Bottling up Feelings

Many clients experience difficulties managing their feelings. Frequently they have learnt to bottle up their feelings as a way of dealing with them, then find themselves struggling to cope when faced with the mounting pressures of living.  When they first come for therapy they may or may not be aware that this is what they are doing.  This week’s blog explores how we learn to bottle up our feelings and how therapy can help.

As babies we don’t know how to manage our feelings.  We are dependent on our caregivers, usually our parents, over the course of our upbringing to help us:-

1.  Identify each of our emotions
2. Learn to express our emotions appropriately
3. Learn that we are still loveable and acceptable when we express our full range of emotions.

Parents are not perfect.  This leaves many clients remaining stuck with some aspects of this learning. There are many ways in which such problems may manifest.  Bottling up emotions is just one of these.  

If parents are uncomfortable with their emotions in some way, it can be very difficult for them to remain relaxed when their child is expressing forcefully some very intense emotions. Most often, it is anger that is seen as a “negative” emotion, although in some clients it is joy that has been inhibited. Thus it may be discouraged, consciously or otherwise.  The child then learns it is not safe to express that emotion which is when the strategy of bottling feelings appears to be protective and useful. 

Over the years, more and more of these angry feelings remain unexpressed with nowhere to be heard and understood.  Sooner or later, such feelings either leak out, or perhaps the individual learns that they are powerless to express themselves successfully.  These are the seeds of depression.  Such individuals sometimes “self-medicate” using alcohol as a means of managing their emotions which only adds to their problems in the long run.

Therapy offers a safe environment in which a relationship based on trust can aid the client to find more appropriate ways of managing their emotions.  Together, the client and their therapist, can explore how they learnt to bottle up their feelings. Through this, the client can develop a more compassionate understanding of themselves. In the safety of the therapeutic relationship, the client can begin to dare to express their full range of emotions, and experience the sense of release and their own power in doing so, knowing that the therapist accepts them as they are.

They learn that these feelings, far from being toxic, are there for their benefit, empowering them to express themselves and potentially move towards outcomes they desire. The final step in the process is when they can apply this to their relationships outside the therapy.  When the client can do this for themselves, they are usually ready to leave therapy.

If you have any questions about this blog or any of the issues raised please feel free to contact me via my website: http://www.garycooktherapy.co.uk

Breaks

Sooner or later in all but the shortest therapy, there will come a time when either you or the therapist will be unable to attend the weekly session due to holidays or illness.  The feelings that accompany the break can be very informative. This week’s blog looks at the sorts of feelings that may be elicited and why therapists are likely to ask you about them.

The most beneficial element in therapy is the relationship between the client and the therapist. Often, feelings experienced by the client before, during and after a break, can give a useful window on the nature of that relationship from the client’s perspective.  These feelings can express the pattern of relating that the client learnt in their formative years.  This pattern is most often not held consciously, “that’s just how it is” can be the client’s response if you only scratch the surface around this topic.

For clients who have learnt to be anxious about their relationships, a break can feel like a threat, particularly where it is the therapist who is not available for a session.  Some such clients may try to sustain contact over the break by emails or texts.  Others may subconsciously “punish” the therapist by not attending the session after the break or by turning up late.  It may also show up in the nature of the material spoken of in the sessions.  Underlying themes of abandonment and loss may emerge here even where it is not about the therapist.

For clients who have learnt to protect themselves from the vulnerability associated with relationships, a break can merely reinforce what they anticipated anyway.  Subconsciously, there can be a sense that “I knew they couldn’t be trusted”.   For some, this feeling is so strong that they may not return to therapy after the break, sometimes without any contact.

For these reasons, I find it important to explore with the client what their feelings are around breaks.  I would try to give at least 3 weeks notice of any holiday that I am to have and request the client to give me as much notice as possible before their holidays. This way, we have a chance to explore these potentially sensitive issues, so the client has the chance to gain a conscious awareness of how their patterns may be impacting their experiences of breaks.

Thus, if they find they are feeling hurt prior to a break, they can begin to recognise their pattern of relating which is the first step towards taking conscious control and beginning, through the trust developed in the therapeutic relationship, to learn new patterns of relating.  In the new pattern, they can begin to trust that they are loveable, are not about to be rejected, and can bear a gap in the support from loved ones without anxiety or hurt.

If you have any questions about this blog or any of the issues raised please feel free to contact me via my website: http://www.garycooktherapy.co.uk

Time

Time has a significance within therapy which may not be apparent to you if you have not had therapy before. So, in this week’s blog we will be exploring some aspects of time which are particularly relevant to therapy.

Often, therapists in private practice see clients in their own home and therefore do not have the luxury of a receptionist & waiting room to accommodate them if they are early.  Even practice clinics or agencies may not have such facilities although they are much more common.  Thus, you will be asked to wait until the agreed time before knocking on the door for your session.  Imagine how you would feel if at the end of your session, which may or may not have been very emotional, to have to walk past a stranger as you leave. I normally allow 10 minutes between sessions which gives time for one client to leave well before the next client is due to arrive.

