Beyond Empathy

A Therapy of Contact-in Relationships

Richard Erskine, Janet Moursund, Rebecca Trautmann

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781134872978
• Edition: 1
• Topic: Psychologie
• Subtopic: Psychotherapie

In this book, the authors focus on the importance of relationship in psychotherapy. Relationships between people form the basis of our daily lives. We require this contact with others, the sense of respect and value it produces, the relational needs it fulfills. As we face the inevitable traumas of life, large and small, our ability to make full contact with others is often disrupted. As this reduction in contact increases, relational needs go unfulfilled, producing psychological dysfunction. Beyond Empathy offers therapists a methodology for assisting people in rediscovering their ability to maintain genuine, contactful relationships and thus, better psychological health.The authors describe an integrative psychotherapy approach that they have developed and now teach at the Institute for Integrative Psychotherapy in New York City. It draws from Rogers' client-centered therapy, Berne's transactional analysis, Perls' Gestalt therapy, Kohut's self psychology, and the work of British object-relations theorists. Written in a conversational style, the book introduces the theory behind the approach while using real life interchanges between therapists and clients to illustrate the concepts it presents. The second part of the book details the application of this method in therapy work and provides almost complete transcripts from seven therapy sessions. These include examples of psychotherapeutic regression, working with a parental introject, couples psychotherapy, and more.The open writing style of this book makes it accessible to both beginners and seasoned practitioners within the field of mental health. This versatile approach to therapy promises to be effective across a wide range of therapeutic situations, making this a valuable book for both students and practicing clinicians throughout the spectrum of mental healthcare providers.

1 Basic Concepts

DOI: 10.4324/9780203778036-1

For generations, psychotherapists began their training by learning the skills of active listening. They studied Rogers’ (1951) three “necessary and sufficient” growth conditions: genuineness, unconditional positive regard, and accurate empathy. Most—perhaps all—carry these foundation skills into whatever additional approaches they use. Empathic understanding, offered in the context of honesty and respect, is the basic principle that holds the therapeutic relationship together.

When Rogers first wrote about his new “client-centered” approach, the fields of counseling and psychotherapy were quite different from today’s therapeutic landscape. There were, essentially, two kinds of therapy available: psychoanalytic and behavioral. Psychoanalysis was expensive, demanding, and somewhat esoteric. Behavioral approaches tended to be brusque, cut-and-dried, no-nonsense procedures. Rogers offered a much-needed alternative, a way of providing an arena where people could sort out their pain and their problems and be in charge of the kinds of changes they wanted to make.

But one innovator—one pioneer—can only go so far. There is a kind of synergy about the development of psychotherapy, in which each of us builds upon the work of those who came before. The Carl Rogers who wrote Client Centered Therapy could not have known about the theoretical and practical contributions of the psychotherapists and psychiatrists of the last 40 years. He could not incorporate into his thinking the work of the Gestalt therapists, the neo-Freudians, the psychoanalytic self-psychologists, the transactional analysts, the British object-relations theorists. Brick by brick, each of these schools—and others as well—has contributed its ideas to the structure of what psychotherapists are doing as we move into the twenty-first century (Wheeler, 1991; Kohan, 1986; Greenberg & Mitchell, 1983). Many of these modern psychologies are referred to as “integrative” in that they attempt to integrate the best and most useful aspects of several different approaches (Norcross & Goldfried, 1992; Erskine & Moursund, 1997).

The authors of this book have been practicing and teaching an integrative psychotherapy for many years. It is an integrative therapy with a particular focus on relationship. We believe that psychic dis-ease arises from relational failure: the repeated failure of one’s significant relationships to meet basic relational needs. Similarly, we believe that healing occurs in the context of a relationship that actively responds to or meets those needs.

This book is intended to describe our therapeutic methods. In it, we talk about how to create, maintain, and enhance a healing psychotherapeutic relationship, a relationship that utilizes many different understandings and approaches to people and their problems. These understandings have grown not only from our own ideas, but also out of the research and clinical experience of a host of other therapists. All of these therapists, no matter how widely their theories may differ, share a common debt to Carl Rogers, who made the word “empathy” almost synonymous with the notion of therapeutic relationship. And all of them, each in his or her own way, have gone beyond empathy, making their own unique contributions to the field. We, too, acknowledge that debt as we embark on our own journey beyond empathy.

In order to understand a method, it is necessary to know something of the theory on which it is based. That is what this first chapter is about: our perspective about how people come to be all that they are, how problems arise in that process of becoming, and how a healing therapeutic relationship can help one to deal with those problems. Once we are all on the same theoretical page, we can move on to the real purpose for which the book has been written: describing a method of effective psychotherapy.

