A Relational Approach to Suffering: A Reappraisal of Suffering in the Helping Relationship

What Is Suffering?

To be clear, suffering is difficult to define and even conceptualize. Synonyms, however, can tell us something of its nature (i.e., distress, misery, agony, anguish, torment, wretchedness, despair, excruciation, woe, helplessness, and hopelessness). There also seems to be a taxonomy of suffering; ways in which to distinguish among the various types of suffering (i.e., physical, spiritual, emotional, psychological, social, etc.). Scientists, philosophers, and theologians have gone to great lengths to justify an ontological separation between those (see Miller, 2004; Nussbaum, 1994, for a review), but this is not the aim for this article. The purpose of this article is to discuss the conceptualization and response to suffering in the therapeutic encounter. Specifically, I hope to provide a brief outline how a radical relational approach to suffering in the therapeutic relationship can alter the understanding of suffering and perhaps the experience of suffering while providing a basis for healing that may be unavailable in many contemporary therapeutic approaches, at least as it is outlined in the literature.

What can be done in the face of suffering? Certainly, there are incessant strains of human suffering that cannot be eliminated such as the death of a loved one. Wheelis (1975) pointed out that “victims still have a choice; there’s always a little corner of freedom” (p. 3), but the choice to suffer or not are oftentimes foreclosed. For many people, suffering is imposed. Perhaps the only option with those strains of suffering is to suffer it (Conn, 2008), chronic pain for example. Van Hooft (1998) argued that suffering can be one of the most profound and disturbing of human experience, because it resonates and relates to our sense of life’s meaning and can threaten our hopes and happiness. Suffering can involve crises that can affect and threaten our physical and contemplative aspect of our lives.

One important question of suffering is whether it is meaningless or meaningful. Noddings (2003) questioned the notion of finding meaning in suffering; she wrote, “We hesitate to reply straight-out no, but many of us would like to avoid the suggestion that meaning inheres in suffering—that meaning has been implanted there to be found” (p. 39, italics in original). Perhaps it might be more accurate to say that suffering is not inherently meaningful or meaningless, rather suffering provides an opportunity to receive or create something of value. For example, money can provide us something of value, often something we could not get in any other way, but the value is not in the money, but in what we can do with the money. Noddings (2003) even acknowledged that people do often find or create meaning in and from their suffering. There is a wealth of posttraumatic growth literature with supporting evidence that people grow and mature through their suffering (Calhoun & Tedeschi, 1999). Indeed, one could argue that the notion of moving from victim to survivor hinges on finding meaning.

The question of suffering is deep, provocative, intricate, and elusive; and Miller (2004) argued that the literature in psychology certainly has been unable to answer the question. In fact, rather than clarifying the nature of suffering, psychology literature has conceptualized human suffering in distinct and various ways while promulgating a variety treatments, some of which are surprisingly depersonalized (Bishop, 2007). Miller (2004) argued that psychology may have lost sight of suffering itself and, as an implication, an appropriate response to suffering. Modern society has come to rely heavily on psychological accounts of suffering, more than on traditional sources found in social, moral, and religious histories (see Bishop, 2007; Gantt, 2005; Gantt & Williams, 2002; Kegan, 1982). Certainly, most outside the discipline of psychology view it as a therapeutic and practical problem-solving discipline (Miller, 2004). Many assume, therefore, that psychologists not only hold the keys to understand suffering but also, hopefully, the knowledge and tools to eliminate it (Gantt, 2005). It would therefore seem valuable to investigate how psychology, as it is portrayed in the literature, responds to suffering as it is experienced, or offer meaningful advice on how it is to be experienced or its effects ameliorated. This is an important consideration since the phenomenon of suffering seems, by its very nature, to be meaningful even if it is painful.

Psychology and Suffering

One could argue that most psychological conceptualizations of suffering seem to revolve around and are in opposition to some preconception of well-being or the “good life” (Gantt, 2002). As Buss (1966) observed, each conceptualization of suffering begins with its own theoretical assumption, usually unarticulated and implicit, about an idealized world of mental health and psychological well-being. These assumptions of the “good life” revolve around the ideal that fully functioning individuals are able to lead happy, productive, and fulfilling lives. This world, however, is not typical of or congruent with the experience of most people (Davies, 2012; Gantt, 2002). To make sense of and conceptualize suffering, then, is to outline, detail, and give an account of the absence of such ideal functioning. The accounts most often describe real-life conditions that are the source of anxieties and abnormalities. “This requires the drafting of a set of specific proposals and prescriptions deemed necessary for the successful treatment of these abnormalities” (Gantt, 2002, p. 67). Suffering, from this perspective, is ultimately best understood as either pathology or at least as a less than optimal response to the vicissitudes of life.

