My Old Wobbly Ladder (why building trust in psychodynamic therapy is an essential part of change)

Why do trust and safety play such an essential part in change?

How did I get to DIY as an analogy of trust in the therapeutic process?

What are four essential factors in therapeutic change?

Well…… Read on to find out more.

I am the honoured owner of two ladders; one was an impulse purchase some 15 years ago from an online shopping channel, the other a recent, more considered purchase. The first is one of those telescopic ones; it collapses down from 12ft to around 3ft high, the latter a sturdy aluminium two-parter, with a wide stabiliser on the base.

A touch of background: My wife and I purchased a smallholding on a small Scottish Island a few years ago. The house itself is generally in good condition; however, the numerous outhouses were poor to ruinous. So, with much help from Clint and Adam, two friendly local builders, I have been mending, re-roofing, demolishing, rebuilding, painting and preserving as fast as I have been able before the winter storms come.

What about trust.

A few months ago, I was inspecting one of the large byres' (an animal shed) roof trusses for woodworm, my wobbly ladder tied to a beam but still wobbling beneath me. And I thought, 'I'm right at the full length of this old sectional ladder, and it is moving all over the place; why am I using it rather than my sturdy new one?'

Realisation came.

I suffer slightly from vertigo, and in my need to feel safe, I had instinctively reached for the ladder I have learned to trust, even though it was not, in reality, the safest option. Having gone to fetch my sturdy ladder, I reflected on the nature of trust, relationships in general and how a solid, trusting foundation is vital in therapy.

Many years ago, as a therapy client, I found it very hard to trust my therapist, to be trustful of anyone, and I sometimes would not engage in communication in sessions for extended periods; silence was my best defence. At the time, I believed I had nothing to say; later, I understood that I was scared, too distrustful to take the risk of letting my words out, and to some extent, I was testing him.

What's the point of trust in therapy? Isn't it just a paid chat? Get stuff off your chest like talking with your friends? No, it is not a paid chat; we are not paid to be people's friends, and the talks in counselling and therapy are unlike most other forms of communication.

But what's the point of trust?

The point of trust is that, with limited exceptions, most psychological harm is caused by a rift of healthy or safe contact between a person and their environment. When I say healthy, I mean in tune with a person's needs, accounting for age, ability, safety and allowing for the fact that we all have differing needs.

However, some requirements are universal; for example, the need to be free from physical or psychological harm and coercion springs to mind.

Try this exercise. Imagine sitting on a chair, trusting that the chair will be there for years to come, to meet your posterior supporting needs. You build trust in the chair; when you sit, it will hold your weight not just adequately but well. Now imagine that randomly, the chair will move, disappear or grow spikes and hurt you, a little or a lot. Even if it only happens occasionally, how long a time will it take before you entirely lose trust in the chair? AND what if there are minimal alternative chair options available, so you HAVE to use that chair, OR you have become accustomed to the one chair and don't see the other options available anymore? Not good? Then ramp that up to the importance of being in an inconsistent or unsafe family system or in a harsh environment with little or no possibility of moving to a better one. How long would it be until your main focus is on navigating this unsafe and unpredictable chair, and there is no room left for you to explore and discover your needs, safety and comfort, what YOU want from a chair?

When a person feels unsafe, significantly in childhood though also very much in adulthood, their 'range' of thinking, feeling and behavioural responses will narrow, become repetitive. To grow as people, we need to express ourselves and, very importantly, to experiment, try new things.

Thomas Edison, the inventor, did not invent one lightbulb; he tried dozens of different designs, most of which were relative or complete practical failures. He then could learn from each 'failure' and pick out the ones that worked the best. People who are scared or lack trust do not readily try something genuinely new and can fail to reach their potential. Additionally, needs, creativity and growth energies may be suppressed, buried (Donald Winnicott) and will not be rediscovered while unsafety and lack of trust in self and others remain. So people are left with maladaptive coping strategies rather than a flexible and creative approach to learning. Maladaptive coping strategies include behaviours that result in or centre around anxiety and depression, intense or painful relationships, rigidity and rules, criminality, drink and drug misuse, repetitive risk-taking, withdrawal, habits or feelings people would like to keep secret and overcompensating – driven-ness.

