Ktismatics

10 April 2007

The Therapeutic Relationship

Filed under: Psychology — ktismatics @ 5:53 am

Yesterday I proposed that therapy is an alternative social reality. Today I explore the relational nature of therapeutic reality. Does this seem right?

The therapeutic reality is relational. It isn’t a set of techniques or procedures, nor is it driven toward the attainment of particular goals. It is the establishment of a particular kind of engagement between individuals, a dynamic situation of being with one another in a distinct sort of hetero-social reality.

The therapeutic relationship is distinct and asymmetrical. Unlike friendships or collegial relationships characteristic of ordinary social reality, the client’s perspective in the relationship is central. The therapist engages in the therapeutic relationship specifically for the sake of the client. However, the asymmetry does not extend farther than this. The therapeutic relationship need not purposely recapitulate other asymmetrical relationships in which the client has previously participated; e.g., between child and parent, student and teacher, patient and doctor, performer and coach, worker and employer, parishioner and priest. The client’s participation in such relationships may affect his perceptions of the therapeutic relationship, and the client may transfer these other stereotypic asymmetries to the therapeutic relationship. While such transferences may prove insightful in the therapeutic engagement, the therapist need not structure the relationship so as to simulate and to relive these transferences.

The relationship is based on care. The therapist cares for the client and regards the well-being of the client as his primary concern in the relationship. The therapist must establish his trustworthiness to the client, that the therapist is not attempting to exploit the client, nor to reduce the client to an object under inspection, nor to treat the client as an instrument for achieving the therapist’s goals, even if those goals refer back to the success/adjustment/health of the client. Whatever understanding or affection the therapist experiences in the therapeutic relationship is directed primarily toward the well-being of the client, not for the sake of the therapist.

The relationship moves in the direction of personal and interpersonal understanding. Every individual understands himself, the world, and other people through a particular interpretive perspective: a way of making sense of phenomena and ascribing meaning to them. Based in care for the client, the therapist tries: (a) to understand the client’s perspective, (b) to help the client understand his own perspective, and (c) to help the client understand the therapist’s perspective. In the course moving toward mutual understanding of one another’s perspectives, the therapeutic relationship emerges into a joint interpretive perspective in which both therapist and client participate. Nonetheless, this joint perspective remains asymmetrical: it arises in care for the client and for the client’s sake.

The relationship is artificial. The asymmetrical therapeutic relationship is not characteristic of everyday social reality. What occurs in the therapeutic relationship may bear little resemblance to social engagement outside the context of the therapeutic relationship. The care within which the therapist engages the client, the asymmetrical joint perspective that emerges from interaction between client and therapist: these need not serve as exemplars for establishing relationships in everyday social reality.

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20 Comments »

  1. So much to think about here John…it is good to see this applied to practice…here are some of my quick thoughts:

    “While such transferences may prove insightful in the therapeutic engagement, the therapist need not structure the relationship so as to simulate and to relive these transferences.”

    It seems like you have Freud in mind here when you write this and I think very few psychoanalysts/psychologist have this type of understanding of transference anymore. In fact, I would say transference (and countertransference) happens everywhere in life, no matter if something is structured to stimulate it or not. All of life is transference to a certain degree. Of course, I am calling “transference” any way in which a person operates “automatically” out of past experience to make sense and organize current experience (I will throw that definition out there for now…I’m still thinking this through, so I reserve the right to come back and call myself a “dumb ass” for this). It seems like the brain is really good at taking repeated past experience and turning it into perceptual expectations which affect how we understand the world, self, and others. This is similar to when you write “Every individual understands himself, the world, and other people through a particular interpretive perspective: a way of making sense of phenomena and ascribing meaning to them.” I call this “transference”.

    The way you frame up an understanding of the relationship in your next to last paragraph is exactly how much of contemporary relational psychoanalysis understands therapy and is a great way to summarize a large body of literature.

    I agree that the relationship is artificial and does not usually bear any resemblance to what occurs outside. Why the hesitation in saying this should serve as an exemplar? It seems like the therapist has to have some vision of the good that informs their work, is it ok to make that part of the discussion? In a tentative way, in a way that allows the client to disagree, in a way that allows the client to articulate their vision of the good?

    One other question that has been nagging in the back of my head given the discussions here and in other posts…are “selves” and “texts” the same? If so, how? If not, what are the problems in equating them? I’m just trying to think these questions through and wondered what your and other’s thoughts were.

