A question that often crops up in my training sessions, especially so when I teach the Post Graduate Students is about dependency — if our clients see us for many sessions then are we not encouraging dependency? Shouldn’t we terminate after 10-20 sessions? My response is usually that our decision to terminate depends to a large extent on our paradigm stance. If we believe we are experts in assessing our clients’ problems and the number of sessions required to solve them, then sure! we may decide when to terminate. However, if we are working from a relational perspective and believe that both trauma and healing happen within a relationship then taking a singular decision related to termination does not fit well into the relational paradigm. The decision to terminate then emerges from the dialogue between the two people engaged in a horizontal relationship, especially when we work from a Relational Gestalt Therapy (RGT) orientation.

RGT rests on the three pillars — Phenomenology, Field Theory and Dialogic existentialism. The clients and therapist’s subjective experiences are equally valid, these are co-created in the therapeutic field and an ongoing dialogue between the two is the crucial element in awareness, growth and change. The client’s subjective experiences of when they feel the readiness to terminate is as important as that of the therapist. Of course, there are many other complex factors that would influence termination of therapy but that’s a thought to reflect over for another article.

Classical Gestalt Therapy viewed psychological health as the progression from other support to self-support — dependency to independence. This made sense given the zeitgeist in which Fritz Perls formulated his theory which was the fascist times of the early and mid-twentieth century. The individual aspired to free themselves from a totalitarian system whether it be family or larger socio-political location. Exercising one’s free will and agency was seen as a sign of health and in much of his work Perls supported individuals towards this. However, in prioritizing independence classical GT failed to be sufficiently attentive to the relational legacy articulated by Kurt Lewin’s Field Theory and Martin Buber’s Dialogic Existentialism. Their theory and philosophical stance clearly pointed towards the human being as emerging from a dynamic social field of relationships. Their premise was that the subjective experiences of the human being was and continued to be shaped in the environment that the being existed in. From this perspective, the growth of a human being is an ongoing process starting from early infancy in which the infant makes meaning of their relational experiences and continues to develop the capacity to relate with others in their environment.

What is relational and how does this school of thought see dependency?

Simply stated relational means how people, things, nature, mind, body, spirit are all interconnected to each other and cannot exist in isolation. We are from conception in relation to another, our relationship starts in the womb, we are born into this world of relationships and we continue to grow, thrive or get traumatized in the relational field. Our experiences of pain and joy are created in relation to another. I remember when my second daughter was a baby, we were posted at a unit where I would try to juggle the household chores and raise our two girls. After sending the elder one to school and feeding the second one, I would place her on a charpoy (cot) under a neem tree in the open kitchen courtyard, while I cooked and kept an eye on her. She would wake up and watch the sunlight for long, chuckle at the sight of shimmering neem leaves and try to grab the sunlight with her tiny fists. Her delight I thought was in relation to the sunlight and trees. When she would whimper and get restless and I would pick her up, my face would pucker up and as I would say to her, “oh my baby is hungry? Bored?” she would calm down and watch my face intermittently while feeding. On occasions when I would be late in picking her up, her crying would last longer. Her body felt both the contentment of her need being met as well as the pain of feeling lonely and neglected far longer than she could tolerate in her tiny body. I believe that she felt these varying emotions of curiosity, delight, joy, and pain in relation to another. This dependency on the other is normative for an infant and a caregiver’s ability to provide a home of soothing for these affect states is important for the development of the child’s ability to regulate emotions and learn ways of self-soothing as well as seek soothing from others with fluidity.

How does this apply to therapeutic support?

