The Patient must Grieve

Hi gang!

I've never seen this spelt out on PC, but there seems to be a school of thought that the only lasting cure for past pain is to grieve over it. Therefore (controversially) the T must never do anything to lessen the patient's pain because that would interfere with the grieving process. This is why the therapist welcomes the patient's tears.

On the other hand, the T has a duty to provide support. Compassion pulls in exactly the opposite direction.

How can this contradiction be resolved? It looks like the sort of judgement call a therapist could very easily get wrong.

I think perhaps the therapist can offer their empathy and presence, and for some patients, that helps them feel heard, less alone, and so the grief isn't so agonizing.

I don't think that's lessening the pain of grief, because some pains just have to be carried, and can't be taken away.

I have wondered if my therapist doesn't intentionally try to prick me to get me to feel and process this grief, but he won't admit it. It also feels like he will satisfy a need kind of (responding to my texts, pretending to care more than he does) and then suddenly stop and wait for my emotional fallout. There have been things, like forgetting our session...

I'm not a fan of this grief theory. I've grieved my entire life, I'm ready and wanting now to stop. They say the average woman cries 5 times a month, I cry 5 times before lunch every day. I'm tired of grieving. The pain is not going away, it never will.

I doubt I cry 5 times a year.

The concept of grief has not come up in my therapy. My therapist is very slow to put names on things. It took a year for her to tell me that I am having flashbacks. I honestly didn't know that's what I've been experiencing. In a way, it helps me put some distance between the past and present, and it's bringing up a lot of grief at the same time.

I have no idea what I'm saying.

Oh yeah, I agree that compassion and letting us stew in pain is a contradiction. And it kind of pisses me off.

My t says that we have to acknowledge pain and grieve at your own pace ( I usually move on quickly but then it hits year later, others grieve right away), but we shouldn't let pain consume us and ruin our lives. If we never stop grieving then something is really off and perhaps person needs more than one hour of therapy.

My t also says too much idle time sometimes creates too many opportunities for being miserable. If I sat home all day i would be miserable probably all day , I don't have time to wallow in pain too much. My day is pretty much planned by the minute.

My t also says we have to accept that some things cannot be changed and we need to focus on what could be changed

It also helps to put things into perspective. Whatever are our struggles millions of people around the world have the same and many way way worse. Compare to my great grandparents killed in concentration camps and what people in Paris faced yesterday whatever bothers me isn't that drastic

Just my take on things


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Shedding the tears of grief, frustration, loss, etc. with one's therapist (solid, caring, compassionate) serves as a way for the patient/client to finally feel they are safe...or gives them the chance to rewrite an old, erroneous script that might still be running. I haven't cried since 2009 when my first love committed suicide - before that, I can't recall when I cried.

My therapist does a lot to lessen my pain. He's extremely compassionate and supportive and encourages me to ring between sessions if I feel like I need to. And he also encourages me to continually figure out the many things I can do to help myself, and has many suggestions for this. I have really changed a lot of things in my life because of this, and have a much better understanding of how I can stop past experiences from hurting so much in the present. Knowing he is really there for me and will help me gives me more courage and helps me to see there is a path to feeling better, and encourages me to keep following that path and taking care of myself even when things feel horribly difficult.

I used to see a therapist who seemed to think that he should never give me any suggestions of what might help me, lest it interfere with whatever I had to endure on my own. This was not helpful, and I think did me a lot of damage.

My T offers to be there as a compassionate witness for me when I shed my tears of grief. It sounded crazy to me in that this process could actually help but now that I've actually done some crying with her as my compassionate witness, the grief is lessening. Strange but true (for me).

This is true for me as well. Also, my therapist one time said something about imagining going back in time and being with yourself or other people in the past. For me it can be a little like that at times- like we are both going back and being with my younger self during the traumatic events of my past. It's an act of imagination, but it can be very powerful for me sometimes.

I think the main problem with this is that there might actually be two distinct types of client:

1. The 'standard' therapy client, who is there to work through some things, but is generally happy and functional in everyday life and who could easily do without therapy. <- This is the client therapy is actually aimed at, IMO. People who already have a fair amount of emotional resilience, won't be that knocked off balance by transference to the extent that they become obsessed, and have an active, rewarding life emotional / work / play wise outside therapy.

