Therapeutic Presence: Mirroring

The second aspect to be discussed is mirroring. Mirroring is a therapeutic technique used to validate the client’s experience, and reflect their self: affect, behaviour and memories back to them. This aspect, unlike empathy, is more tangible and therefore more easily understood. However, it still requires practice and exploration. Carpendale provides us with a number of probing questions that open the gates for reflection (Carpendale, 2006).

What does mirroring have to do with presence?

Presence is the being with an other inside a therapeutic context. Being aware of your own feelings, cognitions and affects, and how these might influence the therapy session. Being aware of time and space, the environment in which the therapy is unfolding, and being mindful of an individual client’s needs. Presence is essential in forming the therapeutic alliance – if the client does not feel that they are heard, seen, or understood, the therapeutic alliance, which is built primarily out of trust, will not flourish.

Mirroring is a core component of presence. When we mirror a client’s affect they recognize that we are not only present in the moment, focusing solely on them, but we also demonstrate a reaching towards understanding. This translates into validation. There are no judgements with mirroring. Mirroring is a verbatim reflection of the client’s experience in the moment, or of a remembered experience. When we mirror we are not adding our own thoughts or interpretations, we are merely reiterating the client’s feelings and experience.

I believe when we mirror it is appropriate to seek clarification. In this way too, the client is offered another way to approach the situation. If we seek clarification, this validates the client’s experience as being entirely their own, with a nod to the empathic response that should be experienced throughout therapy. When we discuss these aspects of therapeutic presence it is difficult to pull them apart and investigate them individually because they are not intended to be isolated – they work together. The whole of our therapeutic presence is comprised of these six aspects.

How do we communicate with mirroring?

We communicate effectively with our reflections of the clients experience. These reflections are not mere repetitions – but they are also not infused with our own thoughts or interpretations. Upon reflection it appears a simple technique, but it is one that requires focus and practice. It is essential to find the balance between merely repeating and adding our own self to the reflection.

The mirroring technique acts in such a way that the client sees themselves reflected in a new light, so that they can infuse meaning, and draw out new interpretations. With our reflections we are holding up a mirror for which they can look into and better understand their self, and their situation.

When words fail and I am grasping clumsily for some understanding, I put the pen down and pick up the paint brush. When expression is contrived or strained through words, art can be my saviour to express what I am hinting at.

I painted “Mirror, Mirror” in response to Carpendale’s question “how do we communicate with mirroring?”

The characteristic mandala is the focus of this image, used in this context as a mirror. Blue, purple and black highlight the mandala, emphasizing its contours with the repetitive strokes. Inside the mirror sits my reflection, with a larger eye seated to the left of my image. In place of the pupil of this larger eye is a koi fish, which extends beyond the eye. Water droplets fill the spaces between this eye and my image, and act as a replacement for my missing eye.

In dialoguing with this image I am drawn to the potent imagery that I rely on, and that I find repeating itself over and over in my art-work. The eye is seen as the window to the soul, and in this way, our mirroring can be understood as something comprised of more than just our words. Mirroring is something that, like empathy, requires all parts of our self – our mind, body, and soul (psyche, spirit). The client can see and feel our mirroring responsiveness through our eyes, body language, and vocal tone. We must be attuned to this throughout the therapy session. The water, a symbol of strong significance which presents itself repeatedly, is representative of the collective unconscious, and the unconscious mind in general. Our mirroring then is opening a window into the client’s unconscious mind, in a similar way to our empathic response.

The koi is a personal symbol, which represents perseverance, ambition and courage. The koi is placed here to represent a direct mirroring of my self within a therapy session. In this instance then, I am the subject of therapy. However, when we think of the meaning behind the koi, we can still apply this to our aspect of mirroring. There is a story called The Yellow River at Hunan, which details the journey of koi fish through the waterfall, Dragon’s Gate. The koi fish who successfully complete the journey through Dragon’s Gate, transform from a koi fish into a dragon. This represents the koi’s ability for change and growth, and when we investigate the symbolic meaning behind the dragon we come to find that the dragon represents growth, luck and development. Therapy is an aim towards change, and furthering self-development. Our mirroring is a significant aspect of our therapeutic presence that provides the client with an opportunity for growth and change, through playing the role of their reflection. When they see their self in such an empathic, understanding way, they are provided with a new way to reflect upon their goals, current development, and life situation.

How were you seen as a child?

This is an important question for us to reflect on. Seen here does not refer to physical appearance, rather, it refers to your true self. We need to reflect on this to recognize our own potential countertransferences in future therapeutic relationships. If we never felt truly seen, understood, validated and so forth, how can we know how to embody it and provide it for a client?

