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  • Writer's pictureMargaret S. Warner, PhD

What is Fragile Process and Difficult Process?

By Margaret S. Warner, PhD Distinguished Professor of Clinical Psychology Illinois School of professional Psychology, National Louis University


Many clients have a fragile style of processing experience that makes it difficult for them to work in standard psychotherapy formats. Therapists often find the experiences of these clients hard to understand and feel thwarted in their therapeutic efforts. Such clients are often diagnosed and misdiagnosed as having borderline, narcissistic, or schizoid personality disorders, and seen as using archaic defenses such as splitting and projective identification.


A client-centered style of working is particularly effective with these clients once the therapist is able to understand the sorts of experiences clients are having while in the midst of fragile process. In this paper I will describe fragile process, offer speculations as to its developmental roots, and consider what sorts of interaction are likely to be effective in psychotherapy.


For the sake of explanatory simplicity, I will describe fragile process as a single phenomenon. It should be kept in mind, however, that people experience fragile process to varying degrees and may have a fragile style of processing for some aspects of their experience, but not others.


Description of Fragile Process

Clients who have a fragile style of processing tend to experience core issues at very high or low levels of intensity. They tend to have difficulty starting and stopping experiences that are personally significant or emotionally connected. And, they are likely to have difficulty taking the point of view of another person while remaining in contact with such experiences. For example, a client may talk circumstantially for most of a therapy hour and only connect with an underlying feeling of rage at the very end. Yet, at this point he may feel unable to turn the rage off in a way that would allow him to return to work. He may then spend hours walking in the park trying to handle the intensity of the feeling. The client may be able to talk about feelings of rage at the therapist and very much want them understood and affirmed. Yet, therapist comments to explain the situation or disagree with the client will be felt as attempts by the therapist to annihilate his experience.


Empathic understanding responses are often the only sorts of responses people can receive while in the middle of fragile process without feeling traumatized or disconnected from their experience. The ongoing presence of a soothing, empathic person is often essential to the person’s ability to stay connected without feeling overwhelmed. In a certain sense, clients in the middle of a fragile process are asking if their way of experiencing themselves has a right to exist in the world. Any misnaming of their experience or suggestions that they look at the experience in a different way is experienced as an answer of “no” to that question.


Clients with low-intensity fragile process are likely to experience personal reactions as subtle emotional shadings, as threads of experience they can barely catch and hold onto. If distracted or contradicted, they are likely to give up on the idea that such experiences have any significance. Therapist comments intended to offer helpful advice or insight are likely to cause the client to disconnect. Clients experiencing high-intensity fragile process feel their experience very strongly and often want to be understood and affirmed in the rightness of their experience. However, even slight misnaming or misunderstanding of the experience is likely to feel violating. For example, a client who says that he feels “irritated” may feel deeply misunderstood if the therapist says that she understands that he is “angry.” Other sorts of interpretive comments or advice are likely to be experienced as invalidating the experience altogether.


The physical arrangements of therapy sessions are likely to affect clients’ abilities to stay connected with fragile process. Knowing that sessions will take place at the same time of the day and week, that they will begin in the same way, that the physical arrangement of the room will remain the same often helps clients stay with fragile process. Changes that might be insignificant under other circumstances can completely disrupt a client’s ability to work therapeutically. For example, meeting in a different office, or meeting at a different time may be experienced by the client as destroying the therapeutic context without any certainty that it can be restored. On the other hand, clients who experience fragile process often feel the need to have considerable control over the arrangements of sessions. Being able to adjust the length of sessions, have sessions at certain times of day, or arrange the room in a way that feels comfortable may allow a client to connect with process that would be inaccessible otherwise.


Clients who have a fragile style of processing often experience their lives as chaotic or empty. If clients with high-intensity fragile process choose to stay connected with their experience in personal relationships, they are likely to feel violated and misunderstood a great deal of the time. When they express their feelings, other people in their lives are likely to see them as unreasonably angry, touchy, and stubborn. These others are likely to become angry and rejecting in return, reinforcing the clients’ sense that there is something fundamentally poisonous about their existence. Clients who continue to express their feelings are likely to have ongoing volatile relationships or a succession of relationships that start out well and then go sour. If, on the other hand, they give up on connecting or expressing their personal reactions they are likely to feel frozen or dead inside. Many alternate, holding in their reactions while feeling increasingly uncomfortable and then exploding with rage at those around them.


Clients with low-intensity fragile process are likely to have difficulty becoming aware of or taking their personal reactions seriously. When they do express reactions, they often do so in subtle and indirect ways. They are likely to feel rebuffed and withdraw personal connections before others are aware that a serious issue was involved. They may simply stay detached for most of the time, living lives that are outwardly functional, but lacking in a sense of vitality. Clients with low-intensity fragile process may not really know that there is an alternative to a low-key, slightly depressive existence.


The Development of Fragile Process

The ability to process experience involves a complex set of intrapsychic skills that develop during early childhood. In a basic sense, everyone who is alive processes, since all people have experiences that go through changes over time. (My thinking about experiential processing is heavily influenced by work of Eugene Gendlin which explores the complex relationship between people’s felt senses and the verbal naming of experience.) I believe, however, that more complex processing requires a basic skill: the ability to hold relevant personal experiences in one’s attention in an accepting way. Children at first have very limited capacities to hold experiences alone and develop their capacity to do so in interaction with nurturing adults. This begins with nonverbal interaction in infancy. “Good-enough” parents will connect with infants’ experiences and draw them into various kinds of nonverbal play while helping them avoid extremes of high and low intensity experience. Infants can be quite good at eliciting this kind of nonverbal empathy from adults who aren’t already skilled at it. Adults also bring a verbal empathy to children’s experiences, typically beginning to name their reactions long before the children are able to understand the words. After hearing their experiences named by others for a period of time, children will begin to label their own experiences. Initially, this labeling will be quite primitive and global, later much more subtle and complex. As children grow older, they develop a sense of how particular experiences fit with larger personal, family, and cultural identities.


When children have learned to hold their experiences with the support of caring, empathic adults, they begin to internalize this capacity and attend to their own experiences in an accepting way. Once this ability to hold their experience has developed, I believe that other experiential capacities tend to develop naturally. During latency and adolescence, children become increasingly able to modulate the intensity of emotional reactions, and to shift in and out of mood states when situationally appropriate. They come to be able to sense their own experiences, shift to taking in the experiences of other people, and use this information to revise their own experience. They become able to consider their immediate reactions in the light of other personal and cultural meanings and let these meanings have an impact on their experiences.


If parenting adults are overwhelmed or preoccupied with their own needs, they may not engage in very much empathic holding of their children’s’ experiences. They may be unresponsive or respond to their children primarily in terms of how their children make them feel. If adults are avoiding facing certain issues in their own lives—such as alcoholism or marital unhappiness—they may systematically distort their labeling of those experiences which their children have that would threaten their denial. Children may develop reverse selfobject relationships with their parents, in which they put their own reactions aside to help avoid fragmentation experiences in their parents. When children have not had an empathic holding of their experiences by adults, the development of other experiential capacities is likely to be compromised. Experiences that have not been held tend to feel unreal, out of control, or poisonous. Rather than learning to process personal reactions to situations, children begin to suppress their experiences or act out of them without understanding their motivations. Over time, these children are likely to develop global feelings of emptiness or badness.


Therapeutic Interaction with Fragile Process

Ideally, therapy with adults who have a fragile style of processing creates the kind of empathic holding that was missing in the clients’ early childhood experiences. If the therapist stays empathically connected to significant client experiences, the clients are likely to feel the satisfaction that comes from staying with their experiences in an accepting way. Initially this tends to be a very ambivalent sort of pleasure, since the experiences themselves are often painful, and the client is likely to be convinced that they are shameful and likely to result in harm to themselves and others. Clients may feel the need to test therapists in various ways, before trusting that the therapist could relate to their experience or believing that their experience could have any value. They may be afraid that expressing their experience will make them vulnerable to manipulation and control by the therapist or that their experience has the power to overwhelm and harm the therapist. Over time, however, clients are likely to find that their reactions make more sense than they thought, and that seemingly inexorable feelings go through various sorts of positive change and resolution.


