Co-Creating the Session: Guiding the Client’s Attention – Establishing Optimal Distance – Leading From Behind

Natalie would always come into therapy with a lot of energy and a million things to talk about. Judy, her therapist, was stumped. “How do I get her to stop talking long enough to help her?” she asked. Joan, another client, is different. As soon as she mentions her boyfriend, she starts to sob uncontrollably. Steve, her therapist, feels helpless to help her.

While they are responding in opposite ways, Natalie and Joan both have the same problem: Neither is able to keep an optimal distance from their feelings. Natalie skips from topic to topic to avoid going into her feelings. Joan plunges in too deeply and too quickly.

Judy and Steve share a similar problem: They are unable to help their client maintain an optimal distance from their feelings. Keeping an optimal distance from feelings is vital if we are to process them successfully. This is especially true when working with shame or trauma, which are so powerful that they can quickly overload the system. The action tendency of shame is to pull in, hide and disappear; so once a client gets caught in shame, it is extremely difficult to reach her at all. And, because it is so powerful, shame—even the slightest hint of it—will prompt many clients to do whatever they can to avoid feeling it.

Diana Fosha teaches about the ability to feel your feelings and deal with life at the same time. Many people have trouble feeling and dealing simultaneously. To help people feel and deal, to keep clients at an optimal distance, is one of a helper’s main tasks. And this is not an easy task.

This is especially true because optimal distance is not static. Our distance from our emotions can change from moment to moment. Maintaining optimal distance means sometimes being closer to them, sometimes further away—but always staying within what Peter Levine calls “the window of tolerance.” Being in our window of tolerance means being able to be with our emotions, neither denying them nor getting lost in them.

My mentor, Al Bauman, always talked about “leading from behind.” The image he used was a guide helping a trekker over a treacherous mountain path. Rather than leading the way, the guide might want to allow the trekker the feeling of accomplishment of leading the way—it is after all the trekker’s trip. But the guide doesn’t want the trekker getting stuck or falling off the mountain. So the guide stays close behind. If the trekker starts to go over the cliff, the guide carefully and patiently corrects his course to direct him safely on the path. He does the same if the trekker goes off course and starts to careen into the side of the mountain. This is the role of the therapist.

How do we lead from behind? How do we stay behind our clients, attune to them, let them go where they need to go, not stifle or stop them—and still lead, still assert guidance and influence over what happens in the session? How do we co-create the session with the client? We need to be right there with the client, in close attunement, so the client will feel accompanied and not alone. And we need to be able to intervene when they seem stuck or about to go over the cliff. The client needs to feel us as both a caring friend and an expert guide. This is the paradox of effective helping.

My first encounter with the term “vitality affects” was in Daniel Stern’s The Interpersonal World of the Infant. We like to talk about emotions, primary and secondary. But there is a whole other category of affects, such as loud or soft, slow or fast. These are the vitality affects, which have a huge impact on what is felt and communicated. It is very difficult and often subtly shaming to try to change emotions or behavior— i.e., in some form conveying to the client not to feel that way or to stop self-harming behavior. However, it is quite possible to lead the client to change vitality affects during the session.

It starts with breathing. How we breathe has a strong correlation with how we feel. When clients come into a session highly agitated or depressed, their mood is mirrored by their breathing. The therapist may feel a strong pull to attune and pick up the client's feelings. She can easily go into agitation herself—or join with the client in feeling that the situation is indeed hopeless. This can happen because the therapist unconsciously picks up the client’s breathing. One of the mantras I have developed over the years is “Whoever is most committed to their breathing wins!” The client is unconsciously committed to their breathing pattern. It correlates closely with their mood. If the therapist is consciously committed to her breathing, and maintains it, she can help the client calm down.

Help the Client Ground. Establish Safety. As helpers, we need to be breathing fully and freely. We also need to be grounded, connected with the earth. Just as the client unconsciously picks up and is affected by our breathing, he also picks up our grounding.

It takes many years for a child’s nervous system to fully mature. Ideally, parents “lend children their nervous systems” to cope with stress. If a child is upset about something, she may come to the parent for comfort and calm. It is not just the words the parent says. The child empathically connects with the parent’s groundedness. As a child, I knew I could not bring my problems to my mother because she would get more upset than I was. The same thing applies to the client-helper relationship. We need to be grounded for the client to feel safe to share their issues with us. Clients are both considerate and self-protective. They will not bother us with material they feel we can’t handle. Clients need to know that we can stay grounded no matter what is happening for them. We can lend them our functional nervous system.

Slow things down. This is a universal principle that I have been taught by Sue Johnson and Peter Levine and many others. When we slow things down, the client gets to look at what is going on. There is more room for observation. We have a better chance of accompanying them. And they have a better chance of feeling us with them. When things go by in a rush, it is like standing at the station watching a moving train speed by. We can’t even see the passengers inside it.

How do we slow things down? Breathing helps. So do comments and questions. From the beginning we can establish a back and forth between helper and client. If we establish a back and forth rhythm—or pendulation—early on, there will be more room for us when we need to intervene. The back and forth will also slow the client down. We work to establish this rhythm right from the beginning. I start with clients by saying I want to make sure I stay right with them so that I can understand what they are saying. I then use the analogy of two trains leaving together from the station, heading in slightly different directions. While they are right next to each other at first, the further they travel, the further apart they become. I tell clients that since I want to stay right with them, I will interrupt if I don’t understand something so that I can understand better and be more helpful. I will also directly ask clients to slow down so that I can follow. Or I’ll ask them to stop and breathe. I might say something like “We seem to be going pretty fast here. Could we (both) just stop and breathe for a moment?”

