Avoidance That Hides in "Productive" Therapy

"Beyond avoidance of people, places, or activities, avoidance as a psychological process refers to the various ways a person distances themselves from intolerable thoughts, feelings, memories, wishes, fantasies, etc. If the avoidance is very effective at its job, then the whole process may be kept out of a person's awareness for maximum self-protection. As a result, both patients and therapists are susceptible to avoidance dynamics in the therapy without recognizing it, especially if one or both individuals are in fact working very hard with good intentions, and therapy has the “look” of being productive."

"Avoidance itself can be unconscious so neither the pain nor the efforts to avoid pain are known. If the avoidance remains outside of awareness, that hard work will not lead to meaningful gains, leaving patient and therapist feeling stuck, confused, disappointed, and possibly resentful. Even when therapy appears to be progressing through effort and skill practice, the underlying avoidance can prevent change."

"Therapy tends to include at least some elements of insight, psychoeducation, and supporting rational thought (thinking). Moreover, patients often benefit from various strategies like behavioral activation, engaging with fulfilling life activities, and maintaining physical activity (doing). However, for some patients and some presenting problems, these useful elements and strategies function as avoidance-based coping, where the thinking and doing act as barriers to connecting with painful emotions or practicing healthy vulnerability and reliance on others."

"These patients may be very motivated, diligent with skills practice and homework, and eager to learn from the expertise of the therapist. Yet, if there is little to no change in the person's quality of life despite these markers of p"

Avoidance as a psychological process functions as self-protection by keeping intolerable thoughts, feelings, memories, wishes, and fantasies at a distance. When avoidance is highly effective, the entire process can remain outside awareness, so neither the pain nor the efforts to avoid it are recognized. Both patients and therapists can become caught in avoidance dynamics during therapy without realizing it, particularly when both are working hard with good intentions and therapy looks productive. If avoidance stays outside awareness, diligent thinking and doing may not produce real gains, leaving people feeling stuck, confused, disappointed, or resentful. In some cases, insight, psychoeducation, behavioral activation, and physical activity operate as avoidance-based coping that blocks contact with painful emotions and healthy vulnerability or reliance on others.

Read at Psychology Today