Working at Relational Depth in Counselling and Psychotherapy

Dave Mearns, Mick Cooper

• Publisher: SAGE Publications Ltd
• Year: 2017
• Print ISBN: 9781473977938, 9781473977921
• eBook ISBN: 9781526416919
• Edition: 2
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Eagerly awaited by many counsellors and psychotherapists, this new edition includes an updated preface, new content on recent research and new developments and debates around relational depth, and new case studies.

This groundbreaking text goes to the very heart of the therapeutic meeting between therapist and client. Focusing on the concept of 'relational depth', the authors describe a form of encounter in which therapist and client experience profound feelings of contact and engagement with each other, and in which the client has an opportunity to explore whatever is experienced as most fundamental to her or his existence. The book has helped thousands of trainees and practitioners understand how to facilitate a relationally-deep encounter, identify the personal ‘blocks’ that may be encountered along the way, and consider new therapeutic concepts – such as 'holistic listening' – that help them to meet their clients at this level.

This classic text remains a source of fresh thinking and stimulating ideas about the therapeutic encounter which is relevant to trainees and practitioners of all orientations.

1 Foundations for a relational therapy

This book is about moments of intense relational contact and enduring experiences of connectedness within the therapeutic relationship. Such experiences of relational depth can be striking in the significance they have for the people involved. That they are striking reflects how far the existence of the human being is predicated upon relationship – we are born into a powerful, usually intensely loving, relationship; we learn to define ourselves through relationship; and throughout our life our evaluation of ourselves is especially influenced by relationship. Equally, it is relationship that can be most destructive to us. Criticism hurts most because it comes from another person, and abuse is particularly damaging when it comes from someone who should love us. There are over 20 clients mentioned by name in this book. Almost all of them had been damaged in relationships and continue to be hurt. Some had been so damaged and were so hurt that they had sought to separate themselves from relationship. Human beings are skilful in relationship and ingenious in trying to protect themselves from it. They can try to close off from relationship – either by avoiding it altogether or by not getting involved. They can pre-empt the attack they fear from the other by first attacking themselves in a fashion that diminishes self-esteem to a degree that inadequacy in relationships becomes a self-fulfilling prophecy. They can also protect themselves from relationship by figuratively, if not literally, ‘killing’ the other person that would threaten them with relationship. All these people are in this book – all of them had found themselves engaged in the potentially dangerous situation of being a client in counselling or psychotherapy. Why on earth did they do that? Perhaps because hope and despair are close neighbours. Perhaps because we are so grounded in relationship, even though we have been thoroughly damaged, we see the best hope of change as being through relationship. Yet, this hope can be faint and the task of therapists delicate: can they offer ‘encounter’ without ‘invasion’ and can they do it in such a way this they will be believed? Therapeutic working through relationship is challenging for both people, but it is a logical way to work – if damage is caused through relationship, cannot healing too?

Over the past half a century, the work of numerous psychologists, psychotherapists, neuroscientists and philosophers has pointed towards this healing potential of the therapeutic relationship. In this chapter, we look at the arguments and evidence that have emerged. In doing so, we want to lay the foundations for a relational understanding of the therapeutic process. If human beings live, die and thrive in relationships, it is through the relationship that the greatest therapeutic change may take place.

The Intersubjective Turn in Philosophy and Psychology: Being as In-Relation

Are we separate beings, or are we fundamentally inter-related with others? Over the last few centuries, the former understanding of human being has tended to dominate the western mind. Exemplified in the thinking of the French mathematician and philosopher René Descartes, this ‘modern’ worldview understands human existence in fundamentally individualistic terms. Here, each human being is conceptualised as a sovereign, autonomous, individual monad; fundamentally distinct and separate from other people. And while, from this modernist standpoint, human beings are seen as having the capacity to relate to each other, these relationships are seen as little more than the meeting between these two separate entities – like two billiard balls knocking together – within which, and from which, the two entities retain their individual status.

Such has been the pervasiveness of this model of the human being that, to a great extent, most of us simply accept it as a given. Indeed, even relational theorists like Carl Rogers have a sizeable foot in the individualistic camp. Rogers’ (1959) classical theory of human development, for instance, starts with an individual, self-contained organism, with the capacity for an autonomous and self-directed existence (see Cooper, 2013a). For Rogers, being is an individual process. Of course, Rogers sees relationships as fundamental to the development of human being, but he does not see human being, in its essence, as fundamentally relational.

