Who is the client sitting across from me? Who is the colleague with whom I am talking? Who are the seemingly old, homeless street people that I meet? That myth, that story has stayed with me as I approach my clients and hopefully, each and every person I meet. My therapy is profoundly shaped by this personal myth! I hope that each inquiry and expression of presence and affective attunement expresses this unconditional positive regard. (Rogers, 1951).
In the process of growing up every child ponders the question, as I did at age twelve, “What does a person like me do in a world like this with people like you?” This existential question raises three dilemmas: Who am I? Who are you? And what is the quality of life? (Erskine & Moursand, 1997/1988). When those three questions are flexible and amenable to new influences, when the answers are continually upgraded by experience and change, they form our ongoing personal story – a story that includes our fond memories, our pleasant experiences, our ideals, the things that have hurt us, the things that have frustrated us, and the philosophies that serve as our guiding principles: what Alfred Adler called “The Lifestyle” (Ansbacher & Ansbacher, 1956). When these decisions and myths about self, others and the quality of life become fixated, when they are rigid, when we hold onto them like a prejudice, they form what Fritz Perls (1975), or Eric Berne (1972) referred to as “life script”. Life scripts are composed of myths and beliefs that limit spontaneity and inhibit flexibility in problem solving, health maintenance and relating to people. (Erskine 1980, Erskine & Moursund, 1997/1988). I think it is part of a therapist’s task to facilitate the client’s telling of his/her life’s story and to sort out and resolve what is a limiting and inhibiting life script from what is each individual’s unique narrative of personal experience. Carl Jung beautifully described this therapeutic process of unearthing the client’s personal life script.
“The patient who comes to us has a story that is not told, and which as a rule, no one knows of. To my mind, therapy only begins after the investigation of the whole personal story. It is the patient’s secret, the rock against which he is shattered. And, if I know his secret story, I have the key to his treatment. The doctor’s task is to find out how to gain that knowledge” (1961, p. 117).
Here, Jung is talking about the realities of psychotherapy -- what we actually do in clinical practice.
The Psychotherapist’s Dreams
Before we go on to the psychotherapist’s realities, let us examine the psychotherapist’s dreams. Not our night dreams, but rather our daydreams or imaginings, the basis of our theories. For a moment, think of all of our many theories as constituting the “dreams” of our psychotherapy profession. The proliferation of theoretical concepts and ideas that have marked the past hundred years of psychotherapy may point to the usefulness of conceptualizing all of these psychotherapy theories, not so much as a true description of reality or of human nature, but perhaps much more usefully, as a collective dream, a psychological zeitgeist. I love to play with theories. It’s stimulating for me to learn them and apply the concepts in clinical practice. I enjoy teaching, but when I try to make any therapy “truth” I get into trouble. When I think of theory as a dream, I don’t argue with it anymore. I’m freed from the search for “truth” and the quest for a real description of human nature. I’m not trying to prove one theory against the other. When clients reveal dreams, we do not argue about the dream’s symbols representation of reality or whether these symbols can be proven by research. Rather, we examine the meaning of the dream in the context of the client’s life experience.
When we examine theory as a dream, rather than look at it as truth, we uncover important symbols about what is occurring both consciously and unconsciously within our client and also within ourselves. Over the past century the writers of psychotherapy theories have argued over which theory is a true description of human nature. We argue over the assumptions of what constitute human difficulties and what methods ease suffering and confusion. The current eclectic mix of theories, some contradicting others, takes on a patient-centered perspective when we view theories as the author’s dreams.
In the Interpretation of Dreams, Sigmund Freud (1913), pointed out that dreams were hidden expressions of wish fulfillment, determined by the dreamer’s waking life and closely related to his current involvements and problems. Ten years later in Beyond the Pleasure Principle, Sigmund Freud (1923/1961) changed his idea and said that dreams unmasked traumatic impression. Jung argued with Freud’s premises: dreams represented neither wish fulfillment nor trauma. According to Jung, dreams inform the dreamer about the unaware condition of his inner and outer life. The dream content hints at ways by which the dreamer might solve his problems (Weiss, 1950). I frequently integrate these three theoretical ideas; two by Freud and one by Jung, as a way to examine psychotherapy theories: the solution to a current life problem that provides an opportunity to understand ourselves and our clients, a wish fulfillment, and perhaps an expression of our own traumatic memories buried in our theory. I often include in this integrative perspective Fritz Perls’ concept that a dream is an existential expression (1973). This post-modern perspective dissolves the sharp line between what is real and un-real, what is provable by research and what is a co-construction of helpful phenomenological experience – it challenges the “reality-making” of theory.
