‘We cannot hold the truth of this world in our hands… And so I am happy to be as I am in this not knowing, to see things without needing to know what they are, if they come from me or they belong to the sky and the hills, my breath and your breath and the way light passes over the stillness of things.’
Paul Lynch, Grace (2017, p.353)
‘Like all good listeners, he has a way of attending that is at once intense and assuasive: the supplicant feels both nakedly revealed and sheltered, somehow, from all possible judgement. It’s like he’s working as hard as you… both of you, briefly, feel unalone.’
David Foster Wallace, Infinite Jest (1996: 388)
When counsellors and psychotherapists introduce activities, exercises, guidance or psychoeducation, what, if anything, is lost? Is therapy enhanced or do we sacrifice something important? One answer to this question can be found in the relational art, ethical rigour and therapeutic value of a practice that does not routinely use these kinds of interventions but instead foregrounds not-knowing, deep listening and the emergent potential of empathic connection.
Here I sketch an account of such an approach, drawing on ideas found in person-centred therapy and psychoanalysis. I also briefly discuss the work of Mark Hollis, a musician whose creative process offers an illuminating parallel for psychotherapeutic practice.
Talk, talk, talk, talk*
When the late Mark Hollis (1955 – 2019), singer and songwriter of the 1980s synth-pop band Talk Talk, shed both the synths and the pop to create his final three albums (Spirit of Eden, Laughing Stock and Mark Hollis) before quitting the music business for good, he took his art into the realms of subtle repetition, whispered refrains, near-silence and bursts of emotive noise that evaporated as quickly as they arrived. He stripped away the formal structure and stylised busy-ness of pop music and focussed instead on the qualities of just a few sounds and the juxtapositions and spaces between them.
Hollis took his time, stretching out both the recording process and the music itself, creating long passages with just the faintest of rhythms accompanied by the delicate flutter of musical ideas, from improvised jazz horns to hard-to-place drones and blues or folk inflected guitar ripples. Dissonance and harmony, complexity and simplicity, are weaved together on these albums. The tides of sound and song surge and recede, with Hollis’ inimitable voice refusing to dominate, even in all its melancholic resonance, but instead hovering, gliding and swooping in accompaniment. As tracks build and fade the combined effect is to create an intricate, intimate and yet wide-open space, full of potential meaning.
What does this have to do with counselling and psychotherapy? I hope the answer will become clear in what follows but the key point here is that therapists sometimes miss a truth that Mark Hollis tapped into and which the usual modality-based language of therapy can struggle to articulate, that when working with the human condition there is much to be valued in apparently doing less (I say ‘apparently’ because there is a lot more to it, as we shall see below).
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As a therapist and clinical supervisor who’s been around a while, I’ve noticed that counsellors and psychotherapists increasingly feel a need to get busy instigating activities and exercises, teaching theoretical concepts and advising on wellbeing strategies. There seems to be a growing belief that such tools and techniques are what real therapy is all about — the supposedly clever stuff that therapists do to help heal their clients’ psychological wounds.
But is this what real therapy is about? Undoubtedly plenty of practitioners see their work in this way, or something close to it. Some expressions of cognitive behavioural therapy (CBT), for example, can be relatively tightly structured around particular exercises with specific goals but therapists of other persuasions may also wonder whether they are doing enough stuff to help clients get the most from therapy: should I use this or that tool, try out this or that exercise, offer guidance on this that or that issue?
Any one of these interventions may (or may not) be helpful. Depending on the therapist’s approach, what’s happening for the client, the relationship between them, and when and how an activity shows up in the session, they might all have some therapeutic potential, so it is not for me to pre-judge their value for any one client in any one moment. In supervision we can explore where the desire to introduce them is coming from — theoretically, personally, relationally, professionally and culturally — but, as some of my supervisees would no doubt testify after hearing me say this too often, I think it is important in these deliberations to remember a deceptively simple principle, that as soon as we start doing something new, we stop doing something else.
