Article

Clinical Perspectives on the Notion of Presence

Abstract

This article explores the theme of presence of the psychotherapist, a concept that has been of particular interest in humanistic and existential approaches. Presence was first associated with the humanistic attitudes of the practitioner and the way he or she embodies these attitudes in the here and now of the encounter. Since the publication in 2002 of Geller and Greenberg’s model of therapeutic presence, several quantitative studies have explored the relationship between the therapist’s perception of presence and other dimensions of the therapeutic process. However, qualitative explorations still seem necessary to account for the complexity of the therapist’s presence and its role in the therapeutic process. Centered on the therapist’s perspective, we use an idiographic methodology and refer to lived clinical experience to highlight the dimension of sensory contact that, through the body, actualize a connection to a virtual space of the therapeutic relationship. We so describe how a therapist can achieve an embodied processing to clinical material from what we describe as “traces of presence” of the other. From this point of view, the patient’s presence incorporates itself into the therapist’s experience and the therapist can perceive aspects of this presence in a tangible, concrete, and useful way. The therapist’s presence thus takes on a meaning that is not reduced to what the patient will perceive and interpret of his or her attitude. It becomes the main material from which the therapist orients his or her clinical interventions. To view the online publication, please click here: https://www.frontiersin.org/articles/10.3389/fpsyg.2022.783417/full
Frontiers in Psychology | www.frontiersin.org 1 February 2022 | Volume 13 | Article 783417
HYPOTHESIS AND THEORY
doi: 10.3389/fpsyg.2022.783417
Edited by:
Emily K. Sandoz,
University of Louisiana at Lafayette,
UnitedStates
Reviewed by:
Cynthia Whissell,
Laurentian University, Canada
Caroll Hermann,
University of Zululand, SouthAfrica
Henry J. Whiteld,
Regent’s University London,
UnitedKingdom
*Correspondence:
Pascal Malet
pascal.malet@icloud.com
Specialty section:
This article was submitted to
Psychology for Clinical Settings,
a section of the journal
Frontiers in Psychology
Received: 26 September 2021
Accepted: 24 January 2022
Citation:
Malet P, Bioy A and
Santarpia A (2022) Clinical
Perspectives on the Notion of
Presence.
Front. Psychol. 13:783417.
doi: 10.3389/fpsyg.2022.783417
Clinical Perspectives on the Notion
of Presence
PascalMalet
1
*, AntoineBioy
1 and AlfonsoSantarpia
2,3
1 Laboratoire Psychopathologie et Processus de Changement (LPPC), Université Paris 8 Vincennes – St Denis, Saint-Denis,
France, 2 Aix Marseille Univ, LPCPP, Aix-en-Provence, France, 3 Department of Psychology, Université de Sherbrooke,
Sherbrooke, QC, Canada
This article explores the theme of presence of the psychotherapist, a concept that has
been of particular interest in humanistic and existential approaches. Presence was rst
associated with the humanistic attitudes of the practitioner and the way heor she embodies
these attitudes in the here and now of the encounter. Since the publication in 2002 of
Geller and Greenberg’s model of therapeutic presence, several quantitative studies have
explored the relationship between the therapist’s perception of presence and other
dimensions of the therapeutic process. However, qualitative explorations still seem
necessary to account for the complexity of the therapist’s presence and its role in the
therapeutic process. Centered on the therapist’s perspective, weuse an idiographic
methodology and refer to lived clinical experience to highlight the dimension of sensory
contact that, through the body, actualize a connection to a virtual space of the therapeutic
relationship. Weso describe how a therapist can achieve an embodied processing to
clinical material from what wedescribe as “traces of presence” of the other. From this
point of view, the patient’s presence incorporates itself into the therapist’s experience and
the therapist can perceive aspects of this presence in a tangible, concrete, and useful
way. The therapist’s presence thus takes on a meaning that is not reduced to what the
patient will perceive and interpret of his or her attitude. It becomes the main material from
which the therapist orients his or her clinical interventions.
Keywords: presence, psychotherapy, embodiment, experiential/existential/humanistic psychotherapy, therapeutic
relationship
INTRODUCTION
Presence may be considered as a posture of action of the therapist in the temporal horizon
of the immediate. is posture requires leaving a theoretical description of the practitioner's
action and amounts to describing (through literal or metaphorical statements) each singular
event (e.g., sensations, perceptions, and mental images) in itself. It requires reintroducing a
role for the ephemeral and the unpredictable, approaching each seemingly innocuous event
for what it proposes in the patient’s and the therapist’s experience.
We also consider a presence that extends to a global conguration of communication,
which could also be a communion between the patient and the therapist. e meaning and
value of the therapist’s experiences should not be limited to what the patient will interpret
in terms of empathy or therapeutic alliance. Some of these experiences are not ordinary in
published: 25 February 2022
Published: 25 February 2022
Frontiers in Psychology | www.frontiersin.org 2 February 2022 | Volume 13 | Article 783417
Malet et al. Clinical Perspectives on the Notion of Presence
nature and intensity. ey could be understood in terms of
a continuum that links the patient and the therapist in an
extended context that is not limited to the time and space of
the sessions.
is perspective implies attentional receptivity and brings
back to the dimensions of contact, of incarnation, of the
relationship to time, to space and to objects of perception.
us, the concept of presence questions the role of these
dimensions of the relationship regarding therapeutic change.
e concept of presence is mainly promoted in the eld
of humanistic and existential approaches (Santarpia, 2020).
ese approaches achieved a major epistemological shi by
conceiving the therapeutic process and its eects in ways that
dier from theories of transference and countertransference
or of elaboration of the patient’s history. In the therapeutic
processes of reproduction, recognition, and repair (Delisle and
Mercier, 2010; Santarpia, 2020), which characterize contemporary
humanistic approaches, the state of presence activates and
fosters the real relationship, which represents the part of the
relational process that is established between the therapist and
the healthy part of the client. It will therefore be the primary
path that restorative acts will take (May, 1967; Delisle, 2004;
Bioy and Bachelart, 2010; Santarpia, 2020).
Several studies (Elliott, 2002; Drouin, 2008; Zech, 2008;
Elliott etal., 2013; Angus etal., 2015) conrm the eectiveness
of humanistic and existential approaches. Meta-analysis by
Elliott et al. (2013) and Angus et al. (2015) concluded that,
in comparative studies with random groups, clients in humanistic
psychotherapy experience change at levels that are as elevated
as those of clients undergoing other forms of therapy. So, as
other approaches, humanistic therapy in its various forms is
an eective means of helping those in distress, and this includes
a wide range of mental disorders: depression, anxiety, adjustment,
and interpersonal issues (Elliott, 2002; Drouin, 2008).
Many leading practitioners have discussed and considered
the role of presence in therapeutic outcomes. e concept is
found in the work of May (1967), Bugental (1976), Hycner
(1991), and Erskine (2015), as well, of course, as that of Rogers
(1957; also see Baldwin, 2013). Geller and Greenberg (2002)
presented an initial model of psychotherapeutic presence that
is centered on a humanistic approach. ey described presence
as a state of sensory receptivity to the present moment. is
focus on the “sensory and bodily” (Geller and Greenberg, 2002,
p. 78) awareness of the experience of self and other can
be included in the idea of emotional awareness (Lane and
Schwartz, 1987; Santarpia et al., 2020). Notions of presence
have also been supported in other approaches. For example,
Roustang (2015, p. 192) stated that “e foundation of the
therapist’s function is the intensity of his/her presence., as
Stern (2010, p. 6) referred to the “‘dynamics’ of the very small
events, lasting seconds,” that are “the dynamic forms and
dynamic experiences of everyday life. e scale is small, but
that is where welive, and it makes up the matrix of experiencing
other people and feeling their vitality.
However, as a concept, Presence remains dicult to handle.
Hycner (1991) notes that, in the therapeutic relationship, it
does not lend itself to objective denitions or clear descriptions.
A rst aspect of presence may beassociated with the therapist’s
humanistic attitudes, particularly the attitudes of congruence,
empathy, and unconditional positive regard proposed by Rogers
(1957). e therapist takes an active approach to being present
(Geller and Greenberg, 2002) in the time and space of the
therapeutic session. e eects of these attitudes can beassessed
by measuring the patient’s perception of the therapist’s presence.
