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Chapter 4

Engage the patient

A great many of our patients have conflicts in the realm of intimacy and obtain help in therapy sheerly through experiencing an intimate relationship with the therapist. Some fear intimacy because they believe there is something basically unacceptable about them, something repugnant and unforgivable. Given this, the act of revealing oneself fully to another and still being accepted nonetheless may be the major vehicle of therapeutic help. Others may avoid intimacy because they fear being exploited, colonized, or abandoned; for them, too, the intimate and caring therapeutic relationship becomes a corrective emotional experience.

Hence, nothing takes precedence over the care and maintenance of my relationship to the patient, and I attend carefully to every nuance of how we regard one another. Does the patient seem distant today? Competitive? Inattentive to my comments? Does he make use of what I say in private but refuses to acknowledge my help openly? Is she overly respectful? Obsequious? Too rarely voicing any objection or disagreements? Detached or suspicious? Do I enter his dreams or daydreams? What are the words of imaginary conversations with me? All these things I want to know and more. I never let an hour go by without checking into our relationship, sometimes with a simple statement like: "How are you and I doing today?" or "How are you experiencing the space between us today?" Sometimes I ask the patient to project herself into the future, "Imagine a half hour from now: you're on your drive home, looking back upon our session. How will you feel about you and me today? What will be the unspoken statements or unasked questions about our relationship today?"