    Comment by Ron — 10 April 2007 @ 9:04 am

  2. I’m on the same page here. And I wondered too, why should the therapist would not hope that the client use the model of the relationship built in “therapy” in working with others? Of course, neither the client nor the therapist can control the reaction of others, but it seems reasonable to hope that the client might try to use techniques of listening, questioning, and understanding learned in sessions for other interpersonal relationships.

    Meilleurs voeux!!

    Comment by bluevicar — 10 April 2007 @ 11:19 am

  3. Ron -

    Yes, I’m thinking about Freud when I talk about transference. But I’m with you: any time a client expects the therapist to react in a particular way it’s a kind of transference of experiences the client has had in other social settings, be it with parents or spouse or whoever. This sort of stereotypic expectation is a kind of “territorialization” of the other that needs to get loosened up. Even somebody walking in the door saying “I’ve got a problem” already frames the relationship in a ritualized way transfered from other helping relationships. In a relationship of care and trust the client might be able to let his guard down, inspect the interpretive framework, loosen the strings a little.

    Regarding psychoanalysis: I’m trying to put forward a praxis based in continental postmodern ideas, and the analysts are a big part of this ongoing context. Europe is less pragmatic, less focused on instrumental rationality and problem-solving than Americans. Go to a bookstore here and you’ll see racks of psychoanalytic stuff written for a generally literate readership, vs. America where there’s hardly any. The next to last paragraph also explicitly reflects the hermeneutical turn of Heidegger and Gadamer, who have probably influenced contemporary psychoanalysis too.

    An exemplar? You’re right, I’m being too cautious. It might be worth engaging in this kind of artificial relationship precisely because it does approach an ideal of trusting the other, of being understood, of being able to understand oneself, of being able to loosen up the structures without getting hammered by the other people in the world. We ought to be able to specify what constitutes excellence in this kind of artificial, hetero-social relationship. It’s like being able to describe what makes for an excellent musical performance or stage play.

    Selves vs. texts? I’ll have to get back to you on that one. Maybe someone else can weigh in on it too.

    bluevicar -

    Using what happens in the idealized but artificial therapeutic relationship as an exemplar for real-world social engagement? Here again maybe I was too cautious. I would hope that could happen too, although the therapeutic milieu occurs outside of day-to-day social reality. We’ve talked about the client transfering perspectives from ordinary reality into the therapeutic reality. It would be helpful to specify why this sort of transfer might work also in the other direction. If it can happen once, maybe it can happen again? Being able to experiment while still seeing the therapist seems like a good plan. Either way, I believe we’re not talking explicitly about a problem-solving, skills-training paradigm, but rather a more organic relationship between realities.

    Comment by ktismatics — 10 April 2007 @ 11:39 am

  4. “The relationship is artificial. The asymmetrical therapeutic relationship is not characteristic of everyday social reality. What occurs in the therapeutic relationship may bear little resemblance to social engagement outside the context of the therapeutic relationship.”

    The thought comes to mind, then…so, is the “outside” social environment the “natural” one? And…why? Simply because that’s the one we grew up in, the one we’re used to? But then I have a feeling you aren’t referring to the “outside” social environment as “natural”, either. So take that as a bit of an imaginary experiment for me to maybe make a point or as a question.

    “…it seems reasonable to hope that the client might try to use techniques of listening, questioning, and understanding learned in sessions for other interpersonal relationships.”

    Why does this seem reasonable? What’s the reasoning, exactly? Not that I disagree…I’m just asking where the reasoning comes from. Might this suggest something that’s out of whack with the “outside” social environment. Maybe this “interpersonal” and “theraputic” one in question is the “natural” one that’s modeled after that of Yahweh and Man. Maybe the tranferrence got lost along the way between His throne and the Capitalist Mobarchy.

    “You’re right, I’m being too cautious. It might be worth engaging in this kind of artificial relationship precisely because it does approach an ideal of trusting the other, of being understood, of being able to understand oneself, of being able to loosen up the structures without getting hammered by the other people in the world.”

    Amen. And why call it an ideal in the first place? :)

    Comment by Jason Hesiak — 10 April 2007 @ 6:37 pm

  5. Jason -

    No, I don’t believe that ordinary social relationships are more natural than an extraordinary therapeutic relationship. They’re just more customary, more of an environment we have to adapt to rather than something we can change by our own attitudes and actions, an environment that partially shapes our social personas and relationships.

