by Paul McDermott

Psyche means 'Soul' and terapia means 'to attend to',  so the word psychotherapy means to attend to the Soul. 

The psychotherapist holds their patients, listens, responds. This is what they do. This is what you see. They are sensing the other, and the gaze is both outward and inward. It is rare; it is beautiful. 

Psychotherapy happens in a mysterious container, a temenos - a sacred space - created and maintained by those present. And there is the sense of being contained, safely held, the outside world is shut out for the duration of the session. The psychotherapist is so close, holding you psychically, perhaps more closely than anyone else in your life holds you. If it is going well the therapist seems to sense you, seems to know you in that moment better than anyone else in the world - knows what you are feeling and what you need. It means that anything can change, in an instant you can find yourself accompanied to a new place.

The psychotherapist has been trained, they have learned diligently, but all of this training must be put aside or it will interfere with the connection, the intuiting, the conversation without aim but which is anything but aimless. 

What one has been taught by others can become an obstacle to spontaneity, to expressing and being oneself. This is the core of psychotherapy: rid yourself of conditioning and you will be left with yourself, with your way of being, relating, and living. 

The way the pair are with each other - this is what warms, this is what instills trust and confidence. In the hands of this person I am safe, I trust, I am trusted, I am more myself here, and here I can glimpse the healthiest, wisest, and most honest and vulnerable and resilient of myself.

The music of the psyche, together with what the Chinese call the Tao ("dao") - this give direction, energy, pace. Thus the leader is outside of the pair. And it is this outside influence that, if the pair are receptive enough, leads the steps, leads this silent conversation behind the words.

The movement is anti-clockwise, back into the past, back to being held, back to learning to walk. But it is also teleological - pulling us forwards, towards a refreshing spontaneity, improvising, fully committing and working the rest out as you go along. 

When the theory is put aside, and the world is reduced to a time and a place, we notice there is space. A new impulse, a new course can be proposed by life and dreams, and responded to at any point. This is flow; this is being in the moment. Zen practitioners understand this. In this sense each session is a singularity – no one has ever before, or will ever again, experience precisely this conversation. It is exciting, threatening, exhilarating. It’s a mystery – you never know where you will be traveling to, or how you will get there. You hold on, you go with it, and you stick with your companion.

The psychotherapist has responsibilities towards their patient. The patient has independence but is in the other’s care, contained as they are within the embrace. This does not imply any heightened importance or significance for the psychotherapist over and above that of the patient, but only a responsibility regarding how they treat the patient - this, after all, is what the treatment is, it is precisely how you treat the person.

Both need to ensure they safely and correctly negotiate the space, and do so in a way that does no harm. They need to be aware of who is around in the patient's life, and what they are doing, keeping their eyes and ears peeled while remaining deeply connected to themselves and to the cosmos. Practitioners of tai chi or the traditional Japanese arts will be familiar with this requirement of outer alertness combined with deep connection. The issue of ‘what’ they can then do within this safe container, this sacred space, and the ‘how’ of it, can be left to their ability to respond and improvise - what the psychotherapist would refer to as free-association.  

All involved must listen intently, must be uncommonly sensitive and receptive during the dance of psychotherapy  And the psychotherapist must recognise that their partner in the dance is not passive, but is receptively active, is autonomous, and must always be put first, the flow of giving going in their direction. The psychotherapist must be ready and free to follow the patient’s process – the length of their step, the direction of it, the intensity and power in it. 

The patient is not in therapy to be told what to do - no matter how much they may long for someone to do exactly that.They are there to relate, actively. And in order to remain with them, the psychotherapist must follow, for this is the only way the psychotherapist can arrive where the patient is. You can only be with someone where they are. 

The patient may come to trust the interventions of the psychotherapist.  But this should not be at the cost of sacrificing their discernment or their place or in any way becoming subordinate to the actions and intentions of the psychotherapist. What they may come to trust is that the psychotherapist has their best interests at heart, that the psychotherapist is there for the patient, that the psychotherapist is serving them, and if that is so there is no reason to distrust. This is an essential ingredient of love: to constantly have the best interests of the other at heart. 

The pair may, and hopefully this will be th e case, inspire each other. No relationship can be satisfactory unless there is reciprocity. How could a mature psychotherapist be fulfilled if unaffected by their patients? How could a psychotherapist keep practicing if not being continually inspired and taught by their patients?

