My husband has struggled with this in relation to me, not his therapist. He gets very focused on hearing the words and forgets to look at the actions. This really became a problem because he kept begging for words and criticizing when they didn't come, analyzing words or lack of them to the complete exclusion to all other evidence. I would get spammed with accusatory texts and emails that were unfounded and hurtful. It wasn't that I didn't say the words; I did, but apparently he had selective hearing--only heard it when it was on his radar, so if I said it when it wasn't on his radar, it was as if the words were never even said.

Through therapy and through me setting very clear boundaries that those kind of unfounded accusations, that kind of begging and pleading was hurtful to me, that it rang like accusations that I didn't love him at all, that nothing I actually DID mattered, that all that mattered to him was words, eventually got him to see that he was going to have to stop and be more mindful of ALL of the evidence before he acted.

He's gotten SO much better about stopping and really taking the time to be truly mindful of ALL of the evidence, to take the time to breathe and think and reflect before going into that spiral of "If she doesn't say the words, then she must not love me. I MUST have the proof." He takes the time and realizes the proof is right in front of him. He has learned to ask for that kind of validation respectfully and appropriately, and his anxiety about the words has greatly decreased in becoming aware of the entire body of evidence.

I suspect when therapists encounter this issue with clients, they work to help them see that they don't necessarily have to live without those words, but they can grow to see actions and evidence and reach some peace with that--to see a balance. Clients can learn that perhaps what they want (caring and attention) is already there, but they are looking for it in the wrong places and looking for the wrong kind of evidence to the exclusion of what evidence is right in front of them if they can learn to actually see it.