Psychotherapists' Responses to Complex Trauma Patients Requesting No Eye Contact

How would you, as a psychotherapist, respond if a complex trauma patient asked you to stop looking at them during therapy sessions? This is a topic that resonates with many mental health professionals, as the therapeutic relationship is built on trust and understanding. Here, we explore various responses to this scenario and discuss the importance of validating a patient's feelings and the nuances of non-verbal communication in psychotherapy.

Respect and Understanding

Patricia Kings, a prominent figure in the field of psychotherapy, emphasizes the empathy and respect needed in such situations. In her response, she acknowledges the patient's request, ensuring that the patient feels safe and comfortable. As a psychotherapist, it is crucial to understand the reasons behind such requests.

I would want to understand why the patient asked me to stop looking at them. I would also want to ensure that they felt safe and comfortable in the therapeutic space. I would explain that I am looking at them to try to understand what they are feeling and that it is important for the therapeutic process. I would also explain that I will respect their wishes and we can discuss other ways to communicate and connect during our sessions.

Creating a Safe Space

Another approach might be to create a safe space where the patient's comfort is prioritized. Recognizing that the patient may be triggered by eye contact can help to foster a more therapeutic environment.

I would respond by acknowledging their request and expressing my understanding of why they may feel uncomfortable with me looking at them. I would also explain that it’s important for us to have eye contact during our sessions as it helps to create a trusting relationship and allows me to better understand their feelings and experiences. I would then offer to take breaks from eye contact as needed and ask if there are other ways that they feel more comfortable with me.

Adapting to the Patient's Comfort

Some therapists might choose to adapt their approach to fully respect their patient's wishes. This can involve asking the patient to take the lead in modifying the therapeutic space to make them more comfortable.

Yes, of course! I might even offer to turn my chair in such a way that would add an additional screen of protection if that would prove helpful. After complying with my patients' wish, I would ask them to simply notice what they might be feeling and encourage them to stay present with their experience. The propensity for dissociation or shame with complex trauma patients requires that the therapist be attuned to the way sitting face to face in therapy can simply be too overwhelming and make verbal communication almost impossible.

Being looked at as an object is different than being seen as a person, and many trauma survivors who have suffered boundary violations feel objectified, which can trigger their symptoms. By acknowledging and validating these feelings, therapists can create a more supportive and understanding environment for their patients.

A Respectful Approach

Some may argue that if any client requested to stop eye contact, it is essential to comply instantly. This response highlights the importance of demonstrating respect and understanding the client's needs.

Easy one! And they wouldn't even have to have cPTSD. If any client asked me to stop looking at them, I would comply instantly. Instantly. It would be a great opportunity to do something very simple that demonstrated respect. Depending on circumstances and intuition, I'd just wait for further instructions. Or maybe say, 'Is this OK.' Or maybe risk 'I'm really interested in why, if you want to tell me, up to you.'

Compliance with the client's wishes is a sign of a therapist’s commitment to creating a safe and respectful therapeutic environment. This approach acknowledges the client's needs while also promoting the trust necessary for the therapeutic process.

Key Takeaways

The response of a psychotherapist to a complex trauma patient's request for no eye contact is multifaceted and requires a balance of understanding, respect, and adaptability. Acknowledging a patient's feelings, adapting to their comfort levels, and prioritizing the therapeutic relationship are crucial elements of effective psychotherapy.

By prioritizing the patient's comfort and understanding their reasons for requesting no eye contact, therapists can create a more supportive and effective therapeutic environment.