 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 45 of The Therapy Show. I'm behind closed doors with myself Jackie Jones and Bob Cook and this week's episode is all around working with the avoidance client. Correct. I'll put my glasses on for this. You better have. No people listen to what we do. But I can't withdraw. I have to have, you know, my exposure. Yes. So come on, tell me what we're going to be talking about with this one, Bob. Well, it's an interesting one. I mean, it depends how you look at all this, of course. You know, I mean, one way of looking at this is, does this type of client ever come to therapy because they're avoiding to the first place? Which is interesting. Yeah, paradoxical. Yeah. So if you look at my continuum of health, where we have traits or the worried well, if you like, may have traits, right the way up to people who are very disturbed and sometimes quite psychotic. If they're the really disturbed level, they'll be so avoidant you won't see them. Yeah. But if we're talking about more the worried well side, more like traits, we will. Okay, you could look at this in terms of attachment styles, of course. You look at Bob's ideas of attachment. He talks about the avoidant client. Yeah. And we can look at this in many different ways, but one interesting thing about this is these clients are often called the schizoid client. A schizoid means split. So that means these clients often split themselves in terms of internal contact. Yeah. So the external manifestation is to dissociate, withdraw, avoid, mainly because they have a fear of exposure. Yeah, they have a fear of exposure. They're scared to have really close proximity with people and certainly intimacy. Yeah. So these people will often be called self-reliant loners. And if you ask them, you know, what's it like being alone? They'll say they'll say fine because they, of course, believe they will be keeping themselves safe by being alone. But they're quite comfortable for loneliness, which is very different from loneliness. They're two different concepts. I think regarding of the personality spectrum, they will, or people will report loneliness, whether it's hysteronic, borderline, narcissistic, all the different personal adaptations you talked about over the last 40 podcasts, maybe, will report loneliness, where somebody who's avoidant, they'll talk about being alone and feeling quite comfortable being alone. So two different concepts. Yeah. My understanding of schizoid personality type is that it's kind of like push me, pull me. They come into the relationship, but then withdraw and avoid, but then come into it. And they're not always out, if that makes sense. They make connections, but then they get overwhelmed, so then they withdraw. Yeah. At this worried well section of health continuum, part of themselves, part of themselves, I think, desires contact. Yeah. But there's a huge part of themselves, which is a fate of exposure, which causes that push phenomena that you're talking about. Yeah. And the therapy needs to be done when they're out, not in. Yeah. Do you leave the clients that don't turn up one week and just disappear on you? No. No. Okay. They're highly disturbed, yes, because they often will really stay avoidant and actually don't often come to therapy if they're really disturbed. They'll be talking about the client who's withdrawn and for part of them still desires intimacy. They are likely to come to therapy and turn up and turn up and turn up because they know that there's something missing somewhere. They're usually very passive personality profile, they're passive, and they expect that therapy is to do it all for them. That includes thinking. Sounds familiar. Yeah. So again, in terms of attachment, they will be avoidant in the sense of not that they won't come to therapy, but they'll avoid going to feelings and they'll avoid going to parts of themselves, which they need to go to. They'll be dissociative. So they may actually be there physically and not contactful emotionally. Physical intimacy, sex, it's all quite overwhelming for the avoidant client and if they do have sex because it's required in the relationship maybe from their famous reference, it'll be very mechanical because part of themselves will not be there. Yeah. They'll always be like a duty function, but they're dissociative in the process. And this personality type or this avoidance is kind of from early childhood experiences or they'll bring in their past in somewhere. Yes, definitely. And several reasons, of course, they may be in a family where that type of avoidance is modelled down to them by such processes as neglect. Or it may be a household where the actual caretakers or parents also are avoidant as well. Not only is it modelled as a way of functioning life, but there's no physicality or emotions floating around at all. So parents are emotionally unavailable themselves to the children. We kind of learn to just not have expectations of emotional connection. It's modelled that way. Yeah. And that's high neglect or that's traumatic in itself, but I was thinking of maybe emotional, physical trauma. So the early child learns that physicality is dangerous. So they go underground and they avoid emotional contact, avoid physical contact. And as the parents aren't really looking at serving the child's needs, they're the only ones that can. So they become self-reliant loners. Yeah. And like you say, split, to just that part of the self is forgotten about somehow. Yeah. Well, yeah. They split and they go underground and they look to meeting their own needs and certainly don't look externally to get their needs met. Yeah. So if you think about that type of profile, how do you think they would be in relationships today? What type of