The psychotherapist’s capacity to be with uncertainty is a defining, but unsung, feature of the profession.
Diana Voller discusses the paradox between the psychotherapist’s role as “expert” and the less widely acknowledged need for the practitioner to hold a space for uncertainty or “negative capability”. The author explores what negative capability means in clinical practice today, as well as possible ways to develop such a skill.
On being a double agent
In the sense that psychotherapists have to be both unknowing and demonstrate clinical expertise/knowledge, have to be emotionally resilient and also be open to being discombobulated by the client, they need to develop an ability to work as double agents. They have to be able to articulate to service providers and clients alike that they have a theoretically informed, scientific, evidence-based approach yet in actual clinical practice it is their capacity to be in and with uncertainty that can be the key agent for change.
The paradoxical term ‘negative capability’ succinctly describes the notion of creatively deploying these two contrasting attitudes at once. It was originally coined by the poet John Keats in a letter to his brother in which he describes his capacity to tolerate both being in uncertainty and unknowing “….when a man is capable of being in uncertainties, mysteries, doubts, without any irritable reach after fact and reason……” in order to allow, as yet unimagined, creative possibilities to emerge (Keats, 1817). The idea of making space for something new, and possibly transformative, is familiar territory to most psychotherapists and distinguishes the art of psychotherapy from other health professions. Yet, for such a defining aspect of our identity as psychotherapists, and such a fundamental facilitative skill, our capacity to be with uncertainty seems to be a well kept secret that is largely unheard of outside the profession, or misunderstood in the context of the general preoccupation with ‘evidence’. This may be because, despite ‘negative capability’ being a central underpinning to the work, we psychotherapists render it invisible by taking it as a given and assuming others do too. A bit like health, you don’t notice it until you feel unwell. More likely, it may be because ‘negative capability’ is something that needs to have been experienced quite profoundly in order for the benefits than that can accrue from it to be understood and this makes it difficult to translate to others in a way that makes sense. Even within the psychotherapy world, ‘negative capability’ seems to be a notion that, although quite often referred to, is variously or vaguely interpreted and it may be that this general lack of clarification also contributes to what I believe is a central tenet of psychotherapy being undervalued.
In the current climate, with its emphasis on regulation and transparency, there is a danger that relying on our tacit understanding of this important aspect of professional expertise could lead to it quietly disappearing from view and betraying what might ultimately be most valuable about psychotherapy. So, the aim of this piece is to bring ‘negative capability’ into the foreground by attempting to describe how it translates into clinical practice today.
What is ‘negative capability’?
‘Negative capability’ is the advanced ability of a person to tolerate uncertainty. This does not mean the passive uncertainty associated with ignorance or general insecurity but the active uncertainty that is to do with being without a template and yet being able to tolerate, or even relish, a sense of feeling lost. ‘Negative capability’ involves purposely submitting to being unsettled by a person, or situation, and embracing the feelings and possibilities that emerge.
In my search for clarification, a psycho-analyst I talked to described ‘negative capability’ as ‘the experience of the conscious mind in the presence of the unconscious’. A variety of psychotherapeutic approaches have terms for something akin to ‘negative capability’, such as being ‘without memory or desire’ (Bion, 1967), or ‘presence’ (Rogers, 1980), ‘the creative void’ (Perls, 1989), ‘unknowing’ (Spinelli, 1967), ‘mindfulness’ (Williams et al, 2002) and even ‘counter-transference’ (Searles, 1999). But these are not quite the same thing as ‘negative capability’; they are mainly definitions derived from theories based on assumed certainties, rather than a personal quality of actually being, or having learnt to become capable of being, in uncertainty. This is what I mean here by ‘negative capability’.
Being capable of being in uncertainty in this particular way is psychotherapeutically valuable because it results in having a relationship to what is not known that is in contrast to the position of most clients. Clients often come to therapy in times of transition precisely because of their difficulty managing the uncertainty of what is unknown and a lot of our work is therefore to do with pulling back from the known, meeting their uncertainty, containing it with confidence, and re-evaluating former certainties.
How does ‘negative capability’ help clients?
