What happens in therapy often happens elsewhere too

One of the things that I believe makes therapy unique is that it does not just involve talking about life, but it also gives us an opportunity to observe how we relate to one another in real time.

As a therapist, I pay attention not only to what a client brings to a session, but also to how they are with me. I don’t do this because I am judging them, but because the therapeutic relationship can often offer valuable clues about patterns that exist outside the therapy room too.

Sometimes, the way a client responds to me is a glimpse into how they respond to partners, friends, family members, colleagues or authority figures. When appropriate, I tend to gently draw attention to these patterns and invite some compassionate curiousity about them. For example, I have worked with clients who apologise repeatedly for crying during sessions and when they cry, they might say things like “I’m sorry”, “I don’t know why I’m crying” and “I shouldn’t be upset about this” and so on.

The tears themselves are actually not the issue but what interests me is the meaning behind the tears such as the apology. Somewhere along the way, they may have learned that showing emotion is unacceptable, inconvenient or something to be ashamed of. Perhaps their vulnerability was met with criticism, dismissal or even punishment in the past, so the session becomes an opportunity to explore what they learned about emotions and whether those beliefs are still serving them today.

Another common pattern is people-pleasing, for example, some clients are incredibly quick to agree with suggestions, minimise their own needs or tell me what they think I want to hear. They may struggle to disagree, even when something does not feel right for them.

Again, this is not a problem within the therapy itself, rather, it can provide insight into how they navigate relationships more broadly. Many clients who come to therapy feeling overwhelmed, exhausted, resentful or disconnected from themselves have spent years prioritising other people’s needs over their own. In that case, the therapy room can become a safe place to practise having preferences, expressing disagreement and discovering that relationships can actually survive honesty. I absolutely love when I get to witness this change in clients, where they feel empowered and confident enough to challenge me, correct me or disagree with me.

One of the areas where these patterns often become most visible is around boundaries and I find this very fascinating. Boundaries can be particularly challenging for those who have experienced trauma, especially relational trauma. Some clients struggle to set boundaries at all, while others have learned that reaction to boundaries should be rigid, defensive or enforced through withdrawal and punishment. However, therapy naturally involves boundaries, for example, sessions start and end at agreed times and there are cancellation policies, and these are all boundaries within the client-therapist  relationship.

I am aware that these boundaries can sometimes evoke powerful feelings, for example, a client may feel hurt, rejected, angry or misunderstood when a boundary is held. Whereas, some may decide to end therapy altogether, whereas others may continue attending but become distant, passive-aggressive or reluctant to engage in the same way as before.

I do believe that while these moments can feel uncomfortable, they are often incredibly valuable as they create an opportunity to explore what boundaries have meant in the client’s life. For example, I would usually ask myself these questions and also explore it with the client where appropriate: Have boundaries previously felt like rejection? Have they experienced people using boundaries as a form of punishment or control? Have their needs historically been ignored whenever someone else asserted their own?

Often, the emotional reaction makes perfect sense when viewed through the lens of their past experiences, and that’s where compassion and empathy come in, yet while still maintaining boundaries. The goal is never to tell a client that they are wrong or shame them, but instead, it is to create a space where these patterns can be noticed, explored, understood, and, where helpful, gently challenged.

One of the most healing aspects of therapy is that it offers the chance to experience something different, such as crying without being shamed, disagreeing without losing the relationship and encountering a boundary without being abandoned.

That is why I often think that the therapy room becomes more than a place to talk about change or process traumas, but also where it becomes a place to practise the change, because often the way we show up in therapy is not separate from the rest of our lives. Sometimes it is a reflection of it and when we can understand what is happening between therapist and client, we often gain a deeper understanding of what is happening everywhere else too.

The therapist’s self-awareness and our own process

While it can be tempting to focus entirely on what the client is bringing into the therapeutic space, effective therapy also requires us, as therapists, to continuously turn some of that attention inward. Reflective self-awareness is central to my practice, informing both my in-the-moment clinical responses and continued professional development. This capacity has deepened through my year-long intense training of Gabor Maté’s Compassionate Inquiry. It focused on me deepening my own reflective self-awareness and attunement to others and to myself, including my internal processes and somatic expressions, and how this influenced my attunement to clients.

Within client sessions this enabled me to deepen the way I actively monitored my internal responses, including emotional reactions, bodily sensations and impulses to respond in a certain way. I view these responses as potential sources of information about the client’s experience, my own experience and the therapeutic relationship. I think this is very important because we, as therapists, are not neutral or blank-slate observers, but are human beings in the room with our own histories, attachment patterns, emotional sensitivities and lived experiences. This means that the therapy space is never entirely one-directional, but is relational, and like all relationships, it can activate parts of us as well.