I have led an incredibly privileged childhood, and both of my parents entered my world in an attempt to understand me. The best and most ready example I have of this is my interest in art. I am where I am today because my parents recognized my interest and ability in art, and nurtured this passion. The important thing to remember here is that how one was seen as a child might appear different for different people – it is the experience of being seen that matters. If I had interpreted my parents support and nurturing as a negative thing, I might not be able to reminisce on my childhood so positively, and I might conclude that I was in fact, not seen. However, this is not the case.

I was seen in all other areas of my childhood as well. Not only was I regarded as an artist, creative, energetic soul, whose passions were directed toward both visual and dramatic arts, I was seen as a whole, complete person. I felt understood as a person with a self, and I was supported in all ventures. How my parents interacted with me as a young child shaped who I am today, and informed my self-concept. This support is imperative to a developing self, something one will undoubtedly encounter in therapy, for we are always developing, always reaching for self-actualization.

At the end of this reflection, I was left with one probing question that had been ruminating in my mind.

What benefit does mirroring have on the therapeutic alliance, and process?

The therapeutic alliance is essential for successful therapy, without which there is no trust, and no relationship. Therapy happens in relation to an other. Mirroring demonstrates to the client that you can be trusted, in that, you will stave off judgements and interpretations in order to enter their world and attempt to fully understand them.

Mirroring encourages the therapeutic process, providing the client with freedom to explore their self in a safe, non-judgemental environment. Unconditional positive regard is an integral part of this aspect of mirroring. In order to mirror appropriately, we leave out personal reflections, interpretations and judgements. We recognize the client, and accept and appreciate them for who they are, in the moment. The change that occurs in therapy will happen at the client’s pace.

Conclusion

Mirroring is another aspect of the therapeutic presence that eludes us to a degree. It is nuanced and requires meditative practice. This is part of being present in therapy – always being attuned and aware of your self, body, and cognitions, and challenging them in the moment in an attempt to provide the client with the most beneficial environment wherein change can occur. One must practice each aspect of the therapeutic presence, which as mentioned before, will be a life-long process.

References

Carpendale, M. (2006). Kutenai Art Therapy Institute Manual. (pp. 45-60).

Therapeutic Presence: Empathy

    Therapeutic presence is a way of being with another person, within a therapeutic context, that reflects the therapist’s full engagement with the client (Geller, 2013). Carpendale suggests there are a number of aspects of presence, that can be examined through different lenses, in order for us to gain a better understanding of what constitutes therapeutic presence, and what it is we should aim for (Carpendale,2006). These aspects are: centering, grounding, containment, empathy, mirroring, and boundaries (Carpendale,2006). The lenses Carpendale suggests are: self, other, metaphor, the manifestation in art, development in childhood and the therapeutic session (Carpendale,2006). Each lens will enliven our understanding of a particular aspect in a different way, and through our examinations we will be able to understand the aspects application in the different arenas in our life (self, other, metaphor and so forth).

    It is important to explore these aspects in relation to our therapeutic presence. We will find that we have strengths in some areas, and are lacking in others. This is significant information to be aware of, so that we can explore how to strengthen and enhance each aspect, integrating them into our therapeutic presence. The first aspect I will explore is empathy.

    Empathy is considered as a ‘being with’ the other person (Carpendale,2006) and from this viewpoint, we could almost consider empathy to constitute the entirety of the therapeutic presence. Rogers presented empathy as one of the core conditions of his person-centered therapy approach (Rogers, 1959, 1961). He defines empathy as a process rather than a state (Rogers,1975) which suggests that empathy is something a therapist can practice, and eventually hone as a skill. It is my assumption that as with any aspect of therapeutic presence, no therapist will ever have successfully honed or developed a skill to a point where growth can no longer occur. That is, empathy, containment, mirroring – any of the aspects of the therapeutic presence – require life-long practice and development. They will alter over time, from moment to moment, and from client to client.

Rogers says of empathy:

“It means entering the private perceptual world of the other and becoming thoroughly at home in it […]being sensitive, moment to moment, to the changing felt meanings which flow in this other person […] moving about in it delicately without making judgments […] not trying to uncover feelings of which the person is totally unaware.” (Rogers,1975).

    Why is empathy so important to the therapeutic process, and in our case, the therapeutic presence? Empathy is related to positive outcome, and supplies a relationship that combats alienation (Rogers,1975). A client unable to express their innermost feelings for fear of being judged or rejected will feel isolated and alone. In a discourse rooted in empathy, the same client will feel an all too real human connection that is inexplicable in nature, and overwhelmingly restorative. There is no longer the fear of rejection, and there is no longer the result of alienation. Through empathic understanding, the therapist meets the client in their world, where they are at, and lays aside all judgements and interpretations. Rogers suggests that another significant reason empathy is so important is because it tells the client that they are valuable, and that someone cares (Rogers,1975). If we consider Maslow’s hierarchy of needs, we see that empathy contributes to the satisfaction of all higher level needs: love/belonging, esteem, and self-actualization (Maslow, 1962).

