People go to therapy for a variety of reasons:  something isn’t right in their world, something’s not right in their experience of self, or there’s a desire to continue growing and developing as a person.  Regardless of the reason, there’s an inherent assumption that going to therapy will help you feel better.

While feeling better, experiencing life differently, etc., is a healthy and reasonable goal for therapy, it is important to know that pain is part of the process.  Being realistic about the involvement of pain and identifying the type of pain you’re experiencing in therapy is important.  In fact, the type of pain you experience in therapy will in part determine the pace of therapy and ultimately, your healing.

Avoidant Pain

Our bodies would prefer that we didn’t experience pain.  Pain is interpreting as a threat to safety, which is a threat to survival.  Layered on top of our body’s automatic desire to avoid pain are the maladaptive coping strategies that kept us safe when it was necessary and have now become an automatic way of engaging with the world. 

Avoidant pain manifests in various ways, often subtly influencing behaviors and thoughts. Here are some common signs:

• Superficial Engagement in Therapy: Keeping discussions light and avoiding deeper, more meaningful topics.

• Deflecting or Changing Topics: Shifting the conversation away from uncomfortable subjects.

• Minimizing Problems: Downplaying the severity or impact of issues.

• Excessive Optimism: Using unwarranted positivity to avoid confronting difficult emotions or realities.

• Reluctance to Face Emotions: Difficulty in expressing or identifying emotions, often saying "I'm fine" when not.

• Procrastination: Delaying or avoiding therapy sessions or homework assignments given by the therapist.

• Over-intellectualizing: Focusing on logical explanations or identifying the “why” to avoid emotional experiences.

• Seeking Distractions: Engaging in activities or habits that keep the mind occupied and away from painful thoughts or feelings.

• Denial of Problems: Refusing to acknowledge the existence of certain issues or their impact.

• Physical Avoidance: Missing therapy sessions or frequently rescheduling appointments.

 Enmeshed Pain

Some people are so familiar with their pain that they end up feeding pain.  They hold tightly to the maladaptive beliefs of shame, inadequacy, helplessness, powerlessness, etc.  Of course they desire to reduce their suffering, but this type of pain has become so familiar that it’s now perceived as part of their identity. 

Here are some common signs of enmeshed pain:

• Persistent Negative Self-Talk: Constantly criticizing oneself or reinforcing feelings of inadequacy, shame, or guilt.

• Repetitive Thought Patterns: Continuously replaying painful memories or thoughts without resolution, feeding the story versus being WITH the experience.

• Emotional Overwhelm: Frequently feeling overwhelmed by intense emotions such as sadness, anger, or fear.

• Self-Sabotage: Engaging in behaviors that reinforce suffering, such as self-harm, substance abuse, continual engagement in unhealthy relationships.

• Identity Tied to Pain: Defining oneself primarily through suffering and negative experiences, stuck in a negative feedback loop.

• Reluctance to Change: Resisting positive changes or fearing life without the familiar pain, fulfilling the belief that it’s better to stay with the pain that is known than the face the fear of the unknown. 

• Seeking Validation through Pain: Finding comfort in sympathy from others, often sharing suffering as a way to connect.

• Attachment to Negative Beliefs: Holding on tightly to beliefs of helplessness, powerlessness, or worthlessness.

Healthy Pain

To heal means having the courage to face our pain.  This involves recognizing the ways we have avoided and/or embraced our suffering.  This type of pain involves learning, practicing and developing the skill set necessary to heal and grow. 

Utilizing pain in therapy as part of the transformation process involves facing and working through discomfort to achieve growth and healing. Here are some characteristics of healthy pain in therapy:

• Acknowledging Difficult Emotions: Willingness to confront and express difficult emotions such as sadness, anger, or fear.

• Reflective Thinking: Engaging in self-reflection (identifying the shadow self) to understand the root causes of pain and patterns of behavior, what was done to you and how you have continued to wound yourself.

• Embracing Vulnerability: Allowing oneself to be vulnerable and open, even when it feels uncomfortable.

• Active Participation: Fully engaging in therapy sessions, including discussing challenging topics and completing homework assignments.

• Acceptance of Discomfort: Recognizing that discomfort is a part of the healing process and not avoiding it.

• Developing Coping Skills: Learning and practicing new coping strategies to manage pain and stress.

• Setting Realistic Goals: Working with the therapist to set and work towards achievable goals, even if the process is slow and challenging.

• Building Resilience: Developing the ability to bounce back from setbacks and continue working towards healing.

• Progress Over Perfection: Understanding that progress in therapy is not linear and being patient with oneself during the journey.

Healthy Pain and Attachment Work

Healthy pain in therapy is characterized by a willingness to face and work through discomfort for the sake of long-term growth and healing. It involves an active and engaged approach to the therapeutic process, with a focus on developing new skills and perspectives. Since so much of our pain is caused in relationships, recognizing healthy pain in connection to attachment is important.  Some examples of this are:

• Facing Abandonment Fears: A client with attachment issues might feel intense fear of abandonment. In therapy, facing these fears involves discussing past experiences of abandonment, understanding their impact, and learning to tolerate the anxiety that arises in relationships without resorting to clingy or avoidant behaviors.

• Exploring Childhood Attachment Patterns: Revisiting painful childhood memories related to attachment figures, such as neglect or inconsistent caregiving, to understand how these experiences shape current relationship patterns.

• Challenging Maladaptive Beliefs: Working through the deeply ingrained belief that one is unworthy of love or destined to be abandoned. This involves experiencing the discomfort of confronting these beliefs and gradually replacing them with healthier, more accurate ones.

• Developing Secure Attachment Behaviors: Practicing new, healthier ways of relating to others, such as expressing needs and boundaries, even when it feels risky or unfamiliar. This can be painful as it often involves breaking long-standing habits and facing the fear of rejection.

• Emotional Regulation Skills: Learning to manage intense emotions that arise in attachment-related situations, such as jealousy, fear, or anger, without acting out or withdrawing. This process can be uncomfortable but leads to more stable and satisfying relationships.

• Repairing Relationships: Engaging in difficult conversations with significant others about past hurts and working towards reconciliation. This might involve feeling and expressing guilt, shame, or sorrow, but it fosters deeper, more secure connections.

• Tolerating Uncertainty: Accepting and managing the discomfort of not knowing whether a relationship will last, rather than trying to control or predict the outcome. This helps build resilience and trust in oneself and others.

• Grieving Losses: Allowing oneself to fully grieve past relationships or attachment figures that were not able to meet one's needs. This can be a painful process but is necessary for moving forward and forming healthier attachments.

• Therapeutic Relationship: Utilizing the therapeutic relationship as a safe space to explore and heal attachment wounds. Experiencing and working through the discomfort of trusting the therapist, dealing with feelings of dependence, and addressing any transference issues that arise.

• Building Interdependence: Learning to balance autonomy and intimacy in relationships. This involves facing the pain of past enmeshment or isolation and gradually moving towards healthier interdependence, where one can be close to others while maintaining a strong sense of self.

Pain is an inevitable part of the therapeutic process. The type of pain you choose to endure will either keep you trapped in unhealthy cycles or set you free. Suffering is an inherent part of human existence, and life forces you to make a choice: develop the skills, experiences, and capacity to tolerate pain, or remain stuck. Some choose to stay trapped, while others choose the pain that leads to freedom.