‘There can be a lot of anguish in the work, but the hope comes back’

Dr Tanya Lecchi is a Chartered Psychologist with the British Psychological Society, Registered Counselling and Clinical Psychologist with the Health and Care Professions Council, Relational Psychotherapist, Mindfulness Teacher, and Senior Research Fellow. As well as working privately as a clinician, Tanya is a lecturer on the DPsych in Counselling Psychology at City, University of London, a senior research tutor, and a senior research fellow within the Child Attachment and Psychological Therapies Research Unit (ChAPTRe) at the Anna Freud Centre/UCL. Tanya has also established the Inner Citadel Institute, a psychology and psychotherapy clinic and training centre in Oxford. 

As a former student of Tanya's, I asked her about her inspiration as a clinician.

What motivated you to train as a psychologist?

As a kid I wanted to become a medical doctor – I had a profound desire to dedicate my professional life to alleviating people's suffering. I really valued my ongoing relationship with my GP; to be able to go back to this person who was holding me in mind and could help when I was unwell. That felt like a deeply meaningful job. Then, my initial focus on physical wellbeing started to shift. In particular, I remember that, when I was about 12, I found Psychology and Alchemy by Jung at the school library. I was captivated by the power of its metaphor of a transformational journey from darkness to the unification of apparently irreconcilable opposites, thus reaching new levels of consciousness. That idea profoundly fascinated me, inspiring further reading into psychoanalysis, depth psychology, and contemplative traditions. In my free time I started to practice martial arts and meditation, at the same time as thoroughly enjoying the study of philosophy at my grammar school, exploring questions related to the human condition. I started to move away from a positivist approach and a medicalised view of the body, developing more interest in the psyche and the humanities.

In the end, I thought psychology could represent a middle ground between medicine and philosophy. I qualified as a clinical psychologist and then completed training in relational psychotherapy. Embracing a constructivist perspective allowed me to appreciate the limitations of theoretical, abstract knowledge, while cultivating what William James called living contemplation – a form of intuitive awareness. During my training I was invited to deepen my mindfulness practice, in particular through Insight Dialogue, a form of interpersonal meditation. I went on several retreats, which helped me cultivate tranquillity and concentration, as well as presence to myself and others. This meditation practice, alongside a personal experience of relational psychotherapy and then psychoanalysis, have been crucial aspects of my professional journey.

I then integrated the experiential side of my training with the research I conducted as part of my PhD on childhood trauma, which led to the design and evaluation of a mindfulness-based intervention for maltreated children in residential care. Studying developmental psychology and doing research with young people shaped my way of working with adults too, as I always hold in mind their childhood experiences and feel open to encounter younger self-states in the course of therapy. 

Can you briefly explain why a relational approach is your choice of therapeutic modality?

Like Martin Buber, I see human beings as being-in-relation. He considered the I-Thou attitude as our original condition, while clarifying that this dialogic contact also requires a 'surprising mutuality' – the actual other is different from myself, so, in order to meet them, I need to accept them for who they are. This intimate encounter asks the therapist not to hold back, not to seek refuge in theories and techniques – to do this, we need to develop an ability to tolerate uncertainty, to sit with our own discomfort and vulnerability. I find this way of working a deeply humbling practice – a moving, emergent process – but at the same time informed by compelling clinical ideas, which are held lightly. 

From a research perspective, it is well known that the quality of the therapeutic alliance is a consistent predictor of positive clinical outcome, regardless of the psychotherapeutic approaches studied. But the therapeutic relationship can be much more than a facilitating factor. Working relationally invites the therapist to constantly reflect on the relational meaning of any intervention – for example, what does offering psychoeducation mean to the client? Am I acting like a teacher? A parent? Why am I doing this, right now? Am I at a loss, unclear about what to say? Am I trying to offer something more tangible, to compensate my sense of inefficacy? What is emerging from this 'dialogue of unconsciouses', as Ferenczi would call it? As we all have an unconscious, therapists also never fully know their minds. This means that our clients might perceive something about us that we are not aware of. How do we handle that? I think these are crucial questions, including from an ethical perspective. Paying attention to the relational is a way of understanding the deepest aspects of our experiences and identity as inseparable from the relational matrix in which we have developed. As our intrapsychic structures derive from our relationships with significant others, which are represented in an implicit procedural or enactive way, therapeutic change can happen when new ways of intersubjective interaction allow the integration and articulation of healthier enactive organisations.

In a nutshell, the main focus of the work is to offer a new relational experience, paying attention to the co-created interaction, moment-by-moment. As therapists we offer our subjectivity, our way of being with the other, which needs to be authentic but also theoretically informed. It's a bit of a paradox. We need to create the conditions that are necessary to facilitate a deep relational engagement, developing a true interest in the other, without forcing any way of feeling or being together. As Buber stated, complete mutuality is a form of grace, which might happen or not. 

What is the highlight of your work?

I think it's related to presence – to being fully there and sticking with what is coming up. It's quite a radical act – trusting that it will be enough, that whatever happens, we can deal with it, we can survive and transform it. Of course, there are circumstances which are impossible to concretely change, but the experience can be survived. Being with it and going through it, instead of avoiding or defending, opens the door to change and beauty also in the midst of trauma. 

