 We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is The Therapy Show, behind closed doors podcast with Bob Cook and Jackie Jones. Welcome back to Episode 43 and this week on The Therapy Show with myself, Jackie Jones and Bob Cook. We're going to be looking at working with frightened clients. Everybody's frightened when they come for the first time, aren't they, Bob? Well, I think as with most of these podcasts, I'm talking about continuums. Yes. So on one side, majority of people come for therapy are apprehensive. Yes. We call that scare. That's fine. So yes, there's a natural apprehension for most people come to therapy. And then on the other end of the continuum, we have petrification. In other words, people are really petrified. Generally not so much. Well, no, no. No, I wasn't thinking about generally, I was thinking about trauma. Okay. So that's what I'm saying. In terms of a continuum, when people come to therapy, they are somewhere in between normal apprehension and petrification, which is usually come from some type of trauma. Yeah. And then according to where they are in terms of their script and life positions will be where they are in that continuum. And of course, once you've got a treatment contract, and once you start working with the therapeutic issues, and you're often dealing with aggression, then you get to different places on that continuum. Yeah. So it's working back to where the trauma is. Yeah, because if you're talking about frightened, I think, and we go past normal apprehension, then most of what people bring usually have a traumatic part to it. And often from that place, you'll find the levels of scare. Yeah. Now, you're right, of course, people have a level of apprehension when they're coming to therapy. And they may go up the continuum to quite a high level of scare if they have issues about being visible or high levels of issues about being exposed, for example, like I was thinking of the withdrawn part we talked about in a podcast some time ago, where people often withdraw because of levels of trauma. So whatever's uncovered in the therapy will often determine the level of fear. Yeah. Yeah, because like you've said in the past, it's about bringing the past into the here and now and the present. And if somebody is regressing back to that trauma, it's going to play out in the therapy room. Yeah. So the contract for the treatment in the first place will determine a therapeutic process. Yeah. Because sometimes therapy goes to a place that neither one of us expect. Yeah, absolutely. Now for me, I can talk about, you know, with some clients talk about a particular subject and it just kind of winds down to something else and they'll drop a bombshell in the middle of a conversation. Yeah, you can have different types of regression. I mean, usually of course, if you've got a contract then you know the sort of, you might have some idea of the type of trauma. Yeah. But you might, people can spontaneously regress. Yeah. In place. I think what's very important at another level completely though, away from past the traumatic progressive process we're talking about here is how we make the therapy room a safe and secure place for people to feel able to do their therapy in. Yeah. Yeah. Which is a really important thing. I think we've touched on it in past podcasts where we don't, as therapists, I don't think we know what necessarily triggers other people. What might be, you know, kind of like a normal thing for us to have or be or do in the therapy room can be a trigger point for somebody else. You know, sometimes with people, they felt uncomfortable with the back to a door. Yeah, but I'll go back to the contract and I know you have a history in transaction analysis. So when I use the word script analysis, which is looking at a person's history in terms of injunctions, drivers and early decisions. Yeah. What a fairly good idea. Especially we've done a lot of work in the contract processes, talking about the trauma, talking about person's trauma and history. You can have a fairly good idea of the healing that needs to be done. Yeah. I mean, right, of course, certain things can trigger people in the therapy room. If the client comes with something and they don't mention the trauma, if the trauma comes up further down the line, if they come for something, obviously they know that there's been a trauma, but they're not divulging it till six months in and then suddenly they talk about it. Yeah. I think what's even more common, though, is minimisation. In other words, well, you and I might call traumatic, they minimise. Yeah. Therefore, oh, I didn't think that was us. That was important. So I didn't mention it in the contract process. Yeah. And then suddenly when you're working with the therapeutic issue, then there may be a regression to the traumatic process in terms of their developmental level. So you're correct. You might, and like going down through an onion, you might come across trauma, which the client has either denied or minimised and you haven't, it hasn't been discovered in the script analysis or the inquiry about someone's history. Yeah. Minimised it or denied the process. And that's when you may find trauma out. You might understand things as differently as a therapist, which you knew nothing about. Yeah. But what sits in all this thought is how the therapist makes the therapeutic room, the place where the therapy happens, a safe and a secure person, in terms of the environment, so they