Therapist response during extreme distress

I’m going through a little bit of a rupture with my T over his responses when I’m extremely distressed in sessions. I very much feel my reaction comes from my body not my brain and in those moments where I have no control over my emotions and I’m sobbing, I have absolutely no connection to him and it just feels like I’m completely alone.

I feel like he sits in silence (I find silence extremely triggering for my abandonment issues and he knows this), staring at the floor but he disagrees and says he does speak but clearly what he is saying is not being registered and is not enough for me to feel soothed. I then end up becoming more distressed by feeling emotionally abandoned by him and my distress becomes about what is happening in the room and not what I was originally upset about. I can’t really talk or explain when I’m in that state I just *feel* A lot.

He’s asked me what I would like him to say or do in those situations to try and forge some connection that might help to soothe my distress.

He is absolutely not willing to offer any kind of physical contact which is what I desperately crave. It feels like my nervous system won’t calm down without being held and my desire for touch feels like a physiological one, not an emotional one. But no matter how much I have pleaded my case and told him I *know* this would help and it would deepen the connection he won’t budge on this boundary. We can’t really even talk about the importance of touch now as it’s a topic that we both become defensive over.

So I guess what I’m looking for is suggestions of things that therapists have said or done that have helped in moments of extreme distress (sometimes suicidal moments) that doesn’t not involve physical contact. What has helped you? What warming and connecting things have your Ts said? Any ideas and thoughts would be much appreciated.

It sounds like you need to find a different therapist. Have you heard of love language? He’s not able to soothe you or give you the exact response thar yiu need or want literally m.

Find a different one that you can connect with. It took me forever to realize that you won’t connect with them all. And some of them definitely won’t care about your needs or feelings at all. He sounds like hens trying to meet your needs at least, but it’s not enough apparently.

To me, it seems like you actually need grounding skills whether or not you stay with this T.

L does many different grounding exercises with me to help me stay or get back into my window of tolerance (with and without touch). One thing we do that helps a lot is breathing meditation. Another thing is identifying the 5 senses. And yet another is questions and answers. Sometimes even jist talking about daily things like my dogs, can put me back into my window. She also has made recordings of her breathing exercises and meditations, so I can use them if she's not available.

I will, however, say that touch is such an important part of our relationship that I don't think I could do the deep trauma work we are doing without it. It was so important that during covid, she came up with holding hands as a safe way to do touch because hugging was too risky. So I do understand the deep desire for touch. If touch is a deal breaker for you, then don't waste anymore time on this T. And if/when you do find another T, make sure you ask if touch is okay before committing to working with them.

First, I'm sorry you're dealing with this. I was in a place a few weeks ago with my T, where I was just sitting there sobbing. It was mainly about something in the therapeutic relationship, but I think it expanded to other stuff in my mind (like past hurts/abandonments), and I struggled to speak. He kind of just sat there, which wasn't helpful to me. He also doesn't do touch (beyond a handshake at the end), but I just wanted him to say *something* supportive.

I talked to him about it the next session and said how it would have helped if he'd just said "I'm sorry you're hurting so much" (or something like that). He seemed surprised that would have helped. I told him to remember it for the future.

Not sure it that would help you, or maybe slightly different words. Basically, I wanted to know he saw my pain and felt some sort of sympathy (or empathy) for it. But if you feel something like that could help you, consider sharing it with your T.

Oh! That's what I forgot! I just read somewhere that people with abandonment issues typically sleep with some sort of noise: a fan, a sound machine, traffic. It's thought that silence triggers their abandonment feelings. I know this really resonates with me. I hate silence. I've told L to never sit in silence with me, that I hate it, and it doesn't help. And I do sleep with all 3 sounds I listed. Especially can't sleep without my sound machine! Even when I drive alone, even if I'm playing music, I crack my window so I can hear traffic.

This is really interesting, because I have abandonment issues and also hate being in silence, whether in a car, sitting with someone, by myself, etc. And I need a white noise machine and/or fan for sleeping. I thought it was partly because I have tinnitus, but maybe it's the abandonment thing, too?

