1. T tracks specific patterns of interpersonal interaction and/or relation between the patient and T
Principle
Te point here is that devotes attention to the pattern o what the patient feels, says and does in relation to T . What the patient says or does shapes what is elt or not-elt (or thought-about or not-thought-about) within the relation- ship. So, too, what the patient eels toward shapes the patient’s thoughts and responses. Tese qualities o relation are the prime ocus or .
Examples
• might reer to the patient’s attitudes experienced and/or expressed toward (humiliation, contempt, denigration, dismissiveness, concern, and so on).
• might comment on the position the patient experiences him/hersel to be in, such as needing to be polite, or to hide what he/she really eels, or to convince that he/she is suitable or treatment.
• will ofen take up a patient’s response to what T says, as an especially illuminating maniestation o the quality o the interaction (and such an intervention would also illustrate how tends to ocus on the patient’s response to what just happened in the session: see item 9 below).
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Illustrative therapist interventions
• “when I make a comment that is aimed at a feeling [you have], this other side of you kicks in—winning, superior, doesn’t need anybody, competing with me and it doesn’t let the other side benefit from my thoughts.” (Here takes up the patient’s response to ’s own utterances, and illuminates what happens to the relation between and the patient.)
• “You see what I’m trying to get back to is, is your way of talking which might be relevant, maybe interesting, but it is really like you said about the last few weeks, keeping you on a certain plane.” ( is highlighting that the relation between the patient and seems to be significant, but this belies
how it is on a certain plane and in fact avoiding deeper engagement and stultifying progress.)
2. T focuses upon role relationships the patient is attempting to establish or avoid in the session
Principle
focuses upon ways in which the patient is shaping the current exchanges in order to make sure the interaction is manageable, while less manageable feelings are avoided.
Examples
• may take up how the patient establishes roles for and/or the patient. Examples might be: “You stress that I am the expert,” or “You want me to be the one who asks questions, which you answer.”
• might note the patient’s state or stance toward . For example: “You step back and observe what I am doing, and it amuses you,” or “You are ready to fight back if I say anything you feel is not justified.”
• may comment how the patient requires that takes such-and-such a view of the patient. Examples might be: “You stress how this is the first time you have come, so you can’t be expected to know what to say,” or “You make it clear to me how you are going to think for yourself.”
Illustrative therapist interpretations
• “You come back with a counter argument and it is a way of getting away from that confusion, not knowing, panic.” ( points out that the patient is trying to establish a role relationship in which patient and therapist argue, and refers to the motive of avoiding an unmanageable state of confusion and panic.)
• “Tere’s a sense that I’m encouraging you to do something that feels too much or dangerous and I’m going to drop you, leave you.” ( focuses on the threatening role relationship of dependency which needs to be avoided,
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while at the same time highlighting how this influences the patient’s expe-
while at the same time highlighting how this influences the patient’s expe-
rience o
rience o ’’s interventions.)s interventions.)
3. T addresses the ways in which the patient avoids, controls, or otherwise
3. T addresses the ways in which the patient avoids, controls, or otherwise
constrains intimate engagement with T
constrains intimate engagement with T
Principle
Principle
is picking up the strategic maneuvers deployed by the patient to deend
is picking up the strategic maneuvers deployed by the patient to deend
him/
him/hersel rom the dangers (whatever they might be) o intimate and vul-hersel rom the dangers (whatever they might be) o intimate and vul-
nerable interactions.
nerable interactions.
Special attention may be given to how a patient deals with eelings stirred
Special attention may be given to how a patient deals with eelings stirred
by separations and—
by separations and—importantly—importantly—the ending o this intimate and significantthe ending o this intimate and significant
relationship.
relationship.
Examples
Examples
•
• might might pick pick up hup how the ow the patient patient gives common-gives common-sense explanations orsense explanations or
what he/
what he/she eels, explaining away rather than really getting to grips withshe eels, explaining away rather than really getting to grips with
difficult issues; or might note how the patient transorms the personal
difficult issues; or might note how the patient transorms the personal
expression o some event into an objective recounting as i rom a third-
expression o some event into an objective recounting as i rom a third-
person position.
person position.
•
• might might point point out out that the that the patient patient is is dismissive o dismissive o anyanythithing ng that could that could stirstir
conflict or anxiety such as a difficult childhood (“My childhood was just
conflict or anxiety such as a difficult childhood (“My childhood was just
normal, rea
normal, really”), or show holly”), or show how the patient imposes rather limited and stere-w the patient imposes rather limited and stere-
oty
otyped orms o relatedness (“I need you to tell me/ped orms o relatedness (“I need you to tell me/be nice to me, Docbe nice to me, Doctor”).tor”).
•
• might might indicate indicate compulsive compulsive sel-sel-reliance and avoidance o ambivalencereliance and avoidance o ambivalence
stirred by the ending o the therapy.
stirred by the ending o the therapy.