To write this speech I had to dream, to imagine. I had to conceptualize, to theorize. Theories can be viewed as our collective professional dreaming. Sigmund Freud (1927) wrote in The Problem of Lay Analysis, “Every philosopher, poet, historian and biographer evolves his own psychology based on individual presumptions” (p.48). If he is correct, then perhaps each theoretical persuasion should be viewed as partly autobiographical.
I have had the privilege of knowing several authors who have written on psychotherapy theory and have read the biographies of others: some of these writers and teachers were exceptional people, each contributing his/her unique perspective on psychotherapy theory and methods. I found in many of their writings their own personal autobiography imbedded in the theory they expounded. That does not detract from the importance of that theory, but it certainly humanizes it. To view psychotherapy theory from its autobiographical origin lessens the need to argue whether the theory is “true” or provable. Each writer describes the subjective experiences of his or her personal/professional life.
My “dream” of an effective psychotherapy is to make the relationship between client and therapist central – to provide an intersubjective space that allows for a therapeutic dialogue. Winnicott (1965) referred to this space as the facilitating environment, the domain wherein the “play” of psychotherapy occurs. Therapeutic involvement is the oscillation between two processes: de-centering and self-awareness. I usually spend a greater amount of time de-centering from my self. That is, I make my own thoughts, my own perspectives, or my favorite theories unimportant. I try to create myself as an empty vessel, to be filled by the client’s phenomenological perspective. Alternately, almost simultaneously, I allow myself to free associate – to explore the many different aspects of my own life, my own therapy, supervision, work with past clients and all the various theories I have studied and read. I may think of the words of a song, a metaphor from history or science, or a verse from the Bible. I think that the oscillation between being de-centered and freely associating to what the client presents, allows for the creation of a different theoretical perspective for each client. When with clients, I try to make this intersubjective process more central than any theory. This allows for a creative interchange in the process of psychotherapy. This is the therapeutic involvement described in Beyond Empathy: A therapy of Contact-in-Relationship (Erskine, Moursund, & Trautmann, 1999)
I would like to share my own perspective on Sophocles’ story of Oedipus Rex as an example of how one’s personal story influences the use of psychotherapy theory. Sigmund Freud (1923, 1924), used the ancient Greek story of Oedipus Rex as a model for describing both his energetic and structural theories: the drives of libido and aggression and the influence of the id and superego on the ego (Greenberg & Mitchell, 1983). Freud’s rendition emphasizes a young man’s murder of his father and a sexually consummated marriage with his mother. Influenced by Freud’s own personal and professional experience (Elenberger,1970; Levenson, 1983; Masson, 1984), this interpretation was used to illustrate the profound human experience of aggression and sexuality (Mitchell, 1988).
A relational perspective of the Sophocles’ story significantly alters our understanding of human nature and interpersonal dynamics. As I read this ancient Greek writer (cited in Mullahy, 1948), his trilogy is one of human relationships; of disruptions in interpersonal contact; of relationships gone awry; and desperate attempts at compensation and repair. Oedipus Rex is a tragedy of failed relationships. Sophocles portrays a tale wherein two young parents become distraught by the prediction of the Oracle of Delphi that foretells of a child killing his father and marrying his mother. Rather than seeking help to solve their fears, the parents instruct a servant to kill the child. Instead of directly killing the child himself, the servant stakes his foot to the ground and leaves him to die. A kindly old shepherd rescues the child, Oedipus and raises him as his own son. But as this young boy grows to manhood, he yearns to find his own way in the world. Because of his maimed foot, Oedipus walks through life with a limp, symbol of the tragic wounding caused by the rupture in parental attachment.
At a crossroads Oedipus meets a stranger and the second element of this tragedy unfolds: the stranger, Oedipus’ father, does not recognize him as his own son. The two men, strangers to one another, fight and Oedipus kills his father, never realizing the paternal relationship. Later Oedipus visits Thebes and lifts a curse on the city, is made the new king, and marries the dead king’s wife. For many years Oedipus has no idea that the man he killed at the crossroads was his father, the King of Thebes.
This is not a story of aggression against one’s father and lust for one’s mother. It is a tragedy about parental abandonment, the attempt to kill a child, and the child’s longing for attachment. It is a story of a mother who cannot recognize that this young man was my baby whom I had abandoned. Years later when a new plague emerges in the city Oedipus is told the facts of his parents’ abandonment and he realizes that the man he killed at the crossroads was his father, the king. Oedipus is so shocked that he gouges out his own eyes, symbolizing the blindness in the family, the failure to see the importance of relationships and attachment. When we look at the myth of Oedipus Rex from a relational perspective rather than from a theory of drives, it alters our therapeutic understandings and challenges the very nature of how to practice an effective psychotherapy.
Each theoretical perspective provides an alternative view on clients’ psychodynamics. When we think of all of our theories as though they are dreams, then we are faced with what we actually do with clients.
