Instilling Hope During Internal Paralysis
There are times when I am facing a client with very little hope for themselves. I sit in their presence, and I feel that hopelessness in me - how will they ever get out of this? In those moments I understand a couple of things. One, I understand the idea of damnation more thoroughly: these clients feel damned to a life of suffering, paralyzed and unable to make progress. Two, I am using my person again through countertransference to understand the extent of this client's hopelessness. Studies show that adult nervous systems resonate with each other within a twelve foot radius. I check in with myself a lot in session to determine where the client is at, and I sometimes respond more to my internal feelings than what the client is actually saying. Of course there is an art to this, and I am getting better at determining what feelings are mine that I bring into the room and what feelings are my client's. If I am not sure, I will not respond from those internal cues.
Hopelessness isn't the sign of a weak constitution. It's the result of years of pain during which no activity, drug, relationship, or treatment made any difference for the sufferer. It's the result of not only not feeling better, but being blamed by close friends and family for not feeling better. For Americans, it's also living in a world where we are expected to pick ourselves up by our bootstraps and make ourselves better when we suffer emotionally.
Usually when a client seems paralyzed with hopelessness, there are certain factors in their life that are common themes in emotional despair. These can include:
-Current life stressors a la Maslow such as food & shelter insecurity.
- Lack of safety due to abuse or violence in and/or around the home.
- Constant exposure to complex trauma triggers (e.g. living in home or community where trauma occurred, unknown and pervasive triggers, etc.).
- Chronic nervous system arousal to an extent that living in one's body is a terrible and painful experience.
-A firm and long-established belief - a self schema - that one is worthless, hopeless, helpless, and inherently bad.
The first two factors listed above may be outside the realm of an outpatient therapist's abilities to help with directly. Linking a client to services that can help them (women's shelters, state/federal welfare programs, case management, child protective services, wraparound services, psychiatry, etc.) is absolutely essential. When a client is steeped in despair and fear because they are living out of their car, it is better to spend the session making phone calls to get them shelter support rather than talking about how difficult their situation is. With that said, we can help directly with the other themes listed above. The rest of this post will focus on ways to effectively address these themes in treatment.
Incredible interest and curiosity in the minutia of the client's suffering. Allowing the client to be an expert on suffering instead of resisting their experience with them or for them is a crucial stance to take with a client paralyzed by pain. I can't even start to keep track of how many times I've had clients apologize for dwelling on their suffering in therapy, when it is this very suffering that drives them to seek help in the first place. These same clients have often been chastised by others for dwelling on their suffering and not "getting over it" quickly enough.The truth is often that their stories of suffering have only gone so deep, because usually they or others stop the story before it can enter new realms of meaning and understanding. By showing curiosity and deep interest, the therapist may provide an open milieu for the client to go deeper into the story of suffering and start to shift it. At the very least the therapist can model a more kind and validating way to look at the client's suffering, even if the client is not quite ready to go deeper into the other, unrecognized truths within their pain.
Deep, deep validation. It is key to find a way to tolerate the experience of the client's suffering and reflect acceptance and understanding of their experience. If a person feels validated when they are at their very worst, it can be a very healing experience: when I have done this effectively at the right time with a client, it often becomes a turning point in that client's treatment. This level of validation means joining the client in their despair and reflecting understanding and compassion for that place. I equate this part of the work to climbing into a dark cave with the client and then climbing back out by the end of the session: it really is like emotional spelunking! This can be challenging on a day when a lot of joining in the dark cave of despair is necessary. It can also be challenging during a time of hopelessness in our own lives when we feel vulnerable and resistant to our own despair. I have done enough of my own processing work that I usually know on a visceral level that everything passes, even deep, toxic despair. When I find myself chronically resisting clients' hopelessness and suffering, however, I resume my own therapy work to understand why.
Narrative work with a focus on survival. If a client is sitting in your office, they are one of the survivors. The fact that they are not yet dead or in long-term inpatient care speaks volumes to the past effectiveness of their coping mechanisms, regardless if those mechanisms are no longer helpful. I like to remind clients of this and ask them to retell their stories from this perspective. As we work on retelling the narrative, I guide the client via questions and reflections to expand the narrative and eventually shift the focus from trauma to resiliency. If I meet resistance in this process, we wait to expand the narrative. If after another few sessions the client still doesn't want to include resiliency in their story, we have a conversation about how identifying as someone who suffers or has been victimized is a key part of their narrative - how hopelessness itself has become central to their life story. And then we continue moving forward, however slowly, in the narrative work.
