Copywrighted by Spencer Overgaard.

Eight Truths about Psychotherapy (2020)

1. The fit between you and the therapist is likely the most important factor in its effectiveness. Pay attention to the fit.

2. Affect (‘feeling, emotion, desire,’ according to the Concise Oxford Dictionary) is the ‘currency’ of therapy. What this means is that having feelings, coming to feelings, and striving toward an awareness of feelings is the essential element of a therapy. For some people, to simply be able to feel anything emotional is difficult. The early part of therapy may be a period of learning what you feel, and, perhaps, to learn that you feel at all. To access one’s feelings may seem elementary, but it can often be far more difficult than one imagines.

3. There is no right way to do therapy.

4. There is no one way to start a session. One supervisor I had used to say, ‘Start with what’s most pressing.’

5. Your curiosity in who you are and how you feel will be an important asset in your work.

6. Psychotherapy is about change. The change that happens will be within you. Others may change as a consequence, but that change is not the reason to enter therapy.

7. The reason a therapist can be helpful will be contingent on their ability to listen. My mentor says, ‘Listening is a profound act.’

8. Part of the becoming a good listener is having had the experience of one’s own therapy. It takes time working on oneself to begin to grasp how difficult looking at oneself closely can be. They know how hard it is to sit in the client’s chair because they have been in that chair themselves.

The space between two chairs. (2014)

When a client first comes to therapy, a space is provided. It’s a space of time – an appointment time, a beginning and end time, usually an hour or so. But there is also a physical space in the office: two chairs, one for the client and one for the therapist, with room in between. That space between the two chairs allows both to be comfortable in a social sense. Since we like our personal space, the distance between the two chairs feels natural. But that space is more than physical and social—it can also represent a value of a different sort.

The space between the two chairs is also an area where self-exploration and awareness can occur. It can be a place where the client can ask to be taken seriously. The space can also be an important buffer between two people. The client may need a secure distance from another he may see as an authority figure. The space can also represent the emotional latitude the therapist gives the client, especially if she is feeling vulnerable. In short, the space can allow for psychological acceptance, learning and growth.

Perhaps one of the most significant uses of “the space in between” is as a container – a place to store things. Just as children have a toy chest where they toss their playthings, or the handyman a box for ready access to the right tool, the space between the therapist and the client can hold and provide access to feelings.

To illustrate this, consider the expression, “She held herself together.” This saying means this person, despite experiencing some stressful emotion, was able to keep her feelings in check. She didn’t fall apart under pressure. She might have been shamed, falsely accused, or unfairly criticized and so on, but she kept her feelings reigned in. And, she didn’t let them spill out to affect others. This capacity is often useful self-control. There are, however, times in our lives when we’re not capable of doing this alone.

Emotions can become so burdensome that they severely affect our behaviour, thinking, and self-esteem. If we have no reliable and safe opportunity to examine those feelings they can undermine our well-being and end up hurting our nearest and dearest. When this happens, we need a place – a space – to let our feelings go. The burden can be let down in the space between the two chairs.

It’s not uncommon that clients without warning begin to weep in their first session. Possibly for the first time, there is a space for them to experience their own feelings without worrying what someone else might think. There is so much in our lives that encourages us to deny, ignore and move away from how we feel.

To allow ourselves the full depth of feeling, especially if it’s something unpleasant like anger or anxiety, can be unnerving. Although it might be out of our conscious awareness, we might seek to avoid experiencing the discomfort of the feeling by, instead, distracting ourselves by scrolling on our phone. To make a commitment to oneself to face the pain of uncomfortable feelings is a big step.

To one way of thinking, the space between the two chairs in a psychotherapist’s office can seem like it’s nothing special. Usually we are only talking about a distance of a few feet. How is it that so little space can hold so much meaning? Donald Winnicott, a British pediatrician and psychoanalyst, discusses this in his book Playing and Reality (Tavistock, 1971). He saw the space between the therapist and the client as a place for creative work. He actually uses the word play rather than work.

As a pediatrician treating infants, young children and mothers, Winnicott had insight into the requirements for healthy emotional and psychological development. Children, he said, need a space to play supported by a backdrop of sturdy parenting. Within this safe space, play could take place with all its possibilities for imagination, discovery and feelings- both good and bad. He recognized that play was essential for the child’s developing sense of self.

If we apply this notion to the therapy office, the space between the therapist and the client becomes an arena for development, for work and for creative play. We can relax the normal hesitation and reluctance to address our feelings. Our deeper feelings can be examined and explored. We can have the hope of being heard and understood. In the space between two chairs, we have room to simply be ourselves, and to feel the fullness of who we are.