The learning and inspiration is available through the constant and instant interplay of expression and response, invitation and reply. A dance, a conversation, is started, regulated by what is possible in the moment, and always – like any good child’s game – holds the possibility of taking the pair to surprising, new, even frightening places where one is on the very edge of terror, or the very edge of beauty. When these impulses are followed, the conversation, the dance, is no longer a matter of conscious choice and decision, but is a flowing creative tumult of released energies and dynamics. And the analysis, the dance, truly begins to happen.

The patient is able to lean into the psychotherapist. It is this that makes the dance and intimacy possible. Remove the intimacy and you no longer have the dance. Psychotherapy and the relationship are one and the same thing. To be able to lean into the psychotherapist, and for that to be welcomed, this can help make the difficulties of life more bearable.

The steps are simple. They only become complex when the ego of the psychotherapist wants to make an impression with all their books and simulations of expertness. At its simplest it is about listening and caring. We learned to take a step by moving the axis of your body onto one foot and then onto the other. We learned this somewhere between one and two years of age, yet it cannot be surpassed as the way of walking. Yet from any one point, this simplicity offers almost unlimited possibilities – the next step could be anywhere. It is so simple, but its very simplicity is its richness for it provides the platform for movement.

The therapy room is the temporary galaxy that supports the pair and provides the space in which they can move. The psychotherapy has an almost cosmic quality to it – the participants move in a constantly deepening circle, tracking the path of what has gone before, everything revolving around some unknown but immutable centre, the pair moved by invisible forces and laws such as gravity, fidelity, responsibility, love. There is a trust in the therapy room that is humbling. 

To offer analysis from a neediness to be seen as wise or good, is not wise or good. Psychotherapy is provided for the benefit of the other. To seek positive judgement is anathema to it. To provide psychotherapy as a sort of choreography - a simulation of a set memorized theory - is also anathema to it. When the improvisation, the free-association, is put aside, it is no longer a craft. 

It is impossible to imagine what it is like to experience good depth psychotherapy if you have not experienced it yourself. At its best it is a sort of cosmic poetry, and each patient has their own language, unique to them in that moment, in that context, at that time, strung together in combinations of almost unlimited possibilities. The patient's language has its alphabet, like any other language, with its own grammar, and this must be mastered by the psychotherapist or all they will say in return will be  gibberish.

Often perople are brought into psychotherapy by life's challenges, but the deeper reason is a longing for intimacy, challenge, truth, meaning and fulfillment.  A person enters  the consulting room in the hope of being met. There is something solitary, brave, and quiet about this, this reaching out into the world for connection and intimacy. We search for each other, and for ourselves, in the consulting room. This is perhaps the most poignant thing of all, the thing that touches people the most. There are not many places in this world where you can feel you feel welcome to spend hours in someone else's embrace, be they a stranger or a familiar.

There is, and perhaps for the first time, a healthy connection available. Real connection. The sharing  of joy, frustration and grief, loneliness and disappointment, learning and failing, hope and humanity and creativity and love and gratitude. And all of this happens within the context of play, as psychotherapy is a simple yet extraordinarily sophisticated game that proffers on us the opportunity to learn as we learn best – through play. This does not imply any purposelessness or superficiality, for children’s games are vital and risky and endlessly formative. 

One can see that psychotherapy developed as a response to essential needs of people going unmet. And it has lasted for over one hundred years because these essential needs remain unmet in our society, now even more so. Our daily life offers less and less in terms of intimacy and fellowship, both inside and outside of the home. One cannot help but recognise the value of a craft that responds to basic human needs, that supports us in being human, in winning ourselves back.

This is  played out in a field of trust of another person, not gods or sages or myths, but trust in an other concrete, limited, fallible person. And this mutual fallibility means we can go into the places we need to go – into our self-consciousness, our stumbling clumsiness, our inability to communicate our desires or act on our choices, all of the things, as Ruskin would tell us, that make us human. And it is possible to learn from each experience, much more than it is possible to learn from the things we do well.  We are known best by our weaknesses. And these limitations force creativity out of us, for this is what limitation can do – force us to spontaneously create new possibilities and so new responses, to oneself, to the music, to the psychotherapist,  to one’s ordinary everyday life. Limitation can force us to improvise, and in the improvisation we are likely to catch a glimpse of ourselves. That is what is so beautiful about it. 

In this world relationships have become hugely complex. In the  consulting room they are pared back, simple: there is the psychotherapist and there is the patient  Their roles are clear. But the next point is crucial (yet rarely found): the practising psychotherapist must know what it is like to be in the other chair for, in my experience, at least two decades. How else can they know it? It is precisely this, the long lonely heart-breaking work the psychotherapist has done on themself, quietly and unseen, that makes the relationship between psychotherapist and patient so touching.