Clin Soc Work J (2015) 43:398–406
DOI 10.1007/s10615-015-0523-8
ORIGINAL PAPER
Relational Theory: A Refuge and Compass
Terri Rubinstein
Published online: 11 March 2015
Springer Science+Business Media New York 2015
Abstract Relational theory offers a structure from which
to understand and treat the interpersonal and intrapsychic
legacy of severe childhood trauma. During the course of
treatment, particularly with such traumatized patients,
therapists are challenged to tolerate and make meaning of
intense feelings in the transference-countertransference
matrix. Relational theory’s ideas regarding adaptation to
and perpetuation of the relational patterns of early life,
dissociation of disavowed and intolerable self-states, and
the inevitability of mutual enactments provide an organizing framework in which to weather and make bearable
the unbearable. In addition, relational theory invites and
supports the clinician in the vital task of meeting the patient’s vulnerability with his or her own authentic and
vulnerable self. The following case material demonstrates
the use of relational theory to find and to work at the intimate edge (Ehrenberg in Relational psychoanalysis: innovation and expansion, Analytic Press, Hillsdale, pp 3–28,
2005) where the impossible becomes possible.
Keywords Relational Enactment Trauma Transference-countertransference Dissociation Self-disclosure
parents were watching us from a blanket on the beach. It all
seemed perfectly safe—we were fairly far out, but we were
standing on a sandbar. All of a sudden, the sandbar washed
away and the water was now well above our heads. I began
paddling my little arms and legs as hard as I could, but to
my horror, I was making no progress toward shore. Had it
not been for my parents or the lifeguards who ultimately
saved us, I surely would not have made it. In my work with
the patient discussed below, the sandbar frequently washed
away revealing a sea that was far more tumultuous and
sinister. In this case, I was not only at risk of drowning, I
was also supposed to be my patient’s lifeguard or savior.
While I was tossed around in the turbulent sea with my
patient, I was sometimes able to find refuge and to orient
myself through clinical theories. They gave me comfort in
the face of overwhelming and painful feelings and helped
me make meaning of what was transpiring within us individually as well as between us. Although I drew on
multiple theories, relational theory offered the greatest
support in weathering the emotional storms that characterized the treatment.
The Therapeutic Dyad From a Relational Perspective
When I was a child, I had a near-drowning experience. I
was about 6 years old and I was at the beach in Long Island
with my family. My sister and I were in the water and my
T. Rubinstein
The Sanville Institute, Berkeley, CA, USA
T. Rubinstein (&)
The Psychotherapy Institute, Berkeley, CA, USA
e-mail: terrirubinstein@gmail.com
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A Two-Person Psychology: Transference
and Countertransference Configurations
Before presenting the case, I want to discuss the major tenets
of relational theory, emphasizing the particular relational
constructs that were most helpful to me in my work with this
patient. While there are multiple relational writers, they all
share in common the ‘‘basic assumption…that development
and unconscious phenomena are marked primarily by relationships, not by drives’’ (Layton 2008, p. 3). Relational
Clin Soc Work J (2015) 43:398–406
theory in general, and as applied to social work by Tosone
(2004), assumes the therapist is complicit in the inevitable
therapeutic impasses and re-enactments that happen between
patient and therapist (Aron 1999; Hoffman 1999; Layton
2008; Orbach 2008; Schamess 2012; Shaeffer 2014). Given
this, the therapist is understood to be a participant actively
shaping the relationship and shared reality between patient
and therapist (Aron 1999; Hoffman 1999; Layton 2008;
Levenson 1992; Shaeffer 2014).
Accepting that the therapist is an ongoing participant
shifts the paradigm from a monadic to a dyadic psychology. The idea of a two-person psychology in which
perception is shaped in interaction with others is fundamental to relational thinking (Layton 2008; Schamess
2012; Shaeffer 2014). Within a two-person psychology,
transference and countertransference do not exist as separate entities; rather they co-mingle and operate as a transference-countertransference configuration or matrix, which
exists in the relational field between the therapist and the
patient (Mitchell 1988; Orbach 2008; Schamess 2012;
Shaeffer 2014). Every therapeutic moment is understood to
be shaped by interactions of two unconscious minds engaged in both an asymmetrical and a symmetrical or mutual dance (Aron 1996; Layton 2008). From a relational
perspective, transference-countertransference configurations are jointly created and the therapist must struggle to
find and to extricate him or herself from them in order to
expand the patient’s relational expectancies (Mitchell
1988). The mutual creation and working through of such an
enactment is described below.
