Nursing & Health Care - Juniper Publishers
Abstract
Both loneliness and psychotherapy have been well
researched and described. The present paper examines the interaction
between them; the salient features of psychotherapy, the needs of the
lonely, and the use of the therapeutic process in helping the lonely
survive and emerge from their ordeal, emotionally strengthened and
spiritually enriched.
Keywords: Level of Internet Use; Students; Selected College
Introduction
The Therapeutic Relations in Psychotherapy
In his book The Road Less Travelled, Peck [1]
suggested that "Entering psychotherapy is an act of the greatest
courage" (p. 53). Psychotherapy, at least in the Western culture, is
associated with emotional pain and "disturbed" patients (or clients) of
psychologists and psychiatrists. Normally, psychotherapy does involve a
trained and, hopefully, skilled therapist who attempts to help the
clients alleviate their problems. However, the therapist also seeks to
contribute to his client s further growth and development through the
interaction and relationship that develops between them. The therapeutic
relationship is so central to the therapist s practice, that its
overall form and structure is often accepted without seriously
considering the idea that "the relationship may have a structure beyond
its temporal, physical and financial boundaries" Schamess [2].
It unfolds according to its own dynamics and the roles of its
participants, and over time, the bond that develops between client and
therapist becomes intimate and close, as well as therapeutically
beneficial.
Whereas in non-therapeutic relationships both
participants are open about themselves and vulnerable (a mutuality which
serves to strengthen their bond), according to Schamess [2]
only the client is expected to do the "risky revealing” in
psychotherapy That being said, it does not have to diminish form the
intimacy between the two participants. The therapist can greatly
contribute to that intimacy by being truly interested in and caring
about the client, and by being genuine, showing warmth and fully
accepting the client. Psychotherapy, not unlike non-therapeutic intimate
relationships is bi-directional, though the participants' roles and
behaviours differ. In non-therapeutic relationships, we can find
relationships where participants promote dependence in their partners,
or engage in a leader-follower pattern of interaction, while in other
relations partners may encourage their loved one to grow and develop. In
psychotherapy, the therapist is expected to structure the relationship
in such a way that it aims, first and foremost, to help the client
alleviate his problems. We should point out that during psychotherapy
some of the therapist s needs are met as well, despite it being focused
on the client. This may include increased esteem, learning about human
nature and behaviour, being seen helpful, and being financially
remunerated Rokach [3]
While it is assumed that the therapist is a reasonably secure person
and that his life is not bleak or desolate, the client on the other hand
may be [and frequently is] a lonely and alienated individual. When they
interact, the therapist attentively listens to the client, sympathizes
with him, and endeavours to understand how he feels; therapists are
supposed to always remain even keeled and does not turn his back on the
client because he cannot stand the outpouring. In other words, the
therapist may be construed as an almost ideal confidante by the client.
Small wonder then that often times the emotional feelings involved in
therapy rise to a crescendo where either or both parties may be
frustrated by the fact that the hour has to end and that both parties
must go on to their private lives, perhaps not to see each other for an
entire week Klopfer [4].
Intimacy, while welcomed in therapy, may become an issue if the therapist and client are of the opposite sex Rokach [3].
It is not unusual--or unexpected--to find a female client who
glamorizes her male therapist (or vice versa) and fantasizes about him
becoming her lover. She may then offer herself to him sexually, directly
and bluntly or covertly, in an attempt to deepen their intimacy and
through it receive increased attention, acceptance, approval, and
closeness to him (see also Holroyd, Lerman, Forer & Greenberg,
1983). The traditional psychoanalytic model refers to it as
transference, while a therapist who has similar feelings toward his
client is said to be experiencing counter-transference. I believe that
it may be a mistake to attribute all of the client's sexual daydreams
and emotional responses to his or her neurotic distortion of the
therapist-client relationship see also Klopfer [4]; Rogers [5]; Szasz [6].
It is suggested that what the client feels and thinks about the
therapist is not as unreal as the psychodynamic approach maintains.
