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Between Client and Therapist: The New Relationship

True NorthTrue NorthCo-moderator
I read this book two years ago when I was with oldT and recently picked it up again. It was written by Michael Kahn who has a PhD in clinical psychology from Harvard.

In re-reading it now I understand what he is talking about from a fresh and new perspective. I had highlighted a lot of stuff in the book hoping to share it with oldT. What I highlighted were explanations of things that I felt I needed from him and things that I felt he needed to know and understand in order to understand and help me. While the book is not specifically about attachment it talks about how certain therapist work with attachment and their theory behind it.

Well, in reading it again... lo and behold... all the things I highlighted and were important to me, things I longed for oldT to know and understand and do for me.....well....my current T is doing all of them! How amazing. Reading this book is like reading my T's strategy for healing me.

Let me explain a bit more. The book covers the theories of Freud, Gill, Kohut and Rogers. My T is a perfect blend of Gill and Kohut with a smattering of Rogers thrown in for good measure. Gill's main theory was called "Re-experiencing" which sort of agrees with Freud in that looking at our pasts to understand where we are today is good ... it's only PART of what we need to do. We also need to reexperience the past in the present, with a therapist. I'll quote Kahn here as he explains what Gill felt about his work ...

"If remembering is not enough what is missing is re-experiencing. Gill believes that because the client's difficulties were acquired through experience, they must be transformed through experience. They cannot be reasoned away. While it is necessary for clients eventually to understand the roots of their difficulties, that understanding cannot be merely delivered as an explanation. It must emerge as clients re-experience certain aspects of their past. And this re-experiencing must occur within the therapeutic relationship" (1997, p. 57).

Gill felt that the client must feel free to discuss all of her feelings, including those she feels towards the therapist and the T must never be defensive but accepting and non-judgemental. The main theme of Gill is really working with the transference and having that corrective emotional experience.

As for Kohut... well Kohut is the self-psychology theorist... meaning the psychology of the self-structure (not to be confused with a self help kind of therapy). Kohut's main objective was showing the client empathy. He felt that this was of the utmost importance. He also uses mirroring, idealized parental imago, and twinning.

Kohut reminds us that defensiveness is one of a T's worst enemies. Kohut counseled therapists to be emotionally available. Again quoting Kahn, "Kohut was concerned with two questions: What exactly was it that his client hadn't gotten from her parents, and what could a therapist do about it?" (1997, p. 98).

And... "We want clients to reveal themselves to us. If we are empathic, they will gradually come to trust us. If we punish their revelations, we will teach them to suppress any thoughts they have learned will be criticized" (1997, p. 103).

Of course, Rogers is a humanistic T and is well know for his theory of Unconditional Positive Regard. He felt that listening to his clients and being totally accepting of them will help to heal them.

All three of the above well respected psychoanalysts stress the importance of the client-therapist relationship, looking at and understanding the past and being accepting of the client's developing attachment/relationship to the T.

It's a fairly easy to read book that I feel is important to those of us who have suffered trauma, abuse and attachment injury. If anyone is out looking for a new T they may want to ask how much they know about the theories of these three influential men.

TN
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True NorthTrue NorthCo-moderator
quote:
I read the book a few years ago (couldn't put it down if I remember right) and remember thinking "wow, the author followed my T around for a few months and just wrote down everything he did."


AG that made me smile. It WAS smart of Kahn to just follow your T around LOL.

But truly, I think the book gives great information on how Ts work with transference and attachment and talks about what has been missing in our childhoods and what we need now from our Ts to heal.

I may share the book with my T at some point, if we can ever get through the minefield that oldT left for us.

TN
lamplighterlamplighterMember
I read this book last year when I first started collecting books on therapy - but I can't remember now what it was like (I actually have it in my pile of books to re-read at the moment.)

What I've found a bit worrying with all my reading of these types of books is that I've been assuming that therapists also have either read them or know about the stuff that's in them - and am finding that proably, I know more about the theories of effective psychotherapy and psychological processes than most of my Ts Frowner

I'd be rabbiting on about something blindly assuming that the T knew what I knew and was applying the same principles as I was, only to realize they probably hadn't a clue. I think part of the trouble is that these books exemplify the ideal therapy, show the various approaches as they ought to work, and are written by people who actively use the ideas and techniques in their own practice so they can give us a misleading expectation that ALL Ts are au fait with the ideas and techniques and understanding...

What's frustrating too is that a lot of this sort of literature is written from a pscyhoanalytic perspective, ie they are based on the process of psychoanalysis and therefore are less likely to be known and understood by those Ts who practice other approaches, even though what they say seems just as relevant in ALL therapies not just analysis.

