Appreciation of the Article “Down and Dirty”
by Colm O’Doherty
Inside Out 99 Spring 2023

by Maria Moran

Colm, in his exploration of psychotherapy “as a seeking out of, or a journey towards, truth”, suggests the word ‘humility’ is missing from the psychotherapeutic vocabulary. In a very eloquent and stark manner he describes the passage of the client into the depths of his/her being, should the quality of the holding by the psychotherapist be sufficient. This can only be developed over time. He describes the descent of the client as follows:

….as they wrestle with the excruciating pain of revealing to themselves a truth, that they know that they have never known, and have never wanted to know. This is not just about remembering, about the mind going back to some half-forgotten memory of awfulness. This deepest dark recesses of their being, as they try to bare and bear the “unbareable” and unbearable, because it is truth, their truth. These clients, whether on a chair or on the floor, have chosen to do this in front of another human being because somehow or other they know that this has to be witnessed.
(O’Doherty, 2023, p. 57)

Colm is speaking about his experience with some clients in long-term psychotherapeutic work, where the relationship is well established. This can provide the possibility of a window of deep humility to open between both parties out of which an experience of this nature occurs.

An article written by Berks & Hoffman (2020) speaks to the importance of Authentic Relational Moments (ARMs) in the psychotherapeutic process. I believe this to be the same arena of experience that Colm is highlighting for us. According to Berks and Hoffman (2020), this way of relating…

…occurs during episodes when the connection is especially strong and genuine between patient and therapist, allowing the dyad to arrive at a symbolic relational space where they connect deeply and authentically, more as humans, rather than professional and patient. We argue that ARMs are a fundamental part of the relational learning process during therapy; in them the patient experientially learns new ways of being with another person. The relational learning in such moments …. can be hypothesised to be a core mechanism for change.

The paper goes on to explore the core aspects of ARMs such as authenticity, understanding and witnessing. The third of these three aspects is described as follows: “…moments of witnessing, in which the therapist genuinely shares the patient’s experience of an exceptionally difficult emotional episode from the past as if the therapist had been present there with the patient.”

Key words that stand out for me as I read (and re-read) Colm’s article are the words humility and witnessing.

Humility engendered through seeking out the truth, I suggest, demands of us that we discard our ego; or perhaps, exercising humility opens the gate to truth and sidesteps the ego. Whatever the case, it feels to me that how Colm puts aside the polite language of words sometimes used by us psychotherapists, such as “sacred”, “special” or “privileged” to describe the experience of the psychotherapist in this deep healing process, is refreshing. Colm, with courage, does not sanitise the depth of the experience and the pain it involves but says it as it is, in a very grounded and shocking way that makes us think again.

At times this struggle may bring them to their knees; they may drop onto the ground (in Latin: humus), down and dirty……This can be a physical, visceral, body-mind-soul break through into the deeper dark recesses of their being…. Whatever was unknown has to become known, whatever the secret has to be seen, whatever was unbearable has to be bourne, has to be survived.
(O’Doherty, 2023, p.57)

This is what the gift of humility opens to those who dare to enter this dynamic. When two people can simultaneously enter this place of deep humility, a truly magnificent transformation can result, bringing deep healing. This is something that cannot be prescribed, prearranged, or contrived but, I believe it to be an integral constitute that comes through the quality and disposition of the relationship.

The second word that I would like to endorse that Colm uses, is witness: the necessity of having a witness present for the client. As human beings, no matter how independent we pretend to be, we do not do well without companionship. It is part of who we are and how we thrive or not, depending on the company we keep! We all know how this works in our own lives; but when we meet another person whom we trust, in this case, the psychotherapist, who can meet us in humility when we need to unburden ourselves and find our truth, I believe what happens is bigger than whoever is in the room and we enter into a universal consciousness or spiritual dimension of the work.

I want to thank you Colm, for the richness of this article and for the humility in which you present it. It is indeed inspiring. If I may, I will finish with your closing and engaging thoughts for us to ponder.

There may be a wider context. Depending on the personal belief system and spirituality of the psychotherapist, there may be an entrusting of my work to a holding of a different and greater order. Many spiritual traditions refer to some nature of an overarching caring presence…. So, the holding that is offered by the psychotherapist can be considered as participating in a way in this all-embracing holding, making present a tiny moment of this dynamic. And moreover, the holding that can at times test the courage and ability of the psychotherapist, can itself be thought of as being held within an all-enfolding supportive holding by this greater presence.
(O’Doherty 2023, p.58).

Maria Moran MIAHIP. Maria works as a psychotherapist, supervisor and in spiritual accompaniment with individuals and groups. She has a particular interest in the area of inter-generational healing. Contact Maria at mariapacmoran@yahoo.ie.

References: 

Békés, V., & Hoffman, L. (2020). The “Something More” than Working Alliance: Authentic Relational Moments. Journal of the American Psychoanalytic Association, 68(6).

O’Doherty, C. (2023). Down and dirty. Inside Out, 99, 57-59. https://iahip.org/page-1076949