The change moments in psychotherapeutic practice 

The challenge with humanistic psychotherapy today is to realize the philosophical con­cepts and theory put into practice. How do we see an I-thou moment in a therapy ses­sion? 

My personal conviction in this topic is borne by the fact that I have experienced change moments – as a client of psychotherapy. Over the years, I have also been able to tell if these change moments had a lasting effect, or if they were just cathartic or tempo­rary because of suggestion and coercion. Perception of from the client’s point of view recorded over lifetime (a couple of years), may be essential aspect of psychotherapeutic process research. 

The process of defining the healing I-Thou moments (Buber, 1936) in psychotherapy often gets lost in language. What some call the transcendental phenomenon (which I have in this paper related to an aspect of Clarkson’s framework), is also called “miracle moments” (Santos, 2003), “sacred moments” (Pargament, 2007), and “moments of meeting” (The Boston Change Process Study Group, 2010). 

What is typically experienced in this moment is typically described like this: “Every therapist knows that there are some special moments in psychotherapy. I experi­ence them as “sacred moments” when immediate realities fade into the background, when time seems to stand still, when it feels as if something larger than life is happen­ing. In these moments, I believe, a meeting of souls is taking place. This was one of those times” (p. 6). 

I had the benefit of attending a presentation at a Gestalt Associates Los Angeles (GATLA) Summer Residential in Lisbon this year which discussed this very topic of defining these moments of encounter. Entitled, I-thou moments in psychotherapy, the study is the result of meta-analyses of psychotherapeutic literature and interviews with therapists. Hence it was found that these I-thou moments: 

  • are memorable, exists in psychotherapy and appears every now and then.
  • are recognizable, significant events.
  • is based on the quality of dialogue.
  • short lasting (in seconds).
  • is rare.
  • is mutually experienced.
    During these moments 
  • perception gets narrowed.
  • there is an unusual level of understanding and acceptance of the other
  • there is experience of being on the edge of something spiritual.

These moments lead to long term change in the therapy and result in motivation for the client to further therapy work. It strengthens the alliance, and has no negative affects (unlike transference relationship). It is also a qualitatively viewed process, and is often arises from sharing of heavy topics and staying long enough at an oftentimes uncomfortable place. Playing the role “I am the therapist, you are the client” prevents these moments from happening. The challenge in studying these moments is the very fact that in trying to grasp the moment, that moment is lost (Pernicka, 2016).

References

Buber, M. (1936). Ich und Du. Berlin: Schocken.

Pargament, K. (2007). Spiritually integrated psychotherapy: Understanding and addressing the sacred. NY: Guilford Press.

Pernicka, M. (2016, July). I-Thou moments in Psychotherapy. Lisbon, Portugal.

Santos, A. M. (2003). Miracle Moments: The Nature of the Mind’s Power in Relationships and Psychotherapy. iUniverse.

The Boston Change Process Study Group. (2010). Change in psychotherapy. NY: W. W. Norton & Co. .

Empathy and Buber’s I-thou contact

I do not fully agree with Schmid’s implication that empathy is about “try(ing) to understand, as exactly as possible, the accurate meaning of what goes on inside another person in the very moment”. This is the common understanding of empathy, but it actually contradicts the principle of Buber’s (1970) I-Thou contact. “Trying to un­derstand” is a process of someone doing something with an aim to furnish a need in oneself. In this case, it is the need to understand “as exactly as possible”. If a therapist has this kind of goal, his/her goal may become a blockage to contact because he/she is distracted by the need to interpret and the need to establish his/her identification as therapist in the relationship. 

Wouldn’t this amount to using the client to find-out-something-so-that-I-can-do­my-therapist-job? This kind of objectifying the Other in the relationship leaves room for transference and countertransference neurosis. If empathy is as what is generally under­stood as described above, it is then not part of the I-Thou relationship, because the I­Thou relationship excludes objectification. 

The I-Thou contact requires seeing the Other first, and not seeing the other in re­lation to oneself. This movement towards the other first is what Emmanuel Levinas considers the ethical movement (Schmid, 2001). 

Schmid clarifies this disparity later in the article in stating the difference between Roger’s and Buber’s comprehension of the activity of making empathic contact. Be­sides what is mentioned, Rogers also believes that it is necessary “to put one’s own un-derstanding completely apart” if one wants to enter the world of another person empath­ically. Buber, on the other hand believes in the mutuality of the process. 

That which lies beneath the I-thou contact is not empathy but something more than empathy. Buber (1970) uses the word, Umfassung, a phenomenon of embracing, which is “more than empathy”. This process requires the recognition of 2 poles, in en­countering the other “as a partner in a bipolar situation” (p. 178). This implies a dynam­ic relationship of “swinging into” (einschwingen) into the experience of the other and at the same time maintain one’s own reality of the self. It shows a dynamic process of be­ing existentially affected by the other, and including the other person into one’s own existence (Schmid, 2001). 

This is not the same as to “trying to understand someone as exactly as possible”, or to step into someone’s shoes. It is rather about me being me, seeing you, and show­ing you how you affect me— at this present moment. 

This way of relating in the present moment is what Buber calls, personale Vergegenwärtigung. It is an elementary way of relating and means to expose oneself to the presence of the other. This is a personal way of becoming aware of, a way of ac­ceptance instead of perception, a way of acknowledgment instead of knowledge (Schmid, 2001). 

The I-Thou relationship is basic existential relationship without the complications of identity and needs. The healing power of this relationship is in the confirming of the other for who he/she is. Buber is quoted to use the word Realphantasie, which indicates that what is happening is that “the Other’s reality is touched” (ibid.). What is experi­enced through this form of relationship is the transpersonal, intersubjective acknowl­edgment of the other, affirming the identity of the other through the presence of the self. Both partners in the relationship attains affirmation of the self. This benefit is mutual, and the relationship is symmetric. What happens in this mutual exchange, Staemmler (2009, p. 96) explains is not a “fusion of horizons”—which happens with just empathy alone— but a widening of each other’s horizons in such a way that that it is integrated with each other’s personal background.

References

Buber, M. (1936). Ich und Du. Berlin: Schocken. 

Buber, M. (1970). I and Thou (Kindle ed.). (W. Kaufman, Trans.) Charles Scribner’s Sons.

Gadamer, H. G. (1975/1960). Truth and method . (G. Barden, & J. Cumming, Trans.) NY: Seabury. 

Schmid, P. F. (2001). Comprehension: the art of not-knowing. Dialogical and ethical perspectives on empathy as dialogue in personal and person-centred relationships. Empathy, 53-71.

Staemmler, F.-M. (2009). The willingness to be uncertain: Preliminary thoughts about intepretation and understanding in Gestalt Therapy. In L. J. Hycner (Ed.), Relational approaches in Gestalt Therapy (pp. 65-110). NY: Gestalt Press.

What’s behind the transforming power of dialogue?

