Therapists Don’t Know Everything

Objects in Space, Arturo Souto
Objects in Space, Arturo Souto

Wilfred Bion used Keat’s term ‘negative capability’ to refer to the capacity to hold onto not knowing until something touches upon the truth, to allow new experiences be new (rather than reflections of past client experiences, or the work of other sessions). This is the subject of Patrick Casement’s book, ‘On Learning From The Patient’. Casement is the psychoanalyst best known for two ideas – 1) the value of recognising and owning your mistakes as a therapist, and 2) the necessity of being tentative with interpretations.

Casement outlines a number of ways of remaining in the experience of the client’s discourse, examining various interpretations of their primary process material, and previewing the impact of potential interpretations (through what he calls ‘trial identification’). This ‘negative capability’ allows the client’s individuality to emerge over the course of therapy, rather than being imposed by the therapist. As a client I have experienced the constraint and disappointment of being misunderstood and misinterpreted, and the damage this can have on the ‘real relationship’ at the core of growth and healing in the therapeutic encounter.

The therapeutic alliance requires collaboration, trust and commitment; and client’s dysfunctional development / family environments may have meant that they have never experienced having these things reliably provided by another person. Hence clients come into therapy armed with their learned patterns of anxiety, distrust, alienation and reactance. These emerge in the development (or obstruction) of the therapeutic alliance. Trust must be earned, through the provision of safe ‘containment’, which both support’s client’s catharsis and restrains client transference.

Casement illustrates this through the case of an obese and intensely manipulative client who had been sexually abused by both parents. His client had experienced an intense erotic transference relationship with her previous therapist, who (at least according to the client) had played into this by engaging in inappropriate touch in his own home. Similarly, while attending therapy with Casement, this client simultaneously attended another ‘behaviourist’ therapist, who also failed to provide healthy boundaries.  Casement reports that by firmly resisting his client’s boundary testing, from the very first session, he was ultimately able to model a healthy, trusting relationship, that became a collaboration enabling the client to separate herself from her enmeshed mother, and ultimately to employ healthy control over her weight and relationships (at least according to the therapist).

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