GET OUT: How to avoid the worst therapy ever. (spoiler alert!)

What is “good” therapy anyway?

By Adrienne Glasser LCSW, RDMT

In order to understand what good, helpful therapy looks like, it helps to examine the worst of the worst …when psychotherapy goes horribly wrong. When most people first enter therapy have very little idea what to expect. Most common associations about psychotherapy come from movies and TV shows. Depictions run the gamut from ineffective, to harmful, to laughably absurd.

 

What About Bob Pic: famousfix.com
The ineffective version of therapy is the archetypical, Freudian variety. These versions usually depict a bespectacled older male (at times female) figure taking notes from behind a patient. The therapist is usually stoically quiet with the exception of an occasional judgmental interpretation.. This familiar setup was what I had seen in movies as a kid, and was a pretty accurate depiction of what I experienced when I entered therapy at age 14. I would go each week and blab away as my therapist sat and nodded. Needless to say this did not calm my anxiety at the time. The ineffectiveness of that experience only made me more committed years later as a therapist to doing something different and trying something that actually works.
More recently, bad therapists in the media have been depicted as not just quiet, but sinister in nature. They are either sexual predators or asking clients to do crazy things for them in “boundaryless” ways.

My favorite example of the worst therapy ever is from the movie “Get Out.” Spoiler Alert!

In this scene, the therapist pretends to introduce a young man (her daughter’s boyfriend, Chris) to hypnosis (which can be very effective when practiced by an experienced with a trauma specialist,) but then dupes him into diving into his most unprocessed trauma. She then leaves him stuck inside the traumatic experience, which the movie aptly calls “The Sunken Place.” Her motives are sinister: Her goal is to immobilize Chris and prepare him for a deadly procedure. The Sunken Place serves as a powerful representation of cultural, multi-generational traumas that often go overlooked in therapy. Part of what makes the movie so powerful and haunting is the evil deployment of a potentially life-shattering technique.

 

“The Sunken Place” is an extreme example of a very common, unintentionally harmful experience that can happen in psychotherapy. Difficult, wounding or traumatic stories are often shared, and in a sense, “replayed” by the client during the session. Illness, death, loss and traumatic interpersonal experiences are usually situations that set off our limbic system in moment which triggers a a fight, flight or freeze response. When re-telling the stories related to these experiences in therapy, there is always the risk that clients’ psyche will go back to visualizing the original circumstances and trigger the same traumatic limbic system response as if it were happening all over again. If we are not mindful, clients can leave no better off than they were when the trauma first happened.

The good news is that many forms of psychotherapy now include methods that look at the way a client is regulating their nervous system while telling a traumatic story to ensure that they have a healing experience. Truly healing from our pasts requires us to feel a previously unknown sense of safety while witnessing our past unsafe experiences. Cultivating the ability to witness our story and different parts of ourselves with compassion is key to resolution. Once I realized this through my own healing process, I became devoted to

Sadly there are times (usually with no intent to harm) that therapy does not pay attention to this process, leaving clients in a “sunken place” of sorts. Also there are situations where therapists are trained well, yet the cues that a client’s nervous system may be dysregulated may not be obvious and important moments are missed. However, with the right training, there are questions and techniques a therapist can look for to ensure a greater sense of safety in psychotherapy.

Therapists should be focused on encouraging clients to witness their traumatic or stressful experiences, when working through topics such as relationship issues, work transitions and “Big T Trauma.” The following is a list of modalities that are used to help clients to stay regulated, leading to a higher rate of resolution:

Mindfulness-informed psychotherapy

Contemplative Psychotherapy

Somatic Experiencing

Eye Movement Desensitization and Reprocessing

Internal Family Systems

Embodied Gestalt Psychotherapy

Trauma-informed creative arts therapies such as :Art therapy, Drama Therapy, Dance/Movement Therapy, Music Therapy

Sensorimotor Psychotherapy

Polarity Therapy

Neurofeedback

Dialectical Behavioral Therapy (with trauma focus)

Trauma-informed Yoga therapy

…and many more

So how do we avoid “The Sunken Place”?

Experiential methods of psychotherapy, mindfulness-integrated therapy and trauma models of therapy allow for the healing of old wounds in a safe way that guards against the possibility of therapy becoming more traumatically activating for the client. By creating a focus point that is neutral or pleasant (such as body sensations, breath, art, music, role-play) it allows for the client to witness their own experience, allowing for the integration of past events and the defense mechanisms we use to protect ourselves to shift, due to increased insight and compassion. For example, a work dynamic, or parental dynamic could be a top stressor, and drinking becomes a way to cope. By allowing a client to increase awareness about what happens in their body when faced with stressors, they are equipped to experience insight and compassion towards the parts of themselves that struggle and increase their resilience in the face of these factors.

These methods are the opposite of “the Sunken Place,” of being frozen, and merged inside the paralyzing trauma. We usually become the parts of us that are trying to protect us or the ones that hold wounding. Good therapy allows for the client to learn about their own strengths, wisdom and resilience so they can help the wounded parts of them thrive, rather than let them take over and sink. One day we will have a film that captures the real, powerful transformations that I have the honor of witnessing every day. For now this great example of the worst therapy can hopefully be a catalyst for awareness regarding racial inequality, cultural legacy burdens and how find the opposite of “The Sunken Place” because there is great therapy that actually works.

To learn more about the “good” psychotherapy options available at Present Moment Psychotherapy check out our website here.

 

Leave a Reply

Your email address will not be published. Required fields are marked *