Monday, February 7, 2011

The Psychotherapeutic Relationship

The therapeutic process is not only about what is intrapsychic (the content of the mind, and the unconscious); it is also an interactive, bidirectional, and co-created engagement between therapist and patient. Regardless of any particular theories one utilizes, fostering from the very outset a mutually respectful relationship with the patient is paramount. Understanding diagnoses will not be helpful if the patient does not come back. To that end, the patient must, from the beginning, implicitly understand that you are trustworthy, respectful, and caring. Sometimes it is helpful to acknowledge with open inquiry the interpersonal experience. Collusion with patients’ illusions, without inquiry, may serve to increase the patient’s anxiety, hopelessness, and self-alienation.

Hoffman (1983) and Aron (1991) recognize that, while the relationship is mutual (both make contributions and affect one another), it is also asymmetrical. Relationships, including those between therapist and patient, are constituted by mutual regulation. We affect and are affected by each other, and, when this is not the case, one or both can feel ineffectual, unrecognized, even helpless. We aspire to mutual recognition. While we want the patient to journey her or his own path, we do not aspire to foster an autonomy that threatens the patient with isolation. When we do not demand pathological accommodation, or when we offer being alone in the presence of the other, it may be the patient’s first, or a rare, experience of autonomy without risk of loss of connection.

In seeking to connect with us, patients may probe beneath our professional fa├žade. Do not mistake striving to know the therapist as [only] hostile or as [only] resistance. Consider the wish for connection and a longing to have an authentic effect on others. Sometimes patient silence is hostile as when the patient is too furious to speak or is withholding. Sometimes an experience or memory has no words. But sometimes it reflects a wish to be accepted as one is, without having to perform or produce. It is okay to admit that you do not know what the silence is about but would like to know, and likewise, it is okay to sit in silence, intimating your willingness to wait. I remember Hermann Hesse’s Siddhartha: I can think, I can wait, I can fast. Sometimes the therapist must be so willing, too.

Aron, L. (1991). The Patient's Experience of the Analyst's Subjectivity. Psychoanal. Dial., 1:29-51
Hoffman, I.Z. (1983). The Patient as Interpreter of the Analyst's Experience. Contemp. Psychoanal., 19:389-422.

1 comment:

UnmotheredChild said...

I enjoyed reading this. I have been in therapy for nearly 7 years, last 4 years in analysis and I have found the relationship to be paramount to my healing. Yes, the interpretations hold but it is the relationship that eventually heals. The realness and the effect I have on the other. I have an effect, I am visible, I am seen and heard, I am someBody. I have a self.
I guess it depends when the wounds were caused, but the relationship is, for me, the most important aspect of my healing. Thankfully my analyst recognises this, thankfully I can now allow 'it'.

Fortunately my analyst does not mind working 'outside the box', I would have not been able to stay if she didnt bring herslef into this relationship [meaning: being herslef, genuine etc] Coldness and detachment was partly what nearly killed me as a child, to have my therapist stay distant from me would have crushed me. The transference is still bad enough with her being kind and warm!