«Therapeutic Presence: Therapists’ experience of presence in the psychotherapy encounter Therapeutische Präsenz: Erfahrungen von Therapeuten mit ...»
Geller and Greenberg
Therapists’ experience of presence in the
Therapeutische Präsenz: Erfahrungen von Therapeuten mit Präsenz in der
La Presencia Terapéutica: La Experiencia de la Presencia que viven los
Terapeutas en el Encuentro de la Psicoterapia
Shari M. Geller and Leslie S. Greenberg
York University, Toronto, Canada
Abstract. A qualitative study was conducted with expert therapists who are proponents or have written about presence and its importance in psychotherapy. Based on a qualitative analysis of therapists’ reports, a working model of therapeutic presence was developed. This included three emergent domains. One domain entails preparing the ground for presence, referring to the pre-session and general life preparation for therapeutic presence. The second domain describes the process of presence, the processes or activities the person is engaged in when being therapeutically present. The third domain reflects the actual in-session experience of presence. Presence is discussed as the foundation of Rogers’ basic conditions of empathy, congruence, and unconditional positive regard and as the overarching condition that allows them to be expressed.
Zusammenfassung. Eine qualitative Studie mit erfahrenen Therapeutinnen und Therapeuten wurde durchgeführt, welche Befürworter dieses Konzeptes sind oder die über Präsenz und ihre Bedeutung veröffentlicht hatten. Basierend auf einer qualitativen Analyse von Therapeutenberichten wurde ein Arbeitsmodell zu therapeutischer Präsenz entwickelt. Drei Bereiche kristallisierten sich dabei heraus: Ein Bereich betrifft die Bereitung des Bodens für Präsenz. Er bezieht sich auf die Vorbereitung vor der Sitzung sowie die allgemeine Vorbereitung im gesamten Leben im Hinblick auf die therapeutische Präsenz. Der zweite Bereich beschreibt den Prozess der Präsenz, die Prozesse oder Aktivitäten, in denen die Person firstname.lastname@example.org The authors would like to acknowledge all the therapists who offered their personal presence and wisdom to help us deepen our understanding of fully encountering another human being in the moment.
Person-Centered and Experiential Psychotherapies, 1477-9757/02/01071-16 71 © Geller and Greenbers Volume 1, Issues 1&2 Therapeutic Presence engagiert ist, wenn sie therapeutisch präsent ist. Der dritte Bereich reflektiert die tatsächliche Erfahrung der Präsenz während der Sitzung. Präsenz wird als die Grundlage von Rogers’ Grundbedingungen der Empathie, der Kongruenz und der nicht an Bedingungen gebundenen Wertschätzung diskutiert und als die übergreifende Bedingung verstanden, welche die Voraussetzung dafür ist, dass diese drei ausgedrückt werden können.
Abstract. Se llevó a cabo un estudio cualitativo con terapeutas expertos quienes han manifestado su apoyo o escrito sobre la presencia y su importancia en psicoterapia. Basado en un análisis cualitativo de informes de terapeutas, se desarrolló un modelo de presencia terapéutica. Este incluye a tres esferas emergentes.
Una esfera consiste en preparar el terreno para la presencia, refiriéndose a la pre-sesión y a la preparación general en la vida para una presencia terapéutica. El segundo dominio describe el proceso de presencia, los procesos o actividades en que la persona está involucrada cuando está terapéuticamente presente. El tercer dominio refleja la real experiencia de presencia en la sesión. La presencia es discutida como el fundamento de las condiciones básicas de Rogers de empatía, congruencia y validación positiva incondicional y como la condición que permite que éstas se expresen.
Presence has been described as one of the most therapeutic gifts a therapist can offer a client.
To be fully present and fully human with another person has been viewed as healing in and of itself (Shepherd, Brown and Greaves, 1972). There are a number of references to the word ‘presence’ in the literature on psychotherapy. Presence is referred to as essential for good therapy and the key to being an effective therapist (Bugental, 1987, Hycner, 1993; Hycner and Jacobs, 1985; May, 1958; Schneider and May, 1995; Shepherd et al., 1972; Webster, 1998). At the same time there are only global theoretically based definitions and explanations of what presence entails.
