The Presence of the Therapist: Treating Childhood Trauma

By Monica Lanyado | Go to book overview

Chapter 1

The presence of the therapist and the process of therapeutic change

When the psychoanalytic psychotherapist enters the consulting room trying to be 'without memory or desire' (Bion 1967), what aspects of the therapist are actively left outside the door and what does the therapist enter the consulting room 'with'?

Some of the answers to these questions are comparatively straightforward and relatively uncontroversial. For example, the therapist actively tries to put aside personal preoccupations and concerns about his or her private life as well as thoughts about other patients, even though at times of worry or stress at work or at home this can be extremely hard to do. The therapist strives not to introduce his or her agenda into a session other than in highly unusual circumstances or in relation to practical arrangements. The therapist makes efforts to hold back his or her opinions about difficult issues that the patient is trying to resolve, as the therapist's opinions do not belong in the psychotherapeutic session in which the patient has to try to find his or her own solution. However difficult it is to meet these standards, it is still comparatively easy for the therapist to identify when these hallmarks of good practice have not been met, and to attempt to consciously improve on them. We are all human, and inevitably at times painfully aware of how difficult it is to meet these exacting standards.

The answers to my opening questions become increasingly difficult and controversial the closer they get to the inner world of the therapist. For example, the therapist tries to be as open as possible to the patient's communications-that is, the therapist tries to leave as many personal defences as possible outside the room. The therapist knows that his or her ego, in the way that it is popularly understood, does not belong in the room. Neither does the therapist's judgemental superego. It is difficult to do this and it requires a level of self-discipline and self-awareness that it can at times be hard to find. These are complex and subtle ideals to uphold, as their roots lie in aspects of the therapist's personality that it is much more difficult for the therapist to observe and identify, or indeed to try to change.

But it is still easier to think about what does not go into the consulting room with the therapist than to think about what does. While there are the

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