Cultivating Presence

How to be

How to be with a client – how to best tune the therapist’s self so that we can be more effective – is as important in counselling and psychotherapy trainings as what to do, i.e. on how to best respond to a particular form of distress in a client.

Recent research (1) shows that developing therapeutic presence enhances the well being of the therapist, makes her more attuned and receptive, and increases spontaneity and creativity in the therapy room. In other words, cultivating presence coincides with both self-care and therapeutic effectiveness.

What is presence?

Daniel Stern (6) captured the Zeitgeist a few years back when he wrote about the present moment in therapy and in everyday life. He and his colleagues in the Process of Change Group in Boston wrote of ‘moments-of-meeting’ as ways that had greatly facilitated therapeutic change. Therapist and client, they wrote “are meeting as persons relatively unhidden by their usual therapeutic roles, for that moment”(7). Inspired by the phenomenology of Husserl and Merleau-Ponty, Stern emphasized the difficulty of grasping the present for its nature is fleeting and dynamic, its manifestation unpredictable, and our verbal account of it cannot do it justice, for it becomes lost in our attempts to explain it. The genuine intersubjective experience of being fully present in the interaction with a client can catch me unaware at times; the experience prompts me to want to be more prepared and attuned to its appearance.

Presenting a view in tune with the humanistic approach, Geller & Greenberg define therapeutic presence as “the state of having one’s whole self in the encounter with a client by being completely in the moment on a multiplicity of levels – physically, emotionally, cognitively, and spiritually” (8). And in her account of working with childhood trauma, psychoanalyst Monica Lanyado stresses the importance of being alone in the presence of someone, emphasising the creative value of the capacity to be alone (9), the importance of peacefulness and stillness in the therapist.

Every therapist will have their own practice, their own way of fostering care of self and find greater attunement. My own favourite method is zazen, or Zen meditation, something I have practiced for more than 30 years. What I find particularly helpful is that in Zen the ‘now-ness’ experienced through sitting silently, although appreciated, is not elevated to a special or mystical status but is processed as part and parcel of our everyday existence. Our day-to-day existence is pretty amazing if we cultivate awareness and a different ways of seeing, and ‘ordinary’ interaction with our clients can disclose a world of insights. The other useful pointer from the Zen tradition is that one practices for no reason at all: not in order to achieve a desired state of mind or to get rid of an unwanted one. At a time when various ‘mindfulness’ practices are increasingly utilized as a set of techniques aimed at correcting pathological behaviour, the Zen perspective inscribes meditation practice in the dimension of non-utilitarian play, for doing something with no gain in mind is one of the definitions of playing. Winnicott had many inspiring things to say on the healing power of this dimension – equating play itself with presence, healing and therapeutic change (10).

Care of the self

Practising self-care is a commitment to continue to work on ourselves, to prevent the possibility of burnout and avoid the emotional exhaustion and stress that go with listening to the depth of our clients’ troubles and dilemmas.

Inspired by the ancient Greek philosophers, Foucault (2,3) saw ‘care of the self’ as askesis,an ongoing practice of mind and body aimed at nurturing our freedom and dignity as individuals yet also as a practice directly linked to ethics, i.e. aimed at relating better to others. Much more than eating healthily, resting, and avoiding stress, care of the self is geared towards greater self-awareness, which for the Greeks was vital for participation in social and political life (4), something Foucault translates as “the formation of the self through techniques of living, not of repression through prohibition and law”(3). In other words, the person who practices care of the self will, adhere to an inner, perhaps deeper ethical code even before abiding by the rules of her profession. Foucault maintains that the two dimensions of ethics, inner and outer, the letter and the spirit of the law, may not or may coincide, depending as to whether the rules and regulations of a given society are geared towards the emancipation or the normalization of individuals.

Crucially, the person who practices care of the self will not be able to deliberately exercise power over another human being, and the therapist will be acutely aware of the power imbalance implicit in the therapeutic relationship. “If you take proper care of yourself" – Foucault writes – "... if you know what you are and ... what you are capable of; if you know what it means for you to be a citizen of a city … if you know what things you should and should not fear, if you know what you can reasonably hope for and, on the other hand, what things should not matter to you, if you know, finally, that you should not be afraid of death – if you know all this, you cannot abuse your power over others” (5). It is remarkable that in the end Foucault openly links our propensity to exert power over our fellows with our fear of death. The poignant and profound lesson inherited from the Greek philosophers of antiquity – and one that uncannily coincides with the teachings of the Buddha – is that ethics is dependent on our awareness of mortality and the impermanence of all living things. 

Care of the self for the therapist could today mean maintaining an ongoing practice of mind/body awareness which also allows for a down-to-earth sense of one’s own environment: an internal/external awareness, a form of ‘introspection’ which is also open to the ethical dimension and our dealing with others and the world.

A therapeutic practice which has care of the self at its core emphasises the fact that theoretical knowledge and technique proficiency are not enough in the difficult and rewarding practice of being a therapist. The therapist’s very self is the fine instrument conveying, above all, presence.

Presence: an integrative notion?

It is debatable to which therapeutic orientation the notion of presence belongs. It seemed to have been already there with Freud’s stress on the “evenly suspended attention” (11) of the analyst, on his recommendation that the physician “must turn his own unconscious like a receptive organ towards the transmitting unconscious of the patient”. The analyst, he added “must adjust himself to the patient as a telephone receiver is adjusted to the transmitting microphone” (12).

