LINEAS DE AUTORIDAD Y RESPONSABILIDAD

The bond between two people features significantly in the process of healing or transformation. Many research studies (see Horvath & Symonds, 1991) have

48

demonstrated that it is the therapeutic relationship between psychotherapist and client that best predicts the effectiveness of therapy and is more influential than theoretical modality (Norcross and Goldfried, 1992). The mutuality that resides within the therapeutic relationship, has also been widely acknowledged by therapists. It is recognised that not only does the client need the therapist, but the therapist also needs the client, in order to chisel their own thoughts about intricate human difficulties, while holding the realization that each changes the other (Clarkson, 1995). For Guntrip (1961), the therapist is not a neutral tool for technical intervention, but effective psychotherapy only occurs when the therapist and client meet the real person behind the other’s defences. Mearns and Cooper (2005) point out that deep insight only transpires in ‘the moment of real meeting’. Therapist authenticity and spontaneity can be beneficial to the client, in this way, providing a model of being that the client can relate to, alleviating their distrust (Clarkson, 1995). According to Casement (2014), it may also result in transformation and growth for the psychotherapist as well. In this kind of therapeutic relationship, the therapist and client share the uncertainty lodged within their human existence.

Although the concept of ‘therapeutic presence’ is highly recognized in most psychotherapies it is only in the humanistic and existential approaches where it is emphasized that the relationship is therapy and not merely a vehicle for creating a safe space to do the work of therapy (Van Kalmhout, 2013). Working at “relational depth” (Mearns & Cooper, 2005) where therapists and client are “fully real” with each other and deeply value the other’s experiences, which helps the client change how they view themselves, is the cornerstone of these modalities.

Person-centred therapy, which is part of the humanistic therapeutic tradition, focuses on how to help people grow and heal and assumes that each person has an innate wisdom of how to do this themselves (Mearns & Thorne, 2007). Despite its influence, historically, on other psychological therapies, in the current UK healthcare setting it has been side-lined by approaches like cognitive-behavioural therapy, which is offered within a medical institutional framework, exerting economic pressures on clinicians to produce positive outcomes within time-limited therapy. This may reflect a larger experiential crisis in broader society, where capitalism feeds a thirst for instant self-gratification, by manipulating the environment, thereby interrupting interdependence amongst people for the provision of their needs. The tragedy of this is that people have become disconnected from each other and their own submerged innovative human energy which can lead them to greater wholeness. While non-

49

humanistic therapies may contribute to understanding about the development and reduction of emotional distress, they sometimes struggle to conceptualise distress that is a consequence of self-estrangement (Cooper et al, 2013). Therefore, the quality of clients’ experiencing becomes a critical element in determining the outcome of their therapy.

Rogers (1958) advocates three necessary qualities for this to happen, namely, that the therapist is authentic; honours the client, holding them in high regard and can non-judgmentally, empathise with what’s upsetting them. However, towards the end of his life he began to talk about his presence in therapeutic encounters as being something distinct from the core conditions, but related to them, in that it is the fundamental base from which they arise (Geller, 2013). In order to empathise fully in this way means that the therapist must set aside their assumptions and prejudices, as it means being in-tune (or attuned) with the momentary felt changes in their client within a session, on a number of different levels, cognitively, emotionally, physically, spiritually and relationally (Geller, 2013). Further, the therapist also has to be in-tune with what’s happening inside them both on an intellectual level, but also importantly, on an emotional, “gut” or bodily level so that they can access embodied wisdom within themselves and co-ordinate this with what they express vocally to the client; and track the impact their interventions are having on the client’s process (Geller, 2013). An added benefit is that a sense of safety can be generated at a neurophysiological level within the client, which can expedite their healing (Rogers, 2013).

There is a lack of research into the concept of therapeutic presence, but Geller and Greenberg (2012) report a useful qualitative and quantitative study they have conducted investigating the interplay between therapeutic presence and the processes in the therapeutic relationship, where therapists from existential, person- centred and cognitive-behavioural therapeutic modalities and their clients rated the quality of presence in certain therapy sessions, using measures which were developed as part of the research. They found that clients reported a positive change after a session when they felt their therapist was present. Interestingly, cognitive- behavioural therapists rated themselves lower on presence as did their clients, which, though not currently integrated into practice may be an important influencing factor. Another intriguing finding was that therapists self-perceptions were negatively correlated with clients ratings of the sessions. Perhaps this was due to the fact that the therapists taking part in the study were inexperienced graduate trainees and had not yet developed a sense of how therapeutic presence manifests within themselves

50

and with their clients. Also, self-report measures were used in the quantitative study which may not have captured the complexity of the construct and would need to be followed up with a deeper qualitative inquiry. Although the sample size was small (n= 8 therapists and 114 clients) and the results cannot be generalised, they remain promising and despite the paucity of research, the importance of the therapist offering a receptive therapeutic presence cannot be overstated, at least, from a conceptual perspective.