I would like to begin this paper by saying a few things about my personal trajectory in becoming a therapist, which has led me to see the process of therapy as an inter-subjective dance between two people within a boundaried space and timeframe, the therapist as an embodied subject being one of the active participants in the dance. My training as a psychotherapist has moved at the cusp between the psychoanalytic and existential discourse, which, at times, felt like having to choose between two mothers who did not like each other, a conflict which resonated painfully with my own personal history.
What has been clear to me all along, even since the beginning of my training years, was that I was not interested in the slightest in adopting a universal theory of pathology through which to view human suffering and that at best, I would engage with psychoanalytic theories as fascinating tales through which one could gain insight into the human condition. Existential thinking on the other hand, is against theory making that adopts an authoritative interpretative stance, but the question as to how one is to make sense of the other’s experience remains. In other words what is the medium for understanding and making sense of human suffering and helping our clients along in their development? I think for a long time in my practice, I experienced the tension between the two approaches as a conflict rather than a potentially creative enterprise. What I want to argue here is that through the experience I will describe below, I came to learn and understand directly that, as recent psychotherapy research has consistently suggested, it is the therapist’s embodied subjectivity and how this interacts with the client’s that is precisely the medium for significant psychic change.
Consistent with existential thinking acknowledging the interplay of being with death and finality, much learning and development took place for me during and after the time I had been diagnosed with a life-threatening illness. Shortly before my diagnosis, I was going through a period of feeling rather ambivalent about therapy work; the neutrality and adherence to boundaries it required, being there for and listening to others for a large chunk of one’s working day, having to be very vigilant about one’s own personal feelings and reactions, having to be disciplined even about one’s own personal bodily needs in order to be there and make space for another. I recall thinking that being a therapist and having a busy practice along with being a mother robbed me of all possible space that I could have for myself. Much of what I describe above will, I expect, be familiar to anyone who has sat with clients in a room for successive fifty-minute hours, having to time even one’s visits to the toilet and other whims of one’s body as well as the thoughtlessness that can be part of most people’s spontaneous response to others in our ordinary lives. Being a therapist may well be an authentic enterprise, but it is equally one that is controlled and self-disciplined.
Consequently, when I received a diagnosis that threw me off balance, I immediately assumed that I was not fit to practise, mainly because I needed the space to process my own feelings rather than be there for others. Although this was true to an extent, I was unable to navigate at the time the dance between my personal needs and the therapeutic relationship; I therefore let all my clients know that I was going to take a break from practising for health reasons and that they needed to find another therapist, as I was not sure when and if I was going to return to practice.
What ensued was clearly a difficult and dark period, but a time when I felt that I could at least take the space and time to consider if I wanted to be a therapist given the other pressures and desires that were emerging in that particular moment in my life cycle. Although painful and frightening, it was also liberating to tell all my clients not to wait for me and to look for another therapist if they needed to. It gave me, during a very difficult time in my life, the sense that I could choose how to be in the world.
It was through a dream about two months into my break from work, that I had a clear sense of direction. In the dream, a client whom I had seen previously for many years, and whose life circumstances were quite similar to mine in that she was of a similar age and a mother of young children, was coming to me for therapy bringing me a colourful present. There was a strong feeling in the dream that we both wanted to meet, but that I was not quite ready, so I had to ask her to wait. I woke up with a clear sense that being a therapist was for me a significant way in which to be in the world and that I had to get back to it as soon as I was ready.
I returned to work two and a half months after the above dream. To my surprise and pleasure, all of my practice at the time consisted of most of my previous clients who came back to see me after I informed them that I was returning to work. I was surprised that they had not sought another therapist in the four and a half months that I had been away, as I knew that many of them were in difficult circumstances. I was also pleased to resume my practice, reuniting with the people in whose life trajectories I had previously been involved. I would say it was precisely the experience of resuming my practice with old clients that highlighted almost instantly to what extent therapy is an embodied inter-subjective dance between two people.