Clients often come for therapy because they feel distressed in their lives and yearn for someone who can support their journey towards relieving the pain, they may also wish for a witness to their joys and celebrations. They seek a relationship where they want to be heard, make meaning of their stories and perhaps understand how to relate with themselves and others to meet their needs. Depending on the intensity, duration and recurrence of or lack of attunement to their needs as children, clients need from therapy will also vary. For e.g., in a deprived and stark environment where the child’s affective states were missed persistently, the need for prolonged therapy would be higher. I have worked with a young lady for more than a decade now, we initially started with three sessions a week which reduced over the years and now it’s more need-based (once in three to six months). In the early phases of therapy whenever I would take a break from work, she would feel highly agitated and angry with me, however now she copes with this with equanimity and checks in with me if I am getting enough breaks! What I am trying to say here is that dependency is not a pathology that needs to be cured and quickly converted to independence. The inability of early caregivers to meet the child’s needs of dependency evokes overwhelming affect states for the child and this gets further exacerbated when there is a lack of attunement towards these chaotic emotions. The therapeutic relationship, when we work relationally, requires us to understand these yearnings and provide a structured safe space for attuned support and meet these needs to an approximation within the therapeutic boundaries. Most unlikely that this miracle can happen in five to twenty sessions because when trauma has been repetitive and cumulative then healing is inevitably prolonged and protracted.

From an RGT stance, I believe that dependency and independence are polarities that we as human beings navigate and in healthy states, we are able to fluidly move between the two as we identify within ourselves our need for support. There are many phases in our lives when self-support falls short of providing us soothing and we yearn for someone else to provide it for us. I have personally accessed therapy for many years, both as a felt need as well as a part of my training requirement, more than two decades ago. For some years I took a break because I felt content with where I had reached in terms of my ability to engage in self-reflection, soothe myself when distressed and live life quite joyfully. Recently I reached out to a therapist because I was facing a personal crisis for which I wanted to have a witness. In my first session, I told her, “I don’t have anything much from the past to talk about, or even my present struggles I manage well with journaling, getting support from my intimate relationships and self-care activities like nourishing food, yoga and meditation. I feel a bit lost and guilty and my mind tells me that I am wasting your time, I am doing well in life, yet my body knows that I want this space where I can receive, feel cared for and perhaps have a soothing witness to my present and future as I go through the inevitable changes of ageing and my growing proximity to death”.

Relational implies the understanding of self before developing the capacity to understand the other.

The concept of the relational model presupposes the therapist’s capacity to be in a relationship with self before they can actually be relational with the client. GT’s relational approach firmly emphasizes the personal awareness of the therapist as the bedrock for the practice of relationality. This necessitates the therapist being in therapy for a fair duration to gain an understanding of one’s own childhood experiences and how this impacts one’s present way of functioning especially so as a therapist. Yet, in my experience, I see many therapists struggling to access support to sustain their self-care and understand one’s own self, especially so in India. Since most training programs in India are heavy on theory and stress on knowledge and skill acquisition, we face a profound challenge in developing mental health professionals who are operating from a space of self-awareness. Often unaware of their own rigid polarization leading to hesitation in seeking support both supervisory and therapeutic. This is compounded by limited resources in India in terms of supervisors and therapists. The disturbing outcome of this is how this spill into the therapeutic relationship in ways that are detrimental to the client.

What do we mean by support in this relational field model?

Support means all the conditions that promote an individual’s awareness, growth and development. The inner field conditions (our subjective perceptions of our experiences and related traits like willpower, faith, confidence, fear, skepticism) interact with the outer field/environment that we see as supportive or lacking in support. In a healthy flow, the individual is capable of accessing both self-support and other support with fluidity and flexibility. Problems crop up when one is stuck too rigidly on either of the poles. Self-support is being able to engage in activities like exercise, breathing, journaling, and self-reflective activities. Another support is being able to reach out to friends, interacting with others, accessing and taking help when we experience the need. Support must come from both arenas; however, it may seem a sign of weakness to seek support for the clients and unfortunately at times for therapists also. Because we are culturally conditioned to be strong, solve our problems ourselves and any emotions and relational difficulties is something we are encouraged to deal with independence or within the family. For lasting changes, there must be creative flexibility in the way we access support for ourselves. Viewed from this lens, dependency is a normative need as is independence and the client has the capacity to decide for themselves in collaboration with the therapist the right time to terminate the therapeutic relationship.