Abstract
ObjectiveTo explore how clients in clinical settings experience the process of opening up and sharing their inner experiences in the initial phase of therapy.MethodsTwo psychotherapy sessions of clients (N = 11) were videotaped and followed by interviews. Interpersonal process recall was used to obtain in-depth descriptions of clients’ immediate experiences in session. A follow-up interview was conducted 3 months later. The interviews were analyzed using thematic analysis.ResultsThe data revealed how and why clients distanced themselves from inner experiences in the initial phase of therapy. The overarching theme was “Holding back and struggling to open up,” which included four subthemes: (a) fearing the intensity and consequences of negative emotions; (b) experiences of being incapable and bodily stuck; (c) being insecure about one’s worthiness and right to share inner experiences with the therapist; and (d) struggling with feeling disloyal to loved ones.ConclusionThe participants held back because they feared different consequences of opening up. A range of concerns led participants to distance themselves from their inner experiences and/or to refrain from openly talking about them to the therapist. Concerns related to appropriate interpersonal conduct as client were especially important. This knowledge is highly relevant to clinicians when building safety for psychotherapeutic work.
Highlights
The therapeutic process in psychotherapy is aimed at facilitating clients’ capacity to approach, recognize and reflect upon challenging life issues with openness and authenticity (Kolden et al, 2018)
In addition to opening up verbally to the therapist, various treatment orientations emphasize that it is necessary for the client to open up to and engage with personal issues internally, even when this is highly painful
Across symptom categories and treatment orientations, emotional arousal coupled with cognitive-reflective exploration in treatment is positively correlated with treatment outcomes (Lane et al, 2014; Barbosa et al, 2017; PascualLeone and Yeryomenko, 2017)
Summary
The therapeutic process in psychotherapy is aimed at facilitating clients’ capacity to approach, recognize and reflect upon challenging life issues with openness and authenticity (Kolden et al, 2018). The process of opening up in treatment sessions is far from straightforward, as apprehension, shame or fright can prevail (e.g., MacFarlane et al, 2015; Baumann and Hill, 2016; Marks et al, 2019). It is natural that disclosure of personal material can take some time, sometimes opening up may occur only after months and sometimes it never happens (Farber, 2003). In addition to opening up verbally to the therapist, various treatment orientations emphasize that it is necessary for the client to open up to and engage with personal issues internally, even when this is highly painful. Different treatment orientations encourage the client to approach. You might not have wanted to speak about it there and
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