Contact and Healthy Development

One of the most consistent of all the activities of the developing human is our striving for contact with others. This movement toward contact is as natural as the movement of a flower toward the sun; it is the first observable manifestation of the need for relationship that characterizes all human organisms throughout the course of life. This striving of infants to achieve contact in relationship is a two-way street: the newborn responds to appropriate contact by engaging in behaviors that indicate pleasure and comfort, and adult caretakers (and noncaretakers as well) are rewarded by the baby’s response. The satisfaction of feeling a tiny hand curl around one’s finger, or seeing a pudgy face light up with a smile, is nearly universal. And although the infant cannot tell us in words about its corresponding satisfaction, we can certainly infer from its searching and seeking behaviors, and its cuddling or smiling or relaxation when interpersonal contact is achieved, that satisfaction is indeed there (Bowlby, 1969, 1973, 1980). Contact with others is a primary motivating experience in human behavior; humans strive for it from birth and, when it is appropriately provided, are universally rewarded by it (Guntrip, 1971; Fairbairn, 1952).

Not only is such interpersonal contact rewarding, it is necessary. Without relationship—without reciprocal interaction with other humans—babies do not grow up to be people. Indeed, there is convincing evidence that they may not grow up at all (Spitz, 1954); the old term “marasmus” and the more modern “failure to thrive” both refer to the physiological effects that lack of contact in relationship can have on an infant. The psychological consequences of lack of contact in relationship are also devastating. Even if a child manages to survive physically, in the absence of adequate human contact, it will be unable to function normally in a human environment. When children do not experience interpersonal contact—when they are deprived of reciprocal relationships with other people—they are unable to behave and interact in ways that we would consider “human.” The damage to the person’s sense of self and to his or her ability to relate to others is probably irreparable. Self—the human self—is a product of relationship, relationship that is a part of the infant’s environment from birth (Fraiberg, 1987; Stern, 1985, 1995). The child who grows up with inadequate responsive relationships, with insufficient contact, cannot develop an adequate sense of self (Winnicott, 1965). Children need human caretakers to provide the necessities of life, and simple contact with those caretakers is as much a necessity as food or shelter.

In the course of normal development, the hours and minutes of waking life are punctuated by many different sorts of interactions with the world around us. One of the first tasks for the growing infant is to sort out this new and complicated world: parts of self from parts of the environment; living things from nonliving things; people from not-people. Considering the complexity of the variables involved, babies are remarkably good at figuring out these differences; by the end of the first year of life most of us have our environment pretty well categorized and have made a sizeable start on the social and interactional nuances with which we contend for the rest of our lives (Bowlby, 1969, 1973, 1980).

What is it about contact with others that is so important for human development? Or, from the other side of the question, what is it about the lack of such contact that is so traumatizing? Why, if a child’s physical needs are met (ignoring the possibility that there may be some actual physiological necessity for active skin stimulation through same-species contact), should that child not be able to grow and develop in a reasonably normal fashion, whether or not it is in relationship with other people? The answer lies in the nature of the psychological makeup of human beings. Humans are unequivocally social animals. The essence of our humanness is inextricably tied up in the ways we relate to others. We are conceived and born within a matrix of relationships, and we live all our lives in a world that is inevitably and constantly populated by other humans—both externally (most of the time) and internally (all of the time) in fantasies, expectations, and memories. To be human is to be in relationship with others. Developing these relationships is a fundamental aspect of our growth (Bergman, 1991; Jordan, 1989; Miller, 1986; Surry, 1985). We cannot live as humans without them, and our environment must provide us opportunities to develop and use them as we move through life. Relationships in which a child is neglected, physically abused, or emotionally attacked are traumatizing to a child, but no relationship at all is far worse.

Internal Contact

Thus far, we have been referring to contact in terms of relationship with others. There is another aspect of contact, though, that is equally important: contact with oneself. Just as fully functioning humans are aware of and able to relate to the external world and the people in it, so they must also be aware of and able to relate to their internal world. This internal world is the world of sensations, emotions, ideas, fantasies, wants, and needs. It is all that goes on inside of our skins, as transmitted to and organized by the central nervous system. The nervous system and brain of the newborn infant is, of course, not yet fully developed; its organization of all this internal material must be somewhat primitive. Curiously, though, in some ways the young child may be more aware of internal reality and may be more in contact with it than many adults. Young children have not yet learned that it is unacceptable, or nonuseful, to know about and respond to all internal events. The stomach contracts: cry. Waste moves in the bowel: expel it. Want of mother occurs: seek mother. Healthy children, children who have not been damaged by their environment, do not know how to censor themselves in the way that adults have learned to do. They do not push annoying or unwanted internal events out of awareness; as needs arise the baby attends to them immediately. When this occurs, children are in full contact with their ongoing internal experience.

