This is cuts to the quick of where I struggle with psychotherapy when I do struggle. How hard would it be for him to tell you he does care? I know they are trained this way, to never gratify and not share their feelings, but it has a manipulative or withholding feel.

Hi [chihirochild],

Thank you for sending this along. I am definitely sorry that this has all been so painful for you. That is not what I would hope for in our work together, and I would like to do whatever I can to make this more manageable for you. I agree with you--there is productive discomfort, and then there is the iatrogenic kind. I do not want to be generating the latter.

It sounds like you are experiencing me as disliking you, and as treating you in a cold and uncaring way. In light of this, I can really understand now what makes it so difficult to answer my questions, and to talk with me about these things--if I felt like someone felt this negatively about me, I would certainly not want to allow myself to be vulnerable to this person. I am also really struck to learn this, as this is not consistent with my experience of our relationship. This is making me very interested in what I might be doing to come across in this way, and also if there is anything happening in you that potentially contributes to this as well.

You said last week that you found "questions" helpful in thinking some things out, so I will share a couple that come to my mind when I read your e-mail:

(1) You mentioned feeling miserable and "like crap" with me, and those feelings seem to be related to this experience of me as not liking you or caring about you. But I really would like to understand more about what this perception of me does to you--how it makes you feel emotionally, about yourself, etc. That seems very important here.

(2) I am also interested in the importance for you of me liking and caring about you
-It may seem foolish to ask, but what would this do for you, if you felt this coming from me?
-Also: what would have to be different about me (what I would have to say, to do) for you to feel like I genuinely cared?

Finally, after reading your e-mail and thinking about our session on Friday, I have been wondering if perhaps us delving too deeply into our dynamic is not horribly helpful for you at this point. (I'm not saying this definitively, but I am curious about it). After your meeting with [the program's psychiatrist], once I realized that you were so much more upset with me than I had realized, I think I have been directing our focus there quite a bit, in the hopes that we could use this dynamic in order to help you with your challenges outside of the room. But now I am worried that this could be counterproductive, and that perhaps we should be directing less time to "us" and more time to your relationships/interactions outside of the therapy. This might be less overwhelming, and generate less panic for you. I really do want to be helpful to you, [chihirochild], so as long as we are devoting ourselves to the patterns that are meaningful to your and your challenges, I am open to feedback about what you think is best for you.

Take care,

[HWMNBN][/I][/QUOTE]