Storm – Edvard Munch. 1893. Wikioo.
“When someone is going through a storm, your silent presence is more powerful than a million, empty words.”
Our ‘silent presence ‘ is crucial to our work as therapists. It is a great relief for the patient when we can stay with their pain, quietly accompanying them on their very difficult and sometimes painful journey into the self.
As therapists, we need to maintain awareness of the nature of our own presence. Do we have an aura of warmth, compassion, containment and empathy when we enter or leave a room, and is this maintained during the process of therapy?
Can we work towards giving the patient such a strong presence that they can hold onto it during the space between therapy sessions?
“People also leave presence in a place even when they are no longer there.”
Below are some of the ways in which a therapist achieves a therapeutic presence with and for the patient and gives a sense of fully ‘being there.’
How often, in life, do we feel constrained to listen to others’ small talk, and ‘a million empty words?’
People frequently fail to listen to one another, make little genuine eye contact and are totally involved in their own words and their own world.
“When people talk, listen completely. Most people never listen.”
Hemingway’s quotation neatly encapsulates the need for us all to listen better to those around us. Listening carefully and empathically to another person is a skill that many of us need to learn and continually re-learn.
In psychotherapy, such listening takes on a whole new meaning. This is a kind of ‘whole body’ experience; it is as if we need to use all our senses to really be present for the patient, remembering that ‘listen’ is an anagram of ‘silent.’
Quiet intervals in psychotherapy allow the patient some space to feel free of therapist intrusion and over-activity.
We can actually listen to pauses and silences. Picking up visual cues from body language, expressions, gesture, is a kind of listening with the eyes. We can be aware of visual clues, just as we hear clues about the meaning behind people’s words.
This is a different way of ‘listening,’ using other senses.
It is a real giving of ourselves, our attention, concentration, our full presence, time and love, to the patient in therapy.
Variation: Depth of Feeling – Alexej Georgewitsch Von Jawlensky. Wikioo.
Empathy is the ability to put oneself into the world of another, in both a thinking and feeling way, as far as that is possible. It is trying to understand how that other person sees and experiences the world.
Real empathy on the part of the therapist means that there will be no rush, no pressure, just a quiet and strong presence.
An empathic therapist can be there for the patient without trying too hard to know how to help, to have all the answers, or rushing into thoughtless activity.
Such ‘activity’ may take the form of over-interpreting or offering therapist-centred thoughts that are not attuned to the patient’s needs.
Instead, there needs to be a strong message of containment and confidence in the value of being there, quietly waiting with the other person for something to emerge from the unconscious that is more than a superficial statement or response.
“The alternative to being is reacting, and reacting interrupts being and annihilates.”
‘Not knowing,’ that is, not thinking we have solutions, allows the therapist to be fully there for the patient, a quiet, strong and reflective presence, listening and attending to the patient’s needs, rather than to their own theoretical formulations.
How often does one experience such calm, authentic support?
Silence – Henry Fuseli. Wikioo.
“Sometimes the only thing you could do for people was to be there.”
Rather than attempting to ‘pull out’ the person from dark emotional places, perhaps the therapist can be emotionally there with them, even for a few seconds, no matter how dark and scary it feels.
A therapist who can be there for the patient, staying in the now, without pressurising or intruding at inappropriate times, who is willing to wait with the patient for feelings and memories to surface in their own time, will be a strong, facilitating presence.
If the therapist rushes into interpretation and quick ‘understandings,’ without waiting with the patient to see what might transpire, something valuable may be lost and the therapeutic process compromised.
Timing and pace are crucial in every psychotherapy session. Waiting with someone in an atmosphere of acceptance and compassion is crucial in this regard.
It involves therapists having the ability to engage in creative listening, feeling with that person, and thinking in a way that is based on the intuitive, rather than the purely cognitive.
Presence – Shirazeh Houshiary. Wikioo.
“Presence is more than just being there.”
The quotation above challenges the idea of being there for someone, implying it is not enough. However, in therapy, I think we know that the kind of ‘being there’ we refer to is in fact close to a full definition of presence.
How is a strong therapeutic presence different from ‘just being there’ in the social sense? What aspects does this possess that are absent when we are merely ‘with’ someone?
The difference is subtle, nuanced, qualitatively distinctive from having someone in our company in an everyday sense. It is difficult to describe…. and certainly difficult to express in paint!
However, in the painting above, the artist does, in fact, reveal something of the subtlety of the concept of a therapeutic presence: the silence, the unobtrusiveness, the feeling that something, or someone, is there, in the room, with us.
(This ‘presence’ in the image could also be interpreted in a somewhat ‘creepy’ way, and that is certainly not my intended meaning in terms of the therapist!)
This ‘something’ is not trying to advertise itself, or to make itself the focus, and we have to look hard to see it.
When we do spot it, we experience its gentleness, its safety, its benignity, its humility, its presence, despite the quietness and intangibility.
This is, indeed, a fitting description of the therapeutic presence, the serenity, the quiet energy, the expectant, but not desirous, attitude of empathy and hope.
- What does containment mean?
The concept of containment refers to an experience of feeling held and protected, both in a physical and emotional sense. It is very much part of the therapist’s role and an important feature of an effective therapeutic presence.
Emotionally, the therapist contains the patient’s feelings and fears through empathy and a strong sense of boundaried, professional care.
There will also be containment in the maintenance of the ‘therapeutic frame,’ which refers to the fixed and largely unchanging aspects of the therapy, both emotionally and physically.
Physically, the therapist can offer containment through reliability, good time-keeping, honesty, consistency, confidentiality, privacy and safety within the bounds of the therapy room.
The therapist will also ensure, as far as possible, that there are no interruptions to the sessions, so that the focus will be totally on the patient.
In addition, the therapy room needs to be welcoming, peaceful, warm and containing, with comfortable chairs into which the patient can relax and feel ‘held.’
Highly relevant here, and a part of the ‘holding’ process, is the concept of the therapist ‘lending their ego,‘ that is, allowing the other person in a supportive psychodynamic therapy to ‘borrow’ their containing adult strength and their ways of thinking during painful times in the process.
The concept of ‘holding’ was introduced by the child psychoanalyst Winnicott in the 1950’s, in terms of the importance of the infant’s experience with the mother. This kind of support is needed in therapy, too, and the therapist’s strong presence is crucial in this.
Mother and Child – Pablo Picasso. 1901. Wikioo.
“What is needed is a form of holding, such as a mother gives to her distressed child. There are various ways in which one adult can offer to another this holding (or containment).
And it can be crucial for a patient to be thus held in order to recover, or to discover maybe for the first time, a capacity for managing life and life’s difficulties without continued avoidance or suppression.”
“I do not ask the wounded person how he feels, I myself become the wounded person.”
© Linda Berman.
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