Patterns that reenact past traumatic relationships can be introduced into therapy by either the client or the therapist. When a client is playing out previous experiences, it can be therapeutic for therapist to skillfully manage the introduction of one of these dynamics. Conversely it can be traumatic for an unskilled therapist to confirm the client’s previous experiences of unhealthy interaction.
When a client introduces one of these dynamics, a skilled therapist will pass through the content (why can’t you call my landlord) and explore the process of the issue (what does it mean when I say “no”. Other people in your life said “no” and sometimes that was life-threatening, like when you were being abused and asked for help).
This list of dynamics comes courtesy of Preventing Compassion Fatigue: A Team Treatment Model by Munroe, Shay, Fisher, Makary, Rapperport, Zimering in Compassion Fatigue: Coping With Secondary Traumatic Stress Disorder In Those Who Treat The Traumatized (Routledge Psychosocial Stress Series) edited by Charles Figley
This can look like a:
- Client who is pushing boundaries, asking for things outside therapeutic relationship.
- A therapist who drags out therapy for their own benefit, maybe to prove something to themselves.
This can look like:
- A client who forces therapist to choose between these roles, cannot accept that the therapist can be “on their side” and not agree every belief or action.
- An unskilled therapist may not challenge the client so as not to lose them. Or a therapist may introduce the dynamic by not allowing the client to challenge aspects of therapy.
This can look like:
- a client who communicates threats, not necessarily violent, to get their needs met.
- Or a client might feel like they don’t have a choice in treatment direction or can’t speak up without getting kicked out of therapy.
Relationship comes to depend on crisis. This dynamic facilitates dependence, which can serve the needs of either the client or the therapist.
When someone has been abused, especially in the context of a relationship, they often learn unhealthy ways of getting their needs met. It’s natural for that to enter the therapy, and even healthy, when it allows the client to relearn how to negotiate. It is never healthy or acceptable for a therapist to introduce on of these dynamics and it is the cue to exit the relationship—NOT, fix it.