Dissociation and Enactments of the Familiar
and Familial
Relational theory generally understands the self to consist
of multiple, and at times conflicting, self-states that emerge
from our relational experiences. In addition, unacceptable
or intolerable self-states are thought to be dissociated (and
as such relegated to the unconscious) and yet they continue
to affect interactions in the form of enactments. (Bromberg
1998, 2003; Layton 2008; D. B. Stern 2004). According to
Donnel B. Stern (2004), we play out the self-states we
cannot tolerate within ourselves and in so doing we unconsciously influence others to adopt a variation of the
original dynamic that led to the dissociation of the selfstate in the first place. In this way, an enactment is the
meeting ground between a dissociated aspect of the patient’s mind and a mutual or reciprocal aspect of the
therapist’s mind (Layton 2008; D. B. Stern 2004). Given
the relational assumption of the therapist’s complicity in
everything that transpires between patient and therapist,
mutual enactments are understood to be inevitable and
continuous (Hoffman 1999; Layton 2008).
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According to Renik (1999), successful treatment depends on the therapist becoming emotionally involved and
retrospectively reflecting on the spontaneous enactment.
Hoffman (1999) stated that the ‘‘heart of therapeutic action…is in the dialectic of spontaneous, personal involvement and critical reflection on the process’’ (p. 74). He goes
on to say that the therapist must bridge the paradox of
participating in enactments while simultaneously trying to
understand and transcend them (Hoffman 1999). From a
relational perspective, it is through the repetition of old
relational patterns with a therapist who is able to reflect
upon and make meaning from the experience, that new
interactional patterns become possible. Specifically, when
either the therapist or the patient can experience the disavowed states that make up the enactment ‘‘as an internal
conflict or can suddenly see the other in an empathic rather
than in an adversarial light…the pair [can] reflect on what
has happened…[and then] the patient [can] experience an
internal conflict rather than a dissociated state’’ and in so
doing the patient can expand his or her sense of self and
relational repertoire (Layton 2008, p. 10).
From a relational perspective, development of the psyche and the individual is based on real events in the interpersonal world. Accordingly, the intrapsychic is seen as
being formed through childhood experiences of being in a
family that exists in a broader cultural context where there
are shifting and at times incongruent relational needs
(Greenberg and Mitchell 1983; Mitchell 1988). In contrast
to classical psychoanalytic theory, which understands
drives as primary, relational theory maintains that the interactive process or experience is primary and as such
provides the genesis of conflict, defenses and fantasy
(Mitchell 1988). In addition, as Mitchell (1988) put it,
children are ‘‘bent out of shape (or more accurately, into
shape) in their early significant relationships, and this is a
result neither of inherent bestiality nor of faulty parenting,
but of the inevitable emotional conditions of early life’’ (p.
275). The relational perspective also sees the individual as
participating in shaping his or her relationships along the
lines he or she consciously or unconsciously feels are most
familiar and familial. In other words, patients cling to
maladaptive relational patterns and symptoms that were
acquired in the unavoidable accommodations made in their
early interpersonal matrix.
Relational Treatment and Therapeutic Action
Relationally oriented treatment attends to how the positive
and negative aspects of relationships have shaped the internal structure of the individual and his or her interactions
with the world. A central goal of treatment is to create new
relational experiences rather than to accurately interpret the
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patient’s past or present intrapsychic world. Whether
treatment is long-term or short-term, once a week or
multiple times a week, the relationship and the resolution
of enactments are seen as the primary agents of change
(Ganzer and Ornstein 2008; Layton 2008; Mitchell 1988;
Orbach 2008). Because the therapeutic situation is seen as
an interactive matrix between two active subjectivities,
knowledge is considered to be co-constructed, and affect
regulation bi-directional (Layton 2008; Orbach 2008;