    Certainly people import social expectations from the “outside” into the therapeutic relationship — this is transference. What is the reasoning behind the expectation that what happens in the extraordinary therapeutic relationship should transfer out to the ordinary social world? It’s a good question, one Anne and I were trying to figure out this morning. A few things. One, if the therapist can understand the world the way the client understands it, caring for the client and without rendering judgment on whether the client’s perspective is “sick,” then the client becomes reassured. At least one presumably non-sick person can see what I see; I must not be completely crazy, completely isolated from ordinary social discourse. Perhaps this lets the client relax his vigilance a little against the rigid defenses he has built to protect himself against others’ misunderstandings and judgments and rejections. This relaxed vigilance perhaps allows the client to be more open with others. The loosening of defenses also makes it possible to experiment with alternative ways of interpreting the social world, perhaps opening his “horizon” to seeing what others too can see. This would reduce abrasions between the client and the ordinary social world. That’s a preliminary and quick summary. Does that sound plausible?

    Note that this extraordinary therapeutic relationship is built around problem-solving, isn’t geared specifically to fix what’s wrong with the client’s relationships in everyday social relationships. The relationship with the therapist is the primary focus, not the outside relationships. This is originally a psychoanalytic premise, in contrast to the pragmatic problem-solving, externally focused praxis characteristic of American counseling. What I’m proposing requires more patience, more listening and seeing and understanding, more of a settling into the extraordinary relationship focused on the client, rather than a pinpoint targeting of problems, a honing of skills, a treatment plan, etc. Again, does that seem possible, desirable, attainable?

    Modeled after the relationship between Yahweh and man? Maybe so, but it would probably require a lot of reterritorializing of that relationship for most clients. To see the therapist as lord or priest or judge is one way to go, but not what I’m proposing here. Though I see an asymmetrical relationship tilted toward the good of the client, I see the therapist as not hierarchically positioned either above or below the client. Maybe a Yahweh-man relationship like the one I propose for Genesis 1, more of an egalitarian relationship where the therapist has some things to offer to the client because he knows stuff and he cares for the client. And maybe the client does partly become recreated in the image of the therapist in how he engages in his everyday social relationships. A little scary, that concept, but maybe there’s something to it.

    I agree that the proposed relationship approaches an ideal from the client’s standpoint. If the client has this kind of relationship in mind when he thinks of his relationship with God, then maybe there is an incarnational ideal at work here. Again, a lot of people attach a lot of baggage to God. Maybe some of that would fall by the wayside if this extraordinary human relationship goes well.

    Comment by ktismatics — 10 April 2007 @ 11:50 pm

  6. “…The loosening of defenses also makes it possible to experiment with alternative ways of interpreting the social world, perhaps opening his “horizon” to seeing what others too can see. This would reduce abrasions between the client and the ordinary social world. That’s a preliminary and quick summary. Does that sound plausible?”

    Sounds not only plausible but like my life.

    “…isn’t geared specifically to fix what’s wrong with the client’s relationships in everyday social relationships. The relationship with the therapist is the primary focus, not the outside relationships.”

    “The plan proceeds from within to without.” – Corbusier.

    “What I’m proposing requires more patience, more listening and seeing and understanding, more of a settling into the extraordinary relationship focused on the client, rather than a pinpoint targeting of problems, a honing of skills, a treatment plan, etc. Again, does that seem possible, desirable, attainable?”

    A big amen. This is why I like Italy. I’m kind of surprised you asked me this, honestly. OF COURSE it seems – to me – possible, desirable, attainable! My Architectural “dream” corresponds to your psychological one greatly.

    “To see the therapist as lord or priest or judge is one way to go, but not what I’m proposing here. Though I see an asymmetrical relationship tilted toward the good of the client, I see the therapist as not hierarchically positioned either above or below the client.”

    How about to see the Yahweh as SERVANT. There to wash the “disciples’” feet?
    :)

    “…where the therapist has some things to offer to the client because he knows stuff and he cares for the client. And maybe the client does partly become recreated in the image of the therapist in how he engages in his everyday social relationships.”

    I keep saying we’re in the same story!

    “A little scary, that concept, but maybe there’s something to it.” “Seek after your salvation with fear and trembling.”

