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The insightful present

In psychoanalytically-informed therapies the transference is understood to be a vehicle for bringing unconscious conflicts into the present so they can be reworked and understood. Freud’s emphasis on using the transference to understand the past leads to typical interventions that ultimately focus on exploring past relationships. So, in Arieh’s case, I would be most interested in Arieh’s irritability and anger as expressed towards his father, perhaps an expression of Oedipal rivalry. Here, the present is used to shed light on the past (e.g. ‘Your anger towards me comes from an unexpressed wish to oppose your father’). This is sometimes called ‘interpreting away’ from the therapist. Although approaching clinical material in this way still has its uses, it can be used as a defensive way of moving away from dealing with conflicts and emotions as they occur between therapist and patient. It also risks focusing on the past as a historical fact that is set in stone. Our current thinking about the past draws much more on the idea that memories, our experiences of the past, are always being revised and reconstructed depending on what is going on in the present. Most therapeutic approaches today see the past and present as being in constant dialectical tension, always changing our sense of self. In fact, if it were not the case that the present has the potential to reconstruct the way we see the past, psychotherapy would not be able to effect change.

More contemporary psychoanalytic approaches favour a different way of using the here-and-now and what is going on between patient and therapist. Emphasis is placed on the therapist perceiving the patient’s talk about past experience as constantly alluding to what is unconsciously going on the therapeutic relationship. Through bringing these observations into the present moment, the therapist works to bring alive fixed expectations, assumptions, etc, that can be worked on in session. This is often called ‘interpreting towards’ the therapist. If I worked with Arieh in this way, I would suggest to him that his thoughts about his father’s absentmindedness were really references to his experience of me as not being able to follow or understand him.

The experiencing present

Some therapeutic approaches focus on the awareness of experience as it evolves in the session. Rather than focusing on understanding and insight, emphasis here is on expanding an awareness of the self, processing emotions, and deepening the capacity to experience. The therapeutic leverage of the ‘experiencing present’ is used in different ways, but all have in common a focus on affective experience in the here-and-now. Emotion-Focused Psychotherapy, (EFT) for example, emphasizes the adaptive effects of expressing core affects. A fuller experience of affect in the here-and-now helps clarify needs of the self that have not previously been permitted authentic expression. Here the therapist acts like an emotional coach, encouraging the expression of adaptive emotions and to help the patient process stifled feelings. Recently I attended one of Leslie Greenberg’s workshops on working with emotion. In watching DVD footage of how he works, one gets a clear sense of how the emotion-focused therapist constantly tracks and attunes to the emotional states of the patient. Is so doing the moment-to-moment following of affect seems to build a great deal of trust in the therapist (always striving to be authentic and active) while working through disavowed emotions.

Another example of using the ‘experiencing present’ as a way of generating change is Safran and Muran’s (2000) Brief Relational Psychotherapy model. In their model, bringing awareness to the here-and-now is used to generate a kind of ‘mindfulness in action’, a fuller, non-judgmental awareness of habitual ways of interacting. Through generating an awareness of our thoughts, actions and feelings in interaction, as they occur in the present, we are able to detach ourselves from being overly immersed in automatic pathological behaviours. In is the ‘in action’ aspect of their relational approach that is important here. Although it may be relatively easy to reflect on problematic interactions after they have occurred, it is much more difficult to remain mindful and reflective while these exchanges are taking place in real time.

Another approach that emphasizes experience in the present moment comes from Daniel Stern’s intersubjective approach to psychoanalysis. He believes that each present moment is driven forward by the desire for intersubjective connection so as to deepen and expand the intersubjective field and open up new ways of being with the other. Emphasis is on ‘lived experience’ as it implicitly unfolds. It is through these new ‘lived’ ways of being with the therapist that we are able to create new ‘present remembering contexts’ (Edelman, 1990) that change the way we reconstruct and remember the past.

 

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