D. B. Stern 2004).
Negotiating Enactments
Benjamin (1995, 1999, 2004) proposed an intersubjective
model of mutual recognition in which connection with
another occurs when one is distinct, and one’s distinctiveness has been recognized by the other. Specifically,
Benjamin asserted that relating throughout life involves the
striving for mutual recognition between two subjectivities
(i.e., between two equivalent centers of being) (Benjamin
1995, 1999; Layton 2008; Orbach 2008). When mutual
recognition inevitably collapses, we fall into ‘‘doer-done
to’’ relations. In this mode of relating, the other is the
object of our feelings, needs and actions, not another
separate, yet similar mind. In addition, Benjamin maintained that patients repeatedly recreate the ‘‘doer-done to’’
configurations of their relational histories in the form of
enactments (Benjamin 1999, 2004). When this happens,
Benjamin (2004) calls for the therapist to act as a ‘‘moral
third.’’ According to Benjamin (2004), the ‘‘moral third’’ is
a mutual and collaborative mode of being. It is an internal
state of mind in which the therapist works to hold the
tension of different needs or experiences between herself
and her patient while remaining attuned to the patient
(Benjamin 1999, 2004; Layton 2008). When a therapist is
able to achieve this, she steps out of the cycle of helplessness, shame and/or attack, which characterizes enactments. In so doing, she re-establishes mutual recognition in
which there are two subjectivities who are separate and yet
connected. (Benjamin 2004; Layton 2008).
In addition, Greenberg (1986a, b) offers a relational reconceptualization of therapeutic neutrality, which also
speaks to the therapist’s role in negotiating enactments
with patients. He asserted that neutrality involves bridging
the tension between the patient’s tendency to see the
therapist as an old object and his or her capacity to experience the therapist as a new object. Further, he stated that
unless the patient has a sense of the analyst as a new object,
he will not be able to usefully experience him as an old
object. In other words, when this type of neutrality (i.e.,
when the therapist embodies a sufficient balance of being
experienced as an old and as a new object by the patient) is
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achieved, the patient can access old relational patterns and
experiences within the safety of a new relationship that in
turn facilitates the integration of previously disavowed
self-states.
Working at the Intimate Edge
Reflecting on how one is consciously and unconsciously
manifesting a patient’s old or new object configurations is
served by a willingness to work at what Ehrenberg (2005)
calls the intimate edge. This is the place of unknown; the
place at which new experience becomes possible. According to Ehrenberg, the intimate edge is not found, it is
authentically and spontaneously lived between patient and
therapist. It requires a willingness in both parties to linger
in spaces of cognitive and affective blindness in which the
unexpected or unimaginable can emerge. In addition, the
intimate edge requires a willingness from the therapist to
reveal his or her in-the-moment reactions and experiences
within the intersubjective field (Ehrenberg 2005). While
relational clinicians vary in the degree of self-disclosure
they employ, there is consensus that relational treatment
involves two subjectivities and as Renik (1999) put it, ‘‘the
analyst is inevitably and necessarily, personally, passionately unpredictably, and even irrationally involved; and
this is not to the detriment of the analytic process, but
rather is what makes it dynamic, alive and potent’’ (p. 407).
Trauma and the Unthinkable
Davies and Frawley (1999) have articulated a relational
model of trauma that speaks directly to my work with the
patient I am about to discuss. In their model, the traumatized child dissociates unbearable affective states and relational configurations such that there comes to exist a
split–off child persona within the abused individual. In
addition, they postulated the development of alternate ego
states or part-selves, which serve as protectors of the
wounded child. They also suggested that the dissociated
relational patterns and feelings of the part-selves surface in
the transference-countertransference through the process of
projective identification. In other words, that which is unthinkable or intolerable is unconsciously attributed or
transferred to the other, and the other, given their relational
configurations, comes to resonate with or experience the
disavowed and ‘‘communicated’’ affective and relational
self-state. As the therapist is able to metabolize and give
voice to the transferred experience, the patient is able to
move toward integration by working through each dissociated relational configuration as it comes to life in the
therapeutic relationship.
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Making the Impossible Possible
The Patient and His Story
The following case material reflects these relational
premises and demonstrates the healing potential of profoundly mutual and authentic exchanges between patient
and therapist. The patient, whose identity has been disguised, will be referred to as Greg. Further, ‘‘Greg’’ has
consented to the disclosure and discussion of his story and
our treatment. It has been years since the sessions described
below, and throughout the ensuing years, we have talked at
length about them. We have also had many conversations
discussing what it means to ‘‘Greg’’ for me to share the
trauma of his past and the painful process we weathered
together with a larger audience. As you read the following
vignette, know that it is deeply moving and important to
‘‘Greg’’ to think or to hope that his experiences and our
work together might be helpful to someone else.
