This has proven a challenging blog to write. It’s personal, if indirectly so. The famed neutrality of the therapist, the blank screen approach, is not so easy in these days of social media and blogs. We are encouraged to opine! Yes, therapists have egos too – and some therapists have quite large egos indeed. I think mine is small-to-medium. I’ve absorbed and worked through enough despair and failure for it to be under my control – most of the time at least. And I hope it remains so in this piece. I've written it mainly for those who are perhaps thinking of embarking on therapy (most obviously with me) and want some hint of what the therapeutic relationship - hereafter written as TR - looks and feels like. Here you will find a broken story written by an averagely broken person.
The prompt for this blog came from thoughts provoked by reading and re-reading my most cherished book about psychotherapy, The Difficult Art: A Critical Discourse on Psychotherapy by the late Italian Jungian analyst Aldo Carotenuto. The book first came to my attention back in 2003 when I was starting out on my counselling Diploma. I was drawn, I think, both to the picture on the cover - Magritte's 'The Therapist' - and the presence of the word difficult in the title. There is no hiding the fact that Carotenuto was and remains a controversial figure. He was certainly 'of his time' as the saying goes and would not have got on well with current gender politics one suspects. His view of women is very twentieth century in particular. As one obituary noted following his death: 'Carotenuto was a gifted albeit controversial figure in the ambience of Italian psychoanalysis, above all due to the kind of relationship he developed with his patients, a very close and affective bond which often made concluding the analysis painful to him. Consequently, as the human relationship to Carotenuto was more important than method, he did not always follow to the letter the rules of the setting.' (https://www.journal-psychoanalysis.eu/articles/aldo-carotenuto-1933-2005) It should be clear in what follows where I depart from him in the interpretation of the view that therapy is primarily a work of love and care.
The central point that Carotenuto returns to time and time again in his book is this: a two-way exchange, and not the healing of a symptom, is the real aim of therapy. (p. 76) The origin of this impulse is Jung's famous alchemical imagery: 'For two personalities to meet is like two different chemical substances: if there is any combination at all, both are transformed.' (Jung, 1929, p. 99, The Difficult Art). The nub of all this is the question of appropriate attunement to the client. In other words, how am I relating to and affecting this person opposite me, and vice versa? What is the quality and tone and spirit of the TR unfolding now with this person? In traditional jargon this is the much-discussed world of transference and counter-transference (how the client feels about the therapist and how the therapist feels about the client respectively). Perhaps attachment - another popular term in therapy over the decades - is a better word to use here than attunement. For the depth and complexity of attachment, though it fluctuates and varies from client to client, can be almost overwhelming at times - and for both parties. Generally speaking the longer the work lasts the more the roots of attachment embed. And pulling up roots when the work finishes can therefore be a painful task and something that may be resisted by both parties. This was a not uncommon experience for Carotenuto. It will need to wait for another blog for a fuller discussion, but the question why Jungians - at least as far as my reading has taken me - should get more heart-broken over the therapeutic relationship than therapists belonging to other schools is a perplexing and fascinating one.
I am drawn to this heart-break methodology because it connects with my own experience. Therapy is not only a most difficult art to get right in terms of honing a set of skills it is also a costly one, emotionally speaking (though frankly, financially too). To simplify: a costly commitment from one's therapist is what (most) clients want and need. Am I really with this client, deeply listening and attentive? Do I enter each session with a beginner's mind, as though we've never met before? From a client's point of view they know to trust their inbuilt bullshit detector; 'You look like you're interested in me, but I don't think you are. Your mind and soul are elsewhere right now.'
Just to be clear: none of what I'm articulating here should be taken as a licence for flagrant boundary violations, emotionally or physically. Nor am I arguing for a casual definition of attachment as a sort of part-time friendship which often leads to therapy turning into nothing more than weekly sessions of chit-chatting catch ups. Therapy overflows with paradoxes as you've probably started to realise: intimate yet made up of boundaries, personal yet professional, friendly and warm but not a warm friendship per se, full of feeling but objectively analytical at the same time … one could go on listing these tensions and perplexities. And they are all there all the time, in every second of every 50 minute session.
Therapy is fundamentally a foray into the unknown; the unknown in this case being the Unconscious. That is really all the word means; parts of me that I find hard to access and hold up to the light, especially those parts that are shameful, deemed unacceptable, or feel too much out of my control such as ancient traumas. It is this interplay of conscious and unconscious minds - there being four minds then in the room at any given time - that the TR exists to track. Because we first came to life in the face of the Other (our mother or other central caregiver) we often need a set apart season in life to walk with someone who will be for us a reliable guide - though never an infallible one - as we seek to tune into our undiscovered selves. This witness or listener will be amongst other things, consistent, reflective and caring, but never just a cheerleader for our best or most public self. Challenge will come, though gently: clients will be urged to stop and feel and think before they rush on ahead with their lives repeating old limiting or damaging patterns. It's a handy analogy for therapy, Dante's Divine Comedy: to go into the darkness and fear of the Underworld and confront there the trapped and suffering ghosts. But not doing this terrifying task alone is what matters. Above and beyond what we therapists might think of as our wit, verbal cleverness, or theoretical interpretative nous, there is simply dedicated, trustworthy, steadfast company whilst the client journeys into the darklands and the swamplands of their soul.
