Emergent Moments in the Relational Field
Change comes into being in the therapeutic relational field in the form of emergent moments: new experiences, relational events, or psychological developments which arise unbidden and in a way that can be neither predicted nor controlled. The hallmark of emergent moments is that they simply arrive: They feel in some essential way “separate” from us (D. N. Stern, 2004; D. Stern, 2010; D. Stern, 2015). In psychoanalysis, emergence is described in terms of third-person qualities distinct from the subjectivity of either therapist or patient, understood in terms of the interpersonal field.6 Emergent moments are described as a characteristic of the clinical process itself. It is the role of the psychoanalytically-minded relational therapist to recognize, understand, and articulate what is emergent.
It has often been said that the most important healing factor in psychotherapy is the therapist’s state of mind (Diamond, 2011). “State of mind” is a broad description. It includes the capacity for “compassionate attunement” which is the hallmark of the therapeutic milieu, as well as the therapist’s psychological traits, such as emotional balance and self-reflective awareness, which provide a living template for the development of healthier self-function in the patient. Perhaps it is useful to think of psychotherapy as a process akin to osmosis in which there is an intersubjective mingling of mind states and in which the therapist’s qualities can be absorbed in whatever ways are most needed by the patient.
When therapeutic moments of meeting occur within a field of deep Presence, their emotional impact is amplified and the sense of experience as emergent is more vividly felt. Mindful awareness registers both what is enacted and what is emergent. This mindful attention to what is emerging in the relational field feels like (or perhaps is) a kind of meditation practice, in which relational emergent moments are felt to arise against a backdrop of a still, heart-centered, receptive listening field (Packer, 2002; Sills, 2009). Emergent moments are facilitated as a consequence of the qualities of alert, focused attention developed through mindfulness meditation practice: deep presence, clarity and its implied wisdom, and centeredness or resilience (“equanimity”). Like other aspects of the therapist’s subjectivity, these qualities of mind are shared intersubjectively in the therapeutic relationship as it unfolds through moments of meeting.
Therapeutic presence entails a number of component skills which are facilitated through the practice of Buddhist mindfulness meditation. The core capacity on which it is based is the ability to sustain focus of attention in the present moment—the ability to bring awareness repeatedly back to a chosen object of attention. Such “whole-hearted attention” is a wonderful frame for psychotherapy. It allows therapists to listen and observe more acutely. It also amplifies the sense of person-to-person connection between patient and therapist.
Mindfulness meditation may be thought of as a process of intrapersonal attune- ment: in essence a process in which we learn to empathically receive and accept our own experience. Analogously, interpersonal attunement is facilitated when we bring mindful awareness to the relational field. It amplifies awareness of subtle cues in body language, facial expression, and language and heightens empathic sensitivity to how the patient is feeling in a particular moment. It helps capture the emotional gestalt of the interaction that is occurring, creating space for feelings to be felt more deeply. Such attunement involves the “reading” both of the text and subtext of communication; both left and right brain (Siegel, 2007, 2012).
Mindful awareness highlights nuances of both the patient’s responses and the therapist’s own (countertransference) responses. In the continual dance that takes place between any Self and any Other, there is much that can be observed about the way “self” (therapist’s or patient’s) defensively protects itself.7 In the process of relational psychotherapy, mindful attention heightens awareness of this—and other relational happenings—at the boundary of Self and Other.
Therapeutic presence is the foundation of relational mindfulness: awareness of the felt sense of connection and relatedness as it shifts and changes from moment to moment (Surrey, 2005). It fosters the therapist’s capacity to respond spontaneously in a way that matches what the patient needs. The therapist’s compassionate acceptance—the “unconditional positive regard” described by Carl Rogers (1995)—also gives the patient a sense that they are not alone, which is the essence of hope. One of the themes in this book is the idea that the therapist’s presence is one of the raw materials used in building this “corrective relational experience.”8