Though some of the client's feelings toward the therapist may be of a
transference nature, it is quite reasonable to conclude that the
feelings the client has for the therapist are genuinely directed at the
human being behind the helper's title. Lonely clients feel their
loneliness to be painful and yearn to escape from behind the walls they
feel surrounded by Peck [1].
And, as many have discovered, "the experience of falling in love allows
us this escape--temporarily- from the place in we may feel confined to.
The essence of the phenomenon of falling in love is a sudden collapse
of a section of an individual's ego boundaries, permitting one to merge
his or her identity with that of another person" Peck [1]
p. 87. It is, indeed, possible for therapist and client to genuinely
fall in love with each other as a result of true feelings of love, as a
consequence of transference, or possibly as a combination of the two"
Klopfer [4] p. 39.
The Therapist
Commenting on the essence of psychotherapy, and
referring to the role the therapist plays in the change and growth of
the client, Peck [1]
noted that it is impossible to truly understand another without letting
that person within yourself. In my experience as a clinical
psychologist, that process affects not only my clients, but me as well.
As a therapist, I am have the very privilege of being allowed into other
people’s worlds. I am invited to become closer to them than they would,
perhaps, allow even their most intimate friends. Consequently, I
witness their pain and assist them in addressing it. The client,
naturally, needs to be committed to therapy, for it to succeed. For the
duration of therapy the therapist is required to make the same kind of
commitment to the client. This commitment entails understanding and
supporting whatever stage the client is at, and he must be willing to
grow and learn from the client. Psychotherapy requires courage of the
therapist; courage to risk change, make interpretations, suggestions and
observations; courage to extend oneself, and courage to be, at times,
different and unconventional. Most importantly, the therapist must
strive to nurture the therapeutic relationship by making room for the
client within himself. And that very commitment is, in my experience,
one of the most rigorous, demanding and all-consuming requirements a
therapist has to fulfill Rokach [3].
Although I do not care for all my clients in an identical manner, I
have never yet treated anyone who I did not care about or for. At times,
I am blessed to work with those I consider unique; people whose
characteristics I highly value, and whom I would certainly choose to
befriend had we met "on the street". However, psychotherapy is a unique
alliance which is confined to a specific time and place, and which is
governed by strict ground rules. Its very existence depends on, and
focuses upon the client.
The therapeutic relationship is established and
carried out in order to help the client and not to fulfil the
therapist's needs. Consequently, although I may yearn to remain a close
friend with a client, to see that person grow and develop, and thus
continue to enjoy the enriching relationship which I had with him or
her, I cannot do so. It has been rare that I have kept in contact after
therapy was terminated, and if I do so, it was on a casual basis, rather
than as a close friend. I read once that every love relationship
involves therapy, and every psychotherapy includes love. Peck [1]
observed that "The essential ingredient of successful, deep, and
meaningful psychotherapy is love" (p. 173). Love, as we understand it,
calls for a continuous and close alliance. However, being a therapist
means being ready to suffer, sacrifice, and give of oneself, not only
while sharing the client’s pain and sorrow during therapy, but also by
not submitting to the heart's desire to continue and enjoy the company
of a person I became close to in my office.
Much has been written about therapist burnout i.e. Figley [7]; Bagel [8]; Bride [9]; Rothschild [10]; Steele et al. [11].
However, very little, if anything, has been written about psychotherapy
as a lonely journey for the therapist. I find it difficult, and at
times painful, to say goodbye to a client which, most probably, I will
never see again. No other relationship is so teasingly painful. In
therapy, two people interact so closely, growing and learning from one
another, only to depart when the relationship is ripe for a more
balanced and enriching experience. Over the 40 years that I have worked
with clients, I have had two "wishes" concerning my clients. One was to
let them know that I would like to remain their friend following
completion of therapy. In so doing, however, I would selfishly declare
that I am now focusing attention on my needs after catering mainly to
theirs. In other words, I would be saying, I would like to be your
friend and remain so not necessarily because it is therapeutic and
beneficial for you, but because I like and value you, and because this
is something that I want and need. As I mentioned earlier, I have yet to
follow through. My other ‘wish’ is quite different, and has to do with
wishing that I could offer psychotherapy in a detached, mechanical way
so as to prevent closeness and mutual fondness from forming. This being
so far removed from the essence and spirit of psychotherapy, and from
the manner in which I practice it, that I could not possibly realize
that wish either, nor would I want to. That means that the profession in
which I have chosen to specialize can be a painfully lonely one.
