A Consideration of Intimate and Non-Intimate Interactions in Therapy†
I would like to acknowledge helpful conversations with Carol Beckner, Laura Benkov, Michele Bograd, Judith Kates, Sallyann Roth, and several clients, about ideas in this article.
Abstract
Viewing therapy as a conversation among participants, rather than as an interview concluding with an intervention selected by an expert, allows one to consider the contributions of each member of the conversation in comparable terms. I propose a distinction between intimate interaction, in which meaning is co-created or shared, and non-intimate interaction, in which meaning is rejected, provided, or misunderstood. I suggest that intimate interaction between therapists and clients is therapeutic and that non-intimate interaction rarely is. However, it is in the acknowledgment and repair of the inevitable lapses of intimate interaction that occur between therapists and clients that there is an opportunity for a profoundly meaningful collaboration.
Therapy is the art of contact and change through conversation. Every conversation creates an opportunity for connection and disconnection; reflection and haste; dialogue and monologue; understanding and misunderstanding; collaboration and instruction; no change and change. Though therapists have sought primarily to understand clients' behavior, affect, and thinking in therapy, and the development of complex diagnostic manuals reflects this perspective (DSM-III-R, 1987), therapists from many theoretical models are increasingly scrutinizing their own participation in the therapeutic encounter (Havens, 1989; Real, 1990; Schwaber, 1983, 1990; Tomm, 1987a, b, 1988, 1990; Weingarten, 1991). It is the thesis of this article that when clients and therapists collaborate in therapy, the interaction is more likely to be intimate and therapeutic than when this does not happen.
Though the notion that “the person of the therapist influences the therapy in very profound ways” (Luepnitz, 1988, p. 151) has been a critically important idea to constructivist family therapies, the current feminist critique of family therapies based on the “new epistemologies” is that they do not go far enough (Luepnitz, 1988). In particular, feminists note the failure of these therapies to account for the ways the wider sociopolitical system influences the therapeutic system, therapists and clients alike (Goldner, 1988; James & McIntyre, 1989; Luepnitz, 1988; McKinnon & Miller, 1987; Walters, Carter, Papp, et al., 1988).
Concurrent with the feminist critique has been a shift away from the cybernetic metaphor to a “‘post-cybernetic’ interest in human meaning, narrative, and story” (Anderson & Goolishian, 1990, p. 161). This move has signaled a turn away from conceptualizing the family as patterned structures, or systems, to conceptualizing the therapeutic system as a linguistic system, comprised of all those who are in communication about a problem or issue (Anderson & Goolishian, 1988; Anderson, Goolishian, & Winderman, 1986).
Feminist and language-based approaches to family therapy require attention to the ways individuals — therapists and clients — make meaning. Both approaches define therapy as a conversation among participants rather than as an interview followed by an intervention selected by an expert therapist who knows better than the clients what is best for them.
The issues that family therapists now find themselves considering with regard to the therapeutic relationship are ones that have an illustrious tradition within individual psychotherapy. Though there are crucial theoretical differences that distinguish the kind of work I am describing from psychodynamically oriented therapy, it is important to note a similarity between the view of the therapist as co-participant in meaning-making that I am describing and the view of the therapist within the interpersonal school of psychiatry, for example, Sullivan, Fromm, Searles, and Semrad (Fisher & Stricker, 1982). For example, Sullivan introduced the concept of the therapist as participant observer, which Fromm felt did not go far enough. He preferred to consider the therapist an observant participant.
Recent writings by Schwaber (1983, 1990) attest to the interest within psycho-analytic circles of reconsidering the analyst's role in meaning-making as well. Schwaber's attention over the last several years has been to analytic listening, and the importance of discovering the patient's meaning rather than imposing the analyst's theory. She writes that “our pathway to what is unconscious is more likely to be reached when it is jointly discovered rather than unilaterally inferred, and the yield will be more empirically derived data” (Schwaber, 1990, p. 35).1
Thus, from a variety of perspectives and in a variety of ways, clinicians are considering the therapist's role in the therapeutic relationship. In this article, I present a tool for thinking about the therapist's influence on the therapy in the form of a set of distinctions about the therapist's contribution to making conversation therapeutic or not.2 These distinctions highlight the therapist's contribution to creating intimate or non-intimate interactions in therapy. While using the language of intimacy to refer to therapy has been uncommon in family therapy until recently (Kantor & Okun, 1989), I believe that the use of such language helps to construct therapy as a more humanistic — as contrasted with mechanistic-and less hierarchical exchange.
