Paradoxes in therapy - Part two of two

In part one, I wrote about the following paradoxes in therapy - change, empathy and the therapeutic relationship. In part two, I will write about the paradoxes of blame, responsibility, ownership and benevolence in therapy.

Blame, responsibility and ownership

It is a well-established understanding within therapy that progress is much more difficult to make if someone is ‘sent’ to therapy. This could be because they have been strongly urged to seek help, or it may be a proviso from their partner that the success of their relationship depends on them ‘getting some help’. Even if these suggestions or recommendations are made with good intentions, are honest and real, it will prove difficult for someone to establish a meaningful connection therapeutically, change or make progress, because they have not made a conscious decision to seek help themselves. It is only once responsibility has been taken fully by someone to seek further understanding of their difficulties, that they can find the experience useful.

The paradox of blame, responsibility and ownership therefore is a complex one. At a rather basic level it could be understood as follows - clients can be told at various stages of their therapy that they are to some extent unable to help who they are or the circumstances or difficulties that have befallen them historically and presently, but simultaneously they are told that in fact, the responsibility is on them to take ownership of their difficulties and only then can they make significant changes. This brings forth a process where by people are required to in a sense, separate their minds from those of others, and find the courage to accept that they have to take ownership of their own difficulties and their own minds.

It is important to note that while taking responsibility for oneself in therapy is an important part of the process, this is not by any means the case for those who have experienced either physical, mental or sexual abuse, a traumatic event such as an accident or lived through war for example. The above list is by no means a comprehensive list, and is given only to highlight this point.

The therapeutic relationship again becomes important with regards to blame, ownership and responsibility. Again in quite basic terms, the relationship could be defined as compulsory within a voluntary setting. Meaning that, clients are told they must, seek help of their own free will, be independent in wanting to make changes and that the success they have in therapy is based upon how much they can engage and give to the process.

However, the compulsory aspects of the therapeutic frame (within private practice at least) are that clients must pay for sessions (depending on their therapist’s policy – pay for missed or cancelled appointments), are asked to keep missed appointments to a minimum and before ending should consult and discuss this with their therapist. So, even though a client comes to therapy off their own back, and the responsibility is on them, there are still rules in place that must be adhered to for therapy to be most effective.

Additionally, a therapist can often be seen as someone who possesses what could be referred to as ‘expert knowledge’, however the therapeutic frame means that the therapist will disengage from offering such advice, instead, choosing to foster within the client the ability to learn, understand and grow themselves. The responsibility is again placed upon the client to engage in the process off his or her own back. This message as you might well imagine, can feel confusing for people. Why if a therapist possesses this level of knowledge do they not share it, why do they conceal what they know? Again this comes back to the relationship, and in terms of equality, the client spills out all of their difficulties, but the therapist remains more or less non-disclosing of any aspect of himself or herself. This is truly, one of the most interesting paradoxes within therapy.

Benevolence

As discussed in part one of this article, therapy is for the most part understood as a benevolent process, one in which the therapist offers acceptance, kindness, understanding and empathy. However, as with the other elements discussed, benevolence also inherently carries with it a paradox. This to some extent could be understood by the demanding, often punishing and painful nature of therapy, where clients are asked to immerse themselves in the ‘work’ of therapy. The paradox of this, is that, as with empathy, benevolence has another side to it. This is that by the definition and role of a therapist being benevolent, they are asking their clients to willingly explore pain, suffering, shame, anxiety and deep rooted feelings that have been buried for good reasons. Again, there is another side to this aspect of therapy.

In closing

There has been over the years a heated debate as to whether psychotherapy is a science or an art, and to quote Magda Denes, “I have no conflict in that realm. I am fully convinced it is an art”. As with any form of art, there are no hard and fast rules or set ways of working. Inherently attributed to art are paradoxes, subtleties, and conscious and unconscious complexities.

What is clear, to me at least, is that the paradoxes as described in this article, are crucial for the work of therapy to progress and flow. The interplay between the different levels of reality within therapy are a fundamental part of the process and the paradoxes are necessary for people, and important to be understand and held in mind.

There is no one thing that constitutes change in therapy or assists it in arriving more swiftly than that of the therapeutic relationship itself. As stated previously by numerous therapists and writers, the therapeutic relationship is in some ways the therapy. This ultimately means that the relationship is crucial and the fact both therapist and client are themselves human and fallible, means there can be no set route, path or plan within therapy.