Much of the psychology literature views suffering as pathological (see, e.g., American Psychiatric Association, 2013; Miller, 2004). This is not to say that psychologists deny the undeniable fact that people do suffer negative effects of life events, relationships, and conditions of all sorts. It is to say that for some psychological approaches a person’s response to these sources of suffering is seen to be pathological. The suffering is problematized. It is understood as a problematic response to life events. The suffering is conceptualized as an unfortunate response to negative situations, and is something to be treated and eliminated.

Much more can be said regarding suffering; however, due to the limitations on space, I wish to identify two specific assumptions as it relates to the thesis of this article. The first assumption is that some contemporary cognitive approaches respond to suffering in a way that is analogous to a medical model. The implications of this approach will be explored below. The second assumption is more ubiquitous and it relates to a general relational dynamic influenced by the philosophical construct of individualism (Bellah, Madsen, Sullivan, Swindler, & Tipton, 1985; Cushman, 1990; Richardson, 2005; Richardson, Fowers, & Guignon, 1999; Taylor, 1985).

Individualism, what Richardson (2005) called a “disguised ideology,” assumes that the self is most important, should be independent and self-reliant, and that the individual’s goals, desires, and wishes take precedence over their relationships because the individual’s goals, desires, and wishes are primordial, and relationships are secondary. In this sense, relationships are important to the individualist as long as the relationships do not interfere with the goals the individual is trying to reach (Slife, 2004). Individualism, I will argue, frames the therapist’s perception of the therapeutic relationship. It will be argued that individualism can tacitly accentuate an experience or perception of isolation or disconnection—which are believed to be hallmarks of suffering (Jordan, 2000) in the therapeutic relationship and thus potentially further contribute to the experience of suffering.

The Medical Model

Suffering, as described in some contemporary cognitive literature, seems to consist of two levels, which I will label as Suffering A and Suffering B. Depression or anxiety, from these perspectives (see Beck, 1970; Ellis, 2004; Leahey, 2004), are seen as the suffering and are assumed to be the symptoms or illness resulting from a particular type of “pathogen.” The “pathogen” is often viewed in the literature as negative cognitive schemata, irrational beliefs, or some other faulty cognitive function that lead to the suffering (i.e., anxiety or depression). This is Suffering A. The cognitive treatment of suffering (at least Suffering A), then, consists of identifying and eliminating the “pathogen” (i.e., negative cognitive schemata or irrational beliefs) that lead to the suffering (i.e., anxiety or depression) and treat it accordingly. It is assumed that if the pathogen is eliminated, the suffering will be ameliorated.

Suffering B, however, is a fundamentally different type of suffering. Suffering B would consist of the experience of any life situation or circumstance (i.e., bad relationships, financial distress, etc.) that can cause distress and give rise to the experience of suffering. The themes found in the cognitive therapy literature seem to deemphasize Suffering B. Perhaps the reason is that cognitive therapy (in theory) cannot fully or adequately address the suffering that may come about due to life issues or difficult circumstance. For example, it would seem unfitting to address a client’s emotional or psychological suffering that is due to financial distress or death of a loved one by analyzing the client’s cognitive schemata. On a superficial level, to take a position to “think differently” or “feel differently” in one of those circumstances would seem a little unconvincing if not inappropriate. This approach to suffering seems to suggest that rather than having a single problem—that is, the life event at the heart of the suffering (Suffering B)—the person really has two problems—that is, the experience of the life event (Suffering B) and the unproductive, pathological response to it (Suffering A). The elimination of Suffering B is not within the purview of the psychologist (or, sometimes, the client). The elimination of Suffering A is the proper response and the goal of the therapeutic intervention. While this approach does not necessarily deny or ignore the suffering or its causes, it does shift emphasis and introduce into the life of the sufferer a particular reading of his or her situation.

