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Reflections on Being a Psychotherapist

Brent Dean Robbins


,Duquesne Uniersity,
I believe that theory and practice oI psychotherapy are intertwined and, ultimately, cannot be
teased apart. One is blind without the other. My reIlections on being a psychotherapist, thus, is both
theoretical and practical.
Traditionally, theory and practice oI psychotherapy has been developed Irom the position
which argues that therapy can and should be "value Iree." The intention behind such an assumption is
that the therapist must remain value neutral in order to evaluate the client "objectively"; that is, as
untainted by "subjective" values imposed upon the client. Psychotherapy inherits such a view Irom
natural science, based on Cartesian metaphysics.
Guignon (1993) writes:
...scientiIic endeavor Irom the outset has aimed at being value-Iree and objective, basing its
Iindings solely on
observation and causal explanation. The result is a deep distrust oI authoritarian pronouncements
and value
judgments. (p. 217)
Yet, one must question such an assumption: Is it, indeed, possible to remain value neutral?
Rutan & Groves (1992) argue that it is not only impossible to be value-Iree, but not desirable. All
therapies are guided by theories oI health and pathology, whether these are implied or explicit.
Further, these theories, although oIten held up as "scientiIic statements," are nevertheless more akin
to systems oI values. For Rutan & Groves, a theory involves a "leap oI Iaith." That is, theories are
embedded with codes oI ethics which are "extensions oI Iaith systems" (p. 6). They contain latent
assumptions regarding what is and is not normal.
Even iI a theorist makes truth-claims based on the testimony that their theory is "empirical" and
"objective," this also implies a system oI values. Empirical science is a "leap oI Iaith," as Rutan &
Groves point out. Empirical science involves a Iaith in the 'truth' oI "objective" Iacts, oI a
transcendent reality which must be quantiIied and stripped oI "subjective" qualities in order to be
predicted and controlled. It is a belieI in the gulI between the 'subject' and the 'object,' and the
implication that the observer must maintain a distant, detached gaze in order to seize the 'truth' oI a
distant world. It is the "classical value system" which holds the value that one must be "value Iree" to
attain 'truth.'
As Rutan & Groves write: "It is impossible to live without some schema or system" (p. 6). This
holds Ior psychotherapy as well, and, thereby, schools oI psychotherapy may be understood as
'churches' in which psychotherapeutic techniques are 'rituals' which "always Iollow and are rooted in
theory" (p. 11). It Iollows, then, that therapeutic techniques, attitudes even, always implicate the
theory and intend the means and ends oI the therapy based on the theory's notion oI health and
pathology. There is no getting around it. And this implies that there is a danger with any approach to
any phenomena, including therapy, which holds that it has no values, but, instead, lays claim to an
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"objective" truth. For, in this way, the values oI the theory -- oI the therapist -- remain doubly latent,
and the therapist remains 'unconscious' oI the notion oI 'normalcy' which guides his or her thought.
The therapist/scientist holds as universally true that which is highly dependent upon the age in which
he or she happens to live.
What iI the age in which a client happens to live is that which provides the conditions Ior the
client's pathology? II, as van den Berg, asserts, neurosis is "sociosis," the therapist who holds as
universal that which is a condition oI the client's pathology is likely to perpetuate the very conditions
which make possible the pathology in the Iirst place. Guignon's (1993) exploration oI a Heideggarian
understanding oI psychotherapy, moral values and authenticity uncovers just such a scenario.
Guignon writes: "It is because mainstream theorizing Iails to account Ior the role oI values in human
liIe that psychotherapy risks becoming 'part oI the neurosis oI our day rather than part oI the cure' (p.
221).
Through the insight oI Heidegger's (1927/1962) notion oI Eriegnis (Event oI Appropriation),
the human being is understood as "an unIolding event or happening." In understanding the human
being in this Iashion, it becomes possible to begin to explore the role oI values in psychotherapy. The
assumptions oI "naturalism" (which understands the selI as a thing or object, understands "action as
based on means-end calculations," and props up the individual as inexorably separate Irom the other
and things) are unable to reIlect upon questions concerning "the good liIe" -- that is, 'mere living'
versus 'higher' existence (Guignon, p. 219). The notions oI the "good liIe" remain undisclosed and
unarticulated. Heidegger's ontology, in the contrary, provides a Ioundation upon which to begin to
explore questions concerning "quality oI liIe," the very questions which remain outside the grasp oI
natural science.
From an existential-phenomenological perspective, we may begin to ask questions such as:
What is mental health? What is mental illness? How does one distinguish superIicial problems Irom
real problems? These are questions oI value, oI the "quality oI liIe," yet no one person or society can
lay claim to the 'truth' oI the answers to these questions outside oI the socio-cultural context in which
they are raised. The therapist cannot lay claim to the 'truth' oI such values. Instead, the therapist may
assist the client by providing a space at the level oI engagement which may open Ior the client new
possibilities Irom which the client may begin to reIlect upon the values which guide his or her liIe.
From the inIluence oI Ricouer (1980), therapy can be understood as providing an opportunity Ior the
client to "renarratize" their "liIe story" through "moral reIlection."
