freedom and discovery within the therapeutic bond

The Am in P.yvchorherupy, Vol. 10 pp. 3-7. E Ankho international Inc., 1983. Printed in the U.S.A.

FREEDOM AND DISCOVERY WITHIN THE THERAPEUTIC BOND

EDWARD R. RYAN, PhD and DAVID READ JOHNSON, PhD*

Commitment to the bond created between two people can result in greater freedom and discovery for each of the participants in any personal relationship. But commitment to that bond has a unique and crucial meaning in psychotherapy. For the patient, psychotherapy may be a formative interpersonal learning experience, and a unique opportunity for development of a greater capacity for intimacy and mutuality. For the therapist, the therapeutic bond is the interpersonal milieu for supporting growth in the patient, as well as being a source of personal renewal of appreciation of the human condition. However, this developing bond may also become a chal- lenge for the therapist and perhaps even a burden, or a threat.

As therapists we would like to describe our efforts toward greater psychological freedom and discovery within the therapeutic bonds with our patients. By greater psychological freedom, we mean greater personal openness to interpersonal experiences, and thus a greater capacity for discovery and intimacy with the patient. The resulting transformation of therapeutic binds into meaningful bonds is achieved through a series of phases of awareness and discovery by the patient and the therapist, based on a redefinition of the therapeutic relationship.

Psychotherapists with humanistic orientations have written extensively of the goals of freedom and mutuality in psychotherapy (Rogers, 1951; May, 1969; Heuscher, 1980; Strupp, 1980). Yet the moment of spontaneous interaction and encounter, which to us is the essence of psycho- therapeutic action, remains necessarily difficult to conceptualize. Psychotherapy research typi-

cally divides this moment into therupisr variables and patient variables (Bergin & Garfield, 1971; Strupp, 1971). For example, empathy, genuine- ness, and warmth are described as the attri- butes in the therapist (Truax, et al., 1966), rather than as characteristics of the interaction between the patient and the therapist. Psychotherapy is often examined by variables external to the therapist-patient interaction, such as technique and diagnosis, instead of aspects of the unique match between a particular therapist and a particular client. However, therapy cognizant of the interpersonal nature of therapeutic bonds requires the therapist to allow the patient access to greater regions of self, in order to encourage the possibility of a therapeutic encounter.

This interpersonal understanding of psychotherapy appears to be held by many therapists, but may still be abandoned, we believe, as the therapist experiences difficulties with the personal demands of the growing bond with the patient, and wishes to remove him/herself from it, Often the therapist does so by resorting to a more comfortable conceptual framework, namely, the “psychology of the individual,” Here psychotherapy is viewed essentially as a process of self-exploration on the part of the patient, in which the psychological territory to be traversed is primarily inside the patient, rather than between the patient and the therapist. Yet,’ the therapist’s struggle to be free from the personal attachment to the patient paradoxically leads him/her into the very stalemate he/she was attempting to avoid. When even the most thor- ough understanding of individual dynamics does not free the therapy from this dead end, coercive

*Edward R. Ryan is Associate Chief, Psychology Service, VA Medical Center, West Haven, CT; and Associate Clinical Professor, Department of Psychiatry, Yale University. David Read Johnson is Clinical Instructor of Psychology, Department of Psychiatry, Yale University; and Clinical Psychologist, Psychology Service, VA Medical Center, West Haven, CT.

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force or rejection often replaces acceptance and understanding, and either the therapist or the patient becomes the exclusive target. Russell (1976) has vividly described this event as the “crunch”; we think of it as an impasse.

The Impasse

To illustrate how this impasse is reached, consider this summary of a therapist’s report to his colleagues of a therapy about which he felt hopeless.

After nearly a year of working together with the patient, the therapist presented his work as a failure. He reviewed the development of certain themes in the patient’s history and current life based on reading, supervision, and consideration of some of the patient’s behavior. He had then made a series of consistent “interventions,” each of which seemed ineffective. The therapist concluded that since his interventions, based on his thesis, did not produce the result he ex- pected “in” the patient, “nothing was happening.”

This not uncommon result in the human ad- venture of psychotherapy is evoked by a certain quality of participation by the therapist. The therapist’s growing discomfort with the ambigu- ity and complexity developing in this specific relationship with the patient leads him/her to believe, not that a discovery is at hand, but that something is wrong. The search for an intellectual framework is thus motivated by a desire to simplify and clarify this interaction. Unfortunate- ly, this may be equivalent to departing from it. Therapists struggling in this way have at their disposal a variety of well-formulated theories of human behavior which simplify the complexities emerging in the therapeutic bond.

