Relationship Therapy – A Prerequisite For Therapists (and Clients)

Freud postulated that human beings instinctively followed certain drives throughout their lives, namely the drives for pleasure (Eros), sexuality (Libido) and death (Thantos).

The premise of this article, the author suggests, is that another essential drive exists within all of us and that is the drive for Relationship and Recognition. In other words it is vital if we are going to achieve an emotional sense of well being, that we relate in some way to a significant other or others, even if it is only as validation of our existence.

Indeed in the same vein, we can observe that any interruption to contact, in the fundamental sense, is of utmost importance to the Psychological outcome.

So if we accept the above, what does this mean for us as Psychotherapists and the art of Psychotherapy.

As Transactional Analysts, we can see that Eric Berne the founder of Transactional Analysis, as early as the 1950’s, recognised the importance of Relationships and Recognition within our lives. His early influence in this direction probably came from his early mentor and analyst – Paul Federn. Paul Federn came from the Object Relations School of the psychoanalytical movement ,and recognised the importance of the significant ‘Other’ in the psychological development of the person.

In ‘T.A. in Psychotherapy’ (1961) Berne suggests that human beings have certain ‘Hungers’ that determine their Psychological make-up. He suggests that their ‘Hungers’ and the search for them to be satisfied are a biological necessity for human beings.

The ‘Hungers’ Berne talked of were namely Recognition hunger, Stimulus hunger and the need for Time Structure in peoples’ lives. He went on to say that if these ‘Hungers’ were not met then the person would experience emotional difficulties within their Psychological development. In other words, in one sense, he was in part putting forward the idea that all human beings instinctively search out and need relationships and recognition for emotional security.

This is highly significant and has not, I believe, been emphasized enough. The high emphasis on the behavioural aspects of Transactional Analysis in the late 1960’s and 1970’s by some practitioners have perhaps clouded the concept of Transactional Analysts working within the ‘relationship’. It is important then, for us to realise that for Berne the need for recognition was, and is, a central core of T.A. theory and practice.

Relationship therapy, or should I say the concentration of the relationship and of putting that first before the use of techniques and models, is prevalent in many of the humanistic models from T.A. to Gestalt, Psychosynthesis and Rogerian psychotherapy.

As a Transactional Analyst, I put the relationship between myself and the client as my major consideration, and that does not detract from me thinking also in terms of Ego States, Structural analysis, Games and Script. I personally think this model is a beautiful and elegant model for the use of effective Psychotherapy.

For Relationship therapy, three major concepts need to be mentioned, they are the cornerstones for any relationship therapist. Richard Erskine talks of the need for Attunement, Inquiry and Involvement as the major prerequisites for any therapist working within a relationship.

“Inquiry is a continual focus in a contact orientated relationship based Psychotherapy. It begins with the assumption that the therapist knows nothing about the client’s experience and therefore must strive to understand the subjective meaning of the client’s behaviour and intrapsychic process” (Erskine 1991).

Inquiry then is very much about finding out. In some ways you must become the Sherlock Holmes, the Inspector Poirot of the therapy process but in a respectful way so that the client does not feel shamed or ‘missed’. With the use of Inquiry you are honouring the client’s experience and historical past, you are respecting this and you are sensitive enough to want to know fully about his most smallest hurts/anxieties and through this process you will be repairing in a very positive manner some of the ways the client has been missed in childhood. In this contact orientated inquiry, you can provide a forum for self validation for the client which is of utmost importance on the road to cure. This process, I believe, is just as important, if not more important than the content of the dialogue.

Attunement is very much 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 attunement validates the client’s needs and lays the foundations for repairing the failure of previous relationships”.

D. Stern, in his book ‘The Interpersonal World of the Infant’, also talks of affective attunement being a prerequisite for effective therapy. An example of attunement he gives would be thus: “A nine month boy bangs his head on a soft toy, at first in some anger but gradually with pleasure, exuberance and humour. He sets up a steady rhythm, Mother falls into this rhythm and says ‘Kaaaaa-Bam, Kaaaaa-Bam, the ‘Bam’ falling on the stroke and the ‘Kaaaaa’ riding with the preparatory upswing and the suspenseful holding of his arm aloft before it falls”. For Stern, affective attunement is “the performance of behaviours that express the quality of feeling of a shared affect state, without imitating the exact behavioural expression of the inner state”.

So, as a therapist working within the relationship it is in my opinion, necessary to attune to the client, to be in tune with the client, to harmonise with the client. Attunement is a two way process, it is mainly about being aware as much as possible of the other person’s sensations, needs and feelings.

It is, as with Inquiry, a sense of really being with the client in a fully present, contactful manner. Attunement does not mean fusion or coming from a confluent position with the client, it means that the therapist is also aware enough and respectful enough to honour the boundaries between the client and the therapist. In that sense facilitating the client to be, not only aware of the relationship between themselves and the therapist, but also aware of their own personal boundaries between themselves and the other.

Involvement, as with inquiry and attunement is about the therapist being fully present and in full contact with him. Involvement is very necessary in any relationship orientated therapy. It is through involvement that we validate and normalise the client’s experience. 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. It is by involving ourselves within the therapeutic process that our commitment is evident for the client. It is through involvement that the person is honoured and respected as a person in their own right. It is through involvement that the client will feel safe enough to share those hurts and traumatic moments.

Within an inquiring and attuned therapeutic relationship the real foundation for repairing the hurts of previous relationships is demonstrated, the road to recovery and cure is well on the way. Involvement, inquiry and Attunement are all prerequisites for any relationship orientated therapy.

I believe that without these fundamental tenets we will not be truly respecting, in any meaningful way, the person who has chosen us to be their navigator in their journey for emotional health. Finally, it must be noted that once the therapeutic relation ship has been forged it does not mean that Inquiry, Attunement and Involvement stop, they are the intrinsic framework of the therapeutic relationship.

In conclusion the therapeutic relationship is vital for any real therapy to occur. That does not mean however, that the humanistic existential Psychotherapies such as Transactional Analysis, Gestalt and Psychosynthesis are not essential – they form the core for the theory and practice of the therapy domain.

Indeed, as said earlier, Transactional Analysis is a fine model to follow. The concepts of T.A. both theoretically and practically have been vital for me in helping me in my work as a therapist today. It is an excellent model for understanding the persons intrapsychic process and early traumas. I believe it gives the therapist and the client a common language and mutuality which is essential to the therapeutic journey.

I think that Transactional Analysis belongs within the context of a Contactful relationship therapy.

This, I believe, is what Berne meant when talked of human beings needing to satisfy their biological ‘hungers’ for Recognition, Stimulus and Structure. Certainly it can be seen that within the therapy relationship -Inquiry, Attunement and Involvement feed and satisfy the clients Psychological hungers.

I am sure that, had Berne been alive today, he would agree with the following quote from Michael Kalum’s book ‘Between the Therapist and the Client’ “At this moment of the existential encounter between therapist and client, the client’s whole world is present. All of the client’s significant past relationships, all their most basic hopes and fears are there and are focused on the therapist. If we can make it possible for them to become aware of their world coming to rest in us, and if we can be there, fully there, to receive their awareness and respond to it, the relationship cannot help but become therapeutic.”

Bob Cooke

Bob Cooke

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Bob Cooke is Psychotherapist, Trainer, Consultant and Supervisor with an international reputation.  In 1987 he founded the Manchester Institute for Psychotherapy (to the present day), of which he is the director. He is also responsible for the Institute’s training programme and oversees trainees from first year to full clinical membership of the UKCP.

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