Greg is a 67-year-old man born in and raised by a
wealthy Southern family. He began treatment because of
the onset of nightmares, intrusive images, and flashbacks of
his father ruthlessly beating and raping him. Although Greg
was just becoming reacquainted with his abusive past
through the unrelenting nightmares and flashbacks, he had
always known something was wrong. At some point in his
life, Greg stopped remembering what had happened to him
in his family; he only knew he was afraid of his father. He
has described to me the decades during which he struggled
to survive and to fit in with his peers. According to Greg,
he nearly went crazy thinking there was something deeply
wrong with him and trying to figure out how to fix it.
I began seeing Greg once a week over 12 years ago. It
quickly became evident, however, that Greg needed more
support and more frequent contact with me in order to
withstand the memories and emotions that were assaulting
him. As a result, we increased our meetings to twice a week
and then to three times a week, which seemed to provide
sufficient containment. As treatment progressed, I learned
that Greg’s implicit self was fractured into three dissociated and distinct part-selves who we have come to call the
Little Boy, the Gruff Voice and the Older Self. Consistent
with Davies and Frawley’s (1999) conceptualization, The
Little Boy represents the split-off wounded child who
housed the dissociated affective states and memories of
being beaten, raped and tortured by his father. The Gruff
Voice and the Older Self are both protective self-states
developed to manage the tasks of ‘‘going-on-being’’
(Schore 2009). The Gruff Voice is a split-off self-state
from the Little Boy and was in charge of avoiding and
managing pain throughout Greg’s childhood. The Gruff
Voice hid the Little Boy and kept him immobile and silent
for hours in order to avoid his father’s cruelty. Sometimes
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this worked, but at other times his father would find him
and grab him by the collar. He would lift Greg off the
ground and the dread of what was to come would flood
through him. One time, his mother was ironing during one
of these terrifying moments. She handed the iron to his
father. The pain and smell of flesh burning came next. In
order to survive the physical and emotional agony of these
and other horrific moments, the Gruff Voice would eventually find and use alcohol as a friend and as a painkiller.
Somewhere between 18 and 22 years of age, Greg’s mind
began burying the appalling reality of his youth. As he
forgot what happened to him, he began living more and
more as a newly emerged part-self who we have come to
know as the Older Self. Each of Greg’s part-selves represent denied and otherwise unintegrated (i.e., dissociated)
aspects of Greg’s inner experiences growing up in his
family (Davies and Frawley 1999; D. B. Stern 2004;
Wallin 2007).
Although Greg did not have explicit access to the
memories, the Little Boy part of him has always known he
was repeatedly raped and tortured by his father. However,
because Greg could not tolerate the overwhelming emotions connected with the trauma, the Little Boy had to
remain dissociated and as such beyond Greg’s consciousness during much of his adult life. As a result, Greg did not
know what had happened to him even though his implicit
memory of the trauma continued to shape his internal and
external object-relational world (Davies and Frawley 1999;
Schore 2009). He anticipated and repeatedly re-experienced the relational transactional patterns he learned in his
youth. For example, he expected to be abandoned, betrayed
and beaten just as he was as a child, and he felt he was
shameful and undeserving of other’s care and attention.
Given these relational expectancies, Greg remained withdrawn and believed the world was hostile and unwelcoming toward him.
Using Theory to Make Meaning of the Patient’s Story
Each of Greg’s part-selves has an object-relational world
we would expect of a person abused in childhood. Davies
and Frawley (1999) aptly described this internal object
world as ‘‘organized around the representations of only
three major players: a victim, an abuser and an idealized,
omnipotent rescuer’’ (p. 290). They add that in order to go
on living in a devastated life, the severely abused child
fantasizes an idealized childhood with an ever-present and
all-loving parental figure (Davies and Frawley 1999).
The relational configurations of a sadistic abuser, a
helpless victim and an ideal savior repeatedly emerged in
the transference-countertransference matrix between Greg
and myself. At times, it was difficult for me to tell the
difference between the additional ego supports, such as
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increased face-to-face and phone contact that were necessary to create a strong enough holding environment for
Greg’s regressed dependence and grieving process, and the
lure and pressure I felt to try to be his ideal savior (Davies
and Frawley 1999; Winnicott 1965). Within the triad of an
abuser, a victim and savior, the latter has the greatest
gravitational pull on me given my relational history. Ultimately, however, both Greg and I had to experience and
metabolize each role in the dynamic.
