This article is a conceptual, practice-oriented position paper. It presents a transtheoretical framework that orients psychotherapists toward three longings that bring people to seek psychotherapy and that represent fundamental themes influencing the quality of human life: the longing for competence in one's own emotional process, the longing to belong and to be held well in the relational world, and the longing for dignity. The concept of the three longings was introduced by Lynne Jacobs at a workshop for gestalt therapy trainers in the Czech Republic in 2022. Later, in 2024, the authors conducted a recorded interview at the Pacific Gestalt Institute residential training with the intention of transforming Lynne's conceptualization, and the authors' subsequent thoughts and dialogue, into written form. The framework thus distills more than 40 years of Lynne's experience as a gestalt therapist, relational psychoanalyst, trainer, and supervisor in both modalities. Accordingly, we do not present it as a universally valid theory of psychotherapy. We believe the three longings speak to widely shared features of the human existential situation: people strive to navigate their emotional experience, they need others to hold them, and they suffer when their dignity is at stake. At the same time, we acknowledge that our articulation of these longings, particularly the language of dignity, is situated within a tradition of Western, relationally oriented psychotherapy, and that other therapeutic traditions and cultural contexts may conceptualize these themes differently. We therefore offer the framework as one possible perspective on the therapeutic endeavor.

The aims of the article are primarily applied. First, we describe the three longings and anchor them in relevant literature, defining the key concepts as we proceed. Second, we show how the three longings operate within the therapeutic relationship itself and what their recognition asks of the therapist. Third, we propose a model of the longings' mutual interaction that can serve as an orientation aid in everyday clinical work. The reader is thus provided with a framework that is simple to hold in mind and that helps direct the therapist's attention and intentionality in often complicated therapeutic situations.

As a result of our investigation of the three longings, we introduce in section 4 a model of ever-flowing, intertwined processes evolving between humans and their world. Given the scope of this article, we focus primarily on the social world, while by no means denying the importance of the natural and built environment and the broader phenomenal field for human life and mental health. In contemporary gestalt therapy, psychopathology is considered a sickness of the relationship between the person and the world, a sickness of the situation (Wollants, 2012; Spagnuolo Lobb & Cavaleri, 2023). By inviting people into our offices, we inevitably become part of their world, and thus we contribute to how the world relates to them, which is an important ethical and humanistic commitment of psychotherapy practice. Section 2 introduces the three longings; section 3 explores how psychotherapists can answer them in practice; section 4 presents the model of their interaction; and section 5 concludes with the implications and limits of our perspective.

The three longings: common themes in why people seek psychotherapy

In this section we introduce the three longings in turn and define the key concepts associated with them. People tend to seek psychotherapy when they do not feel well in their body, relationships and/or the world that surrounds them. This is often accompanied by an experience of emotional difficulties which manifest as depressive states, anxieties, sudden outbursts of anger, somatized difficulties, desensitization, emotional instability, or a general difficulty in navigating one's emotional experience. These issues with emotional regulation fall under the first core longing, the longing for capacity and capability to navigate one's own emotional experiencing and processing. When individuals struggle to process and manage their emotions, they experience a loss of the sense of agency (i.e. felt capacity to influence one’s own experiencing and life situation) over their experiential world (van der Kolk, 2015). Emotional competencies are therefore crucial, as they provide a foundational sense of control and stability within oneself and are strongly related to the experience of mental health (Galderisi et al., 2015).

Difficulties with emotional regulation are rooted in how an individual experiences themselves within their relationships. Emotional experiencing is shaped by relational context, underscoring the second theme: the longing to be held well in the relational world. Given the relational nature of our minds (DeYoung, 2022; Jacobs, 2019; Siegel, 2020), people rely from early childhood on others who recognize and contain their emotional experiences, and this need extends into adulthood, shaping how individuals experience their partnerships, friendships, and connections with larger cultural and societal groups. A sense of belonging is thus essential for knowing that there is a place for us in this world (van der Kolk, 2015).

Finally, from these interactions with others and the capacity to navigate them successfully, individuals derive a sense of dignity, a concept we define in detail in section 2.2. When people feel seen, respected, and valued as they are, their sense of dignity is affirmed and is more likely to become a stable ground of their experience of themselves in-the-world. The longing to be treated with dignity and to experience oneself in dignity is crucial if a person is not to live a life organized by shame.