    Now that I have explored the meaning behind empathy as an aspect, I can explore personal meanings of empathy, how it presents in my art, in relation to others, and most importantly, in the therapeutic setting. The main questions I will be seeking to answer are: How does empathy present itself through my art-work? What metaphors come to mind when you think of empathy? How is empathy expressed and felt in relation to others? How is empathy expressed in the therapeutic setting?

Empathy in Art

    I explored the answer to this question using the paint-brush and my art journal, using a few simple directives: “What is empathy/what does empathy look like”? and “Think of an experience of empathy felt in therapy, or in relation with other. Draw or paint this experience. You can use metaphor to facilitate exploration.”

    In the first image, I very simply drew three circles, or mandalas, overlapping each other. This image is reminiscent of a Venn diagram, wherein the common elements of each set is represented in the overlapping areas. The mandala is a representation of the totality of the self (Jung, 1969), one which I identify with wholeheartedly. This image then directly represents the therapeutic relationship which is rooted in empathy. Each circle represents a separate entity – each circle has its own identity, represented by its own unique colour which emanates from it. In the centre of each circle we find the core of the self – the blue mass, shaped differently in each circle to represent different points of self-development and growth.

Figure 1. Mandalas

    Upon initial reflection I was inclined to suggest that these circles represent the therapeutic relationship itself – the therapist and client, represented in two circles, and the transference relationship embodied in the third. The areas of overlap are a direct representation of empathy as a process – the therapist reaches into the clients world, with their own personality, temperament and interpretations, and lays them aside, holds them at bay so to speak, while enacting empathy. In every relationship with another we bring our selves, there is no way that we can leave it behind. I also would not suggest it. When we enter the world of an other, we are there as visitor and witness, we do not make our permanent home in their world. Therefore I would suggest that if we left our selves behind, we would lose ourselves in the others world in our attempt to be fully empathetic.

    This image denotes the tripartite system to which humans ascribe – we are mind, body and soul. Very simply then, empathy is a bodily experience wherein we enlist our mind, body and soul to be entirely present and open with an other. I would argue that we are not fully present, not fully empathic, if one of these is missing, or not active.

    The next image I drew was in direct response to the second art directive – “Think of an experience of empathy felt in therapy, or in relation with other. Draw or paint this experience. You can use metaphor to facilitate exploration.”

Figure 2. Through your eyes

    This image is an incomplete self-portrait. The breaks in the lines are representative of putting my self aside while interacting with a client, or other, from an empathic stance. The core of my being is present, but I am not, and do not need to be, the focus.

    When I thought of metaphor, I thought about seeing the world of the other, and seeing through their eyes. Again, my eyes are being overshadowed by the eyes of the other. My eyes still remain, my core self still remains while witnessing through the client’s eyes, but they are there to digest the contents of the client’s world so that I can better understand their situation. They are not interpretive, or judging eyes.

    The colour blue holds significant meaning for this understanding of empathy. It is suggestive of water, a clear reference to the unconscious (Jung, 1969). The water bleeds from the client’s eyes, wetting the page. Through my empathic response, I become witness to the unconscious content. In this way, I believe our empathy plays an important role in accessing and truly hearing the client’s unconscious in conscious dialogue.

Metaphors

    Metaphors are an excellent way to illustrate a deeper meaning or felt-sense that everyday language simply can’t achieve. We might find that words fail us at times, and metaphors can be used to express more wholly what we mean. For instance, someone who is angry might refer to themselves as a hot pot boiling over. This denotes a much more detailed, graphic image, and provides us with a valuation of the feeling of anger.

    In regards to empathy, there are a number of metaphors that access the core of what it means to be empathetic. For instance: seeing through someone’s eyes, or being in someone’s shoes. Dante provides us with some excellent allegorical language when it comes to empathy: Virgil acts as a companion to Dante in his journey through hell. This is akin to our idea of empathy as being witness to, being present to, or being a companion through the therapeutic process.

    The idea of worlds also provides a significant metaphor. We enter the other person’s world through the use of empathy, ensuring we make no changes, and remain as visitor, guest, or witness to their world. It is similar to visiting a country or city we have never been to before, and experiencing their unique culture and way of being.

Empathy in relation to other

    Empathy is a multi-faceted concept that I think is too often simplified to “understanding an others emotions” or “mirroring” an others emotions. Feeling entirely overwhelmed by an others emotions to the point where you become the focus rather than the client is dis-advantageous. You exhaust your energies and your focus and you are no longer a present and helpful witness.