A window into this process can be seen in the following
therapeutic moments that happened several years into my
work with Greg. The enactment I describe below reflects
reciprocal dissociated aspects of both Greg’s and my own
mind (Layton 2008; D. B. Stern 2004). Greg was unable to
consciously experience the pain and relational expectancies
that resulted from his early experiences with an abusive
father and a colluding and abandoning mother as an internal conflict. As a result, through mechanisms of projective identification, aspects of his experience were
transferred to me. Not only did this enable me to more fully
feel and understand his inner world, it brought his past to
life between us, making it available for internal integration
and making it possible for new relational meanings and
experiences to emerge. Throughout the enactment, each of
us was tracking and responding to the other’s unconscious
experience. I will describe the process I went through in
struggling to find and to extricate myself from this mutual
dynamic and to make headway in making the unbearable
bearable. As multiple relational writers have suggested, I
needed to participate in the enactment with Greg and then
reflect upon our conflict and how it took form internally for
me in order to help Greg expand his sense of self and his
relational repertoire (Davies 2004; Davies and Frawley
1999; Hoffman 1999; Layton 2008; Mitchell 1988; Renik
1999; D. B. Stern 2004). Given Greg’s fragility at the time,
however, I was selective about which aspects of my internal experience I shared with him. He was both eager to
protect me from any painful affect and vigilantly scanning
for any sign from me that I would reject him. As a result,
resolving this enactment occurred in stages. What is described below is the acute stage. Over the next several
years, however, we were able to more fully explore and
discuss the nuances of what was occurring between us.
Benjamin’s (2004) ideas of mutual recognition and
‘‘doer-done to’’ dynamics are visible in this piece of the
treatment. The pending reality of an upcoming vacation
triggered a ‘‘doer-done to’’ dynamic between Greg and
myself. Ultimately, I was able to access the ‘‘moral third’’
and as such I was able to disentangle myself from the cycle
of helplessness and sadistic attack, which was gripping us.
In so doing, I was able to reestablish mutual recognition.
This process can also be understood in terms of Greenberg’s (1986a, b) conceptualization of therapeutic
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neutrality. During the first few years of our work together,
Greg repeatedly experienced me as a good object as I was
repeatedly available and responsive. As Greenberg suggested (1986a, b), this eventually made it possible for Greg
to tolerate and to make use of experiencing me as a bad or
disappointing object. In the following enactment, I worked
to be neutral (in Greenberg’s sense) so as to bridge the
tension between being enough of a bad object and enough
of a good object to enable Greg to access dissociated selfstates and to integrate them into his personality while
changing the relational expectancies that were linked to
those self-states.
A Pivotal Enactment in the Treatment
During the early years of treatment, my vacations were
excruciating for Greg. My absence is still difficult for him,
but he now knows that I will return and that the gap in our
meeting does not negate our connection and mutual love.
For the first few years, however, my vacations were desperate and suicidal times for Greg. Just telling him that I
would be going on vacation was enough to send him spiraling into deep depression, and in his words, ‘‘beneath the
sea.’’ I would dread the moment when I would tell him of
an upcoming vacation. I would go into those sessions
knowing that I was about to cause Greg tremendous pain
and that no matter what I did to mitigate the pain, it would
be immense. The only path I could see between us was for
me to both weather Greg’s agony with him and to feel I
was the cause of it (i.e., I was the abuser). In addition to
telling him about a vacation at least four weeks in advance,
I also made arrangements for Greg to see a covering
therapist while I was away, and I called him once a week
during my vacations. Although I recognized that the decision to be available in this way might be considered
gratifying or acting out my countertransference from a
traditional psychoanalytic perspective, I knew it to be
consistent with the underlying philosophy of two-person
psychologies. Specifically, from a relational perspective, I
understood the decision to provide this contact as providing
‘‘the necessary holding environment…to contain the intense affective discharge and ego disorganization’’ that
came with this phase of our work (Davies and Frawley
1999, p. 291). From an attachment perspective, I understood the extra contact as a means of developing Greg’s
capacity for attachment and as part of establishing myself
as a secure attachment figure (Walant 1995; Wallin 2007).
