The Use of Self in Therapy

Michele Baldwin

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781135123857
• Edition: 3
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

One of the most powerful factors in therapy is that it involves the intensive relationship between two (or more) human beings. The issues of transparency and self-disclosure therefore become important concerns for therapists; how can they use themselves effectively in their work without transgressing on professional regulations? These issues and concerns are addressed in this new edition of The Use of Self in Therapy by experienced therapists, who share their own wisdom, research, and experiences in valuable ways. Disregarding methodology or approach, the authors demonstrate how to train and develop the self and person of the therapist as a powerful adjunct to successful therapy. They enable practitioners to become more effective in helping their clients to realize and regain their own powers of healing and healthy recovery. This 3rd edition also examines the impact of increasing professional regulation, as well as the impact of the internet and social media on the conduct of therapy. Also new to this edition are discussions of how therapists can use themselves in cultures that are less individually-oriented. This book is a valuable addition to any therapist's library and therapy supervisor's teaching arsenal.

1 The Therapist Story

Virginia Satir

One hundred years ago, as today, we were nearing a new century. Then as now, people strongly felt that they lived in a period of great change. America was moving from a predominantly rural, agricultural way of life to an urban, industrial culture. The battle for human rights was emerging. Unions were forming to protect the rights of workers. Concerned citizens were lobbying for protection of children through child labor laws. Social reformers were mounting campaigns for women's suffrage. In the sciences, foundations were being laid for today's nuclear weaponry, space travel, and electronic communications. In that same period, a new psychology was being formulated that would change the way we think about ourselves. I would like to think that the advent of another new century will bring with it another change of consciousness about ourselves—one that places a high value on humanness. The therapist who makes self ^* an essential factor in the therapeutic process is a herald of that new consciousness.

Sigmund Freud opened his practice 100 years ago in Vienna. In 1921, he visited the United States, bringing with him the new form of psychotherapy that he called psychoanalysis. His main thesis was that human beings carry the seeds of their construction as well as their destruction within them. This was a radical idea that eventually initiated a revolutionary breakthrough in mental health practice. Up to that time, the prevailing reasons for deviant and other unacceptable forms of behavior were thought to be bad environment, personal unworthiness, and “genetic taint.” The cure was usually isolation, punishment, abandonment, or death.

Freud's views also offered a new way of understanding human behavior. By 1940, psychoanalytic concepts underlay almost all psychological thinking and treatment and it continued that way until the appearance of existential and holistic thinking in the 1960s. In some ways, I compare the impact of Freudian concepts with the work of Jellinek (1960), who advanced the idea that alcoholism was a disease and not the result of perversity or weakness. That, too, changed society's way of thinking and eventually led to new methods of treatment which offered hope to those who previously had no hope.

Originally, psychoanalytic treatment was administered by a trained psychotherapist (usually a physician) who, by “analyzing” the emotional experience and process of the patient, hoped to clear the way for the growth of health within the troubled individual. The early treatment model was that of the traditional doctor-patient relationship. The aim of treatment then, as it is today, was the eradication of symptoms, although the nature and meaning of symptoms have been greatly expanded over the years. The basic elements of psychotherapy remain the same, namely: a therapist, a patient, a context, the interaction between the therapist and patient, and a model for approaching treatment. However, the definitions of these elements have also expanded and changed through additions and deletions over time. For example, the patient now is sometimes known as the client, and may represent an individual, a group, or a family (Rogers, 1951). The therapist may also be called a counselor, and can include one, two, or even more persons. The therapist may be drawn from a variety of disciplines in addition to medicine and psychiatry, such as psychology, social work, education, or theology. The context now includes the office, the home, the hospital, and the school.

The therapeutic interaction is also seen as a relationship between therapist and patient and may be characterized by a variety of treatment approaches, such as psychoanalysis, psychodrama, Gestalt therapy, transactional analysis, the various body therapies, family therapy, and a host of others. The model of therapy has been expanded from the traditional, authoritarian doctor-patient relationship to include the patient as a partner (Hollender and Szasz, 1956).