The assumption I am challenging here is not that such interventions can be useful but that nothing is lost by introducing them. If we add something intended to help, the thinking seems to go, then surely the therapy becomes better, more therapeutic. If a client was struggling for words and now seems keen on some therapist-instigated activity, then this must be a good thing, right?
Well, no, not necessarily. While it might be a legitimate choice to teach a client about attachment theory, for example, or suggest they draw out a timeline of their life, we need to acknowledge that something has been lost in doing so, something that itself held therapeutic potential. If we are willing to make that sacrifice, then fine but at least let us acknowledge this loss and make the choice with our eyes and ears wide open.
So what exactly do we lose? Part of the difficulty in answering this question is that therapist-introduced activities are so visible, so tangible, so packed with benign intentions that their absence can seem like a deficit. It might also be argued that nothing is lost because the therapist is still doing everything they were doing before and is simply adding something extra, like scattering some enhancing cheese on a humble jacket potato. But therapy doesn’t work like this — extra ingredients, even highly complementary ones, do not necessarily enhance the dish. Even if they are tasty and enjoyed, we lose the potential of where we were before the extra ingredients were added.
A more theoretical way of thinking about this issue comes from person-centred therapy, where it can be framed in terms of ‘directivity’ – the extent to which the therapist is (non-)directive in their way of being with clients. From this perspective, the loss is quite obvious. The directiveness of the therapist-led intervention leads to a potential disempowerment of the client. We are compromising our respect for the client’s self-authority, losing the purest expression of the person-centred attitudinal stance — as found in Carl Rogers’ necessary and sufficient conditions (Rogers, 1957) — and therefore inhibiting our capacity to create the optimal relational environment for therapeutic change to occur.
In psychoanalysis too there is an awareness that the therapist’s desire to guide or introduce activities can obstruct more important processes, principally the client’s ‘free association’ which is facilitated by the analyst’s free-floating attention. In a famous and contentious paper, British psychoanalyst Wilfred Bion proposed working ‘without memory or desire’ (Bion, 1967), meaning to set aside theory and other knowledge from outside the therapy relationship (‘memory’) and to let go of therapist intentions for the client (‘desire’) in order to attend fully to the truth of the moment. We can link this back across modalities to the person-centred approach and Barry Grant’s proposal for ‘principled’ as opposed to ‘instrumental’ non-directiveness in his ‘ethics-alone’ client-centred therapy (Grant, 1990 & 2004). In this way of working the therapist similarly lets go of any theory-informed intention to change the client (though change may well happen) and instead holds a principled stance in relation to the uniqueness and right to self-determination of the other; a way of being that, ‘like love, is not acted on for what it achieves, but for what it honors [sic]’ (Grant, 1990).
These are intriguing propositions in their own right but I share them here to draw attention to what can be lost in the urge to ‘do something’. When we ‘just sit there’ we are not doing nothing, we are clearing a path for access to the emergent potential of the encounter, which is a fundamentally different way of working with another’s distress.
Note that I am not proposing the therapist sits in complete silence or offers nothing but straightforward empathic reflections. On the contrary, therapeutic dialogue without structured exercises, guidance or psychoeducation can still be alive with possibilities. The person-centred therapist, for example, embodies empathy, acceptance and authenticity in a variety of ways. The reality is we are never ‘just sitting there’, there is always more going on. It is not about reducing complexity or doing less, but doing — or being — something different, which brings us to the question of the nature and purpose of the therapeutic relationship.
I believe in you
It hardly needs stating that in therapy we are always in relationship. It is widely accepted and — if we need such confirmation — supported by evidence from academic research that the relationship is the key factor in what therapists can bring to meaningful therapy. So what kind of relational experience should we offer?
Consider for a moment the wider context of therapy. Our lives are already burdened with an infinite ‘to-do’ list of tasks, even if it is just checking our smartphones for notifications, while the internet gives us access to more expert advice than we could ever possibly need, let alone put into action. At the same time, the professional culture around mental health is burgeoning with ‘new’ insights and treatment techniques, tools of which the therapist is assumed to be a master technician. More than ever, versions of these psychological ideas and exercises now weave into mainstream education for young people, crop up in workplace training for employees in organisations, as well as being shared widely on social media as self-help strategies, a democratised access to psychological knowledge and practice that we might welcome. Yet has this widespread dissemination contributed to an improvement in our collective wellbeing?