Miller (2004) reasoned psychology and other mental health professions focus on the amelioration of suffering by reducing the experience of suffering to symptoms or manifestations of mental disorders, disabilities, diseases, and dysfunctions. This often reduces the person’s misery to a mere epiphenomenon whose experience is transformed into a description of a clinical syndrome that is more easily defined, measured, and explained. The language of suffering has been replaced, as Kleinman (1988) noted, with a lexicon of disease expressed in terms of causal forces and biochemical mechanism. As emotional pain and suffering are redefined in a medical model, the meaning of human suffering is fundamentally altered. Kleinman further argued that this medical model may also prevent the practitioner from taking seriously the patient’s experience of suffering.

A concern of many critical thinkers (see Bishop, 2007; Davies, 2012; Miller, 2004) is that psychology seeks to treat some of our most intimate and personal struggles with a starkly depersonalized methodological and practical approach. The concern of these thinkers becomes explicit when comparing contemporary psychological approaches to other traditional resources and community support systems. These institutions provide resources, support, and care to the sufferer. Psychology, however, “as a discipline offers . . . adjustment” (Bishop, 2007, p. 192). But in our suffering—physical, emotional, psychological—we cry out, “We want our injury to matter, and we want a response that validates that we matter. We want to know that our suffering is understood and of consequence” (Gleave, 2005, p. 82).

The possible latent consequences of a medical model approach to suffering are that the potential meaning and subsequent growth one may engender is obviated or ignored. This may or may not be a problem if suffering is simply pathology—or a problematic response to an unfortunate event. But, if suffering is something akin to what authors like Frankl (1973), Lewis (1994), Wheelis (1975), Van Hooft (1998), Miller (2004), and Davies (2012) proposed, suffering can give rise to meaning and potential human growth. In fact, one could argue that suffering is often a catalyst for change and growth. Frankl (1973) argued that life can be fulfilled not only in enjoyment and satisfaction but also in suffering.

Another implication of the medical model is that the pathogen is often assumed to be self-contained (i.e., irrational belief or faulty schemata). Therefore, the elimination of the pathogen is done primarily by the client. The therapist obviously aids in this process, but does so as an expert, advice dispenser, interpreter, or interpersonal mirror, but the real work is left up to the client. The therapist embraces a role of neutrality or objectivity in the therapeutic relationship, which ultimately plays an important role the type of relationship the therapist develops with the client.

Palmer (2000) and Jordan (2000) argue that one of the hallmarks of depression and suffering, in general, is a state of isolation or disconnection. In a state of disconnection, one can lose their ability to authentically represent their experience. Jordan further argued that shame often accompanies a sense of isolation; and one can often feel unworthy of connection.

Often in shame people move out of connection, lose their sense of efficacy, and lose their ability to authentically represent their experience. Shame is one of the major experiences of chronic disconnection. A way of healing shame is by bringing the person back into empathic connection. (Jordan, 2000, p. 1008)

The therapeutic relationship can help the client reconnect. However, the “structure” of the medical model would, at least theoretically, keep the focus on eliminating the target pathogen (i.e., faulty cognitive schemata) rather than attending to the relational disconnection of the sufferer, and thus systematically circumvent this potential source of comfort or healing.

In contrast to a medical model approach, it is being argued that a radical relational approach (Slife, 2005) can afford a new understanding of suffering by responding to the sufferer in a way that can help create something of value or meaning for the sufferer while simultaneously aiding in the healing process through a strong relational connection. As I hope to describe below, a central portion of this thesis is that many therapeutic orientations—even ones that would eschew a medical model (i.e., Rogers, 1951, 1980)—still make certain presuppositions about the therapeutic relationship that reflect a self-contained individualism that inevitably implicates one’s understanding of suffering and the sufferer. A few vignettes will be provided to further distinguish strong or radical (Slife, 2005) relational approach from other therapeutic orientations.

A Relational Approach

The idea that “relationships heal” hardly seems to be a radical concept and has been around since the inception of psychotherapy (Slife & Wiggins, 2009). Yalom (2000) wrote, “It’s the relationship that heals, the relationship that heals, the relationship that heals—my professional rosary” (p. 98). Jordan (2000) argued that central to the notion of healing is found in the mutual empathic connection in the therapeutic relationship. Slife and Wiggins (2009) claimed, however, that many contemporary psychotherapeutic orientations have not taken this notion seriously enough. What Mitchell (2000) has referred to as a “relational turn” (see also Friedman, 1985; Hargaden & Sills, 2002; Jordan, 2000; Mitchell & Aron, 1999; Sanders, 2010; Slife, 2004; Stern, 2004; Stolorow, Brandchaft, & Atwood, 1987; Stuart & Robertson, 2003; Tudor, 2010; Wachtel, 2008) is not only gaining interest in therapeutic circles but also in psychology, generally (see Gergen, 2009). Space does not permit a thorough theoretical explication of a relational approach in therapy (see Slife & Wiggins, 2009; Wachtel, 2008) nor is that the aim of this article, but a brief outline of some basic tenets will be given here as it applies to a response to a person’s suffering in the therapeutic relationship.

