One aspect of therapeutic learning that can often go unnoticed is the loss of self that occurs in the process of change. I use the term “therapeutic learning” to reflect my growing understanding of the therapeutic process as a developmental process. In other words, the clinician focuses more on creating the conditions for change, and as such clinical techniques and interventions are primarily meant to serve this purpose. Western models of learning typically focus on the accumulation of knowledge, and in this sense it is more akin to collection and advancement. I do not necessarily dispute the forward movement that occurs in the process of learning, but argue that a fundamental aspect of movement is transition. When one gains therapeutic knowledge, or insight, one also experiences the loss of self. Our sense of self is based on our understanding of the world, the way we are situated in the world, and the relationship between self and world. We view our feelings, cognitions, and behaviors in the context of our understanding of this relational matrix.
In therapeutic learning, there is necessarily a loss of self that comes with new insight. The person we once knew is changing, and has changed. We can grapple with our experiences in the world precisely because of our understanding of our place in the world. When our understanding changes, it is a transition that leaves that self behind, and thus we have changed. One example of this loss of self is in the relational and emotional repair of abuse. A theme common among survivors of abuse is the self as deserving of abuse. It is profoundly painful for a child to acknowledge that the ones who are supposed to be our best advocates and allies, our caregivers, could perpetrate such an evil as sexual, physical, or emotional abuse against us. Thus, we orient such betrayal around a construction of the self as inherently bad. We have done something to cause this betrayal. Or, there is some defect in our mind or body, a core aspect of the self that was a catalyst for the perpetration of harm. When, in the process of recovery, the differentiation between perpetrator and victim becomes more clear, we are suddenly bereft of the self-blame that once constituted a significant aspect of the self. As strange as it may sound, this bad self that once provided such comfort is now a stranger.
Therapeutic learning is a process of perpetual grief. I do not mean to compare this to the grief that one experiences in death, only to say that loss is a transitional process, and the therapeutic process is one of ongoing transition. The self has been lost, and it is now time to grapple with the meaning of this loss and the construction of self again. I wonder if this loss is one reason why it is so typical to experience exacerbated symptoms at the beginning of the therapeutic endeavor. This can often be confusing and angering to people who had assumed that meeting for therapy would bring immediate relief. The initiation of catharsis carries a flood of insights that almost immediately leaves one’s sense of self behind. There is an immediate loss, which begins a process of loss, which takes time to get used to. It is perhaps an immediate imprint, a form of the self that first appeared and is now captured and suddenly viewed outside of itself, a jarring and unnerving experience.
Attending to the loss of self may attenuate both the initial and ongoing disturbance in the therapeutic endeavor. Developing scaffolding is essential at the beginning of therapy, and addressing loss as an aspect of therapeutic learning may assist in this process. In the case of the clinician, this can be operationalized by addressing the here-and-now quickly, within the first session, in order to bring awareness to the shifts that have already begun. Attending to the here-and-now also provides modeling for the reflective function of therapy, revealing the underlying methodology that ultimately positions the therapeutic hour as a stance rather than simply a collection of targeted interventions.