Pain of Presence and the Pain of Absence

Here is a common theme that I have seen in several sources and one worth watching for in session.  It can, all by itself, alter the flow of the session and lead to undiscovered aspects of what is keeping a client (and perhaps yourself as the clinician) stuck in the moment.

Consider the following types of pain:

• The Pain of Presence - the presenting problems, challenges, issues
• The Pain of Absence - that which is not present, but is valued

The first is much easier than the latter to detect.  You should note that when working with someone, their complaints are often the first, the pain of presence.  It is that thing they wish would not have happened, that experience or memory that will not go away.  It can best be categorized as their TEAMS, which is why it is important that this concept (TEAMS) be incorporated early in an intervention.

When listening, first take a moment to note the pain of presence and note what approach, tool, metaphor might be useful in this situation.  Second, pay attention to what lies beneath this pain of presence.  This is much more difficult to detect.  Sometimes they will make a statement such as “I would just like a moment’s peace”  or “I just want to connect better with this person”.  These are indications of the pain of absence.

It is usually not so forthcoming, so you will need to listen and see if you can detect, when the pain of presence is described, what is that pain of presence blocking them from?  Common themes (often referred to at the six yearnings) are as follows: