Actors and psychotherapists. Two sides of the same coin
Carpenters and plumbers have tools with which to work. One uses hammers, saws, chalk lines, and so forth to frame up walls and construct buildings. The other uses wrenches and pipes to make sure water runs smoothly through such buildings.
Other professions use different kinds of tools to get different types of things accomplished.
Actors and psychotherapists use a tool as well; they utilise the same tool to accomplish different purposes. The tool they both use is their self. They, themselves, are the tools they use. Whereas the actors use themselves to create a character or persona, psychotherapists use themselves to encounter a character or person. The actor seeks to suspend disbelief so that an audience imagines someone else is present, while the psychotherapist seeks to engender trust in the person who is actually there. The actor lets him or herself be used by giving over to the script and the situation and letting him or herself become whatever is called for in the character portrayed. The actor becomes someone else, or the actor allows him or herself to express what he or she would be like if he or she were that someone else, in that fictional situation. The psychotherapist grounds him or herself in who they know themselves to be, in the current situation of meeting with a client, and the therapist monitors how the situation of the client affects him or herself in order to use that information to help the client find answers in how to respond to other people outside of therapy.
The old days of professional distance, of playing a professional role as “therapist”, “doctor”, or expert on somebody else’s life are gone. These days the intersubjective relationship between therapist and client has taken centre stage in the therapeutic drama. It has been researched and prodded and flipped over and poked and observed and measured in numerous research projects over the last decade or more.
The therapeutic relationship is central to most forms of psychotherapy and has been found to be an effective factor in positive outcomes. Gestalt therapy’s particular nuances in dialogical contact for such a relationship are exemplified in the consilient nature of “therapeutic immediacy”. Mayotte-Blum and colleagues described therapeutic immediacy saying that it involves any discussion within the therapy session about the relationship between therapist and client that occurs in the here and now. Typical examples of therapeutic immediacy include exploring parallels between external relationships and the therapy relationship; client or therapist expression of in-session emotional reactions; inquiring about the client’s reactions to therapy; the therapist commenting on his or her experience of the client; supporting, affirming, and validating the client’s feelings in the therapy relationship and expressing gratitude.
In turn, therapeutic immediacy, an aspect of the working alliance, is emergent of what Charles Gelso described as “the real relationship”, something inherently associated with the working alliance and determinative of positive outcomes in psychotherapy. The working alliance is theorised to emerge from the real relationship. The real relationship is the more fundamental of the two, existing in any and all relationships. The working alliance, on the other hand, develops only when there is work to be done. Thus, it is the alliance that exists for the purpose of getting the work of therapy accomplished, whereas the real relationship has no explicit intent. It simply exists, and it must exist, to varying degrees and at varying strengths. Given this inherent connection, one would certainly expect a close empirical relationship between the working alliance and the real relationship. That is precisely what my colleagues and I have found in four qualitative studies: that therapists’ ratings of the strength of their real relationship with their patients relate moderately to strongly to these therapists’ ratings of their working alliances.
Norcross and Wampold summarised the findings of an interdivisional task force of the American Psychological Association on evidence-based therapy relationships. Their work examined numerous meta-analyses and found that:
(1) the relationship makes a substantial and consistent contribution to outcome independent of the specific type of treatment
(2) the therapeutic relationship accounts for why clients improve (or fail to improve) at least as much as the particular treatment method
(3) efforts to advance evidence-based practices without including the relationship are incomplete and potentially misleading
(4) the relationship acts in concert with treatment methods, patient characteristics, and practitioner qualities in determining effectiveness.
Gestalt therapy is exquisitely a therapy of contact and relationship. All the common factors research supports the notion that gestalt therapy is an evidence-based approach, but above them all the copious research on relationship in therapy supports the assertion that gestalt therapy lends itself to an evidence-based practice.
I take comfort in all this, because some people think of gestalt therapy as either a relic of the 1960s or unsupported as an evidence-based approach.
My eyes also sparkle a bit to think that in matters of faith it is not the professional stance that carries the day, but the actual connection, the contact and encounter one experiences with God. In the Bible God says that He is not all that impressed with the religious sacrifice, but a contrite spirit He will not despise. To me, that is all about the way God looks upon our hearts and wants a relationship with us, a genuine connection in which there is evidence that one matters to the other, that one knows the other, and that one respects the other. Many people say that God is no respecter of persons, but I believe what they mean is that God does not play favourites. To me God is a supreme respecter of persons. He will respect your choice in either coming to Him for relationship or turning your back on Him in disbelief. But it is the relationship that saves. You can experience a working alliance with the various trappings of religion, but if there is no real relationship with God, nothing therapeutic for your soul will emerge from going to church.
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