In the past two years, I have been given the privilege oI sitting with clients and being a
psychotherapist. Many oI the people I have worked with are very similar to me. They oIten have
very similar interests, goals, etc., and we certainly share a cultural understanding oI what it means to
be human. Yet, I have continuously been surprised, when I am open, to notice how each person,
despite these similarities, come to articulate a conception oI "the good liIe" which is very diIIerent
Irom my own. It is a constant temptation to interpret clients Irom my own perspective to be the
one who knows.' Yet, when I am patient and slow down, I Iind that the meanings oI the client's
world are, in many ways, very diIIerent than my own, oIten even radically diIIerent Irom my initial
assumptions. In these moments, I am reminded oI Levinas' (1961) articulation oI the Other as being
radically Other,' a radical alterity which always resists being totalized and which Iorever remains, at
least in part, wholly transcendent. And, yet, when I am able to let go to truly listen I can be
Iace-to-Iace with the client and I can hear and be beckoned by the call' oI the Other. How oIten do
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we listen to a client really isten to the way a client unIolds his or her story and catch site, oIten
in Ileeting moments, oI a mystery at the heart oI it, something alien and wholly Other, which must be
respected as such lest we do a kind oI violence to the Otherness oI the Other? In these moments, I
am called back to my ownmost values which echo back to me against the resistance oI the client to be
totalized in such a way. In these moments, I oIten learn more about myselI, about my implicit values
which guide me as a therapist, than I do about the client. I think this is essential to being a good
therapist, though too oIten I Iall short oI this ideal. For lack oI a better word, it seems to me that
being a good therapist requires a capacity Ior humility. It is this kind oI humility, I think, which
guides Boss (1994) in his distinction between "anticipatory care" and "intervening care." To
anticipate rather than intervene requires a holding back, a waiting-toward the other, which requires an
ability loosen one's grasp on cherished assumptions.
Many might argue that, iI the therapist cannot be the expert' the subject supposed to know'
(Lacan, 1977) then what is the point? What good is a therapist who is not an expert? OI course,
therapist are experts, but not experts at knowing and pushing shoulds' onto a client, as iI most clients
didn't have enough oI those already. Therapists are experts at developing therapeutic relationships.
Thus, my goal at all times as a therapist is to develop the relationship between myselI and the client
and most importantly to make the dynamics oI the relationship explicit to the client. While I
cannot totalize the client as other, I can interpret how I understand what is happening between myselI
and the client.
Carl Rogers (1986) states the Iollowing as his "central hypothesis":
...the individual has within himselI or herselI vast resources Ior selI-understanding, Ior
altering hir or her
selI-concept, attitudes, and selI-directed behavior -- and that these resources can be tapped iI only a
deIinable
climate oI Iacilitative psychological attitudes can be provided. (p. 135)
Based on this assumption, Rogers elaborates three conditions Ior the therapeutic relationship in
order Ior it to inhabit the "deIinable climate" oI which he speaks:
1) "Genuineness, realness, or congruence"
2) "acceptance, or caring, or prizing unconditional positive regard"
3) "Empathic understanding" (p. 135-136)
These conditions deIine what Rogers calls his "person-" or "client-centered approach" to
therapy. This approach is described by Rogers as more a "basic philosophy" than a particular
technique or method, which involves a "basic trust in the person" rather than a skeptical or distrustIul
attitude (p. 136). Rogers' approach begins with the assumption that human nature is essentially
good,' that the person shares with all living organisms an "actualizing tendency...to grow, to develop,
to realize its Iull potential" (p. 137). Rogers places himselI in contrast to traditional psychotherapy
which views the human being as "innately sinIul" and, in turn, which involves a skeptical attitude
toward the client (p. 137).
Friedman's (1992) dialogue between Rogers and Buber reveals both similarities and diIIerences
between the two thinkers. Buber, Ior one, is more inclined to view human beings as polar, in
distinction Irom Rogers' trust in the power oI "selI-actualization" to heal Irom the good' inner core oI
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the person's natural resources. This leads to a Iundamental diIIerence between how Rogers and
Buber understand the relationship between "acceptance" and "congruence." For Rogers, the terms
imply one another, whereas Buber does not equate the two. Buber insists that "conIirming a person
as he or she is" merely marks the Iirst step in conIirming what "in the present lies hidden what can
become" (p. 46). In short, it seems that Buber is less inclined than Rogers toward merely trusting in
the hypothesized goodness' oI the person's "selI- actualizing" potential to lead the person to this
potential.
In support oI Buber's distinction, Friedman writes: "Healing does not mean bringing up the old,
but rather shaping the new: It is not conIirming the negative, but rather counterbalancing with the
positive" (p. 46). Buber and Friedman seem to have a good point in that their take on Rogers allows
Ior a darker side to human nature. Buber understands the human being as potentially destructive as
well as growth-promoting. ThereIore, Buber's viewpoint, as Friedman understands it, considers
conIirmation a "wrestling with the other against him or her selI" in order to strengthen the positive'
pole as opposed to the negative' pole (p. 47). The question remains, however: Who is to
diIIerentiate the negative' Irom the positive'?
As mentioned above, theory inevitably implies a system oI belieIs which have ethical
implications. In the light oI Friedman's dialogue with Rogers and Buber, there is clearly such a
struggle to reconcile two very similar belieI systems which contain diIIerent assumptions regarding
the nature oI the human being. In turn, this implies two potentially diIIerent views oI the nature oI
the therapeutic relationship. Yet, can these two views be reconciled?
In support oI Rogers, I must say that Buber's idea could potentially lead to a therapeutic
relationship in which the therapist becomes the arbiter oI truth,' the one who decides which pole is
positive' and which is negative,' the one who is supposed to know.' This is potentially dangerous,
Ior obvious reasons. Instead, Rogers' view allows Ior an understanding oI the human being as
ambivalent without the need to push the client toward any particular direction. Rogers' view allows
Ior a therapeutic relationship in which the therapist and client may share the struggle.
