Reflections on Psychotherapy



Drawing by Robin Kappy








editor's note:


This is a space for our community to share and reflect on the vast territory that encompasses the intersection of Relational and Focusing Oriented Psychotherapy (FORP). We invite you to bring examples of how you work and how you think about how you work. We want to know what your questions and dilemmas are, clinical moments you are proud and excited about, times you wish you had moved in a different direction with a client, things you said and things you didn’t say. We encourage you to give voice to whatever inspires or perplexes you.


The format is yours with these caveats: please either disguise as much as possible any clinical material you present, or get your client’s permission to print it. Make it brief—between one to three pages. While it doesn’t have to be journal-ready material, we would like to see thoughtful work that has a sense of completeness.





The Shape (and Shaping) of Presence In the Therapeutic Meeting Place

 

by Pam Wernich
August 15, 2009


Pam Wernich’s rich and personal reflection explores the wonderful question of how the way we as therapists “keep company with ourselves” impacts on the client’s inner life and experience of herself, and moves the therapy forward. Pam is a student in the FORP program in South Africa and has a post graduate diploma in counseling. She works as a counselor in a women’s shelter and in her private practice in Capetown.


When I meet a client in her world, our meeting is shaded too by my own particular vantage point in mine, and I readily accept that in our relating, each is transformed. Concepts of intersubjectivity provide a theoretical strut for this sense that a reciprocal interplay is integral to our relating.

Viewed on the focusing landscape, what of the impact we have on our clients, and they on us, not-so-perceptibly, through the way we keep company with ourselves inside?


Here, that exquisitely “possibilityful” quality of presence comes to mind. What begins to emerge for me as I deepen my own experience of focusing, is how the way in which I keep internal companionship with myself, percolates up into the encounters I have with my clients. Presence, it seems, impacts not only within, but also in the space between.


If the presence that we allow forth in focusing has even just a tiny bit of potential to touch in somewhere near the mind states that Buddhists know as maitri (acceptance of ourselves with loving-kindness) and bodhichitta (the awakened heart that responds compassionately to the suffering of others), then indeed as focusers we are working in an incredibly rich space. And because we focus in community, and because we also bring this sensibility into our work with clients, we enter a space that is abundant in its potential for mutual enrichment.


Writing about mindfulness meditation, Buddhist teacher Pema Chödrön suggests that “Attending to our present-moment mind and body is a way of being tender toward self, toward other, and toward the world” (The Places That Scare You: 2001: Shambhala Publications). Whilst meditation practice is clearly distinct from focusing in its intentions, techniques and origins – a discussion I do not intend to enter here – where Pema Chödrön’s observation strikes a chord with focusing is how the self-nurturing attitudes that are generated for self when cultivating presence, also have the potential to permeate outwards “toward other, and toward the world”. It would seem to me that when we work with presence, we reach deeply into the intersubjective realm, and this holds immense possibility in a therapeutic context.


These ruminations have come from a recent experience I’ve had in my work – one that has filled me with delight. In my private focusing I had been tentatively exploring the attitudes I might need to revisit an old trauma I had worked with in earlier pre-focusing days, but was left sufficiently ravaged to close it all up again, and rather prematurely I later felt. When I started to sense into how it might be to explore this issue afresh in an unhurried and careful focusing way, I touched in with an inner ‘something’ that made the whole issue begin to feel open to some further exploration after many years.


What had changed for me between then and now, in part the result of a lot of focusing, was being able to connect with a bodily felt sense of something firm and “bedrockish” located in the main frame of my body and offering a consoling sense that the fragility within can be adequately supported. And more than that, there is also the sense of something else that watches over it all – both the firm and the fragile – and that watching-over quality is what I would call presence. Gendlin talks about “keeping company” with things on the inside.


At the same time as this presence was making itself felt in me in this reassuring way, a client started to reveal some of her trauma that we’d both known about for some time, but mutually understood and appreciated that it was not yet ready to show itself. And then, here it was, being set out between us, and here we were, doing the previously undo-able.


I sat with a warm, rounded robustness filling my chest as I watched my client ‘being with’ the previously exiled parts of her experience, and doing so in a tentatively acknowledging way. She was aware of a shift and the beginnings of an open receptivity to herself, which she described as a “warming up to” things in her, and some sessions later she called it “a kind of compassion”. Attributable to deeper presence, or in different parlance, to an emerging maitri perhaps, this shift suggests how the focusing sensibility can facilitate a more direct and kindly way of relating with ourselves.