Exploring the Power of Dialogue

Dialogue extends beyond mere verbal communication; it’s a profound act of connection. At the core of genuine dialogue lies the “I-Thou” relationship. Could this be what we commonly understand as empathy? While the concept of empathy itself invites debate, for this discussion, I’ll draw from Schmid (2001).

In “Comprehension: The Art of Not Knowing,” Schmid explores Buber’s philosophy through a psychotherapeutic lens, offering a perspective relevant to this analysis (though I have reservations about certain aspects, which we’ll address later). Schmid argues that empathy is an inherent quality that transcends identification or interpretation. It’s the willingness to be moved by another while remaining authentic in their presence.

In true empathic connection, whether through spoken words or nonverbal cues, we prioritize the other person’s needs above our own. We shed the urge to analyze their identity or assert our own. There’s no fixed objective – just the process of authentic presence, extending an invitation for the other to do the same. This is where dialogue finds its transpersonal potential.

(This is a revised version.)

Read also: Empathy and Buber’s I-thou

References

Buber, M. (1936). Ich und Du. Berlin: Schocken. 

Buber, M. (1970). I and Thou (Kindle ed.). (W. Kaufman, Trans.) Charles Scribner’s Sons.

Gadamer, H. G. (1975/1960). Truth and method . (G. Barden, & J. Cumming, Trans.) NY: Seabury. 

Schmid, P. F. (2001). Comprehension: the art of not-knowing. Dialogical and ethical perspectives on empathy as dialogue in personal and person-centred relationships. Empathy, 53-71.

Staemmler, F.-M. (2009). The willingness to be uncertain: Preliminary thoughts about intepretation and understanding in Gestalt Therapy. In L. J. Hycner (Ed.),Relational approaches in Gestalt Therapy (pp. 65-110). NY: Gestalt Press.

Healing through dialogue is an eminently hermeneutical phenome­non indeed

“Healing through dialogue is an eminently hermeneutical phenome­non indeed.”

Gadamer, quoted in Staemmler (2009, p. 65). 

The psychotherapeutic alliance is a dialogue which is action. Through this dialogue, understanding takes place. This understanding comes about through a hermeneutic pro­cess. This process requires the authentic inclusion of the self of the therapist. 

Staemmler goes on to emphasize that in the process of understanding, one needs to be asked to ask authentic questions, bearing in mind the tendency for therapist (per­haps to hide his/her own shame) of not being authentically available to the client by asking pseudo-questions, which includes pre-prepared list of questions or repetitive questions like “how do you feel?” without actual curiosity. Pseudo-questions also in­clude questions that predestine their answers. Authentic questioning requires the bring­ing into the open what is unexpected, with the knowledge that the client has the answer. This means that the therapist needs to be open to listening, and living with the uncer­tainty of the answer that he/she is given. This requires that the therapist relinquishes any control over the client’s answers and meaning-making, and this includes predicting what the client’s answer should be before even asking the question. 

This relinquishing of control in dialogue leads us away from Buber’s “I-it” and towards the “I-Thou” way of relating. Incidentally, this forms the “symmetrical” aspect of the psychotherapeutic alliance as discussed earlier described by Altemeyer, and con­nected to Clarkson’s the person-to-person relationship (point 4) and the transpersonal relationship (point 5). 

Another way of understanding the “I-It” form of understanding is “to claim to understanding the other better than she or he understands herself or himself”. Looking closely this can also be seen as an abuse of professional power “disguised as benevo­lence” (ibid. p. 91-92). The consequence to such behavior to the profession is the dis­trust caused by fear of the client from being misinterpreted and misjudged. 

That which happens in an authentic I-thou dialogue is a mutual exchange. This happens in the “between”. Gadamer, in agreement with Buber: “The dialogue has trans­forming power. When a dialogue succeeds, something remains for us and in us, which has changed us” (ibid. p. 93). “Dialogue that succeeds”, is no ordinary dialogue, but that which is inclusive of the self and the other. Converse to the ‘I-It’ way of relating, it exists, as Carl Roger’s is noted to have explained, “without any techniques, means, aims or intentions” (Schmid, 2001). This kind of dialogue is what Buber terms the ‘I-Thou’. This is the dialogue with transforming power. 

This is the transformative contact which many schools in psychotherapy strive to establish in the therapeutic hour. I use the word ‘strive’ to give meaning to the elusive nature of such a healing contact, and the powerful benefits in the event when such con­tact happens.

What’s behind the transforming power of dialogue ?

References

Buber, M. (1936). Ich und Du. Berlin: Schocken. 

Buber, M. (1970). I and Thou (Kindle ed.). (W. Kaufman, Trans.) Charles Scribner’s Sons.

Gadamer, H. G. (1975/1960). Truth and method . (G. Barden, & J. Cumming, Trans.) NY: Seabury. 

Schmid, P. F. (2001). Comprehension: the art of not-knowing. Dialogical and ethical perspectives on empathy as dialogue in personal and person-centred relationships. Empathy, 53-71.

Staemmler, F.-M. (2009). The willingness to be uncertain: Preliminary thoughts about intepretation and understanding in Gestalt Therapy. In L. J. Hycner (Ed.), Relational approaches in Gestalt Therapy (pp. 65-110). NY: Gestalt Press.

Unconscious feelings and countertransference within the Therapeutic Alliance 

To illustrate how a therapist’s emotions towards client, though brought to awareness and allowed to be revealed, can also be mistaken for authentic reaction to the client’s process, a mentor of mine, in a private lecture on experiences of unconscious effects on a therapist in therapy sessions, narrated a rather simple story he entitled, Chanel No. 5: the client, a middle-aged woman had come to therapy to work on very traumatic and emotionally tragic experiences in her life. The therapist found himself deeply moved by her experiences, and would find himself in tears each time she entered his practice. He questioned his emotionality towards the client only weeks later because he, like many would have, assumed that he was naturally moved by the client’s plight. He subsequent­ly noticed the client’s perfume as she entered the office and asked her what she was wearing. ”Chanel No. 5”, she replied, which was the same perfume his beloved mother had worn for most part of her life. 

In the story, the client instilled emotions in the therapist in which the therapist was unaware of. This gets interpreted somewhat inaccurately at first until the therapist was able to come to a self-awareness. This kind of experience faced by therapists is termed by Freud in a 7 June 1909 letter to Carl Jung, as countertransference, to which Freud explains, “(s)uch experiences, though painful, are necessary and hard to avoid. (…) (W)e need to dominate ‘countertransference’, which is after all a permanent prob­lem for us; they teach us to displace our own affects to best advantage. They are a ‘blessing in disguise’” (Freud, 1909). The unconscious nature of countertransference makes it difficult for the analyst to differentiate between the analyst’s own unresolved difficulties and emotional reactions and impressions that come to the the therapist’s consciousness that are activated by the projective identification of the client. 

While unlike Freud and Klein who considered strong countertransference feelings to have negative affect on analysis and something analysts should work on by gaining more insight into themselves instead, many analysts like Bion have found usefulness in the phenomena. Therapists of the intersubjective and relational schools share counter­transference that they have (and are aware of) as a means to bring authentic contact to the alliance. 

