The Essence of Presence

by Ilyssa Swartout, Psy.D., I.I.H.S. Board Member

"But I don't want to go among mad people," Alice remarked.
"Oh, you can't help that," said the cat: "we're all mad here. I'm mad. You're mad."
"How do you know I'm mad?" said Alice.
"You must be," said the cat, "or you wouldn't have come here."
--Alice in Wonderland

She had come here. Here was many miles from nowhere. Here was hot, it was rigid, it was cold, it was uncomfortable, helpless, sad, dirty, stark, and very orange. She opened her car door, stepped out onto the burning hot, soft, rubbery blacktop. She opened her trunk, took off her opened-toed shoes, one at a time, and tossed them in the trunk of her car as she donned her . . . other shoes. She thought with a strange sort of resentment, "This is mad, wearing closed-toed shoes in 115 degree weather." She reached down and lifted out her box of materials, checking it carefully to make sure she had it all. Funny, she mused, "I am aware I have the privilege of checking to see if I have it all, and they have . . . have what? Nothing! I AM about to walk into madness," she whispered under her breath. It was the madness of the system, the mad-looking faces, the mad thoughts, the mad temperaments, and the madness of not having an identity aside from a number.

She walked into the plain brown building and showed her identification badge, as she walked through the metal detector greeting the on-duty officer, "Good afternoon Officer Hernandez," receiving a mere grunt in reply. She could feel the tightening of her hands around her box of materials which somehow felt soft and warm in contrast to the greeting she just received. This was the first human encounter she had upon walking into the plain, stark, dark, hollow, institution-like building. She continued.

The big metal door closed behind her with the cold, stark sound of hard, lifeless metal as she stepped into the narrow hallway whose one window looked into the office. She showed her identification badge again, front and back, hanging around her neck on a soft ribbon. When her identity was confirmed, the second big metal door opened. She walked out of the hallway and was officially . . . in the State Prison. Looking around, she saw high fences topped with shiny barbed wire, dirt fields shrouded with hovering clouds of brown dust, old brown much-used picnic tables, deadpan-faced officers . . . and her clients. Catching their eyes and seeing their faces and hearts, she was sure to smile at each soul she encountered, and she could not help but ponder what she knew. Human beings are continually in relationship with one another, yet, this resembled nothing more than . . . MADNESS. Somehow she felt as if she was truly Alice, whirling down, down, down, to either the depths of hell or the depths of her soul, but surely not Wonderland!

Her thoughts turned to her inner cords, her profession as a psychotherapist, and why she chose to practice at this place, the State Prison. Was this a way she nurtured herself? Was this a way that brought meaning to her life? Was this her way of resolving her existential crisis? She did not know the answer yet. She did know she was entering this place because of real people with real concerns. People who were real women with real names and real faces and real identities. Women who happen to be human beings. "These human beings were robbed of their essential humanness by being referred to as inmates with numbers and defined by their crimes, not as women with names and accomplishments," she thought, feeling the gentle tug and bounce of her identification badge as she marched on. She now recalled her research and how she wanted to make the words on the pages of her research project have heart blood run through its veins, mean something more than just a right of passage to a degree. She wanted the fruits of her labor, her research, to be used to make a real difference in the lives of HUMAN BEINGS. Parts of her written work became illuminated in her mind as she was about to nurture her relationship with these women and she asked herself, "What does make a therapeutic relationship effective?" At a fundamental level throughout our lives, human beings are in relationship. We engage in friend relationships, love relationships, casual relationships, and at times harmful relationships. An inquisitive psychotherapist may ask, "What makes the psychotherapeutic relationship effective? Is it particular therapist characteristics? Such as, gender, age, ethnicity, religious beliefs, theoretical orientation, or therapeutic skill and technique? Is it certain client characteristics either congruent or incongruent with therapist characteristics? Is it a portion of these characteristics, or none of them? It is true, down through the ages scholars and researchers of psychotherapy have probed this subject endeavoring to find the answers to these questions and to ultimately answer the question; What makes the psychotherapeutic relationship effective?"

The following presentation of the therapeutic relationship is unique, defining the therapeutic relationship from the vantage point of the therapist's soul and existential being, asking the question; "What about the therapeutic relationship makes psychotherapy effective?" (Swartout, 2001, p.37)

And so, her relationship with these women began. Week after week she trekked out to the State Prison, one clanging metal door after another, one act of presence after another. One day after the usual routine upon arrival, she looked up and saw Mona. And Mona had her at, "Hi doc, whaz up?" And she became transfixed by Mona's sparkling earnest eyes. "Iz real tired tonight doc, but I came anyways, is it OK if I go back a little early? I need ta eat, shower, and call home."

"Sure it's OK Mona. You can leave at the break." And she knew she was present. And she understood that in this place, in a place, trying to deny women the gratification of emotional and therapeutic needs, she needed to open the way to meeting emotional and physical needs, to treat them as human beings.

