Recently, I received an email from a reader asking for some help. He knew his cognitive behavioral treatment (CBT) which had gone well for several years, hit a snag. He felt his hidden obsessive thoughts about his therapist were getting in the way of the treatment's progress. He asked me if there were any CBT techniques to help him get past this road block. He said, "...this obsession really
is quite disturbing to me. I feel that it is not fair [to] the therapist
who is not seeing me make any progress. Any advice would be more than
appreciated."
Here, edited a bit, is my response...
What you describe is not uncommon in many forms of psychotherapy, so please do not think poorly of yourself for it. We call it transference.
Transference in psychotherapy is defined as an unconscious process where the attitudes, feelings, and desires of our early significant relationships get transferred onto the therapist.
As your relationship with your therapist deepens, the situation triggers familiar feelings related to previous connections with others, like to your parents, for example. You begin to experience the therapist, in the present, in much the same way you had experienced a significant person from your past. Sigmund Freud, the great grand-daddy of all therapists, was the first to observe this process.
You do not say what form the obsessive thoughts you have about your therapist take, but regardless of whether they are positive or negative, sexual or parental, taking a look at these thoughts can be an important part of your therapeutic process. In other words, instead of giving you some specific CBT exercises to 'get rid of them' I would strongly (and gently) suggest you talk with your therapist about them directly.
I know... this is very hard; I hope I am not asking too much. From what you write you have a reasonably good working relationship with your therapist. You have worked together for years, only now you are both feeling 'stuck'. It could very well be these transference feelings are blocking your progress, as you suggest. As therapists we are trained to help our clients process transference thoughts and feelings in a way that is helpful to you, for your emotional growth.
Since you ask for a CBT technique I will share one that I often use for clients who are faced with doing something they dread. It's called 'Biking up the Hill'.
Imagine you are at the bottom of a big hill and you want to get to the other side, only there is something very scary at the top of the hill (in this case opening up to your therapist about your obsessive thoughts). You work hard biking up the hill but the closer you get to the top where the scary thing is, the more anxious you become. This is a very human feeling; many times we get so anxious we give up, and go back down the hill the same way we came up.
In CBT we recognize that retreating WORKS! Unfortunately, we are less anxious when we turn back, which just reinforces our avoidance. The problem is we still want to get to the other side, so we become frustrated (stuck). Visualize a good outcome when you open up to your therapist. It takes some practice but by repeatedly telling ourselves the anxiety will go down (AND STAY DOWN) if we would only get to the top, through the scary thing, then we can coast over to the other side. Only then are we truly free of the anxiety!It is annoyingly true that the anticipatory fear we experience (imagining telling your therapist about your thoughts) is much greater than how we actually feel after doing the dreaded thing (opening up to your therapist) and afterward (leaving the office with relief). This has happened to me SO many times, in all kinds of situations, and each time I'm amazed at how true this is.
I wish you the very best,
Dr. Aletta
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