In addition, I personally believe we as clinicians have an
ethical obligation, in Levinas’ words, to respond to the
suffering face of the other (Levinas 1981; Levinas and
Nemo 1985; Orange 2010, 2011). Thus, I also understood
the phone calls, as well as the other supports I put in place,
as an expression of my ethical responsibility. In other
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words, they were a response to the suffering face of this
other given our relational field at the time (for more on
applying Levinas’ ethic to clinical work, see Orange 2010,
2011). Despite these moments of contact, however, Greg
would be consumed with pain and spend the days between
our calls in deep depression. Often he would need to spend
nights hiding in the woods, just as he did as a boy. Consistent with his internal relational configurations he would
be convinced that I was sick of him, I would not return to
him, and that he was unlovable and being abandoned.
Eventually, the experiences in the emotional field Greg
and I shared began to shift and I recognized it was time for
me to stop calling Greg while I was on vacation. By this
time, I knew I was a secure attachment figure to him and I
trusted that he would not kill himself while I was away. He
would suffer, but he would do everything in his power to
stay alive and to be there to see if I still loved him when I
returned. He also had developed enough of a connection
with the covering therapist that I believed she could help
him manage my absence more fully. In addition, Greg had
more capacity for affect regulation and could therefore
better tolerate his pain. Simultaneously, as well as in response to these developments, I began resenting the phone
calls with him during my vacations. Once on the phone
with him, I felt connected and engaged, but the anticipation
of the calls came to feel burdensome and intrusive. I also
began imaging and longing for a vacation in some remote
part of the world where I would be unable to call him.
When I considered all of these factors, I recognized a developmental readiness in both Greg and myself to wean
Greg of these calls. Despite this recognition, however, I
anticipated that the transition would be deeply painful to
both of us. As a result, I was quite anxious about initiating
this dialogue with him. Not only would I have to tolerate
his despair, I would also have to tolerate my own feelings
and doubts. I feared failing him as a savior and I questioned, what if I was wrong; what if he was not ready; what
if he did kill himself?
I discussed the pull to be Greg’s savior and my fear of
making a fatal mistake with my consultant. With her support, I braced myself for what was to come and proceeded
with my plan. I was going on vacation the following
month. Although I had already mentioned this to Greg, I
had not given him the actual dates yet. My plan was to tell
him the dates at the same time as I explained to him that I
would not be calling him during this vacation. My practice
is to write the dates of my vacation on a business card, to
put the card on the table next to me, and then to discuss the
dates we would not meet during the session.
The meeting began with our usual ritual of mutual
recognition (Benjamin 1999) and mutual regulation. Greg
sat down and our eyes met. While locked in a reciprocal
gaze, I noticed his breathing at first shallow, then slightly
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deeper, and finally deeper yet as his shoulders relaxed.
After some conversation about his difficulties negotiating
life through the previous weekend, his eyes caught my
business card. His face registered anxiety and I thought,
with my own anxiety, ‘‘here we go.’’ I told him the dates of
my upcoming vacation. In that moment, his head sank
below his shoulders and moments later, his face streaked
with tears, he looked up into my eyes, and said, ‘‘you’re
leaving me…I don’t want to live…this is it…it hurts too
much’’. Through groans and whimpers, he implored, ‘‘You
will call me though?’’ I clumsily managed to say that I
thought he was ready to withstand my vacation without a
call from me. Pain gave way to desperation. With his eyes
streaming tears and his face creased with agony, he begged,
‘‘Please, please, please don’t do this’’.
I found myself vacillating between holding his experience and holding my own. He was bereft; I was leaving like
all of the others. One moment I felt empathic and spoke of
his anguish of never having been loved, and always having
been left. The next moment, I refused to accept his belief
that my vacation meant I was abandoning him. I felt angry
and made futile attempts to use reason to comfort us both. I
said I was not leaving him; I was ‘‘simply’’ going on vacation. While in the midst of this, I remember thinking to
myself, ‘‘You are leaving him each time you assert your
logical reality over his painful reality.’’ In retrospect, I believe my logical assertions were a form of acting out my
anger and inadvertently falling into the perpetrator objectrelational position. They were also expressions of protest
and my resistance to feeling the full weight of the victim
role. On one level, I was protesting what felt like a restriction of how and where I vacationed. On another level, I was
protesting the implicit messages my mind took from Greg’s
despair—messages that I was failing him; I was insufficient.