However, it is not easy to draw a clear line between the
concept of presence and the necessary conditions for therapeutic
change proposed by Rogers (1957). As a matter of fact, in
Geller and Greenberg’s (2002) model of therapeutic presence,
presence sometimes appears as a new condition distinct from
Rogers’ conditions, as well as sometimes appearing as an
embodiment of those conditions. Furthermore, therapists seem
to use the term presence to describe dierent kinds of experiences.
ere are those which are lived in the relationship with the
patient and which can beexplained by concepts like congruence
or empathy. ese experiences are related to a presence connected
to the objective dynamics of the interaction. Beside those,
there are experiences that are non-ordinary phenomena, described
as extrasensory communication experiences by the use of
metaphors. ey do not seem to be related to an objective
temporality in any obvious way.
is leads us to reect further on the notion of presence
and its clinical perspectives. Aer having presented the diculties
associated with the study of the concept, we will use an
idiographic approach. Wewill highlight the role of the therapist’s
receptivity and the possibility of a clinical embodied perspective
carried out from a material made of experiences whose nature
appears pluralistic. We will show that it is possible to conceive
of another form of presence alongside an in-session presence.
More precisely, by taking up Merleau-Ponty and Waelhens
(2013), we will underline the dimension of a sensitive contact
which actualizes through the body the relation to a virtual
space of the therapeutic relationship just as important as the
relation to the physical and actual space of the relationship.
rough the experience of this sensitive contact, presence may
appear as an invisible encounter between two subjective realities
that are partially embodied in the course of the intersubjective
relation. It is possible to consider a global congruence between
the course of the therapist’s pluralistic experience and the
objective evolution of the therapy.
ON THE CONCEPT OF PRESENCE
Presence and Contact in the Humanistic
and Existential Fields
From early on, Rogers held that contact is a necessary and
minimum condition for relationships and change: “Two persons
are in psychological contact, or have the minimum essential
of a relationship, when each makes a perceived or subceived
dierence in the experiential eld of the other” (Rogers, 1959,
p. 207; also see Priels et al., 2006).
In this sense, presence involves being available to oneself
and the other in a complex way that is centered on the bodily:
we welcome the other into our being in a manner that is
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palpable, kinesthetic, sensual, physical, emotional, and mental
(Bugental, 1976). For Erskine (2015, p.12), presence is associated
with the therapist’s “respect, kindness, compassion, and
maintaining contact.” Here, we can feel the inspiration of
humanistic philosophers, such as Buber (1970), and his “I-ou”
relation, as well as his idea of reciprocity and the rehumanization
of the encounter. Hycner (1991) relates presence to the recognition
of mystery and the interpenetration of existence; presence
requires a willingness to engage oneself entirely in the encounter
with the other.
ese are the elements that are possible to connect with
Rogers’s conditions of congruence, unconditional positive regard,
and empathic understanding (Rogers, 1951, 1961). However,
Rogers himself drew a distinction between presence and these
conditions. In an interview at the end of his career, he said:
perhaps I have stressed too much the three basic
conditions (congruence, unconditional positive regard,
and empathic understanding). Perhaps it is something
around the edges of those conditions that is really the
most important element of therapy—when my self is
very clearly, obviously present (Baldwin, 2013, p.28).
He also added, “I recognize that when Iamintensely focused
on a client, just my presence seems to be healing, and I think
this is probably true of any good therapist” (Baldwin, 2013, p.28).
Concerning the healing power of “just my presence,” Rogers
mentions that hemakes use of his self and his responses, but
that hedoes not express every aspect of himself. ere is thus
a subtractive approach to presence, in which irrelevant aspects
of the therapist’s personality and experience are set to the
side. Presence is what remains when everything else has been
removed. is state can be described in terms of its relation
to immediacy and embodiment, and one can also wonder
about its relation to altered states of consciousness.
Paying Attention to the Immediate Past, to
What Is Immanent in the Moment
Presence occurs in reference to a specic temporal horizon.
May (1967) connects it with the notions of the real relationship
and the here and now (also see Bioy and Bachelart, 2010).
For Yalom (2002), focusing on the here and now means paying
special attention to immediate events. is approach is
fundamentally “ahistoric” (Yalom, 2002, p. 46), and it takes
the intersubjective relationship and the therapeutic relation,
understood as a social microcosm, to be the primary factors
of therapeutic change.
James (1912, p. 23–24) had already brought the “instant
eld of the present”—the actuality of its “naïf immediacy”—
which precedes whatever we can say of it, into the eld of
psychology, and had given it a primary role.
In his later writings on the therapeutic process, Stern (initially
known for his work in psychoanalysis and child development)
included insights from phenomenology and certain currents
of embodied cognition. He provides a theory of “present
moments,” subjective moments of very short duration (Stern,
2004, 2010). In this temporal horizon, every person can
participate intuitively in the experience of others, whether in
the form of a “micro-drama” (Stern, 2004, p. 22) or a lived
emotion that is signicant enough for the moment to begrasped
without necessarily being verbalized. For Stern, these moments
have an impact on the intersubjective eld, changing the
relationship and allowing everyone to proceed in dierent
directions: “Changes in psychotherapy (or any relationship)
occur by way of these non-linear leaps in the ways-of-being-
with-another” (Stern, 2004, p. 22).
Centering himself also in this temporal horizon, Roustang—as
Le Pelletier-Beaufond (2019) notes—speaks of the attitude of
the practitioner; this attitude is one of waiting and expectation,
a state of attention to all possibilities and to solutions that
have yet to appear, but which are already contained in the
present. Helocates the psychotherapeutic relationship in terms
of bodies that have been positioned in relation to one another
well before conceptual thought occurs (Roustang, 2015). Healso
presents the concept of “perceptude,” which is a manner of
being in the world by means of immediate perception; this
is located prior to representation and meaning (Le Pelletier-
Beaufond, 2019). Perceptude conceives existence as a silent
background against which a gure is distinguished. It is a
mode of perception that is unaware of time and space.
Embodiment
In the innitesimal of a relation, the therapeutic relationship
becomes a space where bodies live, move, and locate themselves
in respect to one another. e question of presence mingles
with those of the body, the living being, and vitality. Since
the body only lives in immediacy, returning to the body also
means occupying the immediate.
Roustang (2015, p.174) holds that therapy is a movement
of the body in presence: “e positions of the body are at
the beginning; they produce and determine the forms of the
relationships among people and, as a result, their state of well-
being or malaise.” He sought, in his practice, to nd the just
position. For the therapist, this begins with occupying space
and performing a reduction of the human to the animal, setting
language and concepts aside. Bodies perceive and notice; they
“think before speaking” (Roustang, 2015, p. 175). Roustang
states that such embodied thought occurs before conceptual
thought, in both the chronological and the structural sense
(Roustang, 2015, p. 181). Bodies perceive the subtle clues in
basic movements, tones of voice, and expressions. ey know
where they stand in relation to one another. Between the
patient and the therapist, experience becomes immersion or
absorption in the body itself, a bringing together of bodily
presences and attitudes that are shared by all human beings.
Roustang’s views are supported by approaches concerned
with embodied cognition. ese posit that there are forms of
cognition that do not need to berepresented (Gallagher, 2017).
e unit that is studied becomes the “organism-environment”
pairing (Gibson, 1979, p. 8), and action emerges from the
direct interaction between the brain and the environment,
without going through any construction of representation.
Action thus constitutes a context for the construction of meaning.
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For Rosch etal. (1993), cognition arises from experiences lived
by a body, and meaning emerges from lived and sensory
experience that is rooted in the body.
In terms of relationships, Fuchs (2005, p. 98) takes a
phenomenological approach that borrows from the eld of
embodied cognition, describing how human beings can grasp
the experience of others virtually; this process is based on an
empathic relationship that is not inferential. Henotes that the
organism can function in an “as if” structure, where preparing
for actions relies on processes of perceiving and modeling
that are themselves based on motor processes (Fuchs, 2005,
p. 103). Such “as if” structures are involved in interpersonal
relationships and are made possible by a form of “mutual
incorporation” of one another (Fuchs and Koch, 2014, p. 6).