For example, Bugental (1978, 1983, 1987, 1989) defined presence by highlighting three components, an availability and openness to all aspects of the client’s experience, openness to one’s own experience in being with the client, and the capacity to respond to the client from this experience. Hycner (1993) stated that availability and wholeness of the therapist’s self is crucial in the healing process, much more so than the therapist’s theoretical orientation.
Presence is also described as an emptying out of self, of knowledge, of experiences and an opening up to the experience of the client (Clarkson, 1997). The therapist ‘brackets’ or suspends presuppositions, biases, general knowledge about people and psychopathology, diagnostic labeling and theories, in order to take in the uniqueness of the client (Hycner and Jacobs, 1995). The therapist needs to enter each session openly ‘with an eye to discover what will be required of me in this relationship, during this particular time of this particular person’s existence’ (Craig, 1986, p. 23).
Therapeutic presence is defined as bringing one’s whole self to the engagement with the client and being fully in the moment with and for the client, with little self-centered purpose or goal in mind (Craig, 1986; Hycner, 1993; Hycner and Jacobs, 1995; Kempler, 1970;
Moustakas, 1986; Robbins, 1998; Webster, 1998).
Presence is referred to as an aspect of Buber’s I–thou relationship (Buber, 1966;
Friedman, 1985; Heard, 1993; Hycner, 1993, Hycner and Jacobs, 1995). According to Buber 72 Person-Centered and Experiential Psychotherapies, Volume 1, Issues 1&2 Geller and Greenberg (1958) ‘all real living is meeting’ (p. 11), and healing emerges from the meeting that occurs between the two people as they become fully present to each other. Buber stated that in being present we are ‘hallowing the everyday’, which allows space for the numinous and spiritual dimension to emerge (Hycner, 1993). The spiritual dimension refers to the belief that we are not isolated, but rather a part of a larger whole existence.
ROGERS AND PRESENCE: A FOURTH CONDITION OR A
PRECONDITION OF THE RELATIONSHIP CONDITIONS?Rogers’ (1957) assertion — that the therapist’s ability to be congruent, unconditionally positive and accepting and empathic was necessary and sufficient for psychotherapeutic change — was held by him for most of his life. In his later years, however, Rogers began writing about ‘one more characteristic’ that exists in the realm of the mystical and spiritual (Rogers, 1979; 1980; 1986). This ‘characteristic’ (see Rogers, 1980, p.129) has been referred to by client-centered writers as ‘presence’, and as a possible fourth condition of equal merit to the three core conditions (Thorne, 1992). Other writers view presence as a blending together of the relationship conditions (Mearns, 1994; 1997).
Rogers did not develop an articulated understanding of presence, as it was only beginning to unfold before his death.
However, in an interview with Rogers published by Baldwin (2000), Rogers suggested the essential nature of presence:
I am inclined to think that in my writing I have stressed too much the three basic conditions (congruence, unconditional positive regard, and empathic understanding).
Perhaps it is something around the edges of those conditions that is really the most important element of therapy — when my self is very clearly, obviously present (p.
Rogers’ reference to presence as a powerful healing component and an essential aspect of client-centered therapy was quite apparent in his later writings (Rogers, 1979; 1980; 1986), but absent in a posthumous article (Rogers and Sanford, 1989). It is unclear whether Rogers left out this developing aspect, or the editors decided it was not in keeping with classical client-centered perspective. Thorne (1992) posited that Rogers refrained from developing this concept as he was unable to study it empirically. Thorne is of the belief that had Rogers lived we would have heard a great deal more of presence, and that the theory and practice of person-centered therapy would have undergone major changes as a result.
The purpose of the current study is to describe and expand on an understanding of therapists’ presence. To achieve this, an attempt was made to identify and explore therapists’ reflective experience of presence and to develop a model of therapeutic presence, in order to further elucidate this hidden but important quality in psychotherapy.
