Being a Therapist

Being-a-Therapist-2-Christian-Jonathan-Haverkampf

Haverkampf, C. J. (2020). Being a Therapist. In C. J. Haverkampf (Ed.), Psychotherapy Vol V (pp. 200–220). Dublin: Psychiatry Psychotherapy Communication Publishing Ltd.

Being a Therapist

Christian Jonathan Haverkampf, M.D.

Psychotherapy goes beyond skills and theory. A therapist truly needs to be a therapist, irrespective of a particular school of thought. Important traits are an inquisitive mind, the ability to listen and a talent to work with communication, the fundamental tool in therapy.

Keywords: therapist, psychotherapy, psychotherapeutic technique, psychiatry

Table of Contents

Introduction. 4

Support. 4

Thinking. 4

Openness. 5

Awareness and Reflection: CFT. 5

Communication. 5

Making Sense. 7

The Coherent Sense of Self 8

Guided Self-Help. 9

The Search for Meaning. 9

The Therapeutic Relationship. 10

Observation. 11

Empathy and Interest. 12

Reason. 12

Values, Interests and Aspirations. 13

Self-Connectedness. 14

Time. 15

Questions. 15

Meaningful Communication. 16

Everyday Information. 16

Types of Intervention. 17

Questioning. 17

Assembling. 18

The Logic Test. 18

Imagining. 18

Bridging Imagination and Shared World. 19

Creating new communication patterns. 19

Keeping the Interaction Alive. 20

Conclusion. 20

References. 22

Introduction

Psychotherapists need to become experts at communication, from picking up little hints between the lines to making a brief comment that can bring about change. Therapy is both a science and an art, which is not mutually exclusive. Therapy is very practical in that it aims at helping people in their everyday life. On the other hand, there is also a lot of theory underpinning psychotherapy, which can be expressed in many different forms, but overall can also be integrated into an overall image at the end of the day. One reason is that communication, both internal and external, underlies every psychotherapy. Communication as the tool in psychotherapy which gets the job done is a process with rules and processes. Remembering that internal and external communication are to a large extent reflections of each other (Haverkampf, 2010a), therapy is working with one to effect a change in the other.

Support

Communication is a very important part of being a therapist. It is not only about helping people to communicating better, but a therapist also helps a patient contain thoughts and emotions in a way that they can make sense. A therapist provides support when the world does not seem to make sense anymore. When a patient comes to therapy who is suffering from particular symptoms, something in the world is not working anymore.  It is easy to overlook that a therapist as a first intervention should provide support. This does not mean taking over the patient’s responsibility and autonomy, but to provide the support that can instil hope and optimism. Being a therapist is an act of love. Unfortunately, in daily work this can often become forgotten, but without it, therapy is altogether ineffective over the long term.

Thinking

Rational thinking is an important instrument that can be used to feel better. Both, a thought and a feeling are made up of information, and while they are usually seen to have a different effect, they can both be used for similar ends. Both are also the result of the integration of many bits of information. If the focus is only on one of them, information that has gone into the other one is lost.

Openness

Many mental health conditions arise because of what we think we have to achieve, because we think there are no alternative options or because we think we have failed. If one’s thoughts can make one feel worse, it also makes sense to look to one’s thoughts to make oneself feel better. However, the goal is not to engage in endless loops of thinking about unanswerable questions but to engage with one’s thoughts by asking whether they make sense or not. The role of the therapist often is to show the patient that there is much available outside the range of options and actions in the world the patient may see.

Awareness and Reflection: CFT

Key attitudes and approaches include empathy sensitivity, observation, awareness, reflection, and communication. Without communication nothing can get done in therapy. The author has developed communication-focused therapy (CFT) out of the need for an approach which addresses more directly the processes which underlie most psychotherapeutic approaches. (Haverkampf, 2017a) It tries to address some of the shortcomings of cognitive behavioural therapy (CBT) and psychodynamic therapy, as well as those of other therapeutic approaches. However, rather than being integrationist, CFT focuses on processes at the heart of some other psychotherapies which probably make them work. The fundamental insight in CFT is that it is not the focus on content, the use of particular cognitive or behavioural techniques, or even particular relationship characteristics that ultimately delivers results, but the communication processes between therapist and patient. While the latter can be facilitated by focusing on these factors or others, an understanding of the communication processes in themselves brings about the hope for greater efficacy of psychotherapy.

