Relational Interventions in Psychotherapy

A client seems cross in the moment, irritated by something they feel to be happening between us, but neither of us able to put a finger on exactly what it is.  Another hunches, hiding their face, concerned about what I might make of their feelings of dependency in the therapeutic relationship.  Still another remarks on the similarities they perceive in me and their father, though note that little of that comes by way of appearance or behavior—it’s just a kind of…“presence”.

Those who know something about psychoanalytic therapy are likely already familiar with the idea of transference, the kind of unconscious associations to past relationships that repeat themselves in the relationship between client and therapist.  It’s not an essential concept for all therapies, and there are many that attempt to create structures that try to limit or constrain the possible acting out of these dynamics (seemingly without realizing that whatever this evokes is simply another version of the transference playing itself out).  But for therapies that tend towards some form of relational engagement, observing transference is fundamental to understanding what might be taking place between client and therapist and how to work both with and within it.

It is this idea of with and within that I want to explore a bit in this post.  On the one hand, working with the transference is in alignment with the origins of the concept and the classic Freudian notion of the analytic attitude and the blank slate.  The original purpose of the psychoanalytic approach was to allow the client to project onto the analyst what they needed to, through a process of free association that purported to release the unconscious elements of the client’s psyche into the relationship and onto the analyst.  The analyst would then be tasked with taking a neutral stance to these phenomena and offer interpretations that attempted to view the transference objectively, from outside of the identified projections, using this as a basis for highlighting the client’s various defenses as they played out in the therapeutic relationship.

As psychoanalytic theory has evolved, some consideration has been given over to questioning whether this neutral stance of the therapist is even possible.  Surely, there are still those who practice in a neo-Freudian style, or similar analytic traditions—such as Lacanian analysis—who assume that an analyst who is appropriately observant of everything that is going on in the relationship can contain their own experience and filter back to the client the themes of the session in an unadulterated fashion.

Many of the relational and interpersonal approaches (of which I am most fond) question the fundamental basis of this idea.  Certainly, there are enduring elements that the client brings into many or all relationships, and these are likely to emerge in the therapy as well.  Through a relational lens, the only transference we can analyze is one in which we are fundamentally implicated.  This then becomes a genuine matter of technical concern when it comes to what it is we are attempting to accomplish in therapy.  Perhaps more than any other element of analytic consideration, the theory one applies to understanding the transference-countertransference elements of the interaction are going to be highly determinative of what the therapist is or is not going to be willing to share in a session and how they might go about sharing it, to say nothing of what they make of what is happening.  Classical models will tell you that very little of what is going on in the analyst should be offered to the client and that the importance of being properly analyzed or having one’s own therapy/supervision is to contain those biases, perspectives, and attitudes that might otherwise risk entering the analytic field.  The field is negotiated by theory and analysis of the client’s defenses and little else.

On the other hand, the more relational therapist would say the importance in supervision is not merely to understand so that these things can be contained, but to understand such that these things can be metabolized and then thoughtfully and appropriately shared with the client.  An analysis of the transference that does not account for one’s own countertransference is kind of like trying to share what is happening in a work of art without admitting any of the impact it has upon you.  “Yes, well, there’s water lilies, and they seem to be quite pretty, though a bit blurry, and there’s some water there as well” is certainly one way to describe Monet, but not many would care to approach his work from that angle.  Feeling is essential to understanding any interpretive process.  In fact, the very idea that one could interpret without taking into considerations one’s biases and felt sense of the experience of being with the client is something of a fallacy to begin with, as even the idea that the transference is of ultimate importance to interpret and that the analyst can properly neutralize aspects of their own experience, or contain them without even the slightest bit of their own unconscious process slipping into the analytic frame, is itself shaped by unconscious commitments.  We are inextricably implicated in the development of which theories we choose to adhere to and why.  We cannot help but become entangled in a dynamic situation in which we are already involved.

So, taking for granted that we are going to be operating within a realm where countertransference is essential to understanding the transference, that part of the process of doing good therapy involves interpreting the transference, and that (and this is a separate assumption) that therapy involves in some sense an approach to illuminating being—meaning it is cognitive, affective, relational, and so on in whatever ways we might want to parse our understanding of what it is human beings are or “do”—then this points to an incredibly complicated question regarding technique: how does one interpret the transference-countertransference interactional matrix while remaining inside of said matrix?  Of course, in one sense this is a false dilemma, as we are always already within that matrix in the way that I am discussing it, and therefore even the best attempts at neutralizing the countertransference will be coming from inside that matrix.  But what I mean in a sense is how do we respond from a place where we can still feel and hold on to the reenactment while also being able to comment upon it?  Where the being within and without happens (in as much as it can) intentionally.  Something like the participant-observer model described by Sullivan and the interpersonalists.