Match Some of the Vitality Affect. One of the most famous experiments in psychology is the still-face experiment. It demonstrates an infant’s reaction to a totally still face, one without affect. The longer the mother holds her face still, without affect, the more upset the infant becomes. We need to see expression in someone’s face in order to feel that they are with us. If you feel excited and meet with someone's flat affect, it is hard to feel connected. You might feel deflated or discouraged—or pull away to sustain your excitement. The same thing happens if you feel angry or sad or afraid. While the other person doesn’t need to feel the same way you do, you need them to mirror enough of the vitality affect so you feel that they “get” you. If we are to attune to a client, we need to show at least a little bit of the intensity, concern, speed and volume they are displaying.

We can also help the client balance affect. There are times when I will help the client feel his anger more acutely by displaying the signs of anger myself—or get sad about a hurt that I feel the client is minimizing. On the other hand, I may match the client’s volume and intensity at first, then slow things down and lower intensity to help him create some distance from his feelings.

Establish Pendulation. Pendulation is a normal part of living. In life, emotions and moods move through us, one after another. We hurt our arm. We are in pain. We worry whether the injury is serious. We consider seeing a doctor. We feel stupid for having gotten injured. Then we feel hungry and think about what’s for dinner. Nobody feels happy or excited or sad or miserable all of the time. Restoring the client’s ability to pendulate gets her back in touch with the very rhythm and flow of life, which trauma and shame may have disrupted.

Pendulation also brings the client and helper together in co-creation of the session. In addition to helping the client pendulate from thought to thought and emotion to emotion, we want to establish a back and forth—a pendulation—between client and helper. It is useful to establish this pendulation from the very beginning of the session as it slows things down and establishes that the session will have a rhythm created by the back and forth between client and helper.

Guide the Client’s Attention. Slowing things down and matching some of the vitality affect will give us more ability to begin to guide the client’s attention. We cannot pay attention to everything all the time, so we choose. The client usually chooses unconsciously. We can help him make different choices.

Here are some steps:

Find Strengths and Resources. When someone is upset, the whole world can seem bad and gloomy. It is easy to lose sight of what is good, powerful, loving or happy in their life. It is our job to help the client reconnect with the good in her life. That includes both internal and external resources. Internally, what are the strengths, expertise, accomplishments of the client? What do they do well? What do they feel good about? Externally, who are the people that support or inspire them in the present or who have supported or inspired them in the past? What are the places that give them joy or solace? During what times in their lives did they experience a sense of accomplishment, connection, pleasure or satisfaction? If there are not many real resources, we can move to the imagination. One client, who had found most of the attachment figures in his life untrustworthy, was able to imagine the presence and inspiration of Abraham Lincoln.

In my work, I ask a lot of questions early on to find out what the resources are or were in the client’s life and bring them back into the client’s awareness. I will refer to these resources throughout our work together and draw on them to help balance the client’s emotional state.

The more resourced the client is, the more she is able to feel into strong emotions and still maintain clarity and a sense of being larger than the emotion. “This emotion is only a part of me, not all of me.” The client can be with the emotion, not lost in it. Peter Levine calls this “expanding the window of tolerance.”

The helper also actively serves as a resource. Many years ago, a friend pointed out to me that parenting can be quite different for mothers and fathers. If a young child hurts himself, the mother might say something like: “Poor baby. What a nasty boo-boo. Let me kiss it and make it well.” The father might say: “You’re a big boy. I know you can handle it.” Some helpers are better at “fathering.” Some are better at “mothering.” While we may be better at one, we, ideally, supply some of both. We become a resource for the client—offering both support and sympathy—and showing our faith that the client can handle the situation.

Utilize All Four Realms of Experience. Humans are complex. We experience life through various channels. In order to help clients maintain an optimal distance from their emotions —so that they can both feel and deal—Sheila Rubin and I have developed a theory of four basic ways that humans can experience the world: Cognitive, Somatic-Emotional, Interpersonal and Imaginal.

  • In the Somatic-Emotional realm, we are focused on our emotional and physical experience. In this realm, we are closest to our feelings.

  • In the Cognitive realm, we focus on thoughts, concepts, beliefs and abstractions. We are furthest from feelings.

  • In the Inter-Personal Realm, we are focused on our connection with others. This is the realm in which the client becomes most in touch with the helper—both as a resource and as another human being.

  • Children spend a great deal of time in the Imaginal Realm, making up games and experiencing creatures and situations that do not exist in the day-to-day world. Actually, adults do so also, although our imaginal life tends to be minimized in our society. We go into our imagination with movies, books, daydreams, poetry and songs. And we spend several hours every night in an Imaginal Realm—which we call dreaming. We can help guide the client’s attention to different realms of experience to deepen and enrich our work with them—and to keep them at an optimal distance from their feelings.

Utilizing all the steps listed above, we can co-create a balanced and facilitative session with the client. While the client is the expert and leads on content and works on what is important to her, the helper is the expert on how to gently guide the client’s attention while maintaining optimal distance and rhythm. In this way, we can keep the client in a resourced state in which he can feel and also deal—so he can process his emotions and, ultimately, function more effectively in life.

© 2017 Bret Lyon
Photo by Bret Lyon