And the greatest challenge?

At a meta level, it's not easy to allow this kind of work to happen, to explain to our clients and the wider community that there is value in slowing down and being with a process that can be messy, paradoxical, and complex. At times, the work can get very stuck. It can be insightful in one session and then become apparently repetitive, but something profound might be happening, even though we might not consciously grasp it in that very moment. Allowing ourselves to wander a little bit and get lost and then get back on track… there is deep value in that, but it's difficult to trust it if you have never been into therapy before. This is a challenge I encountered in my personal therapy too. Furthermore, there are times when there is the urgency to feel better, which I totally empathise with, but it might push people to try to find a quick fix that is often illusory. This can be quite difficult to communicate and may also be destroying a client's hopes about feeling better quickly. I think it's difficult to embrace depth psychotherapy in our society right now, where everything is very quick, and we want to feel instantly better. 

Tricky question… but who is the 'thinker' who has most inspired you?

The work of Iain McGilchrist, who explored the differences between the brain's right and left hemispheres and their effects on society and human history, is special to me. In summary, the left hemisphere is detail oriented and sees what is familiar, explicit, decontextualised, and reduced to its parts, while the right hemisphere has greater breath and sees what is fresh, unique, never fully known, implicit, and in flux. McGilchrist describes how the left hemisphere is increasingly becoming predominant in the modern world, moving us away from the richness and complexity that it cannot grasp. I find this idea extremely compelling and able to shed light on the emergence of very different approaches to therapy, deriving from two opposing visions of the world. I think we have the opportunity to reflect on our assumptions and harmonise these views, remembering that the right hemisphere is the 'master', while the left hemisphere is its 'emissary'.

What is the psychology book you always return to?

Hope and Dread in Psychoanalysis by Stephen Mitchell (1993). Discussing how contemporary psychoanalysis is moving beyond Freudian drive theory, Mitchell describes the analytic process as both personal and interpersonal, emphasising the wishes and needs of both analyst and patient. In particular, he explores their experiences of hope and dread, which I deeply relate to. I remember my own hopes when I started my personal therapy – the experiences I really wanted to talk about, to transform. And, as a therapist, when there is a new client coming for a consultation, I always notice an authentic desire to help and support change. But then there is also the dread, which might emerge when we experience painful relational dynamics that resemble the past and might create a sense of stuckness, a fear of not being able to help enough. It can be difficult. There can be a lot of anguish in the work, but the hope comes back – there is a dialectical movement between these polarities, which allows therapy to progress. Within the relational dance between client and therapist, moments of crisis and impasse are inevitable but shouldn't be chronic. 

And one poem, song, or piece of prose or art that provides solace and comfort?

I will choose a painting because bypassing language can be so immediate. There is a very well-known painting, Wanderer above the Sea of Fog by Caspar David Friedrich, which touches something profound in me. There is something about the unknown. What is there in that mist? What cannot be seen? But there is this spaciousness, the sublime that is being contemplated and observed, and maybe there is some hope and dread… there is something about a journey into what we don't know. To me it feels like an appreciation, a reverence for nature, for the landscape that we can inhabit. And the person in the painting… they look bold being there, but at the same time you're just a man in a big world and nature is majestic. To me it's quite vital to recognise that we're not the only beings in this world. I think it's important as psychologists to look and see how insightful the arts, literature, and poetry can be in describing the human psyche. Psychological theory and research are not the only perspective that exists – turning towards literature and the arts can open everything up and make it much more interesting and nuanced. There is so much we can't grasp by simply carrying out scientific research. 

What inspired you to establish the Inner Citadel Institute?

The Inner Citadel started as a clinic. I wanted to move away from services designed around a medicalisation of human suffering, seen as an internal, individual dysfunction, to create a clinic where therapists approach clients' experiences as meaningful responses to painful relational and social circumstances. I also wanted to develop a community of practitioners who share similar values, including respect for and appreciation of difference, non-judgment, freedom, and inclusivity. I would like to offer meaningful experiential training courses and CPD, designed to facilitate ongoing personal engagement. By being part of a group, practitioners can discuss topics in depth, do readings together, work on case studies, and try to develop embodied knowledge over time. In my experience it's very important to create some relational intensity to facilitate the integration of new learning, allowing the material to be digested and become our own. All these factors can support transformative learning experiences.

What has been a great privilege over the course of your career to date?

Thinking now about this question, flashes of apparently small relational moments emerge in my mind. Memories about groups that I taught, moments that were intensely moving in the work with certain people, including sitting together in silence while feeling a deep sense of connection. And at other times moments of great crisis that elicited intense emotions and required a profound process of change, clarification, and repair. I remember situations when, while feeling deeply impacted by the interaction taking place and the themes explored, I was grounding myself, trying to be present, holding the space in a state of radical openness and acceptance. Many times, I was just witnessing something powerful that other people were able to repair themselves. I am also connecting to several moments of meeting with my clients, whom I fondly remember while they share their vulnerabilities, as well as their strengths, allowing very tender parts to be seen. I think that's something unique to this profession, which I feel very grateful for.