One of the stickiest traps (and frustrations) for the early career therapist is to find themselves in the realm of a client’s aboutism. What starts as the intention to “really hear and witness a client’s story” becomes a week after week reoccurrence, and soon lands us in impasse…going nowhere; if anything, solidifying what is an already concretised way of seeing the world.
Some of this is a misunderstanding of what “talking cure” means (for clients and for therapists); and part might be attributed to not feeling confident to curb the persistence in our clients’ way of being-in-the-world; the same being that has brought them to therapy. We owe it to them once we have found ourselves in relationship (joining the system) to find our voice (and disrupt the system).
In Gestalt therapy, “aboutism” refers to the tendency of clients to talk about their problems and experiences rather than fully experiencing and engaging with them in the here and now. This is staying at the level of content; the what of the story. As I am exploring in my new book, therapeutic change can only happen when direct experience is contacted, engaging a client’s awareness in vertical and horizontal dimensions. This is the distinction of process; rather than the what of the story, the how.
The story is re-storying in every moment. If it is told in a distanced intellectualised way it will deepen its tracks. If we can support a client to feel into the story as it is being experienced, we have a chance to help them contact the nuances within. My time studying with Buddhist psychotherapist John Welwood on retreat helped me appreciate another aspect; himself a student of Eugene Gendlin, Welwood demonstrated the value of looking into not only the direct experience of a story but also the relationship held with the experiencing of the story.
The story being told
How the story is being told
What it is like to experience this story
Supporting clients experience their stories is an important aspect of our work; such relational support helps clients experience what could not be experienced at the time the story was playing out. There is a helpful framing of this by psychoanalyst Donald Winnicott in his notion ‘the fear of breakdown’: the fear of a past event that has not yet been experienced. Re-membering, in our humanistic frame, is to re-tell the story in a way it can be experienced with sufficient support. Take the client recounting a traumatic childhood scene; the therapist, keeping in mind safe emergence and titration of affect (the work of Peter Levine) aids the storying with engagement in the feelings associated with the recollection. The ‘there and then’ retold in the ‘here and now’; this unlocks the unexperienced event, freeing the client to invent new possibilities, not the fear of the anticipated breakdown…the ‘now-for-next’. This is one way that experimentation and intervention lend the therapist skilful means. The client who shares they feel like “they are holding on for dear life” comes to recognise how their body is holding tension, even the hands gripping the chair, the teeth clenching. Magnification or suppression experiments might bring awareness to how much the client IS holding on. “Gestalt therapy tries to restore the connection between aboutism and action. By integrating action into the person’s decision-making process, he is pried loose from the stultifying influence of his aboutist ruminations” (Polster and Polster 1974, pg 234)
As therapists become more experienced and artful, there is another possibility for working at process level: to recognise how the very story and “complaint” gets played out in the relational between therapist and client; indeed, this is the understanding of therapeutic process as a relational phenomenon (Bott and Howard, 2012). We can just point to the elephant in the room. Like the client who would come to me week after week sharing a number of stories varying around the theme of complaint about friends not reciprocating help. What was striking to me was how complimentary toward me she was, in which I couldn’t help but feel an invite to take sides. In supervision, I shared how impossible it felt that she would not be complaining about me to others. Sure enough, as I shared my curiosity of an imagined “praise / blame” dividing with the client, we uncovered how hard she felt to express her needs, helping others rather than asking for their help (and then blaming when it was not reciprocated). As well as this name it to tame it, Bott and Howard (2012) suggest an alternative way: to actually engage the relaitonal process in such a way that the anticipated outcome is replaced by an unpredicted event. They describe a client whose presenting issue was to remain passive in the face of significantly unacceptable behaviour by the partner whose departure had taken her by surprise. In the discussion of this case, Bott and Howard draw our attention as to how the content (the story being brought) gets played out with the therapist (requiring the work with process). The illustration begins with the therapist’s question ‘What do you want from coming to see me?’ being met with the client response ‘Lots of people recommended you’. As Bott and Howard (2012) point out, it is easy to let such a comment pass, but the process is already being played out: the client “showing you the way in which she does not get her needs met…going off on a tangent based on an assumption about what you might want – praise”. One way of disrupting the client’s story with a relational challenge might be “that I am widely recommended makes me feel warm inside, but I’m no clearer about what you would like”. The relational process is highlighted not simply with a process comment but rather a process guiding intervention.
A few years ago I supported a supervisee through a period of work that nearly had them fall foul of not identifying process playing out in the room. The client came to the therapist for help around the fear of their Dad’s ageing and illness; and his frustration that he and his Dad weren’t talking about the decline and its inevitable trajectory, death. The client was worried that both were on a trajectory of regret, leaving things unsaid. Some months later, his father died suddenly; taken by a heart attack unrelated to the slow burn of the advancing cancer. Experienced as a relief and release from the situation, (felt by both in the dyad) my supervisee and client unwittingly set up a repeated lack of an intentional ending. My supervisee came to realise that their own “endings story” (avoidance) was colliding with the client’s ‘flight to health’ which could have followed through in a premature ending of therapy.
A very helpful foothold into content and process differentiation (for its live working) is the use of theories that describe enduring relational themes; theories on repetition-compulsion (Freud, 1914), enactment of typical relational dilemmas (Bott and Howard, 2012), schema theory (Young and Kiosk, 1993) or indeed the whole list of ‘games’ in transactional analysis (Berne, 1964) can provide useful maps to sharpen our attention. A rather helpful model is that of the drama triangle (Karpman, 2019). When a client identifies with the victim position in their storying, we might soon find ourselves re-enacting the enduring relational theme with them by taking on the position of either (or more typically, switching between) the rescuer and persecutor. Getting out of the story and rumination how the world and everyone is against them is imperative: but note, the task is getting out of the story, not getting them out of the situation: because that is a conflation of content and process not a differentiation of it – if we fall at that hurdle, we are already acting out as the rescuer. A first step might be to support the experience of being the underdog; and once there, they might see with more clarity their projections onto the world that follow the tendency to take the ‘one step down’ position. To move this into the relational process of therapy, we help them see any time the projection process happens through us. To be the underdog with us will always have us as the all bad or all good therapist: the foe or the saviour. Working with a ‘victim’ will often have us working really hard (to save) or feeling spiky (to reject). As a supervisor, my alarm will sound if I have a supervisee saying “I really feel for them, but…” which has echoes of pity and distance; an it-ing that is more comfortable (and inevitable) if someone is holding the ‘one down’ position in a relationship. An important point that bears emphasising: to be true to our frame, no one can be ‘a victim’* in isolation. This is not a process to be located IN the client but rather in the relational. My client can only be a victim if I take up a position of ‘one step up’; so do be mindful of the co-creation of any relational dynamic or ‘game’.
Again, differentiate the story and how it is being told; then, what is it like to experience this story (for the client) in the immediacy of telling it; and how might it be playing out here and now (between therapist and client). When I am helping trainees get to grips with content playing out in the room, I go out on a limb saying that “99.9% of the time the very content of the session is playing out before our very eyes”. Within the fishbowl scenario, this assertion helps the audience remain alert to making that linkage as they watch the working dyad. We might say spotting the drama of the story play out. It is, as with developing relational themes, easier to digest and assimilate this learning on the outside looking in than to be in the trainee chair. Over time, we are able to be both within and without; to be in the relating and simultaneously have a sense of the relational phenomenon that we are tasked to know. As if we can take a helicopter up and watch how things are playing out; yet paradoxically keeping our feet on the ground.
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*Why I deliberately place it in ‘ ‘
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