The Containing Function of Language

It is often easy to get caught up in the mindset of needing to “do something” in therapy.  No more so is this true than when our clients are going through a significant crisis of sorts, pulling on some version of that good-naturedness that I think resides in most people who pursue the craft of therapy as a full-time profession.  Of course there are always some exceptions to the rule, and it could in fact be the case that there are those who otherwise found their way into this practice without recognizing in themselves a tendency to fall victim to the interpersonal dynamics that inherently exist in this work.  Or, perhaps more accurately stated, it could be that there are those who choose not to believe that their sensitivity to and ability to analyze those dynamics could at least contribute something of significance to this work.  My suspicion would be that it stands to reason someone taking up that approach would also, in kind, be of a far more favorable opinion of the idea that we should be willing to succumb to an impulse to “do something” in the work, so long as that something being done corresponds to a somewhat formulaic set of principles that provide a seemingly sufficient doctrine for navigating any potential therapeutic situation.  In some way, I do sort of envy that position.  It would be nice to be able to take that much comfort in dogmatism.  However, such is not my nature, and so that leaves me in the curious position of having to think critically about what it is that I do “do” when posed with a situation in therapy that seems intractable.

As it stands, I probably have a working model around this that is easier to execute in theory than it is in practice.  Not because it is difficult as a matter of technical application, but because it requires an extraordinary amount of discipline.  Which, said as straightforwardly as possible, is that you have to let the language do the work.

For someone who would often like to be perceived as doing more in the therapeutic encounter, who positions the accomplished interpreters of complex interpersonal dynamics as deserving of idolatry of the first order, it can be quite difficult for me to remember the all-too-simple rules of this practice.  Rules that are often overlooked for their uncomplicated and essential nature.  However, the disciplined and thoughtful implementation of good reflective listening is not only the ground from which the figure of any good interpretation might emerge, it also may at times be all that is needed or appropriate in a given therapeutic situation.  It also is much harder than it looks in practice.

Reflective listening still requires, in many instances, our offering some verbal indication of the fact that we are listening.  As Leston Havens shows us in his book, Making Contact¸we can break those reflections down into interesting and useful categories that stand to accomplish different objectives depending on our interpretation of the clients needs.  For Havens, he approaches the question of how to determine what to say from the framework of making some sense of the ways in which the client is already avoiding contact, with our needing to be sensitive to whether they seem distant and hidden; sensitive to invading or feeling invaded by others; seem not to have any internal sense of self at all.  Though these are discretely analyzed by Havens, I would suspect he’d be open to the assessment that clients tend to float in and out of and represent anyone of these positions at any given point in time during a clinical interview.  Granted, it could also be that we want to be sensitive to what is the dominant mode of the client and how they are most frequently showing up.  I think, perhaps more importantly, the text encourages us to be critical of even those moments that seem to boast nothing more than the simple utterances we might use to keep the ongoing dialogue afloat and illuminates the ways in which even this element of the repartee can be essential in bringing the client further into the therapy.

Part of where Havens is coming from here is an interpersonal approach to therapy which emphasizes the fact that nothing the therapist does can ever truly be neutral or detached.  The therapist is always a “participant-observer” in the process, either satisfying or frustrating some projected expectations of what the therapist is or might be to the client.  The blank slate of the traditional Freudian view or the medicalized/behavioral model’s assumption of the therapist being a relatively detached communicator of methods and skills are incomprehensible within this approach.  For the interpersonalists, the client is part of a complicated matrix of meaning-making that involves the ongoing interaction between the client and the various others—real, imagined, or simulated—that populate their world.  This dynamic, once the client is welcomed into the therapeutic space, inevitably includes the therapist and the point of good therapy is to enter into and use that, not to try to skirt one’s way around it.  Of course there are personal hazards here for the therapist.  By way of the introduction to the text, Havens points out the myriad ways in which therapists can be negatively impacted by these interactions, often by their very tendency to be taken in and start to express in their own right some dimension of whatever “pathology” the client is presenting with.  (Havens also uses this to point out the diagnostic value in this aspect of interpersonal impact, leading to the notion that good supervision should never be overlooked, even for the seasoned and experienced clinician.)

I won’t go into a deep analysis of each individual contact style or mode Havens describes in the book.  The whole thing is worth a read, and as clinical texts go is relatively short and written in an uncomplicated and jargon free manner which I think makes it a highly accessible text for anyone interested in refining their technique.  However, I’d like to get back to my original task, which is making sense of all of this in the context of the clinical value of language as serving a containment function in the context of a psychological crisis.  As a general aside, I should also point out that by crisis, I am drawing from my current experience of working with folks who are suitable for outpatient individual therapy that meets once or twice weekly and so the crises in question are those that continue to fit within that level of care.  However, I also think the reason this topic resonates with me and the place where I most refined this skill was in the context of in-patient work where oftentimes there was a pervasive sense of hopelessness and an abundance of dire attitudes about the state of the world or oneself that needed the kind of containment I am thinking about.

Language, and more specifically the thoughtful and empathic use of language, can go a long way towards helping a client get into whatever they are feeling, which oftentimes, though perhaps counterintuitive to the novice or uninitiated therapist, is actually where we need to get our clients in those moments.  That the crisis is usually a crisis of conflict or disconnect between the apparentness of what is already happening and what the client is either allowing themselves or being allowed by others to make of their world and their understanding of it.  So often it is the case that when people are presenting with the kind of debilitating and world-ending crisis I am considering here, the people in their life take up a pseudo-compassionate approach of wanting to provide assurances or guidance.  Rarely are they invited into the hopelessness and direness of the situation as they are experiencing it. 

In a misguided way, I think I often notice myself succumbing to some desire to fix or offer a useful insight.  This misses the point that to be in the presence of someone who is willing to simply utter “It all seems so hopeless” or “That sounds impossible” not only validates the client’s experience but invites them more fully into whatever that experience already is.  But, it also simultaneously locates that experience within themselves and places it within another, namely the therapist, in a way that can bring about the kind of space needed for the client to tolerate that position.  In the context of others who are needing to reassure or make the situation feel or seem better, the client gets left in the loneliness of feeling like it is their responsibility and their responsibility alone to figure whatever this is out.  As a therapist, we invite and are willing to sit in the paradox of the fact that that responsibility is in fact the client’s alone, while acknowledging that that responsibility is most accessible when experienced in the context of a supportive and empathic relationship.

Insight-oriented interpretations can get in the way of this process.  And for the practitioner who has gone a long way to refine that skill set (it is by no means an easy or intuitive one to develop) getting back to uncomplicated person-centered language can be hard without a more comprehensive theory to support why we are doing it.  Havens brings us back to a recognition of the fact that all intervention is a form of interpretation and it takes a subtle and skilled clinician to know when “less” is more.