The Emerging Self in Psychotherapy with Adults

There are several individuals who helped me in the formulation, thinking through and the writing of this book. First, let me express my appreciation and love for the most supportive person in my life, my wife, Eileen, who offered, as she always has, astute feedback and encouragement at every step of the journey.

Colleagues who were of inestimable assistance included the late Dr Herb Goldberg, Dr Bruce Burnett and my long time friend and collaborator, Dr Bernie O’Brien, as well as Dr Esther Urdang and Dr Paul Kline.

The ideas in this book were germinating over the years and my primary place of employment, Boston College, provided the context in which they could develop. I especially want to acknowledge the Graduate School of Social Work and the Department of Counseling, Developmental and Educational Psychology.

I also want to acknowledge the following professional journals in which many of ideas in this book were originally published. These article provided a basis for some chapters, notably those on the biopsychosocial framework of the self, the importance of psychological intimacy in meaningful adult relationships, couples therapy and the significance of personal therapy to the professional self of a psychotherapist. The journals included Clinical Social Work, Sex Roles, The Psychotherapy Patient and Psychotherapy: Theory/Research/Practice/Training.

Individuals at Bentham who were most helpful were Sara Moqeet who guided me through the initial stages of the process of preparing a proposed book for publication and Bushra Siddiqui who offered valuable help in seeing the proposal become a book.

No matter the specific theoretical orientation and technical approach to psychotherapy, this book present a perspective that the self of a practitioner tempered by professional values is the primary resource for helping troubled people, especially those who suffer from a damaged sense of self. The empathic use of self is the centerpiece of the role of a psychotherapist. In this introduction to the book, the context of psychotherapeutic practice both in the past and today are discussed, since context is so important in shaping ideas. The prologue also lays out the my values about theory and practice, which have an equally powerful effect on my orientation and approach to the practice of psychotherapy.

This chapter presents a theoretical perspective on the self that is not only essential for understanding the sufferings of clients but also for reflecting upon our roles in the therapeutic process. In addition to psychological and social factors, neurobiological factors are integrated into the discussion. My intent is to offer readers a conceptual framework for thinking biopsychosocially about clients. The framework underscores empathic understanding as the basis for the choice of specific interventive modes and techniques, and the centrality of a therapeutic relationship as the vehicle through which a new sense of self may emerge for clients. Biographies of three well known individuals are used to illustrate concepts.

Theory is a resource for informing one’s practice. The concepts that are highly useful in understanding how a sense of self emerges over the lifespan are drawn from attachment, self psychological and object relations theories. These theories focus primarily on early development. The chapter also attends to the development in later childhood and adolescence and then introduces the emergence of the self in the adulthood. Beginning in this chapter, vignettes from psychotherapy with clients are used to tie concepts to practice.

The discussion of the centrality of psychological intimacy in meaningful adult relationships to the emergence of a sense of self in adulthood is based on our research into the meaning of psychological intimacy to 216 partners in 108 heterosexual and same sex relationships that had lasted for an average of 30 years. This study is also the basis of chapter 6 on therapy with couples. Factors that had a significant role in shaping the quality of psychological intimacy were the absence of major conflict, a confrontive conflict management style of one’s partner, a sense of fairness about the relationship and the expression of physical affection between partners. These qualities are invaluable resources for development of the self during the adult years.

Often, I have treated individuals who have had previous therapy, sometimes years of it with therapists of different orientations. As a result, there may have been rather specific behavioral changes yet the individual continues to experience feelings about themselves that are troublesome. This chapter focuses on such individuals and uses a case to show the beginning to ongoing process of psychotherapy.

The role of a psychotherapist is operationally defined by the techniques and skills that are employed in working with troubled individuals. Using a single subject design, this chapter focuses on my work with one client by presenting two transcripts of interviews one year apart. This individual suffered from a chronic sense of depletion in herself that resulted in feelings of depression and inadequacy. The empathically informed relationship along with psychotherapeutic skills of support, confrontation and psychoeducation are explored.

Conflict in meaningful relationships, especially those that last for many years, is inevitable. As therapists, we often encounter couples that are in stress and unhappy about their relationships, a particularly critical challenge in view of the importance of intimate relationships to the emerging sense of self in adulthood. This chapter uses the data from our study of adaptation among couples in lasting relationships to explore how partners cope with relational conflict as a result of interpersonal differences. Based on these findings, treatment implications for marital therapy are discussed.

Practice wisdom as well as anecdotal evidence supports the value of personal psychotherapy for clinical practitioners. Although a few surveys of clinical social workers, psychologists and psychiatrists have found that most therapists enter personal psychotherapy at some point in their careers, little research has focused on the potential meaning of personal therapy to the development of a professional self. This chapter is based on a study that used in-depth interviews to explore the significance of personal psychotherapy to the professional roles of experienced therapists and advanced graduate students.

One way of appreciating the adaptive potential of the emerging self is to examine the lives of individuals whose adult years have been characterized by generativity rather than stagnation (Erikson, 1963). These are human beings who experience significant adversities in their lives yet are able to move beyond these adversities in adulthood to make remarkable contributions to others and to society. In the following appendix, the lives of three individuals, who are discussed in chapter 1, are summarized. Each of them transcended various adversities - racism, trauma and poverty - to make important contributions to the world.

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