My client, Sue, had been in therapy with me for approximately six months on a weekly individual basis. She saw me at the Institute and the sessions were of 55 minutes duration. The long term therapeutic contract with me was that she warned to be less agitated and more relaxed in her life.
This particular session was at 1000am on a Thursday morning. I opened the door to her, invited her into my consulting room and asked her if she wanted a cup of tea. She said yes and, after some pastmtting transactions, I asked her what she wanted from this particular session. She told me that she wanted to take the negative aspects of her father off me and to be able to act in a positive healthy way with me.
I asked Sue the reasons that she wished to do this, and she answered, so that she could feel safe and secure with me in the therapy session. I enquired further and asked what benefit it was for her to feel safe and secure with me. She replied that the process would help her positively enhance her life and this was the first step for her in this specific direction. She also added that she would not be able to work in a therapeutic way with a therapist that she did not feel safe with!
I agreed with her that this was was vital for a positive therapeutic relationship to fonn between both of us. I then asked her how she was feeling. She replied that she felt more relaxed and warm inside since we had had some contact between us and that even as we spoke, she was beginning to take some of the negative qualities of her father off me. I asked her how she was doing that, and she answered that the response from me was different than from her father’s, that he would not be with her as I was being. I then asked her to explain more and she went on to say that, with her father, there would be no dialogue, no real conversation. He would not take her into account in any real way, whereas she felt that I was, at the moment, honouring her by being sensitive to her needs. I replied to Sue that I was pleased that she had already begun the important process of separating me from her father.
At this point, I decided to use physical and visual comparisons with myself and her father as a methodology for Sue to differentiate between us. To this end, I asked Sue how different visually and physically I was from her father. She went on to
describe some of the differences. For example, she told me that I had different coloured hair than her dad’s hair, my nose was larger, though for her, my mouth and lips were sinAlar in some ways. She added on though, that my smile seenied much warmer to her than her father’s.
Particularly, at this thought, she seemed to me to be much more relaxed and as the process of differentiation continued her whole posture changed and she was sitting in a much inor relaxed manner. She did not appear to be as stiff and rigid as she had been at the beginning of the session.
I logged this mentally and then went on to encourage her to anchor how she felt now and to integrate and remember the warmth of her visual memories of me and how I am different from her father, so that she could take those different memories away from die session with her.
Sue went on to say that she felt much better than earlier on in the session and now felt much more positive towards me. She reported feeling niore relaxed and secure with me and said that she was happy at that. She then asked me for a hug – which I gave her and we completed the session in this symbolic way.
In analysing this session, I intend to comment on this particular piece of work, firstly from an ~ohject relations’ framework and secondly from a ‘relationship’ frame of reference.
By looking at this work from an object relations framework, the primary goal of the session for Sue was to move inc from her negative self object to a positive self object. The negative self object that she was transferring onto me was her father, who physically and emotionally abused her in her childhood. By Sue placing inc as the negative self object within the therapeutic relationship, she was replaying the abuse within her own intrapsychic structure. She was reinforcing the past as die here and now reality.
Sue recognised that, for her, I was taking on this archaic role. She did not want this, she did not want to replay her past pattens and responses. She wanted to see and to respond to me as a positive self object. This was very important to her, she wanted me to be a healthy self object that would be secure, nurturing and dependable in a soothing and growth-full way. Seeing me in this way would be helpful, not only in an internal soothing way, but also this intrapsychic security would mean that, externally, she would feel safer to contact others within her life in her present day functioning.
This process could be seen within an object relations framework as an ‘idealising transfer’ from Sue to myself This process was helpful to Sue as she reported feeling more relaxed and contented, more secure within herself as she left the session. This indicated to me that she had begun to take me on board as a self soothing, self object that she wanted and needed to enable her to have the internal base to confront the memories and effects of the childhood abuse she suffered at the hands of her father. This then, provides a positive and necessary platform for future therapy.