Over the course of the twentieth century, however, many philosophers and psychologists have challenged this perspective, arguing, instead, that we are fundamentally and inextricably intertwined with others, and that our being is first and foremost a ‘being-in-relation’. In other words, what these authors have suggested is that we do not exist as individuals first and then come together with others to form relationships. Rather, what they have argued is that we exist with others first, and only after that come to develop some notion of individuality or separateness. William James (1909), the ‘father of American psychology’, writes:

[W]e with our lives are like islands in the sea, or like trees in the forest. The maple and the pine may whisper to each other with their leaves…. But the trees also commingle their roots in the darkness underground, and the islands also hang together through the ocean’s bottom. Just so there is a continuum of cosmic consciousness, against which our individuality builds but accidental fences, and into which our several minds plunge as into a mother-sea or reservoir. (p. 374)

This ‘intersubjective’ standpoint (see Crossley, 1996) has been reached from a number of different directions. Existential philosophers like Martin Heidegger (1962) have started from the assertion that human existence is not an object-like thing, in the way that a table or a molecule is, but an ever-changing flux of experiencing. And, if we conceptualise human existence in this way, other existences become much more central to the essence of who we are. In other words, at the level of lived-being, we are constantly doing things with others, or using tools that have emerged from an interpersonal matrix, or directing our thoughts towards them. So, for instance, although I (in this chapter, ‘I’ refers to Mick) might be physically on my own as I draft these words, my whole being, my ‘writing-these-words-now’, is oriented towards an imaginary other: the you that is reading this. At the level of lived-being, then, I am as infused with the existences of you as I am with the air that I breathe: others circulate around me and within me and are an integral part of who I am.

In my writing and relating to you I am also using language. The recognition that language – a socially constructed medium – is so fundamental to who we are and what we do is a major reason why the notion of separate, individual selves has come to be questioned in the last century or so. Contemporary philosophers like Derrida (1974) and Wittgenstein (1967) – as well as psychologists like Vygotsky (1962) and Gergen (1999) – have all argued that language is at the root of all our thoughts, something that we cannot stand outside of, and something that is intrinsic to our sense of who we are. Hence, even notions of individuality or self cannot be seen as ultimate and given truths, but as constructs that emerge out of a particular sociolinguistic and interpersonal context.

This is a point of view shared by many feminist and cross-cultural theorists, who have also challenged the idea that individuality is a given truth of human existence (see Jordan, 2013). Social psychological researchers, for instance, have shown that many non-western cultures have a much more interdependent view of the self, in which the ‘I’ is not seen as an isolated entity, but as something that is defined in terms of relationships with others (see Aronson et al., 1999). When asked, for example, to complete statements beginning with ‘I am…’, people from Asian cultures are more likely to define themselves in terms of family or religious group than people from western cultures (Aronson et al., 1999). Similarly, feminist theorists have argued that the notion of individuality is a particularly male view of human existence, and that females tend to have a more interdependent and relational understanding of who we are (see Jordan et al., 1991). Indeed, from these standpoints, modern individualism is seen as much more than just a benign set of beliefs, but as an ideology that legitimises a very specific set of social relations: western, patriarchal and late-capitalist. This is, for instance, by implying that competition between human beings is the natural state of affairs or that people should not be subverted by socialising influences.

From a developmental perspective, a range of psychologists, psychoanalysts and philosophers have also argued that human infants do not begin life as separate, isolated individuals, but as part of a fundamentally relational matrix. Buber (1958), here, writes that ‘the ante-natal life of the child is one of purely natural combination, bodily interaction and flowing from the one to the other’ (p. 40). This is very similar to the view expressed by psychoanalysts such as Mahler (Mahler et al., 1975), Loewald (see Mitchell, 2000) and Winnicott, the last of whom was well known for his statement that ‘there is no such thing as a baby, only a nursing couple’ (quoted in Curtis & Hirsch, 2003, p. 73). Mahler probably developed the most complex model of this early state of ‘fusion’. Drawing on detailed observations of infant and caregiver behaviour, she argued that, from about four weeks to five months, the infant goes through a symbiotic phase in which he or she ‘behaves and functions as though he and his mother were an omnipotent system – a dual unity within one common boundary’ (Mahler et al., 1975, p. 44). Here, Mahler argued, the infant does not differentiate between ‘I’ and ‘not-I’. That is, external forces which satisfy the infant’s needs (such as the mother’s breast) are not experienced any differently from internal forces (such as burping). Only later, according to Mahler, does the infant develop some sense of self and other. And while, for Mahler, infants learn to differentiate themselves from others as they develop, for Hans Loewald, this symbiotic sense of being-with-others continues throughout life – in fantasy and imagination – existing beneath the more differentiated and conscious sense of self and other (Mitchell, 2000).

