Resurrection After Rape Community Group
Discussion, question-and-answer, general social support, and journal processing for progress-oriented rape survivors. No crisis, no damaging or triggering conflicts--this is for individuals who want to contribute to collective, cooperative action toward the goal of making actual PROGRESS through rape trauma. Much of this work is based on the book "Resurrection After...
(Long and clinical; sorry--I just had to capture some things on my mind)
"It is imperative that clinicians remember that decades of research consistently demonstrate that relationship factors correlate more highly with client outcome, than do specialized treatment techniques." (L. Castenguay, et. al., 1996)
"In many studies, what therapists say and do in the therapy hour that promotes a good working alliance has proven to be the most important contributor to change and positive treatment outcome." (E. Teyber and F. McClure, 2000)
The therapeutic alliance isn't everything in therapy--it's the only thing. No other single factor affects therapy outcomes more than the quality of the client-therapist relationship. One study (Lambert and Barley, 2000) reviewed over 100 previous outcome studies and found that specific techniques used by the therapist accounted for only 30% of the positive outcome. However, the quality of the bond between the therapist and client predicted the results more than 40% of the time!
Factors that influenced this bond included credibility (does this therapist know what they're talking about? And does the client trust the therapist's "rightness" on tough topics?), trustworthiness (Is the therapist "real", and do they truly care about you?), and expertness. The therapist-client relationship is a vehicle that enables and facilitates the specific counseling techniques used by the therapist.
What does this mean in plain language? It means that there is objective data that consistently finds that how the therapist and client *feel* about each other MATTERS. In fact, it is the top predictor of the outcome. It isn't an indicator of "poor boundaries" or "inappropriate emotion" for the therapist to care deeply about his client (and vice-versa); in fact, it is probably the most crucial, necessary, vital aspect of treatment.
In the book "How to Fail as a Therapist," the authors (Ph.D.'s in psychology) include this specific error: "emphasizing technique over relationship-building." The authors states, "The lesson here is one that is all too commonly missed: The therapeutic relationship trumps technique...interviews with clients repeatedly show that...Even though you may have all of your licenses, credentials, and degrees prominently and tastefully displayed on your office walls, it takes time and relationship building to gain the confidence of most clients." One client (who is a DS member) who came through my group in January (who is mentioned by name in my book) still stays in touch with me, and told me this past Friday, "You're the only therapist I've had who I actually want to stay in touch with."
Another mistake therapists make is failing to communicate sufficient empathy and signs of support for their client. It is ESSENTIAL that a therapist show a warm sense of support, care, and dedication to his or her client. I can have the best books, research, and techniques training in the world, but until I am able to show genuine affection and connection to my clients, it means nothing. Many clients terminate therapy because they feel that their therapists lack these qualities.
This can be difficult, too, because as a therapist i have to be able to say difficult and painful things to my clients--they have nicknamed them "Damn you, Matt! moments" (or "DYM's" for short)--and some aren't ready. Some clients don't want corrections in their thinking, they want sympathy and acknowledgment of their pain. And this can be tough, because I don't have a molecule in me that is willing to simply validate pain and allow a hurting person to remain otherwise unmoving in recovery. I regard this as "velvet-gloved abuse."
As a result, when someone complains of flashbacks, panic attacks, distress, self-injury, and suicidal thoughts, I have to tell her directly and honestly that these things do not get better on their own with the passing of time; in fact, they get worse. I have to tell her that the only way out of this is THROUGH it--to stop fleeing and face it directly, and use clinically-guided therapy to overcome these pains. Some people are ready to hear this and it offers them hope for a way out; others are shocked at my "cruelty" because of my refusal to soothe, pet, and console them in their present state. But this blunt, difficult realism can be part of a healthy therapist-client relationship; my patients know that regardless of my love and care for them, they will never receive a watered-down version of truth. As a result, they trust the feedback to be clear, honest, and uttered with genuine concern for them. They also know that they can dispute things with me, disagree, confront me, even lash out at me, and I will not, under any circumstance, retaliate.
If someone is uncomfortable with the direction of treatment, or the traits of the therapist-client relationship, or the techniques being used, or my conclusions, I'm not going to feel threatened and get "nasty" or snide in response. Usually, a client who fears that their therapist would retaliate with anger is transferring her own experiences with a parent of the same gender as the therapist (in my case, for example, a patient who thinks I would punish or yell at or retaliate against her for "standing up to" me or confronting me is the daughter of a punitive father, and she transfers that lifelong learning into her expectations of ME, despite zero evidence of me being any such way whatsoever.)
--Intermission--
Coming up: why clients sometimes squirm with discomfort at being empathized with by a caring therapist.
