Jan shows up weekly, sometimes twice weekly, to attempt to understand why she continues to shy away from any emotional intimacy in her relationships; she is 38. And at 38 the clock is ticking and she is determined to alter her life’s path. Through her face-to-face contact with a trusting therapist, she is able to face the pain she sustained while a preteen influenced by a tyrant mother who successfully wedged a distance between Jan and her father, a pattern she continues in her relationship with potential male partners. In one of several pivotal moments in her treatment, Jan attempts to shut down into her shame, an attempt thwarted only by a supportive and holding relationship with her therapist, a male who just happened to be the same age as her father. In this moment of indeed facing her pain, she discovered her ability to be able to turn back to her father, while simultaneously entering a better place of availability and a potential relationship with a man.
There is nothing that takes the place of a face-to-face process and any classically well-trained mental health practitioner will confer. That said, the weekly process, offers both pros and cons to some.
We know from extensive outcome research that it is the relationship between patient and therapist that is responsible for a large percentage of the variance—that is, has a huge effect on the outcome. The necessity to allow the therapeutic process and alliance to develop is the cornerstone of therapy. We know that it is through the transference, the relationship that shows up between patient and therapist based on the patient’s primitive and developed underpinnings of their psyche, that healing occurs.
That said, the weekly (or more) structure allows for the evolvement of the relationship. Further, healing does not occur without attachment which requires the space for attunement, a process that many of those who walk through our doors maybe without, given their early relationship injuries and trauma.
Ongoing and consistent working together provides too for many other curative factors, and noticing the change in the character, and not just the behavior, is just one of them. That is, we have the opportunity as therapists to notice change that sticks. And if we adhere to the stages of change, from Prokscha, we have the ability to see and hear how the client shows up differently.
Yet for some finding, both the travel time and the time to sit and be (somewhat) still has become a challenge, largely because the world has become so digitized and we are in a constant state of being on, but also because there are other options. When there was one salsa flavor on the supermarket shelf that was the one we chose and savored. It remains dumbfounding to me when I hear a new client report that they have or continue to engage in ongoing phone therapy with the drive less and 15 minutes in duration. That this option can be used for a stand-in for when the patient is ill or the weather is challenging or even if they are in a remote area without options nor great internet service, is not the same as making it routine. During the pandemic, someone told me that it’s easier for the therapist because they have greater access from home as their office space is only available on a limited basis. Neither serves as a sufficient reason.
That said, you, like my two boys, might think that in fact, I’m a dinosaur. That the old ways of doing something are indeed that, antiquated. While that might hold true for the manner in which we navigate our banking, purchase toilet paper or make a dinner reservation, the fact remains: there is nothing that provides a reasonable facsimile to face-to-face therapy.
Please check out the next blog post in this series here.
Please check out the first blog in this series here.