It is telling that many clients arrive in therapy having road-tested these concepts and techniques only to find that they are not really working. Why would therapists just re-tread the same ground? Why not offer something else? We know that people in distress can be actively ‘self-righting’ or ‘self-healing’ (Bohart & Tallman, 1999), given the opportunity, and that a good therapeutic relationship is an ideal environment within which this active growth can take place. Indeed, the relationship is the therapy; it is not an operating theatre where clients undergo other procedures. Therapist-introduced activities might in some circumstances enhance that relationship but we should consider how it could develop if we set aside these interventions to put all of our efforts into attending to the client’s experience with an intuitive, unstructured and welcoming empathic curiosity.
I believe we need to see the therapist less as a technician or engineer of the client’s psychology and more as someone who can bear witness to the nuance, idiosyncrasies and complexity of the client’s internal and external worlds: to accompany them thoughtfully and compassionately in a deep engagement with both their pain and the inherent struggle to deal with it; to provide an exploratory dialogue for this struggle to unfold in its own unique way; to embrace the unknown and emergent dimensions of that process without resorting to simplistic comforts or mechanistic tinkering. The spirit of this is articulated beautifully by Judith Herman when she describes one aspect of working with survivors of violent trauma:
‘simple pronouncements, even favourable ones, represent a refusal to engage the survivor in the lacerating moral complexities of the extreme situation. From those who bear witness, the survivor seeks not absolution but fairness, compassion, and the willingness to share the guilty knowledge of what happens to people in extremity.’ (Herman, 2022, p.101).
If we are getting somewhere close to the real purpose of therapy here, then I hope it is apparent how the interventions that therapists pick up — often absorbed arbitrarily from those used by their own training tutors, supervisors and personal therapists — can close as many doors as they promise to open. Such offerings might be helpful for some clients, with some therapists, some of the time, but we should not assume that they automatically and universally function as enhancements, just as their absence from therapeutic work should not be taken as insufficiency, deficiency or unwelcome scarcity.
Immerse in this one moment
Mark Hollis, the musician referred to at the start of this article, said in an interview, ‘Before you play two notes, learn how to play one note. And don’t play one note unless you’ve got a reason to play it’ (Rune-Schjøtt-Wieth, 1998). I do not read this as an instruction on learning a musical instrument. Taken alongside his later recorded work, it articulates an ethic and aesthetic that — much like the therapy I am describing — peels away busy adornments to find the humanity underneath: taking time; listening closely; feeling the resonance of the moment; tuning in to the qualities of what is being expressed and what exists between those qualities; opening up the potential of a few timeless sounds and their interweaving echoes, harmonies and accompanying words and silences. It is an approach informed by minimalism but is not minimalist in what it creates. It does, however, refuse easily-pleasing ‘simple pronouncements’ that would otherwise crowd the soundstage. Instead these musical reveries invite us into their depths, to swim in their swells, currents and undertows, to feel the pulls and resistances.
None of which is to say that Hollis’ music is particularly cerebral or difficult. Like therapy, it is full of heart and clarity, with each moment carefully and collaboratively carved from a few core elements that have been honed with painstaking commitment, a focussed attentiveness to the intricacy and nuance of the task at hand, as evidenced by the near-mythical tales of the prolonged studio recording for the albums; a process of individual and collective improvisation that mined the raw material from which songs were then created by weaving together musical themes and fragments from different sessions (Wallace, 2019). The direction is towards refinement and distillation but the music is not machine-tooled or mechanistic. It is rooted in the creative potential of the accidental and as-yet-unknown, as well as in the dissonance and harmony found in the human striving for individuality and connection.
Which brings us back to the art of therapy and how, in my view, the relational craft of therapeutic dialogue is — or should be — similarly intentioned. It is not a march but a dance (Thorne, 2009), a boundaried improvisation that distils and refines some fundamental elements of ethical interaction: deep listening, respect, humility and an acknowledgement of the other’s unique humanity; homing in together on the interwoven layers of experience to find meaning, resonance and the possibility of change in what emerges.
