There is this paradox. On the one hand there is the tendency in therapy for the therapeutic relationship to be less than fully alive for the patient; either not alive enough during the actual session or alive in the session but not held onto between the sessions. To a large degree this is simply part of the work of the therapy. However, it is my experience that in many therapies the vividness of connection between therapist and patient does not come fully into being. Hence, the patient leaves therapy without a fully rich internalization of the therapist, without the full development of a corrective emotional experience.
Now this understanding contrasts with another experience patient’s commonly describe in long term therapy, where they notice while driving to their next session that they have the subjective sense of having just been there, as if a week’s time has past in the flicker of an instant.
What I find especially interesting about this situation is the seeming paradox that both experiential situations can exist simultaneously in the same patient. That is, a patient can have a non-vivid experience of their therapeutic relationship, where they seldom think of their therapist between sessions, yet have a recurrent subjective experience of having just been there while arriving at their next session. How to understand this?
This, I think, is a complex state of affairs. My best current understanding is that while vividness of relationship is both a conscious and unconscious experience, the subjective sense of “having just been there” is primarily an experience within the unconscious that occurs in unconscious time. This highlights that therapeutic action takes place within conscious and unconscious spheres. This raises the question regarding how changes in the two spheres are different in their impact upon patient’s “actual lived lives.” And the additional question concerning how changes in each of the spheres interact and influence each other.
Going more to the point, it is very clear that unconscious changes are critically important in long lasting therapeutic change but… what I uncertain of,however, is how much these inner changes manifest in actual changed lives without being accompanied by changes in conscious awareness such as “vividness of therapeutic relationship.” In this vein, it is my experience that outside relationship changes such as “vividness of therapeutic connection” are powerfully assistive in the “phenotypic” manifestation of inner change in peoples actual lives. This is consistent, I think, with the findings from attachment-based marital therapy (see Sue Johnson), that outside emotional safety with ones partner is powerfully supportive of deep changes in ones interior psychological well-being. Again, this is very much a complex matter, that highlights how the two spheres interact and synergize with each other.