    I will provide a brief account of an interaction with a client wherein I practised empathic witnessing, and the results were favourable.

Rosie

    Rosie has been discussed before. She is a geriatric African Nova-Scotian living in Halifax, Nova Scotia. Her primary diagnosis is schizoaffective disorder bipolar type, and she exhibits OCD like behaviours. She becomes increasingly anxious when she is experiencing a hallucination, and she becomes engrossed in these – interacting with them both verbally and physically.

    One evening while Rosie was experiencing an intense hallucination, she became increasingly anxious and frightened. Instead of distracting her from the hallucination, or denying its existence (because for her the hallucination is very much a reality, regardless of whether we can see it or not), I was witness. I reminded her of my presence, through physically being near her (keeping in mind her need for personal space and respecting this). In the throes of her hallucination she was almost entirely non-verbal, other than in response to the hallucination itself. Therefore, my presence was all that I could offer her, as a sort of grounding mechanism to reality, without invalidating her current experience. In this way, I gently, and slowly entered her world.

    After, Rosie remarked how frightened she was, and I echoed her sentiment. Not that I was frightened – I can not lay claim to a sensation or feeling I have yet to experience. This too works to invalidate her experience. Rather, I expressed how she was frightened – how frightening this hallucination must have been to cause her so much anxiety. She continued the conversation, expressing her intense anxiety in reaction to this hallucination, describing her bodily sensations (heart beating rapidly, shaking). Again, I acknowledged these feelings and sensations, without suggesting that I too experienced them. Through my echoing her feelings, I became a validation for her, a sort of container outside of herself to acknowledge the experience and her reaction to it.

Empathy in the therapeutic relationship

    Empathy in the therapeutic relationship is similar to empathy in relation to other – this is what therapy is – a relationship between therapist and client. It is important to remember what empathy is, and how it manifests itself inside the self, our art, and through metaphor, so that we can harvest these grains and apply them in the therapeutic relationship.

    Empathy is a presence, a process whereby we lay aside our personal prejudices, judgements, and interpretations to make room for the client to grow. It is a facilitative agent of change, without it, there would be a block. If the client feels that he is being judged, he will hide things, avoid the main issue that has brought him to therapy, or worse yet, leave the therapeutic relationship entirely. Empathy then is a major component in trust within the therapeutic relationship. The client will be unable to trust you, that you truly care for and have unconditional positive regard for him, if he can sense a judgement or a negative appraisal.

    Empathy avoids interpretation – which seems counter-intuitive when we are talking about insight-oriented therapies, especially when we speak of psychodynamic approaches which are built on Freudian ideas and concepts. However, it is imperative that we avoid interpretation – of both words and art-work. Our interpretations will invariably colour the clients own interpretations of their work, and if we make a premature, or wrong interpretation, this could annihilate the therapeutic alliance entirely. An interpretation could easily be misconstrued as a judgement by the client, and because of this it should be avoided.

Conclusion

    Empathy is one of the most important conditions for person-centered therapy, and a significant aspect in therapeutic presence. I would argue that without empathy, there is no therapeutic presence. I believe that empathy is the bed-rock from which all else is built. Empathy requires practice and regular focus. At the outset of this paper I suggested that each of these aspects that Carpendale proposes require life-long dedication and development. They will change over time, and from client to client. This rings especially true for empathy.

References

Carpendale, M. (2006). Kutenai Art Therapy Institute Manual. (pp. 45-60).

Geller, S. M. (2013). Therapeutic Presence: An Essential Way of Being. In Cooper, M., Schmid, P. F., O’Hara, M., & Bohart, A. C. (Eds.). The Handbook of Person-Centred Psychotherapy and Counselling (2nd ed). pp. 209-222. Basingstoke: Palgrave.

Jung, C.G. (1969). Archetypes and the Collective Unconscious, Collected Works of C.G. Jung, (Volume 9). Princeton, N.J.: Princeton University Press.

Maslow, A. (1962). Toward a psychology of being. Princeton, NJ, US: D Van Nostrand.

Rogers, C. (1959). A Theory of Therapy, Personality and Interpersonal Relationships as Developed in the Client-centered Framework. In S. Koch, (ed.). Psychology: A Study of a Science. Vol. 3: Formulations of the Person and the Social Context. New York: McGraw Hill.

Rogers, C. (1961). On Becoming a Person: A Therapist’s View of Psychotherapy. London: Constable.

Rogers, Carl. (1975). Empathic: An Unappreciated Way of Being. The Counseling Psychologist. Vol. 5, No. 2-10.