A note on my writing

Psychotherapy is a subtle craft, difficult to undergo and challenging to depict. The stories presented here are intended to paint a picture of how I go about my work. There are many different ways to do psychotherapy, so I am hoping these ‘paintings’ will convey a rough outline of my particular style, my way of holding the brush.

Any person I write about does not correspond directly to actual individuals. Rather they are composites, the content drawn from real interactions with real people, but with their identities protected. The interactions presented have been collected over twenty years of practice and have coalesced to become material with which I describe my work. The goal of sharing these stories is to capture moments of work which may be of use to others.

A note on the following article

This article came to me as a result of listening to and reflecting on lectures on William Bion, a British psychoanalyst. They were presented by Chis Mawson & Nicola Abel-Hirsch and hosted and recorded by the Institute of Psychoanalysis in 2018.

Even in situations where there is a firm rapport between therapist and patient, disruptions in the connection occur. These moments can be an opportunity for exploration for both patient and therapist.

When the misalignment happens, the patient’s message might be, ‘Back off, please; I need a moment to gather myself.’

In these interactions, I try to simply stay present with the discomfort manifest in the conversation. I’m pausing and listening to the patient and to myself. At this moment, I’m asking: What is she experiencing? What am I experiencing? What is happening between us?

These pauses give space for the patient to attune more deeply to their own experience and to relate to me where they find themselves.

On occasion, these momentary pauses can open up awareness to emotions lying below the surface.

Breaks in relating (2025)

The patient I will refer to as Sheila had worked with me for a number of years before the interaction described below occurred. At the time of this session, she was in her mid 40’s and had been widowed for four years. Her husband of eight years died of cancer and they had no children.

During our therapy Sheila wrestled with the impact her relationship with her parents had had on her emotional development. Her mother had been overbearing which undermined Sheila’s self-confidence. Additionally, to compensate for this lack of self-esteem and following her mother, Sheila adopted a sense of superiority over others which lingered long into the therapy. Both characteristics limited her capacity for emotional intimacy not only with her husband, but in friendships as well.

Her father was less involved with Sheila than her mother. He was well-meaning but not a very effective figure in her life, especially in tempering the negative effect of her mother. Despite this background, Sheila’s parents provided enough of the essentials of life for her to attain a university education and secure a stable career.

The interaction in question began with Sheila boasting about a work achievement which was not uncommon. As I heard more about this story, I became uneasy. I raised some questions about why she might be sharing this with me. What was the message about herself she wished me to hear? Others to hear? Questioning her about her boasting annoyed her.

She defended her action as something worthy of doing and disputed that she was boasting. In the back and forth of the discussion, I dug in. Her efforts, I said, seemed to be about garnering praise with the goal of shoring up self-esteem. She seemed unpleasantly surprised that I would question her on this matter at all. ‘There’s nothing to see here’ was the gist of her response.

After some back and forth, she allowed she was unsettled by our discussion. Her statement acted like an electric shock on me: I had heard something akin to this from a different patient not long before. It seemed that I had questioned too closely. After registering my shock, my response to Sheila was – fortunately- empathic. I acknowledged I had been unhelpful in that moment. At that point a brief silence descended. I waited to hear what she would say next.

I could almost hear her churning, and processing through our last exchange. In moments like these, I know Sheila is capable of monitoring her responses and to be curious regarding her emotional reactions. This ability is a consequence, in no small part, of our work together.

The open and sensitive response on my part seemed to have reached her since the air between us warmed following the silence. Before long, she says – not without feeling – ‘I miss my husband.’ In that moment, I was stunned. In a matter of minutes, she had gone from wanting to justify her boastful ways to speaking about an emptiness in her life. Revealing an emptiness in her private emotional life was a dramatic shift from grandstanding to vulnerability.

She then added she believed her resistance to my questions was a means for her to avoid her need for love. This was a remarkably honest statement.

Admitting to being lonely was a step forward in our work. Up until this session, she was reluctant to admit to the paucity of her emotional world. Doors to those rooms rarely opened. In years of therapy, she rarely ‘broke down.’ But now, in what seemed like the span of one session, she was opening up to this unknown land within.

In summary, in the space of minutes, Sheila had managed to do several impressive steps: She recognized that our discussion was making her feel uncomfortable and was confident enough in both her self-awareness and our relationship to mention it. She acknowledged my admission of being too inquisitive. At that point, she could have felt sorry for herself or even blamed me, but she moved forward instead. She made use of the silence we gave to one another. Then she looked inward and discovered, flying ‘under her radar,’ a longing to have someone in her life.