Awareness of therapist’s countertransference is supportive to the therapeutic process 

Countertransference, with awareness, supports rather than interferes with the therapist’s work. Freud’s mention of the need to “dominate” countertransference, can be taken as a call to be aware of dealing with the emotions within the alliance rather than rejecting them and becoming emotionally detached. Heinmann (1950, p. 81) considers this use of countertransference as “one of the most important tools for his/her work. The analyst’s counter-transference is an instrument of research into the patient’s unconscious” as a means of bringing to consciousness of the client what he/she does (consciously or un­consciously) to “get under the analyst’s skin”. How can the awareness of countertrans­ference experienced by the therapist be an advantage to the therapeutic alliance?

“(T)he analysis of the transference, i.e., that part of it which deals with the breaking down of the resistances, constitutes the most im­portant piece of analytic work.”

Wilhelm Reich, 1945/1984, p. 5

The answer is explained by Racker (1953) who acknowledged that the therapist may react emotionally to a patient’s enactments or behavior or personality, but he/she is not prevented from “identifying him/(her)self intellectually with his/(her) defense mecha­nisms and object images”. When the therapist is aware of his/her own emotional reac­tion, this countertransference is actually instrumental into “bringing to his notice a psy­chological fact about the patient” for the feelings helps the therapist to detect the pres­ence of the client’s psychological games. Even though the countertransference feelings are neurotic, the therapist who is aware of this is able to react with understanding. For this understanding to be possible, Racker adds, the therapist has to first analyze and overcome his/her own situation and be able to identify him/herself with the patient’s ego. Within the therapeutic alliance and hour, the patient reenacts and recreates situa­tions that are recurrent in his/her daily situations. These undisclosed and undetected activities, is an unconscious means of avoiding the therapeutic process, and thus “prompted by a desire to retain a defensive organization and probably to recruit the ana­lyst into its personnel” (Britton, 2003, p. 77). In order for the impasse to be broken and the “enactments” to discontinue and therapeutic work can progress, Britton suggests that “until the enactment is recognized and described, the belief system that lies behind it cannot be disclosed, but, at the same time, until the patient’s beliefs that drive it are disclosed the enactment will continue” (Mawson, 2011, p. 4-15). 

Transference and countertransference is a phenomenon in the therapeutic alli­ance, Racker’s comment— quoted also in Britton (2003, p. 55)— highlights the attitude towards acceptance of this human condition and working with it’s existence in psycho­therapeutic relationship: “The neurotic (obsessive) ideal of objectivity leads to repres­sion and blocking of subjectivity and so to the myth of the … ‘analyst without anxiety or anger’ The other neurotic extreme is that of drowning in countertransference. True objectivity is based upon a form of internal division that enables the analyst to make himself (his own countertransference and subjectivity) the object of his continuous ob­servation and analysis” (Racker H. , 1968, p. 132). Objectivity, in many respects, is the priced commodity in psychotherapy. If the therapist is caught up in countertransference and is unaware of the fact, his/her endeavors to work with the clients in an objective manner would be unproductive. 

Objectivity as a concept itself needs some careful consideration. For this we can turn to Maturana & Varela (1980): “(O)bjective knowledge seems possible and through objective knowledge the universe appears systematic and predictable”. Objective knowledge, according to the authors, seems possible. It is prized for the very fact that it gives the impression of predictability. When things are systematic and predictable, we feel safe. The authors go on to explain: “Yet knowledge as an experience is something personal and private that cannot be transferred.” The explanation for this is that objec­tive knowledge must be created by the listener. The listener understands and the objec-tive knowledge appears to be transferred (p. 5). The therapist therefore needs to be aware of this phenomenon: that the information being shared between him/herself and the client is experienced and mentally processed by both parties. The reality is, howev­er, that the assumption that common understanding is achieved is only apparent. 

The benefit of keeping this in mind to the therapist is that he/she will be constant­ly on guard and self reflective of his role as observer. The therapist as an observer is part of the system (in this case the client) in which he/she is observing. Since he/she communicates with the client and the client communicates back, and the client is also the observer in return. “Anything said is said by an observer” (p. 8). The observer can­not but interact with the system; the observer is also observed. 

The observer, if self-reflective, is also able to observe him/herself. So in the ther­apeutic setting, the therapist has the work of observing two individuals: the client and himself. What is achieved is a hermeneutic and cyclical process of understanding. This is discussed later in the paper. Maturana & Varela explains this as such: “If an organism can generate a communicative description and then interact with its own state of activity that represents this description, generating another such description that orients towards this representation…, the process can in principle be carried on in a potentially infinite recursive manner” (p. 29). 

This back-forth movement of allowing experiences (via emotions) to occur and then stepping away from the self in acknowledgment and understanding of what has arisen. This acknowledgment of “what-is” happening at the moment describes what Gestalt therapy literature describes as the paradoxical theory of change (Beisser, 1970), whereby healing change happens not by forcefully eliciting change itself (in this case, by repression or ignorance), but by understanding and acknowledging what is happen­ing to the self at the moment. Through assimilation of the situation, in the case of a countertransference effect encountered by the therapist, the therapist is able to under­stand what is going on in him/her. The clarity of this self awareness and acceptance empowers the therapist to overcome and make informed choices. Self-awareness has much to do with being in contact with the self, existentially, in the here-and-now. This is a phenomenological attitude in observing what-is in the present in contact with the client, while being conscious of one’s own biases. 

With the awareness of the self as observer, there will also be an awareness that the other person is different; the other person actually processes his/her own objective knowledge. We will be able to appreciate that there is room for questioning and discuss­ing the ‘facts’ and ‘truisms’, and to investigate the differences between the self and the other. Resnick (2016) tells us that it is the differences between two individuals that ini­tiate the contact. Without awareness and acceptance of these differences—as often hap­pens when people operate in confluent relationships— there is no sense of the other person for who he/she is. Confluent relationships result in the feeling of loneliness in the presence of others, because there is a push for consensus and the authentic presence of persons are thereby not felt. In therapy, this kind of relationship happens when client tries to please therapist and therapist tries to help client. Both try to find compliancy without first looking at the differences. The result is often an alliance without real con­tact.

References

Beisser, A. (1970). The paradoxical theory of change. In Gestalt therapy now (pp. 77-80). https://static1.squarespace.com/static/572d003b40261d2ef97e5b0b/t/59d64989bce1767a9d98ebbb/1507215754788/G+Paradoxical+Theory+of+Change.pdf

Britton, R. (2003). Sex, death, and the superego: Experiences in psychoanalysis. Karnac Books.

Freud, S. (1909). Letter to Jung. The Freud-Jung Letters. Princeton University Press.

Heimann, P. (1950). On counter-transference. The International Journal of Psychoanalysis.

Maturana, H. R., & Varela, F. J. (1980). Autopoiesis and cognition: The realization of the living. London, England: D. Reidel Publishing.