We have all observed that two people using the same approach have come out with quite different results. We have also seen that two other people using quite different approaches can come out with similarly successful results. Yet very few training programs really deal with the person of the therapist. Those that do are usually in psychoanalytic and Jungian institutes where training in psychoanalysis is required or in some family training programs.

The Role of Self in Therapy

Common sense dictates that the therapist and the patient must inevitably affect each other as human beings. This involvement of the therapist's “self,” or “personhood,” occurs regardless of, and in addition to, the treatment philosophy or the approach. Techniques and approaches are tools. They come out differently in different hands. Because the nature of the relationship between therapist and patient makes the latter extremely vulnerable, it is incumbent upon the therapist to keep that relationship from being an exercise in the negative use of power, or of developing dependency, both of which ultimately defeat therapeutic ends.

Freud recognized the power of the therapist. He maintained that the successful therapist had to handle his or her personal life in such a way as to avoid becoming entangled in the personal life of the patient. This led to the neutral, nonpersonal format of the psychoanalytic couch, with the therapist out of sight and relatively nonactive; this despite the fact that Freud is reported to have given massage at times to his patients and to have become actively involved in their lives. Needleman (1985) claims that the secret of Freud's great success and creativity was due to the great force of his personal attention to his patients, which enabled him to project a quality of compassion and insight that radiated a healing influence.

Perhaps doubting his own capacity and that of others not to negatively influence patients, Freud developed the idea of mandatory training analysis for all psychotherapists, during which the trainees were supposed to understand and master their own conflicts and neuroses. This requirement was aimed at protecting the patient and creating the optimum conditions for change.

These ideas clearly stood on two basic principles: that therapists have the power to damage patients, and that they are there to serve patients, not the other way around. Most therapists today would agree that they would not consciously want to harm their patients. On the contrary, they would claim that they try to create treatment contexts that are beneficial to their patients. Most therapists would also say that they are there to serve their patients. However, the words “harm” and “serve” are open to many interpretations.

Furthermore, there was, and is, the idea that unconsciously, without malice or intent, therapists can harm patients through their own unresolved problems (Langs, 1985). One manifestation is reflected in what Freud called countertransference. Briefly, this means that therapists mistakenly and unconsciously see patients as sons, daughters, mothers, or fathers, thereby projecting onto their patients something which does not belong—a real case of mistaken identity. This is a trap, well recognized by many therapists. However, unless therapists are very clear and aware, they may be caught in the trap without knowing it. Unless one knows what is going on, it is tempting to blame the patient for a feeling of being “stuck” as a therapist. A further manifestation of this phenomenon is rescuing or protecting, taking sides, or rejecting a patient and, again, putting the responsibility on the patient.

When the prevailing model of therapeutic transaction, the authoritarian doctor-patient relationship, is experienced as one of dominance and submission, the patient and therapist can easily move into a power play that tends to reinforce childhood learning experiences. Throughout the therapeutic experience, the therapist may unwittingly replicate the negative learning experiences of the patient's childhood and call it treatment. For instance, when therapists maintain that they know, when they actually do not know, they are modeling behavior similar to that of the patient's parent. The dominance and submission model increases chances for therapists to live out their own ego needs for control. Manifestations of this control can appear to be benevolent, as in “I am the one who helps you; therefore, you should be grateful,” or malevolent, as in “You'd better do what I tell you, or I won't treat you.” These, of course, are shades of childhood past. When they are present in therapy, treatment aims will be defeated.