Ultimately, Rogers' elaboration oI the three necessary conditions oI therapy (outlined above)
are geared toward Iacilitating an atmosphere which enables the client and therapist to share in the
struggle toward healing. As Miller, Duncan & Hubble (1997) point out, therapy is "best understood
as a collaborative process," and, thereIore, they keep within the spirit oI Rogers' "person-centered
therapy" (p. 105). The therapist "wrestles" with the client, not by taking on one side or the other oI
the client's ambivalence, but by being with the client in the struggle; that is, participating in the
client's struggle.
Miller, Duncan & Hubble move a step beyond Rogers by outlining an approach which helps to
assure the therapist is aligned with the client's struggle. They recognize that therapy involves
"extratherapeutic Iactors" as well as "relationship Iactors," which need to be taken into account in
order to create a therapeutic alliance (p. 87). First, the therapist should be aware and accommodate
the client's "motivational level oI state oI readiness Ior change." The stages oI change are outlined as
Iollows: 1) precontemplation, 2) contemplation, 3) preparation, 4) action, 5) maintenance, and 6)
termination. These stages oI "readiness Ior change" involve a continuum Irom a position where the
client has no motivation to change to a position in which the client's ambivalence transIorms into
action to change (p. 104). Eventually, the client takes steps to maintain this change. Second, the
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therapist must strive to understand and respect the client's goals Ior therapy. As Miller, Duncan &
Hubble (1997) write:
...treatment is both more eIIective and more eIIicient when the client's goals are accepted at
Iace value without
reIormulation along doctrinal lines, and when these goals, in turn, determine the Iocus and the
structure oI the
intervention process. (p. 105)
Miller and colleagues generally emphasize the client's view oI the therapeutic relationship. In
turn, they are lead to view empathy as an "attitude," the therapist's "thoughtIul appreciation" oI what
the client brings to therapy (p. 112). This thinking is in line with Rogers' distinction between
empathy and inclusion, which he stressed in his later writings (Friedman, 1992). Inclusion
recognizes that the therapist is always entering the therapeutic relationship "as iI" it were his/her
own. The emphasis on the "as iI" is a recognition that empathy is never entirely accurate, since the
person must always understand the other's world in terms oI his or her own world. Similarly, Miller
and colleagues point out that the most important thing is that the client is able to "perceive the
therapist as trying, even struggling, to understand what they deem important and meaningIul" (p.
112).
When the therapist 1) respects the client's values over and above his or her theoretical
perspective, 2) strives Ior genuineness by the avoidance oI "making the special claims on a corner oI
reality," 3) and validates the client, the therapist can be said to be creating a "collaborative"
relationship with the client (pp. 113-120). Moreover, Miller and colleagues create an open space in
which Rogers' and Buber's concerns can be reconciled. This is particularly true oI their discussion oI
"validation." When the therapist "legitimizes" the client's concerns, acknowledges the signiIicance oI
the client's problems, and aIIirms the client's ability "to withstand and eventually overcome the
problem," he or she both "accepts" and "conIirms" the client (pp. 117-118).
Personally, I constantly Ieel the pressure, both inside and outside oI therapy, to be the "expert"
and to solve problems Ior my clients. Over the past two years oI doing therapy, however, I have
quickly learned that doing so is more trouble than it is worth. I Iind that, when I give in to a client's
desire to know my opinion, I largely do so Ior my sake rather the client's. It is out oI my own anxiety
that I give in to the client's demands to be the one who knows.' However, when I hold to the
therapeutic Irame, although diIIicult, I always Iind it to be a IruitIul enterprise, even iI, in the short
run, it causes discomIort Ior both parties. However, unlike Rogers, I do not simply reiterate. How
then does one do interpretations without giving the impression that one knows'? I've learned that
one can do so by moving to the interpersonal dynamics between myselI and the client. I become
curious, not about the content oI the question or demand, but about the question or demand itselI.
Yet, this is a very delicate process. It requires very good timing, which takes practice and experience
to learn, and, even more, it requires an ability to truly listen on multiple levels.
II I am to "struggle with" the client without giving in to the temptation to be the "expert,'
listening is the most important talent I can bring to the therapy. As Nichols (1995) writes: "Few
motives in human experience are as powerIul as the yearning to be understood. Being listened to
means that we are taken seriously, that our ideas and Ieelings are known and, ultimately, that what
we have to say matters" (p. 9). II the therapist is to be truly empathic, this involves an extreme eIIort
on his or her part to listen to the client in such a way that the client Ieels listened to. I've always
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considered myselI to be a pretty good listener. Yet, as Nichols acknowledges, most people think they
are good listeners! Being a psychotherapist, I've discovered a healthy sense oI humility. It is
amazing how oIten I can Iail to truly listen to my clients. Most oIten, I Ieel a distinctive pull to
attend to the "Iacts" oI the stories my client's tell. This is certainly a Iorm oI listening, but is also
leads me to Ieel compelled to engage the client in such a way that I want to intervene with the client's
story to get the Iacts' straight.