If you are late, then the session still ends at the agreed time, 50 minutes after the scheduled start time.  It avoids one client having to meet the next client as mentioned above.  More importantly, it is one of the many ways in which therapists demonstrate their reliability in providing support for the client.  By repeatedly being on time for the start and the end of each session, over many sessions the client can feel at a gut level that here is a pattern of support on which they may rely, even when the client themselves may be irregular in the timings of their attendance.  For clients whose formative experiences when young were of care-givers who were unreliable in their responsiveness this can be an important aspect of the support offered.

It is often enlightening to explore with a client what happened and how they felt about being late. It can often be a window onto how they manage their world and their expectations of it. This is especially true if there is more than one non-attendance and/or lateness. Do they view therapy as an indulgence, therefore not to be prioritised in the face of regular traffic problems? Do they not prioritise themselves and therefore the therapy? Are they trying to impress upon you just how busy they are? The list of possible reasons is endless. What is important, is to try to understand what is going on for the client when this happens. This is all part of the work of therapy.

Sometimes, clients will be full of things to say during the session, and only in the last few minutes engage more fully with their emotions.  There may be many reasons for this.  Often, it is an unconscious strategy to avoid having to stay with difficult emotions for long. Once they recognise this pattern they soon get frustrated as they realise they are getting in the way of helping themselves move forward.  Some clients can feel hurt by the seeming coldness of the therapist in ending a session whilst the client is in the middle of some intense feelings. Different therapists work with this in different ways. Personally, I monitor the intensity of the client’s feelings in the last few minutes of the session, offering them a choice as to whether they wish to go that deep so close to the end of the session. Even so, at times the client may be profoundly emotional in the last minutes, in which case I would allow the client a minute or so to compose themselves before facing the outside world.

Clients can think of things to say just as the session is ending. At that point, there is no possibility of exploring what the meaning is for the client of this story.  Thus, it may be better to ask the client to bring it next time if they wish.  It would be particularly important to address this, if it were a pattern. What is the meaning of the pattern?  To avoid the ending?  To avoid having to stay with difficult emotions that might be evoked by the story? All useful information about how the client relates to their world.

Through all of these issues around time, the client can experience the therapist’s questions around it as criticism for being early, late or whatever. However, the work of therapy is always to try to understand what meanings these events and patterns might have for the client and how they experience, & relate to, the world.  It is an exploration not a judgement.

If you have any questions about this blog or any of the issues raised please feel free to contact me via my website: http://www.garycooktherapy.co.uk

Confidentiality

For therapy to be effective, the client needs to feel free to talk about their issues.  These issues often arise because of the sense of shame which prevents the client from talking them through with others. Thus the client needs to know that whatever is disclosed in therapy remains confidential.  For this very reason therapists are rightly very protective of their clients’ confidentiality. There are however a few exceptions to this rule. This week’s blog explores the limits of our confidentiality.

Supervision:– The therapist will identify the client by a first name only, and give enough detail about the client’s life to help the supervisor understand the background to the process unfolding between the therapist & the client. The supervisor is also bound by their professional code of ethics to maintain confidentiality.  See the earlier blog entry on Supervision for more details.

Risk:- If I have concerns about the safety of the client or of those around them, I may, if the circumstances are appropriate breach confidentiality by expressing my concerns with the client’s GP. This is a last resort and even then, the only information disclosed would be the minimum sufficient to advise the GP of the nature & degree of risk involved, so they are best placed to manage that risk.  If at all possible, I would encourage the client to seek help directly themselves to manage their risk, e.g. take themselves to the Accident and Emergency Department of their local hospital, contact their local GP or out of hours service.  If I felt that the client was unable, unwilling or unlikely to do this, then I would seek their permission to contact their GP on their behalf.  If that permission were denied and I was seriously concerned for their immediate safety I would then contact their GP. This is never undertaken lightly and in practice is quite rare. See the earlier blog entry on Managing Risk for more details.

Legal Requirements:- There are a number of laws which may require the therapist to breach confidentiality. This may be around disclosures of impending terrorist activity or of an ongoing child protection issue. My first reaction would be to encourage the individual to report the matter to the appropriate authorities e.g. the police or social services. Only if they were unwilling to do so would I seek their permission to disclose the information on their behalf, and failing that advise them that I will be breaching confidentiality in the interests of safety. It is also possible (albeit extremely remote) that a therapist’s client notes will be subject to a subpoena from the courts. For this reason, client notes are usually limited to recording brief details of what the client disclosed and no conjecture about the client by the therapist.

In summary, breaches of confidentiality are rare and in the best interests of the client. Therapists are highly protective of their clients' confidentiality as it is the basis of trust in the relationship.


If you have any questions about this blog or any of the issues raised please feel free to contact me via my website: http://www.garycooktherapy.co.uk