Mawson, C. (2011). Introduction: Bion today—Thinking in the field. In Bion Today.

Racker, H. (1968). Transference and Countertransference . London: Karnac.

Reich, W. (1945/1984). Character Analysis (3rd ed.). (M. H. Raphael, Ed., & V. R. Carfagno, Trans.) NY: Farrar, Straus and Girouy.

Resnick, R. (2016). New Contemporary Gestalt Therapy Demonstration Films. Vimeo.

What lies within the therapist-client alliance in Psychotherapy?

The “self” is not a singular, isolated entity, but a function of the person’s life history and experience from living with others through social interactions from which the individual derives their identity (Altemeyer, 2013, loc. 250). The patient brings into the therapy room not only their psycho and soma but rather, their entire intra-psychic relationships integrated. This concept famously relates to Kurt Kofta’s Gestalt Psychology defining dictum, “the whole is more than the sum of its parts”; Arnheim (1961) elaborates “we do not say: the whole is ‘more’ than the sum of the parts; we prefer to assert that the whole is ‘something else’ than the sum of its parts” (p. 91). Kurt Goldstein postulates this holistic concept to a person. He describes an individual as an “organism” that is not an isolated body, but an indivisible whole which dynamically interacts with the physical psycho-social environment (Votsmeier, 1995, p. 5).

We gain a sense of who we are largely through our social interactions, which are relational. When the relationships in this social environment are damaged, the individual experiences symptoms, which can be interpreted in today’s world as psychopathology; which manifests in varying degrees, and is described in the DSM. Conflicts in social relations in turn lead to further social conflicts, social dysfunction and sometimes somatic symptoms. Hence the psychotherapy patient comes into therapy essentially with the purpose of finding a resolution to relational conflicts. These relational conflicts are interpersonal and intra-psychical. In the therapist’s room, these conflicts play out in the relationship between the patient and therapist in which the problematic relationship between the patient and their world unfolds. Transference and countertransference enactments during therapy reveal the relationship patterns of the client. The therapist does not merely talk about these conflicts. They get involved in this relationship to help the client gain the necessary insight from the experience (Altemeyer, 2013).

This is the point whereby the differentiation –though not separation— between Clarkson’s (2003) transferential / countertransferential relationship (point no. 2) and reparative / developmentally relationship (point no. 3) delineates from the person-to-person aspect (point no.4) and the transpersonal relationship (point no. 5)—i.e. the asymmetric relationship versus the “contact” in the relationship. The former is required of the therapist to take notice of the developing transference, like a figure emerging from the background as described by Polster & Polster (1978, p. 28-69).

Bringing the focus of the transference “figure” beyond the reconstruction of life narratives leads the relationship towards the latter levels. Where the transference that occurs within the therapeutic relationship was once considered—in traditional psychoanalysis— a resistance phenomenon against unbearable memories, now memories come under suspicion in the service of the resistance against the transference relationship (Altemeyer, 2013, loc. 260).

Analysis-making is subject to the therapist’s own experience. Wilfred Bion (1984) provides another way of understanding the stratified nature of the therapeutic relationship using the metaphor of a painter painting a landscape. The experience by the painter of the landscape is captured by the painter as a subject onto canvas. While the landscape and canvas are very different things, what is being communicated from the painter to the viewer of the painting is what Bion calls the invariant. “

The original experience, the realization, in the instance of the painter the subject that he paints, and in the instance of the psychoanalyst the experience of analyzing his patient, are transformed by painting in the one and analysis in the other into a painting and a psycho-analytic description respectively. The psychoanalytic interpretation given in the course of an analysis can be seen to belong to this same group of transformations. An interpretation is a transformation; to display the invariants, an experience, felt and described in one way, is described in another.

Wilfred Bion 1984 p. 4

Interpretation, in other words, is the therapist’s act of capturing the experience of their interaction with the client, transforming it into analysis, so as to communicate

back to the client what the therapist understands of this experience. The nature of the invariant that is transformed, Bion adds, depends on what the therapist understands from the experience. How the invariant is transformed depends also on the theory in the therapist uses in order to understand his/her experience. Therapists from different psycho-analytic schools would thus use different invariants— which is not unlike a realist painter and an impressionist painter painting a similar landscape, both presenting different ideas and meanings of the invariants onto canvas.

As the painter’s transformations vary according to the understanding his painting is to convey, so the analyst’s transformation will vary according to the understanding he wishes to convey.

Wilfred Bion, 1984 p. 5

What we can infer from Bion’s analogy is that there are 2 main steps in a psychotherapist’s work:

1. “creation of the invariant”: like the therapist’s sensing of the client,

2. “transformation of the invariant”: like the therapist’s understanding of the client’s

words and communication in analysis. The above also illustrates different steps that happen in the process of the therapist’s work: the first step requires the therapist to sense, and the second requires the therapist to understand and analyze. This, in relation to Clarkson’s relational framework, we may be able to see the correlation between the first part with the person-to-person aspect (point no.4) and the transpersonal relationship (point no.5), and the second part with the transferential / countertransferential relationship (point no. 2) and reparative / developmentally r relationship (point no. 3). On closer look, we may even be able to infer thatanalysis itself is dependent on the transpersonal. In other words, it is the person-to-person and transpersonal— symmetric aspect of the therapeutic alliance— that precedes and determines the quality of the therapeutic analysis. Bion allows us to accept different methods of analysis like a unique style of the therapist in the interpretation and communication of the analytical work. When the different analytic styles and theories used in therapy are seen in the same light as the use of different genres of painting, we may be able to accept the idea that eventually what matters is the quality of the painting, and the emotional engagement of the artist to the subject, and not only the style used.

This being so, what, in psychotherapy, are the elements that determine this quality?

It is fathomable that the quality of the analysis (and the eventual psychotherapeutic intervention) hangs upon the steps that come before the analysis itself. Bion describes the phenomenon that happens before the “creation of the invariant” as the “intuit”. We can perhaps compare this with what we understand as “intuition”. This sensibility comes from meeting with the client’s being and his/her verbal and non-verbal (i.e. the implicit) communication together with the being of the therapist. When we follow Bion’s track, we’ll be able to understand the relevance of this initial intuition and sensibility to the quality of the alliance. The togetherness of the contact is here articulated to be more essential to the psychotherapeutic work and affects the potential for psychotherapeutic change.

References

Altemeyer, M. (2013). Die Wiederentdeckung der Beziehung: Ein Paradigmenwechsel im Psychoanalyitschen Gegenwartsdiskurs. In B. Bocian, & F.-M. Staemmler (Eds.), Kontakt als erste Wirklichkeit. Zum Verhältnis von Gestalttherapie und Psychoanalyse (Kindle ed.).

Arnheim, R. (1961). Gestalten. Yesterday and Today. In M. Henle (Ed.), Documents of Gestalt Psychology (p. 91). LA: University of California Press.

Bion, W. R. (1984). Transformations. Karnac Books.

