“For example, in order to identify these schemas or clarify faulty relational expectations, therapists working from an object relations, attachment, or cognitive behavioral framework often ask themselves (and their clients) questions like these: 1. What does the client tend to want from me or others? (For example, clients who repeatedly were ignored, dismissed, or even rejected might wish to be responded to emotionally, reached out to when they have a problem, or to be taken seriously when they express a concern.) 2. What does the client usually expect from others? (Different clients might expect others to diminish or compete with them, to take advantage and try to exploit them, or to admire and idealize them as special.) 3. What is the client’s experience of self in relationship to others? (For example, they might think of themselves as being unimportant or unwanted, burdensome to others, or responsible for handling everything.) 4. What are the emotional reactions that keep recurring? (In relationships, the client may repeatedly find himself feeling insecure or worried, self-conscious or ashamed, or—for those who have enjoyed better developmental experiences—perhaps confident and appreciated.) 5. As a result of these core beliefs, what are the client’s interpersonal strategies for coping with his relational problems? (Common strategies include seeking approval or trying to please others, complying and going along with what others want them to do, emotionally disengaging or physically withdrawing from others, or trying to dominate others through intimidation or control others via criticism and disapproval.) 6. Finally, what kind of reactions do these interpersonal styles tend to elicit from the therapist and others? (For example, when interacting together, others often may feel boredom, disinterest, or irritation; a press to rescue or take care of them in some way; or a helpless feeling that no matter how hard we try, whatever we do to help disappoints them and fails to meet their need.)”

“Following Strupp (1980), clients change when they live through emotionally painful and long-ingrained relational experiences with the therapist, and the therapeutic relationship gives rise to new and better outcomes that are different from those anticipated and feared. That is, when the client re-experiences important aspects of her primary problem with the therapist, and the therapist’s response does not fit the old schemas or expectations, the client has the real-life experience that relationships can be another way. When clients experience this new or reparative response, a response that differs from previous relationships and that does not fit the client’s negative expectations or cognitive schemas, it is a powerful type of experiential re-learning that readily can be generalized to other relationships (Bandura, 1997).”

“In fact, the same intervention or response may even have the opposite effect on two different clients with contrasting developmental histories and cultural contexts. For example, if a client’s parent was distant or aloof, the therapist’s judicious self-disclosure may be helpful for the client. In contrast, the same type of self-disclosure is likely to be anxiety-arousing for a client who grew up serving as the confidant or emotional caregiver of a depressed parent. Greater sharing with the therapist may help the first client learn that, contrary to her deeply held beliefs, she does matter and can be of interest to other people. In contrast, for the second client, the same type of self-disclosure may inadvertently impose the unwanted needs of others and set this client back in treatment as, in her mind, she experiences herself back in her old caretaking role again—this time with the therapist. This unwanted reenactment occurs because the therapeutic relationship is now paralleling the same problematic relational theme that this client struggled with while growing up.”

“We have also seen that they give clients feedback about the impact they are having on the therapist—and others. It can be a gift when therapists use process comments to provide interpersonal feedback, and therapists can find constructive, noncritical ways to help clients see themselves from others’ eyes and learn about the impact they are having on others (such as regularly making others feel bored, intimidated, impatient, overwhelmed, confused, and so forth).”

“When clients relinquish symptoms, succeed in achieving a personal goal, or make healthier choices for themselves, subsequently many will feel anxious, guilty, or depressed. That is, when clients make progress in treatment and get better, new therapists understandably are excited. But sometimes they will also be dismayed as they watch the client sabotage her success by gaining back unwanted weight or missing the next session after an important breakthrough and deep sharing with the therapist. Thus, loyalty and allegiance to symptoms—maladaptive behaviors originally developed to manage the “bad” or painfully frustrating aspects of parents—are not maladaptive to insecurely attached children. Such loyalty preserves “object ties,” or the connection to the “good” or loving aspects of the parent. Attachment fears of being left alone, helpless, or unwanted can be activated if clients disengage from the symptoms that represent these internalized “bad” objects (for example, if the client resolves an eating disorder or terminates a problematic relationship with a controlling/jealous partner). The goal of the interpersonal process approach is to help clients modify these early maladaptive schemas or internal working models by providing them with experiential or in vivo re-learning (that is, a “corrective emotional experience”). Through this real-life experience with the therapist, clients learn that, at least sometimes, some relationships can be different and do not have to follow the same familiar but problematic lines they have come to expect.”

“Cermak said, “Those therapists who work successfully with this population have learned to honor the client’s need to keep a lid on his or her feelings. The most effective therapeutic process involves swinging back and forth between uncovering feelings and covering them again, and it is precisely this ability to modulate their feelings that PTSD clients have lost. They must feel secure that their ability to close their emotions down will never be taken away from them, but instead will be honored as an important tool for living. The initial goal of therapy here is to help clients move more freely into their feelings with the assurance that they can find distance from them again if they begin to be overwhelmed. Once children from chemically dependent homes, adult children of alcoholics, and other PTSD clients become confident that you are not going to strip them of their survival mechanisms, they are more likely to allow their feelings to emerge, if only for a moment. And that moment will be a start.” (58)”