person think they might pick is a good question to ask you for the podcast listeners? Well, I like everything is psychotherapy. There's this opposite side to the coin. I would imagine that they'd go for somebody that is quite similar to them that also doesn't put any demands on them that allows them to go underground when they'd be somebody that's confident in themselves that they're not reliant on somebody else. I would imagine it's like two separate people that are in the same circle but not actually connecting with each other or the complete opposite and they might want somebody that's very emotional. Well, it's interesting the complete opposite because they may look for people to do the emotional homework for them. Yeah. And kind of like you said, expect the other person to fill in the gaps of them and do the work. Yeah. So they might actually do that. Yeah. Either way, usually there's not much happening in the relationship. Is that probably the reason why they will come to therapy? Often, yeah. And they often come being sent by their partner who talks about them like a Dr. Spock character from Star Trek, if you remember that. But having no feelings or put it another way out of touch with their feelings. Yeah. And it's got to such a state where the partner suggests they go to counselling or therapy to try and address the problem. Sometimes it may appear because their partner is awesome to come. But actually I don't think that's a very good reason. It doesn't really work that way. We'll talk about that in another podcast. But you often do get that situation where they turn up because their partners recommended them to come. Especially if they saw it phenomena. Yeah. And the way you said, you know, Dr. Spock or Mr. Spock, because it's nice sometimes for the listeners to have a character or somebody that they can associate this type of personality with. Because sometimes it's hard to describe it or explain it to somebody. When we talk about shutting down and withdrawing in a relationship, what does that look like? Yeah. So the avoiding character will have shut down part of the cells. Yeah. So they're probably just the operation operating through cognition. Yeah. It's associated and cut off from parts of themselves. Yeah. So how do we work with this type of client then? Slowly. A lot of patients getting to know their system. And one of the things which is tricky is they're going to get overwhelmed really quickly by close proximity. Or if you rush in trying to get to feelings too quickly, they'll shut down even more. So you make contact cognitively through their thinking? Yeah. Or behaviourally through their, say, passive behaviours. Yeah. Also, I'll be thinking in terms of unmet needs from the past. You know, the need for self-definition, because they've been defined so much. The need for security, safety, because usually they've been neglected. Yeah. So I'll be thinking of the unmet needs and how I pay a lot of attention to continuity, predictability, being a secure person for them. All those things which they probably never had in their history. Yeah. Which, like you said, it's going to be a slow process with somebody. Because like all personality traits, it's survival and protection. That's why we all do what we do in order to protect ourselves from something. Yeah. And the avoidant personality, usually there's no one to protect them. They've had to protect themselves. And the way they've worked at protecting themselves is to go underground. And what I mean by underground is split off their feelings and operate through cognition or passive behaviours really. So they're in a child or they're younger self, you know, they protect by not being in connection with it or not showing it. Yeah. I'll just shut this door for my dog who's snoring. Yeah. So there we are. So we don't all hear snoring on these podcasts because I've got a Charles Cavalier that snores like endlessly. I think they're so dissociated. You talk about avoidant personalities. Maybe they go to an avoidant place when they're snoring so hard because they push everybody away. And that's another thing about avoidant personalities. Of course, they push people away by going underground, by not being in touch with emotions and expressing emotions, by being passive, basically by not being in the relationship. And then the other part of the relationship, the partner, there's nothing to catch hold of because they're not there in terms of emotions anyway. I was thinking of a couple of clients that I've seen that I was wondering whether daydreaming comes into this. I don't know. When they withdraw, they daydream a lot. They process their things internally through daydreaming. You know, when you're talking about being alone but not lonely. Whether that's a way of processing or self-soothing or having emotions in a detached way. But a couple of clients I'm thinking of that potentially are schizophrenic. They've both said that they daydream a lot. They dip in and dip out of reality. Never mind the relationship. That's right. Daydreaming can be described as a dissociative function. In other words, these types of people are very creative. Yes. They're very dissociative. That means cut off from themselves. And it may appear just like you've said. And they often daydream a lot or what may appear as daydreaming. In other words, they've gone somewhere else. They're usually very creative. And one way to work with these people as you get to know them is through their daydreams, their fantasies. But the real trick is to, I can explain this, is to be aware that you don't overwhelm them. Yeah. Because if you chase the transaction analysis terms, the child or the younger self, too quickly, they may well overwhelm and shut down. And that means that you don't