Sep

23

2019

Intimacy in counselling

Brighton Therapy Partnership recently hosted a workshop on intimacy in the therapy room, looking at how intimacy can be a vital step in building better relationships with clients and supporting them. The workshop was run by attachment-based psychoanalytic therapist Linda Cundy. Whilst it was packed with insights over the course of several hours, we wanted to summarise the most important issues around intimacy and counselling for everyone here.

What do we mean by intimacy?

First up, it’s important to address what we mean by intimacy in counselling and psychotherapy. Multiple definitions of intimacy have been suggested. A few of them are laid out here:

  • Intimacy is a quality of a safe relationship in which we feel heard, held, considered, respected and accepted – one in which differences can be tolerated and conflict does not destroy.
  • An “I see you, you see me” moment that could take place in any relationship, even a glance between strangers.
  • Something that is felt in the space between two people, hard to articulate or pin down, most probably created by body chemistry.
  • A moment of unscripted spontaneity between two people.

When it comes to therapy, the definition alters a little. Intimacy occurs in the therapy room when a therapist (or client) takes a risk to say or do something surprising – shocking even – that cuts through the defences. It can’t be contrived or planned, it isn’t part of the therapist’s usual repertoire. It comes from somewhere else, “beyond technique and theory” (Stern et al).

Should we encourage intimacy with clients?

So, intimacy sounds like a good thing to have in the therapy. Should we be encouraging intimacy with clients? Well, broadly yes – but with some caution.

Intimacy begins with our earliest experiences of attachment – the hallmark of secure attachment being a capacity for intimacy. The securely attached adult has the ability to risk letting their guard down even when they don’t know what’s going to happen next. Our aim as counsellors is to support our clients to develop ‘earned security’ through experiencing a secure relationship with us. So a hallmark for effective therapy can be seen as the client achieving the capacity for intimacy in the room.

These powerful person-to-person moments can be hugely transformative. This is because what the client expects will happen in the relationship, doesn’t. Their inner working model is partially deconstructed and reconfigured (Stern et al).

intimacy connection

Intimacy is about those moments of connection when you can feel the barriers break down. They can hugely transformative, and powerful in therapy if handled in the correct way.

But moments of intimacy don’t feel safe. It is “on the edge relating” where we – therapist or client – are taken by surprise and put on the spot. We have no option but to respond in a real way, as ourselves, and anything could happen! This is why building safety into the relationship first is really important.

How to create a safe space for intimacy

For intimacy to occur, there needs to be a sense of safety in the therapy room, or else the client will be resistant to the process. There are a number of ways in which safety develops during counselling and therapy. Some occur naturally over time between client and therapist; others require more considered planning on the part of the therapist. We should strive to commit all of these if we wish to see intimacy flourish and find breakthroughs with our clients.

  • By being consistent – holding our boundaries, and reliably offering our warmth and interest each week
  • Through weekly rituals – the client who always pours herself a glass of water at the start of the session, or who begins with a brief discussion of the weather, or the therapist who opens the session with a smile and a “where shall we start?”. These rituals, developed organically over weeks, months or years, offer comfort and reliability.
  • Through attunement – just like the ‘good-enough mother’ judges how much noise, play or other external stimuli her baby can tolerate, so should the good-enough therapist judge when in the relationship their client can take the moment we are offering. We can do this by paying attention to our counter-transference, and making the relationship between ourselves and our clients something that is regularly discussed.
  • Through humour – A shared joke, even an appropriate level of teasing (both ways), can help create safety within the therapy relationship.
  • By knowing the client’s story – and knowing that the client knows you know their story.
  • By openly and explicitly anticipating potential ruptures with the client – so that when they come, they can be viewed as part of the process and measures can already be in place for how we might approach repair.
  • By creating a strong working alliance – complete with a contract to show up for sessions even when feelings run high.
laughter intimacy

Laughter is a uniquely human expression and one which can foster great intimacy in any relationship, including a therapeutic one.

What does intimacy in the therapy room look like?

So far we’ve explored the qualities and characteristics of these elusive moments of relating in more general terms, but what about pinpointing moments of intimacy we’ve actually experienced in therapy? Here are some examples that were shared at the workshop. These are real comments from clients to illustrate how intimacy feels:

  • “I was so upset and feeling so uncomfortable, looking anywhere in the room except at my therapist. He bent his head down to engage his eye contact with me, smiled kindly and said “Hi”. It was as if he was trying to find me. It felt hugely powerful.”
  • “At the end of a very intense session, my therapist asked me how I felt the session had impacted me. Ever the avoidant, I said “I’m fine, it didn’t really have that much of an impact to be honest”. My therapist responded with “Bullshit!”.
  • “I was sharing my worries with my therapist and it began to spiral, till I was catastrophising about all kinds of worst-case scenarios as if they were definitely going to happen. All of a sudden my therapist started laughing. Then I started laughing too. Being able to see the humour in how carried away I had become was a huge relief”.