Nichols points out that there are two purposes to listening: one purpose is to "take in
inIormation" and the other purpose is to "bear witness to another's expression" (p. 15). When I Ieel
the pull to get the Iacts straight,' one could say that I have placed my emphasis on the Iormer
purpose while, perhaps, neglecting the latter. However, I've begun to learn that I am the best listener
when I am able to listen on multiple levels. I can listen to the content oI a client's story without
buying into it too easily; instead, I can listen to how the client is demanding or asking to be heard and
how this creates a particular dynamic in our therapeutic relationship. It is these particular
interpersonal dynamics, I've discovered, which provide the best material Ior interpretation it is
what remains implicit in the therapeutic relationship, lived but unarticulated. By making such
dynamics thematic, one could be said to be making the implicit explicit or the unconscious'
conscious.' Again, these kinds oI interpretations require good timing, and, beIore leaping in, I've
Iound it is best to simply "bear witness" to the client's unIolding story without the need to meddle or
jump in with interpretations. I've Iound that, iI I am truly listening, I am almost always called' at a
very visceral, lived' level (a Ielt sense') to make the interpersonal dynamics explicit with an
interpretation.
Ironically, the best interpretations erupt Irom a place oI not knowing.' In this sense, not
knowing' can be viewed as a kind oI bracketing oI my presuppositions in order to be open to the
possibilities oI the client's language. Yet, I'm also aware that it is virtually impossible to be without
presuppositions. To perIorm such an epoche means, then, to be selI-reIlective in such a way that one
is still with the client, still engaged with the client in-the-world oI the therapy. It requires, at the most
optimum level oI engagement, an attunement a Ieel' Ior the mood oI the therapy and how these
moods shiIt and pull one to be a certain way with the client. The best interpretations (which are
symbolic in nature since one must give language to the pre-thematic) seem to arise Irom a lived, pre-
thematic, pre-verbal, Ielt' movement with the client. Yet, when one rushes to interpret too quickly,
this can actually be a deIense against this Ielt movement with the client; that is, it can be a way to
create distance between myselI and the client. This, in itselI, oI course, is part oI the attunement.
Even iI a make such a hasty move, I can at least reIlect on why now?' Such reIlection can give me an
idea oI how my own values and issues may be interIering with the therapy or it can lead me to an
insight that the client may be subtly inIluencing me to collude with the avoidance oI something that
calls to be spoken yet remains unspoken, perhaps still too anxiety-provoking to be thematized.
Anderson & Goolishian (1992) write:
To not-know is not to have an unIounded or unexperienced judgment, but reIers more widely
to the set oI
assumptions that the therapist brings to the clinical interview. The excitement Ior the therapist is
learning the
uniqueness oI each individual's narrative truth, the coherent truths in their storied lives. This means
that
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therapists are always prejudiced by their experience, but that they must listen in such a way that
their
pre-experience does not close them to the Iull meaning oI the client's descriptions oI their
experience.
This can only happen iI the therapist approaches each clinical experience Irom the position oI not-
knowing.
To do otherwise is to search Ior regularities and common meaning that may validate the therapist's
theory
but invalidate the uniqueness oI the client's stories and thus their very identity. (p. 30)
I Iind Anderson & Goolishian's insights to be very reassuring and validating. When I have
been able to lay aside my initial desire to interpret, I've learned to develop a capacity to be truly
curious about the client's world. When I begin to do this, I realize that there is a subtle, yet very
powerIul, shiIt in my being as a therapist. I begin to Ieel more natural and less mechanical and rely
less on technique-like approaches. At these moments, I have indeed Iound the "excitement" oI which
Anderson & Goolishian speak.
Margulies (1989) is especially privy to the beneIits oI laying aside one's desire to be the one
who knows' as a therapist. For Margulies, it is the "creative capacity to suspend closure, to know
and not know simultaneously" which is the common ground between phenomenology,
psychoanalysis and poetry (p. 3). All three, as an ideal, strive to achieve a sense oI wonder beIore
the phenomenon under investigation in order to see the phenomenon in a truly originary, iI not pure,
state. Further, all three oI these disciplines also recognize that doing so goes against one's natural
tendency.' As Margulies writes: "By innate design our egos, minds, and brains organize our
experience and establish patterns oI perception (p. 13). ThereIore, it takes extreme eIIort to view
phenomena in such a way that one may, like a child, stand beIore it in wonder and curiosity. I very
much agree with Margulies. I can truly say that when I trust my curiosity,' I have the most powerIul
sessions with my clients. The client, at these times, can Ieel proIoundly heard and understood, and I
have witnessed clients weep with joy in the presence oI such a moment. Granted, these moments are
rare, but, I would argue, they are the heart oI the healing process oI psychotherapy. In these
moments, I truly Ieel honored to be given such a privilege to participate in such a proIoundly
aIIirmative and transIormative moment Ior another human being. At those times, I Ieel like being a
psychotherapist is the most wonderIul job in the world.
I've also discovered that really listening to a client ultimately leads me to contemplate the
language oI the client in a way that is very much diIIerent than the everyday' engagement with
language in the natural attitude,' so to speak. Guignon accurately points out the beneIits oI
understanding language in therapy Irom a Heideggarian perspective. A person's character or identity
can be understand as a "happening" or "event" that unIolds over a liIetime and which "can be grasped
only in terms oI his or her liIe story as a whole" (pp. 224-225). When this understanding is
supported by Ricoeur's notion that the "temporal unIolding oI liIe" may be understood as "the
structure oI a narrative," the importance oI the role oI language becomes quite obvious (p. 225). The
narrativization oI one's liIe is provided by the socio-historical context in which one lives.
"Language is the house oI Being," wrote Heidegger. Language makes the "event oI
appropriation" possible by illuminating beings which have been given by Being within Language.
