In this talk, I present my view of the psychotherapeutic process as a shift from the conventions of typical social reality into a therapeutic space oriented toward self-expression and self-experience. This shift is usually a significant challenge both for the patient and therapist, particularly therapists-in-training or early in their careers. The therapeutic couple may collude in an avoidance of deeper levels of the patient's experience and of the therapist's capacity to articulate what he/she observes or feels about the patient. This presentation attempts to conceptualize how the identity of the therapist needs to be altered into a "therapeutic persona" that subverts conventional relational and attachment tendencies in order to liberate the patient's recognition of oneself.

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2. Part I. Recording of the Beginning of a
Session
“Typical Social Reality”
Socialization of Therapists-in-Training
Part II. “Therapeutic Reality”
Part III. Attachment/Splits of the Self
Fear of Crossing the Bridge
Part IV: “Therapeutic Persona” and
“Subversion”
Challenges for Trainees
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3. Recording of the Beginning of a Session
Typical Social Reality
The Socialization of Therapists-in-Training
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4.  Christine French, M.A.
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6.  “The client had anxiety about not
knowing what to say ...”
 “I gave her an out ... I saved her from
sitting with her emotions and discomfort.”
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7. The audio is invaluable in pointing out a
major issue involved in learning
to be a clinician:
Shifting from typical social reality
to therapeutic reality (therapeutic space)
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8.  In typical social reality, a transaction
between person A and person B occurs
guided by certain
expectations/conventions.
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9.  Kindness
 Comfort
 Reduction of anxiety
 Avoidance of conflict or difficulty
 Appeasement
 Compliance/Don’t annoy or aggravate
 Being liked
 Achievement/progress
 Back and forth/Q and A quality (a
conversation – a transaction)
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11.  I want the patient to like me
 I must be kind to the patient and build the
therapeutic alliance
 I must alleviate the patient’s distress, make
the patient feel better, solve the patient’s
problems
 If I am too confrontational, challenging, or
merely direct, the patient will be hurt or
injured, or get angry, and won’t come back
and I will fail as a therapist
 I must be very careful about what I say to a
patient; I can’t say what I really think or feel
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15.  Patient: Hi! It’s good to see you today?
How was your weekend?
 Therapist: My weekend was great,
thanks. It is nice to see you too. How
was your week?
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16. Therapeutic Reality
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18. #1: The patient begins with a blank
canvas.
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19. #2: The therapist establishes a culture NOT
based on typical social reality
(SUBVERSION), but on the patient’s
capacity to paint his- or herself: to
creatively self-express, self-relate and
experience oneself.
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20. #3: Gradually over time, based on the
therapist’s capacity to subvert the
patient’s dependence on typical social
reality, the patient tolerates what he/she
begins to paint and ultimately arrives at
a creative depiction of his/her inner life.
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21.  We as therapists are to
stand next to our patients
and as the patient
illustrates/portrays his or her
life experience, we are to
consider its parts and seek
to understand how all the
parts work together.
 When we can do this, the
patient actually learns who
he or she is (for the first time
in life).
 This is an extraordinary
opportunity!
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22. What the Patient is Able to Produce in this
Process is Significant and Powerful ...
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 The patient has a deeper appreciation of
his/her own life, problems, conflicts, feelings,
and limitations.
 What patients ultimately paint is often quite
different from what they thought they would
paint or would have preferred to paint (they
see themselves more realistically)
 The patient finally has had a new relational
experience: one un-encumbered by typical
social reality.