She walked into the group room as she always did, and after 15 minutes of preliminaries the 15 group members were gathered in the group circle. Life and the course she chose put her in this place, a place that was as foreign to her as China, yet as familiar as sitting at her kitchen table. A place where it was difficult for a woman to experience feelings, become emotionally vulnerable, and contemplate new ideas generated from participation in therapy groups. Could she ask them to be vulnerable for a time, in a closed community, then have them by necessity put their feelings away when they walked out of this room? Could she ask them to entertain accessibility by embracing whatever happened in therapy and make it matter and have an effect on them? She knew this would mean that they would have to reduce their defenses. "Opening oneself to another's influence is significantly investing in that relation" (Bugental, 1987). Would they invest themselves in this therapeutic relationship? Would they feel safe enough to lay aside some defenses? Finally, would they be able to express themselves and let themselves be truly known by the others? "This involves disclosing without disguise some of one's subjective experiencing, and it requires a willingness to put forth some effort" (Bugental, 1987).

And the group began. In the beginning, resentment spued forth from the group members. For many weeks and several months, she would hear, "I'm fine, I have nothing to say." "I'll be up front with you Swartout, I ain't talkin tonight." "What do you know about us, Miss Goody-Two-shoes? I bet you never did a wrong thing in your life." "So, Swartout, tell me, how long does it take you to put on your make-up?" "Don't ask me anything tonight, cause I'm good, I'm angry, and I'm hot and tired. There, now you have my three feelings. I pass." It was resoundingly clear. Many women did not want to be there, to feel, to expose their souls and hearts. Their anger, hurt, and regret were ever-so present. Yet, she persevered week after week, month after month, as she learned to embrace the heart of a dove and the hide of a rhinoceros.

After one year of meeting six hours per week, most of the women grew and learned to know each other well, trust each other, and trust her. The three hour block twice a week became a time of soothing balm for these women. The women who could no longer stand their pain, learned to allow what happened in the group to matter and have an effect on them, and put an effort into disclosing their subjective experiences. This accessibility and expressiveness did not come easily. The trust came out of days and weeks and months of her commitment, her presence, and the women learning to trust her as a human being, trust her skills, trust themselves and each other; trust in the belief change is possible, and most important, trust in the process.

The day she knew they knew, was the day they nicknamed her, and no longer called her Dr. Swartout, but "Dr. Sort-it-out. "In her heart she knew they were her women, her group, and this was her place of personal transformation, as their lives and stories unfolded slowly, poignantly, and sadly. There were so many. Holly was confused and filled with rage. She had a long history of sexual, physical, emotional, and institutional abuse. It was very difficult for her to tell her story. No one tried to be more invisible than Bev, and without much success, as she fidgeted in her hard institutional-like chair. Like Bev, Laura would try to make herself invisible. Her camouflaging would manifest whenever the discussion would focus on physical abuse. She would "disappear" just like when she was a child, when she learned to stay out of the way and not make a sound. Sharon was abandoned by her mother when she was 8 years old and had tried to fill that void with drugs, alcohol, and men ever since. Nancy came from a good family, yet became involved with abusive men and soon became an alcoholic. Joan talked about her emotional abuse as a child, about never being allowed to be a child. Susan's ex-husband kidnapped her two daughters. She soon resorted to alcohol in order to cope with the loss, leading to three arrests and her incarceration. These were women filled with painful memories, women filled with guilt-ridden hearts as they remembered the children, infants, family, and pets they had to leave behind the day they were incarcerated. Themes of hopelessness, helplessness, anger, deep sadness, and regret pervaded the group sessions. These were the women who made up her group. Women who were now in an environment designed to take away their power and their identities. She could feel her internal struggle and she would agonize and say, "How in the world can I lead them to find their power and souls again, in this place? It truly is maddening." Yet, she did know, as therapists we are continually faced with individuals coming through our doors seeking their own souls. They relate stories of looking for it in a myriad of places: in relationships, in lovers, in substances, in play. Yet, only within themselves does the reality exist. We cannot give others anything that does not already exist within themselves. We cannot create what is not in the soul of the other. What we can do, is bring into existence the favorable conditions and the motivation and help to make the internal visible. Nothing more.

She was gaining a bit of hopefulness and her thoughts now progressed to the existential human being. The existential human being is a singular individual who is unique and irreplaceable, who creates meaning in his or her subjective world through relationship with others. The existentialist views an individual with his or her uniqueness, freedom, responsibility, and will to find meaning in life, through understanding normal guilt, hostility, and anxiety. While some scholars criticize and find existentialism lacking on psychological grounds, other scholars believe existentialism may have much to offer, and psychology much to gain. Since the individual is unique, existentialists insist it is difficult to describe individuals under the laws of predictability. Frankl stated, "A real human person is not subject to rigid prediction. Existence can neither be reduced to a system nor deduced from it" (1965, p.169). (Swartout, 2001, p. 64)