Chew-Helbig, N. (2017). The Psychotherapeutic Alliance and Change: A discussion on the healing aspects in a psychotherapeutic relationship. Bachelor Thesis.

Chew-Helbig, N. Analyzing a Gestalt Psychotherapy Session Using the Helbig Method of Dialogue Analysis (HELDA). URL: https://nikhelbig.at/wp-content/uploads/2019/05/NICOLE-HELBIG-PRINTING-copy.pdf

Clarkson, P. (2003). The Therapeutic Relationship. London: Whurr Publishers.

Polster, E., & Polster, M. (1978). Gestalt Therapy Integrated. Contours of Theory and Practice. NY: Vintage Books.

Votsmeier, A. (1995). Gestalt-Therapie und die „Organismische Theorie “–der EinflußKurt Goldsteins. In Gestalttherapie Vol. 1(95) , (pp. 2-16).

Breuer & Freud’s pioneering concept of the psychotherapeutic alliance

Psychotherapy in practice differs from many other areas of medicine, particularly with regard to the patient-therapist relationship.

It has been observed that Breuer’s work documented by Freud paved the way for the less authoritarian attitude of the doctor who knows everything and opened the door to a different kind of therapeutic relationship (Bocian & Staemmler, 2013; Grubrich-Simitis, 1997). Freud wrote in the early days of psychoanalysis of his revered mentor, Jean-Martin Charcot, whose research on Hysteria and its treatment method of hypnosis greatly influenced Freud as a young practitioner, “Charcot, however, did not follow this path towards an explanation of hysteria […].” (Freud & Breuer, 1893). The work of Charcot, notwithstanding, greatly influenced Freud’s transition from neurology to psychopathology (Grubrich-Simitis, 1997, p. 12- 13). Freud acknowledges the contribution of Charcot’s work towards bringing to scientific importance the study of Hysteria, that in having successfully inducing hysterical paralyses in hypnotized patients, Charcot proved that the hysterical paralyses were “the result of ideas which had dominated the patient’s brain at moments of a special disposition” (ibid. p. 13).

Freud’s own studies on Hysteria with Breuer, however, demonstrated the importance of a change in the approach towards the therapeutic relationship in the development of the understanding and healing of a psychological condition. When Freud met Breuer, who became his friend and mentor, Breuer was already in his fifties and was a reputed medical practitioner and experimental physiologist. Breuer had already worked with Bertha Pappenheim, better known as Anna O., in 1880 to 1882, some 3 years before Freud went to study with Charcot. Studies of Hysteria (Breuer & Freud, 1955) were written in 1895, 15 years after the said therapy, and the client by then was known to have been cured of her symptoms. Breuer had, together with his patient— who suffered severe hysterical symptoms and who is often regarded as “highly gifted, and the true discoverer of therapeutic reconstruction”— uncovered the dynamics of mental pathology. Unlike the Charcot school, Breuer used hypnosis “not for the purposes of crude behavioural suggestion but as a route to the memories of pathogenic traumatic experiences that were not accessible to the patient in the waking state” (ibid. p. 21).

Relying on the doctor to carry out treatment while the client remains the passive recipient with the goal of attaining catharsis through hypnotic suggestions, Freud exerts, may not amount to a cure, but a suggestion of a cure. In the case of Breuer’s work with Ms. Pappenheim – in listening with interest to her narratives—the therapist and client were able to investigate the actual events in the client’s life that precipitated the neurotic outcome; this is more than just the knowledge of the existence of psychic disturbance, as Charcot describes it, that is behind the symptoms and desensitizing through hypnotic suggestion. This step of gaining a clear understanding required much more effort, attention and empathy on the part of the practitioner (Freud & Breuer, 1893). Early expert critiques of the Studies of Hysteria reflected Freud’s sentiment of his own work, “[…] it still strikes me myself as strange that the case histories I write should read like short stories and that, as one might say, they lack the serious stamp of science. I must console myself with the reflection that the nature of the subject is evidently responsible for this, rather than any preference of my own (Freud & Breuer, 1895)” (Grubrich-Simitis, 1997, p. 19). With this admittance, we are led to the understanding that procuring a cure requires the abandonment of impersonal scientific learning, but an engagement with the client on a personal level that is different from the conventional attitude of that time, whereby treatment is based on empirical proofs (i.e. what is considered “stamp of science”).

[…] it still strikes me myself as strange that the case histories I write should read like short stories and that, as one might say, they lack the serious stamp of science. I must console myself with the reflection that the nature of the subject is evidently responsible for this, rather than any preference of my own.

Sigmund Freud in Freud & Breuer, 1895

Here we get a glimpse of Freud’s dilemma. He had found a good healing technique, but alas, it did not seem to conform to certain scientific procedures. It is also added that he who “wishes to plumb and describe the mental cannot completely escape the creative writer’s methods of conceiving and describing, however rigorous the will to cool, sober objectivity” (Grubrich-Simitis, 1997, p. 19-20). In many ways, we still find ourselves in a similar situation today, in our discourse on Psychotherapy Science.

That which is more worthwhile to learn from the case of Anna O. is, however, not found in Breuer’s account alone, but that the “psychodrama that took place in Breuer’s treatment, (…), gave Freud raw material for his theories of the Oedipus complex, identification, transference and countertransference, repetition compulsion and acting out (Britton, 2003, p. 8). As if to prove the significance of this first case, Freud (1914) himself reviewed this case 20 years later, pointing out to us to this unique— and often ethically treacherous— aspect of the psychotherapeutic alliance. The word “treachery” is carefully used to emphasize the fact that the danger is insidious and that special attention is necessary to notice and avoid its consequences. In order to investigate a treacherous situation in a relationship, however, we need to understand what lies in it.

References

Bocian, B., & Staemmler, F. M. (2013). Kontakt als erste Wirklichkeit. Zum Verhältnis von Gestalttherapie und Psychoanalyse. EHP-Verlag Andreas Kohlhage.

Breuer, J., & Freud, S. (1955). Fräulein Anna O, Case Histories from Studies on Hysteria. In V. I.-1. In The Standard Edition of the Complete Psychological Works of Sigmund Freud.

Britton, R. (2003). Sex, death, and the superego: Experiences in psychoanalysis. Karnac Books.

Chew-Helbig, N. (2017). The Psychotherapeutic Alliance and Change: A discussion on the healing aspects in a psychotherapeutic relationship. Bachelor Thesis.

Click to access Helbig_2017_Bachelor_Thesis-nh-s-p.pdf

Clarkson, P. (2003). The Therapeutic Relationship. London: Whurr Publishers.

Grubrich-Simitis, I. (1997). Early Freud and late Freud. Reading a new studies on hysteria and Moses and monotheism. (P. Slotkin, Trans.) NY: Routledge.