Communication

Communication is the foundation of any change processes in life, including psychotherapy. (Haverkampf, 2017a) Meaningful messages contain the information which brings about change in the recipient of a message, and quite often also in the sender of the message. In a therapeutic setting, change happens because two people are communicating with each other, which triggers communication on the inside. Therapy is thus a finely tuned process because information to leads to change, when it resonates with information that is already present in the recipient. The work of a therapist is to facilitate the dynamics which lead to therapeutic success. His or her tools are the skills in observing and working with communication.

Communication-Focused Therapy has been developed by the author to focus on this fundamental process and developed applications for several mental health conditions, including depression (Haverkampf, 2017c), anxiety (Haverkampf, 2017b), social anxiety (Haverkampf, 2017f), OCD (Haverkampf, 2017d), psychosis (Haverkampf, 2017e), eating disorder, ADHD, and several others. Some of the techniques may not be new, but how they are integrated is to the author’s knowledge novel. In many psychotherapeutic approaches, a special angle on communication, such as a communication pattern or some specific content is used. Communication-Focused Therapy attempts to identify the wider parameters and underlying laws of how communication pattens work and are effective in therapy (Haverkampf, 2018b, 2019c).

Communication between animals and humans has been described as therapeutic. (Corson & Corson, 1980) While communication is often viewed as a means of generating meaning or interpreting meaning in psychotherapeutic settings, it may play a more direct role in the therapeutic process. One function lies in the mutual regulation of two communicating partners. (Scheflen, 1963). Lennard and Bernstein discussed in the early 1960s how the concepts of the discipline of sociology apply to an analysis of psychotherapeutic process. They considered therapy as a system of action, as an informal exchange system, as a system of role expectations, and considered the interrelations between communication and expectations for the therapist-patient duo. (Lennard & Bernstein, 1960) These discussions, however, risk to see communication as a means to an adjunctive end, rather than seeing communication as the process which brings about change by itself.

Communication is the tool which brings about change, which is not only restricted to verbal channels. Electronic communication (Castelnuovo, Gaggioli, Mantovani, & Riva, 2003), for example, is increasingly seen as means of change, while there has been academic interest in nonverbal communication (Weitz, 1974) for quite some time. It is important to understand communication in a much larger context, as a process that helps organisms to retrieve about important information about their environment and themselves, which helps them not only to adapt to the environment, but also to succeed in getting their values, needs and aspirations met, and to prosper and attain greater happiness as a result of it.

The work of the therapist is to help a patient notice and reflect on these communication patterns so as to gain greater insight into them together with the patient. While communication has been used to describe the therapeutic relationship (Kiesler, 1979), communication is actually the bundle of processes describing the exchange of meaningful information, which leads to change, not only in the patient but also in the therapist, who is then in a better position to help the next patient.

Our physical nature is built on communication, and the exchange of information is what helps us to make change in the world. Even in the worst grief, it is communication which connects us with the universe, the flows of information, which contain what we feel we have lost. When a patient suffers from psychosis, not being able to distinguish which information comes from the outside and which from the inside, as one hears one’s own thoughts as an external voice, looking at information dynamics can help one understand the underlying mechanisms.

Making Sense

Within the space of therapy, a wider world is taking shape as more within it becomes meaningful. Therapy broadens horizons, both in the external and the internal world. Therapy is about widening the world through This does not just mean using logic but seeing one’s thoughts within the context of one’s values and aspirations on one side, and one’s experiences and interactions with other people on the other side. Thoughts are more likely to be actioned on and used for further thinking processes if their objectives and purpose falls within the space of the individual’s values. Many people may have a sense of what they value in life, but to identify it, is often not that easy. The therapist can help through the therapeutic interaction and observing with the patient the communication patterns that emerge. More global communication structures, such as transference as used in This ultimately leads to stable and persistent happiness and mental well-being.

As an example, if one of my values is to provide a safe environment for my family, thinking about how to make more money can lead to greater happiness (and less stress), if I am aware that I am thinking about earning money to be able to buy a house that can offer my family a greater sense of security. If I see money as an end in itself, on the other hand, it can lead to an obsession, which may become endless, because I lose sight of when I have reached my goal.

In other words, life becomes easier once we see our actions and interactions with other people as something that ultimately makes sense for us. One does not need to have a specific outcome in mind. A feeling of significance to oneself is already a good starting point. Many people lack even this general feeling in most of their daily lives, which can lead to emotional disengagement, burnout, depression anxiety, panic attacks, heightened OCD, and so forth. Therapy has to bring ‘sense’ and meaning into the equation again.

