A blog post written in preparation for a CPD workshop in Oxford on 4 March 2018
How safe does the therapeutic space need to be?
In our attempts to create a safe, empathic and accepting environment for the client in which they can afford to feel open, undefended and vulnerable, we provide a therapeutic presence which can appear entirely benign and ‘on their side’.
Therefore, on the most basic level, we aim to provide Carl Rogers' core conditions in the humanistic tradition, and in the psychodynamic at least benign attentive neutrality. In Lavinia Gomez's (2003) terms, we try to position ourselves ‘alongside’ the client, their suffering and their struggles (as an ally and a champion, ultimately of their self-actualisation).
Why do we want to make it a ‘safe’ environment?
Why not just approach the encounter with the client as we would any social meeting, within the ambiguity of them being friend or foe, trustworthy or suspicious, with whatever degree of pain and problems they are willing or unwilling to share and disclose? Why make it ‘nice’?
Because beyond any philosophical bias or presupposition, our experience tells us that unless we are giving at least a minimum of such assurances, clients just don't turn up or don't come back to the second session.
Why do we think it's quite reasonable for the client to expect us to provide a minimum of benign conditions? When we look more deeply into this, we could say simply it’s because we realise the client is already vulnerable - that's why they risk turning up in the first place.
But if we look more deeply, we would need to say: we realise that without some kind of positive indication on the therapist’s part, the client is already liable to assume a self-fulfilling prophecy of a negative outcome. We realise they do not come with neutral expectations: consciously they come with positive expectations, unconsciously they are already half out the door, because in their vulnerable state they are already feeling the likelihood of the worst. Within one-person psychology language Freud might call this the repetition compulsion. In two person psychology terms we could say: the client’s unconscious already expects a re-enactment. The enactment has already happened. We are not dreading some eventual future disappointment, it's already occurred.
In simple terms: in making the therapeutic environment safe we implicitly realise that the client is not only an adult seeking therapy. They are already a hurt child, for whom we quite naturally have empathy and are prepared to make allowances, adjustments, and reassuring gestures. Some therapists have quite valid and categorical misgivings about this, and therefore deliberately refuse to bend or incline the space towards the child or to make it easier for them. As we will see, there are many good reasons for this. But this is one of the areas of therapy where what the left brain thinks and intends is easily undermined by what the right brain (inspired by the heart) actually does - most of us find it incredibly hard to resist nodding and smiling in empathic recognition, and usually that is already a communication to the client’s inner child.
So, in summary so far: we think it's reasonable to make the therapeutic space safe because we have already empathically adjusted ourselves to the wounded child and the reparative response it evokes and needs.
The necessity of the reparative relationship
Many therapeutic approaches make explicit assumptions and pursue strategies that construct therapy as re-parenting the client's hurt inner child, or make it at least one of its central tasks. Petruska Clarkson (1994) validates this modality of therapy as the 'reparative' or 'developmentally needed' relationship - the therapist as the ‘better’ parent who heals the wounds and makes up for the neglect and injuries of childhood: the parent who actively cares and gets empathically involved where there was neglect and coldness; who accurately mirrors the child's reality where there was mis-attunement and parental projection, insensitivity and outright dumping; who spaciously regulates and holds the child’s overwhelming feelings where there was unresponsiveness or reactiveness; and who reliably provides firm boundaries where there was invasion and abuse. These kinds of parental responses are genuinely needed, then and now, and because of their absence then there has been lasting damage (i.e. developmental deficits and arrests) right up until the present moment because the developmentally needed parental responses were not forthcoming. The appropriate maturational responses were systematically lacking, at the crucial time, in the crucial developmental window.
These responses were needed and they are still needed, and it is pychosomatically impossible to give up on longing for them. Whatever tricks the mind tries to play - I am not a child anymore, I am now grown up, I have achieved the depressive position and won't torture myself any further by hankering after an impossible fantasy that is not going to happen - the bodymind does not actually give up (especially the body part of the bodymind).
Sitting in the therapeutic position, our own bodymind as therapists is capable of informing us quite reliably about the presence of the client’s developmentally needed experience, and we naturally want to provide that reparative response, ideally unfailingly.