How easily this is corrupted by the temptation to teach, advise, introduce, organise, lead or guide — to know. ‘Beware the need to appear clever’, warned person-centred writer Dave Mearns (Mearns, 1994), to which we might add, beware the need to know. This principle — a belief in the value of not knowing — can be found in the ethical DNA of person-centred therapy, as well as in existential psychotherapy and psychoanalysis, albeit expressed differently and not necessarily heeded by all who pledge allegiance to these approaches. Note the convergence between Peter Schmid’s description of person-centred therapy as the ‘art of not-knowing’ (Schmid, 2001), Ernesto Spinelli’s philosophy of ‘un-knowing’ in existential psychotherapy (Spinelli, 1997), and Wilfred Bion’s psychoanalytic ‘negative capability’, a concept borrowed from the Romantic poet John Keats meaning the ability of the therapist to tolerate ambiguity, uncertainty and not knowing.
Now contrast this with the instrumentalised free-for-all of knowing found in some quarters of contemporary therapy training and practice, which shows up in the popular ‘toolbox’ of techniques analogy and the pervasive notion that therapists require specific training, skills and treatments for each and every client concern — what person-centred scholar Jerold Bozarth called the ‘specificity myth’ (Bozarth, 1998).
I feel the need here to reiterate that I am not condemning this kind of work. There is nothing inherently wrong with an approach that regularly uses therapist-instigated activities but, likewise, there is nothing lesser about a therapy that refrains from doing so. Such practice has an established history. Person-centred therapy and psychoanalysis are foundational cornerstones of the psychotherapeutic field, yet their philosophical rationales and richly evolved heritages of theory and practice resist the temptation of the toolbox. Rather than wield the tools of the technician, the therapist in this mode makes space for the client to improvise, create and discover within an environment of relational connectedness.
“Accompaniment is not absence, nor is it a mysterious aloofness or superficial friendliness. It is the art of developing a compassionate, curious and uniquely tailored rapport, co-created through sustained empathic engagement”
In one paradoxical sense, the therapist is there in order to get out of the way; not to empower so much as to not disempower. Getting out of the way, crucially, does not mean a lack of engagement. The therapist’s craft is in engaging with great care and attention, to be as fully and authentically present as possible, to listen deeply and — for most of the time — to accompany closely and reflectively while resisting the temptation to conduct or lead. It might be as much about what the therapist does not say as what they do say, but what they do say is still important. Accompaniment is not absence, nor is it a mysterious aloofness or superficial friendliness. It is the art of developing a compassionate, curious and uniquely tailored rapport that is co-created through sustained empathic engagement; one that hears and aspires to articulate the depth and multidimensionality of what is being experienced — from the global, social and historical to the internal and relational — and which suspends the notion of needing to make things happen through expert intervention (‘generating outcomes’).
Implicit in this work is the question, “What is this person ‘saying’ to me in this moment (a moment which includes everything that has already happened between us)?” Not so that I can do something to it — define, categorise, engineer, mold, comfort, soothe — but so that it can breathe, unfold and no longer exist in isolation; so that it can sing, echo, harmonise, clash, replicate, or dissolve. Our job as therapists, as I see it, is to honour that unfolding in all its rich potential, to meet it where it is while tentatively inviting it to continue.
In my experience, this kind of exploratory dialogue will sound simultaneously idiosyncratic and ordinary, uniquely co-created by the participants but so fundamentally human that it reverberates with truth. It needs no predictive map (or musical score) because it usually finds where it needs to go, in its own good time, and while it may falter, need rest, or even occasionally get lost, it rarely runs aground completely. Just as in Mark Hollis’ landmark albums: time is taken; dissonance and chaos are prized alongside tranquillity and space; noise segues into harmony and out again; imposed structure makes way for boundaried improvisation; complexity and simplicity co-exist; repetition weaves into renewal; destinations arrive organically in relationships with their own rhythms, melodies and resolutions.
