New York City, NY

The Healing Bond between a Client and a Therapist

Rev. Sheri Heller, LCSW

Psychoanalysis is in essence a cure through love.~ Sigmund Freud in a letter to Carl Jung (1906)

Recently a therapy client had the courage to ask if loved her. Without hesitation or doubt, I affirmed that of course I loved her. It is only through love that I can responsibly bear witness to her pain. It is only through the love conveyed in the therapeutic bond that difficult challenges can be traversed and growth can happen.

As a therapist well versed in being a patient, it was my first therapist’s devotion and steadfast commitment that sustained me. I was a teenager beset by complex trauma rooted in child abuse and neglect. It was the absence of love that debilitated me and it was the provision of love that saved me.

Decades later, I follow that example. Like all therapists, I operate from a paradigm of a ‘soft’ social science rooted in philosophy and the humanities. A vast theoretical explanation of human nature and a litany of practices are relied upon to treat all kinds of psychological maladies. Yet irrespective of techniques employed or years of clinical experience, as my experience as a patient taught me, it is the element of love that transcends methodology.

Indeed the most consistent finding of psychotherapy research is that, “the quality of the therapeutic alliance is the most robust predictor of outcome.” (Safran & Muran).

Given my personal history of complex trauma rooted in systemic child abuse, it makes sense that many of the men and women I render therapy to evince the agony of loneliness rooted in relational trauma. Since bonding is a fundamental human need critical to well-being, especially for those whose lives have been devastated by chronic abuse and betrayal, the therapeutic relationship and the love within the healing alliance is a vital element for healing and lasting change.

In a life replete with ruptured bonds, betrayal, deficits with object constancy and negative endings, the therapeutic bond’s potential to serve as a template for healthy love is crucial to a positive outcome. When a relationally traumatized client engages in a therapeutic process with a clinician who offers the opportunity for corrective meaningful connection, healing happens. In the context of such a relationship, traumas can be effectively processed.

Validating and giving credibility to this form of treatment, especially in a world so fixated on self-sufficiency and soldiering through sheltering in place directives is fraught with challenges. Prioritizing relational trauma and the healing that can ensue through a humanistic bond with a clinician is becoming a superfluous resource amid an abysmal global landscape beset by a frightening ecological and economic breakdown and a broken healthcare system.

Yet it is during this time of collective upheaval that the need for a therapeutic attachment that can restore hope and encourage new meaningful life-affirming relationships is needed more than ever. Although this is a critical panacea for so many, offering this sort of face to face therapeutic intervention has become nonviable.

That said, after over three decades of providing psychodynamic treatment to folks from all walks of life in the public and private sectors of NYC, the socio-economic climate requires me to shut down my office by the end of this year.

I will still be offering remote therapy and may even sublet a space for occasional in-person sessions, should there be sufficient interest. Still, the landscape has dramatically changed and the sort of humanistic face to face connection I formed with clients has taken a remote role.

Humanistic psychotherapy describes the relationship between a client and therapist as a collaborative effort intent on accessing the clients' innate wisdom and healing. It operates from the core belief that actualizing potentials is related to one's inherent goodness and the application of free will. Principles such as unconditional positive regard (Carl Rogers) purport that a therapeutic alliance characterized by a deep respect and genuine acceptance will nurture the client's capacity for healing and self-determination.

Rogers explains, “When the other person is hurting, confused, troubled, anxious, alienated, terrified; or when he or she is doubtful of self-worth, uncertain as to identity, then understanding is called for. The gentle and sensitive companionship of an empathic stance provides illumination and healing. In such situations, deep understanding is, I believe, the most precious gift one can give to another.”

Whether this precious gift of deep understanding can be sufficiently provided through e-therapy is still inconclusive. With nearly one in five Americans presenting with a diagnosable mental illness (Mental Health America), phasing out in-person therapeutic engagement raises serious concerns regarding efficacy and desired outcomes.

Although cultivating a therapeutic bond via video conferencing is under scrutiny, it is still too soon to know what the long term impact will be. What is clear is how challenges with discerning visual and vocal cues and the absence of steadfast in-person human interaction impede communication.

An amusing personal example of misinterpreting cues occurred during a recent video therapy session. When a fairly new client dissociated during the session I erroneously thought the screen froze. It made for a good laugh for both of us, but it certainly illuminated the multiplicity of complications with discerning relational responses and body language through virtual platforms.

This kind of connected disconnection makes me wonder if the cathected secure base of the therapeutic bond (Bowlby) that conveys empathic consonance and humanity so as to subdue overwhelming fear, helplessness, disillusionment, and aloneness, can be provided through online therapy. This is an especially relevant concern for those who present with major psychiatric disorders, particularly complex relational trauma.