A radical relational therapy is not intended to become a new school of therapy with a new theoretical foundation. Rather, much of what a relational therapy looks like in practice is what good therapists are already doing—even when their therapy theories indicate very different interventions (Slife & Wiggins, 2009). As some therapists have noted (Jordan, 2000; Mitchell, 2000; Wachtel, 2008), it is difficult to articulate the subtleties and nuances of a relational therapy. It is also important to point out that there are differences in opinions with regard to some relational thinking (Wachtel, 2008). However, according to Wachtel (2008), there appear to be two primary criteria that set a relational therapy apart from other therapeutic orientations: attention to context and, perhaps more important, the central role of relational dynamics in the therapeutic relationship.

A central tenet in a strong relational theory is that human beings exist in relationships. Whether those relationships are ongoing with other people, culture, society, familial traditions, personal values, or a relationship with their past, present, and future selves. Attention to the embedded nature of one’s personal relationship is central to a relational approach in therapy (Wachtel, 2008). Wachtel (2008) argued that attending to the nuances of a relational dynamic often unveils implicit processes or faulty cognitive schemata which allows those processes to be recalibrated and integrated into a larger narrative. As Yalom (1995) pointed out, group psychotherapy can be a microcosm of a client’s social relationships. In a similar vein, a relational therapist attends closely to how the client’s relational patterns manifest in the here-and-now therapeutic relationship. The relational dynamic between therapist and client is perhaps the richest and most concrete manifestation of the client’s context available to the therapist and can provide the first and most important aspect for healing (Slife & Wiggins, 2009).

Relational therapy, like some humanistic (Rogers, 1951, 1980) and existential therapies (May, 1989; Yalom, 1980) is not grounded “with a set of abstracted, pre-experiential theoretical principles waiting to be applied, but rather the focus is with the real contextually situated person desiring our help” (Slife, 2005, p. 1). This is not to say that a relational therapeutic approach is antisystemic, but the system from which the therapist might interpret “the data” is based on the here and now and concrete relationship (Slife, 2005). Similarly, Harrington (2003) wrote, “I am not condemning system-making. Psychological data is non-sensical unless given sense by the system or context of which it is a part” (p. 221). For a relational therapy, relationships, connectedness and context, not abstractions, causation, and rationality, is the system that provides the interpretive framework.

Certainly, many psychotherapists (i.e., Freud, Sullivan, Rogers) have thought deeply about the importance of the therapeutic relationship. For example, some may consider Rogers to be a relational therapist (see Rogers, 1942, 1980; Tudor, 2010). However, a radical relational therapist might argue that a Rogerian or client-centered understanding of the therapeutic relationship has been boxed in by a cultural zeitgeist of individualism (see Bellah et al., 1985; Cushman, 1990; Richardson et al., 1999; Taylor 1985). As aforementioned, individualism assumes that the self is more important and takes precedence over relationships or relational needs because the individual’s goals or desires are primary and relationships are secondary in import. That is, relationships are important to an individualist, just as long as the relationship does not interfere with the individualist’s goals (Slife, 2004). Relational therapists realize that because they are relating with the client themselves, they are also actively involved in the client’s contexts (Slife & Wiggins, 2009). This awareness should alter the therapists response to the client and contrasts with the neutrality and individualism advocated by many mainstream approaches: the interpersonal mirror of client-centered therapy (Rogers, 1951), the blank screen of psychoanalysis (Freud, 1966), and the objectivity of behaviorism (Wilson, 2000).

For instance, relational therapists argue that, for Rogers, the self is primary and the therapist’s role is to facilitate a letting go of the values and expectations of others and to clear a space for the individual to self-actualize (Slife & Wiggins, 2009). The therapist plays an empathic, yet somewhat independent role in this process. Indeed, Rogers (1951) described how a person learns only those things that are involved in the maintenance or enhancement of the structure of the individual self. Certainly, a client-centered approach takes the relationship seriously, but the argument advanced here is that the disguised ideology of individualism ultimately places the individual above or at least before the relationship (Slife & Wiggins, 2009). As Fowers’s (1998) research has shown, most divorces occur because the marital relationship is no longer satisfying its individualist function—personal happiness.