Clients may bring their own unresolved trauma, attachment wounds or unmet relational needs into the therapeutic relationship, and this can sometimes be expressed through patterns such as people-pleasing, emotional withdrawal, anger or passive-aggressive communication. These are not simply behaviours to manage, but often meaningful expressions of how someone has learned to survive relationally.

At the same time, it is essential to recognise that we, as therapists, are not immune to emotional responses. We may feel pulled to over-accommodate a client who people-pleases, or we may feel frustration, defensiveness or a desire to withdraw when faced with criticism, resistance or passive aggression. These reactions are not failures but they are useful information that can help with our self-awareness and this is where reflective practice becomes vital.

In my role as a clinical supervisor, I frequently notice that therapists, particularly trainees, compromise their own boundaries, such as routinely overrunning sessions or waiving cancellation fees, which often reflects an underlying discomfort with disappointing others, a need to be liked or anxiety about conflict and rupture in the therapeutic relationship. Bringing these patterns into supervision and reflective practice allows therapists to explore what is driving them, strengthen their confidence in maintaining therapeutic boundaries, and recognise that consistent boundaries are actually a very essential part of safe and effective clinical work.

Good therapeutic work involves ongoing self-checking such as noticing what is being evoked in us, and asking whether our responses are coming from a grounded therapeutic stance or from something more personal being activated. Our own attachment history, past relational wounds or unresolved experiences can subtly influence how we interpret and respond to clients if we are not attentive to them.

This is also where concepts such as transference and countertransference become particularly relevant. Clients may unconsciously project past relational experiences onto the therapist, while therapists may also experience emotional reactions that are shaped not only by the client’s material, but also by their own internal world. Of course, neither of these processes are inherently problematic. In fact, they are often central to therapeutic work, but the key is awareness.

Supervision and personal therapy are therefore not optional extras in the work we do, but they are essential foundations, as they provide a space to process, reflect and disentangle what belongs to the client’s experience and what may belong to our own. Without this, there is a risk of reacting rather than responding, or of missing important relational dynamics that are unfolding in the room.

Ultimately, therapy is not just about understanding the client more deeply, but also about the therapist remaining aware of their own internal landscape. The more attuned we are to ourselves, the more safely and effectively we can stay present with the complexity of the client’s world.

A space to reflect on what we carry

In often reflecting about these themes, I became increasingly aware of something more personal and professional, such as how rarely we are given the space to truly pause and reflect on all of this in depth.

As therapists, we spend so much time holding space for others such as tracking patterns, staying attuned, making sense of relational dynamics and supporting emotional processing, all of which can be very heavy and exhausting. At the same time, we are also carrying our own internal world into every session we sit in. The emotional labour of this work is often ongoing and cumulative, and yet there is limited space in day-to-day practice to step back and fully reflect on what we are carrying, what we are absorbing, and what we are being impacted by in the process. The risk is that before we know it, this can lead to compassionate fatigue, traumatic stress, vicarious trauma and burnout.

This is part of what led me to create my group, which is a space specifically designed for reflection, containment and shared thinking around these relational and emotional dynamics. It offers a nurturing and supportive environment where both the visible and invisible aspects of therapeutic work can be gently explored, including what we bring into the room, what we take away from it, and how we maintain healthy therapeutic boundaries without compromising ourselves or the work. By developing greater self-awareness and reflective capacity, the group also aims to minimise the risk of compassion fatigue, secondary traumatic stress, vicarious trauma and burnout. If you are interested, there is more information here.

Final reflections

For clients / trauma survivors, if called to, I would like you to ask yourself:

• When I notice myself apologising, people-pleasing, withdrawing or becoming defensive in relationships, what might I be protecting myself from?
• What experiences have shaped the way I believe I am allowed to take up space, express emotion or set boundaries with others?

For therapists/ helping professionals, if called to, I would like you to ask yourself:

• What emotional responses do I notice in myself when a client is people-pleasing, withdrawing or expressing anger or resistance, and what might this be activating in me?
• How do I tend to respond when my own boundaries are tested in the therapy room, and what does this reveal about my own relational history or internalised patterns?

These questions are not about finding definitive answers, but about creating space for empathic and compassionate curiosity, about the client and about ourselves, within the relational space of therapy.

©Sharmi under Stepping Stones Psychology – Integrated Mental Health & Specialist Trauma Therapy Services ® ~ All Rights Reserved 2026