The Role of the Therapist and the Role of the Person in Therapy

I thought it would be useful to think about the role of the person in therapy and the therapist in long-term psychoanalytic work.

The Role of the Person in Therapy

If the person in therapy is to get the most from the experience, there needs to be a recognition that a proportion of the problems to be explored lie within the person. Together with this, there also should be the conviction that a deeper understanding of the self, and the way relationships are built, will enable solutions to the issues which the person brings. The person in therapy, furthermore, needs a willingness to put the self in question, challenge what has been taken for granted, and to admit a willingness to change behaviour.

With a willingness to change and grow, the person in therapy joins in a working alliance with the therapist and undertakes to follow what Freud called the basic rule – to say whatever comes to mind, regardless of whether it is embarrassing, irrelevant or emotionally difficult. Following the rule is hard; a more realistic way of putting it may be that there is a gradual willingness to communicate more openly as the process goes on. The person in therapy gives the joint search for understanding priority, even over relief of symptoms and the avoidance of emotional discomfort. Feelings and fantasies are openly admitted and discussed. Equally, there is the attempt not to act out difficult feelings inside or outside the therapy. For instance, anger with the therapist is openly talked about and explored in the therapy session, not acted out by coming late, or perhaps driving recklessly.

Through the process, the person in therapy will become increasingly able to understand the continuing influence of the past in the present, the different levels of experience, and, aided by the therapist, will become aware of unconscious wishes and fantasies, understanding the ways defences against these can cause pain or frustration. The person begins to distinguish between the objective and subjective reality of the therapeutic relationship and to own projections rather than simply believing them to be true. New ways of understanding the self and of relating to others will become available and will be tried out. Original ways of dealing with threats and opportunities can be explored.

The Therapist’s role

The most important role of the therapist is to maintain the setting. If the person in therapy is to relinquish the more defensive ways of communicating and experiencing the self and others, it must be in a setting that feels safe. Any breaks in therapy (for holidays etc) and changes in location will be handled with care and with as much warning as possible.

The therapist listens to the person in therapy’s communication with close attention, but in such a way that the therapist hears not only the manifest content, but also what might be going on under the surface. The therapist is carefully attentive also to internal feelings in the moment and how ideas and memories may be evoked by the person in therapy’s material. Also, the therapist is aware of a ‘free-floating role-responsiveness’, that is, how the material and the attitude of the person in therapy evokes a certain stance or identity in the therapist.

All of these elements will influence the interventions the therapist makes (or determine the lack of an intervention). The therapist is careful and considered in what is said; while the person in therapy is encouraged to express everything that comes to mind, the therapist limits interventions to what will encourage new thoughts or will help to explain what lies beneath experiences and feelings. The passivity of the therapist is more apparent than real; it gives the chance to retain a capacity for contemplation and detachment while at the same time remaining intuitively receptive.

Adapted from Introduction to Psychotherapy, by Bateman, Brown and Pedder