Dear Zana

Learning from clients (patients) is carried out in one area:

The primary "competence" of the therapist (therapist effect) is the development and maintenance of the therapeutic relationship work. The concept of "working alliance" includes therapist, patient, and above all interaction variables. This process depends on the ability of mentalization and to handle the own countertransference. The therapeutic work with different patients with different disorder and transference dynamics causes an implicit knowledge in regard to the further design of the working alliance (tailoring made treatment). For example: To realize alliance ruptures fosters the ability of the therapist to repair alliance ruptures. Supervision, alliance supporting tools and monitoring of the outcome and session quality are the most important "tools"to improve the therarpist effect (Duncan et al. 2010).

But I am not sure whether the interaction between patient and therapist should be a healing space for the therapist. This could also necessitate an abusive relationship to the patient.

best regards

Egon

Duncan, B., Miller, S., Wampold, B., & Hubble, M. (2010). The heart and soul of change: what works in therapy? 2nd ed. Washington: APA.

Hi Egon,

Thanks for the valuable input. We both appreciate the fact that learning from our clients is one of the most significant factor in increasing therapists' competence (Orlinsky & Ronnestad, 2005).

I take your point that reciprocal healing between therapist and client might be abusive to a client. My approach is that it is more beneficial to acknowledge and work with possibility of reciprocal healing instead of denying it. Continuous self-analysis, mindfulness and honesty about our own vulnerabilities and impasses, attending personal therapy and regular supervision are some of the measures that should be followed (Charny, 1982; Kaslow & Schulman, 1987)

Another angle to consider in reciprocal healing is from the perspective of change being an important result and effect of the therapeutic process. From the post-modern perspective therapy is a collaborative process and therapist and client are seen as co-creators. As a result beneficial change may occurs in both, client and therapist (Hoffman, 1993; Marovic, 2010).

Therapeutic interactions with clients can also be potentially beneficial in respect of therapists' professional-personal integration and congruence (Skovholt & Ronnestad, 1992; Marovic 2011).

Best

Zana

Charny, I.W. (1982). The personal and family mental health of family therapists. In F. Kaslow (Ed.), The International book of family therapy (pp.41-53). New York: Brunner/Mazel

Hoffman, L (1993). Exchanging voices: A collaborative approach to family therapy. London: Karnac.

Kaslow, F.W. & Schulman, N (1987). How to be sane and happy as a family therapist or the reciprocal impact of family therapy teaching and practice and therapists' personal lives and mental health. Journal of Psychotherapy-and -the-Family, 3(2), 79-96.

Marovic, S & Snyders, F (2010). Cybernetics of supervision: A developmental perspective. The Clinical Supervisor, 29:35–50.

Marovic, S (2011). The Emergence of a Supervisor: Integrating Professional and Personal Selves of the Therapist. LAP LAMBERT Academic Publishing.

Orlinsky D & Ronnestad, M (2005). How Psychotherapists Develop: A Study of Therapeutic Work and Professional Growth. 1st ed. Washington: APA.

Skovholt, T.M. & Ronnestad, M.H. (1992) The evolving professional self: Stages and themes in therapists' and counselor development. Chichester: Wiley & Sons.

Dear Zana,

I aggree with you: I would call with you continuous self-analysis, mindfulness and honesty about our own vulnerabilities and impasses self-analysis or inter or supervison feedback. It is a life long process which has been called by S.Freud in his book "Analysis terminable & interminable (1937) self-analysis. I hope it is in general what we call development of therapists. This developmental process will in some cases also have features of healing.

Egon

Well said Egon.

An interesting research done by O'Loughlin (2006) looked at therapists' transformation in relation to experience of the human connectedness and journeying with the client. She described several relevant categories affecting therapists' transformation:

• deep presence in the therapeutic relationship

• loosening boundaries

• parallel journeys

• stepping aside from the professional self

• felt sense and embodied connection

• spiritual re-awakening

• interacting with other spaces and landscapes.

Kotler & Hunter ( 2010) have described the following themes in relation to therapists' transformation:

- the power of empathy transcendence and its aftermath;

- experiencing deep intimacy with a client or family;

- experiencing high emotional arousal encounter in the session that was dramatic and unforgettable;

- permitting flexible boundaries in the relationship that made innovation or creative breakthroughs possible;

- having one's most cherished assumptions and beliefs validated;

- being challenged by a client or family to venture into new territory or the unknown;

- being a witness to a profound change.

I would agree with Sandmaier (2003, p. 24) who said that psychotherapy is transformative for both parties and 'an intrinsically, inescapably two-way enterprise ... whenever people open up the contents of their hearts, our own hearts can't help but thrum in response'.

Best

Zana

Kotler, J.A. & Hunter, S.V. (2010). Clients as teachers: Reciprocal influences in therapy relationship. The Australian and New Zealand Journal of Family Therapy, Volume 31 Number 1, pp. 4-12.

O'Loughlin, S.M. (2006). Transformative journeys: Psychotherapists' reflections on being changed by their clients' stories. Armidale, Australia: University of New England

Sandmaier, M. (2003). Therapist heal thyself. Psychotherapy Networker, 27(2).

The interpersonal psychoanalytic tradition has long discussed change as a two-person process, that change invariably involves both patient & therapist.  I recommend Erwin Singer's Key Concepts in Psychotherapy (from the 1960s) & Darlene Ehrenberg's Intimate Edge (1992) as good examples.

Thank you for the input John. 

I learned from my clients a lot about a host of professions, working conditions, family conditions, problematic and pathological behavior, views on life, ways to cope with things, harmful and beneficial conditions of living, etc, and so on. I often admired clients for a number of things. I was more more than once impressed by their strengths than their weaknesses. I did not need them to be healed myself.

This holds for primary psychological care, in which I have been working most of the time. (In 2014 I retired.) 

Dear Zana,

Carl Jung was one of the first to discuss the reciprocal influcence of client and therapist and their mutual transformation. His thinking on this matter probably culminated in his late work " The Psychology of the Transference' (1946), which, I have to warn you, is not an easily accessible  text as it is structured around alchemical  images and metaphor. He also introduced the related notion of the 'wounded healer' into therapy, which you may want to have a look at.

Regards,

Stefan Durlach

Hi Stefan,

Thanks for the input.

I am running retreats for therapists in the mountains near Johannesburg, based on Jung's wounded healer paradigm. The paradigm reflects an understanding that healers' inner wound may not only play an important role in our career choice but constitute an essential factor that is contributing to healing the patient.

Best

Zana