Survival Techniques For Difficult Situations In Therapy

When we have to respond to difficult and unforeseen situations that call into question the viability of therapy, it is advisable to use small techniques that help us maintain our position as therapists. These techniques were called by José Navarro Góngora as “survival techniques”.

In this way, survival techniques are small strategies that allow us to maintain control of the session when the therapeutic relationship, the structuring of the interview or our room for maneuver is in danger.

The use of these techniques by the therapist or psychologist does not mean that therapy has gotten out of hand at a certain point. Rather the opposite, he has hit the button to change the patient in front of him and his resistance to it.

Big fears question the smallest steps

As psychologists we must bear in mind that changes often produce fear; even on many occasions those who question even the smallest steps are great fears. Think that many people see change as something disruptive, something that takes them out of their comfort zone and produces uncertainty.

Therefore, resistance to change must be recognized, assumed and worked on in every therapeutic process. But recognizing it does not mean treating it as something negative and therefore seeking its elimination, it can be treated as a way that the individual uses to protect itself and work with it so that it seeks to nurture the well-being of the change itself raised in therapy.

Resistance itself has energy and poses a course of action that can be harnessed for the benefit of one’s own change. That is why resistance is a guide to change in itself, since identifying it helps to know the needs and fears of the patient himself, to make him feel understood and thus be able to choose change as a product of a personal decision.

With resistance we know what the patient needs and, once you know the way, it is easier for you to lend a hand to reach the goal.

Difficult situations in therapy and survival techniques

Survival techniques help us to work within resistance, without losing validity as therapists when situations pose great challenges. Some difficult situations that can occur in therapy are the following:

If at any point in the session, the patient criticizes the psychologist or therapist, a threat is being produced in the therapeutic relationship. It is very normal for patients to express disagreement or censure about our way of doing things, so we must avoid getting defensive.

The best way to act in these situations is simple,  it is about collecting criticism, trying to understand the patient’s position, validating it, and only in a second moment give an answer:

• Patient : I don’t understand very well why you recommend me to do this task. It seems silly to me. I don’t know how that can help me.
• Therapist : I understand that you don’t see what it can serve you for, that you don’t understand its function. I think that then I have not explained myself well and, therefore, I understand that you do not understand the task. If you think so, I will explain to you what is the logic of what I am asking you.

Digging deeper into the example

The situation can be more difficult, with greater obstacles, if the patient’s criticism is expressed in the form of personal disqualification towards the therapist:

• Patient: I don’t know, all this doesn’t convince me, how old are you?
• Therapist: I am 30 years old.
• Q: And aren’t you too young to help me?
• T: Well I hope not. At least my age has not been an impediment in any of the cases that I have handled so far.
• Q: Yes, but I don’t think your experience is enough for me. I have been an alcoholic for 25 years, with all that that entails. That is to say, you have never had a delusion nor have you suffered what I have suffered.
• T: No, I really haven’t had that problem.
• Q: So how can you help me?
• T: It’s a very good question. I will answer you if you want: I understand that my help does not consist in going through the same thing as you, but on the contrary, seeing things from the outside, from another perspective. See what you want to achieve by coming here and, if I can, help you to get them yourself.
• P: Yes, that is a very nice thing. It’s typical smart-ass psychologist bullshit.
• T: Wait a minute, Antonio. I’m sorry that what I’m saying doesn’t convince you. If you prefer, we can leave the interview here, because it may be more useful to work with another person. But if you want to move on, I am not willing to disrespect me.
• Q: Sorry, the bullshit was a way of talking. But really, I don’t know how you can help me.
• T: Right now neither do I, until you tell me and see how things are and what you want to achieve here. Nor do I want you to be uncomfortable here. We can see how the next interview hour goes and we decide then. Do you agree?
• Q: Okay, let’s do it like this.

The Most Powerful Survival Technique: Metacommunication

As you have seen in the previous examples, and in many more that may arise, survival techniques do not require great skills but they do require large doses of clarity and assertiveness, accompanied by a friendly tone and, if possible, cordial.

That is, to be a good psychologist using survival strategies, you just need to have large doses of empathy and not blame yourself for the patient’s own resistance to change. Therefore, to great evils, small remedies.

Bibliography for professionals:

Navarro Góngora, José (1994): Advances in Family Therapy. Barcelona: Paidós.

Beyebach, Mark (2006): 24 Ideas for a Brief Psychotherapy. Barcelona: Herder.