In Treatment

Psychotherapy is a leap of faith for patient — and therapist

Only desperation could get Joel into an office like mine. He is all about logic, a focus that works well at his strategic planning job. But it gets in his way when he tries to relate to people. He’s skeptical about the value of inner work and tends to ignore his feelings.

He made an initial appointment four weeks ago. Two therapy sessions had followed. Psychotherapy is a leap of faith for Joel and he needs evidence therapy is worth his time. We’ve covered his personal history, begun to probe his problem areas and developed a tentative bond. He feels understood, which is rare for him. But he needs more than that. I’m hoping for a breakthrough soon.

“I feel as if I’m back in my first, terrible marriage,” he told me in our first session. “My wife is always angry and everything she says sounds like criticism. I try really hard to please her, but nothing is good enough. And now my step-daughters, who used to like me, treat me like I’m the enemy.”

Joel had met his wife, Joanne, not long after moving to California. He’d fallen head over heels with her, the first time in his life to do so.

“I remember thinking she is the opposite of my first wife, Sharon,” he told me. “Sharon is like my mother; unaffectionate and hung up on order and routine. Joanne seemed open and spontaneous, and she got along with everyone — even her ex.”

Not long after their marriage, however, Joanne began objecting to Joel’s long workdays and traveling. She felt lonely, and like he didn’t really know her. At first, it seemed like “normal marriage stuff, guy-girl differences,” Joel said. So he ignored it. But over time it got worse.

Today Joel has been telling me about his efforts to discuss the situation with Joanne. “She dismisses me,” he says. “It’s like she’s saying, ‘I gave you a chance and you blew it!’ “

Despite his calm demeanor, Joel is far from indifferent about the chill in his marriage. In fact, he gets flooded with feelings of panic and helplessness whenever he thinks about it. I watch him now as his muscles tense up and his face starts to flush. Suddenly, his eyes well up with tears.

“I can see how much this hurts you,” I observe, “how worried and sad you are.”

“I am sad,” he confirms. “I don’t think anyone knows how sad I am. And I hate being this way, too. That’s why I love work. Work is the perfect distraction.”

“Do you ever just let yourself be sad or angry," I ask, "without pushing it away?”

“Not if I don’t have to,” he answers. Then his voice takes on an earnest tone. “I hear people talk about working with their emotions but I really don’t know what that means. Emotions don’t have any structure or mass. They just appear and take over! And what's the point of letting that happen?” he adds. “To start ruminating about bad things or sit there boiling with anger?”

“I used to wonder the same thing,” I say. “But somewhere along the way I realized that ignoring my feelings doesn’t make them go away. They just pile up — like yours have. Then they start leaking out in sneaky ways and sabotaging things.”

Joel lets that sink in. Then he nods.

I decided to take a small risk. “Perhaps that’s happening to your wife, too.”

My comment hangs in the air a minute while Joel thinks. Then he speaks slowly. “Maybe you are right. Neither one of us is acting like ourselves, or at least they way we want to be. And she does have reasons to be mad.”

“Perhaps you are both confused about how to connect right now," I say, "overwhelmed by difficult emotions and unsure of what to do with them.”

“I think you are right,” Joel agrees. “And you know what is strange? I feel like I’ve been in this situation over and over again. It is like history repeating itself, just with different people.”

Joel is making progress. Earlier sessions touched on his unhappy first marriage and his difficult childhood. He does seem to be stuck — re-enacting destructive patterns from the past.

“That could very well be the case,” I acknowledge. “You may be reliving old, similar, wounds.”

“What do you mean?” he asks.

I see an opportunity to make a connection that would give Joel’s analytic mind some data to chew on. But I want him to find it himself.

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“Let’s try something,” I say. “Can you think of a recent time when you were very upset about something that, in reality, was not all that earthshaking?”

“Last night,” he replies. “I made a point to be home for dinner and told Joanne I’d be there at six. But when I got home, she wasn’t there. She arrived at 6:30. By that time, I was stewing but I didn’t say anything because I didn’t want to start a fight.”

“What emotions were you experiencing?”

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“I was angry and resentful,” he says. “I felt like my effort was unappreciated and that I can never win with her. I felt unimportant and not loved.”

“That’s a lot of bad feelings,” I say. “Do you feel them anywhere in your body?”

“I feel tense in my chest and the top of my head,” he responds.

“Can you spend a moment noticing the emotions you mentioned and the feelings in your chest and head? If you allow yourself to float back as far as you can into the past, what is the earliest time you remember having those feelings? Don’t look for a similar situation, just similar feelings.”

Joel took a long moment. “There are actually a lot of times,” he says with a tone of surprise. “But the earliest one I remember was when I was in fifth grade. I had cleaned the kitchen for my mother. It was one of my chores and I had decided to do a super good job. I spent hours on it and it looked perfect. But when my mother came in, she wasn’t impressed at all. She just scolded me for leaving the sponge in the sink. I was crushed.”

Joel once again has tears in his eyes. “It was such a small thing but it hurt so much," he says. "I remember it like it was yesterday.”

“You tried so hard to please her and it just didn’t work.” I say.

“It never did,” he replies.

I’m happy that Joel stayed with the process and let his feelings guide him to an important memory. He’s starting to work with his emotions, despite his discomfort. Now for one more step.

“Can you link the feelings you had last night with the feeling you had with your mother?”

“Yes, I can,” Joel replies. “They are the same.

“Wow,” he adds. “I never would have made that connection.”

Now I am thinking, “Success!” And I want Joel to have more of it.

“Now you have made that connection, you will start to make others,” I say. “And you might find that your emotions, and Joanne’s too, start making more sense.

Joel gives me a smile. I feel like we turned a corner. Our true collaboration has started.


Joel is not real. He is a fictional character who has much in common with many real-life therapy clients. I created Joel by giving him a history, a set of current circumstances and a certain disposition. Then, like many fictional characters, he developed his own voice. At that point, we began therapy. This is the first of a series of articles designed to show the unfolding nature of psychotherapy and how at least one psychologist might guide that process. If the client were someone other than Joel, with his particular needs and worldview, the session could have gone quite differently.

Alexa Foster is a clinical psychologist that specializes in trauma. Her psychology practice, Off the Couch Psychology, is located in Mission Viejo, CA. You can reach her at

Tags: well being