FRECUENCIA

For the above processes in empathy and counter-transference to take hold, a therapeutic relationship must be established, obviously, so we turn now to the patient as he considers psychotherapy. The preceding discussion of inner-outer, internalized-externalized patients and therapists is a reminder that the therapeutic relationship starts with the separate parties to the treatment and with their preconceived fantasies of each other. At the outset, in terms of a therapeutic relationship, only the possibility of a relationship exists. Where and when a therapy process begins is difficult, if not impossible, to determine. For the patient, it starts somewhere near the time when the mere idea of seeing a therapist takes hold.

Except for someone already experienced in psychotherapy, therapy is typically not the first thing considered. Only after enough time has gone by and enough unremediated disturbance endured is this last resort considered. (Or else the person is so pained or so

tractable that he will accept a well-meaning recommendation.) At this point therapy and a therapist begin to be imagined. The soon-to-be patient often has considerable anxiety and a wealth of fantasies about therapy and about this therapist he is to meet. The patient is going to reveal himself, and he wonders how he will be received and if the whole thing will work. He imagines all this in accord with his mood, his present and past experiences with parents or other figures in support or authority, his previous therapy, and with the reports, if any, of a referring party, whether a friend or professional. Other patients are nonreferred, and get their therapist’s name out of a phone book, which is more of a gamble. (I found my first therapist, a Jungian analyst, in the yellow pages.) Patients also may choose their therapist according to gender, as some people are more comfortable with women than men, or vice versa. Quite a few people directly seeking Jungian modalities anticipate someone like Jung himself, or expect, naturally, a therapy that at least incorporates his principles and psychological material as they perceive them. Some have read Jung’s or Jungians’ books and arrive with impressions or expectations from them. Some try to fit a mold of being a “Jungian” patient, which is an understandable mistake that the therapist might point out.

Patients’ initial contacts and expectations

Whatever their presuppositions, future patients all have some idea of what a Jungian therapist might be like, and they bring this to the first contact with the therapist, whether this is by phone or, less commonly, letter or ^zv102 electronic mail. What is more, the first actual contact with a therapist is usually with an answering machine (or a secretary), which is a striking fact, given the subtleties of the therapeutic relationship that is forming.

(That is why an informed, sensitive receptionist is a boon to psychotherapy, particularly in an agency setting.) Therapists need to be mindful with these initial contacts that contribute so much to the tone and trust-building of the treatment. Even the forms a patient might fill out, if any, and the feel of the waiting room are meaningful, as they, along with the therapist’s actual early-session comments, are the first substantive communications about therapy.

It is necessary, then, to deliteralize the initial stages of the therapeutic relationship, and realize that it takes place very much in a fantasy atmosphere. As Jung once remarked: “A transference is not by any means always the work of the doctor. Often it is in full swing before he has even opened his mouth” (1946, p. 171). This would be especially true with a well-known person like Jung, but would also be the case for an unknown therapist or one with only a local reputation. Even in small ways, expectant fantasies of the therapist are constantly being generated, as when, for example, a therapist comes highly recommended or is characterized by a referring party one way or another (“good,”

helpful, experienced, new, “Jungian,” older, or whatever). The person who recommends a therapist is some part of the equation, too.

Such characterizations and expectations are natural, unavoidable, and related to hope, so there is nothing wrong with them. In fact, most patients entering therapy either have, or are trying to figure out if they dare have, some hopes for it. A patient who cannot mobilize or find some of this in initial meetings is in difficulty, and without it the therapeutic relationship begins in an unpromising state (for both parties involved).

Whether the sources of the patient’s hopeless feelings be depression or defense, negative expectations call for careful assessment, and probably should be addressed quickly. Low expectations may also be fueled by prior treatment difficulties, or negative family attitudes and life experiences. At the same time, even a dubious patient’s attitude is belied by his willingness to come in for psychotherapy. They may disdain it, but they are here.