2. The therapy client who needs therapy to survive. These are people who through genetics or trauma have found getting through the day to be almost impossible without support. These people tend to be low functioning, have serious trouble containing their emotions, may self harm, can't hold down jobs, have little to nothing in the way of interpersonal relationships outside therapy. <- These people, I think, have a really hard time with therapy. Most therapy isn't really geared to them, tends to lure them out on a branch and leave them bereft, tends to stir up feelings that can become life-threatening, etc. I almost think we need a different word for the treatment people like this need, because 'therapy' doesn't really cut it.

For the first group, grieving is probably a natural and for the most part, tolerable part of the process. For the second, it's probably absolutely destroying.

I genuinely do think that in PC and therapy in general, we end up conflating what are essentially healthy, functional people working through some life issues (the worried well, as some therapists call them) and people whose needs go well beyond what your average therapist can handle or contain.

I even think that having a bad reaction to, or repeated seriously negative experiences with therapy (barring those caused by wildly incompetent therapists) could very well point to the fact that the client is in the second group. We blame therapists and therapy a lot here for some woes which might simply be unavoidable, because people are unfortunately doing the equivalent of going to their GP for a missing limb. The GP isn't equipped, doesn't have the time, and can't provide the care they need. Unfortunately, when the GP tries to move them on to a higher level of care, they lash out and feel abandoned.

Some situations are simply lose lose for therapists, which is something that rarely gets acknowledged here.

Anyway, I'm way past the original point I guess in some respects. But yes, grief is probably part of the process. But some people won't be able to tolerate it because therapy isn't made for them really anyway.

You bring up an interesting point about there being two different types of clients. While I think I agree with you about therapy not really being for the second group, my question is why do they claim to have therapies for them then? Like trauma therapy or schema therapy yadda yadda. There are tons of research studies and articles and whatnot about therapy for those who are in your second description, but I want to know where those therapists are that practice that way. I also want to know why they keep pretending to have a solution instead of admitting their limitations.

Or perhaps it isn't quite that black and white. These specialized therapies/therapists may work most of the time and so when therapists start working with a client they may feel pretty certain those same techniques will work, but over time they discover that this is one of those cases that what usually works just isn't. I see that scenario here pretty often, and when a therapist tells a client perhaps they need a different therapist, a different level of care, a different modality than what they first thought, clients take that as rejection and abandonment when the reality is that the therapist is recognizing a need for different care/approach/therapist and is trying to get the client to the right kind of care.

Nothing is 100% predictable unfortunately, not even in medical science when "that drug has proven to cure that illness" do they ever claim it works 100% of the time, and often doctors are stumped and surprised when they run into that case where the usual protocol just doesn't cut it. They have to regroup, try something different, and refer to other practitioners in many cases. Therapy is less scientific obviously, so to expect any accuracy in prediction early on is just not realistic. It takes time for therapists to get a semi-clear idea of who a patient is, what their needs are, and how to best help them, so while we may not like it, it seems understandable that therapists may have to rethink things down the road.

There's another therapy contradiction. On the one hand, T is supposed to validate our feelings. But "putting things in perspective" can be invalidating.

Example:
Me: Therapy is very hard for me.
Madame T: It's hard for everyone.

I felt dismissed and devalued by that, as if my pain was not important.

I have never found the fact that others are going or may be going through the same thing to be of the slightest bit of comfort, reassurance or use. It simply does not matter to me one way or the other if it is common or not. I am not concerned if my reaction is normal or usual or not.

I agree. My therapist likes to say "it's normal" about things that might bother me. For example I have anxiety over bills and she says "it's normal to feel this way". I don't care if it is normal!

But in general I personally don't dwell on things and one of the coping mechanisms for me is knowing that I am not alone and that there are many others in the same boat. But it helps when I do it for myself not when others do it for me!

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Yeah - too bad there arent specialists like there are in medical medicine. Where you study for years, not just get a certificate at a weekend seminar. Otoh, since a lot of what "works" in therapy is just the t couple - finding the right person - maybe what we really need is a better way of determining that. Like the old computer dating. Values are important - i think my t and i are existential nihilists. Feeding his philosphy degree into a computer might have helped match us.

