Therapist’s emotional presence and its interactional functions in promoting client change in relationship-focused integrative psychotherapy

Abstract

Therapeutic alliance is often posed as an explanation for why therapy works, and there seems to be a consistent finding that the stronger the alliance, the greater the therapeutic change. Although extensively documented in the professional literature as an essential aspect of therapeutic alliance, the concept of emotional presence and its actualization in moment-by-moment interaction have not been adequately described. This paper applies integrative qualitative methodology, including tools and insights from discourse analysis and conversation analysis, to five extracts of Relationship-focused Integrative Psychotherapy sessions with three different clients. It examines the concept of emotional presence operationalized in terms of the therapist’s invoking the client’s immediate experience. The analytical focus falls on an interactive sequence involving the therapist’s topicalization of the client’s (proffered) non-verbal cues aiming at eliciting emotion talk in the interactional here-and-now and the latter’s orientation to it. The psychotherapist’s strategy of emotional presence is proposed to play a salient role in promoting the client’s (gradual) change by focusing the talk on the client’s here-and-now experience. Thus clients are prompted to project their emotions and/or engage in overt self-reflexive examination of emotional and relational patterns in the immediate context of their concrete trouble-telling. By being regularly exposed to such practices in therapy, clients are instilled with a sense of being in touch with how they feel about a particular situation or person.