Though there is little written about intimacy and non-intimacy in therapy (Bograd, 1989; Miller, 1989; Whitaker, 1989) and the writing does not focus on the dimension of meaning-making, per se, there is nonetheless acknowledgment that the therapy relationship is vital to the therapy experience. Gurman and Kniskern (1981) assert that “[t] here exists an accumulating empirical literature supporting the relationship between treatment outcome and a therapist's relationship skill (p. 751).
Until recently, within the family therapy literature, the principal analytic categories that have been used to conceptualize intimacy in the therapeutic relationship have been power (Haley, 1976; Madanes, 1990) and boundaries (Napier & Whitaker, 1978; Whitaker, 1989). Recently, gender has become a central organizing dimension in discussing intimacy in family relationships and in therapist/client relationships (Bograd, 1989; Goldner, 1989; Kantor & Okun, 1989). Tomm (1990), drawing on the work of Maturana and Varela (1987), discusses “therapeutic love” and “therapeutic violence,” terms that can certainly be understood within the framework of intimate and non-intimate interaction that I am discussing in this article. According to Tomm, therapeutic violence occurs when the therapist imposes his or her will on the client in any way. Therapeutic love, conversely, occurs when the therapist opens up a space for the existence of the other.
Outside the discipline of family therapy, other providers of therapy have concerned themselves with the issues inherent in the question of whether therapy is intimate or not (Fisher et al., 1982; Kaplan, 1983). Primarily working within a psychodynamic paradigm, these authors have been concerned with assymmetries in therapy, such as assymmetries of mutuality, reciprocity, power, affection, care, authority, liability, sexuality, responsibility, and change. To the extent that they view therapy as assymmetrical in any of these areas, they view therapy as non-intimate; and to the extent that they view the possibility of symmetry in these areas, they are likely to view therapy as potentially intimate.
In this article, I suggest that it is worthwhile to describe the therapist and the client in comparable terms, such that each person's contribution to the production of meaning-making in the conversation is given equal attention. Though there are elaborate systems for describing the ways clients make meaning in therapy, less has been written that describes the ways therapists contribute to meaning-making in therapy. Recent writings by Tomm (1987a, b, 1988, 1990) and Havens (1986, 1989) are eloquent examples of this effort.
Drawing on the language-based, social constructionist approach (Gergen, 1985; Gergen & Gergen, 1983), and working with a postmodern feminist perspective (Hare-Mustin & Marecek, 1988; Laird, 1989; Weingarten, in press), I present one way the therapist's contribution to mean-ing-making in therapy can be understood. When meaning is co-created or shared in therapy, the interaction is experienced as an intimate one, and this is therapeutic. Conversely, when meaning is rejected, provided, imposed, or misunderstood, the interaction is experienced as non-intimate and, at the moment this happens, it is nontherapeutic. It is in the acknowledgment and repair of the inevitable lapses of intimate interaction that occur between therapists and clients that there is an opportunity for a profoundly meaningful collaboration.
INTIMATE AND NON-INTIMATE INTERACTION IN THERAPY
Definitions
Consistent with Wynne and Wynne (1986) and Schaefer and Olson (1981), I conceptualize intimacy as a quality of a particular interaction rather than a relationship (Weingarten, 1991). In this view, intimate interaction is defined as occuring when people share meaning or co-create meaning and they are able to coordinate their actions to reflect their mutual meaning-making. Meaning can be shared through writing, speech, gesture, or symbol. In the process of co-creating or sharing meaning, individuals have the experience of knowing and being known by the other. Intimate interaction can happen with one or more people, in actual or imagined encounters. Refraining from meaning-making and providing, imposing, rejecting, and misunderstanding meaning are associated with non-intimate interaction. Repeated intimate interaction may produce an experience of intimacy, while repeated non-intimate interactions usually interfere with or inhibit intimacy.
I have defined the terms “meaning,”“sharing meaning,”“co-creation of meaning,” and “coordination of action” at length in a previous article (Weingarten, 1991). Briefly, I am distinguishing meaning as internal representation that can be discovered by empirical methods from meaning as intersubjective and a product of dialogue itself. It is the latter definition I am using. Co-creation of meaning implies a step beyond sharing meaning in that a new meaning is developed by the two or more people interacting.