To be held well in the relational world

The human mind is embodied and relational (Siegel, 2019), inevitably intertwined with other people and the surrounding world. People cannot exist without relational threads that hold them in the world, as a person's selfhood and personality emerge in relational encounters within the phenomenal field (cf. Wollants, 2012). Relationships are constitutive: we have no experience that is prior to relatedness (Jacobs, 2019), and our experience is co-emergent and context dependent (Staemmler, 2016). The need to belong has accordingly been described as a fundamental human motivation, whose non-fulfillment is linked to a variety of ill effects on health, adjustment, and well-being (Baumeister & Leary, 1995). Conversely, a fulfilled sense of belonging is considered a vital mental health concept, closely related to indicators of psychological and social functioning (Hagerty et al., 1992, 1996).

To grow up and live with a feeling that we are held well by our communities means to be seen, contained, recognized, appreciated in our uniqueness, valued for our strengths, loved for who we are (not only for what we do), and treated with dignity. Such experiences become a lifelong resource, a secure relational base giving us a sense of belonging to humankind, while living through the opposite is hard to bear and in many cases traumatizing. According to Buber's dialogical theory, "human beings become persons through social interaction and by being part of a community and culture" (Schulz, 2024, p. 32), and the way the larger community is brought into the family shapes where dignity lives at the start. How we are held is a matter of both close and broader relationships, affected by social and cultural norms, public policies, and the distribution of opportunities. This is captured by the concept of social determinants of mental health (World Health Organization [WHO], n.d.; see also Compton & Shim, 2015): insecurities of housing, food, and employment, adverse early life experiences, social exclusion and discrimination, poor education, and poverty in general, which together may form undignified life circumstances or even act as an ongoing traumatogenic factor (Taylor, 2021).

Lack of relational and environmental support can therefore have dramatic consequences for the development of mind and quality of life, as it is within our relationships that we develop (or fail to develop) a sense of dignity and build emotional competencies. Lack of emotional containment in childhood leads to issues with self-regulation, and the experience of chronic misattunement, of not being met by an understanding other, lies at the root of chronic shame (DeYoung, 2022). Even in the most perilous moments, when we face traumatizing events, it is the amount of available social support (cf. Taylor, 2014; van der Kolk, 2015) that makes the difference between navigating experiences of pain and suffering relatively unharmed or developing serious post-traumatic adjustments.

To experience one’s dignity

Dignity is emphasized in the first article of the Universal Declaration of Human Rights (United Nations, n.d.), which asserts that "all human beings are born free and equal in dignity and rights..." This foundational statement underscores the centrality of dignity in human experience and its profound importance; as Mann (1998) notes, "individuals and societies spend considerable energy… to protect, enhance, and sustain their dignity," and "violations of dignity are pervasive events with potentially devastating negative effects on physical, mental, and social well-being" (p. 30). Despite this primal position in human experiencing, dignity is not so often explicitly considered in psychotherapeutic theories. A substantial body of research on dignity has developed in nursing and palliative care, where dignity-conserving care has become an explicit clinical model (Chochinov, 2002; Lindwall & Lohne, 2021), while in general psychotherapy the concept remains largely in the background.

Scholarly literature treats dignity as a differentiated rather than a unitary notion. Nordenfelt (2004) distinguishes four varieties of dignity: Menschenwürde, the universal human dignity that belongs to every human being equally and cannot be lost as long as the person lives; the dignity of merit, tied to social rank and position; the dignity of moral stature, resulting from the moral quality of one's deeds; and the dignity of identity, tied to the integrity of the person as an embodied whole and in many instances dependent on the person's self-image. The dignity of identity can be shaken by the acts of other people as well as by illness, injury, and age (Nordenfelt, 2004). When we speak in this article of the sense of dignity, its loss, and its restoration, we refer primarily to the dignity of identity, resting upon the inalienable ground of Menschenwürde. This allows us to hold both layers at once: dignity as an equal and unconditional human worth, and dignity as a vulnerable, relationally constituted experience.

Mann (1998) captures another duality when he distinguishes an "internal" component of dignity (how I see myself) and an "external" one (how others see me). Developmentally speaking, the external forms the ground for the experience of the internal, as our self-worth and self-esteem are first shaped by how we are perceived and treated within our social environments. People can maintain a sense of dignity even while being despised or rejected by the larger society, yet such individuals are typically sustained by at least a small circle of others, however marginal, who hold them in mind and look at them through appreciating eyes.

Dignity is one of the central themes in Jacobs's earlier writings, where she describes psychotherapy as "a process of either finding or restoring dignity" (Jacobs, 2017b, p. 380). Maduro (2017) summarizes Jacobs's conceptualization of dignity as a unified experience encompassing four key dimensions: (1) self-experience, involving self-worth, agency, coherence, and individuality; (2) the experience of the other, recognizing the sense of the other's worth (other-esteem) and individuality; (3) the experience of organic relatedness or interconnection with the other, where integrity in action and values within relationships becomes vital; and (4) one's experience of one's world, particularly one's being-with-other-in-our-world, kinship and belonging within our human world. From this perspective, dignity can be understood as a relational experience, a quality of being that emerges through interactions with the world, converging with Nordenfelt's dignity of identity.