Helping the Lonely
Since loneliness is not a unidimensional phenomenon,
treatment is frequently multifaceted as well. For example, loneliness
that follows the death of a loved one often requires resolution of the
grief process as a prerequisite to the alleviation of loneliness and
formulation of new social relationships Lopata et al. [12]; Rokach [13].
On the other hand, loneliness which follows a divorce may necessitate
treatment that is initially directed at feelings of interpersonal
inadequacy and insecurity and only then can the loneliness be addressed
Weiss [14].
"Many of the problems and much of the pain I felt came from trying to
resist my loneliness. The moment we begin to build a wall against it, we
have already lost... before we can look at our loneliness, we must stop
trying to resist it. We must stop blaming husbands or wives, children
or bosses for our feelings of loneliness and [the] alienation in our
lives. Schultz [15]
p. 169. This quote describes precisely what many lonely clients do;
they run away, hide or deny their loneliness, ashamed to admit that they
are in pain, or frightened of the stigma which is attached to
loneliness Moustakas [16]; Rokach [17,18].
However, if they do finally talk about their loneliness, they often go
on a rampage, blaming everyone around them for it. My purpose is to,
initially, empower the client to recognize and admit that he is lonely,
his loneliness, and take full responsibility for it. Once that has been
done through nurturing within the therapeutic relationship, the client
is on her way to lessening the pain.
Having been, once, asked how do I help the lonely, I
replied that I see myself as a father or a friend who is attempting to
teach a child to swim while the child is terrified to even approach the
water. That analogy, for me, encapsulated the trust the child must first
have in order to place his hand in his father's. The courage the child
needs to approach the water, and the effort they will both need to
invest in order to teach the child the series of co-ordinated movements
that will allow him to float and move in whatever direction he chooses,
and eventually, be able to swim. Friedman [19]
observed that while paying attention to the community one lives in, is
part and parcel of what sociologists and social workers, psychologists
are commonly trained in the language of individual self-interest, and
thus focusing on the client's community ties and belonging may pose a
challenge. Examining the client s ties to the community and helping to
cultivate a strong sense of belonging are important, but often
overlooked therapeutic goals when that therapy is offered by
psychologists. To begin with, it should be mentioned, reminded us
Friedman that the therapeutic alliance can serve as a way of belonging
which can be nurtured and developed. Especially for people who
experience difficulty in connecting with others, and who are lonely, the
experience of belonging that takes root in therapy, may be a
significant achievement for them and be further extended to their lives
outside of therapy. Thus, a close, intimate therapeutic alliance is the
cornerstone of a fruitful therapy, and a way to help the client feel
belonging and a connection to a caring individual. Doherty [20]
maintained that therapists can educate clients about the need for a
community by providing an accepting and supportive connection in the
therapy room. He, eloquently declared that "there is no fundamental
contradiction between pursuing personal needs and promoting the welfare
of the community. When we promote clients' positive involvement in the
community, we promote their own well-being as well” (p. 100). Friedman
argued, with a lot of conviction that what is needed is a sort of a
holistic approach which together with helping the client explore his
inner self also be aware of the outer realm.
Therapy is seldom neutral, and moreover it reflects and reproduces cultural norms. Cushman [21],
thus, argued that by valorising the isolated individual, we may
actually strengthen the problems that the client is struggling with.
Since the therapy we offer, and our interactions with the client reflect
our values, beliefs, and background - it is imperative that
psychotherapists become aware and adopt the view that belonging to and
building a community is a fundamental ingredient of well-being Blow and
Timm [22].