can feel safe enough psychologically with you to be able to do the work they need to do from as relaxed or, you know, less frightening place as possible. Yeah. Yeah. Non-judgmental non-judgmental and those sorts of things. That's it. But I was also thinking of the environment, you know, that is the physical environment. Yeah. You've got nice seats, you've got maybe, you know, it's a tea, nice cushions, making a cup of tea, you may have soothing music on, depends how you are as a psychiatrist, how you see it. But in terms of making the place a sort of relaxing environment, I think it's really important. Yeah, me too. Yeah. I always have a snuggly blanket as well. I don't know why, but I always used to get cold in therapy. It didn't matter how warm the temperature of the room was, I always used to feel cold. Well, when they talk about fear, they talk about, you know, freezing. Yeah. And people who are frightened, or let's put it another way, they're in a child is fine, or their younger self is frightened, rarely gets to the right body temperature in the therapy process. And you usually report feeling cold. And it's to do with something in that past history that needs healing, not the temperature of the room. Yeah. In the therapy centre. Yeah. It makes sense. Yeah. But because of that, I always have at least two blankets over the back of my couch so that they can pull them off and snuggle up or wrap themselves up or whatever in the process. Yeah. Yeah. And deep, deep aggressive work, of course, where you know there's a lot of trauma, you might even have a hot water bottle. Yeah. See, I think this is what I like about the therapy, the therapy room is there aren't really any, well, there are rules, obviously, in the therapy room, but how you set up your room is down to you, really, and your clients and what you feel their need. Like you say, a cup of tea. It's one of the first things that I do when my clients come in. Yeah. And about colours. So, for example, if you want to promote a safe, secure, relational space, I think soothing colours are not colours like red, which is often designated to the expression of anger. Yeah. Very dark black colours I keep away from. I think the soothing of colours are really important. Yeah. I do believe the importance of an environment being secure and welcoming and soothing is really important. Yeah. They colour the lights, for example. So, for example, you know, I wouldn't think of doing regressive work or even healing at a traumatic level with fluorescent lights on. I'll probably get nice soothing, dimmer, softer lighting. Yeah. And I think thinking of these things are really important. You know, if you're going to do that type of work, you wouldn't want to be in an office room, for example, or you might. A clinical-looking room. Not, yeah. I think it helps if you're going to do that type of work, especially somebody who's petrified or frightened due to trauma in their history. Yeah. So, I think the environment is very important when we're talking about soothing somebody's fear from their traumatic history. Yeah. Yeah. And it being a confidential space as well. So, you know, there's no outside noise or distractions and things like that, which sometimes can be difficult, but yeah. I think what you just said there is very important about, you know, you say confidentiality. Yeah. I, in TIA, they talk about three parts of the ego. The younger part of the ego, often called as the child. The adult here and now part of the ego, probably to what age you are. And then the, you know, the parent-ego state, which you sort of borrowed from the significant people in your history. And I think that confidentiality needs to be heard from all ego states. And sometimes people hear confidentiality from their parent and it's different. They hear confidentiality from their adult. It's different. But it's the child that needs to hear the word confidentiality and what it means, I think. Yeah. So, I think it's crucial to helping somebody who's dealing with frightening history to know that they've there's this safe place, a secure place. Things don't go outside the room. Yeah. Yeah. I think one of the techniques that I've found useful on occasion where I have needed it, you know, if a client's become really overwhelmed with fear and literally having a panic attack in the session, is being able to ground them again, being able to stop and just take stock and bring them back into the present moment, particularly if it's been a heavy session. Absolutely. I agree with that. And for the listeners then, perhaps you could illustrate how you do that. Well, for me, I'm thinking about one particular client. It was literally I went and sat next to them. Obviously, I asked permission first and sat next to them. And I got them to change position. I got them to get open to move position. And then I was using their senses, you know, tell me what you can see in the room. And she couldn't get the words out to start off with. But it was just me, you know, using a calm voice and bringing her down and saying it's safe. It's fine. There's nothing going on. We're in the here and now. Tell me what you can see, you know, tell me what you can hear and just bringing her back down. And it took her a while. Yeah. So you're doing that from the adult state or even perhaps the controlling, nurturing power to your state. Yeah, I did feel like I needed to take control in quite a I don't know whether powerful is the way. But yeah, I needed