I think part of what was difficult in that one recent session with my T was the silence. Normally, he's pretty chatty, so even if I'm not feeling talkative or am unsure what to say, he'll be filling some of that space with talking. So when he didn't, it was more difficult/painful.

I agree with what Scarlet said about grounding skills and finding ways to regulate a little better before you reach that state of utter pain and aloneness. I've gotten better at noticing when I'm reaching the edge of my window of tolerance and telling my therapist, and I can tell that she's getting better at seeing it too. We've tried a variety of things: throwing a ball back and forth, standing up and moving around, focusing on a picture of her dogs and talking about them, lighting a candle, touching her special fuzzy pillow, etc. This past week she pulled an aromatherapy thingy out of her desk and offered to let me smell it. Sometimes the focusing on a sensory thing helps but sometimes even just the very act of trying something together (and shifting focus for a few minutes) makes me feel like she's still there to help me and stops me from getting outside my window of tolerance. Otherwise if I just keep talking about what's upsetting me, I end up feeling like a house on fire regardless of what she says.

That said, my T is interpersonally quite open and warm, and she is open to touch including hugs and pats on the back/upper arm and stuff. I do think it feels different that I know I can get that from her, so I don't want to say that grounding skills alone are necessarily going to be enough if that desire for touch is so powerful it overrides everything else.

My T doesn't do any physical touch either. It's probably the biggest downside to him I think. I understand why he was like it in the begging, but it's strange to me that it hasn't happened naturally over the years. It feels super awkward if I start crying or have a meltdown, he just sits there not even acknowledging the tears. So I try not to cry, if possible. Sorry there's no advice here, I just wanted to say you aren't alone.

I think it is extremely sad and tragic that a lot of t's won't touch....the irony is a lot of people need to be touched. My t always hugs me hello and goodbye.

I think it's ok for a therapist to not work with touch. Whilst touch is a crucial way for some people to connect, touch is also complex and charged for some people. Has he explained why he doesn't work with you with touch? Is it because of his personal boundary, or because he doesn't believe it would be therapeutic for you, or other reasons? It might help to know that it's his boundary and has nothing to do with you.

I am not someone who likes touch and I don't want touch in therapy - at this point. I would like to be someone who likes touch and receives comfort from it. As such, my therapist has said we might get to a point where we work with it. Right now, I find the thought of her touching me low-key disgusting and certainly deeply uncomfortable, but equally, I wouldn't like it if I knew that physical contact was never going to be option. I don't like things being shut down.

Is it worth exploring what touch would give you? You talk about it being a physiological need and a way of calming your nervous system. Can he go any way towards something collaborative? For example, wrapping you tightly in a blanket, even passing you the blanket, or placing cushions around you or sitting on the floor with you? Something which helps you feel the boundary of touch (and that he has a part in) without him touching you. There's a lot of somatic work around calming over-stimulation and bringing you back into your window of tolerance - slowing down movement, you touching "neutral" parts of your body, tapping, etc - maybe it would be possible to incorporate some elements of this into the work, especially for him to do alongside you or mirroring you.

I don't know. I can also imagine that if you have such a yearning for touch that anything which tries to replicate touch without the actual touch itself would just highlight that the touch is missing and then you go full circle right back to feeling more alone and untouchable. I guess even this discussion and your opening post shows that touch is complicated and I would try and not read so much into the ease with which other people talk about it - both of wanting it and of receiving it. Maybe in its absence he is actually opening up a lot of space for you to explore the extremely painful ground of (perceived) untouchable you.

In society in general people are quick to put an arm round a crying person to what they believe comforts them.

The comfort is temporary. I found I had your same struggles in therapy and in the early years, to felt abandoned by T. Felt as if she did nothing.

In time I come to understand that just sitting with a person and not trying to alter what they are feeling is the greatest gift. The truest comfort. Eventually I knew T was there and her strength in just being with my pain become my strength too.

Thanks all, lots of points to consider here.

I have considered ending therapy with him over the whole no touch thing so many times and if still might be the right thing to do. But I know if I leave him I don’t have the energy and strength to put myself through this whole process again and try and find a new one. It was hard enough to find him, I think I would struggle to find someone who worked with my issues, has his patience and acceptance, is willing to tolerate how difficult I am and would offer touch. So I want to exhaust all options before I make that decision. I am very quick to react and be defensive and push him away, I don’t want to repeat those patterns.