"It is imperative that clinicians remember that decades of research consistently demonstrate that relationship factors correlate more highly with client outcome, than do specialized treatment techniques." (L. Castenguay, et. al., 1996)
"In many studies, what therapists say and do in the therapy hour that promotes a good working alliance has proven to be the most important contributor to change and positive treatment outcome." (E. Teyber and F. McClure, 2000)
The therapeutic alliance isn't everything in therapy--it's the only thing. No other single factor affects therapy outcomes more than the quality of the client-therapist relationship. One study (Lambert and Barley, 2000) reviewed over 100 previous outcome studies and found that specific techniques used by the therapist accounted for only 30% of the positive outcome. However, the quality of the bond between the therapist and client predicted the results more than 40% of the time!
Factors that influenced this bond included credibility (does this therapist know what they're talking about? And does the client trust the therapist's "rightness" on tough topics?), trustworthiness (Is the therapist "real", and do they truly care about you?), and expertness. The therapist-client relationship is a vehicle that enables and facilitates the specific counseling techniques used by the therapist.
What does this mean in plain language? It means that there is objective data that consistently finds that how the therapist and client *feel* about each other MATTERS. In fact, it is the top predictor of the outcome. It isn't an indicator of "poor boundaries" or "inappropriate emotion" for the therapist to care deeply about his client (and vice-versa); in fact, it is probably the most crucial, necessary, vital aspect of treatment.
In the book "How to Fail as a Therapist," the authors (Ph.D.'s in psychology) include this specific error: "emphasizing technique over relationship-building." The authors states, "The lesson here is one that is all too commonly missed: The therapeutic relationship trumps technique...interviews with clients repeatedly show that...Even though you may have all of your licenses, credentials, and degrees prominently and tastefully displayed on your office walls, it takes time and relationship building to gain the confidence of most clients." One client (who is a DS member) who came through my group in January (who is mentioned by name in my book) still stays in touch with me, and told me this past Friday, "You're the only therapist I've had who I actually want to stay in touch with."
Another mistake therapists make is failing to communicate sufficient empathy and signs of support for their client. It is ESSENTIAL that a therapist show a warm sense of support, care, and dedication to his or her client. I can have the best books, research, and techniques training in the world, but until I am able to show genuine affection and connection to my clients, it means nothing. Many clients terminate therapy because they feel that their therapists lack these qualities.
This can be difficult, too, because as a therapist i have to be able to say difficult and painful things to my clients--they have nicknamed them "Damn you, Matt! moments" (or "DYM's" for short)--and some aren't ready. Some clients don't want corrections in their thinking, they want sympathy and acknowledgment of their pain. And this can be tough, because I don't have a molecule in me that is willing to simply validate pain and allow a hurting person to remain otherwise unmoving in recovery. I regard this as "velvet-gloved abuse."
As a result, when someone complains of flashbacks, panic attacks, distress, self-injury, and suicidal thoughts, I have to tell her directly and honestly that these things do not get better on their own with the passing of time; in fact, they get worse. I have to tell her that the only way out of this is THROUGH it--to stop fleeing and face it directly, and use clinically-guided therapy to overcome these pains. Some people are ready to hear this and it offers them hope for a way out; others are shocked at my "cruelty" because of my refusal to soothe, pet, and console them in their present state. But this blunt, difficult realism can be part of a healthy therapist-client relationship; my patients know that regardless of my love and care for them, they will never receive a watered-down version of truth. As a result, they trust the feedback to be clear, honest, and uttered with genuine concern for them. They also know that they can dispute things with me, disagree, confront me, even lash out at me, and I will not, under any circumstance, retaliate.
If someone is uncomfortable with the direction of treatment, or the traits of the therapist-client relationship, or the techniques being used, or my conclusions, I'm not going to feel threatened and get "nasty" or snide in response. Usually, a client who fears that their therapist would retaliate with anger is transferring her own experiences with a parent of the same gender as the therapist (in my case, for example, a patient who thinks I would punish or yell at or retaliate against her for "standing up to" me or confronting me is the daughter of a punitive father, and she transfers that lifelong learning into her expectations of ME, despite zero evidence of me being any such way whatsoever.)
--Intermission--
Coming up: why clients sometimes squirm with discomfort at being empathized with by a caring therapist.
so Lucinda, perhaps you were one of those "how to damage your patient" outcomes at that time. Freud believed that projection is necessary for therapists to explore, and thus must remain blank so that they are interpreted by the client into whatever role the client most needs to resolve. He was VERY right about projection (my former client who blasted my loving/empathetic approach actually likened me to, of all people, her coldly-distant and abusive father! No, really! Her rationale was that she assumed if she spoke up in any disagreement, I would angrily harm her, just he would have done in her childhood). Projection and displacement are fascinating (and we should probably talk about them more here).