to take control of the situation and make her feel safe in the room again. Yeah. I think that's really important. I think I mean, TA comes from TA again. But the theory of theory about permissions, protection, potency by Pat Crossman is really important here. The therapists give the right sorts of permissions to the frightened client. The things will be okay. You can be who you want to be here, you know, to help them have the permissions to go to where they need to go to. Yes. Yeah. Because that is scary in itself. That is frightening. Do you know what I mean? That sentence go to where they need to go to because often it's not where they want to go to. No, no. And protection is another sort of really big important word here. Yeah. But there you are. That is their protected space. Yeah. 100%. In that session that I was talking about, it kind of had a knock-on effect or a follow-through effect into the next session. They came in being quite closed after having had that session, whether it was shame or guilt or embarrassment or whatever it was. We needed to do some work on getting back to the relationship that we had after that particular session. Well, you know, it's all those things. Yeah. I think a therapist wouldn't go back to that session and probably inquire about what was happening for them. Yeah. And see where it fits into their past history. Yeah. Because I think it is important to bring everything back into the therapy room if there's something hanging over for the client or for us. Then like you said, to check in and make sure that everything's okay. That's right. And in the end, you need to be a secure, safe object person for the other person. Yeah. So permissions are really important. Protection is really important. And the client needs, the therapist needs to provide those. Importancy as well. I can remember in my training because I think it can be interpreted or explained in different ways, you know, but one of the things that stuck out for me in my training was that sometimes the therapist or all the time the therapist needs to be more potent than the parent ego state. Yeah. Because you see, if you're doing deep therapeutic work, the fear doesn't actually come from the therapist in the room. It comes from their own internal dynamics. And it usually comes from an internalised, scary parent. Yeah. And the therapist needs to be more powerful, certainly through permissions. Yes. Than that scary parent, which is saying scary things, you know, that narrative that's going on in their heads. Yeah. The therapist needs to be more powerful. I just remember that. That really hit me and it made perfect sense to me as well. But it is, it's that internalised parent that is, you know, part of the descriptive stuff. And I was subconscious that's always, well, not always, no, but berates us and, you know, talks down to us. We need to be more powerful. That's right. And if we think of the concept of transference, and what might sometimes happen, which is called negative transfers, is when the client projects onto the therapist, a negative, a negative object or a negative parent that perhaps might have been there, father, grandfather, brother, or yeah, anyway, want to look at that. And the therapist needs to be aware of that. And they can actually work, they could work with negative transference, but I would suggest they, in terms of what we're talking about here, they need to be a positive object, not a negative object. Yeah. And they could even say things, well, I'm not your parent. I'm not your abuser. I am myself and I'd like you to recognise that or whatever, but they need to work in the therapy so that the client sees them as a real person in a different way. Yes. Yeah. Because everything can get a bit mixed up when you're in the therapy room sometimes and separating out, you know, even separating out whose feelings do these belong to. There's a lot of energy and a lot of emotion sometimes in the therapy room. And even as a therapist, sometimes I question, is this my feeling or is this somebody else's feeling? Well, I think it's important to do that almost as a matter of course. Yeah. I can remember when I was doing my training, I felt really unsure of whether I could do the job because I'd seem to, sometimes it felt like I had a bit of an antenna on my head and I was just pulling in everybody else's feelings and it was, it was a bit intense. Yeah. So no, because you're in training to be a therapist, you go to therapy or you do within supervision. But these things are all very important. I think it's always important to ask whose feelings are they? Yeah. Now, a petrified, scared, frightened client won't want to feel that. So they will do certain things. They will withdraw internally, might go passive internally and do many things to protect their younger fight itself. And that is normal. And they also may project onto the therapist and want to get rid of those feelings. Yeah. So that's where the therapist might feel suddenly scared, frightened and capacitated. And they need to ask themselves, when I wasn't scared and capacitated frightened a moment ago, whose feelings could they be? Yeah. This is a powerful thing about therapy, Bob. I think that unless you're involved in it, witnessed it or been part of it, it's really hard to explain to people how it works. Well, I hope I'm not doing too much of a bad job. Not at all. Not at all. I know what you mean. It's very, very hard. And it's a very important question for any