Power Differences in the Psychotherapeutic Alliance

Although there are different nuances within different psychotherapeutic approaches, the difference in attitude towards the client-therapist power difference can be divided into two very broad groups— symmetric and asymmetric following terminology used in Altemeyer (2013):

  1. The symmetric aspects of the relationship: In what is considered the humanistic approaches to psychotherapy, the therapist’s work is to be there as a companion to the client, to work with the client in partnership sans analyzing, judgment and oftentimes “helping”, but instead providing unconditional positive regard towards the client. For this to be achieved, there must exist a coming together of\ two authentic individuals as in Carl Roger’s person-centred psychotherapy approach that is “contact-building and acknowledging quality and empathy— without any techniques, means aims or intentions” (Schmid, 2001, p. 1).
  2. The asymmetric aspects of the relationship: Within psychiatry, and some archaic versions of the psychoanalytic/psychodynamic schools, the therapist is often expected to be the one more empowered to help the client, as a medical doctor would with his/her patient, providing analysis and nurturance, working on the interpretation of transference or dreams and the therapist’s countertransference reactions, and being a guiding figure to the client (Scharf, 2016, p. 50-55). Similarly, in behavioral & cognitive therapies, the client relies on the therapist for instructions, to set agendas, to give structure to the therapy and provide assistance for forming new experiences

Both standpoints are necessary for therapy to work. The therapist is a trained professional and has the theory behind them as tool to help the client through difficulties. Hence the therapist is the doctor and authority – and hence professional authority— with regard to psychotherapy. Concurrently, the healing process brought about through psychotherapy comes from the empathic alliance that the therapist builds into the relationship.

How then, if all approaches are viable, do we resolve these seemingly conflictual ideas of the nature of the psychotherapeutic alliance?

We can get an answer by referring back to the five-relational Clarkson framework, we may see that the asymmetric aspect or the relationship actually belongs to the first three parts of the therapeutic relationship: the working alliance (point 1), the transferential/ countertransferential relationship (point 2), and the reparative/developmentally needed relationship (point 3). The therapist’s role in these aspects of the relationship is clearly defined, and the switching of roles between therapist and client in this regard is inconceivable. The psychotherapeutic relationship must remain, on this level, an asymmetric one since the therapist has the defined role of the one who nurtures, helps the client with analysis and is the one being paid to do the job. The therapist takes on an egalitarian stance when he/she gives attention to the mutual relationship and helps the client to experience his therapeutic observations.

In the relational approaches of psychotherapy, however, the therapist helps the client to focus on the here-and-now and actively reduces the power inclination within the relationship; this with the intent to engage with the client on a more emotional and experiential level (Altemeyer, 2013). From this vantage point, we can see that the fourth and fifth aspect of the alliance— the person-to-person relationship (point 4) and the transpersonal relationship (point 5)— comes into play. With this understanding, we may be able to appreciate how and why all modalities of psychotherapy schools work: because each of the 5 levels of the alliance is (albeit in different measures and emphases) present in the relationships. We may be able to also understand why psychotherapeutic approaches over time evolve from analytical to relational and vice versa. Approaches evolve because therapists, through their experience working with their clients, have realized the need to modify their attitudes dynamically towards the therapeutic alliance in order to be effective in helping their clients.

The symmetric aspect of the relationship is important to consider– i.e. the person-to-person aspect (point no.4) and the transpersonal relationship (point no.5)— and to show that this symmetric therapist-client relationship is unique to psychotherapy and different from other healing or counselling professions. In most schools of psychotherapy, we are expected to reach into the intersubjective aspect of the relationship, which will be explained in this paper (Chew-Helbig, 2019) as the implicit material (i.e. what is between the lines and not necessarily said), whereas in counselling the focus is on the explicit material (i.e. what is being openly discussed). The symmetric aspect of the relationship is the part of the alliance that brings about enduring change in psychotherapy.

Read in this post about this part of the alliance that is actually the foundation of Freud’s work— that which Freud, through Breuer, discovered and proved to be the way to actually cure what is actually a psychosomatic condition known as Hysteria. Further discussions will move deeper into the whys and hows of what this unique aspect of the relationship actually does to alleviate the patient’s symptoms.

Click to access Helbig_2017_Bachelor_Thesis-nh-s-p.pdf

References

Altemeyer, M. (2013). Die Wiederentdeckung der Beziehung: Ein Paradigmenwechsel im Psychoanalyitschen Gegenwartsdiskurs. In B. Bocian, & F.-M. Staemmler (Eds.), Kontakt als erste Wirklichkeit. Zum Verhältnis von Gestalttherapie und Psychoanalyse (Kindle ed.).

Chew-Helbig, N. (2017). The Psychotherapeutic Alliance and Change: A discussion on the healing aspects in a psychotherapeutic relationship. Bachelor Thesis.

Chew-Helbig, N. Analyzing a Gestalt Psychotherapy Session Using the Helbig Method of Dialogue Analysis (HELDA). URL: https://nikhelbig.at/wp-content/uploads/2019/05/NICOLE-HELBIG-PRINTING-copy.pdf

Clarkson, P. (2003). The Therapeutic Relationship. London: Whurr Publishers.

Scharf, R. (2016). Theories of psychotherapy and Counseling. Concepts and cases. (6th Edition ed.). MA, USA: Cengage Learning.

Schmid, P. F. (2001). Comprehension: the art of not-knowing. Dialogical and ethical perspectives on empathy as dialogue in personal and person-centred relationships. Empathy, 53-71.

·

Reich’s Case Examples: Process vs. content in the psychotherapeutic dialogue

Wilhelm Reich, in Character Analysis (1945/1984), illustrates the importance of working on the process of the therapeutic relationship – i.e. what is going on between therapist and client— before jumping into analytical work. Reich points out that neurotic character traits— being symptoms as the result of the failure of the individual to resolve the unconscious conflict between repressed instinctual demands and the ego forces that work against these instinctual demands— need to be worked with first before the client is able to benefit from any analytical work. Reich explains that interpretation is the process of bringing that which is unconscious into consciousness. However, the problem lay in “counter-cathexes”— which can be explained as strict censor of thoughts and desires in the preconscious— that critically selects the thought process of the client, rendering it difficult for the client to freely associate. At the same time, it is the need of the patient’s unconscious to find release for this conflict through contact with the analyst (as it is a need for an individual to contact any other individual or situation). The result is an establishment of a relationship with the therapist that is prompted by love, hate or fear— what is known as transference. This can come in two main forms: 1) positive transference, whereby there is cooperation/compliance by the client due to positive feelings and 2) negative transference, where the treatment is impeded due to ill feelings the client has toward the alliance.

Reich points out that while negative transference is easier to detect – since it works against and irritates the therapist’s intentions— as something to work on, positive transference is as important – or even more important.

Positive transference often gets mistaken for progress until the positive feelings ultimately transform into disappointment. For this reason, it is observed that the tendency of the therapist to begin analyzing every material that the client presents prematurely, to rely on the routine passage of therapy sessions, without considering the effects of transference, is not effective in bringing about a resolution to unconscious conflicts and does not make for a successful healing alliance.