The distinction between the client’s and the therapist’s relation to uncertainty is important: if therapists resist uncertainty, they are simply paralleling their clients’ positions. Clearly, if both people are having difficulty tolerating uncertainty, then exploring the client’s dilemma in any depth becomes too terrifying a prospect for either to take on and so the work reverts to something more manageable but formulaic. In this sense then, it is the therapist’s capacity to be in uncertainty that keeps the space open for the client. It means that things can emerge that may have been blocked because of the client’s (and therapist’s!) fear of moving into the uncertain space; things can be picked up that would otherwise get missed, there’s room for the unexpected and more of the client can be attended to. If the therapist has at least a bit more negative capability than the client, then the uncertainty can be held and the client given some space to explore whatever is going on; at the same time the therapist is demonstrating something about being able to be with uncertainty in general.
The interchange below occurs in a session after several quiet moments, interspersed with a few comments from the client about everyday life:
Client: I’m sorry – I just don’t seem to have anything to say.
Therapist: I was feeling a sense of it all being quite fertile? Does that matter to you? Not having anything to say?
Client: I suppose not – but it’s kind of a mundane “not having anything to say” – not the fertile kind, not as if, when we’re not talking, I’m aware of anything much, or anything in the remotest bit deep or meaningful.
Therapist: You’re aware of what’s there, that’s the meaning – does it matter that it’s not deep or significant?
Client: Well, what’s there is just shallow, superficial stuff, if I talk about that, like what’s for dinner – well, I’m concerned you’ll be bored and think I’m shallow……
Therapist: I’m really fascinated by what’s going on with us right now – far from it
Being able to engage with a client’s uncertainty experientially means one is really able to meet the client where they are; this is likely to facilitate a much more empathic and effective therapeutic alliance, the key factor, after client variables, in beneficial therapeutic outcomes (Asay & Lambert, 1999). It means that the therapist can temporarily ‘hold’ the client’s uncertainty until the client can manage it for himself; in the meantime the therapist is keeping a space for what is unique to emerge, rather than slipping into well-meaning, but premature understandings and solutions that avoid the discomfort and effort, but also the potential, involved in embracing uncertainty.
What does it feel like?
That sounds fine in theory but whilst researching this topic in order to get closer to describing how this rather elusive quality actually translates in clinical practice, I spoke to a number of experienced psychotherapists. They identified the presence of ‘negative capability’ in their work by a felt sense that the therapeutic relationship was very much alive. They described it as being immersed in something, feeling alert and aroused, having a sense of wondering where this is going to go, the excruciating sense of unknown-ness, shame and fraudulence at ‘not knowing’, a familiarity with the recognition that ‘this is the anxiety of not knowing’. At the same time it was also associated with playing, intuitiveness, and experienced as good fun!
No wonder we don’t communicate about it a lot outside the therapy world – shame, fraudulence, playing and fun – how can that be professional? And the above description, the result of many hours of research, is hardly illuminating! Which brings us back to the heart of the issue about the challenge of articulating this key paradoxical tenet of psychotherapeutic practice.
The difficulty lies is in trying to offer a positive description of a negative quality; it’s much less complicated to describe what ‘negative capability’ is not. It’s not easy, it’s not straightforward, it’s not immediately rewarding, it doesn’t make one feel clever, it’s not quick, it’s not routine, it’s not accessible. The word ‘negative’ is itself illustrative of the communication problem: it is meant in the sense that the therapist is actively not being and not doing something, rather than in the dominant, everyday sense which tends towards negative=bad, positive=good; so ‘negative capability’ also involves adopting a counter-cultural attitude – a real challenge for therapists in the current climate, hence the ‘double agent’ descriptor.
How does ‘negative capability’ help therapists?
The tension of the experience of being in uncertainty brings the person of the therapist well and truly back into the therapy. This means that, as well as a more vibrant engagement for the client, it can open things up for the therapist too. ‘It keeps the wellspring fresh’ as one practitioner put it; the scariness and excitement of being willing to be in the unknown, allowing oneself to be temporarily overwhelmed, feel stupid for a while, means that one is gaining new perspectives and growing. This complements, and is in contrast to, the more intellectual, theoretically based aspect of our expertise, which enables the therapist to think about the encounter from a more objective perspective. This is not to say that either knowing or unknowing ways of being are the more important, rather that they enrich one another. The psychological body of knowledge is an essential enabling anchor for ‘negative capability’ because without personal confidence and learning, being in uncertainty can be just scary and inhibiting, rather than slightly scary and exciting. It was for this reason, as well as to make the important distinction between being able to be with uncertainty and the uncertainty of being a trainee, that I spoke to experienced senior psychotherapists about the topic.
