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Introspections   |    
“Being There” in the Psychotherapeutic Relationship: Introduction
Robert Michels, M.D.
Am J Psychiatry 2010;167:1029-1029. doi:10.1176/appi.ajp.2010.167.9.1029
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Copyright © American Psychiatric Association

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Students of psychotherapy have long debated which element of the treatment is the critical one—interpretation and insight or the relationship between patient and therapist, often conceptualized as a corrective emotional experience with a new object or the therapist as container or holder of the patient's emotions. The two brief descriptions of psychotherapy in this month's “Introspections,” with two very difficult although very different patients, point to a crucial element in the relationship—being there, being committed to the patient, and making clear that that commitment is unconditional. One therapist made clear that she would not abandon her patient as the patient feared progressive deafness. The other therapist was flexibly willing to accept the patient's needs and adapt himself to them—whether as an object of scorn, an audience for grandiose display, a partner in a trial relationship, or a friend as the patient embarked upon a new life. Initially, both patients expected very little, and both therapists had little optimism, but, critically, both persisted. Certainly they felt doubt, and probably were themselves surprised by their success, but success they achieved. Their persistence in being there for their patients, for trying in spite of doubt and uncertainty, was a powerful healing force.

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