Reich writes, “If the analyst interprets the material in the sequence in which it appears in each case, whether or not the patient is deceiving, using the material as a camouflage, concealing an attitude of hate, laughing up his sleeve, is emotionally blocked, etc., he (the analyst) will be sure to run into hopeless situations. Proceeding in such a way, the analyst is caught in a scheme which is imposed on all cases, without regard to the individual requirements of the case, with respect to the timing and depth of the necessary interpretations” (p. 8). In other words, it is almost impossible for the therapist to distinguish authentic, useful narrated content from, perhaps, words that are used to manipulate the therapeutic situation or relationship, unless the underlying situation of the relationship itself is understood. It could be difficult to be sure of what goes on in a relationship of which one is part. For the therapist, time, together with an attitude of patient, phenomenological observation, allows the therapist to gain experience of being with the client. Setting aside this time helps the therapist to understand what is in between them and the patient.

Reich’s case examples

In the third chapter of Character Analysis entitled On the Technique of Interpretation and of Resistance (p. 21-38), Reich provides snippets of case studies. These examples help us to understand what Reich means by working on what Freud calls the forces of “resistance and transferences” that interfere with the attempt at analysis before jumping into analyzing the content of the client’s narratives— and the “chaotic situation” that can happen when attention to this is not observed. The case examples cited revealed instances where therapy sessions did not help the patient because the therapist failed to notice and observe resistances due to transference— and character— but instead delved into (or attempted to delve into) interpretation right away, without preparing the client – and therapist himself— for the analytical work first. I shall discuss some of the cases, and briefly discuss what kind of questions could have been asked by the therapist in the situations.

Case 1

“A patient who suffered from an inferiority complex and self-consciousness enacted his impotence by adopting an apathetic attitude (“What’s the use?”). Instead of divining the nature of this resistance, clarifying it, and making conscious the deprecatory tendency concealed behind it, I told him again and again that he did not want to cooperate and had no desire to get well. I was not entirely unjustified in this, but the analysis was not successful because I failed to probe further into his “not wanting” because I did not make an effort to understand the reasons for his “not being able to.” Instead, I allowed myself to be trapped into futile reproaches by my own inability” (ibid. p. 23).

The therapist, frustrated at the client’s perceived non-cooperation failed to acknowledge the process of how the client was unconsciously avoiding the work; by resigning to the belief that there was “no use”. This resignation in itself is the defense mechanism and the ripe material for the work. In trying to fish for cooperation from the client, the therapist missed what was present that could be worked on, as the therapist himself points out: (see above: to probe further into his “not wanting” because I did not make an effort to understand the reasons for his “not being able to.”). The therapist, when unaware of his own need to get cooperation, was in danger of re-enforcing the resignation and breaking contact with the client. Working on the here-and-now, the therapist in such a situation may ask the following questions that address the client’s resignation, and perhaps his lack of will to even try. These questions may lead the therapist and client to a deeper understanding of phenomena in the alliance itself: “what does it mean for you when you say ‘what’s the use’?”, “what would you imagine could happen if you tried?”, “what would it mean if you tried and failed?”, “I am interested to know if would you like to try for a couple of minutes and see how?” “If not, what can I do/not do to help you work this out?”.


Case 2:


“In still another case, it happened that in a dream during the second week of treatment the incest fantasy appeared quite clearly and the patient himself recognized its true meaning. For a whole year, I heard nothing more about it; consequently, there was no real success. However, I had learned that at times material that is emerging too rapidly has to be suppressed until the ego is strong enough to assimilate it” (ibid. p. 24).
What appears to be material, in this case, a narration of a dream may be a way of resistance from being seen through story-telling. It is an example of a therapist focusing on “content”, which is the dream story, and not noticing the “process” which is the fact that the client is telling the story in the first place. The content is enticing. The process is invisible. Unawares, the therapist missed the resistance because it is embedded in the process of what is being said. It would be helpful to ask the client questions that bring him back to the alliance: “I’m hearing your dream and it is really interesting to me that you are so clear about it, and my instinct is to ask you more about it. I’m just curious, what is it you want me to know from this?” “What is important right now for us to work on with regard to what you just said?” or “What is it like for you to tell me this?” With these questions, the client will have a choice to either work deeper into what is really disturbing him about the dream (if at all), or, he may reveal his need to impress or help the therapist by being unduly cooperative as in positive transference (as will be discussed later).


Case 3:


“A case of erythrophobia failed because I pursued the material which the patient offered in every direction, interpreting it indiscriminately, without first having clearly eliminat- ed the resistances. They eventually appeared, of course, but much too strongly and cha- otically; I had used up my ammunition; my explanations were without effect; it was no longer possible to restore order” (ibid. p. 24).
In this case it is an example of the therapist focusing on content, and unsystemat- ically using this content for analysis. The therapist probably failed to notice the process that was going on, i.e. the fact that there is so much unsystematic work in progress with- in the alliance itself. Possible way to make good the “chaos” is to stop and acknowledge the chaos ensuing. “I notice that we are doing much here and it feels chaotic. I am inter- ested to know what you are experiencing right now.” It may be also useful to check out how not interpreting can help the client. In this case, where a symptom “erythrophobia” is clearly acknowledged, the alliance could be a place for experimentation in the here- and-now— like inviting the client to blush “for a moment”, or what would the client think if he saw the therapist blush— to help the client gain confidence within the alliance.


Case 4:


“Another patient, in the course of three years of analysis, had recalled the primal scene together with all material pertaining to it, but not once had there been any loosening of his affect-paralysis, not once had he accused the analyst of those feelings which- however, emotionless-he harboured toward his father. He was not cured” (ibid. p. 23).
This case is representative of situations whereby the patient seems to have the full acknowledgement of the unconscious material. The therapist is satisfied, but the client is not helped even after 3 years. Reich highlights the importance of the patient embody- ing the experience— feeling the emotions and physical reactions as if reliving the past— rather than simply intellectualizing the recall. Intellectualizing memories, which is easily observed because there is a lot of “talking about” without affect, is really aform of resistance; a way to satisfy the therapeutic process while escaping pain. In ge- stalt therapy, this defense strategy is called “egotism”. Egotism is characterized by the individual stepping out of himself, acting as a spectator or commentator of himself and his relationship with the environment (Clarkson, 2014, p. 65). This is what is happening to the client is this case. This resistance often gets overlooked by therapist because they are sidetracked by “interesting” client narratives. Noticing the interruption is a way to slow down the narratives and show the client that he/she is avoiding something poten- tially difficult to deal with.


Case 5:


“A patient with a number of perversions had been under analysis for eight months, dur- ing which time he had rattled on incessantly and had yielded material from the deepest layers of his unconscious. This material had been continuously interpreted. The more it was interpreted, the more copiously flowed the stream of his associations. Finally, the analysis had to be broken off for external reasons, and the patient came to me… It struck me that the patient uninterruptedly produced unconscious material, that he knew, for instance, how to give an exact description of the most intricate mechanisms of the simple and double Oedipus complex. I asked the patient whether he really believed what he was saying and what he had heard. “Are you kidding!” he exclaimed. “I really have to contain myself not to burst out laughing at all this” (ibid. S.26).