As GriIIith & GriIIith (1994) point out, both Heidegger and Merleau-Ponty imagined that the
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"metaphors available to us in our language" can be understood "as lanterns that light up a small area
oI a dark Iorest" (p. 23). The metaphor illuminates' the region oI the human place, the clearing in
which Being can presence, and yet this clearing is always also a covering over, a concealment, in
which Being recedes, leaving only traces oI its presence. The therapist, by attending to and mirroring
the language oI the client, allows the client to dwell within his or her language, thereby making it
possible to re-narratize his or her liIe story. By listening to the Saying oI language as it speaks
through his or her language, the client may be called to new modes oI openness to the world, to
possibilities previously shrouded in darkness. When the client begins to reIlect on the language oI his
or her story, he or she is also engaged in a process oI making explicit what had been previously
implicit or taken-Ior-granted in his or her everyday mode oI being. In listening to his or her
speaking, the world is made explicit and thematized, and, in turn, the client may take the opprtunity
to "take a stand in a world where things are genuinely at stake" (Guignon, p. 227).
Gendlin's (1996) "Iocusing-oriented psychotherapy" is one approach to providing such a
therapeutic context. Gendlin diIIerentiates between "therapy" and "talk." He understands that
language' is an embodied phenomenon, not mere words. One can "talk" with worlds without the
words resonating Ior the person in a bodily way. When words tap into a Ielt sense' in the body, this
means that the words have a deeper connection to one's experience. When one's words "resonate" in
such a bodily way, this means, Ior Gendlin, that one has brushed up against the murky edge oI one's
unconscious, lived experience which is implicit. For Gendlin, any other talk' in therapy leads to a
dead-end instead oI leading toward transIormation oI the whole person. The human being, as a
world-openness oI possibilities, can be transIormed when language speaks through the body, through
one's attunement to what matters. To use GriIIith & GriIIith's metaphor, the client may shed light on
those aspects oI the Iorest' which had previously remained in darkness. A previously constricted
existence can be opened to new modes oI engagement with others and the world.
I have Iound that I do my clients a great service by mirroring his or her language. This is
similar to what Gendlin means by "reIlecting." "To reIlect," writes Gendlin, is "a rare and powerIul
way to let clients enter Iurther into their own experience." The therapist, in this way, is able to be
with the client in a therapeutic way without imposing on the client. Gendlin, however, does not
merely reiterate, but actively encourages the client to unpack those words or phrases which resonate,
and, as he argues, prevents the therapy Irom leading to dead-ends Irom mere talk. Again, this kind oI
attending to language is much more than listening to mere content. It is listening to mood, to the Ielt
sense.' When one is attuned to gaps, Iissures and words that resonate, one can invite the client to
unpack these words, and, almost magically, the client's dwelling within his or her own language
creates a space Ior language to speak the words come and speak what, beIore, had remained pre-
thematic and lived. Like a Ilower Irom the mouth, the unIolding oI the latent meaning shows itselI in
the symbolic. This is essentially the way I understand the making conscious oI the unconscious.
Thus Iar, in summary, I have presented my perspective that the therapist cannot be neutral, but,
instead, must meet the client at the level oI engagement. This process, Ior me, begins with the
Iacilitation oI a therapeutic alliance in which I strive to hold the client with "unconditional positive
regard" and mirror his or her language. By being-with the client in a mode oI active listening, I try to
allow the client to move into his or her own language, thereby making explicit what had been
implicit. Eventually, when the therapy Ieels saIe enough Ior the client and the timing is right, I make
interpersonal-oriented interpretations regarding what is happening between us. Implied, I Ieel that
the client's Ieeling oI being saIe in the therapy with me is truly an essential ingredient to my
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approach. Rather than strive Ior a Iictional neutrality with the client, I strive to make the client Ieel
saIe enough to be genuine and open with me.
Stolorow (1994) also holds the belieI that the "myth oI the neutral therapist" is a Ialse myth.
For Stolorow, neutrality' implies that the therapist can and should be able to "eliminate his own
psychological organization Irom the analytic system," which is, in actuality, impossible (p. 147).
Instead, writes Stolorow:
What the analyst can and should strive Ior in his selI-reIlective eIIorts is awareness oI his
own personal organizing
principles -- including those enshrined in his theories -- and oI how these principles are
unconsciously shaping
his analytic understanding and interpretations. (p. 147)
There is no such thing as "uncontaminated transIerence." TransIerence occurs within the
therapeutic Irame in the relationship between therapist and client. The client is evoked by the
therapist to interpret the therapeutic relationship according to some developmentally perIormed
organizing principle. Therapy evolves, as Stolorow argues, in the "intersubjective Iield" established
between the therapist and client (p. 151). I agree with Stolorow that, rather than pretend I am
neutral, I can maintain "sustained empathic inquiry" by beginning Iirst Irom the "subjective" world oI
the client; that is, the client's "subjective Irame oI reIerence" (p. 148). In this light, I understand
"unconditional positive regard" as an attitude by which I attempt to maintain a consistency regarding
the client's story without Iavoring one course oI action over another. I can maintain "sustained
empathic inquiry" by being equally concerned with the client on all levels and by respecting and
caring Ior the client regardless oI what he or she has to say. By moving in a direction which begins
with the "subjective Irame oI reIerence" oI the client, I am, in a sense, placing my personal and
theoretical assumptions in "brackets."
