Most mental health professionals do not want to do anything to make their clients distressed in therapy sessions. In particular, many therapists long to not trigger trauma reactions or say/do things in therapy that lead to emotion dysregulation. But how bad is it to stress-out clients by pushing them to experience stress or trauma reactions?
Therapists want to help individuals experience less distress in their lives. Isn’t that the whole point of becoming a therapist? So not triggering clients is an understandable goal! None of us want to feel like we are harming our clients. It is especially counterintuitive that some approaches to therapy even work to bring stress out into the open in therapy.
On this front, we can actually and interestingly rest assured. Extensive research finds that when clients become emotionally activated in session, even by the impetus of therapist, it does not actually harm them. This is even the case for emotionally difficult approaches like Prolonged Exposure therapy (PE) or EMDR. Both of these approaches involve encouraging clients to extensively recall their most difficult trauma memories.
But research shows these approaches do not harm clients at all. In fact, when conducted in a supportive way, they lead to significant positive change in therapy. It is distressing for the client during the session, but this distress is very short-term. Distress is also something they experience everyday or many days when becoming triggered outside the therapy office.
The therapist’s office provides clients with a safe space to learn how to regulate their emotions and nervous system when they feel triggered. The office therefore provides a safe space and safe opportunity to build new learning and coping skills for self-regulation (e.g., effectively modify beliefs about the danger of a memory or trigger itself).
Providing this space to be triggered is crucial, because the vast majority of their life is not spent in therapy with us. Finding real relief when triggered but not in therapists’ presence does clients a great service. This is why extensive research on Prolonged Exposure, Cognitive Processing Therapy (CPT), and exposure for anxiety finds that having clients distressed in our office may be the factor that is actually most helpful for them.
But it also does something else. Clients discover the extremely powerful moments when they get to the other side of that triggered distress without experiencing harm. With this experience they realize they are able to cope with it effectively on their own. They also learn that experiencing high levels of distress will not actually harm them physically or emotionally. This steals power from that distress – they no longer fear the fear itself.
Highly dysregulated clients can also be emotionally difficult for therapists. Again, these triggers are experiences many clients live with everyday. If we take steps to avoid those triggers by not working with them in therapy, we unintentionally collude with avoidance (a key behavior that reinforces trauma and anxiety reactions). We also risk missing counterproductive safety behaviors they use. Each therapist should explore for themselves how comfortable they are with the potential of emotionally activating clients in therapy.
Being distressed and dysregulated in therapy is difficult for clients and can be difficult for therapists. But research finds we do not harm clients physically or emotionally when we do things that lead to trauma, anxiety, and stress reactions in therapy. When done in a highly supportive way, that emotional activation may be just the thing that helps most.