I am focusing on understanding as one way of noting coordination of action. Though coordination of action principally takes place through communication within the session, other situations also provide evidence for the presence or absence of coordination of action, such as payment and depositing of fees, arrivals to and departures from sessions, and correspondence or contact outside of sessions.
The thesis of this article is that the description and analysis of the therapist's and clients' contributions to meaning-making are both vital to the therapeutic enterprise. When therapists and clients share or co-create meaning and are able to coordinate their actions, that is, they feel well understood or they respect each others' efforts to understand, these interactions can then be characterized as intimate.
On the other hand, if the therapist cannot share or co-create meaning with the client or clients, has difficulty understanding or believes he or she understands when this is not the case, provides, imposes, or rejects meaning, it is likely that the clients will experience these interactions as non-intimate. If the therapist having been told that the client feels unconnected — claims that he or she does understand the client's experience when this is not the case, the client's experience is likely to be one of mystification, exploitation, intimidation, or coercion. If the therapist acknowledges that he or she is having difficulty understanding, the client's experience is likely to be influenced by the therapist's attitude toward the non-understanding. If the therapist appears frustrated with the client, the client may feel estrangement. If, on the other hand, the client senses the therapist's effort to understand, the client may feel gratified by the therapist's sustained effort.
This analysis does not apply only to face-to-face contacts between therapist and client. Therapists and clients alike are often “in relationship” with each other when they are not in each other's presence, for instance, during vacation periods, between session intervals, or after the conclusion of therapy. During these times, people may fantasize interactions that are intimate or non-intimate, and these fantasy interactions may influence subsequent interactions in therapy, whether with the same or a different therapist.
According to this conceptualization, intimate interactions are considered to be therapeutic, and non-intimate interactions, including ones in which there is joint sexual activity, are considered to be non-therapeutic. Sexual activity between therapist and client — but not the experience of sexual thoughts or feelings (Bograd, 1989) — is always considered non-intimate and nontherapeutic because it can never be genuinely consensual.
Intimate Interaction in Therapy
In this way of thinking about therapy, the therapist is responsible for creating the conditions for intimate — rather than non-intimate — interactions to occur. In this schema, intimate interaction refers to the sharing and co-creation of meaning and the experience of being understood, rather than a feeling of warmth or closeness experienced toward the people conversing.
Therapists have a variety of ways of facilitating the sharing and co-creation of meaning and mutual understanding. In the examples that follow,3 I present ways that are particular to my way of working, which I characterize as a social constructionist, feminist approach to therapy. These examples describe an approach to therapy that is applicable to individuals, couples, families, or groups of unrelated individuals.
In couple and family therapy, when family members are at an impasse of understanding each other, and they are no longer able to share or co-create meanings, it may happen that they are more able to have intimate interactions with the therapist, or in the presence of the therapist, than with each other or on their own. A goal of therapy is to create a “dialogically shared domain of meaning” (Anderson & Goolish-Jan, 1990, p. 162) such that all participants are able to interact intimately, that is, to co-create and share meaning and to coordinate their actions mdash;that is, to understand each other. This does not mean that participants in the conversation will necessarily feel “good” about each other. However, over time, repeated intimate interactions in the absence of a preponderance of non-intimate interactions may indeed lead to feelings of intimacy that are associated with feeling warmly toward or close to another.
One way of understanding clinical consultation is that the consultant attempts to restore or enhance intimate interaction between the therapist and the client(s). In the following example, I use transcribed material from a videotaped clinical interview to permit a close-up look at the actual verbal behaviors of a therapist who is trying to share, co-create, and understand meanings. The portion of transcript I have selected comes from a consultation interview I did, using a Reflecting Team format (Andersen, 1987, 1989). It demonstrates the way in which a therapist, in this case acting as a consultant, and client participate in co-creating meanings by purposeful acts that include, for example, asking and answering questions, suggesting slight modifications in word choice, entering into and expanding a metaphor, and letting go of a suggested word or idea when it doesn't quite fit the other's experience or intention. These purposeful acts include trying to understand (and not understanding), deciphering verbal and nonverbal cues, and ineffable processes as well. However, co-creation does not happen solely by purposeful acts. It is a slow process of accretion through small steps of attention and connection that happen serendipitously as well as planfully. The edited transcript segment is at best a pale approximation to the moments of conversation.