This sounds easy enough. But I've also learned that it is not possible to place one's Ieelings and
belieIs regarding the client entirely in "brackets." I oIten Ieel pulled to be a certain way with certain
clients and this is very compelling. Inevitably, I Iail to maintain "sustained empathic inquiry" at all
times. The beauty oI this approach, however, is that my Iailures, ultimately, are not Iailures; instead,
I can use this deviation Irom "sustained empathic inquiry" to actually deepen my understanding oI
the client and my therapeutic alliance with the client. When I deviate Irom such a consistent attitude,
this in itselI becomes a reIlective moment, a part oI the epoche, and I can begin to inquire about "why
this, why now?" The way I am pulled to be a certain way with the client tells me about what is
happening in the relationship. It tells me what the client wants me to be and my implicit desire to
give over to this demand perhaps to be the one who knows' or to play a particular transIerential
role Ior the client. I can also use this as a way to catch site oI my own implicit demands regarding
the client. In each oI these cases, I can use myselI, my own Ieelings and thoughts regarding the
client, to deepen the therapeutic alliance. And, by doing so, I develop material which, with the right
timing, I can use to interpret what is happening between myselI and the client. Interestingly, these
kinds oI Iailures are oIten the best material Ior interpretations. I like to think this is what Rogers
meant by saying that the therapist should be "genuine."
For this process to unIold in a way that the client Ieels saIe, the therapy must be constructed in
a certain way that is very diIIerent Irom one's everyday engagement with others outside oI therapy.
#elections on Being a Psychotherapist

As Langs (1989) so adeptly acknowledges, psychotherapy becomes a therapeutic relationship by


virtue oI its deviation Irom our typical, everyday, pedestrian relationships. As Langs writes:
Given the realities oI our culture, it is the very nature oI its existence as a commodity that
limits psychotherapy
and sets it apart Irom a Iriendship or Irom the sharing oI problems with a neighbor. In Iact, one
might say that
the therapeutic interchange exists only by virtue oI its structure as a service. The therapeutic
relationship
brackets oII a time and place Ior activities removed Irom the linear eIIort oI everyday survival
issues. (p. 54)
The therapeutic Irame, as a deviation Irom the "everyday" mode, necessarily involves
boundaries' which deIine the therapy. It is Irom the boundaries' oI the therapeutic Irame that the
very meaning oI therapy emerges and, without which, a relationship may no longer be considered
therapy as such. Furthermore, it is within this context that both client and therapist are given the
Iramework in which to make explicit that which is implicit. This process is oIten uncomIortable and
takes eIIort to maintain. For, as Langs maintains, the "conscious system" is "uncomIortable with the
structured Irame oI psychotherapy" (p. 55). While the therapeutic Irame provides stability, the
"conscious system" experiences this stability as entrapping. The paradox implies a struggle both Ior
and against change Ior both parties. Rather than Iace this ambivalence by making the implicit
process explicit, it oIten becomes a great temptation to break the therapeutic Irame. As Langs writes:
"Because this paradox is an issue Ior all oI us, therapists as well as patients Ieel the same kinds oI
pressures to deIend against awareness. The easiest deIense open to either party is to undermine the
therapeutic Irame."
Being that both the therapist and the client are under similar pressures, it is likely that the
therapist and client will oIten conspire to undermine the therapeutic Irame. ThereIore, the therapist
who wishes to avoid such pitIalls must learn to hold Iast to the therapeutic Irame despite the
temptation to deviate Irom it. This necessitates a need Ior a set oI "ground rules" Irom the beginning
so that the therapist may hold to the Irame and recognize his or her unconscious pull to deviate Irom
the Irame. In general, this is the pull' I discussed early: the pull away Irom the Irame tells me
something about what is happening between myselI and the client. I oIten Iail to hold the Irame in
therapy, but, when this happens, it can be genuinely healing Ior the client when this is interpreted and
discussed between myselI and the client. I Iind that this is very powerIul, and, almost always, the
pull' I Ieel involves transIerential dynamics, iI not counter-transIerential dynamics. In short, the
Irame allows Ior the interpretation oI the transIerence, which is in line with Freud's (1917) original
assertions:
...the whole oI the patient's illness...is concentrated on a single point -- his relation to the
docotr...When the
transIerence has risen to this signiIicance, work upon the patient's memories retreats Iar into the
background.
ThereaIter it is not incorrect to say that we are no longer concerned with the patient's earlier illness
but with
a newly created and transIormed neurosis which has taken the Iormer's place. (p. 144)
#elections on Being a Psychotherapist

Healing in therapy happens when my relationship with the client is used to make the patterns oI
the client's relationships explicit in the therapeutic Irame, which must necessarily be a saIe place iI
the client is to avoid re-experiencing original traumas at the heart oI the transIerence (as opposed to
"a newly created and transIormed neurosis which has taken the Iormer's place").
There are various "ground rules" which I Ieel are essential Ior therapy. When these ground
rules are violated or I Ieel the pull to violate them, this becomes a red Ilag, so to speak. First, I try to
be consistent with the client. By maintaining a degree oI consistency, I can avoid Iavoring one action
oI the client's over another; thus, I strive to maintain "sustained empathic inquiry." Whenever there is
a violation oI this ground rule, which happens oIten enough, I acknowledge this deviation. The
deviation, thus, is made explicit and conscious' rather than implicit or unconscious.' Once this
deviation is acknowledged, the transIerence is brought to the table. The client and I are no longer
talking about distant past relationships, but we are now working with our relationship in the moment.
And, ultimately, this is where the healing oI therapy must take place.
