Scattered Thoughts on Therapy Supervision and Client Self-Advocacy

For tonight, it's another copy of a blog post response. This one was in regards to a question asking about therapists and whether they seek consultation regarding their clients. Do they talk about clients outside of session? What happens if the therapist thinks transference, or even countertransference, is happening?

My response wound up touching on several issues regarding the client-therapist relationship. This could perhaps be cleaned up into more targeted posts on various aspects, but I've been trying to do more of getting general content out the door and like how I phrased a lot of these thoughts.

Response...

I found this to be a decent read regarding transference.

It's hard to say with zero context. One thing I hate about therapy is that there is no referee. There's no second opinion to turn to. I hate the position where a client has a worry about a behavior of a therapist, and it's hard to know if it's founded or not.

With no-one else around, we're forced to reply on our own judgement, and that can be such a hard spot to be in. Especially if we feel that we don't have enough information to judge.

At the least, I'd say it's a yellow flag. And yellow flags aren't red because sometimes they are nothing. It also sounds like this is maybe something more akin to idle speculation versus any specific incident?

If it's more of a general curiosity and not anything specific, here's one read on counselor supervision. And, one way to frame this - it can be a good thing if someone is seeking help. Especially if they're ethical about it on things like not revealing details of the client (which is their legal obligation). Think about like any other job - most people ask questions of others in a given field. Therapy has some important specific caveats given the task at hand - very vulnerable and private work - but beyond that it makes sense they'd want to consult outside help / resources as needed.

And, one final note - it's also okay to question a therapist's expertise on your given condition / issues. My personal experience is that therapists will oversell their capabilities. Oftentimes it's very well-meaning. They want to help. They think they can help. But that desire to help can blind or overshadow them admitting that they may not really know what exactly is wrong with you or how to help. When are they feeling confident versus when are they guessing / grasping at straws. It, again, unfortunately thus falls on the client to self-advocate for more upfrontness about such matters.

And, sometimes, non-experts can still deliver good results. Therapy is a very individualized experience. And a lot of it does wind up being more like educated guesswork than guaranteed perfect formulas for success. To me, how the therapist answers questions that are respectfully critical is just as important as the content of the answers in and of themself.

Mental Health and Polyvagal Theory and the Sympathetic & Parasympathetic Nervous Systems

Note: I am not a medical professional. I'm trying to make this "close enough" but not technically 100% correct.

Note: First draft posted 12/13/2020. May come back to edit further and/or build this article out.

Note: This article is not meant to endorse or criticize the study of polyvagal theory or its use is modern pyschotherapy.

Response to a request for simpler language about the terms polyvagal theory and parasympathetic nervous systems...

You have a nervous system. Nerves control communication in the body.

There are multiple subsystems within the nervous system. Sort of like divisions at a company (HR, sales, ect.). Different sub-systems have different roles/jobs. All of these jobs are about communication of one kind or another.

One set of jobs is the body telling your organs what to do. Things like heart rate, breathing rate (lungs), ect. The nerves responsible for this are called...

- The sympathetic nervous system

- The parasympathetic nervous system

The sympathetic nervous system tells the body when to be on alert. Be hyper. Be aware. Be vigilant.

The parasympathetic system tells the body what to do when at rest. Less awareness. Focus on things like digestion. Not over-expend un-needed energy. Be restful.

All of this came into the therapy world as theories developed around poor mental health linking to an overly active sympathetic systems (on alert all the time) and an underutilized parasympathetic system (never at rest).

One idea that gained popularity was a concept to sort of manually trigger and train a person's parasympathetic system to be used more.

The term "polyvagal theory" relates to these studies. The vagus nerve is a main nerve within the parasympathetic (relax) nervous system. Polyvagal theory, in part, relates to studying this system's relation with such concepts as stress and emotional health. Polyvagal theory techniques might, for example, include learning to train oneself on new breathing patterns. Which would serve to (in theory) activate different nervous system responses with a goal of ultimately (again, in theory) resulting in differing overall emotional responses. 

To learn more...

1) Aspects of this are covered in chapter 5 (Body-Brain Connections) of the book The Body Keeps Score by Bessel van der Kolk.

2) Here is an article I liked about polyvagal therapy being used as a therapy tool: Polyvagal Theory in Practice