But Lucinda, that is exactly what happened. Sadly, the projection in that case was "he must not care about me. I must be dull." I had a recent patient who believed that her own issues and feelings were less important than others in the group, so she remained detached and passive/withdrawn during entire groups. Then at the end, she would become irate and chastise the group for "not caring about" her, because the group members had not interacted with her enough! So she projected her own feelings ("I am bland and undeserving of attention, so I won't participate in the group") onto the other group members ("They're not engaging me! they think I'm bland and undeserving of attention!").
So praise Tunkashila ("the Creator", in Sioux), indeed, for how far out of that you have come. And praise Tunkashila that therapists are learning from past mistakes.
Yes, we come into therapy somewhat 'damaged'....we feel defeated and broken. Oftentimes we are angry, hostile, avoidant, and downright dismissive of attempts to engage us in our own healing. To a degree, I suppose this is to be expected. BUT, when is it time for us to recognize that we must take the first steps toward healing, and we have got to find a way to trust the person whom we have collaborated with for our own mental health.
I believe in a certain degree of personal responsibility when it comes to our best mental healthcare, but Matt, there are issues of trust that are so deeply embedded in us, perhaps you could give us some ideas on how to take the first steps toward an open and honest relationship with our therapists? I think trust is the foundation that successful therapy is built upon, but sadly, so many of us find our past experiences of openly trusting others to be hugely in error. Can we talk about that here? I see it so much here, how so many want a therapist, but they fear being open and honest...even me...I hid my truth for so long, it was difficult to finally open up. Comments?
truly caring professionals.
Even after challenging my therapist (out of my fears) by being downright rude, disrespectful, and explosive, my therapist stayed steady. Yes, I was totally embarrassed and did feel compelled to make a mends through small gifts, because of the disrespect I had shown. I wish I could erase those few days to an extent. I would change a few of those things that I did. UGH! However, not all of them. Because, I would have never moved forward to reveal things that I had never uttered out loud. Unfortunately, I think it would be hard to develop that bond for me without seeing the therapist and how he works with another person. I analyze everything! I want to know why, what for, where are we going with this, and the point is...
The therapist is not psychic, they just take clues from little things or gestures that you give or say. Sometimes, things that you don't say may be misconstrued, so it is better that you say more about yourself and your family dynamic or past family dynamic, at least that is something that I could have been better at. I think I left a little too much unsaid. But, at the time I was also too engulfed in my own deep darkness to really explain that I knew how my husband would react. The hatred I had for myself would not accept what my
husband would have given to me. So, I did not want my husband to meet my therapist. The hatred was mine and I wanted to punish myself. I did not want anyone to give me an "understanding" about what I had done in my situation. Which was what I was afraid/knew would happen.
I know stupid, huh!! I did not want that love or compassion that I would be given. Really dumb! I did end up letting it all out and telling my husband. Which was amazingly freeing! I am learning to really love me and am thankful.
Without the bond of trust, hope, understanding, and respect you cannot move towards healing.
Anyway, the point was....some people may need GROUP THERAPY to feel comfortable. I know that I would have never been open in a one on one situation, at least that has been my experience. I had to see to believe, but in that there is still a leap of faith.
However, that is not to say that this is the road everyone should travel on.
One might think the statement thrtherain made makes no sense...how can an unspoken thing be misconstrued? It follows very nicely what she had said about how a therapist interprets the person we present to them. If I walk in to my therpist's office every week and I put on my Cheer Leader face...I am all bubbly, enthusiastic, interested, compliant to every notion discussed....he is going to interpret one of two things most likely. One, I am progressing and moving out of the depression I had been plaqued by when forst he met me, or two, I am hiding and covering things that I will not, or cannot share. Either way, our therapy will take a course determined by....that's right, how HE interprets ME to be...(sorry for the rhyme). So, thrtherain's words make perfect sense in that, our attitudes and actions, whether genuine or false, is ALL our therapist has to work with. Remember....[S]HE ISN'T PSYCHIC.
So, here I am with this completely HUMAN therapist, expecting superhuman attributes to dictate my course in therapy. It goes right along with other ideas we get when someone has a role in our lives that is outside that of an actual relative. Like the Preacher we believe is somehow closer to God...because it's his job to know so much about God. Naturally, we assume our therapists know us intimately, without our revealing any intimate details...because, it's his job to decipher things, right? It would seem so, but, my therapist, although good, has made some assumptions based on what a normal family would have done. Then, I told him what my family was really like, and all his hard work at guessing was down the tubes. He had misconstrued my silence...(way to go thrtherain!)