The insufficiency of the reparative relationship
It would be wonderful for all of us if therapy could be made to work just exclusively within these assumptions and this reparative framework. However valid and essential the core conditions, the therapist's benign presence and empathic-reparative efforts are to building a working alliance, a safe space and relational container, in the longer term we find that the effects of providing such therapeutic conditions are limited. They can provide the necessary foundation, by contradicting the client's negative patterns and expectations, but we find they are often not sufficient for transformation of negative patterns and for healing of deep wounds to occur.
Why is that?
Reason 1: Good-enough is not good-enough
Whatever the particular detail of our developmental injury, because the presence of a good-enough parent could not be sufficiently relied upon frequently enough, as adults we are left doubting that the appropriate response will arrive when needed. We therefore cannot afford uncertainty. We cannot bear to vulnerably wait for a response that might or might not be forthcoming.
So we want certainty or a guarantee: a good-enough therapist won't do. It needs to be a perfect one. In simple terms, the minimum requirement becomes an idealising fantasy of the therapist as some kind of fairy godmother or godfather, who can magically heal the wounding without the client ever having to actually experience it. The medical version would be of some omniscient, omnipotent psychological doctor who can perform characterological surgery under perfect anaesthesia – and we wake up after, healed.
However natural and valid our emapthic response to the client's pain and wounding, we easily end up in a rescuer position - certainly in the client's longing and perception, if not in our own actual intentions and behaviour.
Reason 2: Defences keep out the bad and the good
In our wish to establish a safe and positive working alliance, we then easily miss or underestimate the fact that - before clients come to us - they have spent years building up effective, functional and ideally watertight defences and protective survival strategies (what - at the extreme and traumatised end - Donald Kalsched (1996) calls the 'self-care system’). Our well-meaning reparative therapeutic responses can glance of these defences like water off a duck's back, which means our care and empathy and support do not really land or get received in the deeper parts of the client's psyche, where it matters. However desperate the client is on the surface, the presence of the defences ensures that the system of the client's bodymind-psyche is not really (or not fully) receptive to therapy and its healing influence - in fact: on a deeper level the client's defences shut out the therapy and therapist, work towards maintaining the status quo and thus are designed to make therapy fail or impossible.
Wilhelm Reich (1942) knew this decades ago when he said: "Every [therapeutic] interpretation of the unconscious material glanced off from this secret hostility [defensive shield]. … Every patient is deeply sceptical about the treatment. Each merely conceals it differently."
Donald Kalsched defines the essence of the self-care system as the impulse to destroy the therapy and the therapist, thus consistently proving the impossibility of healing and reconfirming its own (supposedly superior) survival logic and reason for continued existence.
Reich's and Kalsched's formulations come across as quite categorical and extreme, but their statements are not meant to characterise the totality of therapy - both are insistent on pointing out one crucial aspect of the therapeutic process which often gets neglected.
Whilst the history of psychotherapy provides a sophisticated range of concepts and techniques for understanding and engaging with the client's defences (going all the way back to Reich and Freud and especially his daughter Anna’s exposition of defence mechanisms), it is less understood and established that the therapist needs to allow themselves to be affected by the defences, disarmed, unseated, obstructed, foiled and made helpless and powerless.
The clash between the therapist and the self-care system
The defences are a worthy enemy, long-established, well-rehearsed and fine-tuned, and their raison d'être is to avoid the re-experiencing of the wounding which they are defending against and protecting. That is the point where the medical metaphor of a poisonous boil comes to mind – a boil that the therapist knows they need to lance, but is blocked from doing so by the defences. The self-care system knows very well that the lancing of the boil will release the poison in it, and that will be unpleasant, messy and painful, maybe unbearably so.
The therapist is working on the basis of the intuition that that poisoned state will be temporary, and then the healing can begin (once lanced, we can wash and empty out the poisonous swamp spoon by spoon).
The self-care system is working on the basis of the conviction that the poisonous (re-)experience of the wounding must be avoided at all costs.
The therapist relies on the paradoxical theory of change: change happens (spontaneously) when we accept what is (what is, in the metaphor, is that the poison is there; in fact it's silently accumulating while kept at bay and buried).
The self-care system is convinced that the poisonous feelings arising are the truth and the whole truth, now and forever (because they are so strong and ‘real’). The therapist assumes that the poisonous feelings will be temporary - they are a mixture of the past and the present, with the past feelings probably constituting the bulk of the unbearableness.