Power and Therapy

The above are all disguised power issues. But power has two faces: one controls the other; the second empowers the other. The use of power is a function of the self of the therapist. It is related to the therapist's selfworth, which governs the way in which the therapist handles his or her ego needs. Use of power is quite independent of any therapeutic technique or approach, although some therapeutic approaches are actually based on the therapist maintaining a superior position (Dreikurs, 1960). There also are cases where there is outright and conscious exploitation by the therapist, and some even justify their aggressive, sexual, or other unprofessional behavior on the grounds that it is beneficial to the patient (Langs, 1985). Once, a man came to my office with a bullwhip in his hand and asked me to beat him with it so he could become sexually potent. While I believed that it was possible that his method would work for him, I rejected it on the basis that it did not fit my values. I offered to help him in other ways and he accepted.

Using patients for one's own ego needs or getting them mixed up with one's own life is ethically unsound. However, the therapist can be in the same position as the patient, denying, distorting, or projecting needs. It is possible for a patient or a client to activate something within the therapist of which the latter is unaware. It is easy to respond to a patient as though he or she is someone else in one's past or present, and if one is not aware that this is going on it will needlessly complicate the situation. If one is a family therapist, it is likely that somewhere, at least once, one will see a family that duplicates some aspects of one's own family. When this happens and the therapist has not yet worked out the difficulties with his or her own family, the client may be stranded or misled because the therapist also is lost. Therapists should recognize that they are just as vulnerable as patients.

While therapists facilitate and enhance patients’ ability and need to grow, they should at the same time be aware that they have the same ability and need. One way to avoid burnout is to keep growing and learning. A great part of our behavior is learned from modeling, and therapists can model ways of learning and growing. It is also important to model congruence. An oversimplified definition of congruence is that one looks like one feels, says what one feels and means, and acts in accordance with what one says. Such congruence develops trust. This is the basis for the emotional honesty between therapist and patient, which is the key to healing. When a therapist says one thing and feels another, or demonstrates something that he or she denies, the therapist is creating an atmosphere of emotional dishonesty which makes it an unsafe environment for the patient. I find that there is a level of communication beyond words and feelings, in which life communicates with life and understands incongruence. Young children show this awareness more easily. In adults, this level of communication usually presents itself in hunches or in vague feelings of uneasiness, or sensing. If I, as a therapist, am denying, distorting, projecting, or engaging in any other form of masking, and am unaware of my own inner stirrings, I am communicating them to those around me no matter how well I think I am disguising them.

If patients feel that they are at risk because they feel “one down” in relation to the therapist, they will not report their distressed feelings and will develop defenses against the therapist. The therapist, in turn, not knowing about this, can easily misunderstand the patient's response as resistance, instead of legitimate self-protection against the therapist's incongruence. Therapy is an intimate experience. For people to grow and change they need to be able to allow themselves to become open, which makes them vulnerable. When they are vulnerable, they need protection. It is the therapist's responsibility to create a context in which people feel and are safe, and this requires sensitivity to one's own state. For example, it is quite possible for a therapist who is focusing on a technique or a theoretical construct to be unaware that her own facial features and voice tone are conveying the messages to which the patient is responding.

The presence of resistance is a manifestation of fear and calls for the utmost in honesty, congruence, and trust on the part of the therapist. The only times that I have experienced difficulty with people were when I was incongruent. I either tried to be something I was not, or to withhold something I knew, or to say something I did not mean. I have great respect for that deep level of communication where one really knows when and whom one can trust. I think it comes close to what Martin Buber called the “I-Thou” relationship (Buber, 1970).

Very little change goes on without the patient and therapist becoming vulnerable. Therapists know that they have to go beyond patient defenses, so they can help them to become more open and vulnerable. Defenses are ways patients try to protect themselves when they feel unsafe. When the therapist acts to break down defenses, the therapeutic interaction becomes an experience which is characterized by “who has the right to tell whom what to do, or who wins.” In this struggle, the therapist, like the parent, has to win and the patient loses.

