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).