    “I agree that the proposed relationship approaches an ideal from the client’s standpoint. If the client has this kind of relationship in mind when he thinks of his relationship with God, then maybe there is an incarnational ideal at work here. Again, a lot of people attach a lot of baggage to God. Maybe some of that would fall by the wayside if this extraordinary human relationship goes well.”

    Again, this I not only agree with but its my life. Particularly “…then maybe there is an incarnational ideal at work here. Again, a lot of people attach a lot of baggage to God.” We’re in the same story, dude.

    Comment by Jason Hesiak — 11 April 2007 @ 12:19 am

  7. I’m glad to hear it. I do believe this is the right way to proceed. Your references to Corbusier and Italy — this is more of a classical European way of seeing the world, though Americanization is a powerful force for turning people into instruments who need to go in to the psychological (and spiritual?) garage for tune-ups and repairs now and then. Establishing an incarnational relationship of care and trust is the main reason why I doubt that an exclusively virtual online praxis is a good idea.

    And your dream architectural praxis is like this too? Can you clarify that a bit sometime? I can infer it from your profound emphasis on deep structural elements, almost like “participation” in the way Barfield was talking about it in medieval philosophy.

    God as servant — that’s partly why I was interested in Hegel’s master-servant discussion. Are we doomed to the blandness of marketplace interchangeability where we alternate between being buyer and seller, consumer and producer? The blandness of a democracy that’s herdlike? Nietzsche wanted to assert mastery in contrast to what he regarded as Christian slave morality, which is part of what he admired about the Greeks and to a lesser degree the Romans. But that doesn’t really work either, even for Nietzsche I don’t think. God is both servant and lord, which makes him a strange role model.

    Comment by ktismatics — 11 April 2007 @ 12:49 am

  8. My dream in relation to architectural praxis…in relation and correspondence your story of psychological praxis…will probaby happen tomorrow. But yes, I think you’re on the right track. I’ll give a real “practical” example for my “dream” of praxis. Today I was in a meeting with my project manager talking about the roof design of a building that I – mostly – did not design. I came along at the end and did a bunch of design work on the roof.

    So then here comes this project manager today – coming into the game late because the first project manager is moving to Chicago – asking me to move some heavier shit on the roof around in order to align with some walls below. Ultimately to save about one to two thousand dollars in an upscale Beverly Hills 2 mil. per unit apartment complex.

    The problem is I had designed this planter in accordance with a proportion system that placed the planter in proper relation to the rest of the architectural elements on the roof…”based on” long-standing traditional “rules” of proportion which I have tested through the “impression” (type) that they have left upon my very own soul in actual “expereince”.

    So then here I was being forced to move some things around to some relationally/proportionally arbitrary point in order to fit with some technical and “practical” (as opposed to “theoretical”, as my project manager so annoyingly put it today) concerns of “construction” and “cost”.

    But what if – from the get-go – the building, with all the cost, square footage and construction issues in mind as well, would have been properly designed proportionally, leading to more harmonious “relationships” – just like in a theraputic relationship, hopefully? But it wasn’t done that way. There was utter disregard from the beginning for what used to be thought of as “ideal proportions” (“based on” the measures, ratios and proportions of the human body), which were once the “basis” of the most profound architectural meaning and experience.

    And then when I finally get around to doing the roof, I am left with these irreconcilable forces violently clashing into each other rather than some “basic” “essential” stuff (making/”construction”, “action”/”practicality”, beauty/proportion – the Roman Vitruvius’ ancient essential triad of firmness, commodity and delight) harmoniously relating to each other upon the “basis” of something at their ultimate both beginning and end.

    Comment by Jason Hesiak — 11 April 2007 @ 10:00 am

  9. So above my “basis” would correspond basically to your concern with trust, intimacy, compasstion, care, which must FIRST be established in the RELATIOnship. And then the forces that forced me to do what I was forced to do today is the B.S. technique-driven praxis against which we are both reacting, which does nothing but interrupt or hinder proper relationships if the primary concerns for true relating are not first addressed (surprise surprise). There’s an “arche” to this “primary” concern of ours.
    :)

    Comment by Jason Hesiak — 11 April 2007 @ 10:07 am

  10. What is arche really ties things together. “…the rug, man…it realy tied the room together.” – The Dude, from The Big Labowski. Rugs are epiphanic.
    :)

    Comment by Jason Hesiak — 11 April 2007 @ 10:11 am

  11. Ktismatics….Americanization is a powerful force for turning people into instruments who need to go in to the psychological (and spiritual?) garage for tune-ups and repairs now and then. Establishing an incarnational relationship of care and trust is the main reason why I doubt that an exclusively virtual online praxis is a good idea.

