How to handle sadness and grief (by Poul Perris)

I find the same challenge as Wendy did with anger when it comes to differentiating a client´s expressed sadness and grief.

Making an erroneous conceptualization of sadness might be as problematic in therapy as misunderstanding the anger. It might have a therapist believe that he or she is making connection with the vulnerable child part of the client when it´s actually a coping mode being expressed. I´ll try to give you a brief example:

When I supervise new students in Schema Therapy I always stress the importance of connecting with the vulnerable child. I´ve noticed several times that students early on in treatment believe that they´re making good progress and connecting with their clients when I can´t see much healthy connection when viewing their session tapes.

When viewing session tapes the patient might cry extensively, express hopelessness. The patient might tell their therapist things like …”I could never manage life without you…etc.”

If a patient is expressing this kind of behavior very early on in treatment it could indeed be the vulnerable child but it’s very likely to be a surrender coping mode with an external locus of control (I´m a victim and no one cares for me…). Very often this coping behavior is in addition altered with a punitive mode with the function of keeping the patient in the surrender position. I´ve noticed that some students holds the crying and reaching out as valid “proofs” that the patient is being vulnerable, hence that they´re connecting and that this is difficult for them to understand differently.

I´ve found it helpful to have the students (as you also mentioned when discussing anger) try to feel how the client´s behavior resonance with their own feelings. If the crying makes them feel like the client is being a burden it´s most likely a surrender coping mode (if not a therapist schema triggering). If you´re a “healthy” therapist you would very really be irritated on a truly vulnerable child. I´ve noticed also that many times the student finds it relieving to be “allowed” to feel irritated on their patient even if the patient is crying. It’s also helpful to listen to the tone/connotative of the crying etc.

Providing limited reparenting to a dysfunctional crying coping mode is only reinforcing it!
Oh well… just a few notes

Warmly

Poul