My desire to disavow those thoughts and the related shame I
felt manifested in my anger. Not only was Greg responding
to the overt reality of my vacation, he was also responding to
my anger and to my unconscious withdrawal from feelings
of shame and insufficiency, which in that moment were
linked to him. In addition to all this, Greg was overwhelmed
by terror and despair and I did not want to be equally
overwhelmed. In those moments, I wanted to avoid his
agony and to deny that I was the cause of it; I also wanted to
be reinstated as his savior and to feel competent. Ultimately,
I would have to set aside my protests and feel all of what was
happening between us.
When the session ended, I remember feeling and
thinking, ‘‘this is hell; I have just been through hell’’. Then
I thought, ‘‘If this is hell, where was Greg?’’ I felt it then…
I knew the place he went, we had been there many times. It
is a place beyond hell, where you smell flesh, your own,
burning, hear bones, again your own, breaking, and in
flashes you see blood, deep red.
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Greg phoned that night after 7 pm when he knew I
would not return his call until the next day. With anguish in
his voice, he left the message, ‘‘I’m quitting, I can’t take
the pain anymore. I hope to die soon and I won’t be there
on Wednesday or ever again…Good bye’’.
Although I had heard and responded to similar messages
from him before, this time it felt different. In the past, I felt
these calls came when Greg was drowning in pain and that
he needed me to be an accessible and responsive attachment figure (Applegate and Shapiro 2005; Bowlby 1973,
1980; Shorey and Snyder 2006; Walant 1995; Wallin
2007). In addition, similar to Davies and Frawley (1999), I
felt extra contact and sessions were necessary ego supports
during this phase of our work. Accordingly, I would offer
him comfort and suggest he come in for an emergency
session. This time, however, there was something different
in the transference-countertransference matrix. I felt held
hostage—my hands tied by his threats of suicide and by my
own reluctance to be the cause of Greg’s pain. I asked
myself, was I the sadist, like his father, denying his
pleadings for mercy, or was I becoming the victim of
Greg’s threats and fragility? The moment the question
struck me, my body responded; it was a combination of
repulsion and resonance. As a boy, Greg’s hands and legs
had literally been tied as he was beaten and raped.
I now felt I had a deeper understanding of Greg’s experience in the room with me and as a boy with his sadistic
father. I could also think about my own resistance to being
the perpetrator of Greg’s pain and to feeling insufficient, as
well as my aversion to being a victim myself. With these
realizations, I was able to recognize and to think about how
my inner world was entwining with Greg’s—how the
gravitational pull to be a savior and the emotional vulnerabilities with which I was struggling were part of the
enactment, part of my feeling held hostage. Further, the
enactment lost its power over me as I could see and feel
compassion for both of our vulnerabilities. It then became
clear to me that as part of helping Greg heal from his
tortured history, we would both have to hurt and we were
both able to live through it. I recognized that this call from
Greg was not just a desperate cry for help; it was also an
opportunity. This awareness gave me the strength to trust
that this was not the end of my work with Greg. He would
be back even if I was not the ever-present and all-loving
savior.
Rather than encouraging him to come in for an emergency session, I returned his call and acknowledged his
decision to end our work together. I told him I would be
thinking of him and that all he needed to do was to call me
and we could resume meeting. A few hours later, the call
came. I saw Greg the next day at our regularly scheduled
meeting. As usual, our eyes met and minutes passed. With
anguish and desperation on his face, he whispered, ‘‘Help’’.
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Clin Soc Work J (2015) 43:398–406
I responded, ‘‘I’m here,’’ but my words did not register; he
could not hear me. This time, my anger was gone. Instead, I
felt an intense yearning to be seen as the person I am and to
find the place where Greg and I connect. I felt the pain of
being invisible and denied as a person. I shared with Greg,
‘‘right now inside me I feel as you did as a boy—desperation, a pleading, please, please, please see me.’’ My
words and tears found him. Our eyes locked and we cried
as I felt his excruciating pain of having been tortured and of
begging his merciless father to stop, to see him. Our shared
emotions in those moments countered any possibility that I
was abandoning Greg. He would somehow survive my
vacation, and I was not leaving him.