For these authors, emotions arise from the circuit of interaction
between the aective qualities or aordances of the environment
and the bodily resonances of a subject. Bodily movements
that have been amplied or inhibited become the source of
lived emotional experience. e concept of aordance, which
was suggested by Gibson in 1966 (Luyat and Regia-Corte,
2009), depends on the idea of static or transformational
environmental invariants that are perceived by the organism.
is explains how an organism will direct its behavior to suit
its perception of the possible actions that are provided by its
environment. For Luyat and Regia-Corte (2009, p. 315), the
reciprocity of the organism and its environment hinges on
the perception of aordances and on the organisms “eectivities,
which are properties of the organism itself.
In these terms, the practitioner’s presence in the patient’s
environment can be understood as proposing aordances,
actions, and aective investments. What seems supercially to
be trivial has the potential to convey meaning for the patient
and can do so from the outset of the relationship: what s/he
perceives and feels about the spatial organization of the
practitioner’s oce; how s/he experiences the rst contact over
the telephone or the rst meeting with the therapist, and the
therapist’s behavioral invariants. Practitioners should pay attention
to these things, especially since, if we follow Roustang, what
appears initially becomes essential, in the rst instants when
bodies take their places and position themselves in relation
to each other.
Geller and Greenberg’s Model of
Therapeutic Presence
e rst model of therapeutic presence was provided by Geller
and Greenberg, on the basis of qualitative research conducted
with seven experienced psychotherapists who had written on
this theme. ey provide the following denition: “erapeutic
presence involves bringing one’s whole self into the encounter
with the client, being completely in the moment on a multiplicity
of levels, physically, emotionally, cognitively and spiritually”
(Geller and Greenberg, 2002, p. 82–83).
ey highlight three domains of presence:
- e therapist’s “preparation for presence,” which “occurs prior
to or at the beginning of a session as well as in daily life” (Geller
and Greenberg, 2002, p.75) and involves making oneself
available and receptive to the client’s experience. is domain
concerns the therapist’s intentionality, philosophy, and other
personal practices that are involved in “actively clearing a
space inside by putting away personal concerns” that could
damage the encounter with the client (Geller and Greenberg,
2002, p.77).
- e domain of the process of therapeutic presence emphasizes
the receptivity of the therapist. is concerns how therapists
“touch and are touched by the essence of the client” (Geller
and Greenberg, 2002, p.78), and involves a form of “altered
state of consciousness” that encourages “an extrasensory level
of communication” (Geller and Greenberg, 2002, p.78–79).
is “received experience” of the encounter as process “is
inwardly attended to” in an active and personal way by the
therapist (Geller and Greenberg, 2002, p.79). e domain
also includes congruence, one of Rogerss conditions, in the
dimension of authenticity and transparency (Geller and
Greenberg, 2002, p.79).
- Finally, there is the domain of the therapists experience of
presence in the session (Geller and Greenberg, 2002, p.80–82),
where presence appears as a form of paradoxical experience.
erapists become immersed in the subjective process of the
patients, while maintaining a form of objectivity regarding
their position in the therapeutic situation. ey can also
suspend their theoretical knowledge, calling upon it when
there is a need to clarify the intuitive responses that emerge
in the relational process.
is model of therapeutic presence presents a major advance
in the understanding of the notion of presence and its
operationalization, by outlining three dimensions of therapist
presence. However, clarications remain to be made in terms
of the boundaries of the concept and its use in psychotherapy.
THE DIFFICULTIES ASSOCIATED WITH
THE STUDY OF THE CONCEPT OF
PRESENCE
Non-specic Terms in the Denition
On the basis of the denition only, the notion of presence
can appear dicult to apprehend. e following denition
proposed by Geller and Greenberg (2001, p.159) makes use
of non-specic terms, such as, ones whole being, being fully
in the moment, grounded and centered position: “Presence
involves being fully in the moment and directly encountering
all aspects of experience with one’s whole being on a multitude
of levels—including physical, emotional, mental and visceral—
from a grounded and centered position within oneself. Presence
is a quality that can be experienced in many life situations,
such as art, watching a sunset, teaching, or in quiet meditation
with one’s self.
In another denition (Geller and Greenberg, 2002, p. 72)
the authors introduce the notion of intention and movement
by using the expression “bringing one’s whole self into the
encounter”. e model of therapeutic presence (Geller and
Greenberg, 2002) provides important clarications on the notion
Malet et al. Clinical Perspectives on the Notion of Presence
Frontiers in Psychology | www.frontiersin.org 5 February 2022 | Volume 13 | Article 783417
of presence and situates it as a foundation and initial condition
for the relational phenomena that occur. e denition chosen,
however, does not seem to do justice to the model by risking
reducing its meaning to an extension of the Rogerian conditions
of empathy and congruence.
On the Boundaries of the Concept of
Presence
ere seems to be a logical confusion between the concept
of presence and Rogers’ nodal conditions of congruence, empathy,
and unconditional acceptance of the patient. Geller and
Greenberg’s (2002) interpretation places presence both as a
precondition, necessary for Rogers’ three conditions and as
an independent process. Presence, however, is also seen as the
bodily correspondence of the three nodal conditions. Presence
thus appears as a concept that is both independent of and
intertwined with the three nodal conditions. How then can
we situate presence and these conditions, respectively?
One aspect of this problem may lie in the dierent possible
interpretations of Carl Rogers’ conditions. For Tudor (Tudor
et al., 2014), there is a tendency to reduce Rogers’ conditions
to the three so-called nodal conditions of congruence, empathic
understanding of the client’s world and unconditional acceptance
of the client. is tendency leads to a form of simplism. It
would consider that the three nodal conditions are of the
same nature or category, it would ignore the general context
of the theory proposed by Rogers and could lead to errors
in the conduct of therapy. e rst step would be to consider
each Rogers’ conditions in their specic nature. For example,
Tudor noted that Rogers himself dierentiated between the
conditions of empathy and acceptance and that of congruence.
While empathy and acceptance should be communicated to
the patient, congruence, as a way of being of the therapist,
would have to be perceived by the patient only to a
minimal degree.
In relation to the notion of presence, it appears essential
to reintegrate the forgotten conditions of contact, the patient’s
state of incongruence, and the patient’s perception. e condition
of contact, for example, seems to beunderestimated. Considering
presence in relation to the notion of contact allows us to
bring back the elements of relation to space and time. It is
at this level that presence begins and forms a foundation.
Similarly, for example, the condition of empathic understanding
of the client’s frame of reference has been simplied to “empathic
understanding” and then “empathy.” is may have been Rogers
wish, however, the notion of frame of reference contains the
idea of orientation to the patient’s reality, opens up more
perspectives, and suggests that the therapist can perceive and
feel the way the patient is orienting himself in his life.
How to get out of the logical confusion between presence
and Rogerian conditions? A rst element may come from Schmid
(2002) when heconsiders nodal conditions as a phenomenological
description of presence. But this may be a phenomenological
description from the point of view of an observer outside the
relationship, or from the point of view of the client. Schmid,
however, remains in a position that maintains a confusion between
presence and nodal conditions when hestates: “Presence is the
proper term for the “core conditions” in their interconnectedness
as the way of being and acting of the therapist” (Schmid, 2002,
p. 81–82). e author speaks of interaction in immediacy but
does not make a clear distinction between presence, interaction,
and communication. Hedoes, however, mention the link between
presence and contact, which supports our idea of reintroducing
Rogers’ other conditions for thinking about presence. “In the
‘way of being with’ called ‘presence’ the relationship becomes
realisation, and realisation becomes relational: in a certain sense
contact’ and ‘perception’ united” (Schmid, 2002, p. 84).
It seems delicate to insert the notion of presence into a
pre-existing theoretical system without reorganizing this system
in a consequent way. However, nodal conditions may appear
to many practitioners as a foundation that cannot bequestioned
or manipulated. e notion of presence could remain a oating,
ill-dened object, even though many practitioners refer to it
when talking about their practice. Beyond simply reintroducing
the notion of presence in Rogers’ set of conditions, we may
then have to explore the relationship between the notion of
presence and Rogers’ theory as a whole. For example, Tudor
et al. (2014) reminded us that Rogers’ conditions alone do
not constitute the center of his theory. It would be to also
consider the actualizing tendency of human beings, the principles
of non-directiveness, and concept of self. Such a position would
lead us to consider presence as a trans-theoretical notion whose
contours have yet to be determined and then to observe how
presence is embodied in this or that theoretical current.
