I am going to start by owning up to the fact that this post has nothing to do either with the film ‘Frozen’ or with gardening. So for those hoping for some insight on either topic – I am sorry to disappoint. Having said that, if you have any interest in the subject of therapy, or if you are in therapy yourself, I do hope that you read on.
A couple of months ago I had one of those ‘revelatory’ moments through therapy, that it is easy to live for, but hard to come by. It was a significant realisation for me, as it challenged my assumptions about the nature of therapy itself. Those assumptions had affected both my engagement with the process, and also my relationship with my therapist. The ‘revelation’ had an enormous impact on the way in which I approach therapy, on how I relate to my therapist, and on the expectations I have of what ‘should’ happen in session. (“There is no ‘should’, there are no rules”, I can hear my therapist saying….).
In ‘A matter of choice – BPD and self-worth’, I started by saying that therapy has twin tasks – to reveal the ways in which we really think about ourselves; and to ‘make up for’ what has been missing, and that those tasks can be more broadly described as dealing with content (or process) and with relationship. In that post, I said that both of those tasks were important – but that wasn’t the position I started with, several months ago.
So much of what BPD is about is concerned with relationships, and my absolute desire for connection had led me to place the therapeutic relationship at the centre of my therapy. It was my primary interest, and I thought it should be my therapist’s primary interest too. All the reading I had done had pointed to the fact (or so I thought) that the key vehicle for change, particularly with a ‘condition’ such as BPD, was the transformative power of the therapeutic relationship. I thought about it, and I talked about it, endlessly –it was my key preoccupation. Those with BPD are often said to have an ‘all or nothing’ approach to life – and this was certainly the case with how I thought about therapy. The therapeutic relationship mattered – and in the context of sessions, it mattered to the exclusion of all else.
Whenever my therapist suggested that content and process were important too – or that her task was also to uncover my unconscious thoughts about myself – I argued that that was not possible until the ‘re-provision’ of what had been missing in my life, was well under-way. If the ‘patient’ has not already forged a rock-solid relationship of trust with the therapist, and has not yet been ‘re-parented’, how will they be in a position to cope with the potentially devastating realisations surrounding how they think about themselves? Nothing could have shifted me from that position (or so I thought) – and any attempts by my therapist to try and ‘re-focus’ me, I simply construed as rejection.
My husband often grumbles that I listen to my friends but not to him. He can make a point over and over again, but it’s not until I hear it from an ‘independent source’ (whatever that may mean!) that I actually take it on board, and trust it. In this case, it was only when I read the point my therapist was trying to make, in two separate books by Irvin Yalom (a well-known American psychotherapist and author), that it truly hit home. It grabbed me, in only the way that something can when it truly makes its home in the innermost parts of your being. It made both intellectual and emotional sense and I felt it as a conviction at the deepest level.
In his book ‘Love’s Executioner and other tales of psychotherapy’, Yalom describes his work with a client who, amongst other traumas, had suffered sexual abuse by her father. In that context of that tale, Yalom writes the following (the highlighting for emphasis, is my own):
“When I first began to work as a therapist, I naively believed that the past was fixed and knowable; that if I were perspicacious enough, I could discover that first false turn, that fateful train that has led to a life gone wrong; and that I could act on this discovery to set things right again…..But over the years I’ve learned that the therapist’s venture is not to engage the patient in a joint archaeological dig. If any patients have ever been helped in that fashion, it wasn’t because of the search and the finding of that false trail (a life never goes wrong because of a false trail; it goes wrong because the main trail is false). No, a therapist helps a patient not by sifting through the past but by being lovingly present with that person; by being trustworthy, interested; and by believing that their joint activity will ultimately be redemptive and healing. The drama of age regression and incest recapitulation (or, for that matter, any therapeutic cathartic or intellectual project) is healing only because it provides therapist and patient with some interesting shared activity while the real therapeutic force – the relationship – is ripening on the tree.”