Something’s happening here
You do not need to enjoy Hollis’ music to relate to the therapy praxis described. I hope many practitioners will recognise the characteristics, see them at their heart of their work and have other ways of framing them, perhaps most commonly within the conventional theoretical traditions of counselling and psychotherapy. Person-centred therapy, at its best (by which I mean at its least compromised by mechanistic, goal-oriented instrumentalism), can provide an ideal practical and ethical training in the relational craft involved, and, as suggested above, psychoanalytic and existential approaches offer their own ways in too. What matters, though, is that we have sufficiently embedded foundations from which to step into the suffering of another person and to hold that uncertain ground without being driven to take charge by anxiety, fear or a need for power and control.
This is the art of not-knowing. We might even dare to call it love (Keys, 2017). But for me the qualities it most embodies are trust, humility and hope. Trust in the capacity of our fellow human beings to live well without destroying themselves or others, and in relationships as a vehicle for the fulfilment of that potential. Humility in the face of the complexity of the task at hand and the infinite possibilities of both our inner worlds and the entangled connections between them. Hope — not naïve optimism — as a principled stance in the face of our individual and collective existential predicaments, as a protest against the state of things.
There is, after all, much in the world to get busy about. As oppression and inequality tear us apart and we accelerate towards human extinction on a heating planet, if ever there was a moment to ‘just do something’, it is now. But when it comes to personal therapy, let us not extinguish the unique and potentially transformative potential of ‘sitting there’. It might have something important to say about the fractured crises of our times, if only we listen closely enough.
*Subheadings are borrowed from the titles and lyrics of songs by Mark Hollis and Talk Talk.
References
Bion, W.R. (1967) ‘Notes on memory and desire’, Psychoanalytic Forum, 2: 272-723, 279-280.
Bohart, A.C. & Tallman, K. (1999). How clients make therapy work: The process of active self-healing. American Psychological Association.
Bozarth, J. (1998) Person-Centred Therapy: A Revolutionary Paradim. Ross-on-Wye: PCCS Books.
Grant, B. (1990) ‘Principled and Instrumental Nondirectiveness in Person-Centred and Client-Centred Therapy’, Person-Centred Review, 5 (1), 77-88.
Grant, B. (2004) ‘The imperative of ethical justification in psychotherapy: The special case of client-centred therapy’, Person-Centred & Experiential Psychotherapies, 3(3): 152-165.
Herman, J.L. (1992/2022) Trauma and Recovery: The Aftermath of Violence — from Domestic Abuse to Political Terror (fourth edition). New York: Basic Books.
Keys. S. (2017) ‘Where is the love in counselling?’, Therapy Today, December 2017, 28 (10): https://www.bacp.co.uk/bacp-journals/therapy-today/2017/december-2017/where-is-the-love-in-counselling/
Lynch, P. (2017) Grace. London: Little Brown & Co.
Mearns, D. (1994) Developing Person-Centred Counselling. London: Sage.
Rogers, C. (1957) ‘The necessary and sufficient conditions of therapeutic personality change’, Journal of Consulting Psychology, 21 (2): 95-103.
Rune-Schjøtt-Wieth (2023) ‘Mark Hollis (Talk Talk) interview 1998’, YouTube: https://www.youtube.com/watch?v=XYQzJ6ezdLs
Schmid, P. (2001) ‘Comprehension: the art of not knowing. Dialogical and ethical perspectives on empathy as dialogue in personal and person-centred relationships’, pp. 53-71 in Haugh, S. & Merry, T. (Eds.) Empathy. Ross-on-Wye: PCCS Books.
Spinelli, E. (1997/2006) Tales of un-knowing: Therapeutic encounters from an existential perspective. Ross-on-Wye: PCCS Books.
Thorne, B. (2009). ‘A collision of worlds’, Therapy Today, 20(4): 22-25.
Wallace, W. (2019) ‘After the Flood: Talk Talk's Laughing Stock 30 years on’, The Quietus: https://thequietus.com/articles/06963-talk-talk-laughing-stock