To better understand what Slife (2005) calls a radical relationality or what Wachtel (2008) describes as a relational theory, consider the ontologies of Martin Buber (1970) and John Macmurray (1991). Buber (1970) argued that the world is twofold for man according to man’s attitude, and man’s attitude is twofold according to the two basic words which he can speak. The basic words which man can speak are not single words, but word pairs I-Thou and I-It. The “I’ in the “I-Thou” is different from the “I” in the “I-It.” “Basic words do not state something that might exist outside them; by being spoken they establish a mode of existence” (p. 52). The “I-Thou” and “I-It” are not the name of things, but the name of relationships. There is no “I” without “It” or “Thou.” Thus, identity—and all of its constituents—is formed in relationship. Macmurray (1991) described what can be considered a deeply relational understanding of a child’s development. His description is that the infant is made to be cared for, that the baby is made to be in relation. In other words, the baby’s dependence is the very thing that provides him or her with identity—a relational identity with the mother. A mother–child relation as the basic form of human existence.

Like Buber’s and Macmurray’s ontology, a relational therapy is founded on the presupposition that the “I” is inseparable from the context and relationships in which it is embedded. Thus, the “I” is always in relation to nature, time, space, and others. Furthermore, a relationist would argue that our identities are constituted and best understood by the unique nexus of our relationships, including the therapeutic relationship. Therefore, no individualistic functions can reasonably be placed above or before the relationship. A true relational approach should fundamentally alter our understanding of ourselves, our experiences and suffering, and our relationships with others—including the therapeutic relationship. Though we can be distinguished individually from the context and relationships—just as any part of a whole can be distinguished—our very qualities stem from the role our part plays in the whole. For example, a kiss can mean affection, an unwanted advance, or death (Slife, 2005). In this sense, nothing can be completely understood apart from the context in which it is embedded ¹ (Kegan, 1982). Therefore, one could argue that a person, their experiences, including suffering, is best understood in a contextually “thick” world. Although there are different ways in which a person can relate, one can never escape the interrelated or holistic context.

Relationality and Suffering

Given that there is no predetermined set goal in a relational therapy (Sanders, 2010), a relational approach may afford clinician and client an opportunity to respond to and explore the suffering, if appropriate, in a potentially meaningful and transformative way. Rather than attending to a predetermined goal to alleviate the client’s suffering by addressing the “faulty machinery, the un-learning of a maladaptive recipe for living, the reprogramming of a neurocomputer . . . or beating the dents out of a tin can” (Kriz, 2008 as cited in Sanders, 2010, p. 236). That is not to say that, in a given moment, a person may need cognitive retraining, a stable relationship, or an antidepressant medication, but the concrete and contextual relationship would dictate the response and potential treatment. For example, by too closely adhering to diagnoses, techniques, or therapeutic principles, a therapist may run the risk of becoming disengaged from the concrete elements of the therapeutic relationship. A therapist may relate to self-contained or individualistic abstractions rather than the people themselves. “Greater closeness and intimacy become possible when we see people as they are, rather than as our conceptions of them say they are” (Slife & Wiggins, 2009, p. 20).

One might argue here that this is a goal in many humanistic and existential therapies, but an important distinction has been made by relational therapists. The relational therapists view himself or herself as inextricably connected to the client in relationship. This subsequently implicates the therapist in the clients’ experience and therefore cannot act as a neutral or objective coach, expert, interpersonal mirror, or interpreter who is somehow independent of the client and his or her suffering (Sanders, 2010). Gleave (2005) described how therapists often unknowingly engage in this type of individualistic relationship with their clients and, are limited to “fix it,” interventions with the intent to eliminate the suffering (p. 82). This, Gleave argued, can reduce the client’s nuanced and personal experience of suffering to dysfunction.

Jordan (2000) distinguished a radical relational approach from other approaches and argued that true empathy or a true relational connection is part and parcel of the healing process. As a contrast, she argues that empathy, at least described historically in the literature (see also Kohut, 1984), has been conceptualized as a tool or mechanism to establish rapport so that the “real” work of therapy can be done. A relational therapist would argue that the relationship is indelible to the “real” work. A true relational connection “is not just a way of knowing another’s subjective experience but a way of actually experiencing connectedness” (Jordan, 2000, p. 1008). In this process of connection, one can be drawn out of isolation and begin to believe that he or she is worthy of connection and love. This connectedness is a reciprocal attunement between client and therapist.