Person-Centered and Experiential Psychotherapies, Volume 1, Issues 1&2 73 Therapeutic Presence
The goal of this study (Geller, 2001) was to identify and understand the quality of therapists’ presence in the psychotherapeutic encounter from a qualitative analysis of therapists’ reflections on their experience of presence.
Participants Seven experienced therapists who were identified as authors or proponents of the concept of presence were interviewed on their experience of presence. All seven therapists had a minimum of 10 years’ experience practicing psychotherapy and had an active therapy practice at the time of the interviews. Four therapists were from a humanistic/experiential theoretical background, one from a Cognitive-Behavioral (CBT) perspective, one from an Adlerian/ Transpersonal perspective and one from an Eriksonian background. It is important to note that while the majority of therapists reflect a humanistic/experiential orientation, the CBT therapist was an experienced meditator and may have emphasized the importance of presence because of this, as presence is a central focus in meditation. Hence, generalizations on the role of presence across theoretical orientations cannot be made from this study.
Therapists were provided a brief description of presence extracted from the literature, and asked to reflect upon their own experience of presence over their next few sessions with clients. At least one week after initial contact, the therapists were interviewed and audiotaped while describing their experience of presence. A general interview format was followed in which therapists were asked, in an interactive dialogue with the interviewer (SG), about different aspects of their experience, such as the physical, emotional and cognitive elements of presence.
Transcriptions of the audiotaped interviews were used in a qualitative analysis and interpreted according to a method combining condensation and categorization of meaning (Kvale, 1996).
This integrative approach entailed extracting the key components of presence from the transcripts and compressing them further and further into meaningful but briefer statements of presence. This involved the five-step process laid out in Kvale’s (1996) book. First, the entire interview was read through to get a sense of the whole. Second, each transcript was reviewed sentence by sentence and meaning units were determined from the expressions of the therapists. Third, the theme that is expressed in the meaning unit was stated as succinctly as possible. Each meaning unit was either placed under an existing theme or a new theme was created. Themes that were identified in a minimum of two transcripts were used in the remainder of the analysis. Fourth, the themes with similar meaning and understanding with 74 Person-Centered and Experiential Psychotherapies, Volume 1, Issues 1&2 Geller and Greenberg respect to presence were placed under a higher-level categorization reflecting these commonalities. In the fifth stage, the essential, non-redundant themes and categories were tied together into yet another higher level of categorization which will be referred to as ‘emergent domains’.
After much thought and consultation, three emergent domains were generated that subsumed all of the descriptive categories. These three emergent domains formed the foundation for a model on therapeutic presence.
An additional step was added to Kvale’s methodology; the themes and emergent domains were rechecked with the original transcripts and quotations were extracted from the transcripts to further explicate the meaning of the themes and categories.
Two control checks of the analysis were implemented in this process. First, a second rater (LG) checked and rechecked the categories formed from the themes in the formation of the higher-order categories. The categorization was judged by the second rater to be grounded in the original data. Second, three expert therapists performed a reliability check by stating their agreement or disagreement on the themes and categories as reflecting essential aspects of presence. When a discrepancy existed between the categorizations and one other expert’s opinion, there was discussion and, if agreed among raters, the changes were incorporated into the final presentation of the model of therapeutic presence.
A MODEL OF THERAPEUTIC PRESENCE
The model of therapeutic presence will be presented in three stages to represent the three major domains that emerged from the analysis. The first domain reflects the preparation for presence, the behaviors that enhance the capacity for presence to be experienced in session.
The second domain focuses on the process that therapists engage in, or what the therapist does, while being therapeutically present. The third domain deals with the actual in-session experience of presence itself.
It is important to note that separating the totality of the experience of presence into aspects or parts is an exercise conducted to understand and explicate the many presumed dimensions of presence. Presence is a holistic subjective experience that loses its essential nature when analyzed in an objective manner. Hence, it is best to read each section while holding the totality of the experience of presence in one’s awareness. Each part is not only an aspect of the whole but is, in actuality, a reflection of the whole.
Preparing the Ground for Therapeutic Presence