Evaluation of the Patient’s Perception of
the Therapist’s Presence and Qualitative
Discovering of the Therapist’s Presence
Since Geller and Greenberg’s model of therapeutic presence,
several quantitative studies have been conducted in an attempt
to measure the perception of the therapist’s presence and its
impact on other dimensions of the therapeutic process.
Quantitative studies on the therapist’s presence focus on
the idea that the patient can evaluate the therapist as more
or less present during the session, just as the therapist can
evaluate himself or herself as more or less present. is
orientation is consistent with one of the six conditions set
forth by Rogers (1957), considering the need for the patient
to perceive something of the therapist’s attitude toward him or her.
Geller etal. (2010) designed two instruments for measuring
the perception of the therapist’s presence. e authors justied
the need for such instruments by the fact that there is little
research for recommendations that would guide practitioners
training and practice on the topic of presence. e erapeutic
Presence Inventory (TPI) is available in two versions, therapist
(TPI-T) and client (TPI-C). eir validity and reliability were
veried by the authors in a study including 25 therapists and
114 clients. e TPI-T contains 21 items allowing therapists
to rate their predominant experience of presence/absence on
a seven-point Likert scale. e TPI-C contains 3 items allowing
clients to rate their therapist’s presence/absence on a 7-point
Likert scale.
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Quantitative research on presence has oen involved
measuring perceived presence via the TPI-T and TPI-C and
looking for correlations with ratings of the therapeutic alliance,
of relationship and empathy, and patient perceived
therapeutic change.
A rst set of results focuses on the relationship between
perceived presence, therapeutic alliance, and therapeutic change.
Geller etal. (2010) found that clients’ evaluations of therapists’
presence were associated with their perception of therapeutic
change and the quality of the relationship, whereas therapists’
evaluations of their own presence were not correlated with
clients’ evaluations of the therapeutic outcome or their perceptions
of the relationship. e authors explained this result by the
fact that therapists’ evaluations of their own presence would
berelated to their own experiences of the therapeutic relationship.
erapists would experience presence within themselves without
necessarily communicating or expressing it to the client. is
result was conrmed by Vinca (2009) who evaluated the
therapeutic process of a patient and a therapist over 8 sessions.
A client’s perception of his therapist’s presence was correlated
with his perception of the quality of the session. However,
Dunn et al. (2013) introduced the assessment of the eect of
a task performed by the therapist prior to a therapy session.
eir research included 25 therapists in their nal training,
89 patients, for 132 therapy sessions. It showed that the therapist’s
practice of a centering technique for 5 minutes before a
psychotherapy session was correlated with better perception
of their presence by the therapists and with better perception
of the therapist’s presence by the clients.
Another set of results focuses on the relationship between
perceived presence and perceived empathy. Pos et al. (2011,
cited by Hayes and Vinca, 2017) evaluated the relationship
between presence, empathy, and working alliance. e research
included 17 therapists and 52 clients with depressive disorders.
Results showed a correlation between therapist empathy and
presence as rated by clients. However, empathy and presence
appeared dierently correlated with the working alliance. In
this research, the perception of presence predicted the perception
of the working alliance, which is not the case for empathy.
Presence and empathy thus appeared to be related but also
appeared to bedistinct concepts. Furthermore, through research
with 42 therapists in training and 88 clients followed for an
average of 8 sessions, Hayes and Vinca (2011, cited by Hayes
and Vinca, 2017) showed that the therapist’s presence perceived
by the client was correlated with the therapist’s empathy perceived
by the client. It was also found that the more the therapist
rated themselves as present, the more the client rated the
therapist as empathetic.
e results reported above tend to show that it is dicult
for patients to discriminate the presence of other factors in
the therapeutic process, such as empathy, alliance, or perceived
change. ey encourage our discussion above calling for
clarication of the links and dierences between the concept
of presence and Rogers’ conditions for therapeutic change. is
clarication will beeven more important as therapists themselves
do not conceive of presence in the same way. Indeed, in their
2010 article, Geller et al.’s found that cognitive behavioral
therapists rated themselves as less present than experiential
and person-centered therapists. is result could be explained
by a dierent conception of “presence” within each theoretical
approach. erapists may not currently represent the notion
of presence in the same way and do not attach the same
aspects of their experience to it, depending on the theoretical
approach in which they are involved.
Quantitative studies, while useful, do not capture the full
complexity of the internal process followed by therapists and
the relationship between this internal process and the course
of the therapeutic relationship. us, there is a need to further
explore the issue of presence through qualitative studies that
will allow us to study presence as a subjective process specic
to the therapist that should not be reduced to the patient’s
explicit perception. Presence engages the therapist, and hehas
the measure of it through his bodily, sensory experience. Just
as only a subject can describe what he or she experiences in
trance (Bioy, 2021), only the therapist can describe what heor
she experiences in presence.
Two types of qualitative approaches seem relevant to us in
this respect: interpretative phenomenological analysis and
idiographic approach.
Interpretative Phenomenological Analysis allows for the
exploration of how a person makes sense of their experiences,
by attempting to determine the meanings from the language
and state of mind of the person who is experiencing it. is
type of methodology is suitable for studying individual cases
before moving on to generalizing to a set of cases (Pietkiewicz
and Smith, 2012). For Antoine and smith (2017), the researcher
is personally engaged in the research by seeking to interpret
the interviewee’s process. Heor she is also there as a stimulant
of the participant’s reexivity, to get the participant to engage
in the exploration and interpretation of his/her lived experience.
Data collection is carried out through semi-structured interviews.
e data analysis presents a structured methodology. ese
elements have been elaborated by Antoine and Smith (2017)
and Smith et al. (2009).
We dene « idiographic » a science that seeks some particular
event (Toomela, 2009), opposed to the nomothetic approach,
science that seeks only general laws. Humanistic psychologists
and researchers oen use the idiographic approach because
they believe that a person’s subjective experience is more
important to gain an understanding of humans than a universal
generalization (Santarpia, 2022). Indeed humanism (Brown,
1972, p. 103) proposes an idiographic perspective:
- man as a whole, indivisible and immediate, superseding the
sum of his part processes;
- man is unique, a “once in a lifetime” happening, irreplicable;
- man qua man; man assessed in his own terms; man as the
measure of man. Nomothetic approach, on the other hand,
declares man as an "object" of study, similar to other objects.
An example of qualitative research on the subject of presence
is given by Stange Bernhardt et al. (2021), who studied a
dyadic case using the Interpretative Phenomenological Analysis.
ey showed a phenomenon of congruence between the patient’s
experience and those of the therapist. e therapist’s way of
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being was perceived and experienced by both the patient and
the therapist.
However, what makes the presence of the therapist a
determining factor in the change experienced by patients?
Patients undergo a reorganization of their experiences, and
many leading practitioners have noted how important it is for
them to have experiences that are novel to them. For this
reason, special attention is paid to a particular moment in
the course of the relationship, one that is a sort of zero-point,
where patients become able to have a conscious awareness of
what they really feel, in a sensory and visceral sense, without
needing to pass this through the lter of their conceptions.
In this view, the presence of the therapist oers a return to
a vital dimension of experience. e therapeutic relationship,
by its connection to immediacy, can activate aspects of lived
experience that are located prior to conceptual thought. e
therapeutic frame provides a structure for new experiences as
well as the means of orienting how they are organized and
the modes by which meaning is given to lived experience.
For Rogers (1961, p. 76), this occurs when a person, at a
certain point in therapy, can live what hecalls the “experiencing
of experience.” rough it, the person’s everyday experience
can come to include an undistorted awareness of his/her
authentic experience. e security of the relationship with the
therapist is what allows the patient to “let himself examine
various aspects of his experience as they actually feel to him,
as they are apprehended through his sensory and visceral
equipment, without distorting them to t the existing concept
of self” (Rogers, 1961, p. 76).
While Rogers held that people have to become able to look
at aspects of their lived, sensory experience without reducing
them to their self-conceptualizations, Erickson stressed the
importance of creating conditions in which the unconscious,
which hedenes as a natural part of human beings, can come
to the forefront. is involves reaching a moment that is
required for therapy, one in which the patient shows that s/he
has lost all self-consciousness (Vesely, 2014).