Ive been at that point - thats where, for therapy to change you, you have to risk confronting the other person. You say, "that makes me feel as if my pain is not important." And you explore why. But if it gets into an arguing match with the t, "i didnt say that!" - then the t is incompetent.

This was not the case for me. I have no trouble confronting and therapy did not change me.

Maybe part of the problem is that not everyone with trauma actually fits into group two. Maybe therapists really can't tell if someone is going to be hyper attached, and emotionally broiled by therapy until it happens. Borderline people, for example, can be either pretty high functioning or almost unable to get through the day.

I don't know how every therapist acts, but I've never had a therapist who said 'this will 100% cure you'. And the problem for therapists is, say they take on a borderline client (just using that as an example) and then 6 months into it, it becomes apparent that this person is not doing well in therapy... what can the therapist do? Anything they say is taken as abandonment. Usually the client is hyper attached before they even admit it, by the time transference is admitted, the client is already severely affected.

Some therapists deal with this by refusing to deal with borderline people at all - which creates a 'stigma'. But really, that's just therapists who know what they can and cannot treat.

I guess, what I'm trying to say, is that most therapists do not set out to create a nightmare for their clients. But, because clients don't always walk in the door obviously seriously disturbed (and may be really good at hiding their attachment issues etc) the therapist doesn't know until it is often too late.

How often do we hear of people going into therapy and barely talking? Or deliberating for weeks or months as to whether or not to tell their therapist something important? How often are people quite obviously obsessed with keeping their therapist at all costs, regardless of whether therapy is working or not? Seen from the other side, I think a lot of clients are probably damn hard to treat or diagnose because they hide the worst of things in an effort to avoid rejection.

Eventually though, it all breaks down. And then the therapist is stuck with a hyper emotional, potentially self harming client who they are not able to effectively treat, and who breaks down at every hint of them actually being put into effective treatment.

And then who becomes the devil? The therapist. The therapist is blamed for everything. Therapy is blamed for everything. People feel that they've been led astray, when what really happened is that their pre-existing condition simply did not allow them to tolerate therapy. Therapy isn't bad, but it is bad for them.

Maybe there needs to be a lot more warnings about therapy. Maybe people need to be more carefully screened as being candidates for therapy. There are lots of treatments for borderlines, SH, severe depression, but almost none of them happen under the sole care of a garden variety therapist.

But that would annoy people too. Lots of people post about feeling rejected because a therapist won't work with them. "Oh, I can't even pay someone to talk to me." When what's really happening is an ethical therapist knew they couldn't provide adequate service. But people who are distressed don't see things that way. They see everything in terms of whether people like them or not, this desperate grasping for connection. They experience everything as rejection, when it's really just not a good fit.

I wouldn't be a therapist for all the money in the world. People walk in with problems inflicted by others and then blame the therapist for not being able to undo all that harm. In my experience, therapists don't usually pretend to be what they're not. But I think some clients ignore that, idealize the therapist and then demonize them when things inevitably go wrong.

Of course, some therapists really are awful. And maybe there's something to it that really awful therapists end up with quite distressed clients, because they're arrogant, stupid or cruel enough to string them along. I can very much imagine that people with severe issues find it very difficult to find someone who really can help, and that they could fall prey to unethical therapists more often than a client who would walk at the first sign of trouble.

I meant in the case where the client was having a conversation with the t, and felt their pain was dismissed by what the t said, and the client then was even MORE bothered by that feeling dismissed than whatever the problem was to begin with. The dismissed feeling then becomes the rupture between client and t that can be repaired and lead to therapeutic healing. It is my understanding that this is not how you in particular use the therapist. But some people do, and thank you for this opportunity to explain more fully.

glad I could be here for you.

I would feel that way, too, CE.
My T replies with things like: Yes, you are doing very hard work. Not everyone wants, needs or can do the kind of work you are doing.

Doesnt that spark a fire in you? Dont you want to jump up and say something to defend yourself? I do! FOR you! Your feelings come across on the page! Your ts words are just space fillers. What do you want to say? !

Absolutely. And some informed consent.