The Coherent Sense of Self

In order for the world to make sense, one needs to make sense oneself. Individuals look for messages or information that they hope gives them a sense of ‘wholeness’. Often, when people come into therapy, they feel something is broken in their lives, that there is something that is somehow fragmented and does not makes sense. They feel that if they can overcome an invisible barrier, that they will accomplish things in their life, which they otherwise cannot. Coherence plays an important part in mental health, as it does in burnout, anxiety and many other conditions where people suffer because tasks, work, relationship or life in general no longer makes sense, where the connection between them and what they do becomes missing. As a therapist it is important to have an eye on it and identify when a patient experiences a lack of coherence. Rather than seeing what is not fitting in, patients often feel they no longer fit in.  To restore a sense of coherence is often a very helpful milestone in therapy. Communication-Focused Therapy would look at it from the perspective of improved communication and better connectedness with oneself and others.

A greater feeling of coherence through improved communication needs to be experienced in the interactions with oneself and with others. It closely aligned with the need for self-actualization and the quest for the happiness which is brought by fulfilling one’s true needs, values and aspirations. What binds everything together is meaningful information, and it takes a living organism, internally and externally communicating systems, to make it meaningful. As life requires communication, a greater fulfilment and sense of coherence in life requires better communication, internally and externally.

Guided Self-Help

Much of what can happen in therapy depends on the expectations of the patient. It determines how much he or she will participate in therapy and contribute to the process in general. This makes it worthwhile to point out early to the basic working in principle in therapy, that the therapist can help patients help themselves, but should under normal circumstances not tell them what to do.

A therapist encourages patients to help themselves and to learn where to look for the information they need. The method of finding information is what is important to lead to lasting changes. So, the therapist’s main work is to help the patient to acquire information and communication patterns which help the patient absorb and process information which is more meaningful and helpful in the individual situation. This opens a world to the patient, which he or she can determine by themselves based on their own basic parameters, the values, needs and interests (Haverkampf, 2018d).

The Search for Meaning

Therapy is about meaning, helping a patient find relevance in things, which also asks patients to look at their fundamental values and basic interests. Following one’s values and basic interests leads to happiness and not knowing them to such conditions as anxiety and burnout. Many people in today’s busy and increasingly complex world lose their ability to see relevance in the world and in what they do. Helping people to reconnect the world as they perceive it with what they value is an important aspect of therapy. It requires the ability to communicate with oneself and between the inside and outside worlds.

Little things in the everyday world can acquire meaning if we let them. A change in communication and how information is processed in therapy can also help to see more meaning in these little everyday things. That also makes one’s life fuller overall. Therapy can thus contribute to a better life because patients can see more meaning in it. From a therapist, it requires openness, but also the ability to listen to the patient, not just what he or she is saying word for word, but below and beyond it. Understanding, however, has many facets, and empathy is one part of it. Various schools of therapy focus on different sources and kinds of information, some more on content, others more on bodily expressions, and yet others on cognitive thinking. The problem is that one-dimensional communication is not helpful in the delicate process of understanding. This is why a therapist needs to be attentive to details of whatever kind.

The Therapeutic Relationship

Therapy is an exchange of information, which ultimately should help the patient to lead a happier and more fulfilling life, as well as be free from any symptoms that interfere with these goals. The motivation for it should come for a need for the feedback and meaningful information that is provided in the therapeutic setting. The therapeutic relationship provides the channels that make therapeutic communication possible. But in order to accomplish this, the therapist needs to provide the patient with a unique environment, one that goes beyond a specific process advocated by a particular school of therapy.  Common factors such as empathy, warmth, and the therapeutic relationship have been shown to correlate more highly with client outcome than specialized treatment interventions. (Lambert & Barley, 2001) From a communication focused perspective this makes sense because many newer psychotherapeutic approaches focus on pre-defined processes rather than on the process of communication itself which underlies any changes that can happen in therapy.

