Ah, here we are again! Another week. Therapeutic ‘space’ is a topic I’ve been thinking about a lot lately, as I just relocated my office (across the hall from my previous office, which some clients lovingly called either ‘the womb’ or ‘the cave’, as it was a ‘cozy’ interior office without windows). Although I have spent a lot of time considering the physical space over the past month, that seems merely to have served as a metaphor for deeper matters. That said, I thought I would dig up an old essay I composed in grad school on just that topic–from a psychoanalytic / psychodynamic perspective.

We were only allowed six pages and five sources (the only sources we used for this course), and…well, I let you read it. The contents of this essay (barring the citations, of course) is Copyright 2006 D. Michael Coy.

* * *

Considering Analytic Space

Patrick Casement suggests that “the analyst or therapist can be guided towards working more effectively, monitoring the analytic space for what may be intruding upon it and the analytic process for what could disturb it” (1991a, p. 187). As I considered Casement’s meaning here, I found myself reviewing in detail the text from which this quote originates. I will, in this essay, elaborate my understanding of these words through three different yet related dimensions: Casement’s text itself, related course selections, and my own work with clients.

On Learning from the Text

Casement brings together a wide array of concepts in discussing his thoughts about the analytic space and process. He asserts early on in the text that “[t]herapists sometimes have to tolerate extended periods during which they may feel ignorant and helpless” (Casement, 1991b, p. 8). Casement further suggests that “[w]hen a therapist thinks that he sees signs of what is familiar to him, he can become blind to what is unfamiliar and strange” (p. 9). In this case, what might “intrude upon” or “disturb” the analytic space are both the therapist’s own fear of not immediately grasping a client’s situation and the subsequent reliance upon such tools as anecdotal or borrowed knowledge, cliché interpretations, and deflection or reassurance—so to avoid coming in contact with a client’s unpleasant thoughts or feelings, for which the therapist feels unprepared (1991b). Though these approaches can serve as a source of security for the therapist, they can also disturb the analytic space by robbing clients of original, unique insight into their lives. Over time, just as an infant subtly—and not so subtly—cues the parent to an empathic misattunement, so will the client prompt the therapist to attend to their unmet needs in the therapy (1991c). Empathic attunement to these prompts is facilitated by the therapist’s willingness to open himself up emotionally to the client as well as to any resulting countertransference (1991d). Along with this emotional openness comes the need for containment. Casement (1991e) quotes the maxim, “The best containment is a good interpretation” (p. 127). He states, however, that interpretation alone cannot offer holding. This good (i.e., empathically attuned) interpretation must be accompanied by the therapist’s willingness potentially to bear and survive, rather than avoid or retaliate against, the client’s most terrible feelings—else the therapist risks losing the ability, in the client’s eyes, to maintain the integrity of the analysis (1991e; 1991f). Containment is not only, however, a psychological concept. Being mindful of more palpable boundaries also plays an integral part in monitoring the analytic space and process. Here I refer to cases where, for instance, either the client feels the need for particular behaviors (e.g., smoking, etc.), additional sessions, or actual bodily contact within the therapy, or the therapist makes transference interpretations without enough evidence of the transference, offers additional sessions without prompting, or becomes inappropriately directive with the client. Casement himself struggles with what is and is not appropriate for the individual client, always bearing in mind the potential for either disrupting the analysis or traumatizing the client (1991c; 1991f; 1991g).

Casement further notes the importance of being “non-intrusively available” to the client, acting rather as Winnicott’s spatula was available yet not forced upon a child in the therapy space (1991c). This, he later suggests, provides the unobtrusive yet potentially comforting “being alone together” (1991h, discussing Winnicott), which allows the client to engage the therapist’s interpretations “when they are ready” to hear them (1991i). This, again, requires a high level of attunement on the therapist’s part (1991d) and a willingness to allow clients (and themselves) both a certain “playfulness” (1991h) and the flexibility to use the therapy space and the therapist as they will (1991j; 1991k; 1991l), within reasonable limits. On “space,” Casement writes that, “[to] be healthy, every intimate relationship needs space and personal boundaries, and a corresponding respect by each person for the ‘otherness’ of the other” (1991h, p. 341). When the therapy relationship cannot accommodate this, we as therapists lose the ability to protect the client from outside intrusion—namely, ourselves—and the therapy space becomes “tainted” and potentially unsafe as a free space for the client to “be” (1991h).