I am wondering now about how my own bit of forward movement, and giving the time of day to parts of my own deported experience, might have precipitated my client’s brave crossing-the-threshold into a zone of experience that was previously too frightening to enter. What feels significant here, is something about the “finding a new bit of plucky courage” that seemed to move, presence-borne, in the relational space between us.


Thinking about felt sense and presence now as I write this, what pops into my mind is Alfred Krozybski’s idea that “the map is not the territory”. I would say that focusing offers access to the territory, the map, and a something more that stands in relationship to both the territory and the map. When we sit with a felt sense of some piece of the territory of our experience, we may create a map to delineate and describe this territory for ourselves using the “handles” of focusing, and we may also make it knowable in this way to our listener. The map is not the territory, of course, but our best custom-built representation of it in that moment. But then there’s also the something more - a whole frame of mind about the territory, an entire atmosphere, a kind of perspective and way of looking-at-it-all that is more than the sum of the territory and the map. The particular quality of presence that is cast over the landscape at any given time is what I think we also communicate in the relational space. This is perhaps especially so when we relate from ‘felt sense places’. And in a therapeutic context, receptivity to presence is keenly tuned for both in the relating space.

 

 


When Words Were Not Enough

by Susan Rudnick, LCSW
August 2, 2009

As we sat together in silence, I was struggling, having no words, feeling frustrated and sad, with no seemingly good way to communicate what I wanted to express to C, my client.


This piece is a brief reflection on how I used focusing to stay connected with myself, navigating my thoughts and feelings as I ended treatment with a client. In particular, focusing led to my decision to give her a farewell gift. Having initially been trained as a psychoanalyst, where gift giving is not part of that culture, the decision was a surprising one for me. Reflecting on what went into this decision, I realized there are three streams: relational and self-psychology theory and training, Focusing and implicit intricacy, and the sacred or spiritual dimension. In this piece I look at the first two aspects. A later piece to come will make the spiritual underpinnings of this process more explicit.


I had worked with C. for almost two years by the time she decided to leave NYC and move to the Midwest. Leavings are often difficult for me, and this one had a particular poignancy to it. My first sense was, “Oh no, we’ve just really connected and gotten going”, and “there’s so much more to do,” and along with that came some kind of a knowing that most probably, unlike some other people, once she left, she would not be contacting me in the future. My heart sank.


There was so much more intricacy just in understanding my reactions. C. agreed with me that therapy was valuable to her, but she felt her life in NY was going nowhere, and though moving wouldn’t be easy, therapy was not enough to keep her here.


C. had started to see me around an abusive relationship with a man she wanted to leave but couldn’t. During our time together, she was able to leave him, and we began to learn more about how her childhood, which involved the abuse of major neglect, was impinging on her capacity for creating intimacy in her adult life. However, the traumas of her early life made it very difficult for her to access feelings and thoughts, and we stumbled through a lot of silence and awkwardness, as I attempted to help us find a safe way to work together. I sometimes did a lot of talking, explicating our awkwardness, and appreciating whatever attempts she made to open up. She had long hair, which she often tied and untied, when she felt uncomfortable, and I learned to use that as a cue we needed to change direction. Through it all I felt her struggling along with me with a sense of engagement even though she might not have something to say. She felt most understood at moments when I could say to her that it seemed she had no words, how hard all of this was for her because she couldn’t express herself, and how there was so much inside of her that seemed frozen and inaccessible. I realized that my experience of her difficulties expressing herself mirrored my felt sense of our whole process together. I too felt there was so much more that I would want to express and give to her, than I could.


So, to let this process go, felt wrenching to me.

Luckily, we had several months to work on this leaving, and during that time there were some shifts that started to help me feel more confident that the work we had done would stay with her and support her life. Somewhere during that time, in the middle of the night I woke up with the thought that I wanted to give her a farewell gift. And I wanted it to be something that she could take with her, a “real” thing.


This felt at first like one of those moments of imagining that I have sometimes, but then don’t act on. Coming like that in the depths of the night it would be easy to dismiss as not really credible. I likened it to thinking about an old boy friend, having the thought to “google” him, the next morning, but then, in the light of day, not doing it.


