THERAPEUTIC PRESENCE

Did your training as a psychotherapist or counsellor emphasize the importance of being a caring therapeutic presence? Did your training discuss how to cultivate and enhance your therapeutic presence? My training certainly did not. If course theories and techniques of psychotherapy are also important. However, over 40 years of experience in private practice have taught me that cultivating and being a caring therapeutic presence is essential. Without that our theories and techniques are much less effective. It is important for us to remember that the literature on effective psychotherapy consistently has reported that when clients are asked, "What was most helpful to you?" their response is some version of: "My therapist genuinely cared about me as a person"; "My therapist was really there for me,not just using techniques."
It is not easy to find adequate words to describe therapeutic presence. A vital aspect of it is our intention to have our whole self engaged in the session as much as possible on that day with that person. It means physically being there not exhausted or distracted by other objects in the room. It means cognitively discerning what therapeutic perspective and technique will be most responsive to the needs of this person today. It means being emotionally engaged with an open heart trying to sustain an empathic compassionate connection. It means being spiritually open trying to access guidance and wisdom from our own personal Higher Self and whatever other sources of assistance that might be available.
To be that kind of caring presence for many hours each day with a wide range of clients over many years is a profound challenge. Perfection is not possible. However, there is lots of good news for those of us who are trying to be that kind of presence. First of all, brain research has indicated that taking the time before each session to have the intention to do so activates the neocortex which then aligns other parts of the brain so that the probability of deep presence occurring is enhanced. Second, brain research has also validated my experience of over 40 years of doing this work. The more you cultivate therapeutic presence the more brain patterns develop and then get strengthened over time. So gradually the capacity to be that kind of presence becomes easier to access and then you also have a deeper reservoir to draw upon.
Cultivating and accessing a caring therapeutic presence is the work of a lifetime. There are several helpful pathways for each of us to explore. Because this is a brief blog I will just mention some of them and then describe one in more detail. For a thorough elucidation of this topic I would suggest reading, "Therapeutic Presence: A Mindful Approach to Effective Therapy" by Shari Geller and Leslie Greenberg(2012). That work inspired and informed this blog, broadened my understanding particularly of the brain research,and validated my years of experience.
Our own personal psychotherapy is an essential pathway that will help us become more conscious of our personal issues that might be triggered by our clients and are reducing our effectiveness. Also being attentive to our own self-care is vital so that we are not tired from or distracted by the responsibilities of the multiple roles of our lives. Because we are often not good at taking care of ourselves I have written elsewhere(see blog and book chapter on Recharging) on what are some of the psychological blocks that you may have to good self-care. In addition we need to work on developing more compassion - particularly self-compassion - so that we can be more open-heartedly compassionate towards our clients. We may also need to cultivate being a more compassionate presence in our everyday lives. An important question for each of us to explore is: "To what extent am I more present to my clients than I am to other people in my life?" I am not saying that we should be therapists with our family and friends. Rather I am saying there are probably many brief moments in each day when we could be a more compassionate human being. Why that is important is that the brain research indicates that the more that we cultivate presence throughout our lives the stronger those brain patterns become. We then have a deeper reservoir to draw upon during sessions.
I now want to share several practices that I have incorporated into my life that have helped me to develop and deepen a more caring therapeutic presence. Five minutes before I begin my morning or afternoon's work I sit in my therapist's chair and ask my Higher Self and other sources of guidance for help in fulfilling my intention for my clients to be a source of compassion, peacefulness and strength. I follow that with meditational breathing imagining with the out breath that I am letting go of whatever might be blocking me from being present that day. For a few minutes between clients I do the same. This is a practice I have been doing for many years. It is a way of acknowledging to myself that I am consciously moving from the ego realm of ordinary life into a different level of consciousness where my therapeutic self resides. It is fascinating for me recently to learn that brain research is now validating the importance of taking the time to set my attention which then calls into alignment other brain patterns.
In my meditational practice I have developed a relationship with certain nature places that have helped deepen my capacity to be present to my clients. This was certainly not my original intention in developing that aspect of my spiritual practice. However, it has evolved in such a way that is helpful to my work. Often I sit in meditation with my back up against an old ash tree with its thick roots exposed above the ground. For me the tree symbolically represents strength, stability, rootedness. That individual tree has become a living connection to the archetypal "Tree of Life". I also have a poster of a giant redwood in my office. When I look at the poster it reminds me of my local ash tree - and my actual experience of having meditated inside a redwood tree - and connects me at that moment to my intention to be a reliable source of rooted strength for my clients.
I also sit near a local pond and meditate. For me that pond symbolically represents stillness, peacefulness, equanimity. When I sit there I am trying to cultivate those qualities in my own consciousness not only for myself,but also so that I can project - perhaps even transmit - the energy of those feeling states for the people in my life. I have a painting of a pond in my office. When I look at it before I begin my work and during sessions it connects me to my intention to be a source of peacefulness.
I am extraordinarily blessed to have a small brook that is thirty feet behind our home and flows through our property. When I stand or sit by it I ask the brook to help me more connect to the flow of life. There is so much to learn about what the Taoists refer to as "the watercourse way" that is relevant for the human journey. Increasingly, witnessing the ways of the brook have helped me to be more in the flow of a session with each particular client on that day. To be able to let go of my need to control, influence or even know what's going on in a session and simply trust the process. What a challenge for my ego! Yet the brook is a good teacher. Having spent so many hours in the presence of that old tree, the pond and the brook have helped me to cultivate those qualities of a rooted strength, peacefulness and trust in the flow of life. I am then able to offer the presence of those qualities to my clients.

