Echoes From The Therapy Room: Working In The Here-And-Now
you know the drill with our check in - inviting you to take a moment before reading ahead x
How am I thinking
what is the quality and content of your thoughts?
How am I feeling
what level of access do you have to sensation in the body?
How am I breathing
how at ease or not do you feel as you inhale and exhale?
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Echoes From The Therapy Room: Working In The Here-And-Now
For me, here-and-now work is one of the most powerful tools I use in my psychodynamic psychotherapy practice. Rather than focusing exclusively on past events or external situations, here-and-now interventions invite attention to what is unfolding in the immediate moment between therapist and client. This live relational space becomes a window into longstanding patterns of attachment, defence, and emotional regulation. This week here-and-now work was front and centre in one of my sessions when I understood that my client and I were caught in an enactment of a dispute they had experienced earlier in the week.
In psychodynamic thinking, early relational experiences shape internal working models that influence how individuals perceive themselves and others. These patterns do not only appear in stories about the past; they emerge in real time within the therapeutic relationship. A client who fears rejection may anticipate criticism from the therapist (as was the case with my client and I this week). Another who struggles with anger may experience irritation but quickly minimize it. By gently drawing attention to these in-session dynamics, the therapist helps the client observe and reflect on their habitual responses as they happen.
Here-and-now work often begins with simple, curious observations: “I notice you became quieter when I said that,” or “I’m aware that I’m feeling a bit distant from you right now.” Such comments are not confrontational; they are exploratory. They slow the interaction down and create space for shared reflection. This process strengthens mentalization—the capacity to think about one’s own and others’ mental states.
Importantly, here-and-now interventions must be timed carefully (the timing can be the difference between something feeling confrontational or something feeling curious – we want the client to remain able to think).
They require a foundation of safety and trust. When introduced thoughtfully, they can deepen affect, clarify misunderstandings, and repair relational ruptures. Over time, clients develop greater awareness of how they co-create interpersonal experiences.
By working in the immediacy of the therapeutic relationship, psychodynamic therapy also opens up the opportunity for a client to understand that there can be a different outcome in those interpersonal experiences than what they have previously experienced. For my client this was the case – diffusing the perceived criticism by addressing a reaction in real time and proposing a shared wondering about what just played out. The therapy room becomes not just a place to talk about change, but a place where change actively unfolds.
A question for you to ponder:
How often do you pause to reflect on whether your reaction to a situation is based solely on what is happening in the present moment, or whether it is also being shaped by emotions and experiences from your past?