Emotional Fragility and the Need for a Raft in Intensive Therapy
This article is written for therapists and clinicians engaged in ISTDP-informed, depth-oriented work.
Many difficulties in depth-oriented therapy are not caused by a lack of skill, courage, or commitment. They arise when emotional intensity exceeds the client’s capacity to tolerate it. When depth is pursued without sufficient containment - without a ‘raft’ - anxiety escalates, defences harden, and both client and therapist can feel stuck. Building capacity first is not a retreat from depth; it is what makes depth possible. Because ‘good therapy’ is about capacity building
A raft provides stability before movement; without it, depth becomes dangerous.
Why this page exists
Many therapists enter intensive, experiential, or psychodynamic work because they value depth. They are not afraid of feelings, conflict, or intensity. Yet a familiar pattern emerges with certain clients: sessions escalate quickly, anxiety rises, progress stalls, and both client and therapist leave feeling confused or ineffective.
This is often misread as resistance, lack of motivation, or “not enough pressure.”
In reality, it is frequently an issue of emotional fragility.
Emotional fragility is not resistance
Emotional fragility does not signal a client is unwilling, avoidant, or incapable of insight. It refers to a limited capacity to tolerate emotional activation without destabilisation.
As articulated across the fragility spectrum described by Allan Abbass, fragility reflects:
How quickly anxiety escalates when affect is mobilised
How effectively the nervous system can stay regulated under pressure
Whether parts of the self are aligned or at odds with the work
Fragile clients are often highly motivated. They may desperately want change. However, what they lack is not intent, but internal safety.
The cost of misreading fragility
When fragility is mistaken for resistance, the clinical response usually intensifies:
More pressure
More focus on core affect
More insistence on “staying with the feeling”
The predictable outcome is escalation:
Anxiety spikes
Defences harden or fragment, particularly through splitting
Projections and projective identification often intensify
The superego intensifies
The therapeutic alliance strains
At this point, we as therapists may experience self-doubt or urgency: “Why isn’t this working?” or “I must not be pushing hard enough.”
The problem is not intensity itself. The problem is intensity without capacity.
What the “raft” actually is
The raft is not a metaphor for comfort or collusion. It is a set of concrete capacities that allow depth work to proceed safely.
A functional raft includes:
Sufficient anxiety regulation to prevent flooding or collapse
Basic affect tolerance - the ability to feel without dissociating, panicking, or falling into primitive defences: projection, projective-identification and splitting
Alignment between protective parts and therapeutic goals
A working alliance strong enough to withstand emotional strain and potential repeated ruptures
An ego capacity that can observe experience rather than be overtaken by it
Without this raft, pressure mobilises danger rather than insight.
Why parts work precedes graded format
In fragile clients, parts are often in conflict:
One part pushes for change or relief
Another part is terrified of emotional exposure
A third may attack the self for “failing therapy”
Pressing directly for core affect in this context mobilises internal warfare. Anxiety rises because the parts do not yet trust the process of therapy, not necessarily because feelings are being avoided.
Parts work is not a detour from depth. It is the mechanism that makes depth possible.
By helping the protective parts feel understood and respected:
Anxiety reduces
Internal resistance softens
Affect tolerance increases organically
Only then does graded work become stabilising rather than destabilising.
How therapists get pulled into collapse
Fragile dynamics reliably evoke countertransference pressure in therapists. Common patterns include:
Urgency to “make something happen”
Rescue fantasies
Irritation at apparent stagnation
Despair or loss of confidence
Over-responsibility for outcome
These reactions are understandable. They are also signals that the raft is missing.
When therapists internalise responsibility for breaking through fragility, they risk replicating the client’s internal pressure system, often with similar results.
Working responsibly on the fragility spectrum
Responsible depth work requires discriminating when to pursue intensity and when to build capacity.
This means:
Privileging containment over breakthrough
Both therapist and client are tolerating slower progress without self-criticism
Recognising that “going gently” can be technically demanding
Accepting that some clients require extended raft-building before graded work
This is not to be mistaken for therapeutic timidity or falling into passivity. It is precision.