Merleau-Ponty (1962) reflected this notion in his explication of true dialogue. In true dialogue, we can experience true reciprocity. His thoughts are not my thoughts and my thoughts are not his, but if perceptual attunement intervenes, his words draw from me thoughts I did not know I had. He lends me thoughts and I lend him thoughts and they are interwoven into a single coconstitutive fabric. The cocreated experience is shared, neither is the creator. In the absence of reciprocity, the world of one may be subsumed into the world of the other, but this is a false world where no true relationship is possible. Existence must be experienced on both sides.

Taking a neutral or objective position in the therapeutic relationship can interfere with this relational connection. Jordan (2000) argued that reciprocity or what she termed mutual empathy is pivotal to therapeutic change. This process acknowledges that both the client and therapist are influenced by the other and that knowledge is valuable for both parties. “The patient must be able to see, know, and feel (empathize with) the therapist being impacted, touched, and moved by him or her” (pp. 1008-1009). Trying to maintain a neutral or objective position might interfere with the healing process.

As an example, a client named “Jamie” comes to therapy because of persistent feelings of sadness. The therapist learns that Jamie comes from a large family and was often overlooked and neglected growing up. When Jamie would express her feelings to her family, they would often go unnoticed or ignored. This pattern of neglect and feeling unimportant grew over time. If Jamie begins to express her sadness in therapy and the therapist, because of his or her theoretical training, takes an objective, neutral, or impassive role the therapist might unknowingly reinforce those same relational patterns, beliefs, and expectations. In contrast, a relational approach focusing on the relational connection would respond quite differently. The relational therapist would hold that the therapeutic relationship is perhaps the richest and most concrete expression of the client’s available context and may provide the most important aspect for healing. Jamie might see the therapist moved with compassion and realize that her feelings matter. This is a moment of healing and the old relational patterns and expectations of “I don’t matter” may begin to soften. In this therapeutic encounter, Jamie may begin to realize that she has an effect on the therapist. Jordan (2000) refers to this process as a “corrective relational experience” (p. 1009). Again, to be clear, I believe most good therapists respond to their client’s suffering in a similar manner—despite their theoretical training.

Recent research from social neuroscience (Masten, Morelli, & Eisenberger, 2011; Meyer et al., 2013; Rameson, Morelli, & Lieberman, 2012; Zachi, Weber, Bolger, & Ochsner, 2009) has found that many of our experiences of genuine empathy or a relational connection in which we can feel into others’ social emotions and suffering is dependent on the observer’s relationship with the sufferer. Siegel (2010) argues that the presence of a caring trusted other is key to change and growth. His explanations and descriptions go deeply in the physiological descriptions of both brain and body, which is not an objective here; however, the central argument to his thesis is that the relationship can help the client feel safe enough to feel his or her own feelings. “This is how in the moment, face-to-face, we help one another grow” (p. 139). In other words, when we are in true relationship, we relate to and resonate with one another not only experientially but also physiologically. This resonance can provide not only support and aid in a moment of need but also a deeper emotional, psychological, and physiological connection with one another. An instrumental approach using empathy as a tool to build rapport or acting as an interpersonal mirror would seem less likely to achieve the essential relational connection and activate the brain circuitry that is central to the healing relationship.

In those moments where the client and therapist connect, the client can come to know something, something of great value—that they can be known and understood (Sanders, 2010). For example, when a client describes an experience of anguish, and beholds tears welling up in the therapists’ eyes can create this type of knowing. Suffering and isolation is often accompanied by immobilization, which prevents movement back into a healthy relationship (Jordan, 2000). In order for a client to relinquish strategies of disconnection and shift their negative expectations often require a healthy reciprocal relationship. A relational connection can help facilitate this movement which can then help the client translate those movements into other relationships.

Slife and Wiggins (2009) pointed out that many clients avoid closeness and intimacy to avoid rejection. This avoidance, however, also leaves them without the meaning and fulfillment of closeness and community. Authentic relationships can provide a lifeline to those in despair. The therapist in a very real sense would try to identify with the clients’ suffering which has a noted effect not only experientially but also on the neural mechanisms recruited in empathy and social pain (Meyer et al., 2013).

