Being Present: Compassion and Empathy in the Therapeutic Encounter

“No one cares how much you know, until they know how much you care”

― Theodore Roosevelt

      Following the work of Carl Rogers’ Person Centered psychotherapy, Dr. Geller and Dr. Greenburg (2012) discuss the concept of presence in the therapeutic encounter as one of the greatest gifts one person can give to another. Even though presence does not replace a theoretical background, either single, eclectic, or integrative, it is the basis of a healing bond between two people.

      The abstract concept of a state of presence, as ethereal as it may seem, is a palpable inter f8789da205bad8ad5b7cde9fbe89d806and intra-connection with the other based on the clinician’s empowered self; being open and receptive to the other; having an expanded awareness which is rooted on a healing intention of being of service (Geller, 2013) for the other ( as well as clinician ) to empower and grow.  For many clinicians, the State of Presence model, can be or is antonymous to the medical model paradigm of psychiatric  diagnosis and medicalization practices.

      To better understand how this incongruity can meet a state of presence and achieve healing in the therapeutic encounter, Madness Radio host, Will Hall, interviews Dr. Toby Watson   in the podcast appropriately titled, “Ethical Psychotherapy”.

A Brief Summary of the Ethical Psychotherapy Podcast

      Dr. Watson begins by introducing his therapeutic philosophy  and how he shifted from the indoctrinated medical model taught in graduate school to a community based holistic therapeutic concept.  Throughout his career, he realized that the imposed, if not required curative medication,  proved to be more harmful than the assumed therapeutic value. Watson believes the medical model is reductionist and mechanical whereas, the holistic model promotes an ethical practice to uphold the recipient’s right to refuse medication.  For example, Watson smoothly transitions from ethics taught at school regarding the duty to protect by admitting a suicidal patient to the hospital to how the hospital strips the patient from his or her civil liberties and does harm to suicidal patient through their demeaning,  if not,  punishing practices.

      Of importance to the clinician and to the state of presence, Watson speaks to the concept of the clinician’s humanity for his or her patient. Of crucial importance, is how the clinician either embodies or is perceived by the recipient to be the archetypical Hero. The ethical clinician knows that she cannot “save” however, many in the field have that sense of needing to rescue or the false notion that they are healers. When in reality,  it is the state of presence, skills, theoretical expertise, experience, respect, humility, and as Watson describes it, the clinician’s humanness that assists the recipient to feel safe enough to make her own free-willed decision.

If you would like to listen for yourself, please click on number 35 on the list. It is about 50 minutes long, but, packed with useful information  and vignettes.

My Personal Reflections on the State of Presence

        An ethical worker with a state of compassionate presence goes beyond the simple acknowledgment of her working memory, countertransference and shadow self; it is a heightened state of intuitive awareness within the intersubjective dyad creating, for both, a  healing intra-connection.

    Just as the clinician encourages the recipient to adapt to self-reflexibility, responsibility, introspection, and movement, the clinician’s gift of “being present” fosters the same to self.   Self healing is as integral, if not of more importance, than solely possessing a theoretical background and ideology, for it is the essence of the therapeutic encounter and intra-subjective bedrock matrix.  I would like to emphasize here that many clinicians have shifted their self-perceptions overtly believing that they have achieved empowerment, which I describe as, a false ascension; when in reality the overt thinking is incongruent to the deeper unresolved issues and pain. These individuals believe and embody the archetype of healers, masking, repressing, and compensating for their unsettled sense of self.

      As essential as self-healing is to the therapeutic encounter, so it is, to be an empty vessel where the inter and intra exchange is influenced by the present  given moment between the two (or more ) individuals.  For many clinicians, the empty vessel concept is difficult but not impossible to obtain. Thus, the unresolved humanness is translated into compassion fatigue, burn out, overcompensation, enabling, sanism, ableism, stigmatization, ridicule, and at times, unethical practices  towards the recipient of services.  To further complicate this matter, adhering to the medical model, which is not only indoctrinated in most graduate programs, but also utilized in most, if not, all psychiatric settings, distances the caregiver from the recipient. Conforming to the medical model’s ideology of understanding a patient through the lens of a diagnostic criteria, the patient is stripped of  his humanity and the clinician is deterred from establishing a compassionate and empathic bond. Thus, reinforcing the need for the clinician’s self-care, self-healing, humility, and intuitive listening skills.

How to Care for Self: A Brief Summary of Elaine Hammond’s podcast: Burnout and Self Care in Social Work

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      To deter clinician aloofness or disengagement, Elaine Hammond, MSW, from the University of Buffalo inSocialWork podcast utilizes a trauma-informed perspective on clinician self-care. Hammond emphasizes on the use of MORPH to achieve compassion. M is for mindfulness: which is focusing on the breath and able to make choices in our relationships with others. O is for organizing: our thoughts and eliminating shame and blame within the clinician and the recipient. R is for resources: the clinician must ask herself how is she feeling, what does she need, be in check on her given skills and get training if necessary to deter burnout.  P is for pillars: based on the pillars of trauma. H is for humanity: taking care of our own humanity. In addition to the MORPH method, exercise, plenty of sleep, and a good nutrition are all essentials for optimum self-care.

      The podcast is about 51 minutes long, however, it does not identify the various points as quickly as one would hope. In my opinion, it is overloaded with too many examples of how Hammond deals with her own daily life stressors.  Listening to the podcast with an open mind and focusing on the concepts of the MORPH method can be a valuable tool for many practitioners to obtain and provide a healthy state of presence in the therapeutic encounter for both the recipient and clinician.

 Please listen to this podcast to get a sense of MORPH and its application to daily and professional life.

References

Countertransference http://www.goodtherapy.org/blog/psychpedia/countertransference

Geller, S. M (2013). Therapeutic Presence as a Foundation for Relational Depth. In Knox, R., Murphy, D., Wiggins, S., & Cooper, M. (Eds.)., Relational depth: New perspectives and developments. pp. 175-184. Basingstoke: Palgrave.

 

Geller, S. M., & Greenberg, L. S. (2002). Therapeutic Presence: Therapists’ experience of presence in the psychotherapy encounter / Therapeutische Präsenz: Erfahrungen von Therapeuten mit Präsenz in der psychotherapeutischen Begegnung / La Presencia Terapéutica: La Experiencia de la Presencia que Viven los Terapeutas en el Encuentro Psicoterapéutico. Person-Centered & Experiential Psychotherapies, 1(1-2), 71-86. doi:10.1080/14779757.2002.9688279

Hall, W.- http://willhall.net/about/

Hammond, Elaine – Burnout and Self Care Podcast- http://www.insocialwork.org/reviews.asp?ep=133http://www.insocialwork.org/reviews.asp?ep=133http://www.insocialwork.org/reviews.asp?ep=133

Madness Radio– http://www.madnessradio.net

Shadow selfhttp://www.carljung.co/2011/10/jung-shadow-self.html

Watson, T.- http://www.drtobywatson.com

Watson, T. – Ethical Psychotherapy Podcast (# 35 on the list) – https://itunes.apple.com/us/podcast/ethical-therapy-toby-watson/id268090544?i=1000318660831&mt=2

Working  memory– https://www.simplypsychology.org/working%20memory.html

 

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