In explaining the same piece of work from a ‘relationship’ framework, it is necessary first to define what we mean by ‘relationship therapy’.
Relationship therapy, for me, has three major concepts which need to be mentioned here. They are the cornerstones for any relationship therapy. Erskine (1991) talks of the need for inquiry, attunement and involvement as the major prerequisites for any therapist working within a contactful orientated relationship.
Turning to this methodology then, inquiry is a gentle contactful method of coming alongside the client in order to unpack and discover the roots of the past. Inquiry is about finding out. In some ways you must become the Sherlock Holmes of the therapy process, in a respectful way of course, not a shaming way.
If we analyse the dialogue with Sue and myself in our therapy session, we can see that I am inquiring in the following ways:
Firstly I inquire respectfully what she wants from the session, to which she replied that she wished to take the negative aspects of her father off me. I went on to further inquire as to her reasons for doing this. Her reasons were that she wanted to feel safe and secure with me in the therapy sessions. Further inquiry from tue was to find out how she would benefit from feeling safe and secure with me. To which she replied it would enhance her personal growth.
This use of inquiry by mc was vitally important for the relationship to begin to bond and for the attachment process to begin between Sup and
myself. Indeed, it is in the inquiry process that the solid foundations for relationship therapy begins.
Attunement is concerned with the therapist being there with the client, seeing her, hearing her and validating her experiences and feelings. It is the sense of ‘being with’ instead of ‘doing to’. Attunement is about ‘getting into the skin of the client’. It is about the therapist being in touch as fully as possible with the needs and feelings of the other person. As Erskine (1991) says, ‘the communication of attuneinent validates the client’s needs and lays the foundation for repairing the failures of previous relationships”.
With Sue, 1 attuned to her in the following ways:
Firstly, when Sue said she would not be able to work in a therapeutic way with a therapist she did not feel safe with, I agreed with her that it was vital that she felt safe with me in order that she have a positive therapeutic relationship. I validate here, her thinking linked to her past experiences and it is important for her that I have a full understanding of her process and show it in some way, either verbally or physically. I chose the verbal method.
Another example of Sue being attuned to me in this session was that she dialogued with me in a way that she would not have done with her father. This was mainly because she saw me as validating her ‘sense of being’ and that I was sensitive to her fundamental needs.
Involvement, as with inquiry and attunement, is basically about the therapist being hilly present and in full contact with the client. It is through involvement that we validate and normalise the client’s experiences. In other words we involve ourselves through the use of inquiry and attunement in the world of the client. It is through involvement with the client that we come to understand the very nature of the person that we are working with.
An example of how I used die method of involvement with Sue was specifically evident at the end of the session when I asked how she felt now, and encouraged her to integrate and to remember the warmth of her visual images of me and how I am different from her father. My involvement was very much anchored through the bonding that I undertook to anchor the feeling of warmth that Sue had developed towards me through the session. This was symbolised by die hug that she asked for from me and that I gave her at the very end of die work. This hug is true involvement of contact at the somatic level which she can then carry away from the therapy session with her into her present day life.
The active relationship therapy model that I followed with Sue can be summarised as follows:
Through Inquiry I have found out what Sue wanted, and by Attunement with her, we got into the feel of the therapeutic process and therefore helped facilitate what she wanted to experience, which has made it possible for me to be me, and her to be her. Involvement is me using my presence to help anchor arid encourage what has happened between us within the therapy process. The hug encapsulated the involvement which existed within the whole of the therapeutic session.
Bob Cooke BA PTSTA (Professional Teaching & Supervising Transactional Analyst with Clinical Speciz/4g) Lc Princfpal Director for the Manchester Institute for Integrative Psychotherapy (act 1987) where be runs a comprehensive TA. teaching programme and is a practicing psychotherapist Bob Cooke is on the National Register for Accredited Psychotherapists’ and MLIY is a member of the European Association for Psychotherapists
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