In a former blog piece, I addressed the core concept in Emotionally Focused Therapy (EFT) as working with “the space between”. That is, within the interactional pattern of the couple-their dialogue, inter-communication, the synergy that is examined and processed in order for prevailing unhealthy attachment patterns to regenerate into more healthy ones. It is within that space that we join and therein lies the exchange required for connection.
I noted that the formerly established couples models of yore, albeit vague and undefined at the time, looked solely at the relational exchange. That is, the therapist failed to recognize attachment fears and insecurities, independently generated, that guided one or both in the dyad, a primary move ahead attributed to the structure and development of Emotionally Focused Therapy (EFT).
In a recent article, in the Journal of Experiential Psychotherapy, the September 2018 edition, my colleague, Dr. Marni Feuerman reviews the literature and examines the role of Therapist’s Presence (TP) in the treatment of couples, specifically within the model of EFT for couples.
Therapeutic Presence is a Form of Mindfulness
Therapist’s Presence (TP) is a relatively new construct in the research. It shows up to be loosely referred to in that manner, as ‘presence’ by Dr. Milton Viederman, in a 1999 edition of the Journal of Psychotherapy Practice and Research.
Therapeutic Presence (TP) refers to the therapist’s ability to be fully engaged within the therapeutic setting; connected physically, emotionally, cognitively and spiritually. It is the current day version of therapeutic mindfulness, a concept that was first identified by Jon Kabat-Zinn (whose work provided methods to counteract the anxiety of the day, a model or program that provided a substitute for the ‘stress management’ of my days in graduate school).
Therapeutic Presence is Not New
Yet the notion itself of therapeutic presence is not new at all. We know that outcome research attributes a large, if not the most essential, piece to the engagement between patient and practitioner. We know that the therapeutic alliance and presence is key to a successful working process and ultimate outcome, often noted in the research as independent of method. Dr. Feuerman cites research studies confirming this fact, stating “decades of research indicate that the delivery of therapy in an interpersonal process in which a crucial curative component is the quality and nature of the therapeutic relationship”.
To be present within the therapy says Dr. Feuerman, or the space between, allows for the experience of “purposeful attention, nonjudgmental acceptance and empathy”. These features, predominant among both Gestalt, Rogerian and Systems theories, allows for the experience of the interaction and therefore the possibility to interrupt the negative cycle and allow new interchanges within safety instead of anxiety. The facilitation of emotional depth requires a key skill in early attachment . . . attunement, a process that creates a space for the development of mirror neurons and without it does not allow, I believe, for the process of love.
Therapeutic Presence Is Vital for Effective Couples Therapy
What Dr. Feuerman is really contending is that within that space is a fundamental need for the presence of the practitioner, one who is grounded, immersed and completely able to take in, and that the work—the provision of a corrective emotional experience, that allows for healing, cannot be done successfully without it. What she is contending is that there needs to be an experience with the couple that exemplifies that which they are supposed to revolutionize, that of being present with the partner in the safety of the experience. As highlighted, this process of TP becomes that much more complex within couples therapy, given the presence of three people in the room, compared to the interconnection within a dyad in the individual session.
Consistent empathy, congruence, and unconditional regard are all required for what we refer to in EFT as key change events, a replacement of old negative attachment patterns with healthy ones. Therapeutic “ruptures”, moments where the therapist leaves the experience due to some internal or external distraction, can have a potentially negative effect on the therapy and according to Dr. Feuerman can be a sufficiently cataclysmic experience to cause the process create a breach in the process, causing the therapeutic work to shut down and potentially end.
Therapeutic Presence Is Vital for Individual Therapy Too
On another note, it is hard to omit even a brief statement about TP within the classically trained models of therapy as well. With psychoanalytic psychotherapy, my own mainstay, and various and sundry other convention and unconventional models, it would seem that while the method is important, perhaps this aspect of therapeutic presence is even more key in the outcome of treatment. Dr. Viederman questions as to whether this point can be accepted on more than a superficial level due to the foundation of change within the unconscious. He says “presence emerges rather than directly brought about”; it is more involved and complicated than Winnicott’s concept of ‘holding environment’. He cites generative empathy, unconditional positive warmth, and therapist genuineness as factors precipitating presence. Dr. Viederman says presence mandatory for healing as part of the other variables but believes it too can stand on its own as a curative factor. As with most concepts within the analytic frame, it is way too complicated to simply outline here.
You can read Dr. Feuerman’s article here.
You can read more on couples therapy here.