Other Texts, Other Views

Allowing clients to “be”—by allowing ourselves not to know—is a concern that Coltart (1992) shares. Echoing Casement, Coltart writes, “It is of the essence of our impossible profession that in a very singular way we do not know what we are doing” (p. 2). She illuminates this statement when she suggests that, though training, research, discussions with colleagues, etc., are all extremely important to the “process,” each client is unique. Each presents new mysteries, which we must patiently approach, so to allow the client space to reveal them. We cannot afford, then, to apply premature labels and interpretations to the client’s experience if we wish to avoid impinging upon the freedom that allows this natural revelation to occur. This freedom, Coltart suggests, includes being “in the moment,” which sometimes means blurting something out—sometimes when we least expect it. Class discussion (1-12-2006) has also focused upon this issue, the general consensus being that, though less is usually more when commenting to the client (Casement, 1991b; Coltart, 1992), there are times when blurting is necessary.

Maroda (1999) seems to agree with this. Shocking though some of her comments to clients might be, they are infinitely “human” and often, she feels, necessary to reestablish equilibrium in the therapy space, much as Casement’s physical holding of Joy served the same function when her behavior became untenable (1991j). Maroda’s humorous approach to dealing with “difficult” clients adds a new dimension to Casement’s writing. Maroda’s “battles” to maintain a safe space for her clients to explore themselves are often fought against her inner self and the clients themselves. This is no different than Casement’s work, of course, but Maroda’s admissions of her sometimes painfully honest exchanges with clients in times of stress—and her ability to maintain a sense of humor about these interactions—brings into greater relief Casement’s often rather serious musings (see “Mrs. B,” 1991f). It is not that Casement’s exploration is not compelling, because it is. The differences can perhaps be attributed to issues of style and, one might guess, training. Nevertheless, both Casement and Maroda seem to agree that analytic holding is of extreme importance—they just handle it in ways that are more in line with their respective personalities.

Maroda, however, takes to task therapists who allow their clients free reign to abuse them. She delineates anger from abuse, suggesting that, though anger is certainly valid as a feeling, there is little excuse for abusive behavior in the therapy space. Such abuse, she suggests, is (to use Casement’s words) an intrusion upon the therapy space, and robs the therapist of the ability to maintain the freedom that is so needed in for the therapeutic interaction to “breathe.” The point here seem to be that, even in the best of worlds, the client’s right to “be” has practical limits. Limits in the therapy, however, should not be imposed by the therapist’s ideas about who the client “really” is (Foster, 1998; Schonfeld-Ringel, 2001). Though we all as therapists bring all our experience with us into our work with clients, we must be very careful to mind any “intrusion” of either conscious or unconscious agendas. This is especially true for clients who do not share our ethnicity or cultural experience, among other things. This idea harks back to Casement’s insistence that therapists must not allow themselves to impose their wishes and values upon the client—and this imposition, both Foster and Schonfeld-Ringel might add, includes the assumption of cultural norms and shared experience. What’s more, therapists must remain aware of their own unmet needs when working with clients. Casement (1991m) might here suggest that these unmet needs are more appropriately dealt with in the therapist’s own personal therapy rather than in murky countertransference responses that focus upon, among other traits, race and ethnicity. Foster seems more apt to approach these issues head on with the client as a continuation of the “co-creation” of the therapeutic experience. In any case, it is the act of approaching the unknown rather than avoiding it that remains key in the promotion of an unimpeded analytic space and process.

Reflections and Ruminations

I have discovered much about myself while studying both Casement’s and others’ writings included in this course. I wholeheartedly agree with Casement’s comment on analytic space and process. Agreeing with a statement and finding the resources to adhere to it, however, are two different matters. I have found myself in it twice thus far during this school year for precisely this reason. I have found myself sitting with clients whom I found difficult, wanting very much to speak my mind. I have difficulty holding my tongue when I am frustrated, and I now understand why. I strive to be as present in sessions as I possibly can, and also to feel comfortable with “not knowing.” This has been a real struggle—especially with those clients who so desperately want answers. I think of one particular client who is deeply depressed and suffering from PTSD-related symptoms, who so badly wants to be rid of these unpleasant feelings. Neither he nor I can conceive of how to make that happen, and I can admit to myself that it annoys me. I feel limited by my lack of…whatever it is I feel I lack. A class discussion (3-2-2006) comes to mind when I think of this client and his perhaps unrealistic need to be released from his misery. I wonder that he knows what it was like not to feel this way, pervasive as it seems. Time means little to him, as each day feels very much like every other. The clock may tick on, he feels, but he does not move forward with it. Yesterday, he cried for the first time in our work together, and I avoided saying anything, not wanting to encroach upon this moment of being “alone together.” I felt elated that he was able to express an emotion rather than only talk about it. It was a very odd sensation to feel happy that someone could cry in my presence.