The meaning of words must be finally induced by the words themselves, or more exactly, their conceptual meaning must be formed by a kind of deduction from a gestural meaning, which is immanent in speech (Merleau-Ponty, 1962: 179).
What Merleau-Ponty points out here is very similar to what psychotherapy clients have consistently testified in research interviewing – ie that it is the therapist’s gesture towards them, rather than the interpretation, that has made a difference and enabled their recovery. In other words, it is more the ‘being with’ another in a way that conveys respect and consideration for their otherness than the words used to convey one’s understanding of another that seems to make the difference where human suffering is concerned.
Below, I will juxtapose some vignettes of conversations that took place in my practice that conveyed the importance and centrality of the therapeutic relationship and how it was precisely in the inter-subjective dance between us that my clients had placed their hope for living their lives more fully through returning to their therapy with me after the disruption and interruption of the work. The vignettes are not verbatim, but based on my recollection of the conversations that took place. All details have been altered to protect client confidentiality. Clients who may be able to identify themselves have been informed and I have obtained their consent to include these vignettes here.
‘I had to be in therapy for my training, yet, I decided I would wait for you, as I believed that you would return.’
‘What made you believe that?’
‘I don’t know. It was a sense I had of you I suppose, that you would want to continue being a therapist, that you would be all right in the end.’
‘But you could have been wrong.’
‘Yes, I could have been wrong and I thought of that, but I believed that we would resume the work, and so I waited and it turned out that I was right after all, and I could have what I wanted.’
‘So, you trusted your gut feeling.’
This came from a client who normally struggled to believe in her own ability and judgment and to have confidence in herself. We went on to talk about how trusting her gut feeling about her relationship with me could be the beginning of her trusting her ability to be who she wanted to be in her life and not to allow herself to be crushed by her parents’ harsh judgment of her.
This client felt the need to interview me before committing fully to resuming therapy with me:
‘So, how serious was your diagnosis?’
‘Serious enough to throw me off balance and make me feel that I was not going to be able to practise for the time being.’
‘But, I mean, are you likely to die soon?’
‘In terms of the medical diagnosis, no, which is why I am returning to work, but obviously I cannot be sure.’
‘My thought while you were away was that I make everyone around me drop dead, and so I would better not go to another therapist and cause them to fall ill as well.’
‘You caused me to fall ill?’
‘Yes, I damage everyone who tries to get close.’
‘I am not likely to die soon, but if I did, this would not be your doing or your fault.’
‘Maybe that is what we need to work on then, as I would struggle to believe that.’
This client’s father died of cancer before she was two and the guilt for the deprivation and upheaval that her upbringing caused her mother has accompanied her for life. Her ability to affect me without feeling guilty about it, but also her right to leave me if I was indeed frail and dying were now the focus of our work.
‘While you were away, I kept looking at your website and imagining that you had never really stopped working. That you were seeing all your other clients, but not me.’
‘Why would I do this?’
‘To get rid of me, of course.’
‘But you did not truly believe this, which is why you are here.’
‘I could not get myself to find another therapist. It was like this deep sense of mourning had taken over me. In the end, I confided in a friend about what happened, how you had left me forever. I had not registered all the pain until I talked to her about it, and I burst into tears and she said she was truly sorry for me and what happened to me was terrible.’
At this point, I struggled to withhold my tears.
‘It sounds like my absence has caused you much suffering.’
‘After I admitted my feelings, I was getting stronger and I was about to contact another therapist. Right at that moment, you contacted me to let me know that you were returning to work. I was truly elated, it was a miracle.’
This client was seriously ill at the beginning of his life and his mother, who had already lost a child before him, found it hard to visit him and to attempt to bond with him, unwilling to risk experiencing the loss of a child again. Soon after resuming therapy with me, he took the risk for the first time in his life, to allow himself to get close to somebody in a relationship. I think the realisation that there is no escape from pain and grief, if we lose somebody that matters to us was hugely important for him; it allowed him to risk being vulnerable and connected.