therapist listening or anybody who's interested in the therapy world that therapist needs to understand that the feelings that are around in the room are often not theirs. And it's a really, really important question to ask whose feelings are they? Yeah. Yeah. And I'm sure the listeners who are listening to this either experienced it or they're interested in it. But talking to a lay person outside, what if you say to them, you know, in the therapy room, sometimes I don't know whose feelings they are. They look at you as if I don't understand what you mean. It's... Well, you could say to them, well, have you been around angry, frightened people and when you are, what do you feel? Yeah. You know, as I said, you could say to anybody in the street, have you spent any time with a depressed person? And they'll say, yes, well, actually, my brother's quite depressed. Okay. And how did you feel after you had to chat with them? And usually, I'll often say I felt laid down as well. Yeah. So I think if you can use, as I was that to explain, I know where you're coming from with this, it's very hard to explain a person's own therapy to somebody who's not been in that relationship. Yeah. Yeah. You know, I had somebody in today, I was doing the assessments. Oh, I just think of other occasions as well, where people say, shall I share this with my partner or whoever? And I said, well, that's really up to you. But, you know, be prepared that they may not understand what you're talking about, because it's a very internal process where it's quite often hard to explain. Yeah. It may be useful sometimes. And sometimes it may be very unuseful. And then you feel misheard and not understood. And things can get worse. So you are, I think you're correct. It's hard to explain, you know, therapy processes. But I do think I want to go back to the beginning where we started. I think it's very, very natural for anyone coming to therapy, especially at the beginning to have a level of apprehension, which we might all scare. I think it's very, very normal. That'd be very astonished if people didn't. Yeah. And there's a whole continuum. So when we talk about petrification of frightened clients, I'm thinking about that more in treatment rather than the beginning. Because at the beginning, it's much more about apprehension and anxiety. And if you've got a safe, secure place, you've got a welcoming environment, they start talking to you for a while. Then things, they can't, people calm down. But once you start doing the therapy after therapy contracts, so you both know what you're talking about, where you're going. Yeah. Then we may go to a different developmental age, where that younger self was actually frightened. Yeah. Yeah. And then to a different level of fear. Yes. Yeah. Yeah. And again, one of the things I say to clients sometimes, they'll say it's stupid. It's ridiculous that I feel this way. I'm a grown man or I'm a grown woman. And it's really stupid. And they come out with all this stuff. And it's like, well, it's not stupid at all. And explaining about the ego states and how it all works. And in that moment, it's survival. And that's what we do to survive. Oh, that's what I'm saying. People who for very good reasons, when they're different developmental histories, feel scared. It's always for very good reasons. Yeah. And if they're visiting those scary times, it's really important that they have a therapeutic relationship with a therapist who they feel safe and secure with to be able to go to those places to describe what's happening in that scary place. Yeah. Yeah. I had one client explain it once. And I thought it was, it was lovely the way he was explained that I was like a rope for her to hang on to when she was going to those places. Kind of like I could pull her back if I needed to. And that obviously gave them some comfort, but it made me feel comfortable in the situation as well. Yeah, because she knew that at least one of them, one of you was grounded. Yeah. Yeah. And again, it was her metaphor and the way that she visualized it in the room or whatever. And metaphors are so powerful in the therapy room. It allows us to explain something without actually explaining it, if that makes sense. Yeah. So it would be very odd for a therapy treatment or therapy process without going to places where people get in touch with their younger scare. Yeah. However, if the therapists they respect, they trust is with them in these levels of protection I'm talking about. In my experience, they're able to do that. And they're also able to come back to their own age. Yeah. Be who they are and come back next session. Yeah. Which again, I think is a really important thing, Bob, to make sure that the, you know, the client is grounded and back in the here and now before they leave. And that can, you know, if you are doing some hefty work, it's going to take 10 or 15 minutes to get them back into the here and now grounded, relaxed and able to carry on, you know. That's a really good thing to think of. Yeah. Thank you. That was wonderful. So what we're going to be talking about in the next episode is working with the delusional clients. I'll be very interested. Yes. I'll be very interested in that one. As always, until the next time, Bob, thank you. Welcome. Bye. Bye. You've been listening to The Therapy Show behind closed doors podcast. We hope you enjoyed the show. Don't forget to subscribe and leave us a review. We'll be back next week with another episode.