In order for psychotherapy to be truly effective, establishing a strong sense of trust within the therapeutic relationship is crucial. This trust hinges on the presence we embody, characterized by sensitivity, acceptance, and empathic attunement. With this kind of presence, clients can have a felt sense of being seen, accepted, and supported, but it is important to understand that trust goes beyond these qualities of presence. Trust is also about knowing the therapeutic relationship can withstand the discomfort that arises when we challenge our client’s unskillful patterns and the inevitable tension about the changes necessary to initiate longer-term transformation. In other words, the relationship must be able to handle enough stress to facilitate the change the clients are hoping for.
Optimal Stress: The Fulcrum of Change
Optimal stress in psychotherapy might be described as a process of finding the delicate balance between offering challenge and support.  If we shy away from challenge and only provide support, we may unknowingly foster avoidance and complacency. Without enough stress, new growth and mastery cannot occur.
The goal of introducing challenge is not to overly distress clients by bringing deeply buried or defended parts of their personalities to the surface. Instead, the aim is to uncover the layers of anxiety or conflict that contribute to unhealthy patterns. Defenses have been constructed to suppress inner knowing and we have an opportunity to create a safe enough environment to support the loosening of these defenses.
By introducing optimal stress, or the right amount of challenge within a supportive relationship, we seek to disrupt the status quo and, rather than provoke, uncover, just enough anxiety for clients to process and examine. Although it is true that this intentional disruption offers the opportunity for growth and change to arise, the way we help our clients contact their anxiety can make the difference between using it for growth or contributing to overwhelm. And while it is understandable that many clinicians may be inclined to avoid challenge, as it can bring about discomfort and resistance, doing so inadvertently sends a message to our clients that we doubt our capacity to handle the stress together.
It is important to strike a delicate balance when uncovering anxiety and/or conflict. Pushing too hard or at the wrong moment can trigger stronger defenses, potentially leading to a sense of overwhelm or emotional breakdown. The intensity of what is being seen or felt may simply be too much for people to handle or integrate effectively. Therefore, we must stay attuned to both our own and their internal experiences and carefully gauge the optimal level of stress required to facilitate a shift in awareness.
This involves the skillful navigation and mustering of courage to push people beyond their comfort zones, while also providing a secure foundation of trust and collaboration. By carefully attuning to clients’ internal signals, as well as our own sensations and intuitive leanings, we can determine the right timing and intensity of challenges. This dynamic interplay between support and challenge forms the fulcrum of change, allowing clients to gradually unravel their defenses, explore new possibilities, and ultimately embark on a transformative journey of self-discovery.
Attuning to Our Internal Experience to Initiate Optimal Stress
While there are many indicators of a client’s readiness or openness to be challenged, such as their behaviors, attitudes, body language, or demeanor, we can rely on our own internal experiences, including bodily sensations, emotional states, and intuitive insights, to determine when, how, and whether to uncover unconscious material that would cause stress.
For instance, if therapists push too hard or at the wrong moment, clients will give signals that trigger physiological or emotional changes in our system. Similarly, when we hold back and avoid challenging clients, we receive other kinds of clues that are felt through emotional and somatic sensations. These internal signals and sensations are valuable cues for determining optimal timing and approach to providing stress. As we consider pushing our clients so they can stretch into new versions of themselves, turning inward allows us to be finely attuned to the nuances of the therapeutic process and helps us discern our next steps.
For example, when we sense that a client is on the verge of an important breakthrough, we may experience a mix of anticipation, excitement, and perhaps a tinge of nervousness. Our bodies might feel a surge of energy or a tingling in the chest, signaling our readiness to engage in this transformative work. At the same time, we do our best to remain vigilant of any personal biases or past experiences that might impact our judgment or approach. By tracking our somatic experiences, we have a better chance that our interventions are in the best interests of our clients, with less influence from our own unresolved issues or limitations.
By cultivating attunement to our internal experience, we become more adept at navigating the fine line between supporting and challenging our clients. It is through this attunement that we can make conscious and informed decisions about when to gently nudge, when to hold back, and when to meet our clients where they are. The interplay between our internal signals and the external cues from our clients create a dance of therapeutic engagement, fostering trust, growth, and lasting change.
Navigating Opposition and Readiness for Change
When working towards transformation, it is essential to recognize that while clients may express a strong desire for change, only one part of them may be truly ready for the change. There may be opposing, mistrustful, or anxious parts that remain unconscious, creating a dynamic tension within themselves. These opposing parts must be acknowledged and given voice while at the same time, privileging a client’s readiness for change. Because change happens slowly and is a gradual integrative process, rushing in too quickly to shift a pattern usually ends up being unproductive and frustrating for therapists and clients alike.
Exploring Client Readiness for Challenging Patterns: A Reflective Exercise
In the therapeutic journey, there are moments when we sense that our clients are ready to challenge patterns and embrace change. The following reflective exercise invites you to observe your internal experiences when at least one part of your client shows readiness for a transformative process. By exploring the signals they give you and the cues your own system provides, you can deepen your understanding of client readiness and enhance your ability to navigate the delicate balance of support and challenge. It can also prompt you to consider how you test assumptions about their readiness and how you respond when confronted with strong defenses. Self-reflection in these areas empowers you to refine your therapeutic approach and facilitate increasingly meaningful growth for your clients.