The heroic and arduous journey of recovery for the relationally traumatized individual means repairing fragmentation, stabilizing the consequences of somatization and limbic system dysregulation, cultivating life skills, and developing a cohesive meaningful narrative that lends itself to a life-affirming sense of identity and an inspired frame of reference.

As the emotional bond between client and therapist deepens critical relational milestones may ensue. For instance, the therapist’s steadfast and principled emotional investment in the client can help ameliorate poor object constancy.

Object constancy is the sustaining experience of others as predictable and available even when they are not immediately present.

For those who have avoidant attachment styles, the previously denied affective aspects of intimacy and separateness may become more accessible for processing. Those with an ambivalent attachment may feel ready to reclaim autonomy, having assimilated the therapeutic bond (Perls) as a good object. Those with disorganized attachment templates may have constructed a cohesive narrative of their relational trauma and be able to adequately self-soothe and emotionally regulate, so as to safely navigate the vicissitudes of relational turbulence and losses.

Moreover, John Bradshaw expresses in his book Creating Love that the therapist’s championing of the wounded child in exile is a trajectory to self-love. Dismantling the false self to exhume one’s authentic spontaneous nature is a journey client and therapist embark on together. Clearing away life-denying illusions opens one up to discovering and deepening one’s relationship to oneself.

As Bradshaw conveys, “I decided to make my commitment to awakening people to the truth of childhood and to helping them become demystified and start loving themselves. It is impossible to love and connect with others if one lives hidden in an isolated self-to-self trance.”

It is through this collaborative process which Bradshaw references, that exhuming memories of childhood abuse and reclaiming the parts of the self disowned to survive can occur. It is through this therapeutic alliance that the complex trauma survivor can reclaim the birthright they were denied; to give and receive love.

Jean Vanier wrote in Becoming Human, “To be lonely is to feel unwanted and unloved, and therefore unloveable. Loneliness is a taste of death. No wonder some people who are desperately lonely loose themselves in mental illness or violence to forget the inner pain.”

It stands to reason that recovering from the ravages of traumatic loneliness requires an intimate, authentic reparative bond. It is this tenacious bond characterized by deep humanity and compassion that fuels healing in the therapeutic process.

Through the safety of the client-therapist relationship clients are encouraged to take risks to ameliorate loneliness. This is critical as unmet longings for intimacy can be lethal. In fact, loneliness is associated with higher rates of mortality, surges in adrenal hormones, high blood pressure, alcoholism, obesity, and relational discord and familial estrangement. Chronic traumatic loneliness is known to coincide with sundry psychiatric disorders such as depression, addictions, attachment disorders and anxiety disorders.

Mark is someone I worked with for over fifteen years. Together we navigated a treacherous history afflicted by childhood sexual abuse and subsequent dissociative disorders and addictions. We have begun the difficult process of examining the changes in our respective lives due to the conditions of a post COVID, neo-liberal world. We’ve been examining how these conditions are affecting us individually and within our client-therapist relationship.

The possibility of rarely if ever sharing a face-to-face session again was considered. Reluctant tears were shed and we haven’t even begun a process of closure. It is a surreal way to prepare to say goodbye, yet at least we had the opportunity to build our connection and do the necessary work long before lockdown measures and tele-therapy became routine. We are grateful for that.

As I continue to adapt to the reality of tele-therapy I am reminded of the inexplicable depth of intimacy that has galvanized healing and breakthroughs with folks like Mark, who I’ve had the privilege of treating over the years. I am daunted by the eventuality of facilitating closure through video platforms.

It is never easy saying goodbye, or even transitioning into a newly defined relationship. We often bolt from such ordeals. The feelings of loss, of gratitude, of love can be overwhelming and anxiety-provoking. Yet that is where the depth of the therapeutic bond is most tested. That is where we fully honor what was shared and achieved.

Can virtual therapy afford the quality bond needed to successfully assist sufferers of relational trauma and other sundry mental disorders with fully knowing and experiencing all which has been disowned and silenced? Can it offer the necessary depth to navigate the journey of termination? I beg to differ, and from what I hear from my colleagues and clients I’ve worked with over the years, I am not alone.

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As a survivor (and thriver) of complex trauma and a seasoned therapist specializing in treating complex trauma, narcissistic abuse syndrome and addictions, I am intent on creating content that affords informative insight, hope and healing from psychological disorders. I aim for my creative content to assist readers with tapping into the resiliency of the human condition while recognizing the countless challenges of being human.

New York City, NY

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