actually see the real self again for quite some time. Yeah. So even though the person turns up and even though they're in the room with you, it's still that cut off part that is safe to show. Yeah. So the trick is to get to the cut off parts. It is to get to the creative parts. It's just to get to the fantasies like you just talked about. But I really believe that the bigger treatment plan is to get to know them slowly. Yeah. To look at their own relational needs. To ask about, in TA terms, their script. To be there, to see being there, these types of people, just being there and inquiring about the younger self and the neglect or the trauma, is very healing in itself because that is exactly what didn't happen. Yeah. Yeah. These people avoid them for reasons because their caretakers disappointed them, let them be down, being neglectful, being trauma, you know, traumas around this process as well. So they're not, you know, they're not like avoiding for no reason. No, no. And I think sometimes maybe that could potentially be seen by their partner is that they're being manipulative in what they're doing. You know, when they do shut down and withdraw, they're holding something back on purpose. Well, what you might see, and it's interesting, is you might see the avoiding person being in a relationship, and this may seem paradoxical to you, but anyway, being in a relationship with somebody in TA terms has got quite a high parent. Yeah. Now, then you would answer why. Why would somebody who's probably got unmet relational Marines needs about self-definition or self-agency, unmet relational needs about security or safety. So why would they pick somebody who or might pick somebody who may appear comes from a parent place a lot. And the answer is this, that the parent they probably attracted to at the beginning in the relationship was the nurturing parent who provided security, safety, structure. However, as the relationship goes on, and the perhaps the lack of close proximity, the difficulties the avoiding person has of being in relationships brings out the other side of the parent in the person. And then they go underground. Yeah. So they go from nurturing to critical parents. Yeah. And then the avoidant becomes even more avoidant. Yeah. And the really amazing thing is that the partner probably never knows they've gone till they realize after six months where it's, oh, you know, where is this, how can all these things we're talking about, because they've got internally, they're not in contact with the protecting their child. And often in couples therapy, it's teaching the partner that the person has actually cut off, gone away, avoidant, because the other person has become too critical, has demanded too much from the other person. So they become overwhelmed and disappeared in the first place. Yeah. That's that relationship. And then the avoidant, and you said it earlier on the podcast, can often pick relationships with other avoidant people, and then nothing actually happens. But it's comfortable for both of them. Yeah. So they sort of function and rub along, but nothing actually happens in terms of emotions. And for both people, if they're both avoidant, it's quite a safe relationship. Yeah. I think this is one of the things that kind of fascinated me, you know, he still does now, but certainly in the early days that everything is kind of the opposite ends of the spectrum is either, you know what I mean, there's two sides to every coin, either somebody will pick somebody that's very similar to them or the complete opposite to them and how that impacts on the person. And the more fixed their personality is, in other words, more trauma or neglect, hence more disturbance, you're not quite really likely to see them in therapy unless their partner has sent them or attempted to send them. Yeah. So it's interesting because, you know, what you were saying about being alone and being lonely, you know, they are two different things and somebody would probably be okay being alone with this personality type. Well, avoidant, if you have two avoidants, certainly, but if, but if you haven't, so the avoidant person has picked somebody to the emotional homework for them and also hasn't been overwhelmed, but the relationship starts to go that way. Then, you know, you can't out, yeah, I can't, what's the word, you can't outgun a schizoid, so as I say, they usually say try and send them to therapy. Yeah. So the work that we do is very slow and steady, stability, safe, no rush. Yeah. Getting through the thinking, make contact through the thinking, but the long term aim is to connect with the feelings. Yeah. And the word there is the one you just said in the long term. Yeah. Yeah. It's usually where treatment fails is when the therapist initiates too quickly. See, I was going to say that when we talk about long term, what length of time are we talking when we talk long term? Well, I mean, long term. Yeah, I'm going to probably may frighten off the podcast listeners or listeners when I say two, three, four years. Yeah. That's, that's what I was thinking. It's not long term as in six months that that's relatively, well, it is short term in psychotherapy world, but yeah. And, you know, these clients that I'm talking about that I kind of touched on earlier on, they're probably into six years with me now and religiously come week in, week out, unless they're on holiday. It's an interesting one though, because for the therapist, because these types of people are very passive. So the symbiosis with the therapist or on TA terms, the games that the therapist might get involved in would be about trying to think for them, doing it for them. And what happens then is that the therapist can end up in what we call a codependent