The relational dimension and agency are crucial when considering dignity. A sense of dignity includes one's experience of worthiness, autonomy, purpose, possibility of choice, and trust in one's own body. The experience of not being held well often leads to shame; in other words, it threatens one's dignity and paralyzes one's response-ability. Shame induced by challenges to our dignity can evoke complex, intense, and even overpowering emotional responses, including fear, anger, disgust, powerlessness, hopelessness, and feelings of being unclean or toxic (Mann, 1998). Dignity and shame are not simple opposites, and a person may well experience moments of shame while retaining a sense of dignity. Chronic shame (cf. DeYoung, 2022), however, signals a life in which the sense of dignity finds little ground to stand on. These emotional reactions highlight how threats to dignity arise in relational contexts, linking the domain of dignity to the other two themes discussed in this paper.

While dignity is widely named as an inherent human right, not all individuals are born into or live within relationships, communities, or environments that honor this fundamental need (cf. Compton & Shim, 2015). The longing for dignity reflects a deep human desire to be seen, recognized, and accepted as a fellow member of the human community. This recognition is not merely a philosophical ideal but an ethical and therapeutic imperative, guiding the work of psychotherapists to support their clients in reclaiming and experiencing their dignity.

To have capacity and skills in emotional regulation

"Emotion is at the core of internal and interpersonal processes that create our subjective experience of being alive, of our identity, of what is often called the self" (Siegel, 2020, p. 268). Emotions arise as physiological and embodied responses in a given situation (Damasio, 2012) and thus represent pre-verbal responses to the world that form the foundation of how individuals construct meaning (Siegel, 2020). In other words, sensing and feeling is the first form of knowing, a "bodily knowing in relation to the situation" (Wollants, 2012, p. 51), out of which cognitive understanding and behavior take shape. When this emotional process is held in awareness, our understanding of the situation deepens, and our responses become more situationally grounded.

Emotional regulation, defined as the ability to recognize, make meaning of, express, and modulate one's emotions, is an essential feature of mental health (Gross & Muñoz, 1995). It acts as a mediator of stress and adaptation, and its deficits are associated with mental health difficulties (Galderisi et al., 2015; Siegel, 2019). The ability to employ flexible emotional responses is a protective factor, contributing to resilience, a sense of self-efficacy (Bandura, 1997), and the perception of a sense of agency (van der Kolk, 2015). As Bandura (1997) shows, the very belief that one can manage one's own emotional states reduces the stress response and protects against anxiety and depression, while successful experiences of navigating one's emotions strengthen this belief in turn.

People who have been through experiences of not being held in their primary families (and thus may lack foundational experiences necessary for emotional containment and support) or broader communities, who have experienced relational traumata and other adversities, and whose dignity has not been recognized, might experience serious impairment in the capacity to contain, navigate, and regulate their emotional worlds (Siegel, 2020; Taylor, 2014; van der Kolk, 2015). Without emotional competencies, individuals may find it hard to assert their dignity or recognize their worth, and they become more vulnerable to feelings of shame, which makes it harder to feel connected to, or supported by, others. Thus, the capacity and skill in emotional process is deeply interconnected with the other two domains explored in this paper.

Capacity and skill in emotional process supports a person to hold on to their dignity in the moments when it is threatened (e.g., by setting boundaries or otherwise exercising their agency) and makes them better equipped to engage in relationships that affirm their dignity. In practice, this means recognizing emotions, expressing them appropriately within a contextually and culturally acceptable range, tolerating discomfort, reflecting on emotional triggers, and being receptive rather than reactive in interactions (cf. Siegel, 2020).

One's emotional competence allows a person to distinguish between a community rule and their right to feel what they feel, their lifestyle, etc. It also allows the possibility to reflect on and mourn any limitations to relational support in communities people find themselves in and opens a possibility to start seeking fellow members of a new community, as illustrated by the following case example. Simply put, capacity in an emotional process opens more options of adjusting creatively and making meaningful life choices.

Case Example (condensed for illustration; lived situations are inevitably more complex):

Consider a client who is struggling within their church community (or family), which provides a sense of connection but also imposes rigid norms that degrade aspects of their identity. The client expresses feelings of not fully belonging. In therapy, the initial step involves helping the client recognize the source of their discomfort. Together, we explore how the community's rules conflict with the client's authenticity, creating a tension that cannot be entirely resolved.