Effective therapy with fragile process requires high quality listening skills. Clients need more than an accepting presence. They need to know that their therapists have grasped what they were feeling and trying to express. Therapists need to be particularly attentive when clients have a sense of experiences that they don’t yet have words for. If therapists make space for the unclearness, clients are likely to find their own words for the experience. For example, the therapist might say, “Something about that feels uncomfortable, but you’re not quite clear what it is” and the client might then say, “Yes, it’s a kind of sad-hopeless feeling.” On the other hand, if the therapist fills in the meaning, the client is likely to feel misunderstood and angry or give up searching for the right words to express the experience.


Clients in the middle of fragile process often tell stories that somewhat indirectly express their fear that their experience doesn’t have any right to exist in the world. Sometimes these stories express the clients’ sense of hopelessness and shame when other people are upset with them. At other times, clients go to great lengths to explain that they have done everything possible in a situation and that others haven’t done anything to help or have actively made the situation worse. Therapists are often uncomfortable with clients’ extremely high or low assertion on their own needs as expressed in such stories. They may be drawn into reassuring clients that they have no reason to feel ashamed. Or they offer clients advice about how they could look at the situation differently or handle it more assertively.


Clients in the middle of fragile process are usually quite unreceptive to such advice and are likely to seem wounded and irritated when it is offered. They are really just asking to be received in their experience of the situation. And, when therapists are able to hold such experiences with clients, they are addressing the issue that is more fundamental—their clients’ uncertainty that they have the right to have the experience at all. Once clients feel more grounded in their experience of the situation, they quite naturally come to take a view that balances their needs in situations with those of others. Often, they start to discuss their situations with others, taking in alternate points of view and becoming assertive in evenhanded ways.


Clients typically have some themes or life situations that are much more fragile than others. Clients are likely to express themselves in ways that are much more clear, forceful, and seemingly rational around aspects of their lives that are less fragile. When issues are fragile, clients will often express themselves a bit indirectly—through side comments while leaving the session, in themes buried in long stories, or comments made very tentatively and then quickly denied. Such indirectness is one reason that clients who have a fragile process often feel misunderstood. Therapists can easily miss attempts by their clients to communicate about experiences that are fragile and then find that their clients leave therapy or don’t seem to be making any progress.


Therapists who pay close attention to clients’ process can usually learn to decode their communication quite effectively. When clients show signs of being in the middle of fragile process, their therapists should try to understand what feeling states of ways of acting in the world don’t have a right to exist in their clients’ experiences. Clients are likely to alternate between pursuing ways of life that negate such experiences and attempts to reassert their right to exist in the world. When therapists understand the issues that are at stake, they are likely to find that a great deal more of their clients’ behavior makes sense to them. In turn, their clients are likely to feel much more fully understood. Therapists quite naturally come to take delight in the most fumbling or indirect attempts by their clients to reassert their right to have an experiential presence in the world.


When clients come to be able to hold and process fragile experiences in therapy, they are likely to feel very reliant on the therapist for a period of time. At this stage, the empathic presence of the therapist is essential to clients’ abilities to hold experience without feeling traumatized. It is as if the therapist held an oxygen mask for clients who spend the rest of the week struggling to breathe. Quite sensibly, clients may hate to leave sessions and resent the time that they have to spend out of contact with the therapist. Gradually, though, clients come to be able to hold their experience for longer and longer periods of time between sessions. Often having several sessions each week lets them bridge between sessions without losing a sense of connectedness. In this in-between phase, clients can often reconnect with their ability to hold their experience by calling up the image of the therapist in various ways. Brief phone contact, hearing tape recordings of the therapist’s voice, holding an object that belongs to the therapist, or sitting outside the therapist’s office may help recall the therapy experience.


Fragile Process and Self Psychology

Many ideas developed by Heinz Kohut (Kohut, 1984) fit well with a model of fragile process. A number of writers have noted that Kohut’s emphasis on empathy in work with narcissistic clients comes remarkably close to the attitudes of empathy, congruence, and unconditional positive regard that Carl Rogers had earlier advocated in psychotherapy with all clients. Kohut’s discussion of selfobject transferences capture the intense dependency that clients feel while they are in the middle of fragile processes. Kohut was the first theorist to really understand the way that clients may need to use the therapist as an auxiliary ego for a period of time. His discussions of empathy vividly capture the sense of violation that clients experiencing fragile process may feel when they are misunderstood by their therapists.