So TN it is GREAT that your T not only knows and has read about the same things you have read and learnt, but also puts into practice those very ideas - that must make for feeling truly understood Smiler

When I've reread it I'll be back to put in my further 2 cents' worth Razzer

LL
lamplighterlamplighterMember
Hello again UV - it's good to see you back and posting. And very opportune too as I have a question about some defintions in this book (I have started to reread it and am up to chapter 7 now). TN you might be able to help me out here too, or in fact anyone who has read the book.

Firstly want to say that now I'm rereading it I remember it from last time, and my main criticsm of it was that it's both quite superficial (he doesn't really explain the theories of Rogers, Gill and Kohut in anywhere near enough depth to make sense to someone who has no prior knowledge of psychology/therapy/psychoanalysis) and at the same time makes some sweeping assertions without backing them up with examples or enough relevant case histories - even some of the case histories he presents don't (to my mind) explain the point he is making. Even now a year later after having read dozens of books on psychology and therapy and psychoanalysis and thus having a better understanding of the different theories and how they are applied, I STILL don't get a lot of what Kahn is talking about.

So here's my questions, for anyone who has any clues about these things - it's Kohut's self psychology stuff that defeats me mostly - what for instance are transmuting internalizations? I understand internalization, but the explanation Kahn gives of this term makes absolutely no sense to me - I do not understand how an occasional failure on the part of a caregiver results in the child discovering an ability to provide 'nourishing empathy' for itself. I get that occasional failure on the part of a caregiver IF IT IS SUBSEQUENTLY REPAIRED OR RESOLVED can result in the child learning that others do not need to be consistently perfectly attuned for it to still feel loved and worthwhile and acceptable and therefore be able to build a sense of itself as lovable etc, but I do not get how the failures themselves somehow make the child able to nurture itself, it's the prior and subsequent good nurturing from the caregiver that gives the child the ability to hold onto that good image to get it through ruptures and failures etc. Given that I'm not that clued up about these theories and the like, it's probably obvious that I'm not seeing something here so I'm hoping someone might be able to explain it to me?

I also STILL don't understand projective identification. Sometimes I think I get it, most times it too makes no sense to me. I fail utterly to understand how a therapist can attribute his/her feelings as belonging to the client. I accept that a client can act in a particular way that affects the therapist emotionally, but that's the therapist's feelings, not the client's. Anyone willing to have another go at explaining this concept to me?

Lol I had a load more to say about psychodynamic therapy but this is way too long already so I'll finish and hope someone is able to understand better than me some of the things presented in this book.

LL

Edit: Oops just realized that the way I'v written my thoughts about the book might come across as offensive and insulting to people, I don't mean to criticize anyone's views at all and I'm sorry it it's come across that way - it's more my not understanding a lot of what the book is about that's the issue - and I don't really mean the book is superficial, just that from my reading of it, it seems to me to presuppose a lot of prior knowledge of therapy and theories and psychoanalysis in particular, without which I found it really hard to be able to apply the explanations of the three different theories. Sorry Frowner
True NorthTrue NorthCo-moderator
Hi UV, thanks for your thoughts and for providing the link to the Kohut article which I enjoyed reading.

LL...Thanks for the thought-provoking post. I, too, still have problems understanding the projective identification stuff. And like you... sometimes I think I have a grasp on it and other times I can't figure it out. I think we need to realize that these are fairly advanced concepts in therapy and perhaps if we had the full and proper education (as in masters and doctorate level) this understanding would come easier for us.

As far as transmuting internalizations go, I take it to mean that (as like in attachment) you only need good enough parenting not perfect parenting and there will be failures along the way of your development. And if you have enough successes and emapthic attunement with your caregiver/parent then you build a strong enough self structure that when those few empathic failures occur you are able to endure them without damage because you will feel that it has nothing to do with who you are as a person and perhaps it's the fault of the other person who failed you. That is just my interpretation of what he is talking about. I just might ask my T to elaborate further on this so I can understand it better. Like you, I would believe that repair is an important part of those failures but maybe it's not always necessary for a healthy, normal devleopment. I'll let you know if I unearth anything else about this.

I didn't read your post as insulting or critical at all. Your comments were very good. And yes I believe that Kahn tried to simplify the theories of Gill, Kohut and Rogers and I would look to the recommended reading list he provides at the back of the book if you want to delve deeper into the theories of any of these three important psychoanalysts.