Roustang, for his part, describes a movement beyond the
conceptual dimension, in which humans return to an animal,
and the present becomes the place where the therapeutic
dimension really takes place:
“is reduction awakens the existence of the individual
human as animal, as a primitive being who temporarily
lacks the ability to reason. As a result, the past and the
future are forbidden. Anyone who lends him/herself to
enacting this withdrawal will only beable to apprehend
the present” (Roustang, 2015, p.43).
ese authors converge on the idea that one means of
therapeutic change involves reaching a moment in which the
conceptual and inferential aspects of patients’ experience move
to the background, so that they cease to interfere (or interfere
less) with embodied and sensory experience. When the patient
is less engaged in conceptual inference, lived experience becomes
meaningful in reference to the immediate context, which is
structured by the therapist’s presence. In this way, people can
distance themselves from their complaints and open themselves
to new possibilities of meaning and action that are found in
the moment.
The Nature and the Role of the Therapist’s
Responsiveness and Activity
e client’s experience of the therapist’s presence does not
explain, by itself, how patients can live experiences outside
their usual concept of self. So, beside the client’s perception
of the therapist’s presence what is the implication of the
therapist’s receptivity in achieving therapeutic change?
From a large review of results, Lecomte et al. (2004, p. 89;
Santarpia, 2020) listed attitudes of an ecient therapist:
- “Sensitivity to the patient’s characteristics.
- Flexibility in the choice of interventions.
- competence to intervene without inducing a process
of resistance.
- nesse in knowing how to follow the patients coping styles.
- ability to build a therapeutic alliance.
- aective sensitivity conducive to a secure attachment.
- receptivity to encourage not only empathic responses but also
responses of genuine warm acceptance.
- mastery and appropriate application of techniques adapted
to the patient’s needs.
From this perspective, as an openness to one’s own experience,
presence could be seen as what guides the therapist in the
choice and direction of his/her attitudes and interventions.
Bugental’s (1978, 1983, 1987, 1989) notion of presence includes
this idea (Geller and Greenberg, 2002, p. 72). He dened
presence in terms of three components: “availability and openness
to all aspects of the client’s experience, “openness to one’s
own experience”, and the “capacity to respond” to the client
based on that experience. It is with one’s own experience that
the therapist can encourage venturing outside the usual
conceptions of self.
But if presence is about the therapist’s receptivity and
engagement of their self in the here and now, how do they
do this? Krug (2009) compared the concept of presence of
James Bugental and of Irvin Yalom. One idea emerges
from his comparison. If presence is about being in the “here
and now,” the “here” for Bugental and the “here” for Yalom
diers. For Bugental, the “here” refers to the practitioner’s
focus on the patient’s subjective activity. For Yalom, the “here”
refers to a focus on the intersubjective space. By extension of
this idea, we are faced with the fact that the therapist can
orient his or her receptivity in multiple ways and have experiences
of all kinds of nature and intensity.
Another Form of Presence
Presence is oen understood on a scale of intensity, in terms
of presence/absence. Its usefulness is then thought in terms
of congruence, in terms of patients perception of the empathy
shown by the therapist, or in terms of therapeutic alliance.
is amounts to considering a presence perceived by the patient.
is is obviously essential. However, we need to go deeper
Malet et al. Clinical Perspectives on the Notion of Presence
Frontiers in Psychology | www.frontiersin.org 8 February 2022 | Volume 13 | Article 783417
into the description, analysis, and use of the therapist’s experiences
and perhaps discover other meanings of those experiences.
Beyond the eects of attunements observable in certain
moments of the therapeutic interaction, experiences described
as extrasensory communication in Geller and Greenberg’s model
suggest another form of presence, which appears to us to
be of a dierent nature. Indeed, the therapists studied by the
Geller and Greenberg (2002) used terms, such as “sharing
sacred space” (p. 78), “empathic resonance with a place that
she wasn’t even expressing” (p. 78), “vessel of information…
there’s things sort of, again this is esoteric language, sort of
moving through me and connecting to me” (p. 79). ose
experiences could relate to the notion of “extraordinary presence”
proposed by Hayes and Vinca (2017). e authors considered
two types of presence. “Ordinary presence” would bea prerequisite
for Rogerian conditions. It refers to presence that can
be experienced by the patient. “Extraordinary presence” refers
to a “deep state of connexion to oneself and to a ne source
of energy of which one is typically unaware” (Hayes and Vinca,
2017, p.95). It would bedicult to describe and would involve
altered states of consciousness. Hayes and Vinca (2017, p. 96)
also consider that extraordinary presence would facilitate the
therapeutic process regardless of the therapist’s theoretical
orientation: “the quality of extraordinary presence is therapeutic
in and of itself.” However, the role of this other form of
presence still needs to be conceptualized and highlighted.
AN IDIOGRAPHIC APPROACH
ILLUSTRATING A CLINICAL USE OF
DIMENSIONS OF PRESENCE
rough an idiographic approach taken from a sequence led
by one of us, weaim to show some clinical interest of another
form of presence that weconceptualized as “traces of presence”.
It supposes a form of presence not localized to the time of
the interaction in session. is form of presence approached
by the plural experience lived by the therapist allows an
embodied perspective of the clinical process which can
be deployed from the use of a raw material which would
belocated as close as possible to the real experience. It testies
of a global congruence between the course of the subjective
experience of the therapist and the course of the therapy
thought as a continuum of experience between the partners
of the therapy.
The Therapist
e therapist is a man in his mid-forties. He works in private
practice in Reunion Island as a clinical psychologist and
psychotherapist. He has completed ve years of training in
psychology and psychotherapy, is trained in hypnosis, and has
been practicing for ve years at the time of this follow-up.
Before obtaining the title of clinical psychologist and
psychotherapist, hehad a rst 12-year professional life in the
eld of management and nancial direction of organizations,
followed by a 5-year coaching/counseling practice of individuals
and organizations. e follow-up mentioned below was carried
out at the same time as the completion of a doctorate in
psychology on the theme of the therapist’s presence.
The Patient as Seen by the Therapist
Mrs. Arthur is 35 years old, married, and well established in
her professional activity. She had already undergone a previous
course of therapy with me, which had considerably reduced
the frequency and intensity of night sweats. She has a very
good capacity for elaboration and integration around the
therapeutic work. Isaw her again several months later on the
basis of an initial request concerning regular cannabis use.
With the lockdown decided in France, linked to the Covid
crisis, aer a rst session in the oce in physical presence,
we carried out three sessions by videoconference, spaced out
two weeks each, followed by three other sessions in the oce.
Therapeutic Approach
For Mrs. Arthur, the therapeutic approach took a form of
experiential/person-centered therapy. Some aspects of the
hypnotic approach were sometimes used to guide Mrs. Arthur
in attentional tasks and focus her attention to aspects of her
current experience.
In what follows, the therapist describes his experience of
a sequence starting with the rst videoconference session.
Session 1
e previous night before the video conference session, Iwoke
up at about 4 am with the sneaky and surprising “real” vision
and impression of Mrs. Arthur standing at the foot of my
bed. At the beginning of the session, which took place around
mid-morning, Mrs. Arthur did not bring up the topic of
cannabis use which had been discussed during the rst session
and which was the explicit object of her request. She mentions
a recurrent diculty related to her sleep. She describes lucid
dreams in which she is aware of being in a dream. In these
dreams she tries to solve problems. She says that in the same
dream she repeats the same scene several times in an attempt
to nd a way out of the problematic situation that is taking
place. In the dream, solving the problem would allow her to
get out of the dream and she says she experiences the anxiety
of not being able to get out of the dream. She states that
these dreams occur between 4 and 5 am. She says she is very
frequently anxious and exhausted when she wakes up. At this
point, I obviously associate the hallucination of her presence
at the foot of my bed at 4 am and her description of these
lucid dreams between 4 and 5 am. Idecide to focus the session
on the question of these dreams.
During this session, I use a hypnotic induction where the
scenario of a peaceful awakening is evoked and repeated several
times in multiple forms. Mrs. Arthur responds perfectly to
the hypnotic experience proposed and is calm at the end of
the session. However, she expresses skepticism and a touch
of disappointment about the eects she can expect from the
session. However, she resumes her appointment for a
psychotherapy session a fortnight later.