The client-therapist relationship has been operationally defined as the feelings and attitudes that therapist and client have toward one another and how these are expressed. (Norcross, 2010). From a communication-focused perspective one needs to add the past and the future. It exists because it has a past with a series of interactions and because it has a future with the expectation, or at least the hope, that these interactions will continue into the future and bring about a change that benefits the patient. But this also means that the therapist can provide some emotional and cognitive holding, a stability which the patient may be missing in her life, as well as the human feedback which is so central to therapy. Holding, however, does not mean providing just somewhere to hold on to, even though that can be crucial particularly in the beginning of therapy, but a stability, help and guidance, that springs from the unique experience, training, reflection and knowledge of the therapist, which also means that a therapist should be well trained, have the ability and interest in reflecting, be knowledgeable, and have a deep interested in people and communication and a desire to help. And what about a therapist who is just setting out? As long as there is interest, inquisitiveness, a willingness to focus on detail, and no shame in learning and asking questions, together with genuine empathy, the particular school of therapy seems to matter little (Haverkampf, 2019a).

The person of the therapist matters, since personality is what is being communicated with the outside world, what shines through regardless of content. Does this mean some therapists make a better match with patients of a certain personality type? While there can be some benefit, particularly in the beginning, if the therapist has some personality attributes given a specific patient, this should wane as the therapy progresses. Then, other aspects become more relevant, such as the ability to pick up on communication and develop together with the patient an understanding for the communication dynamics also between patient and therapist.

Observation

The therapist should be able to see how patients deal with information and interact with themselves and the world around them. Better communication with oneself and others can lead to the patient feeling safer, developing greater abilities of introspection and reflection and facilitating a healthier communication with oneself and the environment. All this requires that the therapist has an understanding of the dynamics of interactions in general and of the interactions of the patient in specific, the mutual flow of information and the values, aspirations and interests everyone holds. It has been shown that personality similarity between client and therapist can strengthen the bond between them, which was associated with outcomes through its association with tasks and goals (Taber, Leibert, & Agaskar, 2011). However, since personality is the sum of communication patterns, it is not necessarily that the personality has to be similar, but that the therapist understands how to use communication and has the skills and self-reflection to pick up on communication cues and patterns the patient uses.

To observe, the therapist needs to adopt the mind of a learner, which requires openness, reflection and remembering little bits and pieces and details. This requires certain patterns of dealing with information. An important step in therapy is that the patient acquires patterns that also support and promote learning, which may be one of the central objectives of therapy. Patterns of information processing and communication organise evolving processes (Haverkampf, 2019d). A question is such a basic communication patten, and it is quite a powerful one (Haverkampf, 2017h).

Empathy and Interest

Therapeutic work requires empathy and an honest and true interest in the patient and his or her inner worlds. Fears may again stand in the way, such as the fear that one cannot contain and promote the unfolding dynamic and may not be able to help the patient. To counter this fear, the best tool is within the therapist. The better connected the therapist is with the own needs, values and aspirations, the basic parameters, the easier it is to help someone else connect with himself or herself. The therapist should have an interest for the own inner worlds and how they can benefit in the interaction with the patient. In psychoanalysis, the concepts of transference and counter-transference mirror some of the processes that take place within this space but is important to note that the information flows taking place are much wider.

The work of a therapist is to help a patient explore and find help in the own resources within (Haverkampf, 2019b). Learning communication patterns that help the patient explore what he or she values, needs, and aspires to is an important part of this process. For the patient, practicing empathy and awareness for the subtleties of communication can be fine-tuned in working with a therapist who has experience working with communication patterns and structures. The therapist participates in and observes communication patterns and works through them with the patient. This does not mean one has to practice communication like a role model, but it means to help patients towards greater awareness of their communication.

Reason

Mostly therapy is about helping the patient with questions and comments on a uniquely individual path to find new perspectives, open up to new information and process information in new ways. The epiphanies should take place in the patient, while the therapist can create the setting in which they take place. The motivation, ownership and integration into the own person that takes place in them is important for the success of therapy.

It is important for a therapist to often ask question and look at the own patterns of reasoning and thinking and communication (Haverkampf, 2018c). When it comes to self-awareness, the process is at least as important as any content. Observing and living the information dynamics in a session helps the patient (and the therapist) experience connectedness with the world, feeling oneself in the world and the world in oneself. This connectedness with everything and the connectedness of everything with oneself is an important realisation with the therapeutic process. In its essence, therapy becomes limitless. The therapist’s ability to observe as rational thoughts as a form of communication is central to an understanding of the power of thinking and forming a thought. In communication with the patient, in the exchange of two independently thinking minds, insights can be gained into the specific and into the general which either person on their own would not have had. Therapy therefore has an element specific to the patient and therapist themselves, while also reflecting on life more generally.

