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Paralysis in the here-and-now

Like all approaches to psychotherapy that are used in a rigid, dogmatic fashion, focusing on the here-and-now can have a paralyzing effect on productive dialogue. A friend of mine once asked me why his therapist insisted on bringing everything into the here-and-now. He expressed discomfort with this as it seemed to be some kind of misplaced habit that got in the way of their work. This kind of approach often comes from misunderstanding the ‘now’ as an isolated, static, moment whereas it is best conceived as a subjective experience that is always dynamic and connected to the past (what has just happened or more distant memories) and the future (what might happen, where it is leading to). In other words, in asking the patient to focus on the ‘now’ we are always moving along to another ‘now’ moment as he starts to consider his experience. Ironically then, there is no such thing as ‘now’ in and of itself; it is always being constructed and understood as we allow ourselves to move away from it.

Current emphasis on working in the here-and-now often leads to a misunderstanding that we are not doing good therapy unless we are constantly asking questions like ‘what are you feeling now?, ‘do you experience me as …?’, ‘what is going on between us?’. But these interventions are useless unless there is ‘felt need’ for them and there is an appreciation of how we are inevitably always moving along in our experience. What you feel now changes as you allow yourself to dwell on it. Put differently, there is a temporal contour to present experience, a flow of experience that constantly moves from past to present to future.

The breakdown of the basic subjective experience of temporality is often expressed in different pathological states. Depressives appear stuck in the past, unable to use the present to mourn lost objects or experiences. Schizoid patients, on the other hand, live in fear of the intimacy of the present moment, while manic and narcissistic individuals often fixate on a ‘future’ self, an ‘ideal’ self that skips past the reality of the present. Still further, borderline patients feel imprisoned by the here-and-now. They feel everything at once and cannot relegate anything to the past or future. It is also often the case that substance abuse is used to attain a dissociated psychic state that is characterized by a sense of ‘timelessness’, a means of avoiding how the past impacts the present. In attempting to connect with our patients, the sense of the here-and-now takes on very different ‘feels’ according to how the patient processes experience. This suggests that working in the present poses different challenges for different individuals.

Tolerating ‘here-and-now’

Whether acutely focused on tracking emotion or interpreting conflicts in the therapeutic relationship to bring about an experience of integration, both approaches implicitly work on helping the patient tolerate being more present in their own experience. Although the here-and-now has become an emerging focus in psychodynamic, humanistic and experiential therapies, it is also one of the most challenging aspects of our work. To dwell in the present moment induces a great deal of anxiety (in therapist and patient) because it brings us closer to experience as it is lived. In my understanding, a great deal of preparatory work, building trust and security, is needed before both therapist and patient can tolerate exploring the here-and-now so that it leads to greater understanding and awareness. Preparatory work also involves tentatively alluding to the patient’s internal experience in a way that can be thought about without it being dissociated or dismissed defensively (e.g., ‘I wonder if something shifted for you just then’, ‘I have a sense that we are moving away from…’, ‘I seem to experience you differently when you …’, ‘I’m aware that I…”. ).

Working on present experience also means that we are focusing on what is largly ‘unkown’ and unformulated. We don’t know what the next moment will bring. But this is where the power of the here-and-now lies, it offers new ways of approaching and understanding what is emerging in the interaction. This is highlighted by the fact that no moment is completely the same as the previous one. Although our preconceptions (projections, construals, past memories of the patient etc.) may convince us that we know what is going on, in reality each new moment has novel elements to it that can help us see past defenses and habitual ways of relating. When we are attuned to each moment as novel we start to notice that each session starts differently, each interchange has unique qualities waiting to be attended to.

One final thought about tolerating ‘here-and-now’ relates to its paradoxical nature: although it brings us closest to ‘raw’ experience as it is ‘lived’ it is always fleeting and ungraspable. This is one aspect of the therapeutic process that has received relatively little attention. I have a sense that, by focusing on the immediate, we learn to better tolerate the ephemeral and ungraspable nature of emotional experience. It brings home the fact that we cannot ‘have’, possess or freeze the process of experiencing, we can only allow it to unfold and learn from it. When we have difficulties in focusing on the here-and-now, it is partly because we are preoccupied with previous moments or events which we wish we could possess or expel. One might say then that in order to be fully immersed in the here-and-now one has to also notice and tolerate its passing.

 

References

Bion, W.R. (1962). Learning from experience. London: Karnac

Edelman, G.M. (1990). The Remembered Present. New York: Basic Books.

Safran , J.D. and Murn, J.C. (2000) Negotiating the therapeutic alliance. London: Guilford Press.

Strachey, J. (1934). The nature of therapeutic action in psychoanalysis. International Journal of Psychoanalysis, 15, 127-159

Stern, D.N. (2004) The present moment in psychotherapy and everyday life. London: Norton

 

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