Mixed motivation is standard, and an attitude of overly high expectation may ultimately have to be tempered by a response of realistic hopefulness. One potential, very upbeat patient, for example, told me on the phone that colleagues both in the Northwest and New England had spoken highly of me. This was a source of therapeutic optimism to the patient; as for me, though I did not know these references personally, I was flattered by the idea of literally coast-to-coast fame. In spite of myself, however, ^zv103 I responded with a neutral, “Well, we’ll see how it goes when we meet.” Perhaps I was foolishly raining on the parade, or recoiling from overstimulation, the burdens of high expectation, or idealization, but to me my response felt about right, because I really did not know. I could not know.

Because a patient’s myriad mental activities and unconscious expectations pour into the therapeutic relationship before he meets the therapist in person, a therapist has the difficult task of trying to see through and sense what the patient might be feeling even at this very first contact. While the therapist often cannot understand things this fast, this soon, it helps to have an empathic mind-set in place and some theoretical possibilities in place, since an attitude of seriousness and potential understanding is what the patient is probably seeking. The therapy is already happening during the first call.

The therapist’s expectations

At the outset, psychologically speaking, the therapist is waiting for a patient, albeit the unknown patient, and ready for the therapeutic relationship to begin. The therapeutic outlook described in Chapter 3 provides the basis for this. To work via the therapeutic relationship, one has to expect it and, of course, have some faith in it. This connects, too, with the realistic hopefulness just mentioned. While this faith may start out intellectually for the therapist—based on what he has read, been taught, and thought about the therapeutic relationship being the backbone of psychotherapy—it becomes more concrete with experience, including his own experiences as a patient. Psychotherapy for therapists is necessary because through it they know a theory inside out and know it fits them. His personal work shows a therapist at a tangible level how healing within a relationship can take place and provides conviction: he knows this treatment can work, it helped him.

While this more or less successful process has also expanded his specific range of feeling—that is to say, his empathic range and potential—it is the personal therapeutic experience overall that forms the emotional bedrock for his future work.

For example, in my experience it was not exactly what therapists said to me that helped but what was conveyed to me over time (more accurately, what formed in me while I was

“in their care”). My cares were in their care, which is what I needed to feel, and the bottom line is that a patient needs to feel psychologically contained or held. They listened, seemed to understand, and what I was trying to say seemed to matter and was not rejected; therefore I mattered. The painful and shameful were acceptable ^zv104 to them

and, gradually, to me. What’s more, I felt there was always somebody there, whose exclusive attention I had. Whether this was true or not, I could feel and create it in my mind, in effect finding or creating the internal therapist I needed. Ultimately I began to like myself better and came to myself. (I emphasize the “liking” part because it follows a dream where a former therapist, listening to my overpsychologized explanation of how I was doing, said simply, “You mean you like yourself”)

A patient may feel understood more than he understands per se. My example suggests not only how the therapeutic relationship is absorbed but that what a therapist knows about therapy, and what he is inclined to focus on, are modeled on his own therapy. His way of doing therapy is also modeled on his own therapist. For instance, I notice at times that some therapists sound to me like their former therapists; I also notice, more reluctantly, that I sometimes half assume an attitude or make a gesture like one of my ex-therapists. This is communicating out of an identification with one’s therapist, and is not unlike looking in the mirror one day and realizing one physically looks, let’s say, like one’s mother or father. The childhood form of this is imitation—like the pleasure of walking around in your father’s or mother’s big shoes. Its more conscious, and sometimes more difficult, adult form is realizing how much one acts, thinks, or feels like one’s teacher, which can be disconcerting. In therapy the identification with one’s therapist(s) is usually a stylistic matter—a way of saying something—but can be embodied in a general attitude or approach to a therapeutic problem at hand.

Identification is a way people learn unconsciously, and, it should be noted, also a way a patient learns from a therapist. Specific teachings from supervisors also flash across a therapist’s mind sometimes, ready reserves to be called up. Thus, this special relationship that the therapist as patient or trainee received, or found, in therapy is now passed on in almost unconscious ways to his patient, much like a family gesture. Some of this may explain why some therapists have pictures of Freud, Jung, or other mentors on their office walls (a practice, however, that seems questionable vis a vis the transference-countertransference situation). Nevertheless, as with a family influence, it is the subtle, overall influence that lingers and means more than imitative physical gestures.