Therapeutic Internalization
Patients who linger in the therapist's psyche.
Psychotherapy in general and psychodynamic-based therapy specifically centers on exploring internalized representations of relationships with significant others. Internal representations of relationships (internalization) develop during infancy and early childhood based on dynamic, interactive interactions with early caregivers. These representations form the templates for how an individual regulates and directs their behaviors in interpersonal relationships.
Psychotherapy provides a chance to explore and rework these relational patterns as they are experienced between therapist and client within the therapeutic relationship. Essentially, “the recurrence of interpersonal themes in the therapeutic relationship provides clients with a unique opportunity to explore and rework them in vivo to develop more flexible ways of perceiving and experiencing…” (Atzil-Slonim et al., 2015, p. 2). Given the relational nature of the internalization process, it is clear that psychotherapists can also experience taking in or having the patient linger in their psyche between sessions and after the psychotherapy treatment comes to an end.
Therapeutic Internalization
Human beings are messy and complex. Psychotherapists are no different. Although we have professional training and can hold space for others, we are still human. We make personal and emotional investments in the therapeutic process and relationship. The nature of transference and countertransference, alongside the foundational aspects of the therapeutic relationship, fosters an environment where therapeutic internalization occurs.
It is not a matter of if internalization or the ‘taking in’ aspects of the patient is happening on the therapist’s end; it is about paying attention to when and how. Psychotherapists must pay attention to the extraordinary holding of the patient in their mind between or outside of sessions. Longer periods may provide ample warning that the patient’s wounds are activating the therapist’s vulnerabilities. When these arise, instead of bearing these struggles alone, therapists can seek support from a trusted colleague or supervisor. Supervisors must honor the tensions that arise throughout the therapeutic internalization process with balanced attention to both risks and potential benefits.
Aiming for an Experience Near Position
Psychotherapists place great value in the relational nature of psychotherapy, wherein both counselor and client bring their personhood to the therapeutic encounter. Yet, counselors hold primary responsibility for the maintenance of clear interpersonal boundaries between client and counselor throughout the therapeutic process.
Bearing this in mind, the therapist must foster the ability to maintain a “third” or experience-near position. Taking on this stance requires a shift in the therapist’s role of “alternating between participation (being a carrier of the patient’s inner world) and observation (starting from the self and going to the patient)” (Bimont & Werbart, 2018, p. 21). Ultimately, ethical and effective treatment depends on therapists’ ability to attend carefully to the subtle balance between closeness to and distance from their clients, distinguishing what belongs to the patient from what belongs to the therapist.
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