Although these philosophical and psychological developments may seem abstract, they have important implications for the theory and practice of therapy. If clients are understood as separate, individual monads, then the focus of the therapeutic work is likely to be on what goes on inside them: their cognitions or emotions. But if clients are understood as fundamentally in-relation-to-others, then this relational being becomes a more significant focus of the therapeutic work. Here, what happens between myself and my clients will be fundamental to their therapy, because they are these lines of relating. That is, they are this meeting-me and this relating-to-me, such that what happens between us will be essential to their (and, of course, my) very existence.

Moreover, from this intersubjective standpoint, the importance of an in-depth therapeutic relationship is not simply that it adds something to clients’ lives: a bonus to their natural state of individuality. Rather, from this perspective, a deep therapeutic relationship does something much more profound: it returns clients to their natural state of connectedness with others. Like a fish out of water, the client who is isolated from others cannot breathe, cannot take in the nutrients they need to sustain life. Here, the therapist offers clients an opportunity to return to their natural habitat – a deep and swirling ocean of human connectedness. This, then, is not just about changes at the surface level of actions and behaviours. It is about the client’s very psychological survival.

Social Neuroscience: Relatedness and the Brain

Over the past few decades, some of the strongest support for a relational understanding of human being – and healing – has come from the field of social neuroscience, along with closely related disciplines such as interpersonal neurobiology, affective neuroscience, and sociophysiology (Cozolino, 2014, p. xvii) (for excellent introductions, see Cozolino, 2014; Gerhardt, 2015; Music, 2016). These interdisciplinary fields seek to understand the relationship between the brain and social processes and behaviours. They are rapidly growing areas of inquiry due, in part, to advances in neuroimaging techniques, such as functional magnetic resonance imaging (fMRI) (Fishbane, 2007).

Research in these areas is showing that, when people interact, they are continually impacting upon each other’s internal biological states, ‘influencing the long-term construction of each other’s brains’ (Cozolino, 2014, p. xv). This influence is particularly significant during infancy, where the ‘external foetus’ (Gerhardt, 2015) – thrust into the world at a still-early stage – needs to complete its growth. Babies come into the world with a certain set of genetic predispositions, but these genes can either be turned on or silenced by the interpersonal experiences that we have (Music, 2017). Early interactions with our caregivers lead to connections in our brains being maintained, strengthened and created; and they can also lead to those connections being eliminated (Siegel, 2001). Hence, writes Siegel (2001), ‘Human connections create the neural connections from which the mind emerges’ (p. 72). Research shows, for instance, that school-age children who have greater maternal support in early childhood have larger hippocampi (Luby et al., 2012). This is a part of the brain that plays an important role in memory and learning. In such respects, Siegel (2012) argues that interpersonal relationships are the main form of experience that shapes our brain.

Research suggests that one of the principal ways in which relational experiences impact on our internal biological states is through the release of particular hormones. Cozolino (2014) writes, ‘Early bonding and attachment experiences result in a cascade of biochemical processes that stimulate and enhance the growth and connectivity of neural networks throughout the brain’ (p. 117). Of particular importance here may be the neurotransmitter oxytocin, the ‘love hormone’, which is released when we are in relationships, feel loved and cared for, and experience social support (Fishbane, 2007). Also important may be internally generated opioids such as endorphins, which are associated with feelings of safety, wellbeing and calm; and dopamine, which is associated with feelings of reward (Cozolino, 2014). At the other end of the spectrum, however, interpersonal experiences that are frightening, traumatic or abusive can lead to the release of the ‘stress hormone’, cortisol, which can damage the hippocampus as well as other parts of the brain (Gerhardt, 2015). This includes the prefrontal cortex, which is vital for emotion regulation and more advanced cognitive abilities (Gerhardt, 2015; Music, 2017). Most perniciously, perhaps, chronic stress in early life can make the amygdala – a primitive part of the brain which plays a central role in appraising threat and mediating our flight-or-fight responses (Cozolino, 2014) – more sensitive and reactive (Gerhardt, 2015; Music, 2017). This, then, can add to the infant’s difficulties in managing their emotions, and mentalizing (i.e., conceptualising their own and others’ mental states) in a way that allows them to develop more conscious control of their lives (Fonagy et al., 2004).