Attending psychotherapy has not been condoned in the North American
society for a long while. At the dawn of the 20th century it changed and
many more are attending therapy and hiding it less. And still, therapy
is offered in confidentiality to the individual, the couple or the
nuclear family, but the rest of the community is not represented except
by the dialogue between client and therapist. Morgan [23]
indicated that this point is addressed by Narrative therapists who
encourage their clients "to re author their lives” (p. 2) in order to
create newer and more appropriate 'stories’ which may include or even
focus on one's community and connections. At times, family members,
friends or even work colleagues may be invited into the therapy sessions
to celebrate the client's accomplishments and or to simply bear witness
to the creation of new stories Freeman and Combs [24].
While the therapeutic relationship has been
established, strengthened, and is supportive and empowering of the
client, and when working with individuals, we address the pain that one
feels being lonely, especially for a long time, and feeling deeply
stressed and saddened by it. Some clients attempt to distance themselves
from the pain and thus tend to supress, or even deny that they are
lonely and experience the accompanying negative feelings and cognitions.
Facing their loneliness, admitting to themselves that they, indeed,
experience it and not run away is the first step. We then attempt to
understand the nature of one’s loneliness. Is it a transient one
influenced by events in the client's life, or is it a chronic, long
term, experience that is more troublesome and requires a concerted
effort to resolve. The reasons for the loneliness that the client
experiences need to be examined and understood, for only then addressing
it can be possible. The next step is empowering the client to explore
ways to address the loneliness. One approach to that empowering is
addressing possible learned helplessness that the client may exhibit,
and which prevents a free and courageous exploration of coping
strategies. We also highlight the importance of a steady and committed
approach, which while it may not always succeed, the client will
persevere and have the inner conviction that she can diminish her
loneliness and reduce its pain. Some writers Moustakas [25]; Rokach [13,18]
suggested that loneliness, just like pain, can be a beneficial force in
one’s growth and development. Firstly, it directs us to look inwardly
(an experience which the extroverted way of life in North America does
not encourage), helps us take "personal stock,” and evaluate our
relationships, goals and our priorities. Loneliness, just like the
effects of intense fire on gold, can clear and purify our understanding
of who we are and what we want out of life. After experiencing the
intense pain of loneliness, suggested Moustakas [25]
we may emerge knowing that our resources for coping and living are
appropriate, discover new capabilities within ourselves, gain a better
understanding of the wondrous and beautiful things in nature and the
universe, and learn anew to fully appreciate human contact, intimacy,
and love. I aim to help my clients realize it and renew their hope for
more fruitful human interaction and personal fulfillment. Group
approaches to loneliness are, naturally, somewhat different in that the
group members can serve as an invaluable source of insight, support,
direction, and ‘quality control’ of the client’s journey in addressing
his loneliness. Group members, in addition to their support of the
client in-group, may also provide friendship outside of the group and
encourage the person to explore relationships, friendships, and social
intercourse.
Cognitive Strategies: Deshawn Besse [26]
reviewed the self-deprecating manner in which the lonely perceive
themselves, commonly feeling inferior, unattractive, less socially
skilled or overall worthless. One of the consequences of such a point of
view is that they tend to perceive the world as negative and others as
not trustworthy or accepting Luhmann et al. [27].
Being so unhappy with themselves and their surroundings, the lonely who
may want to connect with others, may also be quite hypervigilant which
further impacts their negative perceptions of the world and viewpoints
about others. These biases, may intensify their loneliness, confirm
their negative view of the world and of others Cacioppo and Hawkley [28].
The lonely, consequently, often believe they are helpless and incapable
of changing their situation, believing their loneliness is the result
of personality characteristics (such as, for example, shyness or low
social competence) rather than circumstances and traits that may be more
malleable Heinrich and Gullone [29,30].
In light of this vicious cycle, treatment strategies that were
suggested included educating the lonely of the connection of their
negative and unrealistic thoughts and how they may be contributing to
their current situation.
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