A closing orientation
Fragility is not a diagnosis and not a verdict. It is a clinical reality that demands careful and considerate adjustment, instead of escalation.
When therapists are permitted to slow down, build capacity, and prioritise safety, something paradoxical often happens: depth becomes accessible without force.
Depth work done responsibly protects the client, and therapist.
If this reflection resonated, you might explore:
The Therapy FAD? Rethinking our Feelings, Anxiety and Defences Across Modalities
Why Feelings Don’t Make Us Ill, and What Actually Does
Therapy When Emotions Feel Overwhelming
Explore more in Depth
Therapist FAQ: Working with emotional fragility and containment
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Resistance usually involves capacity with avoidance: the client can tolerate affect but actively deflects or defends against it.
Fragility involves limited capacity: affect mobilisation quickly produces anxiety, disorganisation, shutdown, or harsh superego attack.
A simple test:
If pressure reliably produces more clarity over time, you’re likely dealing with resistance.
If pressure reliably produces more anxiety, confusion, or collapse, fragility is the more accurate frame.
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Common early indicators include:
rapid shifts from emotion to confusion or blankness
escalating bodily anxiety (tight chest, dizziness, nausea)
sudden intellectualisation or excessive reassurance-seeking
a sharp rise in self-attack after sessions
These are not failures. They are signals that containment needs strengthening.
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Slowing down is therapeutic when it increases capacity.
It is avoidant only when it preserves stagnation.
The question is not speed, but trajectory:
Is the client becoming more regulated under affect?
Is anxiety decreasing over time?
Are parts becoming less oppositional?
If yes, the work is moving forward, even if it looks quiet.
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Parts work becomes depth work when it:
reduces internal conflict
weakens the punitive superego
increases affect tolerance
If parts work results in greater emotional access later, it has done its job.
If it becomes endlessly explanatory or reassuring, the focus may need recalibration.
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This is common, especially in fragile presentations.
Often one part is requesting pressure while another part is terrified of it. Taking the request at face value can unintentionally ally with internal pressure and increase anxiety.
A containing response is to explore:
which part wants pressure
what it fears if pressure is not applied
what happens when pressure increases
This preserves collaboration without escalating risk.
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Graded work tends to become viable when:
anxiety peaks and settles more predictably
the client can reflect on their experience while feeling
protective parts interfere less aggressively
the therapeutic alliance remains stable under affect
At that point, pressure no longer destabilises; it starts to organise.
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Pay attention if you notice:
persistent urgency to “do something”
repeated self-questioning after sessions
irritation followed by guilt
fantasies of rescue or breakthrough
a sense that the work is always on the brink of collapse
These reactions often reflect the absence of a raft, not therapist inadequacy.
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Containment is not accommodation.
You avoid collusion by:
naming anxiety when it rises
keeping emotional focus clear but tolerable
resisting both premature pressure and endless soothing
maintaining a steady, confident stance
The aim is expansion of capacity, not protection from feeling.
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Fragility is state-dependent and modifiable, not a permanent trait.
With sustained containment:
affect tolerance increases
anxiety regulation improves
the superego softens
depth becomes accessible
What looks like fragility early in treatment often looks like resilience later.
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Trying to prove that depth work can be tolerated, rather than building the conditions that make tolerance possible.
Depth does not need to be forced.
It needs to be prepared for. -
Working without a raft exposes therapists to:
chronic self-doubt
burnout
enactments of pressure and collapse
erosion of clinical confidence
Responsible pacing preserves the therapist’s capacity to think, feel, and stay present, without hardening or withdrawing.
About the Author
Rick is a UK-based Psychodynamic Psychotherapist and BetterHelp Brand Ambassador.
He focuses on emotional regulation, unconscious dynamics, and co-creating therapeutic relationships for lasting change.
From his bio:..
Psycho = Mind, Dynamic = Movement; together we do some movement of the mind.
Rick helps both clients and therapists understand how our feelings, anxiety, and defences shape our inner and outer lives.
Acknowledgements
Glynis van der Hoek, Liza Chera, and Jon Frederickson, whose insight and guidance helped shape my practice. BetterHelp for welcoming me into their Brand Ambassador Programme.
