Presence and psychotherapy

Psychotherapy is about being present. What this means varies from person to person, from therapist to therapist and from client to client.

It is about being fully present in relation to another human. This connection is rare to achieve. However we can fully tuned into another human being also outside of therapy. This connection is one of the central aims of therapeutic contact. This is part of the work of the therapist, to be actively pursuing it. This is not to say that we can have that level of connection for the whole session. We will try to create it in those ‘I-Thou moments’ described by Buber (1923). This is opposed to I-It relating.

The reason why the therapist is trying to create the contact is to enhance the presence. There is no full presence without connection. This leads to the underlying assumption behind this statement. The assumption is that we only exist in relation to ‘otherness’. Otherness can be a person, a place, time, or even myself. The role of the therapist is not necessarily to be the other the person relates to, but to be the witness of the relating (in whatever shape or form). This stance is properly referred to as phenomenology, which means ‘being with the phenomenon’. The phenomenon is ‘what happens’, or better ‘what is happening’. Phenomenology necessarily has a temporal dimension. As we are reminded by Hiddeger, we can only be-in-time (Being and Time, 1927). The essence of being is temporary and constantly vanishing. So perhaps this is why we link therapy and presence.

The temporal dimension also applies to the very notion of self. This was explained extensively by Perls (1951). We consider the self as a phenomenon, which expresses itself only in relation to ‘otherness’. In Perls’s terms, the self ‘happens’ in the relationship. This also implies that the self does not even exist without ‘the other’. However, we encourage self-awareness, because this is the only internal skill to validate the self. The subject can self-validate using self-awareness. In other words, the subject can do both things at the same time: they can express the self, as well as validate the self by being the witness.
This ability to be the subject-witness can also be seen as the ability to turn the subjectivity into the object of enquiry. In Nietzschean terms, the individual would then be the subject and object of the enquiry. The individual would be able to perform the tasks of subject and object at the same time. This is one of the tasks of therapy, to create this self-examination which is both challenging and enriching.

Presence has also something to do with authenticity. We can only truly experience what we are aware of. So the ‘being present’ refers to the experience that is subjective and might or might not be shared with others. The presence itself is therefore subjective. In therapy this is true for symptom management: the client experiences the symptom therefore the symptom exists. The existence of something is sometimes the only thing we can address congruently. This is not to say that the therapist would not ‘help’ the client with symptom relief.

I believe that an existential and phenomenological stance on therapy doesn’t have to clash with practical needs and education. The line between therapy and teaching is often blurry, but it does not need to be. The therapeutic presence is in itself part of the learning process. When the client thinks about their self-development only in terms of practical skills and symptoms management, I find it useful to explain the importance of the phenomenological stance. There is a tension between echoing the frustration for the lack of immediate and sudden changes, and the open communication about my phenomenological aim. This is because I believe that presence brings changes. In fact, a congruent presence is often already a change.

Buber, M. (1923, trans. 1937) I and Thou. Edinburgh: T&T Clark.
Heidegger, M. (1927, trans. 2008). Being and Time. New York: Harper Perennial.

Perls, F.; Hefferline, R.F.; Goodman, P. (1951) Gestalt Therapy, Excitement and Growth in the Human Personality. London: Souvenir Press.