Loving Presence for Therapists

The basic task of helping professionals in general, and psychotherapists in particular, is to become full human beings, and to inspire full human beingness in others who feel starved about their lives.
Chogyam Trungpa

Loving presence is a way of being and of relating that offers a particular quality of therapeutic relationship, one that is safe, accepting, and appreciative. All by itself, loving presence can be transformational and healing. As the basis for psychotherapy, it increases effectiveness immeasurably.

Loving Presence emerges spontaneously as a way of being, rather than something you do. Yet, being in loving presence gives tone and form to everything you do and this has a powerful effect. In therapy, this sets the tone for the whole relationship. It is perhaps the only way of being truly non-violent. It by-passes resistance. It transcends the use of methods and techniques. It is natural, enjoyable, respectful, nonhierarchical, and mutually nourishing.

For a therapist, the practice of Loving Presence can change many things. It is a key to the prevention of job-related stress and burnout. It is an effective, yet relaxing and nourishing way to work. It creates a context of safety for the client. And it uses the aspect of the therapist’s personhood as an essential ingredient.

Michael Mahoney, in his book, Human Change Process ((Mahoney, M. J. 1991, Human change processes: the scientific foundations of psychotherapy, BasicBooks, New York.)), reports that studies about what makes psychotherapy effective have revealed the following:

the largest variation in therapy is accounted for by preexisting client factors, such as motivation…. Therapist personal factors account for the second largest proportion of change, with technique variables coming in a distant third.

In fact, says Mahoney, several major research projects have shown that “the therapeutic impact attributable to the psychotherapist was eight times greater than that associated with the treatment techniques”.

He goes on to say this:

The ‘person’ of the therapist, and the ‘therapeutic alliances’ she or he is capable of encouraging and co-creating, are much more central to the quality and effectiveness of professional services than are the specific techniques, explicit interpretations, and theoretical scaffoldings for structuring and enacting the experience of psychotherapy…. The bottom line here is that humans can, indeed, help other humans change. It is the quality of their (our) relationships with other humans that most powerfully influences the quality of lives and the pace and direction of the developments within them.

What is it about the therapist that makes who you are eight times more impactful than any treatment techniques? What is the key ingredient? Mahoney calls it personhood. Trungpa, full human beingness. We call it loving presence.

There is something very important about who therapists are as human beings, something about personal development and spiritual growth that apparently holds more weight than the particular form of therapy used.

In A General Theory of Love, psychiatrists Lewis, Amini, and Lannon agree on the importance of the therapist him or herself as the key factor in the psychotherapeutic relationship — “the person of the therapist is the converting catalyst, not his order or credo… the agent of change is who he is.” ((Lewis, T., Amini, F., & Lannon, R. 2000, A general theory of love, Random House, New York.))

Early approaches to psychotherapy had the idea that something was fundamentally wrong. Today, the therapist needs to have a goal based on something other than the idea that something is wrong with the client or with the world. That idea is the very mistake which is the cause of most of the client’s suffering. Psychotherapy based on that pathological idea wanders the maze forever, exploring more and more dead ends, never finding the route to freedom. Perhaps the primary goal of therapy is simply for the client to have an experience of being witnessed by someone who is truly being present in a nonjudgmental and loving way and who sees the client as beautiful, inspiring, and whole.

To sustain the energy for psychotherapy, the practice of loving presence is an effective antidote to habits based on looking for what’s wrong, on feeling overly responsible, on breaking down resistance, on trying to make something happen.

Joan Borysenko writes in Nourishing the Soul, that a healer is:

… someone capable of sending thoughts of unlimited possibility to his or her patients … The communication of unlimited potential is healing to even the most damaged or neglected soul. ((Simpkinson, A. A., Simpkinson, C. H., & Solari, R. 1995, Nourishing the soul: discovering the sacred in everyday life, Harper San Francisco.))

There’s a time in a professional relationship, in psychotherapy, for example, where as therapists we start to see the people we’re with as being extremely beautiful, in the sense of esthetic beauty. It’s like a wonderful painting… a masterpiece. When we start to see them that way, the whole space we share with them starts to change.

We can start with very simple pleasures like interest and curiosity, from there moving to the fun of working with the mystery and complexity of human behavior. Then we become aware of the honor and privilege of being present with and for someone’s inner work, and we move on to seeing the beauty and courage of the human spirit. There is so much more. This way of perceiving moves us into loving presence. And it is felt tangibly by the client.

In loving presence, both the therapist and the client are being nourished. This view – seeing something inspiring in the client – besides offering a source of nourishment for the therapist, helps to reveal the client’s strengths and inner resources. It is inevitably recognized by the client’s unconscious as providing a safe place to explore hidden places and deep feelings. This safe and loving context is the best place for the healing to unfold naturally and spontaneously.

For a therapist who practices loving presence, who sees beauty and inspiration in the client, a result of therapy is that the client begins to feel better about herself, to see herself differently, to rediscover her own inner resources, and therefore begin to have a more nourishing experience of life. He or she learns to be more at ease, calm, and happy, more able to be loved and loving.

When one person is in this state with another, the other can usually feel it. An infant can feel it from the mother. A student feels it from a teacher. So you can imagine that when this relationship is between therapist and client, and the therapist is taking in this kind of inspiration and nourishment, how it creates a loving, compassionate state which is naturally felt by the client.

Seeing and feeling loving presence in the therapist, the client (perhaps without realizing it) recognizes an opportunity to explore core issues and to express deep emotions. In this way, a healing process begins to unfold spontaneously. This expression of feelings creates an opportunity for the therapist to take in more non- egocentric nourishment. Each person inspires and is inspired by the other. Loving presence inspires emotional healing. Healing inspires loving presence. Each sustains the other, one moving towards unfolding and healing, the other towards caring and compassion.