Which brings us to the issue of how therapists deal with managing client expectations and handling their disappointment; success and failure in other words. Clients can be at their wits' end and are desperate for you to help them. And if you don't or can't, what then? How will you deal with either the conflict, the complaints or the ghosting - all possible reactions to feeling disappointed by the therapy process. Though I often say at the start of therapy 'I can guarantee you only one thing - and sometimes not even that - namely increased self-knowledge', this may not be recalled or desired at the start, middle or end of therapy. Sometime the client just wants the pain to go away, and fast. On the issue of therapy's perceived 'failures' or lack of cure, the psychoanalyst Josh Cohen has commented:
'An immediate problem with therapeutic success as a criterion of judgement is that it makes no space for the educative value of failure in the development of clinical treatment. Freud stated repeatedly that he had learnt far more from therapeutic failures than from his successes. For him the essential purpose of clinical work ... was not to help ailing individuals, but to advance our knowledge of the structures and mechanisms that govern psychic life. In fact, the very distinction between these aims is probably otiose; the clinician guided by the wish to understand is always better placed to help than the clinician guided by the wish to help. Where the wish to help, which is necessarily influenced by the therapist's wish to gratify the patient, inevitably constricts the clinical imagination, the wish to understand opens and expands it.' (Josh Cohen, TLS, November 11, 2022).
And yet I wonder if the urge to help - and yes to experience gratification through our work - is actually impossible to eradicate in Cohen's rather cool, clean, Freudian way? One of the most challenging views Carotenuto sets forth in his book is his risky encouragement to be real before the client, to be rather than do the therapy. The following will not meet with widespread approval because it is quicksilver in its slipperiness and skates over a great deal of in-session skill, mostly concerned with timing, tone and content. But still, he names a truth that can help move the TR onto significantly deeper and richer levels:
'If we consider that it is the personal wound ... which leads one to take up this profession, it becomes clear how strong the need is to be accepted and loved by patients for oneself and one's suffering humanity and not only in the role of 'saviour' or comforting and infallible guide. In my opinion, this is the secret hope motivating the analyst to embrace the suffering of the individuals who come to us. Being aware of the dark side of our work can help prevent the transformation of those desires into unconscious exploitation.' (p. 264)
We may be vulnerable then but we are also resourced for the work of transformation, or we should be. Though we may need to be seen and regarded on some level, our orientation towards the client's growth is always primary. In this we shouldn't lose sight of two vital aspects: our power and our capacity to hope, to keep going on. The therapist may feel lost or hopeless at times, but probably not as lost and as hopeless as the client feels. When the client is near exhaustion our commitment to them may be one of the few things that is keeping them going on. These moments are amongst the hardest in therapy to endure: the moments when the psyche feels hollowed out and can taste nothing but despair. And despair as strong as this can migrate to the therapist's psyche too; but we have more capacity to bear it than the client does. This then is why therapy is costly to client and therapist. Carotenuto glosses our power of hopefulness when he writes: 'The analyst, having already traversed the shadows, knows that there is no such thing as perennial darkness - it is always possible to provide some light, if only that of a candle, to make possible the first steps forward.' (p. 35)
But still, 'failures' will happen. I put the word in quotes because who is to say what counts as a failure? The client, most obviously, and it is their right to do so. I may not agree, or might be more inclined towards doubt and ambiguity: 'Some things were achieved but many were not.' The client may see things differently in six months or in six years; or they may not. They may come back to you at some later date, or go and see another therapist, or they may never want to think about therapy ever again. All options are possible and as therapists we have to be OK with them all. Nothing is more protean and in flux than the human psyche. Which only brings us to back to our need for humility.
The Italian movie The Great Beauty came out in 2012. The film's lead character is Jep Gambardella: writer, journalist, and man-about-town. He appears to spend most of his time wandering around Rome at 5am following another night of partying and witty conversation with his friends. That's it for plot, essentially and perhaps also finding out the answer to the question, 'Jep, why did you never write another novel?' But he's an appropriate figure to end with not least because it keeps the Italian theme going! But more seriously, Jep embodies for me all the qualities of a good therapist: he's loving, intelligent, non-judgemental, empathetic, knows the power of memory and the sacredness of the present moment in equal measure; he adores life but accepts and allows himself to be wounded by death and illness. But above all he is a teller of truth. Truthfulness is certainly very near the top of my list of essential therapist qualities (certainly up there with humility). I also wanted to end with a lay figure like Jep, and not a revered analyst like Aldo Carotenuto, for this reason: therapy, like so many professions today, is ever more set apart, regulated, categorised, and hedged about by qualifications, competency tests and hierarchies. As a result anxiety now profoundly pervades a profession dedicated to helping people live lives that are not saturated by anxiety! Jep would make a great therapist because he has lived through the heights and the depths of life and is able to put these experiences into thoughtful speech. In spite of his immaculately pressed shirts and trousers he's got his hands dirty over and over again.
I'll leave the last words to him, the last words of the film. His insights into living with zest and truthfulness come about not through the avoidance of pain but from imaginatively bearing it. We are never too old - or too world-weary - to tell our story again - or perhaps even for the first time. For Jep this fresh living is the realisation that he has indeed time to write that second novel.
'This is how it always ends. With death. But first there was life. Hidden beneath the blah, blah, blah. It is all settled beneath the chitter chatter and the noise. Silence and sentiment. Emotion and fear. The haggard, inconstant splashes of beauty. And then the wretched squalor and miserable humanity. All buried under the cover of the embarrassment of being in the world. Beyond there is what lies beyond. I don't deal with what lies beyond. Therefore let this novel begin.'
Photo by Emir Bozkurt: https://www.pexels.com/photo/grayscale-photo-of-pigeons-in-a-cage-14725557/