As disconnectedness from oneself and isolation from others is a frequent manifestation and also cause of many mental health afflictions (Haverkampf, 2010b), applying the practice of communication in therapy to the fabric of one’s interconnectedness with oneself and the world can lead to greater insight into what makes one tick, which then also helps to make it easier to communicate with others. Rational thinking is here an important help in breaking through isolation, as new strategies can reverse it. Thinking can thus be an important instrument in changing feeling states. The therapist needs to be inquisitive and interested in the thought patterns a patient uses and receptive to the emotional cues the patient is sending, both at the same time rather than focusing on one to the expense of the other.

Values, Interests and Aspirations

The psychodynamic process helps to navigate through the more superficial and derived values to help the patient rediscover the fundamental values a patient holds. Here are the things which are of primary importance to the individual, and of which the pursuit makes life happier and much more worthwhile. To compromise these values when making iteral compromises will lead to situations which often cause great suffering and a loss of direction in life. Values, needs and aspirations have been termed the basic parameters by the author (Haverkampf, 2018d), because they change little over time and help steer life in a direction that leads to greater well- being in the long-run. The therapist helps the patient in this discovery process to be more inquisitive and adopt communication patterns that support insight into them.

Often, when people come into psychotherapy, they may feel that something is not working for them anymore, but they may also be afraid to pinpoint what it is. Especially here, it is important to reduce any fears or anxiety that one has to change one’s life by pointing out that therapy is not about changing the person, but to make things work better for them by adopting new ways and strategies. Often, these new ways and strategies will revolve around communication, since this is very fundamental in getting one’s needs met. The therapist may have an idea where the journey is going, but she cannot be certain of it. Important is to be open and welcoming, even if an idea the patient is playing with may not seem to lead anywhere. The freedom of the mind is something that needs to be rediscovered and reexplored repeatedly in life (Haverkampf, 2017g).

Self-Connectedness

The information to be gained from inside one’s body can be tremendous if one is willing to listen to it. We produce a lot of information in our body, which, though it requires the environment to interact with, is in many ways a very complicated self-contained system. The parallel information processing power of the nervous system and the networks of cells of the rest of the body, connected by chemical and electric pathways, is very large. Even information coming in from the outside world has to pass through cellular networks to reach higher brain centres.

Self-connectedness means being aware that the information reaching the brain is made up of information that is largely influenced by the information processed in our bodies. It requires becoming aware of the shear infinity of information sources our brain is processing, and not just the sentence one may see on a computer screen at work. This awareness is important to deal with anxiety, OCD, burnout, depression, psychosis and a host of other conditions. It does not mean one has to process all this information consciously, just that the processes are stable, while the sources and the information may change. Our values as a result of these processes change little, while our experiences on the summer vacation may be vastly different from year to year.

Self-connectedness can happen through many channels, both internal and external. Greater awareness for a sensation, a perception, a thought and a feeling leads to better connectedness and greater insight into what is meaningful. This is then an important starting point in accomplishing real change. One task of the therapist is to be aware of the many ways in which a patient can be helped to better self-connect. This can encompass a large range from verbal questions (Haverkampf, 2017h) to body focused work (Haverkampf, 2018a). The specific approach is often less important than what it is supposed to accomplish, which is to facilitate and deepen communication which has become more difficult for the patient.

Time

For many therapists, time is a complex concept. There is the time line used by a patient when he is narrating an event, but there is also the time frame of the session, and how the therapist organises her own time. There are moments when there seems to little of it, when, for example, a patient strikes on a very relevant topic as the session is about to end, which often happens, or too much of it when a patient engages in seemingly irrelevant empty talk. While even something which is apparently empty can say a lot about a patient’s state and communication patterns, it can still be very tiring for the therapist if she wants to give the patient the latitude to find out what is happening.

To many patients, time has become convoluted. They do not know what to do with their past, are afraid to think about their feature, and are caught between past and present which deprives them of the present. Making sense of the relationship between the present, the past and the future establishes the bridges that can anchor them in the present moment. Awareness, feelings, feedback and communication are important factors in this process.

Thinking about values and interests helps to rebuild a future, but this might confront the patient with ‘bad decisions’ in the past. The best way to deal with this is through acceptance and integration. This means the past has to be accepted and to a certain extent embraced, which is an important process in therapy.