These “technical solutions” reflect what Mumford C 1970) has called the dominant cultural “myth of the machine”-only now it is applied to that unique and formative opportunity for human intimacy and change: psychotherapy. The expectation is that. as with machinery, psychotherapy requires a knowledge of the mechanics of the machine (the patient), an expectation that all machines operate according to similar basic mechanical principles (the dynamics), a pre- scribed manipulation (the “intervention”) by the operator (the therapist), and the expectation of an appropriate product (outcome) (compare

Hartmann, 1958; Langs, 1973). “The psycho- therapist is a technician, and psychotherapy in the final analysis is a technology” (Strupp, 1971, p. 129). This view precludes the discovery of creative human alternatives and personal change in intimate relation with the patient. When this discovery does not occur, the therapist assumes that the machine is not working. The result is inevitably the continuation of the impasse and growing discouragement in the therapist.

One source of discouragement in therapists is their own implicit, horizonal awareness that the machine-model of psychotherapy is severely lim- ited. However, their intellectual devotion to the individualistic approach usually prevents them from seeing this more centrally. Instead, therapists will usually say that it is the patient who is so discouraging, perhaps concluding that the wretch simply cannot “use” therapy. However, therapists who have available to them the notion of countertransference can also come to an alter- native view: that something is wrong with them. The confusing bind between patient and therapist can now be located within the therapist. The cost to the therapist in increased guilt feelings is easily balanced by the intellectual mastery and personal status one is assigned by colleagues through public acknowledgement of one’s own countertransference reactions. However, the resulting obsession with countertransference is no more than the therapist’s counterpart to the patient- as-specimen approach.

As attempts to locate the “problem” within patient or therapist fail, the therapy will often falter, and either or both therapist and patient may conclude that nothing more is to be gained (Miller, 1977). At this point, the listener to the therapist’s report-a teacher, a colleague, or the therapist himself in a moment of introspection, may realize that the report is incomplete, that neither blame nor pathology may be assigned to either person individually. For either party to accept blame’or the assignment of pathology is an attempt to possess within the self that which exists between. Thus, the listener might reply: “So, you are trying to tell me about yourself and the ptrtient, and where you actually stand together. You’re in the same boat. You’re going through some rough weather now, and it doesn’t seem you’re getting far on your journey. But is jumping out or pushing the patient out the an-

FREEDOM AND DISCOVERY

swer?” The therapist is encouraged to accept only his/her responsibility for what has become of the bond, while giving up his/her possessive- ness of the patient and their relationship. The therapist may now realize that it will only be through a creative act that the therapy can continue-and that such a creative act must be a mutual endeavor, arrived at through phases of awareness and then discovery.

Phases of Awareness

These experiences may occur both during and between therapy hours. They are phases of silent but intense participation. Sustained by a more complex understanding of what the patient and therapist mean to each other, the therapist can allow him/herself to experience more deeply the sense of stagnation, which can lead to a morato- rium on all frantic efforts to do something. Strength to go on is recovered with the awareness that the stagnation and hopelessness which have been weighing one down are shared with the patient. The most immediate experience is relief, the feeling of setting aside a burden, perhaps accompanied by a glimmer of renewed lov- ing feelings for the patient. At the very least one might have a revived intellectual experience of mutuality, which begins to glow again at this moment of relief.

Yet, no fancy theorizing about the hopelessness is required. In fact, such intellectual activity creates distance and can crush out the new-found glimmer of mutuality in the therapist. However, it is important to recognize the reason why intel- lectualizing is so tantalizing. When the therapist recognizes that he/she shares a sense of despair with the patient, he/she loses possession of the experience. The personal self-boundaries of the therapist give way at the point of possession, and the therapist lets go of that which is not his/hers to possess. The therapist’s personal boundaries then reform around a diminished sense of self. This can be a frightening experience, and can be accompanied by feelings and fantasies that ap- pear new and perhaps even bizarre to the therapist. These usually arise out of a sense of loss felt by the newly reorganized self. Concurrently, there may be an unsettling feeling of joy in the revived sense of personal commitment to the bond. It is only natural that the therapist, in the

midst of this powerful emotional experience, may seek to postpone a new adjustment-by trying to continue his/her personal possession of the experience with a theory about what it all means. However, only the deeper emotional acceptance of this next adjustment toward mutuality can lead the therapist toward an integrative understanding with the patient. The following is an example of this accepting awareness.

A therapist and his patient had been working together for a year, three times a week. The relationship had been stormy from the beginning: the patient had missed many sessions, refused to talk about the topics the therapist considered meaningful, and actively and often successfully humiliated the therapist in front of colleagues. The therapist had responded with a trou- bled eclecticism of unflappable tolerance, angry limit- setting, and ineffective but incisive interpretations. In this way, they learned about each other and, since familiarity also breeds comfort, they came to like each other very much. The patient gradually came more often to therapy, and the therapist felt less ashamed with his colleagues.

