Individual psychotherapy – that is, engaging a distressed fellow human in a disciplined conversation and human relationship – requires that the therapist have the proper temperament and philosophy of life for such work. By that I mean that the therapist must be patient, modest, and a perceptive listener, rather than a talker and advice-giver. Thomas Szasz
The communicative engagement with another human is can be a treacherous journey one can embark. It is an arduous task to decipher the mind of another, partly, if not mostly, because one cannot decipher one’s own. Delving into the unknown seas of the mind, one encounters a precarious complexity to the human psyche. The mind, naturally homogenized with a myriad of intertwined multilevel stratum of divergent cognitions, emotions, and lived history, create for many a listener and a self an indiscernible paradox which is almost incomprehensible to grasp. The plight for effective communication and a receptive psychotherapeutic engagement goes beyond clinician training, patience, modesty, and perceptive listening skills. Additionally, clinician self-awareness and reflection with a solid personal construct are cornerstone to an effective empathic connection with another. I emphasize that to establish a genuine unbiased, non-judgmental, and compassionate interconnection with another, the state of presence, encompassing the aforementioned traits, are necessary for an effective psychotherapeutic and/or alliance with another.
There is abundant literature on the state of presence and mindfulness within the therapeutic encounter and in the daily attainment of balance in life. Thus, the concept of presence is not a new one. According to Bazzano (2013) the state of presence may be comparable to Freud’s term of, evenly suspended attention of the analyst. Bazzano quotes from Freud’s work extracted from ” Recommendations to Physicians Practicing Psychoanalysis”,
…on his recommendation that the physician must turn his own unconscious like a receptive organ towards the transmitting unconscious of the patient. The analyst must adjust himself to the patient as a telephone receiver is adjusted to the transmitting microphone. (2013, pp. 2)
This can be the first step to obtain presence. However, without the clinician’s self-reflection and own empowerment, it can prove to be very dangerous to the client/patient. Even if the clinician is (partially or totally) aware of her unresolved and unhealthy counter-transference, recognition does not supplant the clinician’s own healing journey. Concordantly, Sherwood’s (2001) phenomenological study describes clients’ experiences within the therapeutic encounter with a dis-empowered and harmful psychotherapists,
A harmful counselling relationship is drained of human presence and transforming power. There is no alive human connection, no two-way glow. The counselor is experienced as insubstantial, with no solidity, no ability to hold traumatic experience or pain. The client meets a cold reception from exposing himself/herself to the counsellor that has the power to shatter, fragment and splinter the client. The counselor is full of self concerns …In the client this may lead to terror, and physical symptoms of sickness and anxiety. The counsellor may be full of their own fears and are experienced by the client as unbalanced, chaotic, avoidant and overwhelmed.. There is a weak human connection and the therapeutic encounter results in a weakening of the human potential for recovery…(pp. 12)
Thus, the clinician’s unresolved issues and humanness renders harm, and for some, irreparable damage to the recipient’s already fragile ego. Along this argument is Newcomb’s article on counter-transference states the importance of the therapist’s self-reflection and acknowledgement is to assist, not harm, the client.
In reviewing the literature, I conclude that if the clinician connects to and with the client from her own unconscious, as with evenly suspended attention, the result is a synthesis of unresolved history and fears conveyed and communicated onto the recipient. This methodology is contrary to what Szasz describes as being an efficient or empowered clinician. Parlance and theory may shine a glimmer of light onto the clinician’s overt intellectual apparatus, however, it reflects back as a dim votive for the lost recipient seeking healing guidance. Insomuch, this methodology, for many, extrudes pathologizing, sanism, abelism, medicalizing, pity (Burton, 2015), and for some identification with the client. In other words, she is the all-knowing, intellectual, unhealed clinician who wants to rescue and cure the client. Additionally, I have found that in many psychiatric facilities the unhealed clinician also presents with an infantilizing subject/object relations with the pained other, where power and pity towards the patient prevails over understanding the recipient’s humanness and presenting crisis.
The new institutionalization regulations calls for short-term treatment and stay, which many inpatient social workers describe as conveyor belt services. Barbara Taylor (2014) explains,
Pushing remedies at people instead of listening to them is a very old story…the preferred mode in mind-doctoring has been to deal with madness from a safe distance. Listening to people, taking their words seriously, brings them too close. Thinking about the meaning of someone’s symptoms-instead of just trying to dose the symptoms away-risks feelings of recognition and empathy (pp. 264).
Knowing what Taylor experienced in the psychiatric hospitals, especially through her last hospitalizations, where medication and fast discharge prevailed over listening to her emotional/spiritual crisis, points out that the system may need to be shifted. Yet, this notion is unforeseeable. Or is it? Perhaps the system cannot be shifted or changed, but, it can start with the individual ethical clinician’s shift through self-reflexibility, acknowledging and integrating what Jung termed the shadow self, and achieves empowerment. The clinician can best serve the patient by being present and listening. The empowered clinician is now the guiding light for the patient to find his own way within.
Personal thoughts on the Art of Presence
The Art of Presence is achieved through the clinician’s self-care, self-flexibility, mindfulness and spirituality, along with an intuitive, respectful understanding of the pained other’s humanness. Comprehending that a diagnosis of the pained other or non- conformist is a tool, not a means of understanding the other person. Understanding that medication is used temporarily to reduce the acute overt behavior is not a necessity for the pained other’s biochemical illness. The ability to listen and ethically handle the non conformist’s acting out behavior without personalizing. The clinician should be able to utilize creativity in treating others. And very importantly, the clinician is cognizant, knowledgable and comfortable with her own humanness.
Bazzano, M.(2013) – http://www.counselling-directory.org.uk/counsellor-articles/cultivating-presence
Newcomb, B.(2011) – http://brettnewcomb.com/counter-transference-in-therapy/