5: Developing Comfort with Pain
Note: Play Therapy Across the Lifespan is created to be heard. If you are able, we strongly encourage you to listen to the audio so that you are able to appreciate the emotion and emphasis that cannot be captured by text alone. Transcripts may contain errors and differ slightly from the audio. Please check the corresponding audio before quoting it in print.
Resources and Links
Elliott, R., Bohart, A. C., Watson, J. C., & Murphy, D. (2018). Therapist empathy and client outcome: An updated meta-analysis. Psychotherapy, 55(4), 399–410.
Prologue
Welcome back to the last episode of our first season. This has been fun! I have loved getting to spend a few minutes with you, sharing my love of play therapy. Today’s episode is Developing Comfort with Pain. While I think play therapy is a lot of fun, seeing clients hurt isn’t fun at all. If you’ve listened and applied the previous podcasts, then you will feel a lot of pain with your clients. It’s the downside of high empathy. As helpers, sometimes we have the mistaken idea that the more we are upset by the hurt around us, the more we care. That’s just a recipe for burnout.
Instead, what I want you to learn is how to be comfortable with pain, without taking on the responsibility to fix it. That might sound hypocritical since clients come to us for relief from their hurts, but the best way for us to help is to create the path for the clients to do the work. Really, even if you had the most brilliant and healing plan in existence, it wouldn’t be as helpful to clients as letting them do their own work. That means that you will witness their frustration at times at not knowing what to do, their sadness at the situation they didn’t choose, or their anger at not having a voice. Their ability to honestly express those things is important for being able to resolve them.
So, I have three suggestions for developing comfort with pain. First, let the client do his or her work. I can’t emphasize this point enough, but for the client to heal, he has to have the safety and the space to walk through the pain, and you cannot do it for him. Once you fully understand this, you will begin to reframe the discomfort with pain as an encouraging step towards healing. It’s hard, but it’s healthy.
Second, don’t rush to rescue. We want to help, especially children, so our inclination is to ease the pain. “Here’s a tissue.” “It’s okay.” “What kind of things make you feel better?” But, none of this really gets to the heart of the pain, and they might send the message to dry the tears, tuck the pain back inside and put on your brave face. It might even send the message that this isn’t a safe place for big feelings. A lot of times, this comes from our own discomfort. We don’t know what to do or how to fix it, and we feel a responsibility to do so from the parents or our agency, so we try to problem-solve. Problem-solving is much more comfortable than problems. The problem with that is that the client can’t express what is most needed to be able to resolve the problem. By rushing to rescue, we short-circuit the process.
The third suggestion for getting comfortable with pain is to use curiosity instead of problem-solving. “I wonder what you are going to do?” “I’m curious to see how the little kitten gets out of this one.” This keeps the responsibility on the client, not you, yet clearly lets her know that you are right there with her on this journey. She won’t be alone, and she won’t be alone with her hard stuff.
To summarize: let clients do their own work, don’t rush to rescue, and be curious. This won’t make the pain easier, but it will make it easier for you to witness it.
Sitting in the Stuck
When older clients feel deep pain, especially when it is accompanied by a sense of helplessness to do anything about it, I call it "sitting in the stuck." That’s what we do with our clients. We sit in the stuck with them… again, without the responsibility to tow them out because this is their work.
When clients creatively express their situation using expressive arts, they see their experience from a 3rd person perspective. They may only see that the situation is beyond their power to change. Maybe the abuse happened 20 years ago or the person who hurt them has died. As they look at what they have created to depict their experience, they may feel powerless to change it. As helpers, that often triggers in us a desire to help the client get past this to be able to do the work. We feel helpless, too. Instead, the real help is to let the client acknowledge the emotions that come up. They don’t do the work after they get past this stuck. This stuck is the heart of their work.
It’s hard. It’s hard to sit with deep pain.
Adults need the space to really feel the depth of their pain. Here in North America, this isn’t socially acceptable. I’m guessing it isn’t acceptable a lot of other places, too. It’s usually not considered okay to show negative emotions… unless maybe you are on reality TV. We very rarely show raw emotion to anyone else on the planet. That’s why having a safe space to do therapeutic work includes being safe enough to feel whatever comes up when looking at the creative expression of an experience.
So, if you want to do deep, healing play therapy with older clients, learn to become more comfortable sitting in the stuck.
Research Summary
Before we dig into some research, I just wanted to echo the heart of what has already been said; that is, it is not the therapists job to fix or eradicate a client’s pain, but to see it and validate it, to learn how to lean into it with the client, to communicate that we are with them in it, and that we believe they are capable of healing and moving through whatever it is that they need to work through. This is what it means to hold space. We must be careful not to take responsibility for someone else’s process. If we do take responsibility for saving, fixing, or healing someone, the message we send is: I don’t see you as capable of navigating this, I am better than you, I am more capable than you, you are broken.
This is not what we want to communicate to our clients. What we want to communicate is empathy and validation. The belief that they have within themselves what it takes to heal. This is how empowered people empower people.
Based on an updated meta-analysis on therapist empathy and client outcome, in general, clients have better outcomes in therapy when clients perceive that their therapist understands them, meaning that empathy is a crucial and necessary element of any therapeutic relationship. This has been supported by over 80 studies and now in multiple meta-analyses. Over the last 20 years, there’s been an explosion in the research on empathy, and recently its rippled into other related disciplines.
The empathy research has several clinical implications. I could speak to so many of them, but for today’s segment, I’m just going to speak to three.
First, of all, empathetic therapists do not simply parrot words back to a client; instead, they try to understand the client’s goals, emotions, and beliefs, their unspoken nuances and non-verbal’s. Good therapists utilize reflections, specifically of emotion, to convey understanding and empathetic attunement, especially when a client discloses something particularly painful.
Second, there is no evidence that therapists accurately predicting client’s own views of their problems or experiences or self-perceptions is effective. Therapists should neither assume that they are mind readers or that their experience of one client will be similar to other clients. Empathy requires humility.
And the last clinical implication is that empathy requires individualizing. For example, certain clients may find the usual expressions of empathy too intrusive, whereas super self-protected clients may find empathy too directive. We need to titrate empathy, to know when to respond with more or less empathically-oriented responses, depending on what our client needs.
The updated meta-analysis includes several other clinical implications that may be worth your read! So, we’ve linked the article to the show-notes!
Elliott, R., Bohart, A. C., Watson, J. C., & Murphy, D. (2018). Therapist empathy and client outcome: An updated meta-analysis. Psychotherapy, 55(4), 399–410.
Credits
That’s the end of Season One of Play Therapy Across the Lifespan. I’m a little sad that it is ending, but we have plans for next season already in the works, so make sure you have subscribed so you will be one of the first to hear Season Two. That’s your action step for today. Play Therapy Across the Lifespan is made possible through the Lipscomb University Center for Play Therapy and Expressive Arts.
If you have any comments or questions, or things you want to hear next season, let us know at playtherapypodcast@gmail.com. We have links to all the research and references in the show notes for you at the website playtherapypodcast.org. A huge shout out to all of our grad students and alumni who contributed their time and talents to this podcast season: audio engineer Sheldon Clark, songwriter Sara Beth Geoghegan, research lover Rachel Sellers, and all those who ask such great questions. I’m your host, Dr. Denis’ Thomas. Go play, create, and heal.
