One of the current trends or fads in psychotherapy is the concept of “immediacy.” Rather than concentrating on the client’s issues during session the therapist is supposed to ask questions like “How do you experience what I’ve just said?”, “Are you satisfied with this direction in our conversation?”, “How am I doing now?” and even “How did I do in our last session?” The client is supposed to use sensory-specific language in reply, such as “I feel … because.” The therapist is supposed to listen non-judgmentally and listen to and absorb the client’s point of view. The therapist then is supposed to comment, “Thank you for sharing, I feel (this way) because …”
The theory underlying immediacy is the “here and now” is an effective lens or window into the underlying issues that brought the client to therapy. According to group theorists such as Irving Yalom it is the single most effective lens or window because it presents a microcosm of the client’s world and its most important issues. There is no other exemplar that’s more vivid because immediacy is what’s happening right now.
This is a peculiar approach and even rises to the level of serious error. Unlike role-playing, psychodrama, interior voice techniques or straight-forward analysis and interpretation, discussing the “here and now” is not therapy. Rather it is a kind of meta-comment on the process of therapy, which in and of itself has no therapeutic value. A comment about how the therapy is going, or the client’s reactions to being in therapy, is just that – not a way of revealing or expressing a deeper issue.
In confusing therapeutic dialog with process comments Yalom et al. are making a simple logical category mistake (which, among other issues, carries with it the problem of recursion). They also are making a token/type error. Even if an immediacy statement has some therapeutic value it only is one instance of dozens of other types of statements that also might have therapeutic value (potentially, a lot more). It expresses only a single facet of a complex underlying problem. There is no reason to extrapolate the therapeutic potential of an immediacy statement (to the extent it has any) beyond its original limited scope.
My concerns about immediacy also are based on classic psychoanalytic theory of transference particularly as developed by Freud. A therapeutic outcome depends on the development of a transference neurosis between the client and the therapist followed by its resolution and then generalization to other aspects of the client’s life. The client projects his/her issues onto the therapist or identifies the therapist with someone who played a role in the development of those issues, redirecting unconscious thoughts towards the therapist. In turn the therapist may experience counter-transference, which is a reaction to the client’s transference vis-à-vis the therapist.
Statements or behavior indicating the development of transference have substantive propositional content regarding some aspect of relationship between the client and the therapist. Immediacy statements on the other hand simply are verbal ejaculations. They come from an irregular and impressionistic source, which is the client’s expression of an emotional reaction (as opposed to genuine dialog between the therapist and the client). Particularly in group contexts immediacy statements likely are corrupted by group dynamics such as the client’s perception of power relationships within the group.
Another grave risk with an immediacy statement is that it may violate boundary conditions between the therapist and the client thereby damaging the therapeutic frame. It may invite or precipitate reactions above and beyond transference. For example the client may believe he/she must make what might be characterized as a premature decision or comment about the state of transference. Transference may not yet have developed or it is incomplete. Soliciting an immediacy statement before the client is ready to make one voluntarily could disrupt the transference process. It actually might be counter-productive by encouraging or reinforcing cognitions or behavior, which themselves are the object of therapy.
It is important for me to clarify what I’m not saying. It is necessary and highly appropriate for the therapist to express empathy for the client. I mean “empathy” in the expansive Rogerian sense, that is, “I understand from what you’re telling me that …” It is equally crucial for the therapist and the client to establish an effective working relationship – an interactive therapeutic alliance. Thus any number of empathic or quasi-empathic expressions might be appropriate if the client is refractory to therapy, for example, because he or she is there as part of a court-ordered program or has no motivation to change. These techniques however do not make therapy itself the focus of therapy. Rather they are preconditions to effective therapy.