Review of Beyond Empathy, A Therapy of Contact-in-Relationship

Beyond Empathy contains 380 pages of text, references, and indexes. It has 13 chapters. It is divided largely into two sections: the first explains and illustrates the authors' theoretical system and the second demonstrates through verbatums of therapeutic encounter the various aspects of the approach they advocate. Chapter six divides these two sections with a heuristic for understanding how the authors see the dynamics of their theoretical system in operation.

In the preface to the volume, Erskine, Moursund, and Trautmann describe their approach as follows:

..."integrative" refers to our theory of therapeutic method, which integrates concepts and techniques from a wide range of approaches. We gratefully acknowledge and utilize the insights of client-centered therapy, transactional analysis, Gestalt therapy, and of contemporary psychoanalytic perspectives, particularly the intersubjective approaches and British object relations theory. Unlike an "eclectic" approach, we have attempted to build a therapy that is logically consistent, one in which each element or technique grows out of a basic and clearly defined set of concepts about the nature of human relationships. And we have reserved the right to pick and choose: to incorporate only those aspects of other theories and approaches that fit within a consistent and comprehensive theoretical framework and that have proven to be clinically useful. (p. x-xi)

Whether or not the authors have succeeded in avoiding eclecticism is a matter of opinion. What, for instance, is the organizing principle that guides their choice to include or to exclude any particular piece of the puzzle? What distinguishes eclecticism from true integration?

Four alternatives face individuals interested in crafting an integration: 1

Selecting (also known as eclecticism): Adding one whole thing onto others; a patchwork of concepts and practices (differences and similarities ignored). “I do a little this and a little of that.” “I practice object relations, but I chart cognitive behavioral.”
Translating: Identifying different words and expressions for identical concepts and practices. (Differences denied and similarities exaggerated) “That’s the same things as...” “When I do that, I call it...”
Linking: Matching bits and pieces of similar concepts and practices. (Combination of 1 & 2 above, on a micro level) “Your emphasis on making meaning out of experience fits with my belief that every client is an active constructor of his or her own reality.” “I use empty chair work to get people in touch with their unconscious solutions.”
Assimilating: Contemplating, breaking down, and incorporating concepts and techniques inherent to another perspective into the structure of one’s existing theory and practice. (Doing one’s own version of another thing, understanding differences as well as similarities) “In Gestalt therapy empathic attunement is accomplished with phenomenological tracking in the context of a dialogical relationship, but instead of attributing a feeling of someone to someone else, when I work, I like to check out my assumptions about the other’s experience.”

In Beyond Empathy it is not clear which approach to integration the authors actually follow. Does this invalidate their observations? No, but it does mean that the reader needs to be more sophisticated, to read with a critical mind engaged. If the authors have indeed created an entirely new psychotherapy, a logically coherent theory that is distinct from the various sources they cite, that is not self evident. If it is such a new therapy it is not evident how that is an improvement over the approaches from which they borrow. Regardless, the reader must decide, and thus the reader is cast into the same decision as the authors might have once found themselves. Which approach to integration will the reader perceive or even employ him or herself to mine the riches of this book? It is a basic question of orientation one would be wise to consider before getting too far into the pages of it.

Perhaps one organizing principle for their integrative therapy would be this statement: "Psychotherapy, as we view it, is a relationship that can be utilized to heal the cumulative trauma of previous ruptures in relationships. (p. 5) And perhaps the closest the authors come to identifying whole heartedly with the paradigm of Gestalt therapy is when they say

If symptoms are the result of patterns of fixed gestalten, then the remedy is to dissolve those fixed gestalten. If psychological disruption and emotional pain arise from lack of full external and internal contact, then restoring contact should cure the disruptions and ease the pain. All that the therapist needs to do is to help the client work through and integrate the old trauma, bring the split-off aspects of self back into awareness, and regain full internal and external contact...The client cannot do it alone, for it is based on the unfolding of awareness through relationship. (p.12)

Expanding on this the authors maintain that inquiry, attunement, and involvement constitute the essence of a successful therapeutic relationship. In fact, they devote individual chapters of their theoretical explanation to each of these three tenets. In doing so, they also reveal how influenced they are by standard psychoanalytic fomulations of defenses and the unconscious - that the self is hidden as opposed to expressed in the present. In some places the reformulation of standard Freudian structural organization is evident, as when they say

As people begin to reclaim lost aspects of themselves, in the nourishing environment of the therapeutic relationship, they inevitably recover thoughts, feelings, behaviors, and memories that are associated with previous developmental stages. These patterns of experience - what Eric Berne (1961) referred to as the "archaeopsychic" or "Child" state of the ego - manifest themselves as client regressions: the client is able to experience both self and others in the same way as he or she did at that earlier time. (p. 62-3)

Erskine, Moursund, and Trautmann suggest a remembrance of childhood and a corrective experience through relationship with the therapist, which is essentially an object relations paradigm.

Perhaps it is artistic license or the extent to which they have been influenced by psychoanalysis, but even these authors sometimes lapse into open use of interpretation, leaving behind a thorough-going phenomenological method.

The words demonstrate not only that the therapist is attending to the content of the story, but that he or she is also sensing why the story is important. "That really hurt" or "You needed someone to be there with you" supports and respects the client's experience and invites movement to a deeper level of awareness. (p74)

Maybe and maybe not. That is their clinical judgement, but it becomes the whispering voice of confusion regarding to which theoretical camp this book belongs.