However, after some time during which the therapy seemed to have been progressing, the relationship seemed to take another turn for the worse. Neither one could think of things to say, each began to dread meet- ing with each other, and a sense of frustration and blame slowly permeated the therapy. They did not often look at each other. This continued for many sessions. The therapist began to reason that the therapy had reached its potential for effectiveness. Nothing was happening. However, he couldn’t explain why he felt like strangling his patient. One day, this therapist said, “Well, Charlie, what about this relationship you and I have?” “It’s all in a mess, isn’t it?” Charlie replied. The therapist experienced a feeling of empathy from his patient. “It’s as if we’re at some sort of impasse together,” he said, and Charlie responded with an enthusiastic, “Yeh.” An immediate and strik- ing feeling of relief and closeness welled up in the room between them. For several sessions little was said, though each was able to look directly at the other more often, with greater comfort. Occasionally, Charlie would say, “Remember, we’re at an impasse,” and smile. It was as if the blame for the messed-up therapy was now a joint responsibility; instead of distance and desire to escape, a feeling of closeness and co-owner- ship of “the impasse” characterized their relationship.

The patient and the therapist had come to recognize that beneath the impasse was a bond which they shared. There they would sit, looking at one another in puzzlement, wondering at the

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power of their nontherapy. A state of emotional awareness had now been reached.

The Phase of Discovery

In the final phases of the impasse, the therapist often interrupts the process by adopting the’ interpretive mode, telling the patient and himself what happened. However, acceptance of mutual responsibility for the hopelessness could lead the therapist to abandon this mode, or, in fact, any standard technical mode. As the usual therapeutic structure collapses, the therapist, like Odys- seus, must now wander about, cast by the winds and tides, with integrity but without hubris. The tension that develops in the therapist is between his/her faith in the therapeutic bond and fear of being adrift. The therapist in this situation is roughly comparable to a scientist wh6 has worked deductively for hours, days, months, and even years, and now has come up empty. At first there may be terrible personal discouragement. Resentment may follow, and the anger is directed at the work, at the self, at a colleague, or perhaps even at Nature. Gradually it may become possi- ble for the scientist to accept that he/she is no more than a participant in the truth, and that Na- ture is capable of being known but not domi- nated. A moment then comes when the scientist pushes back from the desk and away from the pages of attempts to dominate. The hopelessness and discouragement do not vanish; for now the “prize” is beyond grasp, and even the method has been found useless.

However, the imaginative moment is now at hand. For a moment the scientist becomes free of accustomed ways. In this freedom, he/she can see as never before. Like Einstein riding in a trolley away from the town’s tower clock and playfully wondering what would happen if the tram were going as fast as the speed of light, the scientist sees the solution. This is the creative moment in which the imagination of the scientist spontaneously encounters the design of Nature in the discovery of a truth. Similarly, in psychotherapy the discouraged therapist can encounter the creative solution if he/she can become free to participate imaginatively with the patient.

A therapist had been seeing a client for over a year, three times a week. Bob had been previously hospital- ized and now was living at home with his parents.

The therapy had been exciting and productive, and the therapist and the patient had liked each other from the beginning. The patient had never missed a session. After a long period in which the therapy had reached a plateau, Bob began to complain of depression, stating that he didn’t want to do anything at home, had trouble talking to others, and felt hopeless about himself. In therapy sessions he became unable to speak, and stared at the floor. Sessions of complete silence followed.

The therapist was initially convinced that this behavior was both a reaction fo several events in the patient’s home life and a transference to the therapist. He spent many hours formulating his reasoning. How- ever, exploring these issues and interpreting them to his patient had no effect. The therapist then became convinced that his countertransference issues were in- terfering with the therapy (e.g., jealousy of Bob’s progress, desire to have him rehospitalized so therapy could be terminated, homosexual fears). Self-exami- nation of near heroic proportions coupled with a series of interpretive inquiries testing out whether these issues were influencing Bob proved fruitless. The patient seemed unable to make therapeutic use of the sessions, though he continued to come promptly to every session, much to the disappointment of the therapist, who by now experienced them as a fotm of tor- ture. The therapist finally began to consider whether he was incompetent. The patient was apparently not improving, while he just sat there, and did nothing. Anything he did say was obviously not helpful, and sometimes seemed ridiculous. The patient kept coming and asking for help, so he could not terminate the therapy. What was he to do?