Therapy is fundamentally a creative process, a discovery of new thoughts, feelings, perspectives or behaviours. On a physical level, it is changing old and creating new neural networks.

Another aspect of trust is protection; a client will often present with a negative or punitive internal dialogue. The client will need to build confidence in the counsellor or psychotherapist to understand this and learn not to be intimidated by what can feel like insurmountable levels of inner anger and criticism. It is important for a client to trust their therapist to be undaunted by what scares them. A gentle therapist can be potent; a timid or unreliable therapist can have limited effectiveness in assisting a traumatised client in facing down their history.

So what's the 'secret' of building trust in the therapeutic process? Well, it isn't one factor; there are, to my mind, five:

First; Time, Time, And More Time. It is a frustrating part of the process. My job is to get you back out the therapeutic door as swiftly as possible, but there is no substitute for time. There is no 'Get over it'; it is a challenge to change the way we think and feel that involves learning, discovering new perspectives against sometimes stiff resistance, and experimentation when this seems impossible.

Depending on the already established levels of internal support, some people may need only a short time in therapy; others may need a more extended period.

Second; Right Thing At The Right Time. I have seen inexperienced therapists reading from an internal textbook and pushing for deep feelings and thoughts right from the first session; because we're supposed to get to the 'inner self', right? Well, some people will come with their feelings right there; others may take weeks or even months to be ready to explore their feelings and look to discover new ways, should they want to. Whichever way, in twenty-four years, I have never known a client to come and tell me everything about themselves right away. No matter how open they are, something is always held back until trust forms. If a counsellor or psychotherapist badly mistimes a question, communication or intervention, it can result in a client's internal door slamming shut.

Third; Empathy. Training and experience can go a long way to producing a competent psychodynamic counsellor or therapist. It is essential to know how people work and understand that people don't just think differently; they have widely differing ways of thinking, feeling, processing, and experiencing themselves and the world. The psychodynamic approach is advantageous when helping people who get 'stuck, have complex histories, or engage in hamster wheel behaviour patterns in relationships. On top of training, empathy helps a therapist tune into a client's internal experience and appreciate their challenges.

Fourth; Safety And Focus. To be safe from; all forms and types of harm (by inclusion or omission), coercion, disapproval or violence, be that physical or psychological. Safety in therapy requires privacy, respect and sensitivity around information sharing. There is also a need for precise boundary setting, applied with a degree of flexibility if needed, as agreed between the two or more participants. The focus of sessions needs to be on you, the client, people are complex, and we need time and space to understand our challenges and needs.

Fifth; Reliability and consistency: Your therapist needs to be reliable, turn up to arranged appointments and be reasonably consistent in their methods and moods. Many people who come to therapy are familiar with being trepidacious around a 'moody' parent figure or changes in family circumstances. There is a caveat to that; sometimes, it is necessary to 'shake things up', challenge or change things around, but only within the considerations of the second requirement.

Conclusion; only if the above are adequately and skilfully applied are the optimum conditions for growth present in therapy. What stays hidden from ourselves or is not sufficiently shared with another does not usually change; this is especially true with deep hurt. There needs to be trust and safety present to enable a real inner focus to facilitate a deeper understanding of self. Trust and safety create the conditions to allow our desires and innate wisdom to make themselves heard. Trust and safety are different from dependence, where the focal point is building an external support framework. In contrast, though therapy may involve a time of relying upon another, ultimately, it is about building internal resilience and skills for future discovery and learning as we grow.

Outside of therapy.

I am very familiar with self-punitiveness. Before I went to therapy, I would berate myself for the slightest digression from what I saw as the right way to do things or in my efforts to care for other's needs. My therapist was patient; he understood I was traumatised and fearful. He was undaunted by the terrifying experiences I was attempting to deal with, and he allowed me time to work at my pace.

See my entry on The Good Self – Self Relationship to get some tips and tools. Read Here >

'And pray for a good physician, like a ship to pass in the night' The Stranglers, album Feline, 1982.

Thanks, Bob, you were the right therapist at the right time.

While I am sad to let go of my trusty old ladder, I will be using my new sturdy one in the future.

'And pray for a good physician, like a ship to pass in the night' The Stranglers, album Feline, 1982.

Thanks, Bob, you were the right therapist at the right time.

While I am sad to let go of my trusty old ladder, I will be using my new sturdy one in the future.