It is like what I am currently struggling with in therapy. He could guess that I am struggling, but isn't it more efficient for me to share my absolute disdain for semen....and let him in on how I am exposed to it every day in my job...and let him help me help myself?
That seems to be a key thing some are missing in this therapist-client relationship, the real reason we are in the relationship in the first place. It isn't so we can find new and exciting ways to spend hundreds of dollars. It is so one human can reach through our pain, and TEACH us how to help ourselves. When it is uncomfortable, it usually signals a "growth spurt". When I struggle...I am coming up on a new-found positive.
I wonder. If our relationship with our spouse/boyfriend/girlfriend/best friend...was determined by how much they can decipher from words we will not utter, how close would that bond be?
I could get angry, and retaliatory every time my therapist fails to connect the dots, to follow the breadcrumbs, to make sense of my non-sensical behavior...but, is it really him I should be angry with?
Thank you! I am always happy to learn. :) I was trying to be general with the whole MY THERAPIST thing, but I guess most people on here know that it was you! I mean "You Rock" and I didn't want to be too descriptive and set expectations so high for other therapists to meet. I really appreciate you my friend!
Mockingbird, I am happy that you could understand the meaning in my words. I accomplished what I needed to do in group with Matt, that I know. But, I know that it would have been easier for both of us, had I been more forthcoming. Oh, you know hindsight is 20/20. Yes, it was a learning experience. I learned that and it has made me so much stronger. I cannot say that I have changed overnight; but rather more a work in progress in becoming less silent. The fear has tremendously lessened.
As the band Living color once sang, "You don't have to follow me/only you can set you free."
One purpose of good therapy is to increase the client's functioning, not to create greater dependency. If anyone ever catches me implying that I am, or was, or would be the key to their success, call me on it and condemn it. Since the day I started here, I have tried to keep that as a firm boundary: each of us is a support and resource for the others, but none of us gets the honor for any other person's success.
You can't give that away.
We all have thoughts outside of therapy that are prompted by something from therapy. This week, I had many. I spent a fitful night tossing and turning...and thinking. No epiphany, but, some valid considerations.
In considering just how hurt I felt, I was also forced to investigate if the feelings were just, or had I blown things out of proportion, as has been a thing I have been known to do. I am interested in healing, not who is right and who is wrong...so, I concluded this:
My therapist:
Has always demonstrated to me his concern for my well-being, even when it hurts to hear some of his words, they have always been with my well-being at the center.
Has always been patient with me, even when my time has expired, he has allowed me to sit in the outer lounge until he makes sure I am safe to drive, and not in crisis, or likely to dissociate or escalate.
Is honest with me.
Believes my experience to be tragic, but I am not.
Wants me to learn to nurture that child, and realize SHE IS ME.
Ultimately, has a desire to help me learn ways to control my emotions, and the triggers that unsettle me.
Considers knowledge to be a key factor in healing, and therefore works hard to teach me the things he knows about recovery...not holding truths of healing as secrets only privvy to therapists, but knowing fully his best work is done when I know what he knows, and can apply it.
Believes in me, and my worth and value as a human being (even when I don't see it).
Hurts.
Cares.
Tries.
Encourages, honestly.
Is preparing me for the day I will no longer need him.
I believe my therapist is all of these things for me, and for so many others. I believe he sees my struggling, and wants to help me succeed. I know he sees a thing in me that I can't always acknowledge - my strength. I sometimes adopt the little girl attitude and walk in to therapy feeling small and needful. He is attempting to help me learn how to prize the child while living as the adult.
How can I not credit him for a portion of my recovery? But, he certainly is not responsible for my work...I do that. I apply my whole self into the act of healing, he can't do that for me. But, you know what? Even if he could, his best work is possibly stepping away from me, pushing me to the head of the line, and watching with contented pride, as I live my life, unaided by him.
So, for those of us who cling to therapy as a necessary thing...an unending necessary thing....we have been failed if therapy never comes to a close. If the goal of therapy isn't to aid us in living life on our own, victoriously unaided, then something is wrong with the therapy. If your therapist has helped you to move forward, to take your place at the front of the line as [s]he steps back, say a hearty "Thank you", for their job has been accomplished. Does that mean you have lost your therapist? Probably not. In fact, they would probably appreciate the 'once in a blue moon' appointment to tweak things, or just to get their input or approval for your strides.
Someday I plan to give my therapist a gift. I won't wrap it. I won't leave it there on his desk or even in his office. The gift I plan to give my therapist is me, as a success story. I plan to take that gift with me, right out the front door of his office. Somehow, I believe he will treasure this more than anything I could purchase for him.