In general I’ve come a long way with him, it’s just this one sticking point that is a major issue. We’ve had lots of conversations around why he won’t allow touch. He has said if he believed there was a way to do it that would keep us both safe then he would consider it. However because we can’t guarantee how I will react to it then it’s too risky. He also agreed that it was about the risk to him as a therapist as well in case I made accusations against him, which really hurt as I would never do that without a true and valid reason. It felt like he believed I would falsely accuse him.

It’s hard because I am very very touch averse usually and don’t like anyone touching me. But as I’ve come to trust him and feel safe with him, it’s really felt like something I desperately need. And denying that when he knows I am usually completely uncomfortable with it just feels even more cruel.

I like the suggestion of trying to find some somatic element that is similar to touch and that he is involved in but doesn’t actually include any touch, that might be worth exploring with him.

All aspects of therapy are risky because we are going into the unknown and experiencing new things. Risk can be managed.

I had imagined that his reasons might have been to do with his personal boundaries about touch (he doesn't like it, only touches loved ones, etc), not because he is viewing a client as a predatory lawsuit in waiting. Honestly, with this attitude, I would not trust him with touch. The risk to him because you might report him?! That is extremely offensive and hurtful. Of course you would not accuse him of anything unless he perpetrated an offense and it's really prejudiced of him to believe otherwise. He does not sound skilled enough to work with touch. As painful as it is for him to withhold that element of the work, ironically it might be best for you to not experience that with him if he is unable to practice it with awareness and confidence.

As an aside, it's interesting that you don't like touch but want touch with him - the person who is not willing to give it. I would want to explore that.

Thank you, this a really useful and insightful post.

I’ve gone through the all aspects of therapy are risky thing with him but he seems to feel like touch is different. I’ve also approached it from the viewpoint that touch is not something I’m comfortable with or used to, but I’d like to be, so isn’t therapy the safest place for me to try it out as if it goes wrong then he has the understanding of what might have happened and our relationship is set up to try and heal it rather than attempt it in the ‘real’ world at some point when the other person isn’t going to get it in the same way he does.

He does admit he doesn’t have any training in using touch and he feels that means he may lack the skills to work in that way, but when I suggested he could upskill himself and do some CPD he said that wasn’t really something he was interested in doing as he personally doesn’t believe in using touch in therapy.

I hadn’t thought about the last point that you make and yes you’re right, this probably would be good to explore. I would imagine it’s something to do with unmet needs as a child now reappearing, but how does that get resolved if he won’t meet those needs?

The problem we have is that any conversation around touch is triggering for me and I become very defensive which causes him to become defensive. But again this is probably a conversation we need to have and explore both of our reactions to it, which I know he would be open to doing.

Thank you, this has really helped and got me thinking.

I agree so much with this.

My therapist wasn’t against touch. We hugged. He occasionally held my hand. But he was very, very careful about touch when I was crying inconsolably. He sat and let me feel, without any intervention that might cause me to stifle my experience in that moment. So often we have good intentions in holding a person or handing them a Kleenex, but the subtle message is that the crying should stop, that it is too much.

What my therapist taught me through his willingness to just be there with me in those moments was that my emotions were not too much. They were okay. I was okay. And sure enough, I was.

We sometimes want others to “fix” us when perhaps what is more important long-term is that they accept and validate our experiences of pain and sadness and grief, without interference.

Usually, after I got through those moments, THEN we decompressed and processed and had a hug at the end of the session. Interestingly, I usually left with some relief to have gotten through it all intact with my therapist trusting and knowing that I could do it all on my own.

You know, this is a really good point and something I hadn't thought about until now. The learning how to sit with intense pain is separate from the occasional touch for me/us too, and I think that's a good thing. I also think that sitting with her in the pain feels less unbearable because of the history/memory of her hugs (I literally feel less unlovable/untouchable in her presence), but touch in the midst of the intense emotion would short circuit the process in an unhelpful way.