Of course, there is no way that anyone—infant or adult—can attend to everything all at once. There is just too much, internally and externally, to take into account! Our attention moves from one thing to another, from internal to external, and from this need to that perception and back again. Contact is really a verb, not a noun; it is dynamic rather than static. It is similar to a flashlight beam playing over the contents of a darkened room, lighting up first this object and then that one. It is not a random movement, though; in full and healthy contact there is a shuttling between internal and external events, with neither overbalancing the other. We move from awareness of self to awareness of our environment and especially of other people in that environment. From self to other to self and back to other again (Perls, 1973; Perls, Hefferline, & Goodman, 1951).

There is much more that could be said about the development of external and internal contact and how both change over the course of one’s life. But this is a book about psychotherapy and only incidentally about general human development. Psychotherapy, as we view it, is a relationship that can be utilized to heal the cumulative trauma of previous ruptures in relationships (Erskine, 1993/1997, 1997; Lourie, 1996; Khan, 1974). We turn now to the role of relationship in human development, and specifically to how our contact with other people affects the way we understand and experience the world.

Relationship and Becoming Human

It is through relationships that a child learns to make interpersonal contact in increasingly sensitive and inclusive ways. It is through relationships that this same child learns to set and maintain boundaries: he or she learns that I and me are separate and distinct from you. It is through relationships that the child learns to accept and use appropriately all the aspects of internal contact: to recognize needs, to daydream, to be angry or sad or joyful or scared. To join internal with external contact: to ask for help or to enjoy the interpersonal transactions that make us fully human. And, finally, it is through relationships that the child develops social interest, the sense of relatedness and empathy and compassion that allows us to survive as a species on this planet.

When healthy relationships are not available, children must take care of themselves. They, like all humans, must learn to cope with both painful external events and with the discomfort of internal needs that are not met. When children have been deprived of contactful and need-responsive relationships, they are likely to develop the expectation that nobody will be there to help them—really help them, with the kind of help they need—now or in the future. Bowlby and his students have identified this expectation as “avoidant attachment” (Bowlby, 1988; Ainsworth, 1969; Ainsworth, Blehar, Waters, & Wall, 1978), and that phrase gives us a flavor of the ambivalence and the tension that such a person must live with. Wanting with no hope of getting, or needing with no possibility that the need will be met, is terribly painful. The result can be that one learns not to experience one’s emotions fully (because experiencing them alone only makes it hurt more), not to recognize one’s need for relationship (for the same reasons), and eventually to split off unruly thoughts and feelings and wants and needs into a separate and barred-from-awareness part of the psyche (Tustin, 1986; Guntrip, 1968; Bettelheim, 1967).

Relationship is nurturing, stimulating, and restorative. Responding to another, and being responded to in turn, allows us to discover who we are, what we want, how we feel, and what we think. When this process of discovery is impeded by unresponsive or absent relationships, the coping skills that we develop will tend to interrupt both internal and external contact and to split, fragment, and deny important aspects of the self.

Much has been written about trauma and how traumatic events can leave psychic scars that influence a person’s ability to function throughout life. Usually, however, it is not the traumatic event itself that creates such scars: it is the event unmitigated by healing through relationship (Erskine, 1993/1997, 1997). A single abusive experience is just that—an experience. For a child who can work through that experience in relationship with a caring and sensitive adult, the experience will become just one memory among many others. What is truly damaging is the absence of a healthy relationship following such an experience. When we have been traumatized by the actions of others or by some circumstance of life, we need a reliable other who will listen and respond to our pain. The overwhelming, helpless-making nature of a traumatic experience threatens our cognitive and emotional stability as well as our physical security: it is natural and instinctive to reach out for help when such experiences occur. Following an undeserved punishment, a beating, or any other abusive experience, there is an intense need for someone who will to talk with us about what happened and how we reacted, offer a realistic way of understanding the situation, keep us safe while we recover, and protect us from future trauma (Lourie, 1996).

Even when there is no active abuse, the absence of relationship is in itself abusive and damaging. Neglect and isolation produce a kind of cumulative trauma, a growing set of expectations that others will never be available and that life is difficult and painful. Many psychotherapists work with people who have suffered from cumulative trauma (Kahn, 1963). These people cannot identify any single or repeated experience that they can use to account for their sense of dis-ease, and they often feel guilty and ashamed about their need for help. They may even imagine that people who have been raped or starved or beaten are better off—at least those people have something to point to that will help them understand their pain. The cumulative trauma of contact deprivation, in contrast, leaves one with feelings of longing, of emptiness, and of “something’s wrong,” but with no way to make sense of those feelings.

When a reliable other is not available, a person’s need for relationship is met only sporadically and unpredictably, if at all. If there has been abuse, the pain is compounded: now the need for relationship is intensified, and still nobody is there to help. What to do? Don’t feel it, push it down, and split it off. Tell yourself that it isn’t/wasn’t really that bad, that you ought to be tougher/stronger/more grown up, that others are much worse off. Try to forget about it. Thus begins the process of isolating and excluding experiences and, in more extr...