Psychotherapeutic Work between Insult and Connectedness – Reflections on a Challenging Interpersonal Event

Nataly Hoffmann & Margit Schmolke

The authors reflect on the meaning of connectedness in the psychotherapeutic work on the basis of a sound therapeutic relationship which can be shaken or jeopardized from time to time. A main topic of the presentation are reactions of patients who feel insulted due to various reasons within the therapeutic process. Such reactions may lead to high tension, disruption or even to a break of the therapeutic relationship. Possible reasons of a patient’s reaction due to insult may be severe self-esteem crises, narcissistic wounds, misunderstandings on a verbal and nonverbal level or the feeling of being ignored and are accompanied by feelings of anger and shame. By feeling devalued by the patient, the therapist may develop specific counter-transference feelings which puts a strain on the therapeutic relationship particularly when the therapist does not reflect sufficiently those negative emotions. Some examples from the literature illustrate how conflicts come to a head and how possible solutions can be developed. For the authors, the reconstruction of the interpersonal connectedness – the basis of the therapeutic relationship – is important for a possible conflict resolution. Reconstruction of mutual confidence, appreciation and connectedness is considered as a complex and challenging event which is significant not only for the psychotherapeutic work but far beyond for the togetherness in society. This process requires an active effort towards understanding, capability of reflection, feeling mutually touched by the other person, and a work context supporting and strengthening the therapist.