Michael Vincent MillerExcerpted from Michael Vincent Miller’s presentation FEAR of the OTHER Oct. 24, 2015

First of all, it needs to be acknowledged much more emphatically that as a rule the patient fears the therapist, and the therapist fears the patient. Otherwise why have they both so often resorted to ways of denying the other’s full humanity by reducing it to a part or a category? Take traditional diagnosis, for example. I’m not against all diagnosis: worn lightly and metaphorically, diagnoses can be useful lenses to organize information. Not to learn the diagnostic tradition is willful ignorance, like a jazz musician who refuses to learn the chord progressions or the music that precedes him. But many therapists have been taught, depending on the school they are from, to reduce the being of their patients and to keep them at a distance by confining them behind bars in the cages of diagnostic categories.

The patient, in turn, has ways to reduce the therapist to a part or a function. I had one client who referred to me as his “mental health provider.” Several call me their “shrink,” a venerable term that originally referred to the therapist as a “headshrinker” who reduced the patient; but used as a noun, it makes me feel reduced. Many years ago I had a client who reduced me to his idea of a Gestalt therapist and himself to his notion of a Gestalt therapy patient before he had any sense of who I actually might be. Having moved east, he had been referred to me from the Gestalt Institute of Los Angeles. When he came into my office for a first session, he immediately sat down, and began talking not to me but to an empty chair nearby. Then before I said a word, to my utter amazement, he leaped up, plunked himself down in the empty chair and answered himself.

Then there are modes of denying that either member of this dyad fears the other. There’s premature trust, where the client comes in to a first session without being curious and questioning or evaluating, perhaps barely looking at the therapist, and begins without further exploration pouring out his or her deep secrets and privacies simply because he or she is with a “therapist.” The therapist’s counterpart to this is premature empathy of the kind that implies much too soon, “I know how you feel,” which may never be true anyway. Both of these look like yielding to one another, but in actuality they do more to push the other away.

I think that Gestalt therapy from early on has made efforts to bring the therapist-client relationship more out in the open, rather than disguise it in diagnostic labeling or fixed role definitions, such as the doctor who cures the patient’s illness, and so on. However I must confess that I never saw Fritz Perls or Isadore From, when working, let themselves become particularly vulnerable, if at all.

But various subsequent developments in Gestalt therapy—the relational viewpoint drawn from Buber’s I-Thou, the conception of the field as offering open-ended, fluid possibilities for the creation of roles and the emphasis on therapist-patient co-creation have allowed fundamental relationship anxieties between them to come more out of the closet, sometimes even if it has meant disclosing the therapist’s uneasiness, though most of us are hardly comfortable yet doing much of that.

Even with respect to these valuable developments in Gestalt therapy, I would still bring to bear a concern that has occupied me a lot for the past twenty years. In my book Intimate Terrorism I argued that myths of romantic love, idealized claims by culture about marital roles, etc. tended to repress the fact that power is at work in all close relationships. Issues of power have never been made very clear in therapeutic relationships either, with the exception perhaps of Jay Haley’s wonderfully ironic article, “The Art of Being a Failure as a Therapist,” and the work of Thomas Szaz around the question of who is in control of the definition of the relationship (if you remember him and his books such as “The Myth of Mental Illness”).

Neither the hyphen between I and Thou nor the suggestion of democratic co-creation in thinking about the field sufficiently addresses the issue of therapeutic power structure, which is inherently there because the therapist is regarded as an authority, highly paid for his or her expertise. And all authority roles pick up residues of our early dependence on parents. That’s where Freudians gained their insights about transference, after all. Granted that Gestalt therapists are not likely to draw on the model of the expert doctor who cures the sick patient by interpreting the unconscious or through reconditioning cognitions and behavior. But we have to be careful not to promote ourselves as experts on how to live in the present moment or artists of the human condition. All of these can all too easily lead into the therapeutic relationship as a mild form of sadomasochism, which is based not on inflicting or desiring pain but on the parent-child power structure which creates two modes of controlling uncertainty: The certitude of being in command, on the one hand; the certitude of being told how to be and what to do, on the other.

I’d like to see this kind of question more taken up in Gestalt therapy circles. I don’t have all the answers by any means. I tend to regard my role as therapist not as though I’m the artist, but the client is. I see myself more like an art critic or piano teacher or sports coach, a somewhat more humble position. That is, I like to focus attention on the client’s strengths, not on the findings of pathology, and collaborate in exploring how they can be better used in his or her service.

Sometimes I wind up in the import/export business. In the final pages of Intimate Terrorism, I wrote about a married man and a playwright, who came in for his therapy session week after week, hanging his head in depression while he told me about yet another terrible marital quarrel. When I finally grew weary enough of the repetition, just to change the channel, I asked him what kind of plays he wrote. To my astonishment, he replied, “I write farces.” I told him something like, “Please tell me again about last night’s quarrel, but this time do it as though it is one of your farces.” He sat up and soon was standing up, playing both himself and his wife, moving around with antic gestures and hilarious one-liners of dialogue. We both wound up laughing uncontrollably. I suggested that he take this home: That is, every time a battle starts up with his wife, go into his farce-creating mode. It wasn’t long before he told me that whenever they got into a fight they both ending up laughing.

But I also have an additional proviso that differentiates me even from art and music teachers or coaches. I remind myself often that I have to remain open to each client teaching me how to be his or her therapist; that I do not know how in advance. This turns out to involve a lot of willingness to not know, which is not an easy attitude to develop.