Kohut’s contributions have been extremely helpful to many client-centered therapists in coming to a deeper understanding of their clients’ experiences in therapy. On the other hand, Kohut’s theory is much less elaborated than the client-centered tradition on the nature of empathy, ways that empathy can be expressed most effectively, and the sorts of client processing likely to be fostered in an empathic understanding relationship.


While Kohut saw his thinking as an extension of psychoanalysis, his ideas fit somewhat uncomfortably within the psychoanalytic model. Most psychoanalysts try to avoid gratifying infantile wishes of their clients and rely on interpretation to engender awareness and change. Kohut was suggesting that, when preoedipal issues are involved, the therapist needs to replicate a number of parental selfobject functions that the client missed earlier in life by fostering similar selfobject transferences with the therapist.


By suggesting that positive elements of the therapists’ style of interaction potentiate natural, self-directed change processes in the client, Kohut is expressing ideas that are much more compatible with a client-centered model of therapy than a psychoanalytic one. Of course, he moderated this by suggesting that this noninterpretive, empathic stance should only be taken while clients are dealing with preoedipal issues and should be abandoned with more advanced clients. In some ways, Kohut’s attempts to make his thinking compatible with drive theory may have impeded fuller development of an internally-consistent model of psychotherapy with narcissistic clients.


Interpretations of Fragile Process as Archaic Defense

Many therapists interpret negative therapist reactions as resulting from unconscious communication on the part of clients, who they see as using the archaic defense of projective identification (Kernberg, 1975) Initially, therapists often feel uncomfortable being with clients who are in the middle of fragile process. They may feel that clients are detached and boring, that they are perversely unwilling to receive helpful interventions or that they are unreasonably angry about minor disruptions in the therapy process. They may then conclude that the client unconsciously wants the therapist to feel bored and frustrated so that the therapist can understand how bored and frustrated the client is or has been feeling in her life.


I believe that it is wise to be quite conservative about such judgments when clients are experiencing fragile process. Clients are usually just trying to hold onto their own experiences and keep them from going out of control. They generally have no particular wish for the therapist to feel frustrated or out of control in the process. In fact, they often feel a terror of burdening or harming therapists by their relationship with them. I believe that therapist discomfort usually arises for one of two reasons: (a.) the therapist doesn’t understand the client’s process and therefore experiences clients as perversely frustrating and unreasonable, or (b.) the therapist has unresolved control and dependency issues that are hooked by the clients’ needs. Jumping to the conclusion that clients unconsciously want to create uncomfortable feelings in the therapist can easily stop therapists from trying to understand their own and their clients’ reactions. In the process it can impede the very empathy that is so essential to these clients.


There are times when the clients in the middle of fragile process are intentionally trying to create negative feelings in their therapists. I believe that these are better understood as interpersonal strategies secondary to fragile process rather than unconscious defenses. Clients are usually trying to find ways to handle their intense needs for therapist support. They may try to test the therapist with negative behavior to find out if the therapist is likely to leave them before risking the intense dependence that will occur if they open up fragile processes. Once they are in a close relationship with the therapist, they may try to find indirect ways to get more help from the therapist when they feel overwhelmed. Or, they may want to express resentment that they suffer so much pain and abandonment in the therapy relationship and the therapist doesn’t seem to suffer at all.


While it is important for therapists to understand that their clients may be having these sorts of reactions, there is no real purpose served by interpreting these motivations to clients. As always, therapists need to be sure that they take care of their needs in the therapy relationship so that they do not become overextended and come to resent their clients. In an understanding climate, clients will talk about their underlying motivations when this is relevant to them.


Many therapists will interpret the reactions of clients in the middle of fragile process as “splitting” and assume that the client is having difficulty integrating good and bad qualities into a single image. They then feel that it is important to point out the other side of each issue-noting, for example that people idealized by the client are fallible and that people who the client is angry at also have good qualities. (Kernberg, 1975) Clients are quite likely to idealize a therapist who is successfully connecting with fragile process. And, they are very likely to feel angry with other people in their lives by whom they feel misunderstood and mistreated. On the other hand, they are likely to switch and be extremely angry at the therapist when they feel misunderstood and mistreated in that relationship.


