My T understands that she has caused me pain.....not that she always meant to cause it, and not that she hasn't been sorry for it, too. Sometimes, though, some things are simply going to hurt......therapy hurts sometimes, healing hurts sometimes.
Sometimes Ts are aware something will hurt, sometimes they are not aware something that they have said or done hurts. Whatever the situation, whatever the cause of the hurt, communication about it helps! Ts can't always know that something caused hurt, or how much hurt it caused, or do anything to help the hurt, unless they're told! Just like sometimes I don't know something I said hurt and can't apologize for it unless the other person tells me.....
I've learned to just tell T when something hurts, so I know she knows and we can talk it out!