Let’s take a moment to reflect by exploring some questions. For this reflection, see if you can bring to mind a client that you sense has been ready or is currently ready to address a harmful relational pattern.
What do you notice when at least one part of your client is ready to challenge a pattern?
What signals do they give you?
What signals does your own system give you?
How do you test your assumption about their readiness?
What do you do if a strong defense arises when you present them with a challenge? Do you usually back off or meet them?
How might this experience inform you in navigating optimal stress with this particular client? With clients in general?
Case Example: Carla’s Crisis Call
I recently received a message from a female client in her twenties who I have been working with for about three years, requesting that I call her because she was in a crisis. After getting back to her, we scheduled a session for the following day. I will refer to my client as Carla.
Carla was deeply distressed about an unsettling interpersonal conflict that occurred shortly after she learned about an environmental crisis affecting her homeland. We discussed the environmental crisis and its impact at length. Carla mentioned feeling better after talking with her family, knowing they were safe, and knowing that I cared about what was happening.
Carla then described a series of troubling interactions with a friend, which prompted her to reach out to me. She shared that she casually divulged some delicate personal information she had become aware of about this friend. Subsequently, the friend panicked and began verbally attacking Carla, and followed by sending abusive and accusatory messages. This behavior persisted for several days, leaving Carla overwhelmed, betrayed, and because both women work in the same company, concerned about her emotional wellbeing and job security.
As Carla recounted the story that led to her “crisis call,” I noticed that the casual comment she made to her friend was not as benign or as casual as she initially portrayed it. It felt to me like a comment, either consciously or unconsciously, intended to hurt or disrupt. I did not suggest that Carla had intended to hurt her friend, as the moment was not appropriate for such an interpretation. However, I wanted Carla to reflect on any possible underlying motives. I noticed that I felt a sense of irritation that Carla hadn’t mentioned or considered this possibility.
As I reflect on this experience, I realize that in going forward, I want to explore the potential unconscious desire Carla may have had in wanting to hurt or shame her friend by making those comments. However, despite the strong bond of trust between us, I’m aware of my nervousness about broaching this subject. I have found myself repeatedly rehearsing how I will express this to her and as I rehearse it, I notice a cold clammy feeling in my body as I imagine speaking these words. I fear that Carla will deny any such motivation, and that my question will create distance between us. This scenario triggers memories of feeling alone and unrecognized, which is reminiscent of my experiences within my own family of origin.
Furthermore, as I envision our future conversations, I notice a surge of energy running through my body—a mixture of fear and excitement. Although I feel anxious, I am also enthusiastic about pushing beyond our usual comfort zones and discovering new experiences and energies. I recognize the need for utmost care in introducing my thoughts and questions to Carla, considering her sensitivity and the depth of trust she has placed in me.
As therapists, we often encounter many moments when we sense that a client is teetering on the edge of an important change in their lives. Because you can deepen your awareness of how you respond to the potential need for a gentle push by reflecting on your own internal experiences, let’s try a reflective exercise.
Reflective Exercise: Navigating the Edge of Change with Clients
In the following exercise, I invite you to bring to mind a client who you believe is on the cusp of transformation. As you think about this client, reflect on the following questions:
Are you comfortable with the idea of pushing your client towards growth or do you tend to lean towards a more passive approach of waiting?
When you contemplate pushing your client, do any internal sensations arise that trigger memories of past circumstances?
Are there instances in your own life when you could have benefited from a push but didn’t receive one? Alternatively, have you experienced times when you received a push that felt inappropriate, leaving you feeling unseen and unsupported?
Allow yourself the space to process these memories and the associated emotions.
Now, envision yourself fully expressing, in your own personal space, all that you might want to say to your client about the change you sense they are on the brink of embracing. Contemplate how you can thoughtfully communicate your observations while respecting any hesitancy you may feel.
Can you imagine sharing your internal dilemma with your client in a sensitive manner, acknowledging your hesitation?
For example, you could say something like, “I am wondering if it would be ok to ask you something because I am feeling torn. On the one hand, I can see you are ready to do something different. That’s why you are here in therapy. On the other hand, you have been saying the same thing for three months so… I am imagining that it must be really challenging, or even scary, to take that next step?”
Or, “I imagine that even though you are aware that you can no longer allow him to mistreat you, the fear of potentially losing your father’s love and support must be overwhelming.”
Take a moment to come up with your own language around your client’s growing edge.
In conclusion, this article has emphasized the significance of building relational trust in psychotherapy by implementing optimal stress. By skillfully balancing support and challenge, we can create an environment that fosters lasting change. By attuning to our own internal experiences, we gain valuable insights that inform our therapeutic interventions.
Recognizing the readiness of clients for change and acknowledging the conflicting aspects within them are vital elements in this process. I hope the reflective exercises and case example presented in this article have offered practical tools and real-life illustrations to help you implement optimal stress in your therapeutic practice in a way that works best for you and your clients.
1. Stark, Martha, MD. (2015). The Transformative Power of Optimal Stress: From Cursing the Darkness to Lighting a Candle. Chevy Chase, MD: International Psychotherapy Institute.
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