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Metacommunication
Metacommunication can begin with questions or observations by the therapist that focus the patient’s attention one or more of three dimensions. The therapist might start by focusing the patient’s attention on his or her own experience with a direct question such as “What are you feeling right now?”, or with an observation about the patient’s demeanor, such as: “You seem anxious to me right now. Am I reading you right?” The therapist might also direct attention to the interpersonal field by asking, “What’s going on here between us?”, or observing, “It seems like we’re in some kind of dance. Does that fit with your sense?” A third approach is for the therapist to judiciously disclose some aspect of his or her own experience or attempt to articulate an intuition or felt sense, as part of the process of beginning to explore what might be going on in the therapeutic relationship or in the patient's experience. For example, "I feeling kind of cautious right now, as if it it might be easy for me to say the wrong thing. Does that make any sense to you?"
We have outlined a number of general and specific principles of metacommunication, but some basic ones include:
Invite a collaborative inquiry and establish a climate of shared dilemma. The implicit message should always be one of inviting the patient to join the therapist in an attempt to understand their shared dilemma. Patients often feel alone and demoralized during a rupture. Ruptures should be framed as shared problems to be solved together. Therapists learn to expect ruptures as an important part of therapy and as valuable opportunities for change. This sensibility should be conveyed to clients both explicitly and implicitly. In the same vein, therapists should communicate observations in a tentative, exploratory manner that signals an openness to patient input, rather than conveying information as if it has an objective status. In this way, instead of being yet one more in an endless succession of figures who do not understand the patient’s struggle, the therapist can become an ally who joins the patient.
Focus on the present. The focus should be on the here-and-now. A specific, immediate focus helps patients to become observers of their own behavior and to discover their internal experience in the moment, instead of speculating about it. This does not mean that that therapists discourage patients from talking about the past or about previous sessions. When exploring the past, however, therapist should always monitor what is happening in the present moment. This involves 1) paying attention to the patient's relationship to his or her own feelings (are they in touch with them or avoiding them?), 2) paying attention to their own emerging feelings, and 3) paying attention to that is going on in the therapeutic relationship.
Monitor patients' responses to all interventions. How does the patient respond to a specific intervention? Is he or she withdrawing? Does he or she seem to feel criticized? Is he deferring or agreeing too readily? Does he or she seem to be making constructive use of the intervention? Does he ignore it or change the topic? Does he or she contact emotions? If it is difficult to get a sense of what the intervention means to the patient, it can be helpful to inquire (e.g., "It's hard for me to get a sense of what's going on for you right now. Can you say anything about what you're experiencing?") Exploring and understanding the patient's response to an intervention helps the therapist to further refine his or her understanding of the patient's internal world. Therapists should constantly be gauging their subjective sense of relatedness to the patient.
Pay close attention to one's own emerging feelings as a potentially valuable source of information. Therapists feelings are alway providing them with information about themselves in relationship to the patient in any given moment. Their feelings are not an infallible source of information about the patient but they do provide information about how this specific therapist is affected by this specific patient. Therapist can err either in the direction of 1) ignoring or discounting the potential relevance of their feelings to understanding their patients, or 2) overvaluing the relevance of their own feelings as a potential source of information relevant to understanding their patients.
Recognize that the relationship is constantly evolving. It is important for therapists to keep in mind that
that the therapeutic field is changing on a moment-by-moment basis. For example: 1) a therapist is trying to understand the patient's experience. As the patient withdraws the therapist becomes more persistent in his or her exploration. A pattern is beginning to emerge in which the patient feels persecuted by what he or she experiences as the therapist's relentless pursuit; 2) A patient asks the therapist to explain "how therapy works?" The therapist attempts to provide a rationale, but the patient appears not to understand. The therapist elaborates his or her explanation, but the patient continues to appear puzzled. A pattern emerges in which the therapist is attempting to persuade a patient who becomes increasingly skeptical.
The therapist's overarching task in these situations is to attempt to maintain a meta-awareness of what is being played out in the relational field as each new moment unfolds. The first step in this process often involves first becoming aware that one has lost his or her reflective capacity or meta-awareness. It is precisely this type of ongoing reflective process that we term mindfulness-in-action. Therapists should always try to use whatever is emerging in the moment as a point of departure for further exploration and metacommunication.
Emphasize one's own subjectivity and be open to exploring one's own contribution. Therapists should emphasize the subjectivity of their perceptions. This plays a critical role in establishing a climate that emphasizes the subjectivity of all perceptions and helps to establish a collaborative, more egalitarian relationship where the patient feels freer to decide how to make use of the therapist’s observations. In addition, therapists should be open to exploring their own contributions to the interaction with the patient in a non-defensive manner. This process can help patients become less defensive, more able to look at their own contributions, and more aware of feelings they may be experiencing, but have difficulty symbolizing and putting into words because of their fears of retaliation or abandonment.