Furthermore, if we grant the primacy and importance of relationships as tied to and embedded in all aspects of our identities, including meaning making, then we can conclude that there may be pivotal meanings found in suffering which may only become available in a healing relationship. Instead of automatically trying to ameliorate one’s suffering, seeing it as something to be avoided or chemically anesthetized, or even view suffering an experience in which the therapist is to be empathically present (defining empathy in the weak or individualistic sense) to help facilitate self-actualization—which is an individualistic ideal, the therapist and client could investigate the experience of suffering and discover the meaning or value it might provide conjointly. To be clear, the client is going to make meaning out of the experience of suffering and the therapeutic intervention regardless of the therapeutic approach, but the shared experience in the therapeutic encounter and the meaning that is constructed would change dependent on the therapists and client’s response to the suffering. Relational therapy is focused on connections and disconnections. “It is not just understanding these connections, but actually reworking them in the therapy relationship that contributes to change” (Jordan, 2000, p 1007).

Relational therapists hold that relationships provide the primary means for change, as opposed to other therapeutic systems that give precedence to cognitive schemata, internal conflicts, or a more firmly defined sense of self with a greater sense of autonomy and self-sufficiency—which all could detract from the true relationship and obligation. That is not to say that those concepts are unimportant, it is to say that by holding those concepts as primacy over the relationship could potentially deny a fuller understanding of the other and, by implication, his or her suffering. Jackson (2005) argued that the natural intimacy found in the relationship between the therapist and client can make one’s tacit or implicit self-contradictions more explicit. The helping relationship can also elucidate or “serve as a means” to help the client understand and appreciate his or her own context and “establish a truthful way of being within it” (Jackson, 2005, p. 211). A couple of examples are given below on how a relational approach has been used to illustrate the theory.

Ann is unhappy in her marriage. Defensive and resentful about her choices, she struggles in a therapy session against any possibility that she is contributing to her own difficulties. She tells her therapist she doesn’t like herself in the marriage. Her therapist asks, “Do you like yourself with me?” A bit startled, but responding to the immediacy of the question, Ann says, “Yes, I like myself when we’re in session . . . when I’m here . . . you know, when we’re here talking.” Her therapist asks, “What kinds of things are you doing that allow you to like yourself with me?” Ann brightens, enjoying the happier turn in the conversation, and breaks off her defensiveness: “Well I like myself because you understand me so well; you really listen; you always know just what to say.” “But, Ann, I want to know what you are doing that allows you to like yourself with me?” insists her therapist. “Well, I guess I’m showing up every week,” offers Ann, “even when you’ve missed the point completely like last week. And I guess I haven’t dumped you like my ex, just because you’re off-base sometimes—way off base.” Ann falls quiet. After a moment she asks, “So if I can put up with you, how do you manage to put up with me?” (Slife, 2005, pp. 1-2)

Here, we can see the therapist use the relationship to serve as a means to reveal her self-contradictions and behaviors. The relational therapist responds to Ann’s defensive struggle with a question about their own relationship and sense of connectedness to each other: “Do you like yourself with me?” This helped Ann recognize her own behavior not only in the therapeutic relationship but also in her relationships with others as well. Even though Ann attempted to appeal to the therapist’s expertise and supposedly superior qualities (i.e., expert) of the professional, her therapist reminded her that she is a full actor and is contributing to the relationship to make it work. Real demands can be made of each other and real expectations can be expressed. The question certainly arose, even if Ann did not articulate it: Could she also be similarly responsible for the struggles (i.e., her suffering) with her husband? And why would he—therapist or husband—stick with her given her responsibility (Slife, 2005)?

Slife (2005) argues that all these questions arise because of the authenticity of the therapeutic relationship. One could further argue that these realizations may have never arisen if the therapist played a more neutral role as an interpreter or interpersonal mirror. “If Ann were allowed to continue with the common assumption that therapists are compassionate but disinterested clinicians whose relationships to clients are purely instrumental, it would not occur to her to ask how her therapist puts up with her” (p. 2). Analysis or interpretation systematically restrains a true relational connection. In contrast to the relational approach, a cognitive therapist might see her defensiveness as an opportunity to identify and reprogram inner core beliefs and attend to her suffering on abstract individual level. Simply, this relational approach helped Ann see that she may have contributed to much of her marital struggles and suffering which helped reconceptualize her relational dynamic with her husband.