In some ways the above ideas are incredibly simple. In application, however, they can feel complex and challenging with a client experiencing paralyzing hopelessness. I write this as much to help myself as I do to help other therapists who are feeling at a loss with a client's despair.
Usually when a client seems paralyzed with hopelessness, there are certain factors in their life that are common themes in emotional despair. These can include:
-Current life stressors a la Maslow such as food & shelter insecurity.
- Lack of safety due to abuse or violence in and/or around the home.
- Constant exposure to complex trauma triggers (e.g. living in home or community where trauma occurred, unknown and pervasive triggers, etc.).
- Chronic nervous system arousal to an extent that living in one's body is a terrible and painful experience.
-A firm and long-established belief - a self schema - that one is worthless, hopeless, helpless, and inherently bad.
The first two factors listed above may be outside the realm of an outpatient therapist's abilities to help with directly. Linking a client to services that can help them (women's shelters, state/federal welfare programs, case management, child protective services, wraparound services, psychiatry, etc.) is absolutely essential. When a client is steeped in despair and fear because they are living out of their car, it is better to spend the session making phone calls to get them shelter support rather than talking about how difficult their situation is. With that said, we can help directly with the other themes listed above. The rest of this post will focus on ways to effectively address these themes in treatment.
Incredible interest and curiosity in the minutia of the client's suffering. Allowing the client to be an expert on suffering instead of resisting their experience with them or for them is a crucial stance to take with a client paralyzed by pain. I can't even start to keep track of how many times I've had clients apologize for dwelling on their suffering in therapy, when it is this very suffering that drives them to seek help in the first place. These same clients have often been chastised by others for dwelling on their suffering and not "getting over it" quickly enough.The truth is often that their stories of suffering have only gone so deep, because usually they or others stop the story before it can enter new realms of meaning and understanding. By showing curiosity and deep interest, the therapist may provide an open milieu for the client to go deeper into the story of suffering and start to shift it. At the very least the therapist can model a more kind and validating way to look at the client's suffering, even if the client is not quite ready to go deeper into the other, unrecognized truths within their pain.
Deep, deep validation. It is key to find a way to tolerate the experience of the client's suffering and reflect acceptance and understanding of their experience. If a person feels validated when they are at their very worst, it can be a very healing experience: when I have done this effectively at the right time with a client, it often becomes a turning point in that client's treatment. This level of validation means joining the client in their despair and reflecting understanding and compassion for that place. I equate this part of the work to climbing into a dark cave with the client and then climbing back out by the end of the session: it really is like emotional spelunking! This can be challenging on a day when a lot of joining in the dark cave of despair is necessary. It can also be challenging during a time of hopelessness in our own lives when we feel vulnerable and resistant to our own despair. I have done enough of my own processing work that I usually know on a visceral level that everything passes, even deep, toxic despair. When I find myself chronically resisting clients' hopelessness and suffering, however, I resume my own therapy work to understand why.
Narrative work with a focus on survival. If a client is sitting in your office, they are one of the survivors. The fact that they are not yet dead or in long-term inpatient care speaks volumes to the past effectiveness of their coping mechanisms, regardless if those mechanisms are no longer helpful. I like to remind clients of this and ask them to retell their stories from this perspective. As we work on retelling the narrative, I guide the client via questions and reflections to expand the narrative and eventually shift the focus from trauma to resiliency. If I meet resistance in this process, we wait to expand the narrative. If after another few sessions the client still doesn't want to include resiliency in their story, we have a conversation about how identifying as someone who suffers or has been victimized is a key part of their narrative - how hopelessness itself has become central to their life story. And then we continue moving forward, however slowly, in the narrative work.
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In some ways the above ideas are incredibly simple. In application, however, they can feel complex and challenging with a client experiencing paralyzing hopelessness. I write this as much to help myself as I do to help other therapists who are feeling at a loss with a client's despair.
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