Illustrative therapist interpretations
Illustrative therapist interpretations
•
• “Tere’“Tere’s s something really shaming something really shaming about about exposing that exposing that needy needy wishiwishing ng sideside
o you, and I think very much here with respect to the sessions ending …”
o you, and I think very much here with respect to the sessions ending …”
(implying that the patient is avoiding vulnerability and dependence).
(implying that the patient is avoiding vulnerability and dependence).
•
• “in terms o “in terms o your coming heyour coming here wre we hae have ve to see to see that it that it actuactually lifally lifs you s you outout
o the domain o getting to things that are more personal and sometimes
o the domain o getting to things that are more personal and sometimes
difficult” (implying that this way o coping deflects rom potentially dis-
difficult” (implying that this way o coping deflects rom potentially dis-
tressing
tressing states)states)..
4. T h
4. T highlighlights what the ights what the patient conveys to T about the patient’patient conveys to T about the patient’s emotionals emotional
state in the here-
state in the here-and-and-now of the sessionnow of the session
Principle
Principle
It is ofen important that picks up, and is explicit about, what a patient
It is ofen important that picks up, and is explicit about, what a patient
is communicating about his/
is communicating about his/her position and eelings in relation to . Tereher position and eelings in relation to . Tere
are two aspects to this. One is that indicates how takes seriously
are two aspects to this. One is that indicates how takes seriously that that the the
patient is
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100
explicit). Te other is that is concerned with
explicit). Te other is that is concerned with what what the patient is conveying. the patient is conveying.
Sometimes the patient has been explicit about this, while at other times
Sometimes the patient has been explicit about this, while at other times
interprets what considers is conveyed between the lines, or even what is
interprets what considers is conveyed between the lines, or even what is
communicated unconsciously.
communicated unconsciously.
Examples
Examples
•
• might refl might reflect how ect how the patient the patient stresses how hstresses how helpless elpless and pessimisticand pessimistic
she feels.
she feels.
•
• might might comment comment how how the the patient patient half-half-conceals irritation that does notconceals irritation that does not
immediately answer her legitimate questions.
immediately answer her legitimate questions.
•
• might might take up hotake up how the pw the patient fatient feels trapped within a poeels trapped within a power rwer relationelation
where the patient’s own views can be dismissed.
where the patient’s own views can be dismissed.
Illustrative therapist interpretations
Illustrative therapist interpretations
•
• “Y“You do ou do your best efforts and then your best efforts and then you feel you feel I find fault, when I find fault, when I say I say that’sthat’s
not good enough and you think … whatever I do is never any good.” (
not good enough and you think … whatever I do is never any good.” (
captures bot
captures both what the patient experiences in the relation, and th what the patient experiences in the relation, and the patient’he patient’ss
efforts to deal w
efforts to deal with this.)ith this.)
•
• “What you “What you convey convey is that there is that there is somis somethiething in ng in you that you that requires noth-requires noth-
ing less than perfection.” ( takes up what it is like to be the patient,
ing less than perfection.” ( takes up what it is like to be the patient,
including being in intimidating/
including being in intimidating/intimidated states that were also beingintimidated states that were also being
experienced—
experienced—in fact, by the therapist as well as the patient—in fact, by the therapist as well as the patient—at times inat times in
the
the session.session.))
5. T comments on how the patient experiences T’
5. T comments on how the patient experiences T’s attitudes, ts attitudes, thoughts, feel-houghts, feel-
ings, and actions concerning the patient and what the patient says, does
ings, and actions concerning the patient and what the patient says, does
and feels
and feels
Principle
Principle
Tis is a specific aspect of ’s focus on current patterns of relatedness toward
Tis is a specific aspect of ’s focus on current patterns of relatedness toward
himself/
himself/herself. may comment on what the patient imagines, thinks, feels,herself. may comment on what the patient imagines, thinks, feels,
fears, hopes for, or tries to induce in by way of ’s own attitudes toward the
fears, hopes for, or tries to induce in by way of ’s own attitudes toward the
patient.
patient.
Examples
Examples
•
• might commen might comment on t on a patient’a patient’s anxiets anxiety lest y lest is s is simply ouimply out to impose t to impose ’s’s
own view
own view
•
• might might reflect that the reflect that the patient fpatient feels eels is ouis out to t to exploit the exploit the relationship relationship forfor
’s own ends
’s own ends
•
• might state might state that a patient that a patient feels feels wilwill not l not properly properly register a patienregister a patient’st’s
vu
vulnerabilitlnerability or y or need to need to assert himassert him//herself, orherself, or, by contrast, by contrast, might remark, might remark
that the patient feels
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Illustrative therapist interpretations
Illustrative therapist interpretations
•
• “as you “as you leave leave and then what you and then what you do in thinkdo in thinking about it ing about it is ‘is ‘oh gosh, oh gosh, ohoh
gosh, h
gosh, he thinks e thinks this, he thinkthis, he thinks that,’ and … ys that,’ and … you think I’m actually kind oou think I’m actually kind o
disapproving.” (T takes up not only how T is experienced as disapproving,
disapproving.” (T takes up not only how T is experienced as disapproving,
but also how the patient becomes preoccupied and unsettled.)
but also how the patient becomes preoccupied and unsettled.)