The inter-subjective dance of relationship
As Van Deurzen points out in Paradox and Passion (2001), the therapeutic relationship is a particular form of an intimate relationship, one in which the therapist is closely involved with the client, but where the intimacy comes from attending the client’s experience and the dialogue that unfolds between the two, rather than from burdening the client with the therapist’s specific sorrows and struggles in life. On the other hand, as Van Deurzen and Iakovou state in the introduction of their co-edited book on relationship therapy:
Existential philosophers recognise the centrality of relationship to human existence and they have argued convincingly that individuality is secondary to relationship, as we are always in relation and are shaped and defined by the very relationships we have. (Van Deurzen & Iakovou, 2013: 1)
In my attempt to protect my clients from my distress during an unexpected crisis moment in my life, and to unburden them from their attachment to me, I unwittingly caused them more suffering through the sudden loss of what they had come to experience as an intimate and trusting therapeutic relationship. The therapeutic relationship is not an equal one in the sharing of feelings, and it would not have been professional of me to work when I was feeling too distressed to contain mine; what I came to learn from the experience was that there is no avoiding the painful feelings that the loss of being close to another generates. As difficult and tense as the conversations with my clients were, following my return to practice, they testified again and again in what extricate ways we affect each other as subjective and interdependent beings.
We live in a world that is increasingly favouring solution-focused brief therapies, often in the context of denying the validity of acknowledging any negative feelings and sitting with them in therapy. Experiencing sadness, bewilderment and disappointment, and allowing such emotions expression as a response to life’s losses and the suffering that the human condition entails, is often pathologised. We are all supposed to be happy and create convincing pictures of our rich lives. Of course, when clients come to us in despair and a sense of loss of orientation in their lives, the purpose of the therapy is to help them orientate themselves and rediscover their passion for life (Van Deurzen, 2001) The question though is how we are supposed to do that. Whether we can do it from a place of positioning ourselves alongside them, as subjects equally exposed to our own suffering and life’s vicissitudes or whether we do it from the position of the expert possessing techniques that show the road from pathology to health. I would suggest that the latter is a position whose ethics need to be questioned. Positioning ourselves alongside our clients as embodied subjects, potentially as vulnerable as they are is, I believe, an ethical stance that can allow for a richer and more authentic therapeutic journey.
I hope I have demonstrated here, through the vignettes from my practice, how at a moment of loss of faith in the therapeutic relationship, I managed to rediscover, with the help of my clients, the unique value of the inter-subjective encounter that therapy is. Upon my return to work after illness, I unexpectedly regained not only my faith in the therapy relationship, but my faith in the potential for intimacy in all relationships through the work with my clients. I could now see more clearly, how with each one of them, the therapy space was a delicate inter-subjective dance that brought together the uniqueness of each participant through dialogue and being with each other in a boundaried space.
Christina Moutsou is a UKCP Registered psychoanalytic psychotherapist since 2002 practising from Queen’s Park, NW London. She has an academic background in social anthropology (Ph.D., U. of Cambridge) and she is the author of three co-edited books. Her latest book (co-edited with Rosalind Mayo) The Mother in Psychoanalysis and Beyond: Matricide and Maternal Subjectivity was published by Routledge in the UK and the US in October 2016.
An earlier draft of this paper was presented as part of the NSPC workshop in the First World Congress for Existential Therapy, London, May 2015.
Deurzen, E. van (2001) Paradox and Passion in Psychotherapy: An Existential Approach to Therapy and Counselling. Chichester: John Wiley & sons Ltd.
Deurzen, E. van & Iakovou, S. (2013) ‘Introduction: Setting the Scene: Relatedness from an Existential Perspective’ in E Van Deurzen & S. Iakovou (eds.) Existential Perspectives on Relationship Therapy. UK: Palgrave Macmillan.
Merleau-Ponty, M. (1962) Phenomenology of Perception, Great Britain: Routledge & Kegan Paul Ltd.