So there is an inescapable paradigm clash between the therapist's rationale of paradoxical healing (requiring that the wounding will be re-experienced as part of the process) and the self-care system's binary rationale which is not going to be dragged back there, come hell or high water (locked into a linear, either-or logic, which refuses to be titrated and regulated, as there cannot be shades and degrees of experiencing the wounding - there can only be all-or-nothing: EITHER the defences are all victorious and succeed in conquering the wound OR the wounding will take over and we will be at the mercy of it all over again).
The elusive transformative object: beyond the 'idealised' versus the 'bad'
The transformation of the wounding cannot be strategically achieved – to some extent it can be consciously and deliberately prepared, but it cannot be made to happen. The shift from the pain of the ‘bad’ towards the experience of the good-enough cannot be manufactured. It needs to occur spontaneously. We may be able to invite and give space to that transformation – it may require both therapeutic doing and being.
How do we generate that therapeutic space, permeable and malleable and susceptible to the unconscious?
We do that by allowing the extremes of the idealised and the bad to manifest and be constructed within the space, by allowing ourselves to be constructed as those objects. It's only in the ‘here & now’ of the enactment that the wounding is sufficiently present, in its full bodymind and relational intensity and reality, that it can ever become available for change and transformation. It's only in the charged ‘here & now’ emotionality of the enactment that neuroplasticity exists. It's only when the therapeutic position is lost in enactment, and the therapist expands beyond their professional role, and fails the idealised promise required by the client’s self-care system, that healing can occur (in any fashion that is deep enough to be satisfying and lasting).
Every wounding in the psyche constellates - as a minimum - these four figures: the hurt child, the bad parent, the idealised parent and the elusive transformative object (as summarised in this hand-out - Soth 2014). Once we get into an enactment of the wounding, in the actual detail it gets more complicated, but these four figures are the minimum we need to pay attention to and understand, in order to stand any chance of surviving the enactment.
That means we need to be able to allow ourselves as therapists to be constructed in these four positions, as these four figures.
The essential conflict in the therapeutic position
The co-construction and re-enactment of the wounding involving these four figures is in constant tension with the possibility of an authentic meeting between client and therapist. So the fundamental polarity in the therapeutic position is between intersubjective relating (or as relational psychoanalysis, following Jessica Benjamin, calls it: mutual recognition) on the one hand and allowing the construction and enactment of the wounding on the other. Winnicott profoundly advanced our understanding of allowing ourselves to be constructed when he spoke about the 'uses of an object'. Rather than the therapist insisting on being ‘themselves’ and recognised as ‘themselves’, an important aspect of allowing the client's unconscious to manifest and even dominate the space is that the therapist can allow themselves to be used as an object.
Something is being put upon me and into me so strongly that I am becoming it (i.e. projective identification; process-oriented psychology has a nicer phrase: I'm being 'dreamed up'). Once I gain a bit of awareness of this initially unconscious process, my subjective experience is that I'm being objectified - I am being made into a particular object.
For most of us, being on the receiving end of this as a therapist is not the first time in our lives that we experience being objectified. For most of us, it has profound - and painful - resonances with our childhood, and we are entitled to be scared of it, to resent it and avoid it like the plague.
Allowing - and importantly: sustaining - the experience of being objectified, of being constructed, is counterintuitive. The only reason for sticking with it as a therapist is because initially I can see the point of it (so I am inclined to experiment with hanging out there), and over time - surviving enactments over and over again with unexpected and occasionally magical results - I gain confidence in its profoundly transformative power.
Our therapeutic capacity to allow ourselves to be de-constructed
But before that becomes possible, I need to risk my habitual position. For most of us as humanistic integrative practitioners, succumbing to being constructed feels like a disturbingly alien idea, counter to all our principles of authenticity and the importance of genuinely being ourselves.
What about my congruence? Isn't that essential?
Yes it is, but from the perspective of the unconscious, that's too neat, straightforward and convenient. Congruence is only as helpful and robust as the degree of incongruence it can allow and embrace.