Later the humanistic tradition emphasised presence as crucial to therapeutic change, as a factor a great deal more important than the acquisition of academic knowledge or the mastery of a particular set of skills. Rogers famously wrote: “I find that when I am closest to my inner, intuitive self, when I am somehow in touch with the unknown in me ... then whatever I do seems to be full of healing. Then, simply my presence is releasing and helpful to the other” (13).

A way of being

The practice of the phenomenological reduction, a.k.a. epoché or ‘bracketing’ – putting aside any assumption so as to meet our clients more directly – is a reminder of how the therapist can become more open to presence in the therapy room. Its first advocate was a Greek philosopher called Pyrrho (365 – 270 BC), for whom it represented a strategy to overcome dogmatism, the latter defined by one of his followers, Sextus Empiricus, as “metaphysical entities, transcendental realities, in order ... to ... ‘explain’ [our lived experience]. All of these realities are ... unverifiable” (14). Many centuries later Merleau-Ponty (15) will extend the practice of bracketing to scientific and psychological theories, no matter how great or well established they might be, so as to free us from the Promethean desire to master the fundamental uncertainties of life.

Several questions still remain, however: having accepted the validity of bracketing, how do I do it? Do I just push away and suppress any unwanted thought, feeling and emotion? What do other therapists do to cultivate presence and put aside assumptions that get in the way of a genuine encounter? How can I be with the intersubjective process in the room? ‘Being with’ is for me what provides the key, and my temporary, empirical answer is: meditation. For meditation is essentially, in my understanding, being with whatever arises without judgment and with no attachment.

Contemporary Buddhist teacher Stephen Batchelor writes that in 1979, as a 25-year old recently ordained monk in the Geluk school of Tibetan Buddhism, he went to a lecture by the renowned phenomenologist Emmanuel Levinas on Husserl. During the lecture, Levinas mentioned the phenomenological practice of ‘bracketing’ (epoché): putting aside concepts, assumptions and opinions so as to meet reality more directly. How do we achieve bracketing? Batchelor asked, but Levinas had no answer. Can meditation help a person be more aware of his own assumptions and so become more open to experience? The question was to no avail: “the notion that one might require a rigorous meditative discipline to achieve such bracketing – Batchelor writes – was an entirely alien idea” (16).

There are of course specific ways in which we can increase therapeutic effectiveness. Preparing to be with a client, bracketing, letting go of self-concerns and issues, being congruent, and having a clear intention to be present in the interaction: there are detailed exercises and practices which can help us being more fully present. It might be useful at first to consider what is our habitual way of approaching the therapy session and whether we go to meet the next client with a sense of stillness and receptivity (17).

Conclusion

Cultivating presence is an ongoing practice. It is a way of being rather than the acquisition of a set of techniques, yet there are methods we can use in order to invite more presence in the therapy room and be helpful to our clients. It is a discipline, yet inspired by the dimension of play. It prepares the therapist to meet the unknown, the “pre-cognitive” and “pre-reflexive” (18), the genuinely new.

REFERENCES

1. Geller, S.M., Greenberg, L.S., & Watson, J.C. Therapist and client perceptions of therapeutic presence: the development of a measure. Psychotherapy Research, 20, 599-610

2. Foucault, M. The history of sexuality Vol. 3. The care of the self, 1988. New York: Random House.

3. Foucault, M. Ethics, subjectivity and truth. New York: The New Press, 1997, pp. 281-301.

4. Batters, S. M. Care of the self and the will to freedom: Michel Foucault, critique and ethics

University of Rhode Island, 2011 Internet file http://digitalcommons.uri.edu/cgi/viewcontent.cgi?article=1241&context=srhonorsprog, retrieved 13 Oct. 12

5. Foucault, M. Ethics, subjectivity and truth,op cit p. 31

6. Stern, D. The present moment in psychotherapy and everyday life. New York: W.W. Norton & Company, 2004

7. Cited in Lanyado, M. The presence of the therapist: treating childhood trauma. London: Routledge, 2004, p. 9

8. Geller, S.M. & Greenberg, L.S., Therapeutic presence: a mindful approach to effective therapy. Washington DC: American Psychological Association, 2012, p. 7

9. Lanyado, M op cit

10. Winnicott, D.W. Playing and reality. London: Tavistock, 1971

11. Epstein, M. Psychotherapy without the self: A Buddhist perspective. London: Yale University Press, 2007, p. 101

12. Freud, S. Recommendations to physicians practicing psychoanalysis. Standard edition, 12. London: Hogarth Press, p. 115

13. Rogers, C.R. A way of being. Boston, MA: Houghton Mifflin, 1980p. 129

14. Madison, G. B. The Phenomenology of Merleau-Ponty Athens, Ohio: Ohio University Press 1981, p 301

15. Merleau-Ponty, M. Sense and Non-sense. Evanston: Northwestern University Press, 1964.

16. Batchelor, S. Confession of a Buddhist atheist. New York: Spiegel & Grau, 2010, p. 52

17 Geller, S.M. & Greenberg, L.S. op cit p. 75-91

18 Merleau-Ponty M. Phenomenology of perception. London: Continuum; 2010.