30. Attachment/Splits of the Self
Fear of Crossing the Bridge
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31.  Given the validity of attachment theory,
we can assume that every patient –
despite diverse presenting concerns --
has had to accommodate to his or her
primary caregiver (and to the world).
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32.  The evolutionary drive to survive is so
hardwired in our genetic makeup that
we are literally programmed to adapt.
 Compromises and accommodations to
social demands occur over and over
again, inevitably resulting in splits in our
identity as typical social reality takes
over our experience of ourselves and
others.
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33.  By so doing, each patient’s “self” has
been compromised, to a greater or
lesser degree.
 Over time, the patient developed a
characteristic repertoire of being in the
world that systematically
accommodated to that which was
needed to survive in the social realm.
 Winnicott’s notion of the “false self.”
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34.  The False Self
 The True Self
 The Lost Self
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35.  At the core of our personality as adults is a
highly adaptive child (if the adaptation
worked early on, we repeated it again and
again – it became habituated across the
lifespan).
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37. When patients enter the therapeutic
situation, they have and know only one
(typical social) reality and resort to it
immediately ...
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38.  The danger, of course, is that NOT only
the patient, BUT ALSO THE THERAPIST, has
one (social) reality as well ....
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39.  Kindness
 Comfort
 Reduction of anxiety
 Avoidance of conflict or difficulty
 Appeasement
 Compliance/not annoying or aggravating
 Being liked
 Progress/Change/Positive Outcomes
 Conversation/
transactions
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43. Patient starts to paint the
picture of their pain, sorrow,
sadness, anger, etc.
Therapist engages in typical
social reality efforts: Reduce
the client’s affective or
cognitive states by:
--comforting the patient
--avoiding the
affective/cognitive states of
the patient
--helping/problem-
solving/advice-giving
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44. When this
happens:
1. Patient will
usually return
to the typical
social reality
where they
will conform
and comply
with what they
perceive the
therapist
wants.
2. Or the patient
will try to paint
some other
experience.
Either way:
1. The therapeutic
relationship becomes no
different than any other
relationship in the
patient’s life.
2. The patient has been
impinged upon and can
no longer engage in the
process of self-expression
and self-experience. 44

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“Therapeutic Persona” and “Subversion”
Challenges for Trainees

46.  “Persona” suggests that therapists
cannot just be themselves and act as
they always do, i.e., with an adherence
to typical social reality.
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47.  Instead, you must adopt a therapeutic
persona that is partially you and partially
alien to you, i.e., one that cultivates and
lives in an alternate reality oriented
toward therapeutic presence and
therapeutic reality, not social reality.
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48.  Kindness
 Comfort
 Reduction of anxiety
 Avoidance of conflict or difficulty
 Appeasement
 Compliance/not annoying or aggravating
 Being liked
 Progress/Change/Transformation
 Conversation/transactions
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49.  Embodying this therapeutic persona, the
therapist consistently works toward:
(1) resisting patients’ preference for
typical social reality, and
(2) helping patients evolve out of their
characterological repertoire of
adaptation which has compromised
their identities and their own self-
recognition and self-understanding.
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50.  In this way, the therapist works to
“subvert” attachment patterns and self-
relational tendencies that have become
habituated over time.
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51.  Getting to the other side of the bridge!
 Patient AND therapist both transition out
of a typical way of being with self and
others (typical social reality) into a new
way of being that no longer depends on
accommodating to the needs of others
or compromising one’s self in order to
play a role with others.
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52. • Therapists must
do the exact
opposite of what
they are socialized
to do or do what
they “fear” the
most.
• Therapists must
recognize that
“being liked” or
“client progress or
change” are not a
part of the client’s
self-experience.
• The therapist’s
goal is to help the
patient see and
acknowledge
what they have
been doing
(adaptively) all
their lives.
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53.  “Empathy” in a typical social reality sense
(as it is often taught and conceptualized)
sets up the therapist to perpetuate yet
again the instruction the patient has
received from all others: we each must exist
for the other and not for ourselves – we
must stay in the familiar/nothing new can
happen that has not happened before.
 Rather than finally relieving the patient of a
social/transactional burden, the therapist
merely affirms its necessity once more.
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54.  Empathy has more to do with drawing
patients’ attention to what they have
had to do to accommodate to
significant others in their lives -- it is
promoting the patient’s awareness of
what he/she had to be (a clown or XYZ).
 This is shameful, embarrassing, and
profound when patients finally see their
repertoire and realizes that you see it.
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55.  Notice that this is not transactional
(typical social reality) and not replete
with accommodation, but instead is self-
oriented/self-observant/self-
transactional.
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56. In Conclusion ...
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57.  (1) We provide patients with another
reality, i.e., another way of being;
 (2) They become exposed to a self-
relational experience that is more
realistic, tender, and curious;
 (3) The therapist is able to promote the
patient’s growth, decision-making, and
adherence to one’s self.
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58.  Ultimately, with this perspective, the
therapeutic alliance will be enhanced by
the patient’s gradual recognition that the
therapist is different from all prior caretakers
and people in general.
 The patient will realize he or she has finally
found someone who promoted growth and
tolerated the true nature of the patient –
which no one else had been able to do
previously in the patient’s life (this may be
one way to perceive love).
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59. James Tobin, Ph.D.
Licensed Psychologist PSY 22074
220 Newport Center Drive, Suite 1
Newport Beach, CA 92660
Assistant Professor of Clinical Psychology
The American School of Professional Psychology
at Argosy University
Email: jt@jamestobinphd.com
Website: www.jamestobinphd.com
949-338-4388
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