Allow me to go back to one of the examples I opened the post with to get a better understanding of what I mean here.  For the client who is looking at me crossly, but for reasons which neither of us have a clear understanding, let’s assume (in a really simplified way of understanding the idea of transference) that they had a highly judgmental father.  As such, some part of their experience is not just to hear much of what I say as coming from a place of judgment, but also involves evoking a space in the therapeutic situation where some of what I am prone to reflecting back may in fact carry an air of judgement.  Some element of what they are projecting into the space makes it impossible not to have a strong reaction to something it is they do within our sessions or are reporting about their life.  From this position within the paternal transference, one potential possibility would be to seemingly detach from the experience altogether, comment in a rather flat way on what the client is doing—i.e. making me into a version of their father they can continue to do battle with for whatever form of gratification that might yield for them—and in delivering that over to them enough times hope that it organizes their conflict and allows for the analysis of repressed feelings of aggression, guilt, and so on.

That approach would be fine, and many folks have “success” operating from that angle, whatever we might want success to mean in that sense.  However, there is something about this approach that (I think purposefully) sterilizes the interaction.  By that, I mean that it takes out the very element that we as therapists should be most interested in, the experiential charge that the client is bringing into the session, and working through that as opposed to on it.  As such, you effectively take the client out of it as well, removing everything but the more cognitive elements of the interaction, therefore allowing the possibility for some change, but change that is cordoned off to a space of intellectual “knowing”, a place where a client might be able to say they “get it”, but not to a place that allows that conceptual insight into their relational patterns to have embodied or affective resonance, thereby limiting the scope and depth of the thing they are attempting to get a handle on.

So, what else might we want to do with an experience like this?  Well first off, we need to be able to catch it, which is where good supervision, having your own psychotherapy, reading work that involves developing a relational lens, and other reflective practices come in.  But assuming those are structured into one’s system for how they go about supporting their own work—and assuming the client is at a place in the relationship where they could tolerate this kind of engagement—you might take a moment where  you notice the client becoming defensive or yourself feeling whatever sensation leads to the accusatory position you’ve been getting pulled into.

From a classical framework, this is where you might describe the paternal transference (“I feel like you are inviting me to shame you, much like your father did”), or even in an object-relations way you might signal something about projective-identification (“there’s a kind of hostility in this response I’m having, but I don’t think it is entirely mine”).  Both of those acknowledge something of the transference that is playing itself out but fail to see the full scope of the interaction.  They offer the therapist, and therefore ultimately the client, the safety of stepping outside of the interaction to determine some explanation of what is going on.  This overlooks the fact that this is not just transference, but is something that is actually happening right now.  Which is to say that there is something both the therapist and client are doing, perhaps before any of this even begins, that is creating the process by which we are getting to this place.  This might be some consequence of parataxic distortions the client brings to the relationship (it almost certainly is), but the healing isn’t happening in the past.  It is happening in the real-life relationship between the client and the therapist, right here, right now.

Rather, we might implore the clinician to notice their own feelings in the moment.  Perhaps they do begin to feel judgmental, or sympathetic, or bored at the repetitiveness of this aspect of the client’s behavior within session, or perhaps slightly amused (as one might towards a child who was insistent on being taken seriously), or annoyed, or increasingly tender towards the client.  Each of these is an interactional position one is being asked to take within the interpersonal dynamic between client and therapist.  The challenge is to not let the position we are taking up overdetermine our role within the interaction and organize the interaction such that it limits the possibility for meaningful contact.

So how do we invite the client into a relational dialogue?  Notice the difference between these responses and a strict “interpretative” position as previously described:

“I noticed something in the room just became quite tight.”

“I can feel myself almost becoming evaluative right now.”

“I can’t help but have a sense of a growing distance between us in these moments.”

None of these try to organize a psychic mechanism.  They name what is happening and invite the client to be curious about the process as well.  These kinds of interpretations open the way to a different kind of therapy, but one that is alive, intimate, and gives the client a genuine opportunity to be with the therapist in a way that they can carry with them into other relationships.  We don’t just teach them how to be in tension, explore conflict, embrace ambiguity, or hold the charge of meaningful contact with another human being, we enter into it with them and, in a way, admit to our own uncertainty but desire to be in that space regardless.

It’s a challenging shift to make in one’s approach, as I don’t sense that many of us are organically brought into this way of relating to others.  And admittedly, it may not always be what the client needs.  Perhaps at times the right therapeutic move is for us to occupy their desired position in the relational frame, without examining or deciphering what it means in every instance.  Developmental considerations matter.  Nonetheless, this stance represents a potential mode for the therapist to dare to occupy which opens up some of the most dynamic and profound opportunities for being with the client that the clinical encounter can offer.