The Psychotherapist’s Realities
The realities of psychotherapy require that we develop a high level of interpersonal skills to engage in complicated and sometimes painful interactions with clients, to combine empathy and attunement with understanding and the support for change. If we take a client-centered approach to psychotherapy we are faced with the questions, “What do I know about this person? What does this client need from me, now? What can I provide?” Answers to these questions are best if formed, not from a theory, but from what I know directly from each client.
To paraphrase the earlier quotation by Carl Jung, the psychotherapist’s task is to find out the person’s whole story: that which he or she already knows and the story that is a secret, a secret even to the client. The discovery of the client’s secret is facilitated through inquiry. Inquiry is a genuine investigation into the psychological experience of the other person. Inquiry is multifaceted: it includes a respectful conversation about the client’s phenomenological process, historical and transferential experience, defensive copying style, and psychological vulnerability. Phenomenological inquiry always begins with the assumption, “I know nothing about this client’s experience.” When I embrace this assumption, none of my theories, none of my past experiences, not even my observations tell me enough about what it’s like to live in this person’s skin. To engage in a phenomenological inquiry, I use questions or statements that focus on the client’s internal experience: What’s it like to be sitting here talking to me? What do you feel when you tell me that story? Describe what is happening in your body? What sense do you make of that?
Respectful inquiries allow the person to tell their own personal story; the narrative of his or her life. An empathic inquiry provides an opportunity for the client to express who he or she is to a willing listener. The purpose of such inquiry is primarily for the client to discover aspects of self that were previously not known or spoken about. Inquiry is focused on the client’s discovering his or her internal process, not about factual information per se. Phenomenological processes often reflect expectations and, simultaneously, aspects of their history. An historical inquiry is about the client’s experience of important events in his or her life: Who did what? Who said what? How did that affect you? Do you anticipate that I will do the same?
In conjunction with an historical inquiry, we may again return to a phenomenological inquiry, such as, “What’s it like for you when you remember that your father treated you that way?” This frequently leads to discovering how the client coped and may reveal his or her system of psychological defenses. We may then return to either a phenomenological or historical inquiry that focuses on what decisions, conclusions and survival reactions the person made in previous developmental phases. This inquiry is about the beliefs that form the life script. An effective inquiry often brings the client to an awareness of how they arrived at conclusions about “Who am I?” or “Who are those other people?” Examples of such conclusions are: “I’m not loveable,” “Something is wrong with me,” “People can’t be trusted,” “Other people come first.” These conclusions and decisions may have helped the client cope with difficult situations at an earlier time in life. However, over time such conclusions may become rigid beliefs that stop the person from responding freely and being aware of relational needs.
The client’s psychological vulnerability is the fourth area of inquiry. Vulnerability is that precious sense that all of us have of being in touch with our needs, our own sensations without having to be defended. It is that capacity to know that in this relationship I need security and validation, as I do every day of my life. In this therapeutic relationship I need to be able to rely on this therapist, but also at times I need a shared experience. I need to know that sometimes this therapist has suffered like I have suffered so that I have a sense of that human connection. Also in the therapy, as in every human relationship, there is the need for self-definition, the need to make an impact on others, and the need to have the other reach out and do something for me. Also, the need to express gratitude and affection is essential in every relationship. When those eight relational needs are addressed, the person feels valued, cared for, and loved (Erskine, 1998).
Almost forty years ago, Harry Guntrip wrote a wonderful description of the realities of psychotherapy. He said,
“It is the psychotherapist’s responsibility to discover what kind of parental relationship the patient needs in order to get better. . . The child grows up to be a disturbed person because he is not loved for his own sake as a person in his own right, and as an ill adult he comes to the psychotherapist convinced beforehand that this ‘professional man’ has no real interest or concern for him. The kind of love the patient needs is the kind of love that he may well feel in due course that the psychotherapist is the first person ever to give him. It involves taking him seriously as a person in his difficulties, respecting him as an individual in his own right even in his anxieties, treating him as someone with the right to be understood and not merely blamed, put-off, pressed and molded to suit other people’s convenience, regarding him as a valuable human being with a nature of his own that needs a good human environment to grow in, showing him genuine human contact, real sympathy, believing in him so that in the course of time he can become capable of believing in himself. All these are ingredients of true parental love (agape, not eros), and if the psychotherapist can not love his patients in that way, he had better give up psychotherapy” (Hazell, 1994, pp. 10 & 11).
How do we do what Harry Guntrip describes? We love them through our phenomenological inquiry, through understanding their defensive process, through valuing their vulnerability. We connect with them through affective attunement: when they are sad, we meet them with compassion; when they are angry, we take their anger seriously; when they are scared, we create that psychological holding environment that surrounds them with protection; and when they are joyful, we meet them with vitality. Those are the realities of our therapeutic process that make our dreams come true because we share our personal presence in an inter-subjective arena between client and therapist.