Ryan Howes (Psychology Today) writes:
Perhaps the most powerful yet simple tool in psychotherapy is the here-and-now: sharing the raw, honest thoughts and feelings about what's happening in the moment. The concept has been around forever, but no one champions its clinical use quite like Irvin Yalom.
Here-and-now is based on the idea that the client's interpersonal issues will eventually emerge in the therapeutic relationship. A woman who feels betrayed by all her friends and family will probably feel betrayed by her therapist at some time. A man with anger issues will eventually feel angry in therapy. Addressing the material that emerges in the room becomes the focus. Therapy becomes less talking about issues and more working with them as they happen, in the here-and-now.
Yalom encourages therapists and patients alike to take the vulnerable risk of discussing what's happening in the moment, a noticeable shift that often bears fruit.
The here-and-now aspect of therapy is, indeed, a neglected aspect of psychotherapy, but I don't see the problem of here-and-now neglect in quite the same way Dr. Yalom does. My impression is that Yalom encourages discussion of conscious thoughts and feelings about what is happening, in the moment, between patient and therapist. If I understand him correctly, Yalom believes that stories about people and circumstances that aren't explicitly about the present moment would not qualify as here-and-now conversation. And therein lies the nub of my disagreement with Yalom. I believe that there-and-then stories are often encoded communications about here-and-now. In many instances, there-and-then stories can actually offer more honest appraisals of disturbing here-and-now situations than the conscious here-and-now stories encouraged by Yalom.
In a pair of recent posts, I offered examples of here-and-now communication disguised as there-and-then narrative.
First, let's return to my post about former Chicago Tribune columnist Bob Greene. If you haven't read the post, it's here. This was Greene's first column following his termination from the Chicago Tribune, two years earlier, for engaging in sexual misconduct with one of his young fans. The manifest subject of Greene's article is the dire consequences of the erosion of boundaries between professional athletes and fans.
If we view the column as a conversation between Greene and his readers, the unspoken here-and-now dimension of the conversation is the distress Greene was feeling as he made his first attempt to reconnect with readers infuriated by the behavior that led to his two-year professional exile.
If we apply Yalom's notion of here-and-now to the column, we would say that the column was a then-and-there conversation about the relationship between athletes and fans. But in my discussion of the Greene column, I noted the remarkable parallels between Bob Greene's damaged relationship with his audience and Greene's account of the damaged relationship between professional athletes and fans. If we understand the column as an unconscious parable, it offers an account of what Greene is thinking and feeling about his relationship with the audience actually reading his column in the here-and-now.
In a follow-up to the Bob Greene post, I offered another example of a distressing here-and-now situation masquerading as a then-and-there situation.
[I]t can be difficult, if not impossible, to tease out the encoded meanings in everyday conversation, but sometimes the meanings are all too clear. Overheard today, for example, a woman speaking to a female companion with absolutely gorgeous hair:
She doesn't want to admit it, but my friend Donna is insanely jealous of my hair.
Well, the speaker is almost certainly revealing her own disavowed feelings of hair envy. Mind you, I can't say I blame her. Her female companion had what might be the most beautiful hair I've ever laid eyes on.
[Encoded communication is] an unavoidable consequence of a two-tiered mental apparatus consisting of conscious and unconscious processing systems.
What is the relevance to psychotherapy?
Listening to the encoded subtext is one among several ways to listen to patient narratives when the patient is allowed to free associate without the disruption of a talkative therapist. Sometimes there is a [here-and-now] subtext [encoded in a then-and-there story] that just begs to be heard.
But by prematurely encouraging direct here-and-now discussion, we can get in the way of the creative mental processes that allow us to reveal the darker, hidden dimensions of here-and-now situations.
Would anyone argue that only here-and-now nonfiction books reveal the truth of our present lives? I suspect that many would argue quite the opposite, that the deepest here-and-now truths are often revealed in there-and-then fiction. After the fiction is written and after we read it, we may find that we have a rich vein of truth to explore. But we can't mine that truth if we prevent the writer from telling the story in the first place.