Several parts of this blog have been inspired or influenced by my recent reading of: Therapeutic Presence: A Mindful Approach to Effective Therapy by Shari Geller and Leslie Greenberg.

THE SABOTEUR

"I did it again. I know what's good for me to do and I don't do it or I do it for a little while,but can't sustain it. It doesn't make any sense to me why this always happens." This is usually said by my patients with a mixture of frustration, confusion and self-anger. Of course it doesn't make any rational sense to them. Why, even with the best intentions and firm resolve, they are unable to stay with their exercise program, eat the right foods, choose the right partners, not return to their addictions etc. It is so frustrating. And insidious.
My patients want to know why. I usually ask "What comes into your mind about why this might happen?" After he/she gives several possible reasons, most of which are usually accurate, I add "Those reasons are probably correct. And, for most of the people that I've worked with there is usually something else, something unconscious, a part of their personality that I'll call The Saboteur. This is a part of your personality that lurks in the shadows out of your awareness. His/her main function is to undermine your happiness. He loves to be in the dark - that increases his power. So the first step is to bring him out into the light and get to know him, how he works, where did he come from." Of course, it doesn't make any rational sense that we would undermine our own happiness. "Yet", I continue," at some level of your consciousness it makes emotional sense. We need to find out what are the reasons for his/her existence. How did he become so secretly powerful in your personality?" Most of my patients feel a mixture of perplexed and intrigued. It does make sense to them however, that they may be sabotaging themselves because they have witnessed the consistent pattern.
I suggest to them that usually the personal historical roots of The Saboteur are in their childhood years wherein, at some deep level they were made to feel unloveable, unworthy of having a good life. It is not feasible within the limitations of a brief blog entry to discuss all the possible derivations. A few examples may be helpful: one patient was told on multiple occasions by her mother,"I wish that I never gave birth to you"; another patient, in a family of high achievers, was told that he was a "fuck-up" and a source of family shame; another always had a sense that no matter what he dud was "not good enough". One aspect of the therapy is to uncover the roots of this pattern, to look at it with compassion, and to begin to question the validity of this inner narrative.
Another aspect of the work is to use imagery. I tell my patients,"The Saboteur loves to be in the dark out of your conscious awareness, to work in the shadows. That increases his power, his effectiveness. What we want to do is to bring him out into the light, to name him, to develop an image of him." Once they understand how insidious and effective The Saboteur is in consistently undermining their happiness most patients like this part of the work. It makes the perplexing pattern less mysterious, reduces the sense of helplessness and introduces an element of playful creativity. One patient calls this sabotaging part of himself "the little fucker" and imagines him as a gremlin-like creature who stands in the corner of the room and who sometimes has a demonic expression and at other times an impish gleam. Another patient has named him simply "The Voice" and imagines him as a heavy-metal rock star who in a gravelly voice sings a particular song whenever he is trying to get my patient to do something that is not in his best interests. Another person uses her artistic ability to draw pictures of her saboteur and brings them into the office. It is interesting to witness the evolution of these drawings as her saboteur diminishes in power. During sessions with each of these patients whenever I notice an example of the undermining pattern I will say,"It looks like 'the little fucker' or 'The Voice' showed up and ask my patient to imagine what they may want to say or do to their saboteur at that moment. Gradually my patients are able to do that increasingly outside of the sessions and reduce the impact of that part of their personalities.