I believe that the primary difficulty that clients with fragile process have is one of not being able to hold their own experience, rather than a difficulty in integrating good and bad images into a single gestalt. In fact, the ability to hold one’s experience may be an essential precursor to the ability to form a complex and integrated view of oneself and others. Intense positive and negative reactions make sense when seen from the perspective of clients in the middle of fragile process. Once clients gain a sense of security in their ability to hold experiences, the ability to integrate good and bad images of themselves and others develops on its own. Clients tend to become more interested in understanding the experience of others and they become more able to use that experience to modify their understanding of their own situations. As they become more able to hold and affirm their reactions, they are less likely to feel thrown off and violated by other people’s reactions to them. They become more able to switch back and forth between their own points of view and those of others or to postpone interactions that could be dealt with more effectively at later times.


Conclusion

While the concept of fragile process can be used within a number of therapy modalities, it fits most comfortably within the client-centered tradition. Fragile process seems to be engendered by empathic failure during early development and to be helped, almost exclusively, by participation in the sort of nonintrusive, empathic relationship characteristic of client-centered therapy. Interventions that may be helpful with other sorts of clients in various therapy modalities are likely to impede clients’ ability to hold fragile experience.


Person-Centered Psychological Services

If you are looking for an empathic therapist who works with fragile process, Person-Centered Psychological Services offers individual, family, and relationship therapy provided by clinical psychologists who have specialized training client-centered therapy and expertise in working with fragile and difficult process in its many forms.

You can schedule a free Initial Consultation with one of our clinicians using our secure client portal. For more information about our therapy and psychological services, visit our website at pcpsychservices.com. Please contact us via email at intake@pcpsychservices.com or call us at 773-231-7715 if you have any questions about our therapy services or advanced graduate training in Client-Centered and Person-Centered Therapy.


References

Kohut, H. (1984). How Does Analysis Cure? Chicago, IL: University of Chicago Press.


Kernberg, O. F. (1975). Transference and countertransference in the treatment of borderline patients. Journal of the National Association of Private Psychiatric Hospitals, 7(2), 14–24.


Frequently Asked Questions About Fragile Process in Psychotherapy

What is fragile process in psychotherapy?

How do therapists work with clients who have fragile process?

How might the physical arrangement of therapy sessions affect clients with fragile process?

What are the challenges faced by clients with fragile process in their personal lives?

How does fragile process develop in individuals?

What is the role of empathy in therapy with clients experiencing fragile process?

How do therapists differentiate fragile process from archaic defenses like splitting and projective identification?

Can clients with fragile process integrate positive and negative images of themselves and others?

What is the therapeutic orientation that aligns most with the concept of fragile process?


About the Author


Dr. Margaret S. Warner is a Founding Partner of Person-Centered Psychological Services and a Distinguished Professor of Clinical Psychology at the Illinis School of Professional Psychology at National Louis University in Chicago, IL. She is a client-centered therapist who has practiced for over 35 years, with a particular emphasis on work with clients experiencing “difficult process,” those typically diagnosed as borderline, narcissistic, dissociative identity disorders or schizophrenia. Her clinical training was undertaken at the Chicago Counseling and Psychotherapy Center, an offshoot of the original Counseling Center founded by Carl Rogers at the University of Chicago. Dr. Warner is an author who has presented at several international conferences on her psychotherapy research and theory. She was the 2022 Recipient of the APA Division 32 Eleanor Criswell Hanna Award, Celebrating Women in Humanistic Psychology for recognition of professional accomplishments that celebrate the achievements and contributions of women in humanistic psychology. She is also a member of the Association for the Development of the Person-Centered Approach.


More Publications on Fragile Process, Difficult Process, and Client-Centered Therapy by Dr. Warner:

Soft Meaning and Sincerity in the Family System.

Does empathy cure? A theoretical consideration of empathy, processing, and personal narrative.

A client-centered approach to therapeutic work with dissociated and fragile process.

The Language of Psychology as it Affects Women and Other Traditionally Disempowered Groups.

Person-Centered Psychotherapy: One Nation, Many Tribes.

Person-Centered Therapy at a Difficult Edge: A developmentally based model of fragile and dissociated process.

Empathy, Relational Depth and Difficult Client Process.

Psychological contact, meaningful process, and human nature: A reformulation of person-centered theory.

Client processes at the difficult edge.

Difficult client process.


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