Example
In this segment, I am speaking to Debra, the client for whom the therapist, my colleague Carol Becker, Ph.D., has requested a consultation. Dr. Becker is also in the room. The client, who is in her early thirties, has been depressed for the last 10 years. The therapist has said that their ten sessions have been productive, but that they haven't produced a focus, which is puzzling to her and troubling to Debra. The word “focus” has co-evolved into the metaphor of a “thread.” In this portion of the interview, I try to understand Debra's view of the problem. Debra has used the image of the thread and the metaphor of a logjam. She has said that she feels that there is a “logjam” and that the therapy is missing a “main thread,” though many topics have come up that feel like “incomplete threads.” She has also said that she wants to be able to make herself feel “special” so that she can “repair my hurt myself.”
| Kathy: | You've used the image of a thread and a logjam. You've said you are looking for the key to the logjam. I find that interesting because you aren't saying you want to get rid of the logs; you're saying you hope to get the logs moving along. If we were to cross metaphors, and if you put the image of the thread into the logjam image, what does the image or the idea of a thread provide? |
| Debra: | The thread would be the lumberjack going from log to log: “Well, this isn't it, this isn't it, but I'm getting closer and closer because the logs are getting tighter.” |
| Kathy: | You're after something that will get you to the area of most jammed-upness, most stuckness, through some means. Carol has had the idea that talking, Al-Anon, and/or medication may loosen up the stuck logs. It seems to me that I also heard you have an idea about how to do this. It sounded like you thought a solution to your feeling the way you do would come if you were able to provide your own feeling of “specialness,” that was your word, and, I'm going to use a different word here, if you were able to be compassionate to yourself, be nurturing to yourself, you would feel less hurt. |
| Debra: | (smiling) I think this is going to be complicated. I'm smiling because I've talked to a friend and she's told me about a book that sounds like what you're saying. There's a resonance between what she said and your idea. |
| Kathy: | My idea? An idea that I just had? |
| Debra: | Yes, the idea that if I were compassionate with myself some hurt would be resolved. |
| Kathy: | I thought I was just amplifying an idea of yours. Did it feel like I changed the idea? |
| Debra: | Yes. The change of word changed the idea a little bit. |
| Kathy: | Let me stay with your word. If you could make yourself feel special, you wonder if you would feel less hurt? |
| Debra: | I have no idea how to generate a feeling of appreciation for myself. I have no idea how to apply the poultice of specialness to myself. |
| Kathy: | If you could, you wouldn't feel so hurt? |
| Debra: | (nods agreement) |
| Kathy: | If we take the idea you have, that if you were able to apply the poultice of specialness to yourself, things would be better, and go back into the metaphor of the logjam and the lumberjack and the pole — I know this is very difficult, maybe it's not do-able — where is the idea of the poultice in the metaphor? |
| Debra: | I'm not sure it's there. (pause) What it might do is that it might expand the river, not such that you find a particular logjam, but such that you change the place where the logs are stuck. |
| Kathy: | So it might change the shape of the river? |
| Debra: | Right. |
| Kathy: | If the shape of the river were different, if the rocks were different, the banks, the flow of the water was different, the logs would assort themselves somewhat differently… |
| Debra: | Or they could just flow. |
| Kathy: | Oh, they could just flow out. |
In this portion of the interview, there are exchanges in which we are sharing meaning and we understand each other; exchanges in which I inadvertently provide meaning when I have not understood and then retract my meaning; and exchanges in which we eventually co-create meaning by entering into and describing a metaphor together. The sum of these interactions was sufficient to produce an overall experience of intimacy in the participants of this conversation: to me, to Debra (who said that this portion of the interview felt intimate during a followup meeting 3 months later), to the therapist in the room, and to the two colleagues behind the mirror.4 However, though I think it is essential to shift non-intimate interactions to intimate ones, I do not think that a quality of intimacy will necessarily be produced if interactions are predominantly intimate. Other factors such as timing, mood, interest, or situation may influence the movement from intimate interaction to intimacy.
This exchange between me and Debra took only a few minutes. It was an intimate interaction that created conversational possibilities for Debra and her therapist (Carol), which then led them to the sharing and co-creation of meaning. The next few minutes of conversation between Carol and Debra also reveal a process that leads to and enables the sharing and co-creation of meaning. This is precisely the way intimate interaction between a therapist and one member of a couple, family, or larger system creates opportunities for intimate interaction among the other participants in the conversation. Sequential, dyadic exchanges often lead to intimate interaction for all members of the conversation.
