Joining
Joining is a way of coming alongside the patient emotionally,
which enables the patient to feel understood and accepted. This requires that the therapist be willing to “go
into the pit” with the patient, and to get in touch with his own feelings in
the pit. A therapist can work with a rape survivor without having been raped himself. He can identify with the feelings of being overpowered, overwhelmed, trapped, powerless and hopeless. So, as he counsels someone who was raped, he can get in touch with these feelings and feel them, along with the patient. This enables the therapist to be able to “go into the pit” with the patient.
There are two types of Joining: Ego-Syntonic Join, and Ego-Dystonic Join:
Ego-syntoic Join
This Joining sounds “smooth to the ear,” and the patient feels understood and accepted.
For example:
A patient says, “I feel like I’m doomed to be single for life! I can’t get my act together. I am now 35-years-old, and I still have never dated. I’ll never get married!” The therapist replies, “Things have never worked out for you to have anyone special!”
Ego-Dysyntoic Join
This Joining sounds “jarring to the ear,” while the patient feels understood and accepted. The goal is to help the patient to feel understood and accepted, but at the same time, hears how jarring what she says sounds - in order to start to re-think and to evaluate the truth of what she believes emotionally.
For example:
Using the same example above, the therapist this time would say instead, “It’s too late for you! If you haven’t dated by the age of 35, you’ll never get married!”
Joining only “works” when the therapist really feels the feeling behind what he is saying. The therapist needs to “Match” emotionally, how the patient is feeling. So, if the patient is loud and agitated, the therapist matches her in volume and agitation. If the patient exhibits a flat affect, the therapist Joins with the same flat affect.
When we Join, it’s important to join the feeling, and not get caught up with the content of what is being said by the patient. Feel the feeling beneath the content of what is being said, and join that.
When Joining is used solely as a technique, the Join will backfire, as the patient would experience it as a technique, and sometimes feels mocked, dismissed, and/or suspicious of the therapist’s intentions. So, it’s important not to Join your patient until you fully feel the feelings. This is especially so with Ego-Dystonic Joining. As a matter of fact, one should not use Ego-Dystonic Join until the therapist has a pretty good idea that the patient will respond favorably. This is because inappropriate timing of the Ego-Dystonic Join can damage the therapeutic alliance.
Toxic Introject
We internalize our parents' (aka: Primary Care Takers) negative views toward us, such that we believe their criticisms are "true assessments/evaluations" of ourselves. We then live our lives believing this to be true of us and of our worth.
For example:
A patient of mine had a father who was extremely critical of him and repeatedly gave him the message that he wasn’t smart enough, witty enough or eloquent enough. This person grew up believing his father’s judgment of him and believes he indeed is what him father had said he was. In treatment with me, he then projected onto me that I too, am not smart enough, witty enough or eloquent enough…
Treatment Option:
We are to
help the patient to project onto us his Toxic Introject, to remove the toxicity, and to feed him now with the nurturance he
needed but didn’t get from his parents. One way to accomplish this is through Ego-Dystonic Join. The patient feels understood
through our Joining, and at the
same time feel jarred by it. This can help the patient to re-examine what he has
believed about himself all along. We then help him to externalize the toxicity, so he can view this
false assessment (from him parents) more objectively. When he can realize that
the assessment about him is false, then we can feed him with the nurturance he
needed all along.For example:
This aforementioned patient criticized himself in our sessions all the time: from his indecisions in life, to him having wasted his session criticizing himself. He told me that I wasn’t smart enough, witty enough, or eloquent enough. After working with him for over eight years, one day he said to me, “Why is it that my friends’ therapists always gave them interpretations, but you wouldn’t give me any?” By then, I was able to really feel and mean what I told him, “It’s because you are a Looser, and you picked a Looser therapist…We are well matched!” He laughed and laughed, and felt understood by my comment. For the next two years, I’d preemptively attack him by starting the session with, “So what does the Looser has to report on what a Looser he was this week?”
