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Come unstuck in therapy

Updated: 3 hours ago


Print for a politician by Grayson Perry.
Print for a politician by Grayson Perry. Depicts the perpetual conflict of faux demographic groups. Ranging from 'agnostics' and 'provincials', to 'homosexuals.' Each group stuck in their prescribed reciprocal roles.

This blog looks at how to come unstuck in psychological therapy, through adding to our usual roles. A role is one way to relate with other people. Reciprocal roles are roles which reinforce each other. In some situations this pairing creates a useful complementarity. For example if we want to stop change occurring and perpetuate a beneficial status quo.


In other situations, reciprocal roles can perpetuate distressing patterns of relating. For example in wholly sadomasochistic relationships. Perhaps as part of a trauma reaction. This blog details reciprocal roles, links them to common mental health problems and suggests practical changes therapists can make to help us add to those roles.


How do roles come about?


People develop a range of roles in order to survive the environment they grow up in. Our preferences for interaction indicate our usual roles. Our roles may also be unconscious. Bringing these roles into our awareness can help us examine their usefulness and consider if we want to add to them. Some common reciprocal roles are listed below :

Role A

Role B

intellectualising

unthinking

emotional

unfeeling

hopeful

​hopeless

responsible

irresponsible

sadistic

masochistic

controlling

controlled

sad

angry

anxious

calm

seducing

seduced

disclosing

witholding

rejecting

rejected

selling

buying

parent

child

judging

judged

narcissist

acolyte

doer

done too

Each role represents one part of reality. Allowing someone else to represent a different part for us. When paired together they may allow the two people to better cope with reality as a couple. So we get the lock of complementarity. Unfortunately, this lock can also mean it is harder to add to the roles we take. We may even feel phobic to the opposite role. Split off from that part of ourselves. Reciprocal roles can also over emphasise one aspect of reality and neglect another. This can lead to problems. They may also occur in the context of mental health problems.


Reciprocal roles in the context of common mental health problems


Generalised anxiety - reciprocal roles which a) over or under value the benefits of worry b) focus on the future or the past.


Social anxiety - reciprocal roles which a) differ in the fears of being authentic or causing offence b) people pleasing, finishing the session early, arriving late c) acting as if we were incredibly fragile or beyond harm d) seeing therapy as typical or wholly different experience of life.


Health anxiety - reciprocal roles which disagree about a) how desirable it is to accept uncertainty/mortality/vulnerability b) where expertise lies c) what is a realistic speed of change.


Chronic grief - roles which contrast in their views of a) endings b) the period of our lives which is most salient c) mark or ignore the passing of time.


Depression - roles with a variety of approaches to a) experiencing sadness / anger b) status, education and/or income c) critical, shaming, demanding and/or punitive interactions versus helpless or rescuing ones.


Anger related issues - roles which disagree about a) the value of expressing sadness b) passive aggression or not saying if we are hurt by the other c) experiencing other feelings.


Paranoia - roles where there is a suspicion of motives or an unquestioning of interactions.


Violence - roles which include a) submission, masochism or a lack of boundaries b) a lack of explanation, abrupt interactions, non verbal communication c) ruptures.


Medically unexplained symptoms - roles which vary in their a) experiences of uncertainty, control, confusion and anger b) feelings of exclusion, discrimination c ) meaning of physical symptoms.


In the face of these reciprocal roles how could a therapist (or anyone else) help? Well I think the job of a therapist is to create experiences useful to the client. Engaging in repeated, healthy and conscious interactions with all aspects of reality. This includes adding to the reciprocal roles we, consciously or unconsciously, take. A therapeutic process promoted by particular habits.

Therapeutic habits


In my experience the following habits help clients add to their usual roles :


  • The client decides when to start and when to end therapy e.g. persisting when it is not clear to the therapist how therapy can help.

  • Communicating an expectation of honesty and that any therapy will only be partially successful.

  • Opening each session with : 'What would you like and /or need from me today?'

  • Offering the client choice about the level of structure, homework, silence, past/present/future focus, challenge, theory and /or practice in each session.

  • Co-creating a lawful, moral and rhythmic relationship.

  • Doing new things together e.g. taking turns in being vulnerable.

  • Carefully articulating our immediate thoughts and feelings, as well as, more considered ones.

  • Noting what, and how much, is thought, talked about and emotionally experienced.

