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As a PTSD therapist, is it okay to show my emotions in sessions?

Therapist are people, not robots. Especially when working with PTSD, we hear some very distressing things and it is a normal, human reaction to feel upset at times. Furthermore, our clients do not want us to be robots; showing an emotional reaction to their stories tells them that we are listening and that we care. Sitting completely poker-faced when someone recounts a horrible experience will feel and come across as unnatural and unfeeling.

Having said that, therapy is about our clients, not us as therapists. We don’t want our clients to hold back from telling us certain things for fear of upsetting us. Nor do we want to give the message that whatever has happened or whatever is in their mind is intolerable or should not be spoken. No matter what it is, we can hear it and will still accept them. Therefore, while showing an emotional reaction is fine, our response should not dwarf our client’s, nor detract attention from them. As a wise supervisor once told us, “it’s okay to cry with your client, just try to start after they do and stop before them”.

As we have written about before, certain types of trauma or other aspects of a case may strike a chord with us particularly for some reason. Perhaps a story is very close to our own, or a client reminds us of a family member or friend, or we are simply going through a difficult time ourselves. If so, our emotions may be particularly close to the surface or may feel overwhelming and we might need to take steps to protect both our own wellbeing and the therapy relationship. Taking this to supervision is a good place to start as well as prioritising our self-care. If we regularly find ourselves becoming distressed in sessions or feeling upset for a long time afterwards, it may even be time to take a break from trauma work.

It is also good to be aware of our own therapist (and supervisor) schemas, as sometimes strong feelings in sessions arise because one of our “emotional buttons” has been pressed. This might relate to our feelings towards injustice, our helplessness in the face of someone else’s suffering or a need to rescue and make things right. Completing your own schema inventory, for example, the Therapist Schema Questionnaire (Leahy, 2001), can help you identify these emotional buttons, and how they might impact on your therapeutic style.

Where strong emotions suddenly arise, both positive and negative, it can be useful to take a step back and observe what our client, or their material, is bringing up for us. This is most important when we feel a very strong push or pull to say or do something outside our normal comfort zone. Often this a sign that a powerful schema has been activated, which might not necessarily be adaptive to our role as therapist. For example, we might jump in to reassure someone that their trauma was not their fault, rather than giving time and space to Socratically explore what it would mean if they were to blame (or others blamed them). In supervision we find it helpful to reflect on these strong sudden feelings of being pushed and pulled, by using the ideas from the “Drama Triangle” formulation of victim, perpetrator and rescuer/bystander roles (Karpman 1968).

Practice points

· Showing an emotional reaction to disturbing details of a traumatic experience is natural and shows our clients we are human

· However, our reaction should not dwarf our client’s nor draw attention from them

· Some stories or clients may strike a particular chord for us

· If we are having difficulty with the emotional content of therapy, we need to take steps to protect both our own wellbeing and the therapy relationship

Further reading

Karpman, S. (1968). Fairy tales and script drama analysis. Transactional Analysis Bulletin, 7(26), 39-43. Available at Leahy, R. L. (2001). Overcoming Resistance in Cognitive Therapy. New York, Guildford.

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