Joining Versus Fixing in Psychotherapy

By Elizabeth Dickson, LCSW




“Even when–and it always is–the story is very complex,

a willingness to walk together into the deepest circles of

the patient’s experiential hell characterizes the attitude of

compassion or emotional availability that I believe the

process of clinical understanding requires.”


Donna Orange from Thinking for Clinicians


“For those who have compassion, woundedness is not a

place of judgment but a place of genuine meeting.”


Rachel Naomi Remen from My Grandfather’s Blessings


Creating a “Relational Home”


The attitude of compassion in psychotherapy is about the willingness of the therapist to welcome and walk together into what Donna Orange refers to as “the deepest circles of the patient’s experiential hell.” We do not leave our clients alone with their vulnerability, pain, shame, or despair. Rather, we do the opposite and actively befriend that which is shunned, judged, feared, pushed away, and hidden.


When we take the journey together and encourage them to tell their story, we are offering our clients a new kind of “relational home” for all that is associated with their suffering. Sometimes this act in and of itself can produce a distinct emotional shift, as when it “crushes and destroys the pain” like the Buddha quote proclaims. But the emotional shift does not have to be dramatic for compassion to be healing. Whenever compassion “shelters and embraces the distressed,” we can assume that there is always the potential for healing, even in the more difficult or stuck times.


The Role of the Therapist


“In attending to our own capacity to suffer,

we can uncover a simple and profound connection

between our own vulnerability and the vulnerability in all others.

Experiencing this allows us to find an instinctive kindness towards life

which is the foundation of all compassion and genuine service.”


Rachel Naomi Remen from My Grandfather’s Blessings


I imagine that most psychotherapists are drawn to working with a client’s pain and suffering, something that people outside of our field might find surprising or bewildering. But for those of us who feel called to serve in this way, having the opportunity to be with a client’s emotional pain can feel like an honor. When we have learned to accept and even cherish that in ourselves which is most capable of suffering, we come to know in a visceral way that “simple and profound connection” that Remen refers to that connects our vulnerability with the larger human vulnerability.


As therapists, we need to be in touch with our own emotional wounds, including those aspects of ourselves that  might embarrass us. As Remen says, “For those who have compassion, woundedness is not a place of judgment but a place of genuine meeting.” Ironically, it is often through our vulnerability that we bond with our clients, not through our sophisticated interventions or the extent of our psychological knowledge or expertise.  And in true moments of meeting, it is not just the therapist’s compassion that is healing. In these moments, compassion feels more like a force that is present in the room; it is not just something that the therapist brings.


But it would be misleading to imply that all of psychotherapy is a continuously enriching process, filled with genuine moments of bonding based upon the most heartfelt experience of compassion. As therapists, we learn to listen to our hearts when they respond to the pain of others, and to use our natural compassion to help our clients in their process of healing. But when our natural compassion does not feel strong enough to guide us, we can still take on a compassionate attitude; we remember to actively welcome the patient’s suffering and pain, since that is the place where they most need us to join with them. Taking on a compassionate attitude helps us to continue to shelter our clients and provide a holding environment, even when their suffering does not present itself in ways that are easy for us to connect with.


Balancing Compassion and “Fixing”


Of all the careers that are available to those who feel called upon to exercise compassion, the role of psychotherapist is uniquely suited to compassion as the Buddha defined it–the compassion that is about the direct connection with another person, as opposed to compassion that leads people to perform good works or to focus on correcting wrongs in the world. As psychotherapists, a large part of our role is to  “be with” suffering and to facilitate, with the help of our clients, the shelter and embrace of compassion that the Buddha was referring to.


The gesture of joining through compassion is an entirely different gesture than identifying a problem that needs to be solved–a distinction that psychotherapists are intimately familiar with. That is a big part of the difference between looking to a friend for “help” versus seeing a psychotherapist who has been trained to understand how to use compassion in the healing process. While the feeling of compassion may be accessible to many people, the ability to facilitate a compassionate encounter requires considerable sensitivity and the discipline to keep the focus on what the other person needs. Learning to be with our clients in their place of suffering sometimes feels counter-intuitive, which is why this can be the most important skill that we develop as psychotherapists.


Yet even after all our training to avoid falling into the “fixing” trap, we still can make the mistake of trying to “fix” suffering at times when it would be more helpful to join it or to gently explore it. This is because the reality is that psychotherapists need to do both–sometimes the joining and sometimes the help with fixing. And the need to balance these two often opposing types of attitudes and interventions can involve a complex dance that takes many years of practice to even begin to master.


When Feelings are Judged to be Wrong


“When something hurts in life, we don’t usually think of it

as our path or as the source of wisdom. In fact, we think

that the reason we’re on the path is to get rid of this painful

feeling. In this way, we naively cultivate a subtle aggression

against ourselves.”


Pema Chodren from When Things Fall Apart


We are ultimately in a paradoxical position as psychotherapists. Our clients often come to us looking for help in alleviating their painful feelings. And yet their actual feelings may not be the primary cause of their suffering. What can be a bigger factor is the sense that they shouldn’t be feeling what they are feeling. It is often their judgments about their feelings that contribute significantly to their distress. So if we are too eager to help them “get rid of” what they are feeling, it can end up reinforcing these negative judgments. As Pema Chodren says, at that level of wanting to get rid of our feelings, we can “cultivate a subtle aggression against ourselves.”


This tendency to judge painful feelings is something that therapists see often and have many names for. I have heard it referred to as “feelings about feelings” or “the bruise on the broken bone.”  I call it “the double whammy.” Clients often fear that their feelings make them bad, not loveable, defective in some way, and that their pain or suffering will drive others away. This is particularly true where our clients had parents who were not attuned to their painful feeling states, contributing to the conviction that they were not loveable when they were hurt, frightened, insecure, angry, discouraged, lonely, frustrated, anxious, failing or in any other type of distress.


Therapists must always be sensitive to the larger relational dynamics of the moment. It is better to miss an opportunity to help “fix” a problem than to jump in at the wrong time and send the message that the client’s feelings or experience is wrong in some way. As therapists, what is most important is to provide a relational home for the suffering self of our clients. We want to validate that what they are feeling makes sense to us, that we also experience painful or difficult feelings, and that when they expose their pain in the therapy process they will not be quickly judged as a problem to be solved or seen as a burden or a threat, but rather will be joined in an experience of compassion. I like to tell clients that we are all entitled to our struggles in life. Struggling is part of what makes us human, and it offers us the opportunity to learn, grow and develop wisdom.


Conclusions: Finding Acceptance


When we provide a new kind of relational home for our clients, we are reinforcing that they can be loved and accepted as they are. This does not mean that we would not help them manage their feelings in interpersonal interactions in ways that work for them or help them achieve their goals. But, in doing so, we do not question the feelings themselves or make their feelings wrong. If we are successful, our clients stand a much better chance of using the psychotherapy relationship as a model for how other intimate relationships in their lives can succeed, without requiring that they hide who they are from the people close to them.