology Intersectionality Long Term Therapy Loss Loving Yourself Memory Metaphors In Psychotherapy Microaggressions Money Multiple Identities Neurophysiology New Information New Normal Normal Not Knowing Pain Physical Contact Positive Emotions Present Moment Priorities Privacy Questions Rage Real Relationships Resentment Resolution Rites Of Passage Rituals Rupture And Repair Sadness Safe Spaces Safety Safety Plan Safety Versus Comfort Secrecy Session Structure Short Term Therapy Silence Stigma And Mental Health Suicide Survival Strategies Themes In Psychotherapy Therapist Client Relationships Touch Trauma Trigger Warnings Values Vicarious Resilience Vicarious Trauma