Reciprocity

Psychotherapy is a hybrid exchange with a point and purpose, ordinarily about functional matters of relationship and morality, relationship fractures, breaches of morality, parenting, intimacy, love, trauma, etc., now, in the past, maybe into the future. Whilst the specific subject matter of each modality may vary, the exchange itself is most definitely carried by reciprocity and compassion, moderated by ideas about inclusion and exclusion. Each modality has its own idea and theory about who is to be included in this therapeutic dialogue, and who is excluded.  

Reciprocity is the give and take between the people engaged in a significant exchange with each other, in this therapeutic dialogue. This reciprocal exchange, this give and take, includes some people, and excludes most. It is circular and recursive, each side of the dialogue informing the other, acting as a catalyst for the others response, about the functional matters of importance in the life of one side of this exchange.  

The therapeutic dialogue peddles compassion and empathy, as a primary virtue of the dialogue itself, the absence of which contradicts the point and purpose of that therapeutic dialogue. The therapeutic relationship is intended to be a deeply compassionate and empathic exchange between the practitioner and the client(s), carrying sufficient reciprocal characteristics to enable those functional matters of significance to be practically transacted. In other words, the therapeutic process peddles compassion, and a limited form of reciprocity, as its stock in trade. Each modality peddles compassion as its central virtue. Each modality has a different take on reciprocity premised upon its own definition of its point and purpose. Each modality exploits compassion and empathy in a substantially similar way, to achieve each modality’s idiosyncratic definition of what those reciprocal ends actually look like. That may well be where the different modalities part company with each other. Some modalities privilege compassion and empathy as the pathway to change, often linking that to other virtues such as hope.   

The task of the practitioner here, is to exercise significant command over themselves and their interactions with the client(s) and others. Why? Because they are peddling private compassion and empathy for public purpose.  This means the practitioner must manage their use of compassion and empathy in the exchange with the client(s) and others, and moderate this to achieve particular defined and reciprocal ends. Compassion and empathy are a given in the therapeutic process. Reciprocity is a negotiated part of that process. Different modalities negotiate reciprocity differently. Some modalities assume that therapeutic reciprocity is implicit in the problem. Others locate the definition of therapeutic reciprocity in the contract for therapy itself.     

The peddling of private compassion and empathy, for broader public purpose, carries with it an inherent risk, well-articulated by every modality from psychoanalysis to the present day; in the definitions of resistance, transference and countertransference, deeply interlinked concepts. The truth is – if compassion and empathy are to be exploited in this way by the practitioner, then that practitioner is going to feel and think things with, for and about the client(s) and others, that inform the reciprocal point and purpose of the therapeutic dialogue itself. These feelings and thoughts are not disembodied, they are not located somewhere else, they are located inside the physical body, specifically the neurobiology, of the practitioner. 

The therapeutic relationship is collective and cognitive. The therapeutic process is a process of embodied cognition; a big, collective, physical, visceral, and continuous think. To this end, the practitioner must manage themselves, and their own emotional, physical, and cognitive responses to the client(s), to ensure they maintain maximum flexibility and dexterity in the therapeutic process. Inflexibility is cognitive death to any therapeutic process. A core skill in any therapeutic process is interactional flexibility.  

Any process of interaction, in any moment, is either symmetrical or complementary. This is in the nature of living systems. They are inclusive and exclusive; they are organized, constrained, patterned, and deeply predictable. Resistance is the emotional, physical, and cognitive experience of the practitioner about the client(s) in relationship to the contract for therapy, the specific, reciprocal, basis of the therapeutic relationship and exchange itself. 

Therapists expect gratitude or at least some respect. When their best efforts are met with indifference, scepticism and even hostility by the client, the therapist’s response is not always rational. These are breaches in the reciprocal and compassionate basis of the therapeutic exchange, in the moral basis of the exchange. In entering the therapeutic relationship, the practitioner agrees to invest their compassion and empathy in the client(s), in order to deal with a particular symptom or problem. In return, the practitioner expects the client(s) to honour the agreement and to participate wholeheartedly, openly, without excessive constraint, in order to get the job done. Most modalities have the idea that the basis of the symptom or problem may be in such excessive emotional constraint. So, in reality, practitioners in this field expect the client(s) to participate wholeheartedly, without consciously imposed constraint. Such conscious constraint may suggest dishonesty to the practitioner, that the practitioner’s goodwill, their compassion, and empathy, invested willingly in this process, are being gratuitously exploited or obstructed, way beyond what is reasonably implied in that contract for therapy. Practitioner’s ordinarily expect some recognition for their efforts, maybe some gratitude, or at least some respect. They certainly do not expect their best efforts to be met with indifference, scepticism, or hostility. The practitioner’s response reflects the fundamental nature of the breach; a breach in the contractual and moral basis of the therapeutic exchange itself. Practitioner’s need to change this. There is a confusion in the professional discourse about this matter. My view is that the practitioner should not expect gratitude or anything emotionally positive in the exchange with the client(s). I am old fashioned in this regard.  

My view is the therapeutic exchange should be absolutely clear what it does not include on the downside (e.g. disrespect, hostility, violence, threats, a physical exchange, sexual egress, criminal behaviour, money beyond the fee for service, etc.), and that exchange should need to be not be clear about what it includes, or does not include, on the upside. Some modalities believe in gratitude and others do not.  

I am with Edgar Levenson on this question, when he says [The Fallacy of Understanding (1972)] “… therapeutic leverage does not lie in the patient correcting his feedback or having a new experience with the therapist … neither insight, clarification nor novel experience will make any difference. All these are grist for the transformational mill. It is, paradoxically … the therapist pointing out the failure of these attempts to matter that makes the difference …the function of the therapist is through awareness to resist a transformation. Like a continuous discordant note, he (sic) shifts the melody. What emerges is still the patient’s private myth… but a myth shifted to account for new data, much as the ancients revised their myths and extended them as the astral precession shifted. The therapist does not, as in the machine paradigm, act as the ‘servant of a process’… Nor is he midwife at a delivery. Rather, he acts from within the structure of the patient’s transactional field – as it were, by being unassimilated. The patient can reject the therapy … or he can encapsulate it … or he can meet the new experience by changing. Successful therapy may not be so much a consequence of what the therapist does as it is of what he does not permit to happen, in the Zen sense of non-action (not in-action).”  

The practitioner must be ever on the alert for breaches in the moral basis of the exchange, reciprocity and compassion, stand firm on this ground, and ensure the therapeutic process does not come to include characteristics that undermine its space and time limited point and purpose. The idea of stillness, in the emotional and behavioural sense, has significant merit. The idea that the practitioner’s stillness requires of the client(s) a response – symmetrical, matching, stillness will become disengagement, which will probably be the end of the therapeutic process; or complementary, different, not matching, a form of accommodation to the practitioner’s well practiced stillness, producing a different interaction with the practitioner, and such interaction is cognitive. In my view, the practitioner must not move off the still position, except when the therapeutic exchange itself moves off its moral ground – when reciprocity and compassion are compromised, when the contract for therapy is altered and/or empathy is compromised.