Questions

One of the most important communication tools one has in psychotherapy is to ask questions. In Socratic questioning the question can lead to insights for both, the patient and the therapist. But it is important to realise that this type of questioning, and the individual questions used, are just one form of using communication. Important is not that a patient learns a new technique, but that he or she learns to create, modify and abandon communication patterns as they fit and improve the individual quality of life. One of the lasting breakthroughs of classical psychoanalysis was free association, which derives from the presumption that giving a patient the space and freedom they may not have otherwise to create new communication patterns and to link up information in novel ways is part of the healing process.

A therapist needs to be able to help the patient ask the right questions that lead to greater awareness, insight and connectedness and a better grasp of the patient’s values, interests and aspirations. Helpful is if the therapist thinks ahead to gauge possible answers, while still being open to anything different that may come up. Often, this crystal ball gazing is something that comes with experiences, but the therapist’s own life experience, reflection and self-connectedness can help provide a very useful ‘gut instinct’.

Meaningful Communication

One needs to have faith that the interaction between therapist and patient will reveal the information that provides the course in treatment. And this will always happen if there is meaningful communication, which means that something new is communicated every time information travels between the two partners in the interaction. Information can be little gestures or a twitch on the forehand which signal emotions or thought processes, words that can be understood by the other person and in general every signal that can be sent and received by therapist and patient. This requirement is easy to satisfy, if there is openness to engage with the other. It can easily be seen in this context that as therapist is someone who engages with the patient, but in a way that neither takes away the patient’s autonomy nor reduces the therapist to an invisible presence in the background, for in the communication between therapist and patient insight can be gained into the everyday communication patterns of the patient (as well as into those of the therapist).

One important objective of therapy is to make meaningful communication work better for the patient. It is after all through meaningful communication that the patient is able to meet needs and can attain aspirations.

Everyday Information

Information that can be used in everyday life can be very helpful for the patient. To improve ways to find this information is an important part of therapy. Many patients have problems in life because they are using strategies that no longer work or operate from information that is no longer helpful. Change does not necessarily require that one knows here one is headed, but it necessitates enough information that one can at least have the hope that there will ne something better in the future.

Too often, it is forgotten that there is an everyday life, and the therapist needs to be herself grounded enough in the ‘real world’ to be helpful for the patient. It can be helpful in this vain if the patient explains how the world looks from his perspective and what it is like being him in normal everyday life as well as in special situations.

Types of Intervention

An intervention should create greater awareness, insight and connectedness in the patient. A few examples follow. The author is going into much more depth when working with communication patterns elsewhere (Haverkampf, 2018b, 2019e). Important are again openness, empathy and a deep interest in the unfolding dynamics between therapist and patient. The intervention reflects on the unfolding communication patterns. It is often not focused on content, but on the communication patterns a patient uses. The intervention is in turn another communication pattern. Two examples of communication patterns a therapist may use in certain situation would be questioning and assembling. Questioning is futher elaborated elsewhere (Haverkampf, 2017h).

Questioning

“I want to be in control in social situations.”

“What does it mean to be in control in social situations?”

“I would feel free, I would not think anymore so much, I would not analyse so much what other people think.”

Questions are really the key tool in any therapeutic work. Although most patients are looking for answers, it is important for the therapist to resist the urge to give quick answers. The best answers come from the patient, because no one has as much information about the patient as the patient herself. Over time, the questions should pursue an objective, namely, to help the patient to acquire the skills to see more meaning in himself and the world.

Assembling

The information from the patient needs to be put in a different form to create something new. Often, the easiest way to do this is by way of summary, such as

“So, you are telling me that you …”

A summary is sufficient if it presents the information from the patient in a novel way. However, the communication from the therapist should also reflect on the communication patterns and styles used between therapist and patient, which is one of the key elements of why the ‘talking cure’ works. It is not necessarily a reflection on the relationship between therapist and patient, but on how messages are assembled and disassembled, how information is identified as meaningful, and how all this takes place relative to the present situation and the communication space.

“I understand that … It sounds to me that … What do you mean by …?”

The Logic Test

The logical test is a result from assembling the information. Here contradictions can become clear, or spots that have not been thought through. Often, there is a belief that the emotions and the rational mind are at opposing sides. However, when a patient helps to think through things in a constructive way, it often helps to identify and reconnect with underlying emotions. The same also works in the other direction. Emotional energy is important to drive the cognitive processes of the mind. The lack of motivation and initiative one sees in depression is linked to an emotional disconnect and leads to impairments in an individual’s ability to drive rational thought processes.

