Interactions Between Patient and Psychotherapist
Various moments in psychotherapy are experienced, by both the patient and psychotherapist, as an effort to provide a new understanding of the other, as well as an effort to be understood in a particular way. Sometimes, the focus of discussion is more on the patient and his/her feelings, and other times, the patient’s focus is squarely on how the psychotherapist is affecting him/her (whether positively or negatively-tinged). The modern Kleinian psychoanalyst John Steiner has written eloquently about the tactful shift between “patient-centred” and “analyst-centred” interventions (Steiner, 1993), based on whether the patient can bear new understanding, or tolerate being understood. This can lead to statements that directly clarify or interpret the meaning of a patient’s experience (e.g. ‘You seem to feel x and carry that with you into other situations,’ or ‘When this happens to you, you react with y, and for z reasons’), or statements that begin with at least an acknowledgment of the analyst’s particular experience (e.g. ‘Now, it is as though you experience me as feeling x towards you’). As a whole, alternating between the two types of emphasis forges the process of working through difficulties that might emerge in conversation, and whether such difficulties are considered related to the patient’s effort to protect him/herself, or the analyst’s feelings about the patient, or both. Relational analysts and therapists have gone further still, advocating a disclosure of the therapist’s subjective experience, in an effort to further the conversation between patient and therapist (Renik, 1999; Ehrenberg, 1992). Whether and to what extent this can be therapeutic varies with each therapist and patient, as well as each moment in the interaction. Nevertheless, monitoring one’s feelings with the patient can be a useful aid in considering what to say to a patient and how to say it. Most of us agree that our goal includes helping with greater possibility for tolerating new ways of relating, with insight into new ways of managing difficult emotions in conversation with real and imaginary others from the present and past, and with the further, creative elaboration of new meanings in our patients’ mental lives. Often, moments when we are surprised as therapists by our patients can make all the difference in our patients’ lives, and we assume a curious attitude of, and create a safe space for “courting surprise” with the patient (Stern, 1990). A safe, actively-engaged, and straightforward interaction between patient and therapist can allow the patient to shift with greater agency between greater immersion in his/her subjective experience, and reflecting upon that experience constructively.