During that vacation, I did not speak with Greg. I did
speak with my covering therapist when she became concerned that Greg would kill himself. Together we assessed
the situation and decided he did not need to hear from me.
When I returned from my vacation, and Greg and I met at
the appointed hour, the relief was palpable. We were both
there. Greg was beginning to learn that his past did not
have to be repeated in the present; I was not abandoning
him.
New Possibilities
In the years since that vacation, much has changed. There
are two metaphors we have come to use that reflect Greg’s
progress. The first metaphor Greg spontaneously used to
describe his felt experience, and the second metaphor I
offered to depict both his irreparable damage and his recovery. From Greg’s perspective, life has changed from
darkness to light, from night to day. As such, he no longer
lives in a world in which the background fabric of life is
shaped by terror and despair. Instead it is a world in which
it is possible for him to be welcomed, safe and loved.
Accordingly, Greg feels less alone and more alive than at
any other time in his life. Greg’s newfound security and
aliveness, however, is at times punctured by the legacy of
his trauma. When talking about this aspect of his life, we
use the metaphor of a three-legged cat who has to learn to
live with his disability. Like his imagined feline friend,
Greg will always be impacted and in some ways restricted
by his past. However, he now knows what happened to him
and how his internal relational world has been shaped by
those events. As a result, he can recognize his vulnerabilities and ask for accommodation. In addition, like
the cat, he can never escape his losses and injuries, but they
do not preclude him being loveable and finding meaning in
life.
Specifically, Greg no longer has flashbacks or nightmares, he is better able to regulate his affective states and
to distinguish between past and present relational experiences, he is clean and sober, and he has formed and
Clin Soc Work J (2015) 43:398–406
deepened several relationships. While we still at times deal
with the pain and horror of his past, much of it no longer
needs to be dissociated and can be experienced directly.
This has made it possible for us to begin to identify and to
loosen the grasp of the more subtle ways that Greg has
learned to perceive and to respond to the world. The focus
of treatment has been shifting from learning to live with his
past to learning to live in his present.
Our work and in particular, the intersubjective exchanges between Greg and me represented in this enactment, and repeated many times in the treatment,
demonstrate what it means to work at the intimate edge
(Ehrenberg 2005) where the impossible becomes possible.
Greg and I entered these clinical moments not knowing
what would come of them. We each felt and staggered
from the pain of Greg’s inner relational world—a world in
which he would always be abandoned and uncaringly hurt.
I believe that in order for the unimaginable (i.e., being safe,
not alone and loved) to become possible, I had to meet
Greg’s raw vulnerability with my own authentic subjectivity. As such, I let Greg affect me and I felt deeply
painful feelings within myself. I also shared aspects of my
in-the-moment reactions and experiences with him. This
created an experience of full intersubjectivity (D. N. Stern
2004) and forged a new relational possibility between us
and within Greg’s internal object-relational world (Davies
1994; Ehrenberg 2005; Maroda 2005).
Conclusion
While no single theory holds the elusive key to therapeutic
action, the primary tenets and particular voices within the
relational literature, have helped and continue to help me
make meaning of my experience with Greg. Relational theory has also helped me understand the impact Greg’s early
experiences have had on his past and present life. Together,
Greg and I have used this understanding to create a mutually
constructed and coherent narrative of his life and to expose
and shift the ways that he has perpetuated the object-relational patterns implicitly learned in his childhood. However,
as I mentioned at the beginning, there were times in the
transference-countertransference matrix when I was adrift in
the sea with him. In these moments, his memories and feelings of terror and despair mingled with my own memories of
the power and danger of the sea. In order to keep myself, as
well as Greg, afloat during these storms, I relied on relational
theory. Paradoxically however, the moments I could surrender to the emotional intensity held the fullest potential for
Greg’s healing and growth. Over the years, both of our
abilities to surrender to the storms have grown, while simultaneously the storms have subsided. Greg and I have
405
found that as we mutually feel and make meaning of his
trauma and its effects on his life, he is freer to be himself and
to be flexibly related in his present world.
Conflict of interest
conflict of interest.
The author declares that the author has no
Ethical standard This article does not contain studies with human
participants or animals performed by the author. The article does
contain a clinical vignette and informed consent was obtained from all
individual participants included in the treatment.
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