Imagining

Imagining is that step in which people project their wishes, needs and aspirations into their inner world using building blocks they know from the real world. It is here where we build the world we compare the real world with. This comparison motivates us to change our world, but it can also raise emotions, such as fear or happiness. As emotions have influence over the worlds we imagine, so the worlds we imagine have influence over our emotions.

Our vision of the future plays an especially important role, because it can provide motivation and a sense of direction, as long as it is congruent with the person’s underlying values, aspirations and interests.

“Can you imagine what it would be like not to feel socially anxious anymore?”

Imagination is not important as a means to disappear from the real world, but to find new answers and creative solutions in the real world. It is thus important to see the imagination as another tool to help achieve health, happiness and fulfil own needs and aspirations in the shared world.

Bridging Imagination and Shared World

The focus needs to be on changes that may have to be made in the present world to get closer to the imagined world. These thoughts should then lead to behaviour changes that get the patient closer to where she wants to be. It is thus a patient’s discovery of and connection with own values, needs and aspiration which facilitate the bridge between the imagined and the shared world, because they should be equivalent and relevant in both spheres.

Creating new communication patterns

Change also means one has to communicate with the world in new ways. This grows out of the rediscovered values and interests, the feedback and dynamics in the work with the therapist and the life of the patient outside the therapy. Over time, the new communication patterns should solidify as the patient is reinforced by better interactions with the environment.

If a communication pattern or a communication process helps the patient connect with or achieve the authentic self in the form of deeply held values, interests and aspirations, then it is adaptive to implement it and to use it more often, either generally or limited to specific circumstances.

Communication patterns and styles are practiced and experimented with in the interaction between therapist and patient. Therefore, it is important that the communication setting is one where the patient can feel safe in, safe enough to experiment without having to feel anxious about the therapist’s judgment of him and without any fear of recriminations.

Keeping the Interaction Alive

Important is to keep the interaction going, because the exchange of information in the form of meaningful messages is the process where insight can be gained, and change occur. This requires a commitment of therapist and patient to continue engaging in the free flow of information which is necessary so that a wide spectrum of meaningful messages can be communicated. Out of the communication between therapist and patient new ways of dealing with issues and new strategies can emerge. The dynamic drives the process, a dynamic that eventually develops when humans, or living organisms in general, interact.

Listening, awareness for the dynamic and connecting with oneself are key attributes of the therapeutic approach. Being sensitive to information keeps the dynamic running. This has to become in a way second nature to the therapist. Important is to look for anything that can help the patient lead the life that is in sync with the patient’s needs, values and aspirations. Through the journey of therapy, but more importantly through everyday life, the patient should be supported and encouraged to hone the skills of discovery, which happens through internal and external communication.

Conclusion

Psychotherapy is both, creative and supportive work. It requires a keen eye for the processes and dynamics unfolding within a session. Working with the patient on communication patterns, interaction dynamics helps to uncover needs, values and aspirations, which in turn should inform the communication patterns used in interventions. At the same time, improvements in communication patterns, help to make clearer the patient’s needs, values and aspirations. Much depends on the attitude of the therapist, who needs to bring in creativity and openness towards change.

The therapist and the patient are at the centre of the unfolding dynamic. They both have to steer through the waters on a journey that leads to unknown places but at the same time is certain to bring about change. An increase in the patient’s quality of life involves the patient’s basic parameters, the values, needs and aspirations he or she holds. On the journey together, the therapist is a companion, guide, follower, observer, observed and scientist. It is, however, always the patient’s compass which sets the destination from within a communication framework the therapist helps to construct, observe and reflect upon. Engagement in meaningful communication is what it means to be a therapist.


Dr Jonathan Haverkampf, M.D. (Vienna) MLA (Harvard) LL.M. psychoanalytic psychotherapy (Zurich) trained in medicine, psychiatry and psychotherapy and works in private practice for psychotherapy, counselling and psychiatric medication in Dublin, Ireland. He is the author of several books and over a hundred articles. Dr Haverkampf has developed Communication-Focused Therapy® and written extensively about it. He also has advanced degrees in management and law. The author can be reached by email at jonathanhaverkampf@gmail.com or on the websites www.jonathanhaverkampf.ie and www.jonathanhaverkampf.com.

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