When the patient is somehow thought of as a trophy on the therapist's success ladder, this is another repetition of the way in which many children experience their parents—where they were expected to be a showcase for family values. Sometimes the therapist puts the patient in a position of being a pawn between two opposing authorities—as when a therapist puts a child between the parents, or between the parents and an institutional staff.

When the therapist sets out to help someone and leaves no doubt that he or she knows what is best for the patient, the therapist is subjecting the patient to repetition of another childhood experience. There are therapists who feel challenged to make something of the patient, “even if it kills you.” These are often therapists who want to give messages of validation, although the outcomes are often very different.

The Positive Use of the Self

If therapists can influence therapeutic results negatively through their use of self, then it must be possible to use the self for positive results. Therapists have that power by virtue of their role and status and person. We know that this power can be misused and misdirected. However, therapists also have the choice to use their power for empowering. Because patients are vulnerable, therapists can use their power to empower patients toward their own growth.

In the new model of treatment that emerged in the 1950s and 1960s, the therapist began to form a partnership with the patient. Patient and therapist could work together utilizing their respective actions, reactions, and interactions. The therapist was encouraged to model congruent behavior, and the focus of the therapeutic partnership was on developing health through working with the whole person. Eradication of the symptom was achieved by the development of a healthy state, which no longer required the symptom. In the traditional, authoritarian doctor-patient model, the emphasis was first on eradicating the symptom, with the hope that health would follow.

When the emphasis is totally on empowering the patient, the therapist will tend to choose methods that serve that purpose. When therapists work at empowering, the patient is more likely to have opportunities to experience old attitudes in new contexts (Rogers, 1961a). They have the experience of literally interacting with their therapists, of getting and giving feedback. The treatment context becomes a life-learning and life-giving context between the patient and a therapist, who responds personally and humanly. The therapist is clearly identified as a self interacting with another self. Within this context the therapist's use of self is the main tool for change. Using self, the therapist builds trust and rapport so more risks can be taken. Use of the self by the therapist is an integral part of the therapeutic process and it should be used consciously for treatment purposes.

My Use of My Self

I have learned that when I am fully present with the patient or family, I can move therapeutically with much greater ease. I can simultaneously reach the depths to which I need to go, and at the same time honor the fragility, the power, and the sacredness of life in the other. When I am in touch with myself, my feelings, my thoughts, with what I see and hear, I am growing toward becoming a more integrated self. I am more congruent, I am more “whole,” and I am able to make greater contact with the other person. When I have spoken of these concepts in workshops, people thank me for speaking out, legitimizing what they have been feeling themselves. In a nutshell, what I have been describing are therapists who put their personhood and that of their patients first. It is the positive people-contact which paves the way for the risks that have to be taken. Many adults have reported they did not feel they were in contact with their parents and the others who brought them up. They did not feel like persons, but were treated as roles or expectation...

Table of contents

• Front Cover
• The Use of Self in Therapy
• Title Page
• Copyright
• Dedication
• Contents
• About the Editor
• Contributors
• Foreword
• Preface
• Introduction
• 1 The Therapist Story
• 2 Interview with Carl Rogers on the Use of the Self in Therapy
• 3 Revealing Our Selves
• 4 Some Philosophical and Psychological Contributions to the Use of Self in Therapy
• 5 The Implications of the Wounded-Healer Archetype for the Use of Self in Psychotherapy
• 6 Uses of Self in Therapeutic Boundaries: Lessons from Training and Treatment
• 7 The Self of the Addiction Counselor: Does Personal Recovery Insure Counselor Effectiveness and Empathy?
• 8 Functional Analytic Psychotherapy and the Use of Self
• 9 The Person and Practice of the Therapist: Treatment and Training
• 10 Congruence and the Therapist's Use of Self
• 11 An Eastern Perspective on the Use of Self
• 12 The Therapist's Self in the Age of the Internet
• 13 The Self of the Therapist in the Empire of Overregulation
• 14 “I” Is rising: Parallel Play, Transcendence, Irony, and Jouissance
• Index