NonIntimate Interactions in Therapy
The therapist's job is to help produce intimate interactions among participants in a conversation. It is also the case that the therapist will try to minimize the production of non-intimate interactions. In order to reduce non-intimate interactions, it is necessary to have a conceptual framework that can account for the development of non-intimate interactions. Within a psychodynamic perspective, the concept of countertransference provides such a framework. In the next section, I describe four ways that non-intimate interactions may be produced that, unlike countertransference descriptions, are compatible with social constructionist theory. These four ways are meant to be representative, not exhaustive, of the many ways non-intimate interactions can be produced.
Therapists can participate in producing non-intimate interactions in several ways, by: 1) failing to acknowledge the therapist's position as part of, not outside of, the “system” or conversation; 2) premature “understanding“; 3) sliding from sharing to imposing meaning; and 4) the construction and protection of joined narratives. Each of these paths to non-intimate interaction can occur in the context of individual, couple, family, or larger system therapies. It would be interesting to explore whether there are systematic variations in the ways non-intimate interactions are produced across and within the different therapy settings.
The first pathway—failure of the therapist to acknowledge that he or she is a part of the “system” or conversation, rather than outside of it and able to look at it dispassionnately— has great potential for leading to non-intimate interaction. This failure has been described by Keeney (1983) as linked to “errors of objectivity” (p. 77). Havens (1989), an interpersonal psychoanalyst, makes a similar point:
The clinical observer cannot simply note and correct. The material is extremely difficult to judge and the judge himself may be deeply involved in the very creation of the material. And because each encounter has unique elements (these two people have never come together before), it cannot be considered simply another example of something the judge already knows. In some measure the interview is always a creation. It is necessary to acknowledge that there are two parties to that creation. [p. 70]
The ability to appreciate one's position in the “system” or conversation has been linked to a particular ethical stance (Anderson et al., 1988; Hoffman, 1990; Keeney, 1983). Once the therapist appreciates his or her position as part of the co-evolving process, the concern with changing others shifts to an interest in changing the self. This leads the way for an ethics of observing or an ethics of responsibility to replace an ethics of objectivity (Keeney, 1983). As Anderson and Goolishian (1988) write, this ethical stance is in contrast to two prevailing views of ethics:
The first requires that the therapist take a strong stand and take action based on his or her ethics…. The second view requires that the therapist's ethics must be shielded and that he or she must serve as a blank screen, that is, the therapist does not take a position. [p. 385]
A therapist who is guided by an ethics of responsibility may conceptualize his or her relationship to the client differently than does a therapist guided by objectivity. First, the therapist may accept that he or she is constantly selecting aspects of the conversation to amplify or diminish, and believe that this process of selection is guided by a number of variables, including the therapist's experiences gained by virtue of being located in a particular racial, gendered, and class position in the wider sociopolitical context within which the therapy takes place.
Second, the therapist may re-define therapy from a consultation with an expert who can “pre-know” what is meant and what should be done (Goolishian, 1989) to a conversation with a person who has expertise. The responsibility for the ways that the therapist's expertise is used may be shared with the client. For instance, if the client knows that the therapist has expertise in teen-age suicide, if the client's child has made a suicidal gesture, and he wants the therapist to offer concrete advice, within this conceptualization, the therapist's refusal to offer suggestions would produce a non-intimate interaction. Therapists working this way may believe that the clients' participation is necessary to identify, name, and modify the ways in which the therapist inadvertently restricts meaning. The following examples may clarify these points.
Example 1
In this example, my gender biases, in addition to those of the couple, initially contributed to a difficulty in the clinical work. A couple I have worked with intermittently over a period of years decided to work in therapy on whether or not to have children. After several sessions, over a number of months, the husband reported that he felt I was conducting the sessions with gender bias. He said he never felt I understood his experience as adequately as I did his wife's. I agreed with him that I did not seem to be able to understand him as well as either of us would have wished.
In trying to understand better the difficulty we were having, we decided to meet individually for a few sessions. During these meetings, we developed the explanation that he had been reluctant to share his most private thoughts and feelings with me for fear of feeling shame about sensitive sexual matters, and I had failed to perceive soon enough that he had scaled down and restricted his sharing. We both thought that gender issues had contributed to his previously withdrawing from meaning-making with me, and also contributed to my not noticing it.