The profound impact of interpersonal relationships on our neurological structures and processes can be explained in evolutionary terms. Cozolino (2014) writes, ‘our social brains have emerged during natural selection because being social enhances survival’ (p. 5). Psychoanalyst John Bowlby was one of the first theorists to develop such a perspective, with his attachment theory. Bowlby (1969) argued that, for evolutionary reasons, human beings are born with a predisposition to become attached to their caregivers, and that they will organise their behaviour and thinking in ways that maintain these attachment relationships (Mitchell, 2000). Evidence for such a hypothesis is abundant. Any parent who has tried to walk around an unfamiliar house, for instance, with a toddler strapped to their leg because they are afraid of the other grown-ups, will know the true meaning of attachment theory. Infants also seem to be equipped with one of the most powerful tools for attracting the attention of caregivers when they are frightened or distressed: an ear-piercing shriek.

In summary, then, contemporary neuroscientific research suggests that we are ‘wired to connect’ with others (Goleman, 2006, p. 4). When we don’t, when we experience isolation and disconnection, we experience stress. This serves an evolutionary function: to motivate us back into connection with others, to the safety and security of the group. However, if that is not an option – if, for instance, interpersonal connections are so threatening that we would prefer to stay alone – then that stress response can become chronic. It eats away at our insides, with the potential to cause long-term psychological – as well as physical – harm. We will explore this further in Chapter 2.

From this perspective, then, counselling and psychotherapy may offer people an opportunity to return to the realms of connectedness in a safe and enduring way. It gives them the opportunity to turn off their stress response, and to resettle themselves in the bosom of human connectedness. And, encouragingly, although neuroscience research reveals the long-term damage that unhealthy relationships can do, it also highlights the plasticity of the brain to respond to improved circumstances. The presence of a loving and attuned other, for instance, can reduce sympathetic nervous system activity (which stimulates the body’s fight-or-flight response) (Cozolino, 2014). Similarly, parenting intervention focused around increased nurturance and synchrony can lead to more normalised patterns of cortisol production in young infants (Bernard et al., 2015). Hence, there is good reason to assume that providing clients with a supportive, caring and non-threatening relationship may ameliorate some of the neurological damage done through early interpersonal trauma. And, indeed, psychotherapists informed by social neuroscience, such as Cozolino (2014), put the development of a ‘safe and trusting relationship with an attuned therapist’ at the heart of their therapeutic model (p. 394). Cozolino states:

Research in social neuroscience … supports the importance of the quality of the therapeutic relationship to therapeutic success. This finding is true regardless of the theoretical orientation of the therapist and whether or not the therapist considers the relationship to be an active ingredient in the change process. Therapists tend to undervalue the impact of the human relationship as they focus on diagnostics, intervention strategies, and management issues. (p. 397)

Developmental Psychology: An Innate Desire and Capacity to Interact

With the social neuroscience field, discussed above, there is a tendency to focus on the value of attachment relationships to the infant’s brain functioning. However, it can also be argued that human beings have an inborn desire and capacity not only to bond to caregivers, but also to interact, communicate and ‘connect’ with them in a two-way, dyadic encounter (see, for instance, Stern, 2003; Trevarthen, 1998). In other words, while human infants may want affection, security and unconditional acceptance – particularly in unfamiliar or frightening situations – they also seem to have...

Table of contents

• Cover
• Half Title
• Acknowledgements
• Title Page
• Copyright Page
• Acknowledgements
• Contents
• Digital tools
• About the authors
• Preface to the second edition
• Preface to the first edition
• 1 Foundations for a relational therapy
• 2 Psychological distress: a relational understanding
• 3 Relational depth in therapy: what it is and why it may help
• 4 A continuing relationship at depth: ‘reaching the parts…’
• 5 Working with Dominic: a ‘partial’ drunk
• 6 Earning the right to work with Rick: a traumatised client
• 7 Facilitating a meeting at relational depth
• 8 The therapist’s developmental agenda
• 9 Towards a revolution
• References
• Index