With another client, whom I see in his home, the therapy space has for months been intruded upon by his rather large television. At first, he left the television on, unmuted, for the entire session. This lasted for a couple of months. Around the close of 2005, he began either to turn down the volume significantly or to mute it. All through this time, I never said a word about it, figuring that if it didn’t bother him, then it must serve a purpose. In the past three or so weeks, he has begun to turn off the television, each time describing it as “a distraction.” Yesterday, I mentioned it to him. He replied, “I don’t need it anymore. I used it as a way to not think about things during the session, and now I don’t have to do that. Things are different.” There have been times, working with this client, that I have felt really depressed about seeing him. I often wonder if my presence makes any difference at all. I felt really moved by this experience, partially because it helped me realize that my client is, in fact, taking what he needs from our work together. The effort is not put forth in vain.

I have, through reading Casement, placed much greater faith in my own patience with my clients (and myself) and developed far more respect for the usefulness of interpretations (feeble as mine often seem, to me)—especially when I am able to wait for clients to lead me to them. I look forward with great anticipation to the time, very soon, when I can devote more of my professional energy to developing relationships with those people who choose for me to accompany them down the dark paths that we all so often fear to walk alone.

References

Casement, P. (1991a). Introduction to part two: the analytic space and process. In Learning from
the patient (pp. 187-188). New York: The Guilford Press.

Casement, P. (1991b). Preliminary thoughts on learning from the patient. In Learning from the
patient (pp. 6-28). New York: The Guilford Press.

Casement, P. (1991c). Processes of search and discovery in the therapeutic experience. In
Learning from the patient (pp. 140-157). New York: The Guilford Press.

Casement, P. (1991d). Forms of interactive communication. In Learning from the patient (pp.
64-86). New York: The Guilford Press.

Casement, P. (1991e). Key dynamics of containment. In Learning from the patient (pp. 111-
128). New York: The Guilford Press.

Casement, P. (1991f). Analytic holding under pressure. In Learning from the patient (pp. 129-
139). New York: The Guilford Press.

Casement, P. (1991g). The search for space: an issue of boundaries. In Learning from the patient
(pp. 158-179). New York: The Guilford Press.

Casement, P. (1991h). The analytic space and process. In Learning from the patient (pp. 339-
356). New York: The Guilford Press.

Casement, P. (1991i). Theory rediscovered. In Learning from the patient (pp. 180-184). New
York: The Guilford Press.

Casement, P. (1991j). A child leads the way. In Learning from the patient (pp. 214-247). New
York: The Guilford Press.

Casement, P. (1991k). The experience of trauma in the transference. In Learning from the patient
(pp. 258-272). New York: The Guilford Press.

Casement, P. (1991l). The meeting of needs in the psychoanalysis. In Learning from the patient
(pp. 273-292). New York: The Guilford Press.

Casement, P. (1991m). Internal supervision: a lapse and recovery. In Learning from the patient
(pp. 52-63). New York: The Guilford Press.

Coltart, N. (1992). Slouching towards Bethlehem…or thinking the unthinkable in psychoanalysis.
In Slouching towards Bethlehem (pp. 1-14). New York: The Guilford Press.

Foster, R.P. (1998). The clinician’s cultural countertransference: the psychodynamics of
culturally competent practice. Clinical Social Work Journal, 26, 253-269.

Maroda, K. J. (1999). Reflections on the analyst’s legitimate power and the existence of reality.
In Seduction, surrender, and transformation: emotional engagement in the analytic
process (pp. 161-180). Hillsdale, NJ: The Analytic Press.

Schonfeld-Ringel, S. (2001). A re-conceptualization of the working alliance in cross-cultural
practice with non-Western clients: integrating relational perspectives and multicultural theories. Clinical Social Work Journal, 29, 53-63.