That's why we have a profound paradigm clash between the humanistic and psychoanalytic traditions – and that's why it is a valid and precious and creative clash we would not want to be without. That's why the integration of these traditions is difficult: it requires bringing together equally valid, but mutually exclusive, diametrically opposed, philosophical truths.
Most of us in the humanistic tradition are deeply invested in the idea of a self-actualising authentic self (or in Winnicott’s - worryingly binary - terms: ‘real’ self as opposed to the ‘false’ self).
But we become less sure of who that supposedly coherent self that I supposedly am, actually is, once we experiment with allowing projective identifications, allowing ourselves to be constructed, allowing ourselves to be ‘dreamed up’.
It's one thing for post-modern philosophy to postulate that my 'self' is contextual, socially constructed, multiple - dependent upon the web of relationships I am currently experiencing; or for spiritual wisdom to encourage me to open up to our fundamental interdependence as humans or for existentialists to declare our a priori relatedness.
It's quite another thing to actually feel deconstructed, mangled, confused and disturbed by experiencing myself as actually becoming the object. It can be pretty maddening, actually. And it is especially disturbing to become a wounding object when my habitual position as a therapist is to be an empathic, benign healer (wounded maybe, but definitely not wounding).
Supporting our capacity to be constructed and de-constructed
So in order for us to be 'big' enough to allow ourselves to be constructed (especially as the 'bad' or the 'idealised' object - which really are two sides of the same coin), which we are willing to do for the deeper purpose and the greater benefit of our clients' therapeutic process, we need to be supported by others who see the wisdom rather than just the folly of that adventure. We need a community of the like-minded, so we are able to stretch ourselves beyond our habitual position as therapists.
If we want to include in our client’s therapeutic process the unconscious, on its own terms (rather than on the preferred terms of our therapeutic ego), we realise we need to drop any number of cherished beliefs, sophisticated assumptions, barriers and protections, which we have been trained to embed into the structure and framework of the therapeutic space we offer.
We need permission to be ‘bad’ and nasty as well as to be idealised and grandiose. We need reassurance that this can indeed become transformative, so we are capable of sticking with it when it gets unpleasant and the going gets tough.
We need support to process, reflect and think within the enactment (which is when usually our clear mind departs as we are going unconscious), and gather the systemic bodymind fragments of the enactment.
I have used the metaphor of a vortex in the sea to describe the enactment: rather than frantically struggling sideways to get out of it and drown, the way to survive the vortex of enactment is by surrendering to being sucked down and down to the bottom where it will then spit us out. We are then free to float back to the top. Once we have been through it and down it a few times, and we are less panicked by being sucked down, we might even have spare attention to enjoy the scenery and be curious about what we encounter on the way down.
So ideally we want to establish a community of practitioners that support each other in these disturbing and deconstructing realms of the therapeutic relationship.
We want to help each other holding the tension between being able to be truly ourselves in an authentic way (as wounded healers, with personal-professional integrity) on the one hand versus allowing ourselves to be constructed and used as an object on the other hand. We can formulate this as the essential conflict inherent in the therapeutic position (as illustrated in this hand-out - Soth 2014)
The workshop will be an opportunity to explore how we each can thrive within these realms of uncertainty and contradiction, access a genuine sense of therapeutic authority (regardless of the fact that it is built on quicksand), and develop our own resources and style for inhabiting the paradoxes of the therapeutic space.
Clarkson, P. & Wilson, S. (1994, 2003) The Therapeutic Relationship. Oxford: Wiley-Blackwell
Gomez, L. (2004). Humanistic or psychodynamic - what is the difference and do we have to make a choice? Self & Society, 31, 6, 5-19
Kalsched, D. (1996) The Inner World of Trauma: Archetypal Defences of the Personal Spirit. Routledge.
Reich, W. (1942, 1948, 1973, 1983) The Function of the Orgasm. Souvenir Press.
Soth, M. (2014) The 4 Main Countertransference Objects in the Enactment (2014). Retrieved: 1/12/2017 http://integra-cpd.co.uk/cpd-resource/soth2014_therapist-4objects_in_enactment/
Soth, M. (2014) The Essential Relational Conflict Inherent in the Therapeutic Position: Object- versus Subject-Relating. Retrieved: 1/12/2017 http://integra-cpd.co.uk/cpd-resource/soth2014_therapys_essential_conflict_object_vs_subject/