As Kahn (1997) points out, remembering is not enough, and, iI so, "what is missing is re-
experiencing" (p. 57). Kahn quotes Gill (1982), who emphasizes the essential nature oI re-
experiencing' in psychotherapy:
The transIerence is primarily a result oI the patient's eIIorts to realize his wishes, and the
therapeutic gain
results primarily Irom re-experiencing these wishes in the transIerence, realizing that they are
signiIicantly
determined by something pre-existing with the patient, and experiencing something new in
examining them
together with the analyst -- the one to whom the wishes are now directed. (p. 44)
In keeping with Gill's sentiments, I am constantly striving in therapy with my clients to bring
the transIerence into the open so that it can be re-experienced in the therapeutic relationship. And
even when I Iind myselI avoiding this, this in itselI becomes an object oI curiosity, and it, too, can be
used as part oI the interpretation. This concept is central to what I have already discussed so Iar. By
being attuned to the client's mood and deepening the client's language, I attempt to allow the client to
be in touch with his or her Ieelings. I do not think this can happen unless the client Ieels saIe in the
therapy; thus, "unconditional positive regard" and "sustained empathic inquiry" are essential Ior
providing a Ieeling oI saIety Ior the client, as is my eIIort to hold the Irame. When these Ieelings are
resonating in the room, I can Ieel' them they are palpable, visceral, and Ielt through my lived
body with the client. I Ieel the pull' oI the mood oI our relationship. When the timing is right and I
Ieel the client Ieels saIe enough to bring that material Irom a distant past to the present moment
between us, I oIIer this as an interpretation in a non-judgmental, nondeIensive and interested way. In
time, I am then able to make connections regarding how what is happening between us is related to
transIerential phenomenon how it is related to the client's past, that is. The past, in this case, is no
longer a distant past, but a past already being re-experienced in the therapeutic relationship.
Other, perhaps more obvious, elements oI the therapeutic Irame (ground rules') are also
essential: dual relationships are oII limits, and physical contact, selI-disclosure, advice-giving, and
undue deviation oI time lengths are all avoided. In all oI these cases, these aspects oI the Irame
separate the therapy relationship Irom a pedestrian relationship, which gives the client a saIe space
within which to re-experience transIerential phenomena without re-experiencing the trauma in
#elections on Being a Psychotherapist

damaging ways. TransIerence in pedestrian relationships involves repetition oI the trauma, whereas
the therapeutic relationship is in the service oI using transIerence phenomena Ior psychological
transIormation towards healing and growth.
As LeShan (1996) has pointed out, the therapist is "all to human." As he writes:
A therapist who is not in supervision should be regarded either with suspicion or with awe.
He or she is making
a statement that they learned all that is needed Ior one oI the most complex problems in existence -
- helping
others to be as Iully human as possible and to survive and exult in the human condition. (p. 91)
LeShan points out an important lesson which I have learned Iull Iorce since Iirst becoming a
psychotherapist: I have much more to learn. Yet, I've also learned that I have the capacity to be
therapeutic by sticking to the therapeutic Irame and, even iI I inadvertently deviate Irom this Irame, I
can acknowledge this within the therapeutic context. I am human and Iallible, but that does not mean
I am not competent. I Ieel, today, that I am a much more competent therapist compared to two years
ago. And, within the next several years, I expect that I will continue to become more competent. I've
appreciated the proIessors and supervisors who have helped me along the way. I know now that I
can engage a client in therapy in such a way that it is truly therapeutic and transIormative Ior the
client because I have seen the results oI my work. I expect that I will only get better and that Ieels
good.
One oI my constant struggles with my approach to therapy is how to deal with the issue oI
"resistance" by my clients. As I mentioned previously, I am inIluenced by Levinas' (1961)
philosophical anthropology which implies that the client is always radically alterior, radically Other.
To totalize the client, to attempt to Iully know' the client, is to do a kind oI violence to the client's
transcendency as the Other. In this sense, I Ieel that there is a health in what is termed "resistance"
by the client the client always resists being Iully known. Thus, part oI my struggle is the question
oI how to deal with "resistance." When is "resistance" healthy and when is it pathological? Even
with the "sustained empathic inquiry" oI a non-directive approach to therapy, resistance occurs. Yet,
there is little agreement as to what "resistance" means. Further, the way a therapist interprets the
meaning oI "resistance" can actually evoke Irom the client a particular manner oI "resistance," and, in
turn, will inIluence the way the therapist responds.
Kepner (1987) identiIies Iour diIIerent understandings oI resistance: "common sense,"
psychoanalytic, Reichian, and Gestalt perspectives. "Common sense," according to Kepner, may
understand a client's resistance to change as "anti-selI" (alient to the I'), as "weakness (lack oI will),"
as "irrational," or as "Iorce oI habit" (p. 61). Yet, as Kepner points out, there is a potential danger
inherent in the "common sense" understanding oI resistance. The person who is resistant to change
may, in Iact, attempt to change by overlearning a new, good habit to replace the old habit. In doing
so, the person risks masking the original conIlict which may become "inaccessible beneath a thick
layer oI secondary repression" (Kepner, 1987, p. 62).
"Common sense" thinking believes that a person will inevitably change iI only they really want
to change. Freud, on the other hand, uncovered another possible understanding oI change: Wanting
to change, yet being unable to do so. Freud saw resistance as a person's deIense against internal
drives that threaten the personality structure. It Iollows that Freudian psychoanalysis understands
#elections on Being a Psychotherapist

resistance as some-'thing' which should be overcome' in order to make the unconscious conscious.
