Building the Therapeutic Sanctuary

Psychotherapy in this age of managed care and time-limited patient contact is in danger of losing its most important discipline: the discipline of creating a sound, safe, and healing relationship. Most of the training psychotherapists receive today is in how to become a technician. We have learned how to be technically helpful, often at the expense of personableness. With the burgeoning focus on diagnosis and treatment plan has come an efficiency in helping people that is often incompatible with the essence of good relationships, and if, as is my assertion, the most significant healing occurs in the relationship between therapist and client, then psychotherapy as it is being most commonly practiced is often trivial in the healing process. The trouble is that we are teaching therapists that the correct beginning place for psychotherapy is diagnosis and treatment plan. That is a mistake. The place to begin is in the relationship, and the way to do that is to begin with building a solid frame, a sanctuary for healing.

Students and supervisees of mine have typically been most responsive to descriptions of how to specifically do psychotherapy. The way I teach psychotherapy is to avoid the focus on technique so prevalent today, and instead seek to describe the tedious care that must be taken in the creation of the therapeutic sanctuary. That sanctuary is what has been commonly referred to as the frame of therapy. I use these terms interchangeably. They both evoke a sense of boundary, although the word 'sanctuary' also evokes the sacred, which is what the best relationships evoke. Martin Buber used the terms 'I-it' and 'I-Thou' to contrast relationships that are objectified and cold with those that are respectful and warm. I see therapists being trained in I-it styles of relating in order to protect their professional status and over-involvement with clients. One purpose of this book is to present a way of treating clients in an I-Thou manner, creating a truly care-full sanctuary.

When I was a beginning psychotherapist, the best book I read on psychotherapy was Sheldon Kopp's Back to One, a primer on the details of the psychotherapeutic frame. Over the years I have recommended Back to One more than any other book as a basis for psychotherapy. The intent of this book is not to replace but to compliment Kopp's book. I have my own way of creating a good therapeutic frame. Although it is very similar to Kopp's, what I have to say adds a theological base for understanding relationships. This book expands on Kopp's work by tapping much of what I have learned as a pastoral counselor. What makes pastoral counseling unique among the psychotherapy disciplines is its rich insights into the interplay between theology and psychology. Theology is about asking universal questions of meaning, and psychology is about asking individual questions of meaning. Having some theological sophistication adds clarity to the psychotherapy discipline that has made an enormous difference in my work. I think it will be helpful to the apprentice therapist, seasoned therapist, as well as the master therapist.