Expect initial attempts metacommunicate to be just the beginning of an ongoing process. It is important for therapist to bear in mind that their first attempts to metacommunicate are just beginning of a process of disembedding from a relational dance that is being enacted. These initial attempts may result in more ruptures and can lead to new interpersonal dances or enactments. It is important for therapists to keep in mind, however, that these interpersonal dances are an inevitable part of therapy. In many cases these enactments can provide therapists with some of the more valuable opportunities to refine their understanding of their patients in a way that can ultimately facilitate the change process. Periods of hopelessness for both patients and therapists can be necessary stages in the resolution process. As therapists come to trust in this process through their own experiences, it enables them to have faith even in the context of their own hopelessness, and to convey this sense of faith to their patients.
We have outlined a number of general and specific principles of metacommunication, but some basic ones include:
Invite a collaborative inquiry and establish a climate of shared dilemma. The implicit message should always be one of inviting the patient to join the therapist in an attempt to understand their shared dilemma. Patients often feel alone and demoralized during a rupture. Ruptures should be framed as shared problems to be solved together. Therapists learn to expect ruptures as an important part of therapy and as valuable opportunities for change. This sensibility should be conveyed to clients both explicitly and implicitly. In the same vein, therapists should communicate observations in a tentative, exploratory manner that signals an openness to patient input, rather than conveying information as if it has an objective status. In this way, instead of being yet one more in an endless succession of figures who do not understand the patient’s struggle, the therapist can become an ally who joins the patient.
Focus on the present. The focus should be on the here-and-now. A specific, immediate focus helps patients to become observers of their own behavior and to discover their internal experience in the moment, instead of speculating about it. This does not mean that that therapists discourage patients from talking about the past or about previous sessions. When exploring the past, however, therapist should always monitor what is happening in the present moment. This involves 1) paying attention to the patient's relationship to his or her own feelings (are they in touch with them or avoiding them?), 2) paying attention to their own emerging feelings, and 3) paying attention to that is going on in the therapeutic relationship.
Monitor patients' responses to all interventions. How does the patient respond to a specific intervention? Is he or she withdrawing? Does he or she seem to feel criticized? Is he deferring or agreeing too readily? Does he or she seem to be making constructive use of the intervention? Does he ignore it or change the topic? Does he or she contact emotions? If it is difficult to get a sense of what the intervention means to the patient, it can be helpful to inquire (e.g., "It's hard for me to get a sense of what's going on for you right now. Can you say anything about what you're experiencing?") Exploring and understanding the patient's response to an intervention helps the therapist to further refine his or her understanding of the patient's internal world. Therapists should constantly be gauging their subjective sense of relatedness to the patient.
Pay close attention to one's own emerging feelings as a potentially valuable source of information. Therapists feelings are alway providing them with information about themselves in relationship to the patient in any given moment. Their feelings are not an infallible source of information about the patient but they do provide information about how this specific therapist is affected by this specific patient. Therapist can err either in the direction of 1) ignoring or discounting the potential relevance of their feelings to understanding their patients, or 2) overvaluing the relevance of their own feelings as a potential source of information relevant to understanding their patients.
Recognize that the relationship is constantly evolving. It is important for therapists to keep in mind that
that the therapeutic field is changing on a moment-by-moment basis. For example: 1) a therapist is trying to understand the patient's experience. As the patient withdraws the therapist becomes more persistent in his or her exploration. A pattern is beginning to emerge in which the patient feels persecuted by what he or she experiences as the therapist's relentless pursuit; 2) A patient asks the therapist to explain "how therapy works?" The therapist attempts to provide a rationale, but the patient appears not to understand. The therapist elaborates his or her explanation, but the patient continues to appear puzzled. A pattern emerges in which the therapist is attempting to persuade a patient who becomes increasingly skeptical.
The therapist's overarching task in these situations is to attempt to maintain a meta-awareness of what is being played out in the relational field as each new moment unfolds. The first step in this process often involves first becoming aware that one has lost his or her reflective capacity or meta-awareness. It is precisely this type of ongoing reflective process that we term mindfulness-in-action. Therapists should always try to use whatever is emerging in the moment as a point of departure for further exploration and metacommunication.
Emphasize one's own subjectivity and be open to exploring one's own contribution. Therapists should emphasize the subjectivity of their perceptions. This plays a critical role in establishing a climate that emphasizes the subjectivity of all perceptions and helps to establish a collaborative, more egalitarian relationship where the patient feels freer to decide how to make use of the therapist’s observations. In addition, therapists should be open to exploring their own contributions to the interaction with the patient in a non-defensive manner. This process can help patients become less defensive, more able to look at their own contributions, and more aware of feelings they may be experiencing, but have difficulty symbolizing and putting into words because of their fears of retaliation or abandonment.
Expect initial attempts metacommunicate to be just the beginning of an ongoing process. It is important for therapist to bear in mind that their first attempts to metacommunicate are just beginning of a process of disembedding from a relational dance that is being enacted. These initial attempts may result in more ruptures and can lead to new interpersonal dances or enactments. It is important for therapists to keep in mind, however, that these interpersonal dances are an inevitable part of therapy. In many cases these enactments can provide therapists with some of the more valuable opportunities to refine their understanding of their patients in a way that can ultimately facilitate the change process. Periods of hopelessness for both patients and therapists can be necessary stages in the resolution process. As therapists come to trust in this process through their own experiences, it enables them to have faith even in the context of their own hopelessness, and to convey this sense of faith to their patients.
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