The argument has been made that suffering is often accompanied by immobilization and disconnection from others. This can manifest in a client’s reluctance or unwillingness to communicate in therapy. A simple example outlined by Wachtel (2008) demonstrated how a relational approach can reframe the client’s experience and understanding of his or her suffering. In response to a client’s silence, a therapist might say, “You seem to be having difficulty talking today.” This question tacitly suggests a neutral or disengaged individualistic view of the therapeutic relationship. In contrast, a relationist might say, “Sometimes you seem to be able to talk to me about what you are feeling more easily than others” (Wachtel, 2008, p. 288). This approach may be more disarming for the client, as the therapist highlights the fact that he or she recognizes the client is not always subdued or unresponsive and explicitly identifies himself or herself as part of the context. It also brings to light the fact that the therapist is influenced by the client in a reciprocal relationship. Again, in a more traditional therapy, it may be tempting to call attention to the client’s avoidance rather than identify the difficulty the client is experiencing at that time with the therapist. A relational therapist who implicates himself or herself in the process can invite a responsiveness from the client while simultaneously exploring hidden patterns of behavior. Just a simple reframing within the context of the relationship can afford a new perspective on the client’s experience and suffering. For thorough, fleshed-out examples of a relational approach to therapy, see Jordan (2000), Jackson (2005), and Wachtel (2008).

Because there is no predetermined goal in a relational therapy, a relational approach to suffering seems to be in a better position to respond to a person’s suffering, whether the suffering is due to poor decisions (i.e., cheating on one’s spouse leading to a bout of depression), from the facticity of life (i.e., death of a loved one), or from a potential chemical imbalance. It may also involve a commitment to comfort those in need of comfort and suffer with those as they struggle to find meaning or grow from their experiences. That is not to say that “I drown my tears in your beer” and “you drown your tears in mine,” but it is to say that perhaps it is better to respond to some forms of suffering—matters of the heart with the heart. As Mother Teresa (1975) said “ . . . for only by being one with them can we redeem them” (as cited in Inchausti, 1991, pp. 67-68). Thus we can experience, perhaps more easily, the naturally occurring relations and human contexts that help and sustain others through their suffering (Kegan, 1982). Oliver (2001) wrote, “We are by virtue of our relations with others. Our sense of ourselves as subjects and agents is born out of . . . relations. We can speak only because we are spoken to and only because someone listens” (p. 183).

With regard to suffering, perhaps the fundamental moral question incumbent in the suffering of others is not necessarily how it is to be alleviated, but how to respond to one’s suffering (Davies, 2012; Gantt, 2005).

One of the hardest things we must do sometimes is to be present to another person’s pain without trying to “fix” it, to simply stand respectfully at the edge of that person’s mystery and misery. . . . Blessedly, there were several people, family and friends, who had the courage to stand with me in a simple and healing way. (Palmer, 2000, p. 63)

Conclusion

The thesis of this article suggests that suffering does not necessarily need to be avoided or chemically anaesthetized, but rather, some forms of suffering might be best served by exploring and understanding it for what it is and what it could potentially provide. There is a wealth of literature supporting the notion that people grow from their suffering. Therefore, suffering may provide a person something of value which would be lost if ignored or avoided, which could paradoxically cause more suffering. Indeed, suffering often serves as a catalyst for growth and change. A relational approach to suffering seems to offer a unique approach to facilitate that growth. One could argue that we are best understood in our relationships and concrete human practices and that our relations are a fundamental reality of our existence. Thus, our experiences, including suffering, may be best understood from a relational approach that explores the suffering in a contextually thick world. Furthermore, several therapists (Jackson, 2005; Jordan, 2000; Sanders, 2010; Slife, 2005; Slife & Wiggins, 2009; Wachtel, 2008; Yalom, 2000) have argued that healing occurs in a truly empathic and relational connection. In a “relational moment” where the client comes to know that he or she is known gives “confirmation of being, the recognition of another’s humanity and confirmation of one’s own. This knowing requires some degree of self-with-other encounter” (Sanders, 2010, p. 239).

Clearly, there are many elements within a relational approach to suffering that still need to be fleshed out, but this preliminary investigation of a relational approach to suffering may have promise and potential in our understanding, engagement, and response to human suffering that other psychotherapeutic orientations may not provide or even consider. Responding to a sufferer in a way that can provide hope, direction, and knowledge that the person is not suffering alone is, at least, potentially comforting to those who are in their depth of sorrow. As a therapist once told me, “My clients don’t thank me for what I know; they thank me for being their friend.”