Here's the first installment from my training class on the Stages of Healing that I taught to prospective therapists a while ago. Readers will note that the stages of healing in therapy move along with what should be our natural stages of development. In this relationship, both the patient and the therapist have responsibilities that intertwine.
Stage One: Forming a Therapeutic Alliance
Basic trust is the first issue in therapy, just as it is the first issue in life. In a sense, a person coming to therapy initially is somewhat like a newly arriving human being in that the new patient is acting from her natural impulse to reach out in an act of trust when it is in crisis of need. That capacity is innate within all of us at birth. The first call to the therapist is an expression of basic trust. It is the first positive diagnostic sign. Even though the new patient doesn’t know the therapist, he still makes the call for help, somehow, just as a baby will reach out for the caregiving adults around it that it doesn’t really know in any way…except intuitively.
Indeed, intuition and gut feelings are strongly at play in the first contacts between a patient and therapist, beginning even before the first session, over the telephone. Little children and animals, naturally connected to their own “6th sense”, either trust you or “bark” at you almost immediately. This is often true of persons in an emotional crisis, when our guts are very active in providing guidance.
A patient in a first session will respond very strongly to energetic and aesthetic details in the same way, though perhaps less consciously, that you, the therapist, will assess a new patient’s presentation of self. Your office décor and ambiance, including colors, smells, knickknacks, pictures, etc., your clothes and general appearance, your body language and character structure, attitudes, etc., all will be reacted to by the person sitting across from you in those first moments. (Freud believed that there was a direct communication between the patient’s and the analyst’s unconscious.) However, this doesn’t necessarily mean that if a patient doesn’t take to you as a therapist or she decides not to see you that you are not trustworthy. It could just mean that the energetic chemistry wasn’t comfortable between you, as happens in any relationship. AND THE THERAPUETIC RELATIONSHIP IS A REAL RELATIONSHIP!
So…how does basic trust develop further, beyond the innate movement to reach out, and become the basis for a relationship that will prove beneficial for the individuals involved?
This is not a matter of technique, and technically, it can’t be taught. A therapist cannot learn how to act trustworthy toward a patient and expect to be experienced as genuine. A therapist can become able to trust herself in the same way that a patient does – through a process of discovering the inherently loving nature of who we truly are and the inner guidance that is always present within ourselves.
If a lack of basic trust develops in infancy, it is at first in relation to an environment that was hurtful, depriving, frightening, etc. – not trustworthy. Yet, it is mainly the infant’s not trusting its own impulses to reach out for help, nourishment, and love that become the lasting source of dysfunctional behavior and characterological problems. The main channel for healing, then, becomes the patient’s willingness and capacity to reach out, which will tend to be proportionally related to the therapist’s willingness and capacity to reach out…or reach back.
So, as the person doing the guiding, the therapist must have done and/or be doing that work on himself in order to help the patient to do it. Basic trust will develop in the therapeutic relationship, therefore, to the degree that therapist and patient become able to trust themselves as capable of giving and receiving.
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