In his book ‘The Gift of Therapy’, Yalom puts the same point in this way:
“But it is not the content of the intellectual treasure trove that matters but the hunt, which is the perfect therapy mating task, offering something to each participant: Patients bask in the attention paid to the most minute details of their life, and the therapist is entranced by the process of solving the riddle of a life. The beauty of it is that it keeps patient and therapist tightly connected while the real agent of change – the therapeutic relationship – is germinating.”
As Yalom also states, “In practice, there is a great complexity in the link between the intellectual project and the therapist-patient relationship”. And he does not deny that the key therapeutic force is the relationship itself. So my focus on this aspect was not misplaced – but my focus was certainly too narrow and too exclusive. The therapeutic force – the relationship – needs feeding in order to maintain its momentum, and its food is both process and content. Its food is ‘the hunt’, ‘the intellectual project’.
I have a tendency to want to ‘do everything right’ – and therapy is no exception. It would be easy for me, therefore, to substitute an exclusive focus on ‘getting the therapeutic relationship right’, with an exclusive focus on ‘getting the content and process right’ – or to try and do both. But I think that would be to both misunderstand the nature of therapy, and also to misunderstand what Yalom is trying to say. In the same chapter in ‘The Gift of Therapy’, Yalom writes that he discovered that what he and what his clients remembered and valued about sessions, were very different. He tended to value intellectual interpretations, whereas they tended to value small personal acts that were relevant to the therapeutic relationship. The precise intellectual interpretation was not what made the crucial difference. He writes that, instead, “…the search for explanation kept us engaged and our engagement ultimately made the difference”.
I take that to mean that it is not necessarily the precise content of sessions that is most important, but the process of talking about the content, and indeed that it what Yalom said when he talked about the ‘treasure hunt’ being more important than the contents of the ‘treasure trove’. And I have seen this borne out in my own therapy. Recently we discussed a difficulty in a friendship, for which I felt a failure and was blaming myself entirely. My therapist kept offering up suggestions for what might have been going on with my friend at the time, and when I thanked my therapist in my next session for the fact that I had since felt much better, she said she had been trying to give me a different perspective. However, what I took away from that session was a sense that she was on my side. Without that sense, I would have been unable to get through my distress and take on that different perspective. The intellectual interpretation and the personal act: two different views on one session, in which our relationship was made stronger through our shared endeavour and exploration.
What I learned from my reading, and from experience itself once I applied that reading to my sessions and ‘widened my focus’, is this: therapeutic alliance is central to change, but it doesn’t have to be central to the conversation.
I was ‘majoring’ on our therapeutic relationship, but in doing so, I wasn’t giving it room to breath or grow. By constantly putting the spotlight on it, I was freezing it in time. By neglecting the importance of content and process, I was completely missing the fact that the relationship grows, in the background, using the process and the content as its sustenance. I was not feeding our relationship – I was stifling it, and starving it of oxygen. I was expecting a flower to grow, in an expanse of ice. I wanted, desperately, for my therapist to care about me. But what was I giving her to care about? What was I telling her about myself, or my life? We all know that our best and deepest friendships are based on shared experiences, and a shared journey (emotionally, even if those friends are not physically present). My therapist and I need to go on a journey together, and to get to know each other through the things we encounter. If we only encounter each other, in isolation from the world around us, there is not enough ‘grist for the mill’, and there is no way to deepen the relationship.
I still have the urge to spend most sessions talking about ‘the relationship’, just as I spend so much time thinking about it. But when I do leave room to talk about other things, it’s amazing how often and how naturally ‘the relationship’ comes into it, whether that’s through the interpretation of a dream, or the way I reacted following a session, or some other situation. But it comes up in a way that is not forced, and which provides continuity and a deeper understanding between us.
So for those who are also struggling with what to expect of the therapeutic relationship and who find themselves constantly engaged in thought or in talk about it, my suggestion would be – take your eyes off it for a little while. It will grow – if you let it. But it will do so in the background. It will germinate, it will ripen on the tree, while you are engaged in turning over and ploughing other fields. And when you turn your attention back to it again, you will have a rich harvest of shared experience, understanding and mutual caring. You relationship will have matured, and it will be beautiful to behold.