Business Woman Talking To His Psychiatrist Explaining SomethingTherapists bother me1. For most people, this is not an issue. They can dodge therapists like politicians can dodge honest answers. Being a therapist, I don’t have the luxury of dodging other therapists. Instead, I often sit in meetings with, make multiple phone calls to, and conduct therapy near many, many therapists. Alas, enduring therapists has become a cross I have to bear, just as society will always bear the oppressive yoke of lying politicians.

As a therapist, I often find myself doing many therapist-y things, like thinking about why I dislike therapists so much. The other day I was in a meeting, a meeting of only therapists (of course), and one of the reasons I dislike therapists struck me: therapists love talking about safety.

Just about everything therapists do or say seems to come back to the idea of “creating a safe space for people to explore their true feelings.” But safety, specifically in therapy, is about as specious a promise as the promise to “Make America Great Again.” Not only is the promise a farce, but even if it could become true, the meaning of the promise rests too heavily on the promiser’s understanding of the words “great” or “safe.”

In reality, therapy isn’t safe. By definition, therapy is the process of understanding not only the self, but the context in which the self develops. At any moment, therapy could reveal that you never loved your lover, that your parents never really cared for you, or even that you hate yourself. How, I wonder, can any of this process be considered safe? The only therapy I can think of that would ensure safety would be therapy that would never be worth exploring. This is a therapy that blinds you, tells you your life at status quo is fine, and kills the desire to deepen your relationships. Therapists can’t promise safety in psychotherapy any more than scientists can promise that water isn’t wet or nuclear reactions are safe. Therapy, like a splitting atom, is inherently dangerous.

So what can therapists promise? I believe that when most therapists speak of safety in therapy they are actually referring to trust. I cannot promise my clients that exploring the depths of their personhood and context will cause them no harm, but I can promise them that they can learn to trust me in the process. I cannot promise my clients that the truths they come to won’t influence the way they look at themselves or others, but I can promise them that I will do everything I can to understand their process as they come to truth. The inherent danger of psychotherapy is valuable within the confines of a trusting relationship, just as the danger of nuclear reactions is valuable within the confines of power plants (or at least, sort of).

It would be easy to read this article and assume that the difference between trust and safety are primarily semantic and have little to no effect on the therapeutic process. But emphasizing safety over trust has drastic implications for the therapeutic process. First, when therapists emphasize safety, rather than trust, they are denying their clients’ reality. Clients walk through our doors in terrible pain and often understand the route to healing will require even more. Emphasizing that therapy is a “safe place” communicates that the expectation in therapy is that there will not be pain or that “everything will be okay” if they are able to talk about it. In my experience in psychotherapy nothing could be further from the truth. Clients have to struggle with their pain, wrestle with their insecurity, and grapple with realities that have been slowly drowning them for years. Simply telling our clients, “it’s okay, this is a safe space” communicates that their reality isn’t as pressing, that their pain isn’t as real as it seems to them. Emphasizing therapy as a safe place inherently denies our clients’ reality, blunting emotion, and neutering the therapeutic process.

Highlighting safety in psychotherapy also masks clinical information that is particularly valuable. Typically, therapists emphasize safety in psychotherapy when they experience resistance or hesitancy from their clients and feel they need to do or say something to assuage disclosure. But clients’ resistance to disclose is often a greater sign of the work they need to do than the content of what they are disclosing. Recently I began work with a client who was particularly anxious about her therapeutic work. She came into my office and began asking me questions about myself, about how I view therapeutic work, and about how I work with clients. Her anxiety about therapy was palpable. At this moment it would have been easy to assert that therapy is a safe place and it is okay for her to disclose about her own process and what she needs. Instead, I reflected:

“Talking to a complete stranger about the most difficult things in your life is pretty petrifying, isn’t it?”

The client paused and smiled, “I had a panic attack on the way over here, and I almost didn’t walk into your office.” Resisting the urge to use the concept of safety to ease her anxiety, the client and I further explored what was making her so anxious.

“What’s the scariest thing about talking to me?” I asked.

She paused again and queried, “Why do you care about me?”

“That’s a great question” I responded, “I care about you because you are in front of me.”

The client looked at me as if I were insane.

“Let me explain a little bit better. For me, therapy and healing are deeply embedded within my understanding of ethics and personal responsibility. From all I’ve studied and from all I’ve thought through, I believe that on some level everyone’s suffering is always asserting, ‘Don’t let me die alone’ (Levinas in Orange, 2011). So I believe that my duty to humanity begins with not letting people die alone. That is why I care for my clients.”

My client’s anxiety melted, and like ice to water, turned to a weeping sadness. She sobbed, “I feel so much like I’m dying with my pain and I’m all alone.”

At many points in this scenario, it would have been easy for me to emphasize safety as a means to sooth my client’s anxiety and pain. But at each juncture, I was able to emphasize trust by inviting my client to explore who I am with her. This revealed much greater clinical information than simply asserting “this is a safe place, it’s okay to talk to me” ever would.

Last, I’ve also found that many clinicians attempt to use the notion of safety to communicate to their clients that they will be “judgement free” and that they can “talk about anything.” While the notion of a person being “judgement free” is certainly alluring, the reality is therapists cannot even imagine what it would be like to be judgement free, let alone make such a promise to clients. The only way a therapist could ensure that the therapy room is actually “judgement free” is to have a complete knowledge of what a client will talk about and how the therapist would experience what the client will talk about; both of which are impossible in therapy. As a result, therapists are luring clients to a false sense of safety through lies. This “come hither” lie of being a “judgement free clinician” creates dulling, unrealistic expectations for therapy. Clients who are willing to believe this farce come away with the belief that nothing they say can influence the therapist negatively, limiting their agency within the therapy process. Clients aware of this sham must be able to rightly recognize it as a therapist’s attempt to “get into their psyche,” creating even more neutering distrust between the client and clinician.

All of these notions share a common theme: safety dulls therapy. Whether it is in denying a client’s reality, keeping pertinent clinical information covered, or lying to clients, therapy becomes less impactful by emphasizing safety. Therapy is valuable not because it is safe, but because it is trusting. I don’t want a therapist that assures me they will keep their understanding of truth out of the therapy room, I want a therapist who promises to be honest and reflective about their experience without the threat of terminating or destroying our relationship. The safe therapist promises only to pad my delusions while the trusted therapist promises to expand the very bounds of what I understand relationship to be. The dulling illusion of safety evaporates in the daring reality of trust. Or at least make it so I can stand sitting next to therapists in meetings.

1. I like to joke with therapists, because well, they are therapist. But honestly, I love therapists. I am a therapist — I even married a therapist. Sometimes we have to make a little bit of fun of ourselves because, if you haven’t noticed, we can be really weird.  

References:

Orange, D. (2011). The suffering stranger: Hermeneutics for everyday clinical practice. New  York, New York: Routledge.