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Session 2
Mrs. Arthur tells me that she was very surprised by the return
of a very peaceful sleep and awakening, the night aer session
1. She also species that the change has been maintained since.
e day aer session 2, early in the morning, 6am, I am at
home and a particular subjective experience takes place in
the form of feelings, diuse and concrete impressions, associated
with the impression of locating Mrs. Arthur spatially. Idecide
to “pretend” that these residual traces of the other’s presence
constitute a real presence and that it is possible to establish
a form of “dialogue” with this residual presence using writing.
On the level of my subjective experience, it was as if I were
exchanging with the residual presence of the person as it
appeared to me in my bodily experience, in the physical absence
of the patient. From an interpretative point of view, this
experience calls upon a material made up of certain elements
of the patient’s discourse. But also, and above all it was an
experience of a tangible presence with which I could interact
ctitiously by giving a form to the experience through writing.
e text produced, which Ihave entitled "letter to your presence"
and which is reproduced below, was written in one go, by hand.
“Letter to Your Presence”
"You are back. We see each other for a few sessions. You come
to talk about guilt. en you feel better and decide to get on
with your life, as you say.
Here you are again. It's a few months later, maybe a year.
Something has changed.
I can feel all the eorts you make not to show sadness. An
impression. I tell myself that you are unhappy. And there are
like tears inside me. But I know how to control this feeling, it's
a piece of information about you, an event in the course of
the session, and Itell myself that it doesn't show that Iperceive
this. I don't talk to you about it at the moment.
You talk about your goal. But it doesn't speak to me. It's
at. What is strong is the sadness, the eorts you make to hide
it, or maybe you have come to show me the sadness. Maybe
you expect me to see a sadness that you can't name.
I see this call. A call for someone to hold you, much like a
mother comforts her child, or a father rather. It’s like a call to
nd enveloping contours. Your energy comes to me, it projects
itself. ere is your body, and another you that projects itself.
ere is another you calling for help and coming to me for
help. She is standing next to your physical you. You do not
hear it, you speak to me. I am talking to you and I hear her.
Her message is insistent, repeated several times.
e images scroll by. Isee you cowering, covering your ears.
I also have the impression that everything is too open, that
there is no longer a place where you are safe and sheltered
from the world for a moment.
ere is the image that you need someone to wrap you up.
It is this presence of yourself outside of yourself in fact that
seems to be asking for it. Ikeep in touch with this presence of
yourself that you ignore, while talking with you.
You talk about your irritations and annoyances. You say
youhave to control yourself. Inotice that the one who experiences
the irritation, the one who feels annoyed, her experience, youdon't
talk about it. Iask you. You say that it is not done to complain,
that others must experience the same things as yourself and
that they do not complain, that it is up to you to manage.
You are looking for a refuge. It seems to me that you nd
something here, security perhaps. You can talk about him. I'll
give youback the words youuse. It's not rape aer all, yousay,
even if yousay that you feel assaulted sometimes in the marital
bed. You should know better than to say no and you say that
you love him.
I appreciate all the eorts you are making. It moves me
inside. You take so much care of the other person's subjective
state. You take care not to disturb the other person, to meet
their expectations, to avoid any disappointment or frustration.
en you get exhausted and sometimes it explodes.
You seem exhausted. And you say so.
is word, boundary, came to me from the start, with the
vision of you being unhappy. You say it sometimes, you feel
something and you tell the other person about it, and then
when the other person has spoken, you don't know how to
distinguish your thought from theirs.
I would like you to learn to make that distinction between
what comes from you and what comes from the other, to
re-establish a boundary when you wish. To be in the world is
to have an eect on what is around you. You would like not
to exert this eect, to make as few waves as possible. You feel
the waves that are propelled by others, that push you around
and you say you can't complain.
You cry of course. You can. Idon't remember seeing youcry
before. You seem to want to explore this question of boundaries.
Not too fast, there is no rush. I know you're afraid of the
consequences that come with hearing what's talking inside you.
You might have to leave, you might have to say to yourself
that you did this for nothing. And that's not possible. You've
already done this in response to guilt. To give it up would beto
face the guilt and then the guilt of not having faced it.
You don't talk about the addiction anymore. You can see
that it's not the most important thing right away. Now youdiscover
that here you can risk hearing something that comes from
inside you. You manage to approach it. From a distance still.
For the moment, just to see that this other you is there, even
if youdon't know how to look at it yet. ere is the beginning
of an approach”.
Subsequent Sessions
In the session conducted 15 days aer session 2, Mrs. Arthur
spontaneously and directly mentioned her relationship with
her partner. I had indeed associated certain elements of the
text relating to the virtual dialogue with the theme of the
couple, which Mrs. Arthur had hitherto addressed only in an
informative and laconic manner. I believe that post-session 2
experience brought a practical way to bring to maturity a
material related to my perception of Mrs. Arthur's internal
states and this allowed me to accompany her in a more ecient
and uid way.
Mrs. Arthur’s follow-up continued for 3 more sessions at
my oce, with work refocused on her relationship with her
partner and her perception of her place in the couple.
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Frontiers in Psychology | www.frontiersin.org 10 February 2022 | Volume 13 | Article 783417
She expressed the need to allow herself to express her limits
and needs more freely.
More than a year aer the end of her treatment, Mrs.
Arthur tells me that she feels fullled in her life as a couple.
She announces the birth of her rst child and the cessation
of her use of Cannabis. She is attributing these changes to
the psychotherapy.
DISCUSSION
Experience and Process of Presence in
These Sessions
e sequence illustrated above testies a posteriori to the
diversity and plurality of the therapist’s experience during the
session. Geller and Greenberg’s model evokes the alternation
between phases of immersion in the relational process and
the therapist’s return to an objective position regarding the
relationship with the patient.
Only part of the information available to the therapist is
explicit during the session. However, it is possible to develop
an awareness of and availability to material that can only
be described through the use of metaphor. Several elements
of the letter to the presence testify to a composite material
made up of images, perceptions, sensations, and interpretations
and intuitions. is material may have clinical value, for example
the therapist’s perception of a dissociation between the person
expressing himself or herself verbally and the person they
perceive as seeking help of another kind.
As to the nature of this type of experience for the therapist,
we can return to James' idea of immediate experience and
the pluralistic dimension of experience: “I have now to say
that there is no general stu of which experience at large is
made. ere are as many stus as there are ‘natures’ in the
things experienced. If you ask what any one bit of pure
experience is made of, the answer is always the same: “It is
made of that, of just what appears, of space, of intensity, of
atness, brownness, heaviness, or what not.…Experience is
only a collective name for all these sensible natures, and save
for time and space (and, if youlike, for ‘being’) there appears
no universal element of which all things are made.” (James,
1912, p. 27).
Traces of Presence
e post-session 2 “letter to your presence” shows that the
experience of the therapist that remains as a trace aer or
between sessions can be processed and transformed in a way
that is useful for the therapeutic process.
e therapist conceptualized this process as follows.
“When I am in contact with these patients during a
session, sensory and perceptual experience takes the form
of a tangible, palpable material that imposes itself on lived
experience; this material can be located either inside or
outside the body, and can beworked, “handled,” transformed,
and used in the clinical situation. It appears as a compendium
of information that is not initially comprehensible in an
explicit manner, seeming to belong to the dimension of
that which initially evades conceptual thought. However,
this compendium can unfurl or unfold over time. An
instantaneous lived experience can be unfolded over the
course of several minutes or more, through an exchange,
and a meaning can then emerge from it. These traces of
the presence of the other can sometimes be there without
my having any idea of what to do with them. I am not
required to do anything with them unless they become
insistent, but it is also important not to ignore them or
try to pretend that they do not exist.
In a session, they provide the sensation that a dialogue is
taking place on several parallel lines or levels. One line of
communication is located on the verbal level, while another
transpires with another dimension of the person; this dimension
appears to be dissociated from his/her physical body, yet it
remains perceptible and can even be located spatially in his/
her vicinity. is other dimension of the person can appear
as a sort of insistence, as if a request were manifest on an
implicit level, one that is separate from verbal expression. ere
is thus a contrast between what the physical person is asking
for and what comes from something else. At times, it is as
though, while the person is speaking, some invisible “other”
is communicating in another way, as if “it” were calling out.