The lives of these women were reduced to a system, the prison system. She was on a mission to help them discover uniqueness. The women were always very grateful to her around holidays, for it was during those sessions she nurtured their unique creativity, bringing all sorts of materials for them to make cards for their loved ones at home. She would play music, and watch them enter their own worlds and develop their creative flows, some singing or humming to the music. At times she would walk around and ask them to show her what they were making. She hoped she was the "good-enough-mother" for whomever needed one at that moment. Some would relate stories of their childhood they were reminded of as they colored with the crayons, or as they used the glitter, or water color paints. Some stories brought warm feelings, others brought regret. But they were their stories and she was willing to listen to each one, and sometimes more than once or twice. She hoped that for these women it was never too late to have a happy childhood. And she was once again reminded herself what she knew about being a therapist.

A therapist can be considered a lover of music, eager to hear the themes and variations of a client's story-music over and over and over again. A therapist is also a nostalgia buff, never tiring of hearing about the good old days, and the bad old days (Storr, 1990). The business of therapy is not a scientific enterprise. It is an art demanding the therapist be congruent and never adopt the concept of the client as an object to be manipulated, diagnosed, and dissected. Therapy is more like a greenhouse where the growth of the client and therapist alike occurs as a result of trust, empathy, understanding, and unconditional positive regard.

One day, she made the discovery the perfume she wore aroused the women's sense of smell. "I know that you're here ‘cause I can smell ya Doc." "I like your perfume Dr. ‘Sort-it-out.' All we get to use for perfume are those scratch and sniffs in the magazines." Knowing the sense of smell was the only sense bypassing the cognitive centers, transmitting impulses directly to the emotional center of the brain, she decided perfume was going to be the way to the present moment for her women. Through the essence of her perfume, she helped them recognize memories connected to smells in their lives, bringing this experience into the present moment. She helped them experience the present moment and the healing that happens in the moment. They were so used to being in some other place and time, being pulled into the past or out into the future. She knew being in the moment in this place, the State Prison, was something they wanted to escape from, even if fleeing was only in their minds. Yet, she also knew bringing their attention into their sense of smell, was in essence bringing their awareness to their internal state and following it into the moment. This would give them the strength self-awareness brings, and give them back their power. The essence of the perfume would lead them to the essence of their subjective experience with her, each other, and their own self.

The therapeutic relationship is the necessary starting point of every therapeutic encounter. The therapist and client, two existential human beings, can establish a bonded alliance, creating a collaboration and intersubjective communication. This intersubjective communication is the intuitive therapist sensing the client going beyond words. It is through the client/therapist intersubjectivity an entity called the "third essence" emerges.

The third essence is the unknown piece of each therapeutic dyad. It is the part of the therapeutic relationship uniquely developed between the therapist and the client, and is different from all other therapeutic dyads because it is based on the subjective world of the client and the therapist at particular moments in time. It is more than the therapeutic techniques of interpretation, clarification, support, and guidance. It is on the other side of technique, as the therapist orients therapy almost entirely around the center of the therapeutic relationship, believing only in the present therapeutic relationship precipitating long-lasting life changes. The third essence is a corrective relationship the client can assume as an added component of the client's relationship with self, obtained through relationship with the therapist, which in turn, allows the client to self-create ongoing life changes, whatever the therapeutic techniques employed by the therapist. This is the objective of therapeutic encounters and is the orchestration of psychotherapy. (Swartout, 2001, p. 65) She had done her time at the State Prison with no regrets. She knew she had orchestrated a therapeutic symphony composed of the subjective experience of the women in her therapy group at the State Prison. Each individual played a different song with a different instrument. An underlying rhythm resounded, playing, "Trust in the Process, and Look Inside Yourself." To her ears it was harmonious, and she named the song, "Increased Freedom." She knew the women were not physically free yet, but they had learned the essence of how to free their hearts and souls. They had experienced the essence of presence.

It is the world of your own soul that you seek. Only within yourself exists that other reality for which you long. I can give you nothing that has not already its being within yourself. I can throw open to you no picture gallery but your own soul. All I can give you is the opportunity, the impulse, the key. I can help you make your own world visible. That is all.


Bugental, J. F. T. (1987). The art of the psychotherapist (1st ed.). New York, NY: Norton.

Frankl, V. E. (1965). The doctor and the soul (2nd ed.) (R. Winston, & C. Winston, Trans.). New York, NY: Vintage. (Original work published 1946)

Hesse, H. (1970). Steppenwolf. New York, NY: Bantam Books.

Storr, A. (1990). The art of psychotherapy (2nd ed.). New York, NY: Routledge, Chapman and Hall Inc.

Swartout, I. (2001). The interplay between client and therapist subjectivity promoting therapeutic change highlighted in the existential-humanistic model, including a proposal for future research. Unpublished doctoral dissertation, The Arizona School of Professional Psychology, Phoenix.

© 2003 by Ilyssa Swartout, Psy.D. All rights reserved