relationship, easily gone for five or six, seven years. Yeah. So it's, it's a tricky one really because the level of passivity for an avoiding client is very, very high. The hypnotic induction for the therapist or the projection onto the therapist is the therapist does something for them, thinks for them, initiates things. So you've got a, you've got a wheel, you know, you know, projection on the therapist here. Now, if the therapist buys into it, you end up in a codependent relationship, which could go on for years. Yeah. And the therapist needs to do the complete opposite. And, and, you know, and, and encourage the person to think for themselves. And also to say things like give them permissions like it's okay to think and feel at the same time. Yeah. So you could get to the, so things like, well, what do you think about your feelings then? Now that's an interesting paradox for somebody who's avoidant. Yeah. Confusing. Say that again. Think about your feelings. Yeah. So, so when I say long-term therapy, yes, I might be saying three or four years, but I'm really talking about, you know, really moving away from that symbiotic trap. Yeah. Avoidant plans will manoeuvre you into or attempt to move you into. Yeah. I think for me, working with these sorts of clients, there's the temptation for them or the, you know, the attempt for them to do a lot of past timing in the session. Correct. To talk surface stuff and just past time. Then they'll dip into the feelings and the deeper stuff and then comes right out of it. In, you know, the sessions where we have really done some good work on it, it's the relationship after the next session after they've opened up and really connected with something that they kind of even more avoidant in that session as if the shame or guilt or something around having expressed feelings. When you've said it, you just said the exact words there. Yeah. Usually they'll go away. The defences come down pretty quick and it's used to shame. Yeah. So it's kind of building it back up again and then it's, you know, it's not one step forward, two steps backwards. We don't go right back to the beginning, but again, it's that safety and security and giving them permission and those sorts of things after they've opened up. Yeah, the therapist needs to understand the treatment of shame with these types of people. Yeah. Because they're usually highly neglected and they're highly ashamed for being themselves. So, you know, they will tell themselves off for any expression of feelings. Yes. Yeah. So they will shame themselves or they'll look to be ashamed. So the therapist does really need, does very much need to understand the treatment of shame to work with the avoidant personality. Yeah. Exactly. Yeah. It's very interesting, Bo. I think we're going to talk about shame. I think that's on our list of things to talk about, which is quite a good one because there's a lot of shame for the clients in the therapy room when they're making changes or attempting to do something different, particularly when we're looking at scripting stuff. So with the, lastly, the one to say one player for avoidant clients, and I know it's a tricky one, given all the things I've just said, but the relational need for initiation usually or self-agency is usually unmet. In other words, as we grow up, we need to have permission to be able to define ourselves, take ownership of our own beliefs, thoughts and emotions. Well, that is a need which usually unmet with these people. So the therapist, if they understand relational needs, needs to think about self-definition. Now, what the therapist then needs to do is start to initiate conversation. So tell me a little bit about your thinking about your feeling or some way to start to get to that younger self and the avoidant personality. It's a very tricky one. I think I've said it twice on this podcast, but it's a very tricky one because the person gets overwhelmed so quickly and often feels shamed. So it's very, very, very gentle work. If you are going to initiate, the best way to initiate is also to inquire. So when I make this suggestion, is that okay for you? If I talk about maybe what you might be feeling, is that okay for you? So you're always checking up the inquiry questions, especially if the inquiry questions are aimed at the younger child. Yeah, because those inquiry questions are keeping the connection, if they're thinking and then coming back with an answer, the possibility of them withdrawing at that point is minimised by that inquiry question. Yeah, you're keeping them in the room. It's a very, very, very gentle balance though. And the therapist needs to be on the alert for if the client gets overwhelmed or shamed. And the best way to observe that is by asking how they are from a query place and to look out for anything that might sniff of them going somewhere else and not actually being able to transact back to with you from a feeling place. So it's a very, very, very sensitive, attuned, patient type of therapy with these particular clients. Yeah, which again, it links into back in the early days of getting to know the client and that initial assessment of the client and the treatment plan and all those sorts of things. Yeah, he takes time to build up that trusting relationship. So thank you for that, Bob. What we're going to be talking about in the next one kind of links into this a little bit, I think. He's working with a client who doesn't know why they are there or doesn't know what they want from therapy. Oh, how interesting. Yes, I've met lots, well, I did, I've stopped working clinically now, but yes, I look forward to talking about that. Me too. So until the next time, Bob, speak soon. You're welcome. Bye-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.