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Friday, August 24, 2012

The Creation of a "Holding Environment" in Psychotherapy

The concept of the therapeutic "holding environment" was developed in the mid-20th Century by the British psychoanalyst and pediatrician, Donald Winnicott, who was a member of the Independent Group of the British Object Relations school of thought in England. Winnicott is one of my favorite psychoanalysts and theorists because of his views about the therapeutic "holding environment."

Donald Winnicott and the "Holding Environment"
Winnicott came to psychoanalysis from a pediatric background, and his ideas were influenced by what he saw as the nurturing emotional environment that a loving mother provides to her child.  From a Winnicottian perspective, a loving mother holds her baby, both physically and emotionally, and she is attuned and attentive to the baby's needs.  Observing this, Winnicott extrapolated his ideas of how crucial it is that a psychotherapist develop a symbolic "holding environment" for psychotherapy clients.

Donald Winnicott, psychoanalyst and pediatrician, wrote books for children and adults
Most psychotherapists today would agree that the therapeutic "holding environment" is a crucial part of psychotherapy.  The "holding environment" in psychotherapy is often subtle.  To create a therapeutic "holding environment," the therapist must be compassionate and empathic to the client.  The "holding environment" starts with the therapist maintaining the therapeutic "frame" in the treatment which, in the most basic sense, means that the therapist is a reliable and consistent individual.

Playing and Reality by Donald Winnicott
By maintaining the treatment "frame," the therapist is consistently there.  She is clear about what is expected, and she maintains appropriate boundaries with the client.  Although these are basic things that most clients come to expect from a psychotherapist, for many clients who come from chaotic, dysfunctional families where parents might have been abusive and erratic, just this alone can be so healing.  For the client whose family was chaotic and dysfunctional, knowing that a skilled psychotherapist is reliable, consistent and trustworthy provides a safe place for the client to come to on a weekly basis.

A Therapist's Empathic Attunement to Clients:
Beyond maintaining the treatment "frame," the creation of a therapeutic "holding environment" also includes the therapist's empathic attunement to the client.   When a therapist is compassionate and empathic, on the most basic level, the client feels cared about by the therapist in a way that maintains appropriate boundaries between client and therapist.  This is crucial for any successful therapy.

Empathic Attunement
For clients who come from families where they were abused, either physically or emotionally, it might take a while for them to be able to trust that their therapist cares about them.  After all, when you grow up in a family where you feel that your own parents don't care about you, it's hard to believe and trust that anyone else would care.  It often takes time for these clients to develop this trust in their therapists.  Most of the time, there's no substitute for time in these cases for the therapist and client to develop a therapeutic rapport.  Without a therapeutic rapport, it's hard to accomplish anything worthwhile in therapy.

For some clients, who were abused as children, being with a compassionate and empathic therapist allows them to feel safe and supported in the treatment.  They will feel, often for the first time, that someone is there who puts their needs first.  This can be a very healing experience.  This is also generally true for clients who grew up with narcissistic parents who neglected them emotionally, who were not willing or able to meet their children's emotional needs.

For clients who might not be sure how to choose a psychotherapist, I usually recommend that, beyond choosing any particular treatment modality, that clients focus on whether they feel a therapist provides an emotionally supportive environment.  This might be difficult to assess in the initial consultation when most clients feel anxious.  But, over time, most clients can discern if the therapist is emotionally attuned to them and whether it's a good therapeutic match.  I urge clients to trust their instincts about this and to continue their search for a therapist until they feel it's the right match.  

You can also read my article: "How to Choose a Therapist". 

I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist.  I also provide psychodynamic psychotherapy.  I work with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (212) 726-1006.

photo credit: scatterkeir via photopin cc

photo credit: AJC1 via photopin cc

photo credit: AlicePopkorn via photopin cc




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