That gender biases of the therapist may influence therapy is both extremely likely and difficult to substantiate because of the paucity of studies done in the setting of therapy itself (Brodsky & Hare-Mustin, 1980). Sherman (1980) concludes that therapists' sex-role values are “operative” during therapy. By talking about the evolution of non-intimate interaction in our relationship, by sharing our ideas about the way each of our gender biases were interfering with our co-creating meanings with each other, my client and I were able to reestablish intimate interaction both in the individual sessions and then, later, in the couple meetings.
Example 2
In this situation, a therapist's belief that he was outside of the therapeutic system and able to work objectively, led to a decision to work with a client who later felt betrayed by the therapist's presumption that he could divorce himself so neatly from the treatment process. A therapist had accepted a client for treatment whose presenting issue was her grief over her mother's death from cancer. The therapist, who himself had had cancer 2 years previously, unilaterally decided that he would not have difficulty working with the client even given his own illness experience.
Three years after the treatment started, the therapist published a first-person account of his own cancer experience, which his client read. The client was outraged that her therapist had considered taking her on as a client in the first place, felt betrayed by the therapist's failure to inform her of his own cancer status, and worried that much of the work they had done had been influenced in ways that she could not completely account for by virtue of the therapist's own experience with cancer. When the client confronted the therapist with her reactions, the therapist insisted that he had maintained “impeccable boundaries,” and that at no time had his experiences affected the sessions. The client, who believed that the therapist was not an objective obeserver of the therapy process but a participant in it, was shocked and enraged to learn that her therapist had a different point of view.
The client reported to me (the couple's therapist) that she felt the therapist had imposed his meaning on her. She clearly felt that the therapist's behavior had produced non-intimate interactions. What was even more alarming to her was that she was now recontextualizing the entire therapy and calling into question whether the therapist had ever shared meaning with her or understood her experience, that is, whether they had ever had intimate interaction.
While there are undoubtedly many factors that can account for the client's intense response to the situation with her individual therapist, I wish to call attention to her reaction to the therapist's imposition of meaning. This example raises thorny questions: whether it is more or less intrusive for a therapist to speak of his own life difficulties; who decides this; under what circumstances a therapist might shift the decision he or she made; and by what process such a determination is made. I do not mean to suggest that there are easy or invariant answers for all therapists, clients, or situations.
The second pathway to non-intimate interactions —premature “understanding”— occurs when either therapists or the clients think that they understand each other, or indicate this, before it is really so. Anderson and Goolishian (1988) and Goolishian (1989) discuss this from the perspective of the therapist's “pre-knowing.” They believe that the risk of listening from a “pre-knowing” or “knowing” position is that there is “less opportunity… for dialogue, and… more opportunity for misunderstanding” (Anderson et al., 1988, p. 382). Similarly, Gurevitch's scheme conceptualizes problems of premature “understanding.” He believes that in most close relationships, there is a propensity for the individuals to become locked into an “inability to not understand.” When this happens:
understanding, as well as not understanding, thus remains reactive rather than active because it is dominated by a supposition of understanding…Both sides are locked into positions charged with interest, conviction, and belief, and no direct short cut to understanding exists. Further understanding and deeper acquaintance are interpreted only in terms of already formed conceptions, thus strengthening the inability to not understand. To get out of this situation and open the way to understanding, a crucial point of passage is needed: the ability to not understand. [p. 163]
Difficulties arise in some therapies because there is a premature movement from not understanding to believing that there is understanding. This may happen because the therapist is unable to tolerate being in sessions while operating from the position of not understanding. I believe that only out of operating in such a position can the dialogue necessary for genuine understanding occur.
Example
A therapist may assume too much, as in the following situation. A young couple came to therapy asking for help with religious differences. The man reported that he had thought his girlfriend had agreed to convert to his religion, but that, after a brief separation, they had come back together and she was now refusing to do so. The girlfriend agreed that she had changed her mind, saying that the time apart had allowed her to identify more clearly what she could and could not change about herself. The therapist nodded agreement and told the couple that they were having difficulty because during the separation the woman had discovered that she could live without her boyfriend; therefore, she had much more flexibility in negotiating with him because she could tolerate the outcome of their separating permanently. The woman looked interested and agreed. The therapist then continued the session as if the woman had confirmed that she was “ready” for the relationship to end. This premature “understanding,” which may or may not have turned out to be a version of her experience that the woman would have chosen to tell her boyfriend, interfered with the couple's constructing their accounts of themselves in the relationship.