Sometimes this other “person” is “on hold,” “keeping watch,
remaining “quiet,” “crying out,” or “coming into contact.
With patients who elicit this kind of experience, certain
residual traces persist aer the session.
I conceptualized this idea by evoking the notion of residual
traces of the other's presence. e spontaneous method that
arose on this occasion was structured and rehearsed. It consists
in carrying out a dialogue of the as-if type based on the
following rules
- writing as soon as possible, but perhaps not too soon in
relation to the session. Within 24 hours or more, or at the
moment when this presence is felt suciently
- writing in the present tense, without reference to your own
history or as little as possible. is favors the evocation and
description of perceptions and sensations.
- writing in short sentences. Combined with the present tense,
they create a particular dynamic that helps in this process
- writing in “one go”
- writing without referring to the person's rst name in order
to make less reference to already existing concepts about
the person
- writing addressing the residual presence while referring to
interpretative aspects of the experience in relation to this
residual presence. Describing not only moments, perceptions,
sensations, emotions, but also what comes to mind, from what
has already been elaborated about the person, from the ction
wehave constructed of him/her. ere are things that may
have been said and also all those things that were not thought
or said during the process. It is as if what has been said initiates
other things that emerge outside the session
- writing with compassion in mind
- As few contextual elements as possible. e residual presence
becomes the only element of our context.
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- Like in dreams, there is no anteriority to the scene described.
Just what comes in reference to that scene; wedescribe the
material contained in that scene, then another scene is there,
etc. e scenes follow one another without necessarily an
anteriority or chronology.
In doing this, I was, on one hand, giving a concrete form
to the wealth of information that had been incorporated over
the course of an interaction. Carrying out an “as if” sort of
conversation with the incorporated residual presence allows
the available compendium of information pertaining to the
therapeutic relationship, which has not yet been put into words,
to be actualized. On the other hand, I was able to observe
that this way of proceeding has specic eects. For example,
following such a “remote session,” the residual presence changes
and becomes less distinct. It can also happen that it leaves
me with a foreknowledge of the patient, in which certain
elements that were located at the margins of what s/he said
become central in the written conversation, and then emerge
spontaneously in the therapy session, when the patient brings
them up as the main theme. Similarly, other elements that
were implicit then become explicit for me in my interaction
with the residual presence, and later become explicit for the
patient. Finally, this work with my lived experience of the
other’s residual presence seems to enhance my long-term sensory
and perceptual acuity.
Virtual Space, Sensory Contact, and
Traces of the Presence of the Other
How can weunderstand this type of experience, which suggests
that there is a form of responsive, sensory contact between
patient and therapist? Merleau-Ponty’s (1966) early concepts
of virtual space, virtual movement, and the virtual body are
helpful here.
Merleau-Ponty’s denition of virtual space is based on the
work of Wallon in the 1920s. As Parmentier (2018, para. 7)
notes, Wallon conceived of virtual space as a place where
“nascent or aborted movements,” whose “physical component
is repressed…and remains only in the state of a trace,” can
appear. Parmentier then adds that, for Merleau-Ponty, virtual
space is composed of a “cluster of [possible] trajectories” (para.
17), an extension of the body, which is understood as “the
living envelope of our actions” (Merleau-Ponty, 1942, p. 188;
cited in Parmentier, 2018, para. 17). In order to perform a
movement, a human being would have to belocated in virtual
space, while also being located in physical space. Whereas
physical movement takes place in the actual, abstract movement
takes place in the non-actual, that is, the possible (Parmentier,
2018, para. 23).
As a result, the place where the therapeutic relationship
occurs can beinterpreted as one in which the therapist deploys
a presence in terms not only of what happens in the physical
space or in his/her thoughts, but also of what is going on in
the virtual space. One hypothesis is that an aspect of presence
involves the psychotherapist’s ability to grasp and actualize in
an embodied manner the virtual space of the relationship.
is space contains gestures and movements that are not
performed in any actual space. When bodies are in presence,
their movements may be on the way,” interrupted, or held
back; they may not nd a means of expression in the physical
space or they may berepressed. In all of these cases, movements
exist as possible, in a non-physical or virtual space. ey are
not perceived consciously; instead, they are actualized by the
psychotherapist as traces in the lived body, without actually
being conceptualized. e therapist’s use of these movements—
which exist in the possible and not yet in the physical—by
the intermediary of his/her bodily experience, may encourage
the patient to (re)turn to new possibilities. is use guides
the patient’s experience beyond his/her habitual concepts and
ways of thinking. In this way, the patient can add to the sum
of all his/her experiences, as Rogers (1957) suggests.
Presence thus becomes presence to the virtual space as
much as to the physical space or to the already conceptualized
aspects of immediate experience. It may also bea sign of the
therapist’s relation to a virtual body, a relation that develops
over the course of professional practice in his/her relations
to patients.
Presence, relation, Relation, and
Therapeutic Change
Presence thus appears to be intimately linked to the capacity
to actualize the information resulting from the relation to the
virtual space as well as to the actual space of the relation. It
allows the emergence of a clinical material which is elaborated
from the presence of the other as it appears in the experience
of the therapist. is presupposes the existence of a primary
disposition to welcome the other in our psychic reality.
We refer to Buber’s groundbreaking work of 1923, I and
ou, which has served as a point of reference for humanistic
and existential approaches. For (Buber, 1970, p. 82), the world
is twofold for humans, in accordance with our twofold attitude.
ese attitudes and worlds appear bound to the way in which
time and space are considered.
In the rst attitude, humans perceive and treat perceived
objects as things, whether they are things, facts, actions, or
living beings. In this attitude, things are conceived of as situated
and included in space and time; they are compared with each
other and organized in a world that human beings cannot do
without. Buber explains that “although [this world] takes a
somewhat dierent form for everybody, it is prepared to be a
common object for you” (Buber, 1970, p. 83). While the
“reliability [of this world] preserves you,” it is also true that
“you cannot encounter others in it” (Buber, 1970, p. 83).
e relational eects where the patient perceives the therapist’s
empathy or acceptance could belocated in the temporal dynamics
of the therapeutic relationship. ey are part of the facts that
can be objectied by observing and comparing the discourses
between patient and therapist.
It could bedierent for the phenomena that we have tried
to describe concerning the therapist and Mrs. Arthur. Buber
describes an other attitude in which human beings do encounter
“being and becoming” (Buber, 1970, p. 83). is encounter is
unique each time, involving “always only one being and every
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thing only as a being” (Buber, 1970, p. 83). Further, “e
encounters do not order themselves to become a world, but
each is for you a sign of the world order. ey have no
association with each other, but every one guarantees your
association with the world” (Buber, 1970, p. 83). e world
that appears in this way is “unreliable”'; it lacks both density
and duration (Buber, 1970, p.83). In this attitude, the relation
to time and space has been reversed. In the rst world of
things, the “It-world,” we consider things to exist in a space
and a time; in the second world, the “You-world,” space and
time are included in each encounter (Buber, 1970, p. 84).
is idea goes hand in hand with Buber's distinction between
relation” and “Relation.” As relation is situated in time and
space, Relation constitutes a primary fact, a welcoming disposition,
a psychic mold, a global conguration which allows the encounter
and in which the relationship to time and space will bestructured.
In support of these ideas, we can consider therapeutic
presence from the point of view of relation and the active
part by which the therapist engages his or her presence in
the encounter with the patient. And wecan consider presence
from the point of view of Relation as a rst global disposition
of welcome to all that this psychic mold can contain and
propose in terms of natures and intensities of experiences.
Presence here starts as something immanent. Presence in
this case appears as a global conguration that is conceptually
situated before the physical encounter and that structures
the physical encounter.
We can speak of a willingness to let our experience of
the other take on its full shape and suspend the usual course
of our relationship with the world. In what may appear as
altered states of consciousness, space and time are no longer
separate elements or the containers of our experience. In
the case presented above, for the therapist, a disposition to
a stream of experience related to the patient is activated at
the time of the appointment. Part of this activation seems
to be quite implicit and not located in the time of the
session. We understand this as a readiness for the presence
of the other in our experience. is activation can result
in specic experiences, such as the hallucination of the
patient’s presence on the morning.
e relationship to the other and to the world becomes
then an intimate experience. It is from within the variation
of these states of consciousness that the human and clinical
relationship is lived. e therapist perceives the moment when
Mrs. Arthur speaks about her lucid dreams as something
signicant but also normal as heis immerged in the encounter.
