Presence in psychotherapy
James Bugental spent four decades practicing and teaching what he called depth or life-changing psychotherapy. He was one of the founders of the existential-humanistic school in the United States. In 1987 he published The Art of the Psychotherapist, a book for working therapists. Its second chapter, "Communication Level", is where he explains presence.
The chapter opens on a short scene from a therapy session, written as a parody. Bugental calls what it shows the sin of non-presence. The words are all there. The people are somewhere else.
A word for being in the room
Bugental then follows one client, Donna Davis, from her first interview to a point months later. He sets five of her self-descriptions side by side. What changes across them is how much of her is in what she says. He calls that difference presence, a word that points to
"how genuinely and completely a person is in a situation rather than standing apart from it as observer, commentator, critic, or judge."
— James F. T. Bugental, The Art of the Psychotherapist (1987), chapter 2, "Communication Level"
He gives presence two sides. One is accessibility: letting what the other person says actually reach you. The other is expressiveness: letting what goes on inside you be known. The two overlap, and neither is on or off. Both rise and fall with the person, the subject and the moment.
Five levels of a conversation
The chapter's main tool is a scale. Bugental describes five levels at which people talk, in therapy and outside it.
- Formal relating. Each person keeps up a front and sizes up the other. Talk is external and impersonal.
- Contact maintenance. The familiar exchange with people we see often but briefly. It follows a ritual, and if someone breaks the ritual the level changes.
- Standard conversation. Ordinary talk about the matter at hand.
- Critical occasions. Conversations that make a difference. Bugental says that talk which stays at this level for a while changes the thoughts, feelings, words or acts of at least one of the people in it.
- Intimacy. The deepest of the five.
A figure in the chapter draws these levels as veils wrapped around a center. Bugental suggests that the center is where everything a person shows comes from. The figure marks it only as a point.
He draws the levels twice, once for everyday talk and once for therapy. Therapy meant to change a life, he argues, has to spend much of its time at the fourth level. It rarely starts there. The standard level is usually the way in.
Not the same as rapport
Bugental looks back with some surprise at how long he overlooked presence. He also notes how little attention it had received in the literature. Therapists, he writes, often assumed that rapport with the patient was the same thing. He insists it is not. Getting along well says nothing yet about the level at which two people are talking.
He is sharper about the therapist's side of the room. The ideal of "therapeutic detachment", he writes, is countertherapeutic. The next chapter, "Therapist Presence and the Alliance", turns the question around. A client does not go deeper alone. Bugental argues that the therapist has to bring her own subjectivity into the work. Later in the book he adds a warning: a therapist who hears only what fits a theory becomes more present to the theory than to the person.
What the scale asks
The levels are something both people can notice while they talk. A sentence can be true and well put, and still come from the second level.
That leaves the question the chapter keeps circling. In the conversations that matter most to me, how much of me is actually in them?
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About the app: an AI therapist for long-term therapy
This page is about a school of psychotherapy. It is not medical advice and not emergency help. If you are in danger right now, contact your local emergency number, or find a helpline in your country at findahelpline.com.