Developing the capacity to be in uncertainty
Sound theoretical grounding and much experiential knowledge of the therapeutic process seem to be consistent with the capacity to be in uncertainty. But is it simply something that is absorbed and developed by osmosis en route to the professional ‘individuation’ period that supposedly occurs sometime after the first ten years of practice (Skovholt & Ronnestad, 1995) or is it gifted since it also seems to be consistent with an inherent sense of wonder and willingness to engage with the mysterious? Probably it is both given and grown. But if it is accepted that ‘negative capability’ is a key tenet, a fundamental, defining aspect of psychotherapy, if, as one person I talked to said ‘my expertise is dependent on the degree to which I’m able to hold uncertainty’, then is there anything else that can be contributed to developing it? For Keats it was “books, fruit, French wine, fine weather and a little music out of doors played by someone I do not know”; psychotherapists likewise find their own specific context for development.
Intimate experiential knowledge of development through being held in uncertainty in personal therapy is hugely important. Supervision too, since the fogginess of not knowing is often not easy to tolerate – it can tap into deep-rooted anxiety, issues of self-worth and shame for the therapist. Films, TV, art, literature and the theatre are also rich everyday resources for choosing to be temporarily unsettled and ready to be ultimately changed by other ways of seeing things. Whilst ‘negative capability’ certainly cannot be reduced to a ‘trained-in’ competence, the unsettling but rewarding experience of grappling personally with some of the philosophy that underlies the practice of psychotherapy is an overlooked aspect of many trainings that do not question assumptions or engage with the big, apparently obvious, questions, like: What is psychotherapy for? What does it mean to make people better? Would engaging with such issues develop trainees’ experiential and intellectual understanding of being with uncertainty?
Supporting Negative Capability
Whether ‘negative capability’ is given or developed, being able to deploy two such paradoxically contrasting states of being is a defining feature of the art of psychotherapy. Yet, because of its everydayness, perhaps we have taken it for granted. Could it be that rather than celebrate this ability that makes us distinct, (not just from most other health professionals and low intensity IAPT workers, but also from clients’ friends and families), we have instead focused on what we share with pretty much everyone, our anxiety with uncertainty? In terms of psychotherapy practice, the anxiety around uncertainty is being thoroughly attended to with increasing professionalism, higher levels of training, books, journals, and research but I would like to make the case that we use this increased knowledge to facilitate our capacity to take an attitude of committed uncertainty, rather than overlay it, or even lose sight of it, in the process.
As we have seen, ‘negative capability’ has a mercurial and ephemeral quality and it does not get sufficiently attended to; however it is hoped that even the process of trying to capture some of the subtlety of this part of what we do will contribute to more explicit recognition, and support, for therapists in their function as ‘double agents’ and further the contribution we can make to other mental health workers who are now being encouraged to adopt an attitude of ‘respectful uncertainty’ (Laming, 2003).
Diana Voller MBACP, Snr. Accrd. is a UKCP Registered Integrative Psychotherapist and BPS Chartered Existential Counselling Psychologist. She has a private practice in South West London, and has been teaching and supervising at Roehampton University since leaving the NHS where she worked in Primary Care. Correspondence: firstname.lastname@example.org
Asay, T.P. & Lambert, M.J. (1999) In Hubble, M. Duncan, B. L & Miller, S.D. (Eds) The Heart and Soul of Change: What works in Therapy. Washington: American Psychological Association pp.33-55
Bion, W. (1967) The Psychoanalytic Forum Vol 2. No.3
Keats, J. (1817) in Gittings, J. (Ed) (2002) John Keats Selected Letters. Oxford University Press
Lord Laming (2003) The Victoria Climbie Inquiry. Department of Health
Perls, F.S. (1989) The Gestalt Approach & Eye Witness to Psychotherapy. Calif: Science & Behaviour Books
Rogers, C (1980) A Way of Being. Boston: Houghton Mifflin
Searles, H.F. (1999) Countertransferences. Connecticut: International Universities Press
Skovholt, T.M. & Ronnestad, M.H. (1995) The Evolving Professional Self: Stages and Themes in Therapist and Counsellor Development. Chichester: John Wiley
Spinelli, E. (1967) Tales of Un-knowing. London: Duckworth
Williams, M, Kabat-Zinn, J, Zindel, V, Segal, J & Teasdale, J.D. (2002) Mindfulness-based Cognitive Therapy for Depression. New York: Guilford Press