But as much these events appear meaningful and normal in
the moment of the experience, so much they can appear as
strange or simple coincidences when seen from the outside.
On another note, moments can beobserved in the therapeutic
process where there is a duality between what Mrs. Arthur
considers to be her problem and what the therapist perceives
and uses:
- the patient’s request for support in relation to an addiction
evolves into a request concerning her sleep and then her
relationship with her partner
- her skepticism at the end of session 1 and her surprise to see
the absence of disorders aer the session and in a lasting way
- the perception by the therapist of an implicit request dierent
from the one expressed verbally, and the fact that this other
request, at rst on the margin, will become central later on.
ese elements seem to conrm the “need” for the patient
to have experiences outside of the usual conceptions of self,
as discussed above, and the place of immediate and pluralistic
experience in this process.
It is also observed that a continuum linking the patient
and the therapist was in motion, remarkable for the mirrored
experiences, such as that of the therapist’s hallucination and
the patient’s dream, or that of the letter to the presence, which
account for a process internal to the patient as perceived by
the therapist, at rst at the margin in her discourse and
becoming central in the later sessions. e therapist’s subjective
experience translates or even anticipates the evolution of the
relational continuum and clinical process.
Further Directions
We have attempted to outline some of the clinical perspectives
enabled by the concept of therapeutic presence. e therapist’s
posture centered on immediate experience and his availability
to pluralistic experiences generates a body of information with
potential value and role in therapeutic change. e therapist’s
availability to immediate experience is as much about an
availability to actual as well as virtual aspects of experience.
Presence takes shape in a continuum between patient and
therapist and gives rhythm to therapeutic change.
Future research should address the confusion of logical levels
between presence as a concept and Rogers' attitudes. is
confusion of logical levels may come from a confusion between
two types of presence. One presence would beassociated with
the therapist’s posture and the dimensions that he mobilizes
and invests in order to get in touch with the patient. Another
presence as proposed by Hayes and Vinca (2017), could
be qualied of ‘extraordinary presence’ and probably belongs
to another conceptual category. Should we even distinguish
in the concept of presence, three aspects of presence:
- Presence of the therapist as perceived by the patient and which
supports the quality of the relationship
- Presence as an embodied perspective characterized by body-
related processes including the integration of perceptions and
representations and by which the therapist deploys
clinical interventions
- Extended or extraordinary presence which testies to the
therapist’s state of deep connexion to oneself and to a global
conguration of communication with the patient. is type
of experience is dicult to conceptualize, and its description
requires the use of metaphors.
In any case, it seems important to deepen the research
about presence that guides the therapist and extraordinary
presence. Hayes and Vinca (2017) think that it is rare and
dicult to nd and to measure extraordinary presence.
Malet et al. Clinical Perspectives on the Notion of Presence
Frontiers in Psychology | www.frontiersin.org 13 February 2022 | Volume 13 | Article 783417
However, this type of presence could be much more frequent
than we would think. We believe that therapists can train
themselves to be more open and receptive to ne dimensions
of their experience that reect the relationship at a deeper level.
In our opinion, the concept of “traces of presence” could
prove to be an interesting concept to guide therapists in the
observation of variations in their own altered states of
consciousness. It could help to recognize and describe our
experiences with greater accuracy to account for their plural
nature while considering their value as a guide or as a
therapeutic principle.
In this sense, presence of the therapist is primarily his or
her receptivity to his or her own experience of the patient’s
presence. It represents his ability and willingness to engage
his or her sensitivity in an interaction (from interaction to
communication or even communion) with the patient’s presence,
simultaneously at dierent dimensions of the relationship, in
a way that is experienced as tangible, palpable, and concrete
and in a context that is intended to be therapeutic. ese
dierent dimensions are in particular:
- Temporal. ey imply changes in the orientation of time with
a focus on the horizon of the smallest moments, the immediate,
the birth of movements.
- Spatial. ey imply an orientation of the therapist to the actual
or virtual space of the relationship.
- Corporeal. ey imply the relation to the actual body and
movements as well as to the virtual body and movements,
and the relation to the traces of the patient’s presence in the
therapist’s bodily experience.
- Identity. ey imply putting aside aspects of the self that
should not interfere with the encounter.
is presence is inscribed in a general context of the
relationship that is not limited to objective time and space.
It produces perceptual, sensory, emotional, and conceptual
material that the therapist can use to set up the conditions
for therapeutic change.
DATA AVAILABILITY STATEMENT
e raw data supporting the conclusions of this article will
be made available by the authors, without undue reservation.
ETHICS STATEMENT
Ethical review and approval were not required for the study
on human participants in accordance with the local legislation
and institutional requirements. e patients/participants provided
their written informed consent to participate in this study.
AUTHOR CONTRIBUTIONS
PM: conceptualization, methodology, investigation, and writing
original dra. AB and AS: conceptualization, supervision, and
writing—review and editing. All authors contributed to the
article and approved the submitted version.
FUNDING
Université Paris 8 Vincennes – St Denis: contribution for translation
from French to English
ACKNOWLEDGMENTS
John Holland: Translation French to English (rst submission).
Chantal Wood: Proofreading and correction.
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Objective: There is a need to understand more of the dyadic processes in therapy and how the therapist’s ways of being are experienced and reflected upon by both patient and therapist. The aim of this dyadic case study was to investigate how the therapist’s personal presence was perceived by the patient and the therapist as contributing to change. Method: From a larger project on collaborative actions between patient and therapist, a dyadic case involving in-depth interviews of the therapist and patient was selected to examine the research question. Interpretative phenomenological analysis of four interviews with the therapist and one interview with the patient was conducted. Results: The analyses indicated that the therapist’s way of being, as perceived by both therapist and patient, was expressed at a superordinate level through the concept of embodied listening, which was of particular help for the patient, and influenced by the therapist’s theoretical orientation, as well as being rooted in his own personal history. Three sub-themes emerged from the analysis, each illustrating how embodied listening contributed to the therapeutic relationship and process. Our findings flesh out how the underlying phenomena of emotional attunement, presence, and genuineness are observable in therapeutic encounters.
Conference Paper
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Ce travail d’écriture relate une présentation orale (effectuée à plusieurs voix ) au colloque « Vers des archives de la Présence » (9 et 10 mai 2019, Université du Québec à Montréal) organisé par Florence Vinit et Sanja Andus L’Hotellier. Il s’inscrit dans un projet de recherche québécois, financé par le FRQSC (mai 2018-mai 2022, Fonds de recherche du Québec – Société et culture: FRQSC – 2019-RC2-260306) et la Fondation Canadienne pour l’Innovation (FCI - FOND DES LEADERS). Ce projet vise à mieux comprendre les effets psychologiques (sentiments, idées, émotions) et psychophysiologiques (par exemple, l’activité électrodermale, l’activité cardiaque, l’excursion respiratoire) d’une œuvre immersive en arts vivants, à la fois chez les performeurs et les spectateurs. Plus précisément, il tente d’explorer comment une œuvre en arts vivants centrée sur le corps peut jouer sur les processus de régulation émotionnelle , de conscience émotionnelle et d’homéostasie socioculturelle – c’est à dire – quel type d’œuvre scénique peut contribuer activement à notre mieux-être ? Dans cet écrit, nous allons d’abord présenter l’histoire du laboratoire LAVI. Ensuite, la conception de l’œuvre interdisciplinaire Kalos, eîdos, skopeîn (2019) d’Andrée Martin, et enfin nous relaterons l’expérience de mieux-être à travers « les paroles de la présence » des quatre interprètes de l’œuvre mentionnée.
Chapter
Ce chapitre présente le contenu de l’un des articles les plus cités publié par Rogers en 1957 et qui postulait six conditions nécessaires et suffisantes (CNS) au changement thérapeutique, une brève synthèse critique des commentaires énoncés à propos des CNS qui ont été largement discutés dans la littérature, l’impact historique et épistémologique de ce texte pour la recherche et la pratique en psychothérapie, une synthèse de l’évaluation scientifique de la pertinence de ces postulats et de leur actualité dans la recherche empiriquement validée.