The third pathway to nonintimate interactions in therapy involves a sliding from sharing to imposing meaning. In any relationship in which there is a high level of involvement and repeated interaction, there are bound to be some non-intimate interactions. Between any two people, there are times when, for example, it is efficient to provide meaning —“Always wash and dry fruit before putting it in the refrigerator”; prudent to reject meaning —“Don't touch me that way again”; and reasonable to impose meaning —“Please just do it my way this one time.” However, if the persons involved are a therapist and client, one needs to think carefully whether there are any circumstances in which providing, rejecting, or imposing meaning are acceptable practices. When concrete suggestions are requested by a client, the provision of meaning may be helpful. When clients misrepresent their therapist's remarks, rejecting their meanings may be useful, depending on whether this is done in a way that enables more discussion, and not in a way that makes the client feel reprimanded.
While I can imagine times that the provision and rejection of meaning may be therapeutic, I have difficulty imagining situations in which the imposition of meaning is therapeutic (at least if this is a common practice). Therapists who construct their role as that of the expert may be more vulnerable to imposing meaning than those who do not construct their role as that of an expert. Therapists working as “experts” often subscribe to a normative perspective (Anderson et al., 1990; Hare-Mustin et al., 1988). For example, a couple in my practice reported that, shortly after their infant was diagnosed with a terminal illness, a therapist told them, “It takes at least two years to grieve adequately, and over half of couples who experience a child's death eventually divorce.” The couple had a strong, negative response to what they experienced as the therapist's “dropping a bomb,” imposing meaning, on them.
Though clients may recognize that the therapist is imposing meaning, their range of responses to such imposition depends on a great many variables. To name just a few, their responses will vary according to whether or not they agree with the therapist, how desperate they are for help, how vulnerable they feel they are, how persuasive the therapist's manner is, and how certain they are of an alternative point of view.
What may be even more problematic in treatment situations than the imposition of meaning, which is clearly identified as such by the clients, are those situations in which the imposition of meaning is not noticed by clients. This may occur following a period of interaction — either in the course of one or several appointments — in which the clients feel that the therapist has been primarily co-creating or sharing meaning with them. This slide from sharing meaning to imposing meaning may take place in stages across sessions or occur within minutes.
A slide may occur through such a subtle process of shifting from one type of interaction to another that clients may have difficulty realizing that it is happening, and thus be unable to protect themselves from it. Further, in retrospect, once a client does realize that the therapist has imposed meaning, the client may wonder whether intimate interactions had ever truly been established.
In instances in which sexual abuse of the client by a therapist occurs, the concept of a slide from intimate to non-intimate interaction may be one useful way of describing a part of the process by which such abuse takes place. Though the imposition of meaning is never therapeutic, the effects of a therapist's imposing meaning in the sexual arena are particularly devastating (Pope, 1990).
Example 1
Some therapeutic impasses occur when the therapist's frame dominates the treatment and the therapist stops listening to and trying to understand the client's perspective. A middle-aged man called for a consultation to his long-term therapy that he said was at the “termination phase and running into trouble.” He had begun training for a marathon, and his therapist was interpreting his behavior as a resurgence of his “defensive use of solitary pursuits to handle interpersonal anxiety,” in this case, feelings of loss about the ending of therapy and the loss of the relationship with the therapist. The man reported that he felt grossly misunderstood. The therapist insisted that his view was correct, and that the client's insistence that the running was a sign of health was further evidence of his defense. Because this man believed that it was essential to go through a “proper termination,” he felt unable to leave the therapy, though he was increasingly distressed by it.
The man's description, admittedly one-sided, suggests that he was experiencing a coercive therapy interaction after a therapy that he felt had been successful. In his view, the therapist's logic produced a bind for him, which the therapist was unable to discuss as a situation in which they were co-contributors.
Example 2
Therapists may abuse clients by sliding subtly from sharing meanings to imposing their own idiosyncratic meanings onto clients who have come to trust them. Therapy in which this happens is often characterized by a process in which the therapist is not helping clients experience their own capacity for meaning-making, but rather encouraging agreement with the therapist.