In one torturous session during which the therapist had just finished thinking about recent repairs on his car and returned to pondering the problem with his patient, he began to think about why Bob always came to these sessions. He then realized he hadn’t thought much about how Bob must feel about the lack of activity between them. Immediately the therapist guessed that Bob was probably humiliated and self-critical about his inability to speak, as he was about his own inability to help his patient. After a moment, the therapist said, “This is pretty humiliating, huh?” Bob looked up suddenly: “Yeh! I feel awful wasting your time like this. I don’t know what’s wrong with me.” The therapist, thinking as much about his own feelings, said, “How can you stand the embarrassment?” Bob replied, “1 don’t know,” and then with dawning realization, “I guess I thought you were supposed to help with it too.” He then broke into a broad smile. The therapist, feeling understood, replied, “Yeh, it’s really unforgivable, isn’t it?” “Yes, I’ll say,” Bob retorted. The two looked intently at each other in silence. The therapist, on an impulse, then said. “Will you forgive me?” and immediately wondered, “What

FREEDOM AND DISCOVERY 7

have I done?” Bob grinned, “Yeh, if you forgive me. ” An immediate sense of relief emerged after this ihter- change. In the silence that followed the therapist for- gave himself, too, inside, and perhaps Bob did as well.

Their impasse began to resolve itself after this session, and in the next several weeks Bob’s depressive state lifted and he was able to speak and participate meaningfully again in the therapy.

The respect for Nature in science is analogous to the respect for the patient and for the interpersonal bond in therapy. No effort of inner logic or interpersonal manipulation will suffice. Through surrender of domination, the therapist’s imagination is freed to wonder “What would happen if. . . ?” and to take the risk of answering that question with the patient. What the therapist or the patient then does may seem quite illogical, even to them. It is impossible to prescribe just what either will do or say, or will not do or say. Neither can one predict that things will get better as a result. All that can be said is that the therapist’s awareness of the shared, interpersonal nature of the bond that exists between them cun lead to the experience of freedom, and then to the discovery of a more intimate level of being together therapeutically.

Limitations and Possibilities

This view of psychotherapy cannot replace a regard for the integrity of the individual and an understanding of the psychology of the individual. However, it may offer a way out of the impasse caused by possessive individualism, in which the therapist attempts to dominate phe- nomena that are essentially interpersonal.

The moment when the way out is discovered is always a spontaneous, unexpected one. One must be willing to fail. In our experience failure has resulted from a lack of inspiration or a mis- take in judgment-about oneself, or the patient, or what we had going together. Despite therapists’ desires and willingness to refine their judgment, such failures seem inevitable. How difficult it is to maintain the view that psychotherapy is an interpersonal bond two people are developing as best they can!

The possibility of experiencing psychological freedom within the therapeutic bond is, for us, a

uniquely rewarding goal for psychotherapy. Only after one’s relationship with a patient becomes experienced as a burden or a bind can it be trans- formed into a creative bond with a sense of personal freedom. In a similar way, individualistic psychologizing may serve as a stepping stone to an appreciation of the complex interpersonal experience which is psychotherapy. Psychological freedom is thus discovered in the transformation of confusing, burdensome relationships. The therapeutic effect is realized as the therapist and patient participate in establishing that freedom over and over again as new binds and impasses occur.

Establishing psychological freedom within an interpersonal bond is a central focus of psychotherapy. This process involves the creative transformation of therapeutic impasses into uniquely meaningful interpersonal events in which patient and therapist discover the freedom to experience their shared emotional bond.

REFERENCES

BERGIN, A. & GARFIELD, S. (1971) HundbooX ofPsycho- therapy und Behavior Chunge. New York: Wiley.

HARTMANN, H. (1958) Comments on the scientific aspects of psychoanalysis. Psychounulytic Study of the Child. 13. 127-146.

HEUSCHER, J. (1980) Psychotherapy as uncovering of freedom. Psychotherupy: Theoy. Reseurch. und Practice, 17, 467471.

LANGS, R. (1973) The Technique of Psychuunulyric Psycho- therupy. New York: Jason Aronson.

MAY. R. (1969) Love und Will. New York: Dell. MILLER, R. (1977) Disappointment in therapy: A paradox.

Clinicul Sociul Work Journal. 5. 17-28. MUMFORD, L. (1970) The Penragon of Power. New York:

Harcoun, Brace & Jovanovitch. ROGERS, C. (1951) Client-Centered Therupy. Boston:

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sonal statement of the therapist’s essential values. Psy- chotherupy: Theom, Research und Practice. 17, 396401.

TRUAX, C[,- WARGO, D., FRANK, J., IMBER, S., BAT- TLE. C.. HOEHN-SARIC. R.. NASH. E. & STONE. A. (1966) Therapist empathy, gennineness, and warmth and patient therapeutic outcome. Journal of Consulting Psy- chology, 30. 394-401.

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