Present Moments, Moments of Presence

Moments of Meeting in Psychotherapy

Verbally understanding or narrating something is not, in and of itself, sufficient to bring about change. The premise of relational psychotherapies (including the Buddhist-informed approach described here) is that change comes into being as a function of special moments of communication between psychotherapist and patient. The psychoanalyst Daniel Stern (2004) terms these “moments of meeting.” The defining quality of such special now moments is the profound sense of mutual connection. It is on this stage of the therapeutic here-and-now that change most readily unfolds.

The prototypical “moment of meeting” is the one that occurs in the first moments after birth, when the new baby looks into the eyes of a mother who is looking back. Important moments of meeting occur in psychotherapy every time something is said and received in such a way that the patient feels deeply seen, felt, accepted, and understood. Dan Siegel (2010) describes this as a process of interpersonal attunement in which the Other experiences “feeling felt” by us. Such moments of deep contact, “mutual now moments,” are what the philosopher Martin Buber understood as the essential meeting of “I-and-Thou” (Buber, 1958).

The therapeutic encounter provides an opportunity for a unique and vivid kind of connection. Patient and therapist participate together in the mutually-lived experience which takes place between them and, in addition, in the creation of a healing narrative which describes that shared experience. Such therapeutic moments of meeting involve more than just an exchange of information; both participants engage in co-creating the mutually lived story between them. This is the secret of the relational here-and-now (Stern, 2004).

The importance of Now Moments is widely recognized in the literature of relational psychoanalysis. Of many relevant descriptions, I especially like the phrase fertile mutuality, referring to the field of unseen emotional action within and between people.1 The descriptive term “intersubjective” is also broadly useful, carrying the general meaning that two (or more) minds come together in a space of shared thought and feeling. So in this language, we can define therapeutic now moments as experiences of deep intimacy at the intersubjective intersection.2

Deep “now moments” have also been termed blood moments (Shafer, 2010), a description which derives from the native American ritual in which two members of a tribe mixed their blood in celebration of bonding as brothers. By this metaphor, we can understand an intersubjective now moment as one in which two individuals co-mingle their most vital essence. The idea of a blood moment also carries the meaning that real feelings and actions are taking place between real people in real time (Stern, 2004). Last but not least, because blood is a quintessential element in birth, the term “blood moment” is also well suited to express the meaning that something new is being born. From my point of view, psychotherapeutic blood moments are those in which new aspects of self come into being.3

The following vignette briefly describes an extended series of therapeutic moments of meeting that occurred in my work with one of my patients, “David.”

Clinical Illustration 5.1: David

David camefor help at age 40, reluctantly, when his wife left him unexpectedly and he fell apart. He spent much of the time in our early sessions sobbing deeply for the first time in his adult life and got in touch with wounds from his early life that had been opened up by this new loss. I didn’t say much, at first, but I felt deeply moved by his pain—sometimes to the point that I found myself welling up with tears. We worked together for about a year and then he moved on. On a return visit recently, David told me that he could see from the perspective of time passing that he had been sealed off and compartmentalized for most of his adult life. His emotional shut-down was what had allowed his marriage to slowly die without his even being aware of it happening. My deeply felt response to his pain had moved him, he said. It was pivotal in his taking the risk to open up and gave him hope that it might yet be possible to find real connection with a woman.

This vignette conveys the importance that cumulated “now moments” can have in psychotherapy. It is important to emphasize, in addition, that such moments of meeting occur as a function of two subjectivities, therapist’s and patient’s, both immersed in the present moment as a lived experience. The important implication here is that the therapist, as an individual, is intimately connected to and radically engaged in moments of meeting. His or her emotional responses, personality, and state of awareness are all integral parts of the unfolding mutual experience—in positive as well as in limiting ways. In this framework, clinical detachment is a hindrance (although this should not be taken to mean that clinical objectivity and neutrality are undesirable).

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