The second major question is how to use the text. Should it be a text book in academic programs of psychotherapy? Sure. Should it be a text used in Gestalt therapy training programs? Yes. This book is digested, seasoned experience; it is insightful and articulate therapeutic wisdom. What the authors talk about is the essence of therapeutic work. There is much to like about this book, but it needs to be used with a corresponding pedagogic wisdom. Even nuggets must be shaped into settings for precious stones before they become valuable jewelry. The best use of this text is by another seasoned person, a teacher who understands how to craft critical thinking and fashion opportunities to experiment with the concepts and observations made by the authors.

That leads to the third question. Who will benefit from what they are reading? It takes someone who's been practicing for some time to recognize that what the authors are saying is true, and not only true, but also quintessential and fundamental. It's ironic that only those who already understand what the book has to say will appreciate what the book has to say. If students of psychotherapy read the book and are given an assignment to "learn" it, they will read without discernment, and they won't be able to recognize just how important some things are. In addition, Gestalt trainees may misunderstand how to distill those things that are germaine to Gestalt therapy as opposed to those which are a blending of Gestalt with something else.2

Having said all that, some sections of Beyond Empathy delightfully detail specifics that expand larger Gestalt therapy theoretical tenets, and other sections offer cogent statements of crucial therapeutic principles.

Consider the description of the rythms of treatment as depicted in the movement of therapeutic choice points:

Remember when we described contact as being like a beam of light, illuminating first one part of a dark room and then another? In just such a way, the therapeutic dialogue moves in different directions and in different patterns, depending upon the therapist's interests and beliefs, and, equally, upon the client's view of the world, understanding of the problem, willingness to risk, and intensity of affect. All of these shape the course of therapy. (p. 13)

Look at how sensitve the authors are to the therapeutic contract:

Working with the client, rather than working on the client, makes the client a partner in the therapeutic enterprise. Resistances and dead ends become problems to be solved jointly (Safran, et al., 1990) The client's sense of efficacy and control are enhanced, and with efficacy and control comes a greater sense of safety and willingness to risk (Basch, 1988). (p. 30)

Or, in referring to presence, see how they describe one of the aspects of involvement:

It uses all the information gained through inquiry, and all the sensitivity of attunement, to maintain a genuine, caring, and responsible relationship within which the client can find the support he or she needs in order to grow and change...It is a balancing act, this business of contact. It is more than back and forth, more than just the shuttle. Each aspect feeds, informs, and enhances the other. My awareness of the client evokes a response in me that is flavored and deepened by my awareness of my own internal process. Each potentiates the other, and together they create a climate that invites relationship. (p.99)

In some places the authors reshape standard Gestalt tenets, as in the following case with regard to the paradoxical theory of change:

The therapeutic relationship captures in microcosm the paradox of all human relationships: one must have contact with others in order to become fully oneself, but that self is inevitably changed through the very contact that allows it to survive. (p.103)

Or, in the following case with regard to the dialogical relationship in the service of therapy:

Technical expertise without caring and vulnerability would be sterile and unproductive; caring and vulnerability without therapeutic competence would be self-indulgent and unethical. Together, each informs and guides the other; the combination is the essence of the therapeutic relationship. (p. 104)

There are at least two sections of this book which are delightful and pleasingly practical. One expands upon the phenomenological method by offering an "inquiry menu." It is a way of focusing on the internal experience of the client, and in Beyond Empathy Erskine, Moursund, and Trautmann contribute a detailed and specific list of examples for therapists who wish to develop this aspect of their practice. They fine tune the tracking of another's individual experience, offering a great progression and subtle distinction among their various categories. For instance they distinguish between physical sensations and physical reactions, they consider emotions, and they finesse the differences among memories, thoughts, conclusions and decisions, meanings, expectations, hopes, and fantasies.

In another practical section, they clarify distinctions among kinds of attunement. For instance, in characterizing cognitive attunement, they state:

Cognitive attunement is more than simply attending to content. It is not the same as "understanding the client's cognition," because it goes beyond simple understanding. It involves attending to the client's logic, to the process of stringing ideas together, to the kinds of reasoning that the client uses in order to create meaning out of raw experience. It is about what the client is thinking, but more importantly, it is about how the client is thinking it. As we attune to the client's cognition, we enter the client's cognitive space, moving into a kind of resonance with the client and using our own thoughts and responses as a sounding board to amplify the tiny cues that the client is giving. We bring the client's words and nonverbal expressions into ourselves; take on their meanings , implications, and connections; and experience this way of thinking ourselves in a kind of internal "as if." (p.54)

And in characterizing affective attunement, they state:

Affect is more than just emotinal fizzing and erupting. It is a form of communication, a way for a client to tell the therpaist about things that cannot be formulated in words...In order to be affectively attuned, the therpaist must hear what the client's emotion is communicating. All of the facets of affect are important: the feelings themselves, the meanings they have for the client, and the message (request, need, or even rebuke) they have for the therapist. (p. 58)

The entire section on facets of attunement convers cognitive, affective, rythmic, and developmental aspects. It is rich.

The second section of the book is comprised of a series of transcript chapters. They illustrate how the authors' "keyhole" heuristic models a therapeutic process of inquiry, attunement, and involvement operating at the various levels of contact interruption, "inviting the client to heal the distortions and restore contact with self, with therapist, and with others in his or her life." (p. 177) There are six such chapters demonstrating a variety of clients and situations.

For those who are familiar with the work of the authors, this book will be a welcome addition. For those who wish to increase their appreciation of the craft of psychotherapy, a process that is both a bit of science and a bit artistic creativity, this book will expand and inspire. For those who wish to augment their Gestalt training with freshly stated descriptions of therapeutic process, and who can assimilate into a Gestalt framework what they acquire from Beyond Empathy, the book will prove a treasure they can mine extensively.