Here, Reich gives another example of a “knowledgeable” and “cooperative” cli- ent whose knowledge and cooperativeness was the resistance itself. Reich explains this behavior to be of narcissistic defense. The therapist is unaware of what Reich describes as “latent resistance”, which he explains are “attitudes on the part of the patient which are not expressed directly and immediately”, but expressed indirectly. The patient’s negative regard towards the therapy (i.e. feelings of doubt, apathy, distrust, etc.) is disguised under the cloak of exceptional docility, or complete cooperation. Reich says that this is “more dangerous” than passive resistance, and the way to handle such situations is to tackle it as it happens, without hesitating to interrupt the flow of communication. Our challenge as therapist is to first notice that such-like phenomena are taking place. It is from this vantage point that Reich emphasizes the topic of character.

Reich’s advice on avoiding “chaotic situations”


Reich tells us that through this process, can we avoid what he terms “chaotic situations” which occurs as the result of:

Premature interpretation and work on unconscious materials, and symbols. Resistance to the therapy itself, when not yet exposed, prevents the patient from assimilating the work. The client ends up “going in circles completely untouched” (p. 26): This phenomenon can be explained as egotism in gestalt therapy. Egotism is a defense strategy whereby the client’s ego distances it- self from the experience, and sees the self from a distance, as if he/she is look at another person. This situation of the client going in circles may help to explain why some clients, though compliant, do not seem to get better.

“Interpretation of the material in the sequence in which it yields itself, without due consideration to the structure of the neurosis and the stratification of the material” (p. 27): The mistake happens in interpretation, because the ma- terial is not worked through in it’s full context, but worked on in unsystemat- ic fragments, leading to loss of meaning.

“The analysis is embroiled not only because interpretations are pursued in every direction but also because this is done before the cardinal resistance has been worked through” (p. 27): The main problem here is due to the re- sistance not being acknowledged and worked through before interpretation is done. The situation becomes confused when the work is entangled with the relationship to the analyst. The unsystematic interpretation works in a vi- cious circle to affect the transference relationship further.

“The interpretation of the transference resistances is not only unsystematic but also inconsistent“ (p. 27): When there is a lack of acknowledgment of the power of the client’s resistance (and latent transference resistances) to need to conceal resistances. These resistances are also masked behind “ster- ile accomplishments or acute reaction formations” i.e. the client may seem to be cooperative, show signs that there is the change in direction expected, or the client may react to analysis in a way so as to deflect from getting to the authentic unconscious material. Therapists may tend to shy away from developing and following up consistently on these resistances in whatever form, due to their own feelings of discomfort (their own resistances) in dealing with the transference resistances in a consistent manner.

It is from the understanding of the effect of transference, that we may be able to appreciate the challenge of being aware of how the interpersonal feelings in the alliance get in the way of therapeutic work.

Click to access Helbig_2017_Bachelor_Thesis-nh-s-p.pdf

References

Chew-Helbig, N. (2017). The Psychotherapeutic Alliance and Change: A discussion on the healing aspects in a psychotherapeutic relationship. Bachelor Thesis.

Chew-Helbig, N. Analyzing a Gestalt Psychotherapy Session Using the Helbig Method of Dialogue Analysis (HELDA). URL: https://nikhelbig.at/wp-content/uploads/2019/05/NICOLE-HELBIG-PRINTING-copy.pdf

Clarkson, P. (2003). The Therapeutic Relationship. London: Whurr Publishers.

Reich, W. (1945/1984). Character Analysis (3rd ed.). (M. H. Raphael, Ed., & V. R. Carfagno, Trans.) NY: Farrar, Straus and Girouy.

·

Freud and the here-and-now in the therapeutic alliance

The phenomenon of the present moment often termed the here-and-now is the centre of focus in the practice of other psychotherapeutic schools, and in particular gestalt therapy. Referencing back to Freud, we can see that he makes the distinction between doing analysis and working on the resistance of the client in getting the analysis done. Doing analysis alone deals with past material while working on the resistance deals with the phenomenon of the here-and-now. Doing so is an attempt at tracing the symptom back to the past. Freud explains:

“It may thus be said that the theory of psycho-analysis is an attempt to account for two striking and unexpected facts of observation which emerge whenever an attempt is made to trace the symptoms of a neurotic back to their sources in his past life: the facts of transference and of resistance” (Freud, 1914).

Psychotherapeutic work, at its commencement, is an act of attempt— a process—to investigate. What emerges in during therapy sessions that works against and interferes with this attempt is what we learn to be resistance and transferences. The patient’s unconscious resists analysis. The “resistance” that the therapist encounters during the therapy session, and is considered the point of focus at which to work through the client’s neurotic symptoms.

This resistance is interference within the client to realize an emerging need. Simkin (1973/1990) explains metaphorically that this emerging need is the “figure” that emerges from a “ground”, that, if not realized and met, cannot achieve completion. Unrealized/un-met needs (unclear figures) leave the person with off-centeredness (mangelhafte Zentrierung) and their needs de-differentiated (Entdifferentierung) which become manifest as heightened arousal (Erregungsschwelle), which is lived as the neurotic symptoms (Votsmeier, 1995). The clearer a need is to the client, the more possibility for this need to be met. In therapy, the therapist leads the client towards sharpening this figure, and realizing the need. Needs that aren’t met are also known as unfinished businesses.

The goal of almost all psychotherapy approaches is to work through unfinished businesses, which are situations whereby completion is not achieved resulting in repetitive patterns in behaviour that do not serve the client. Work is done by either bringing awareness to the unfinished situation and/or through saturation/exaggeration by “continuing until you feel fed-up” (Simkin, 1973/1990, p. 87). The resolution comes when completion is achieved, and the figure goes back to the background, allowing other figures to emerge. So that the organism can make contact with the environment.

The process of psychotherapeutic work is initiated by, and consists of, the observation of the interruptions to the work, and not the content of the analysis per se. The resistance to the attempts, when dealt with in the here-and-now, brings about awareness of unresolved situations. This is fodder for therapeutic work.

Click to access Helbig_2017_Bachelor_Thesis-nh-s-p.pdf

References

Chew-Helbig, N. (2017). The Psychotherapeutic Alliance and Change: A discussion on the healing aspects in a psychotherapeutic relationship. Bachelor Thesis.

Freud, S. (1914). On the history of the psycho-analytic movement. In Standard Edition (pp. 2877-2928).

Simkin, J. S. (1973/1990). Gestalt Therapy Mini Lectures. With a new introduction by Ervin Polster. (Kindle ed.). The Gestalt Journal Press.

Votsmeier, A. (1995). Gestalt-Therapie und die „Organismische Theorie “–der EinflußKurt Goldsteins. In Gestalttherapie (Vol. 1(95) , pp. 2-16).