    So we have the Americanized “tune up” mentality. Combine that with Jason’s example of a make-it-work approach to design based on the fact that the building was designed wrong from the get-go. (I hope I’m summarizing Jason fairly accurately.)

    But is it reasonable to assume that in a client-patient anything more than a tune-up could really happen? I’m just poking around here and playing devil’s advocate. For example, Jason doesn’t really seem to have any other choice on the roof b/c he inherited a poor structure. Do we Americans have any real hope for substantial change when the structure is already in place, built with faulty material and hasty design? Do we have to completely rebuild if we want substantial change? And how would a therapist convey this to the client?

    Comment by Jonathan Erdman — 11 April 2007 @ 1:17 pm

  12. Jason -

    A frustrating tale. Architecture based in principles and ideals rather than just problem-solving and technique: right on, but difficult to do in this culture. Postwar European architecture is pretty daggone ugly, the contrast with all the older eras is striking. Though I suppose some of the crappier architecture of the past was torn down to make room for the new crap. The rug = the garden = the four corners of the earth with the fountain of life bubbling up in the middle.

    Comment by ktismatics — 11 April 2007 @ 1:31 pm

  13. Jonathan -

    This it the disheartening part: is there any room in our culture for this other way of going about things? And when everything is territorialized by marketplace, does everybody just see the list of names in the phonebook and the fees rather than the substance? There is variety in the marketplace — regression therapists who help you resolve conflicts in your prior lives, native American herbal practitioners who get you in touch with your wolf-spirit, Chinese balancers of life forces, and who knows what-all. So if you squeezed in a niche that’s a sort of postmodern hermeneutical semi-analytic practice, maybe some people would get it and groove on it. At least this is a one-on-one thing rather than requiring a corporate client to stick his neck out with company money. But how to convey it to the client? I keep trying to avoid that question, don’t I? Most of my efforts to attract people to my stuff don’t work worth a hoot. Partly it’s me, partly it’s my ideas. Something with blogs and brochures, I suppose. Not sure about referral networks. Any suggestions?

    Comment by ktismatics — 11 April 2007 @ 1:47 pm

  14. Suggestion: Have a strong vision and articulate it with passion.

    Don’t sell it. Just state it. People will give it a shot if you believe in it.

    Comment by Jonathan Erdman — 11 April 2007 @ 3:43 pm

  15. Isn’t that what Miguel had going for him????

    Comment by Jonathan Erdman — 11 April 2007 @ 3:44 pm

  16. Jonathan -

    It would be good if that would work. I’m better at articulating and being committed than I am at marketing. Sadly, Miguel was a fictional character. But then so am I.

    Comment by ktismatics — 11 April 2007 @ 6:20 pm

  17. Jonathan,

    Suggestion: Have a strong vision and articulate it with passion.

    Don’t sell it. Just state it. People will give it a shot if you believe in it.

    Oh yeah. That’s the same approach I would take.

    Meilleurs voeux!!

    Comment by bluevicar — 12 April 2007 @ 6:28 am

  18. First off I want to say wonderful blog! I had a quick question that
    I’d like to ask if you don’t mind. I was curious to
    find out how you center yourself and clear your mind before writing.
    I’ve had a tough time clearing my mind in getting my thoughts out there. I do take pleasure in writing but it just seems like the first 10 to 15 minutes are usually wasted just trying to figure out how to begin. Any ideas or tips? Many thanks!

    Comment by classified ads online Sevilla — 24 September 2012 @ 2:40 am

  19. You can focus on the writing in 10 to 15 minutes? I should be asking you for advice. I don’t have the experience very often of writing nonstop for 2 or 3 hours at a time. I waste a lot of time even while actively engaged in writing, sometimes between one sentence and the next in the same paragraph. And yet I find that the words do gradually pile up.

    Comment by ktismatics — 24 September 2012 @ 11:26 am

  20. まで、

    The Therapeutic Relationship | Ktismatics

    Trackback by まで、 — 11 August 2014 @ 5:49 pm


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