By looking at how we create intimacy in the section above, coupled with these examples of the sense of intimacy unfolding the therapy room, we can see how therapists can carefully craft an atmosphere and ambience of intimacy during counselling.

What about the risks of intimacy?

Creating and experiencing these potentially transformational moments of intimacy with our clients does come with a danger warning. Here are some of the things we need to be aware of:

  • Intimacy happens when you don’t know what’s going to happen next. This can be highly distressing for clients dealing with unresolved trauma, especially if the trauma occurred in an intimate relationship with an attachment figure.
  • A mis-judged moment of ‘on-the-edge’ relating carries the risk that the client will feel angry, humiliated or shamed and either retreat or leave therapy altogether.
  • Intimate moments can feel seductive, which could lead to confusion about the therapist’s motives.
  • The client could attack (verbally, or otherwise).
  • The client could make a formal complaint, or slander the therapist.

Every client reacts differently to growing intimacy, so it’s important that we should attune ourselves to how they’re feeling and walk a fine line between developing intimacy in the relationship without pushing too quickly.

Intimacy and attachment styles

As counsellors we are well used to considering how our clients’ attachment histories may be affecting the work we are doing and the quality of the relationship between us. When it comes to understanding the impact of intimacy in the therapy room, attachment should be a key part of our clinical thinking once again. Let’s take a quick look at how intimacy can unfold with different attachment types in therapy.

Secure

Securely attached clients should be the group in which intimate moments can occur with relative ease, once the therapeutic relationship has been established safely.

Avoidant

Avoidant attached clients are armoured and prone to shame. Intimacy with the therapist is much wanted but much feared, and when it is experienced it can feel so painful that there is an immediate retreat (Orbach & Eichenbaum, 1987:64). Attunement is key here – paying close attention to the client’s outer signs which reflect their inner emotional state. This will help set the pace for how soon we can ask the client for emotional and personal vulnerability and disclosure.

Anxious

Anxiously attached (or ‘preoccupied’) clients need clear, defined and consistent boundaries in order to create the safety in which intimate moments can occur. These clients can often become enmeshed in relationships, inviting merger rather than intimacy (think of the client who regularly brings gifts, is reluctant to leave the room at the end of the session, or sends lots of emails between sessions) . We need to support the preoccupied client in their search for autonomy, as intimacy can only occur when we are emotionally separate from the other. In order to feel autonomous, some anxiously attached clients need to attack the therapist (via ruptures, anger etc) and the therapist needs to survive the attack. This process supports the client to separate from the therapist, rather than become enmeshed.

Disorganised

For clients with a disorganised (‘unresolved’) attachment pattern, safety is the goal of therapy. It could take years before the relationship feels secure enough to allow for unpredictable moments.

The therapist’s attachment

Let’s not forget however, the significant role of the therapist’s own attachment style when it comes to intimate relating in the therapy room. This will manifest slightly differently with each client attachment pattern and will of course impact the relationship dynamic with our clients.

Research has shown that when avoidant clients work with avoidant therapists, the significance of the relationship between them is more likely to be underplayed (Mohr et al., 2005) and when an avoidant therapist works with a highly anxious client, they may find it challenging to attune to the client’s bids for intimacy and vulnerability (Marmarosh et al., 2014). When avoidant clients work with preoccupied therapists, they may experience the relationship as too intense because the therapist wants a level of intimacy that initially repels the client (Connors, 1997 as cited by Mohr et al., 2005). And a preoccupied therapist may find it harder to ground and regulate a preoccupied client than would a therapist with a less anxious attachment style  (Marmorosh et al., 2014).

June Lin-Arlow has put together a fantastic article on the impact of a therapist’s attachment style on the client relationship.

Intimacy and counselling

Overall, intimacy is something that can be a powerful tool in working with clients. It can help us proceed to towards important moments of discovery and rupture, and progress the therapeutic process when handled in the correct way. It is up to us as therapists to understand how we can foster a greater intimacy with a goal of supporting clients through a stronger relationship. However, it’s also down to us to foster this intimacy in a responsible – to take great care as we push for greater intimacy in the therapy, and also be aware of how attachment styles at play can alter the process of developing a more intimate relationship.


This article on intimacy in the therapy room was written by workshop attendee and counsellor, Amy Benson.

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