•
• “Y“You see hou see how much ow much you havyou have to ocus on e to ocus on what is in mwhat is in my mind … what y mind … what I’mI’m
expecting, what I’m thinking, what I’m inquisitive about.” (Here T reflects
expecting, what I’m thinking, what I’m inquisitive about.” (Here T reflects
not just on how t
not just on how the patient experiences T, but the patient’s whole orientation.he patient experiences T, but the patient’s whole orientation.))
6. T takes up what the patient is needing T to take account of, and/
6. T takes up what the patient is needing T to take account of, and/or holdor hold
for/
for/withstand from the patient e.g., anxiety, anger, vulnerability withstand from the patient e.g., anxiety, anger, vulnerability
Principle
Principle
T is likely to be explicit about the role and stance that a patient needs T to
T is likely to be explicit about the role and stance that a patient needs T to
adopt. T might include specific mention o what the patient wants T to regis-
adopt. T might include specific mention o what the patient wants T to regis-
ter and grasp about the patient’s position, whether in relation to vulnerabili-
ter and grasp about the patient’s position, whether in relation to vulnerabili-
ties or strengths a
ties or strengths and abilities.nd abilities.
T is very aware that patients distribute anxieties or other mental states to
T is very aware that patients distribute anxieties or other mental states to
other people, so that T might need to experience things or the patient. T is also
other people, so that T might need to experience things or the patient. T is also
aware that it is sometimes o value to clariy when this is the case. For instance,
aware that it is sometimes o value to clariy when this is the case. For instance,
T might remark on how a patient has to give T responsibility or ta
T might remark on how a patient has to give T responsibility or taking tking the leadhe lead
over the subject matter o exchanges; or T might take up how important it is
over the subject matter o exchanges; or T might take up how important it is
that T is able to respond to the patient’s urgent expressions o need (or anger)
that T is able to respond to the patient’s urgent expressions o need (or anger)
without being overwhelmed. However
without being overwhelmed. However, this item does not necessa, this item does not necessarily mean trily mean thathat
T interprets the patient’s need directly—
T interprets the patient’s need directly—this might be premature and persecu-this might be premature and persecu-
tory or some patients—
tory or some patients—and T might merely convey what seems to characterizeand T might merely convey what seems to characterize
T’s side o the emotional transaction within a current phase o the session.
T’s side o the emotional transaction within a current phase o the session.
T may also make direct or indirect allusion to the emotional importance
T may also make direct or indirect allusion to the emotional importance
o T being able to listen to, understand and contain the patient, i necessary
o T being able to listen to, understand and contain the patient, i necessary
with firmness. In other words, either implicitly or explicitly, T is alert to the
with firmness. In other words, either implicitly or explicitly, T is alert to the
patient’s sensitivity toward T’s ability to manage what T him/
patient’s sensitivity toward T’s ability to manage what T him/hersel mayhersel may
experience in the course o the interaction.
experience in the course o the interaction.
Examples
Examples
•
• T T might state might state that patient that patient needs T needs T to rto realiealize that ze that he/he/she is not only vulner-she is not only vulner-
able, but also able and quick to make his/
able, but also able and quick to make his/her own judgements.her own judgements.
•
• T might T might say that say that that a pathat a patient needs tient needs both T and both T and the patient the patient to be to be awareaware
that the patient can be less than honest; or that the patient needs T to be
that the patient can be less than honest; or that the patient needs T to be
able to sif the trustworthy rom the shify.
able to sif the trustworthy rom the shify.
•
• T T might express might express the view the view that a that a patient patient needsneeds T T to know what it is like to to know what it is like to
eel anxious and untrusting (in relation to the patient him/
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Illustrative therapist interpretations
• “I can see you really are trying today to talk to me. I can, you know, there’s a feeling of urgency coming from you even, but I do think it’s difficult for you to believe perhaps that you can get something from somebody else.” ( feels the patient needs to take account of the patient’s genuine attempt to com- municate, and also the patient’s pessimism about what can be achieved.) • “On the one hand wanting I think this time to be moving, to have some
impact, to understand more about yourself, but you’re also aware of the parts of you that can be much more destructive, as a sort of tongue-in- cheek, the way you can use your humor to move away from meaning. And you end up losing out in that respect. Can I be aware of both aspects, that it’s important?” ( indicates not only that the patient has different sides to his personality, but also that he needs to be aware of how these are con- tributing to the present communication with herself.)