  • Paying attention to what is happening in our bodies as well as minds.

  • Grounding ourselves e.g. by slowing down, cleaning glasses, drinking water, reducing eye contact, facial expressions and saying what we are experiencing. Particularly when emotions make it hard to think or thoughts make it hard to feel.

  • Using our experience as a resource not an instruction manual.

  • Remembering our opinions, 'may be true of you, or merely you with me, or merely my perception of you based on my own experience. I may not always think this to be true. You or I may disagree' (Benjamin, 1995.)

  • Remembering the 'otherness by which we are always likely to be surprised (ibid).' A mutual recognition of difference. This can be a helpful relational basis for our evolving struggle, co-operation and the negotiation of conflict.

  • Witnessing, acknowledging and utilising breaks in the rhythm of therapy. In particular failures in responsiveness are acknowledged and repaired. Noticing what has gone unacknowledged in the clients experience.

  • Not placing ourselves between two significant relationships e.g. father and son.

  • Wondering how therapy might have re-enacted the harm the client experienced in the past? Saying 'I got that wrong, I am sorry and wonder what that reveals for us both?'

  • Noticing what is not being thought, talked about or emotionally experienced. For example culturally taboo experiences like identity, sex, death, child abuse, incest, anger, violence and money. Before giving explicit permission to do so and modelling how this might be helpful in a relationship.

  • Keeping an eye out for popular interpersonal games e.g. 'yes, but'; 'it's simple'; 'it's too good to be true'; 'if only' and 'why me.'

  • Sometimes allowing ourselves to be cared for as a precursor to people allowing care.

  • Engaging in parallel play and/or turn taking as preparation to surrender to each other's influence.

  • Identifying, and communicating, apparent similarities in early, and other, experiences. Like two children who compare their experiences and understand each other completely (Ferenczi, 1995.)

  • Modelling that imperfect separate people can be loved and useful to each other. Integrating a memory of the other person in order to limit our capacity to damage each other.

  • Seeking regular feedback in multiple forms.

  • Reflecting on the session away from the session including through monthly clinical supervision. Identifying any possible dissociation. Sharing that reflection, demonstrating that the patient, and their experience, have a consistent place in our mind.

So by being flexible, in response to the reality of each relationship, we can help create therapeutic change. Avoiding a my way, or your way, battle. Instead communicating that reciprocal roles can be both respected and added to.


These changes may be seen as diluting our experiences in therapy. I think this is no coincidence. In my experience, to work, therapy has to 'feel real but not too real.' This difference allows for play instead of just drama. So the interactions in therapy are consequential but without the usual consequences. All aiding the participants to tolerate a wider range of emotional experiences than outside therapy. Dilution for therapeutic effect (Benjamin, 2019.)


How to come unstuck in therapy


We have considered how we might come unstuck in therapy. Repeating patterns of relationships which have led to distress in the past. These reciprocal roles may be unconscious and pervasive on both sides. Bringing these possibilities into our awareness, recognising commons patterns, evaluating their usefulness to us and consciously shifting practise we when we seem stuck, can all help.


References

Benjamin, J. (1995). Like subjects, love objects: Essays on recognition and sexual difference. Yale University Press.


Benjamin, J. (2019, Apr, 1). Enactment and the theory of the third. Retrieved : https://www.youtube.com/watch?v=GA0dcQ13rt8&list=LLSr6fHMgXhGzrFJ1qwcKfJA&index=2&t=0s


Berne, E. (1968). Games people play: The psychology of human relationships (Vol. 2768). Penguin Uk.


Ferenczi, S., Dupont, J., Balint, M., & Jackson, N. Z. (1995). The clinical diary of Sándor Ferenczi. Harvard University Press.


Perry, A. (2020). A typical initial consultation, white board video. Retrieved : https://www.youtube.com/watch?v=sj7iek0lNYk


Ryle, A., Kellett, S., Hepple, J., & Calvert, R. (2014). Cognitive analytic therapy at 30. Advances in Psychiatric Treatment, 20(4), 258-268.


An earlier version of this article is available on my counselling directory page. See https://www.counselling-directory.org.uk/memberarticles/the-surprising-ways-you-can-come-unstuck-in-therapy


n.b. I have also collated a list of other free resources on psychological therapy. You can access them here : CLICK HERE


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