The vocation of psychotherapy confers a few unexpected fringe benefits on its practitioners… it impels participation in a process that our modern world has all but forgotten: sitting in a room with another person for hours at a time with no purpose in mind but attending. As you do so, another world expands and comes alive to your senses… ((Lewis, T., Amini, F., & Lannon, R. 2000, A general theory of love, Random House, New York.))

Why Love Matters

The detection of a person as safe or dangerous triggers neurobiologically determined prosocial or defensive behaviors. — Stephen Porges ((Stephen Porges, Neuroception: A Subconscious System for Detecting Threats and Safety, http://bbc.psych.uic.edu/pdf/Neuroception.pdf))

Stephen Porges, M.D. uses music to work with autism — music played through headphones and limited in frequency to the range of the human voice. It triggers a complex neurobiological system which he has named the social engagement system.

Listening to range-limited music causes a person’s middle ear to change the tension on the ear drum. This action of the middle ear is one of the normal functions of the social engagement system. Some of the other functions include smiling, looking directly at someone, and regulation of the larger nervous system in support of all prosocial behaviors. That is, behaviors that enhance human-to-human communication.

This system only activates in situations that are perceived as safe. When it is active, it inhibits the other two main nervous system configurations, the high sympathetic activation of the fight or flight response and its opposite, the high parasympathetic response of giving up.

When the middle ear acts to hear the voice of another person, it screens out any other frequencies. This action is only part of the prosocial state. Porges talks about the middle ear as a portal to the system; stimulating it triggers the system. It is a gateway to a state of mind, a state of mind that is not defensive. It is the kind of state in which the feeling of love towards another human being is possible. A state in which comfort can be given and received, laughter shared, and where emotional healing can begin.

Porges believes that a person can also be a portal. A loving face, calm, steady attention, a soothing voice, these too may trigger the system. A feeling of love, expressed through these behaviors, has the power to open another’s heart, to calm a troubled soul, to start the process of renewal. One nervous system calling to another. It is part of what is meant by being “good with people”.

As the poet Robert Frost says at the ending of his poem, Directive:

Here are your waters and your watering place.
Drink and be whole again beyond confusion.

Loving presence is a key ingredient in any successful psychotherapy. The result for clients in therapy is simply this: healing. Clients are healed because they begin to remember their wholeness. They remember and recover their essential lovability. They experience a new way of relating to others and to themselves, a way that changes old habits that limit aliveness and cause unnecessary stress and suffering. They make this life-changing transformation, not so much because of what the therapist does, but more because of how the therapist is being.

The person of the therapist is the converting catalyst… the agent of change is who he is … if therapy works, it transforms a patient’s limbic brain and his emotional landscape forever … thus the urgent necessity for a therapist to get his emotional house in order. ((Lewis, T., Amini, F., & Lannon, R. 2000, A general theory of love, Random House, New York.))

One of the ways you can be skillful with clients is not only to see them as people of value, with strengths and resources and the ability to change limiting beliefs and behaviors, but also to demonstrate this to them in a way they can easily recognize. It is not enough to have the right attitude about people. You must learn to communicate this to each person in a way that can be received and believed. Again, this has less to do with what you say than it does with the subtle nonverbal cues you give out unconsciously, that register – albeit mostly outside of consciousness for the client – the cues they pick up about what and how you are feeling about them.

This is why it is so important to become more aware of yourself, as a therapist and as a person – aware of the signals you send out and the ways you perceive and react to others.

The Role of the Therapist

What do we expect when we are in despair and yet go to a man? Surely a presence by means of which we know that, nevertheless, there is meaning. – Martin Buber

Most of the latest research about successful psychotherapy – as reported, for example, in the APA’s publication The Heart and Soul of Change: What Works in Therapy ((Hubble, M. A., Duncan, B. L., & Miller, S. D. 1999, The heart & soul of change: what works in therapy, American Psychological Association, Washington, DC.)), – proves that the role of the therapist has more to do with a certain quality of presence and good relational skills than with techniques and method.

… the bulk of the empirical research efforts in this area have failed to correlate positive outcomes with specific techniques, and they suggest that such correlations will likely never be found. … the effectiveness of psychotherapy is due primarily to client factors and the therapeutic relationship, not to the expertise of, nor the techniques employed by, adherents of specific theoretical orientations.

A lot has been written about the importance of the therapeutic relationship and of what Mahoney called the “personhood” of the therapist in determining the successful outcome of therapy[8. Mahoney, M. J. 1991, Human change processes: the scientific foundations of psychotherapy, BasicBooks, New York.]. In the Heart and Soul of Change, the research suggests that therapist training should focus more on the therapist becoming “a person who prizes others”… that this feeling of being “prized” or appreciated by the helper is perhaps the key ingredient that helps the client feel that therapy was successful ((Hubble, M. A., Duncan, B. L., & Miller, S. D. 1999, The heart & soul of change: what works in therapy, American Psychological Association, Washington, DC.)).

This is the key to loving presence – the intention and act of “prizing” the other, of seeing the other as awesome and wonderful, of feeling humbly and truly honored to be present for part of the other’s healing journey.

Giving priority to the taking of inspiration over any other agenda may seem like a radical idea for a therapist. Other more common agendas, such as directing and controlling the process, advising, interpreting, reframing, solving problems, or gathering information by asking a lot of questions, these usually take priority.

However, the priority in the practice of loving presence is for the therapist to seek inspiration in the client, which is what sustains the therapist’s compassion, patience, understanding and constant loving attention.