Reich, Iurther, expanded upon Freud's notion oI resistance by seeing resistance as a Iunction oI the
person's character and character armor' which he saw as equivalent to the body armor' oI one's
chronic physical tensions.'
Kepner also recognized a potential problem with both the Freudian and Reichian theories oI
resistance. One's resistance can also be understood as a "protection." II so, the client, by resisting the
therapist, is protecting himselI or herselI Irom a perceived harm. ThereIore, Freud and Reich's
approach to resistance, as requiring it to be "overcome," implies an intrusive maneuver by the
therapist to penetrate and/or remove the resistance. Yet, how can one expect a person to relinquish
his or her "protection" when he or she perceives the therapist as a potential threat?
Gestalt therapy provides an alternative to the Freudian and Reichian approaches to resistance. As
Kepner explains:
...resistance is not considered a mechanism or tool oI the selI; it is seen as the selI itselI in
action. There is nothing
behind the resistance itselI, no 'true selI' diIIerent Irom the resistance. Both the deIense and the
deIended are selI...
To break down or eliminate resistance would be the same as breaking down and eliminating a
capacity oI the selI.
(p. 65)
The therapist, by attempting to "overcome" the client, runs the great risk oI creating a situation
in which the person's deIenses become even more rigid. The therapist does, indeed, become a threat
a threat to the very selI' oI the client. Nevertheless, the insight oI psychoanalysis sheds light on
the double knot oI the selI: The selI both seeks and resists change. As long as a person's resistant
selI' remains outside oI awareness, this reduces the possibility Ior the client to express his or her
resistance Irom a position oI choice; that is, until it is Iully owned. The therapist's task, thereIore, is
the gentle art oI assisting the client in becoming aware oI both aspects oI his or her selI'; the selI'
which wants to change and the selI' which resists this change. I use this non-violent' approach to
therapy in order to allow the client the openness necessary to dwell in this ambivalence, to notice it as
iI Ior the Iirst time without the need to immediately take up one side or the other. Once the client's
ambivalence is "Iully owned," the client can then be said to be acting Irom a position oI choice.
Further, iI therapy is about making the unconscious conscious, it is an error to believe that one must
break through a client's resistance in order to do real' therapy. I Ieel that the person's growing
awareness oI their own "protective" styles oI engagement, as part oI what constitutes their being as a
particular person, is what makes therapy therapeutic. ThereIore, the therapist's engagement with the
client's resistance is the therapy, rather than a hindrance to therapy. I believe this is in keeping with
Levinas' (1961) understanding oI ethics.' This is ethical therapy in the service oI the other as
radically other.
While Kepner utilizes the insights oI Gestalt therapy to uncover the nature oI resistance, Teyber
(1992) moves a step Iurther by articulating ways in which the therapist can address resistance in such
a way that will be therapeutic. Like Kepner, Teyber recognizes that resistance can be understood as
stemming Irom the client's ambivalence. Teyber also, like Kepner, views resistance as a way Ior the
client to protect him- or herselI. He sees resistance as stemming Irom "layers oI Iear" tied to the
client's presenting problems (p. 2). Yet, Teyber also realizes that therapists avoid dealing with a
#elections on Being a Psychotherapist

client's resistance out oI their own insecurity based on naive notions oI the therapeutic relationship
Irom a position which understands the therapist as superior' or out oI a desire Ior the therapist to
be liked (p. 3). For Teyber: "Both the therapist and the client must honor the client's resistance, as it
originally served a selI-preservative and adaptive Iunction" (p. 4). Ultimately, Ior Teyber, the
therapist should encourage the client to talk about their negative Ieelings about therapy. Otherwise,
the client is more likely to act out on these unspoken Ieelings by dropping out oI therapy.
Teyber and Kepner's approaches to resistance are consistent with my non-directive approach to
therapy which I have elaborated in this paper. Teyber's approach is also consistent with Stolorow's
notion oI "sustained empathic inquiry" and Rogers' idea oI "unconditional positive regard." I Ieel that
iI I am truly unconditionally curious about everything a client has to say, the client will Ieel more Iree
to openly discuss his or her ambivalent Ieelings and, indeed, my experience has proven to me that
this is the case. Even when I Ieel the need to break through a client's deIenses,' I instead strive to be
deeply curious about the client's deIenses' in a non- threatening manner, neither breaking through'
nor avoiding them out oI a desire to be superior or to be liked by the client. Through mirroring the
client's language and well-timed interpersonal interpretations, I strive to assist the client in
recognizing his or her unconscious deIenses, and, thereby, I've Iound that the client can then begin to
"own" these largely unconscious,' unarticulate, lived, protective' styles oI moving through the
world.
From this perspective, Buber's idea oI "wrestling" with the client can be understood in an
alternative way. I "wrestle" ith the client, not against the client by bearing witness to the client's
struggle to change. The client deepens his or her understanding oI his or her language by attending to
the words and phrases which "resonate" in the body, and he or she begins to catch site oI the
dynamics oI our relationship which discloses habitual styles oI relating to others. In turn, he or she
may begin the process oI a change which begins with a "Ielt sense" and moves toward
"renarrativization" oI his or her story: A story which opens up new opportunities Ior healing and
growth and which literally involves a reconIiguration oI the client's horizons. The client can discover
a new openness to new possibilities and a wider perspective compared to his or her old, constricted
world-relatedness Irom which the client had suIIere/
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