But in this case the thought did not leave me. Something inside me kept listening, and didn’t just want to dismiss it. I began to think and struggle with this. At first I thought “No, that’s not appropriate.” Giving a gift to a patient is something I have hardly ever done (perhaps for a long awaited child that came, or a particular marriage that happened). In the old paradigm psychoanalytic training I received, “real” gifts can be frowned on, and, prior to learning to work in a focusing way, would have been looked upon as a counter -transference reaction that should be analyzed. Since I come from that tradition, and that is part of who I am, it did feel useful to ask the questions from that context: What was my need to give something “concrete”? Why did I need to give something more than the gift of my having been present with her throughout our time together?

I decided to work on these questions with “focusing” over a period of time. Just in making this decision I noticed that in the previous way I asked these questions, although they were useful, there was a tinge of seeing this need as pathology. When I examine myself from the analytic paradigm there is a tendency to become judgmental and shut down. In part that derives from remnants of the medical model that is looking for symptoms of disease. In that paradigm, as well, I would be looking in a quasi-scientific way for an explanation in a cause and effect way for what is causing me to want to give a gift.


When I work in a focusing way I’m asking into my felt sense, “What is in me now about all of this now?” I was sensing into the implicit of this whole experience. My experience of this process is more of openness just to what is, without judging it. Here’s some of what came. I feel like a mother to her, and mothers give real presents to their children. And then, but she is not my child in that sense, and with that came a kind of sadness and frustration. And then, a sense of how brave and tenacious she has been in her life, and with that the acute awareness of how she’s never been given any recognition. And then, a longing in me of how much I really, really, really, want her to know that she is a valuable person, and that I value her. There was also a sensing of her as a little girl and a loving of that in her, and then that there is so much that remains unexpressed between us, and how I want to find a way to do that. Then came a few questions that veered back a little to the older paradigm: “Am I reluctant to let her go? Yes. Am I undervaluing my own impact on her that I need to do this? Maybe. Am I trying to prove something? Not sure what. What does it mean to be a mothering/therapist? Is this a caretaking need?” I allowed it all to be there, even the judgments, which all felt a little more spacious.


Each of these had felt sense places that came up for me, and lived in me for a time. The crux of all of this seemed to be about mothering, so I made a big place for the mother in me, and waited. What came was giving and letting go, the sense of giving all I can, and then, as with my own child, having to let her go on her own path. Then, a larger place emerged for me that I named with the word “limitations.” First, the limitations of the therapy process itself, and what we can and cannot do to insure someone’s moving forward in their life. Then came the limitation of being human in the face of someone else’s suffering. And finally, although words so often clarify and open doors, sometimes words are not enough.


Clearly my struggles as a mother in my personal life, as well as in my work as a therapist are included here, but then something larger emerged. As I stayed with all of this what came for me in a definitive and clear way, was that in giving this gift, something from the deepest part of me that was seeking to be expressed would be coming through to her. This impulse felt like it was arising out of the human condition itself; the experience both of how we are all connected, and of how we are all alone. And how we struggle with all of that.


I felt that from my whole struggle with all of this, that I and we could use something special, a more, to honor our work together, and carry us through.


I was now feeling strongly that the gesture of a “real” gift would expand the therapeutic frame, and could be a step that could perhaps allow us to connect in another more basic and rich way. In particular in our work, words were so difficult for C., and there was so much that remained unexpressed for both of us.


Staying attuned in a focusing way and not closing off that initial impulse supported and nourished a core wellspring place in me. It would have been easy to tune these initial stirrings out, by minimizing their importance, or by reciting chapter and verse of theory I have learned. Listening inside and giving attention to all of that in me allowed me to be true to myself, and understand in a deeper way the wordless intricacy of the therapeutic process, and how I bring myself to it.


More focusing helped me find the gift, which turned out to be a pair of handmade, curved, beeswax candles that I had originally bought for myself. In a synchronistic way this turned out to be a perfect gift. When I gave it to her, she giggled like a little girl, and asked if she could unwrap it now. There was a lovely excitement, and a glowing between us. In that moment it felt to me that what was being unwrapped and revealed about us encompassed so much more than the act of giving the actual gift!