A client had been talking to her therapist about her early memories of her relationship to her mother. Together, she and the therapist had developed the idea that her mother had been unable to supply her needs as early as the nursing period. The client had experienced the therapist as profoundly in tune with her during these sessions. Later, the therapist suggested that she suck on his penis as a way of “repairing her early unsatisfactory experience.” When she refused to do this, he told her she would never “get better until she was able to heal herself by a positive reparative experience.” Confused and intimidated by him, she assumed he knew her needs better than she. She reluctantly agreed and this activity persisted for months.
The fourth pathway is the construction and protection of joined narratives. Gergen et al. (1983) use the concept of self-narrative to present their view that the self is not a stable, fixed achievement of maturity in the Eriksonian sense of identity (Erikson, 1968) but a “potential for communicating that such a state is possessed.” (Gergen et al., 1983, p. 266). From this perspective, the self unfolds with each communication about itself, rather than being a state that can be described once and for all. Gergen and Gergen suggest that the self unfolds through a process they call “narrative construction.” Narrative construction, they assert, is never private, but always an implicit social act. Additionally, each of us is “knitted” into others' constructions of the self-narrative. “This delicate interdependence of constructed narratives suggests that a fundamental aspect of social life is a reciprocity in the negotiation of meaning” (p. 270). Narrative constructions can only be maintained if those who are “knitted” into ours cooperate. If the other or others do not cooperate, it “threatens the array of interdependent constructions” (p. 270).
Therapists and their clients may be vulnerable to being “knitted” into each other's lives. Though therapy can be a close, intense, and intimate situation in which sharing and co-creation of meaning occurs, it is essential that the material about which meanings are shared and co-created is predominantly from the client's and not the therapist's life, and that the “knitting,” if it occurs, does not involve the construction and protection of joined narratives. Therapists who routinely review their clinical work with colleagues are in part acting to minimize the possibility of creating joined narratives with their clients that might impede the client's growth and development in an autonomous fashion. Though therapists use their life experience as the foundation from which they do their work, their life experience must not become merged with their clients' life experience.
The construction and protection of joined narratives can occur in subtle and flagrant ways. In the example that follows, a therapist and her client had implicitly constructed a narrative about the therapist in which she was always helpful and supportive to her client. When evidence suggested that the therapist had missed an opportunity to be supportive of the client, the therapist and client jointly protected the original narrative and failed to expand their narrative of the relationship to one that could have included more complexity about the nature of therapy and their relationship.
Example
A 50-year-old woman had been in therapy for 2 years when she decided to separate from her husband. She explained to her therapist that she could not tolerate his violence toward her any longer. The therapist, who could only recall one time her client had mentioned that her husband had been violent to her, was surprised at the reason, though she was keenly aware how unhappy her client was in the marriage. The therapist and the client proceeded to discuss the way in which the client's shame had prevented her from mentioning the violence more than the one time. The therapist did not suggest that the client discuss what her experience had been that one time she had talked about her husband's violence. Nor did the client volunteer any information about her experience during or subsequent to the session in which she had described her husband's violence to her and her therapist did not take this up with her.
CONCLUSION
I have presented a conceptualization of intimate and non-intimate interactions in therapy that stems from a social constructionist, feminist approach to understanding intimacy. I have suggested that, by attending to the ways intimate and non-intimate interactions are produced, therapists may be better able to produce therapeutic interactions and repair non-therapeutic ones. Non-intimate interactions can occur in a wide variety of ways, within a range from unwitting with benign intent to deliberate with malevolent intent. Non-intimate interaction, whether single or chronic, is always nontherapeutic.
Of critical importance in this conceptualization is that the therapist's feelings, opinions, values, and experiences are understood as significant in the therapy. Therapy is a process in which neither the therapists' nor the clients' views can be violated without repercussions. I am suggesting that one crucial aspect of therapy takes place in this space between — in the working out a way of sharing meaning and sharing the meaning of the meanings that are shared.
Though intimate interaction is difficult to sustain moment by moment, this must be every therapist's ultimate goal. The inevitable lapses that arise can become opportunities for reestablishing intimate interaction if the therapist is able to acknowledge his or her inability to understand or empathize with the clients when these episodes occur. This kind of acknowledgment and discussion, in and of itself, may be therapeutic for clients — and therapists — in that it may develop awareness of non-intimate interactions and entitlements to intimate ones. Additionally, through such ubiquitous lapses and their recognition, acceptance, and repair, the skills to transform non-intimate to intimate interactions are forged. Though the failure of intimacy is bound to be painful for both clients and therapists, it is not nearly as devastating as the failure to acknowledge and rectify these occurrences.