Best,
TN
lamplighterlamplighterMember
TN thanks for explaining those ideas to me – yeah if you do get any more clarification about it from your T, that would be great if you could post it here. I hate it when I come across terms that I don’t understand, especially if it’s stuff that is likely to be known to a T and applied in therapy.

STRM thanks for that example – that sounds just like what projective identification, as explained in some books, seems to be. I still fail to see though how a person can actually feel another person’s feelings, but maybe it has to do with empathy? That if a T is attuned and attentively and empathically listening, maybe they subconsciously pick up on feelings the client is experiencing and feel them as if they were their own? Though the bit about PI that I don’t understand is that it seems to be to do with feelings the client is not owning or aware of that somehow get projected onto the T who then proceeds to experience them as his/her own. That does my head in trying to understand that. Confused Confused Confused

LL
Attachment GirlAttachment GirlAdmin
Hi LL,
I really must get off to bed (deadline in a week and I'm working insane hours) but wanted to take a quick stab at explaining what is meant by a T saying that feelings are coming from a patient. It is confusing, because part of forming good boundaries is for us to recognize that we are NOT responsible for other peoples' feelings, only our own. So I think at least part of the problem comes from us hearing it negatively, that somehow if our T is feeling our feelings then we're trying to dodge our responsibility, but I don't think that's what they mean at all.

I don't know if you've ever read about mirror neurons? Recent brain research has discovered that there is actually a "social" center in our frontal lobe, that is dedicated to understanding other people. Human beings are social and depend on relationships with other people to survive and thrive so part of what developed in our highly developed brains is a way for us to understand what is going on in someone else's brain.

Do you know how we're always talking about how so much of communciation is non-verbal? How so much can be misconstrued when we're only using text? It's very real and the reason is that this social center of our brain is tracking a lot about a person we're with. As we pay attention, these mirror neurons actually fire up in response to all the cues we pick up about another person. For instance, if we walk into a room and notice someone is really sad, we instinctively slow down, talk more quietly and in general slow our system down to match theirs. That's because we "feel" their sadness in these mirror neurons. This plays an important part in understanding other people.

T's, at least good ones, are people who have focused on honing and developing their skills at picking up on what another person is feeling so they can understand them. With feelings that we are aware of and express, we tend to have a flow. The feelings arise, we acknowlege them, then they move on through us and we release them. But if we're carrying feelings that are too dangerous or scary to acknowledge, they often stay stuck. If we cannot be aware of them, we also cannot let them move through us. So in some sense, they're like this constant thrumming that isn't changing. A sensitive T sitting across from us will sometimes pick up this "thrumming" and in their mirroring capacity start to "feel" our grief or anger or fear. Another important part of a good T is their ability to not only be aware of what is going on with a client, but also to be aware of what is going on inside themselves. So essentially if a therapist starts to experience intense feelings, such as anger or grief, they check inside themselves to see if it's "theirs" so to speak. Like, are they getting triggered? Is what is going on with the client somehow reminding them of an old relationship and they're reacting to it? This would be countertransference. So if the therapist is having a strong feeling that the patient is not talking about or claiming and they check within themselves and realize it's not their own reaction, they are left with the conclusion that the feeling is actually clients. That they are picking up on that feeling. They're acknowledging that isn't about accusation or shaming or pointing out that the client is doing something wrong. It's doing their job of bringing something unconscious to to the awareness of the client. We can only know ourselves in relationship and we cannot change ourselves until we can understand what it is we do, without thinking usually, and why we do it. That understanding is our key to change. Hope that helps, I'm off to bed. Smiler

AG
lamplighterlamplighterMember
AG thanks for taking the time to explain that (I hope you got a good night’s sleep too!)

It all makes perfect sense and you’ve explained the difference between countertransference and PI nicely so that even I understand it now (I think!). I guess it still bothers me the ‘projective’ part of it – I can understand how unacknowledged or unowned feelings can be picked up by someone else (your thrumming explanation makes that very easy to understand!) – but the stuff I’ve read about PI implies that clients are unconsciously projecting their feelings onto the T – as if there’s some sort of deliberate aspect to it. While it wouldn’t be threatening if a T said that s/he was experiencing my feelings, it would be threatening if they maintained that I was somehow intending them to pick up those feelings, as if I’m manipulating them to experience or own my unacknowledged and unfelt feelings. Does that make sense? Or have I completely misunderstood this aspect of it?

I guess at the end of the day it’s not that big a deal, my T never uses psychological jargon so it’s not as if I need to understand it, it’s just me, if I don’t understand something it bothers the hell out of me – I’m nothing if not obsessive lol.

LL

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