Rather than simply suggesting the client leave the community, the therapist helps them understand that belonging to this group will always involve some grief, an acknowledgment that parts of their identity cannot be fully held by this particular community. However, the therapist supports the client in reframing this experience, helping them see that the issue lies not within themselves but within the community's limitations. This work often involves grieving the aspects of themselves that cannot be acknowledged within that context while also seeking support and validation from other communities that celebrate these dimensions of their being.

Through this process, the therapist helps the client build dignity and a deeper sense of agency. The client learns to draw support from multiple sources starting with therapeutic relationships, recognizing that belonging need not be confined to one group. This allows the client to maintain their connection to the church community (if they choose to do so) while simultaneously cultivating relationships in spaces where they feel fully seen and valued.

In summary, emotional regulation is not just about managing feelings; it is an essential process that integrates bodily responses, cognitive understanding, and relational dynamics, and provides a person with the ground to experience oneself as competent in navigating the sometimes perilous waters of life.

Simple principles and the hard work: answering the longings in psychotherapy

In this section we turn from describing the three longings to the question of how psychotherapy can answer them. A focus on the three longings resonates with many of the common factors associated with positive therapy outcomes across modalities (Tschacher et al., 2014; Wampold & Imel, 2015), such as fostering the therapeutic alliance, developing emotional regulation, supporting affective experiencing, tackling desensitization, instillation of hope, assimilation of problematic experiences, mastery and success experiences, behavior regulation, and developing new self-narratives. Notably, the three factors judged most relevant by the experts in Tschacher et al.'s (2014) survey, namely patient engagement, affective experiencing, and the therapeutic alliance, map closely onto the territory of the three longings: affective experiencing onto the client's emotional process, the alliance onto being held well in the therapeutic relationship, and patient engagement onto the client's exercised agency. Therefore, a focus on the three longings also employs therapeutic capacities and skills associated with the common factors (cf. Norcross & Lambert, 2018; Vaz & Rousmaniere, 2021), such as alliance focused and empathy skills, the capability of positive regard and affirmation, repairing alliance ruptures, and managing the therapist's emotional experience and countertransference (or we may prefer to say the therapist's co-emergent emotional process, resonance, and enduring relational themes, see Jacobs, 2017a). It is worth noting that while emotional regulation and the quality of the therapeutic relationship are firmly established in the common factors literature, dignity as such is rarely named explicitly; its closest counterparts are humanistic positive regard, respect, and affirmation (cf. Farber et al., 2018). The framework presented here thus builds on well-documented therapeutic processes while bringing into focus a dimension that usually remains implicit.

Looking through the lens of the three longings, the task in psychotherapy is to accompany people on the journey of developing and broadening capacity and skills in emotional processing, empowering their relational capacities, and finding or restoring their dignity. Such a journey can be adventurous, intimate, and also perilous, and it includes building an attuned relationship that affirms the clients and their new self-narratives. Such an endeavor inevitably includes setbacks, ruptures in the therapeutic alliance, nuanced relational movements, and challenges to the therapists' own emotional capacities and sense of dignity.

Accompanying clients in developing capacity and skills in emotional processes

The essence of psychotherapy lies in helping clients develop the capacity to navigate their experiential worlds effectively. The organization of self is "dependent upon the manner in which emotion is regulated" (Siegel, 2020, p. 268). The therapeutic relationship offers a co-created space in which these capacities can be reconstructed and emotional regulation modeled, practiced, and integrated.

We have already mentioned that issues in emotional regulation are among the primary reasons people seek psychotherapy. Clients coming to psychotherapy often feel overwhelmed by emotions such as paralyzing anxiety, sadness, or anger, and struggle to transform these immobilizing feelings into new ways of experiencing themselves and their world (cf. Greenberg, 2015). In this process, the psychotherapist's act of listening, sensing, and responding supports clients in reclaiming their feelings and facilitates the transition of these emotions into new, creative experiential gestalts (Robine, 2025).

At its core, emotional regulation begins with interoception, the awareness of bodily and sensory processes (van der Kolk, 2015). Interoceptive capacity forms the foundation for allowing one's bodily sensations to develop into identifiable feelings, naming them, and tolerating their intensity while maintaining an open mind to assess the situation with clarity. The therapeutic process enables individuals to titrate emotional reactions, address challenges constructively, and develop resilience in the face of difficult emotions.

For clients to develop emotional skills, the therapist's own emotional regulation and co-regulation capacities are paramount. A therapist must not only model these skills but also engage in a dynamic give-and-take with the client, adapting their responses to foster emotional processing. Clients often stretch the therapist's emotional capabilities by expressing intense emotions which may originate in experiences of shame, powerlessness, or feelings of being trapped, and point toward the unmet relational longings. Anger, rage, and protest are often responses to a violation of dignity. The question arises: Can the therapist tolerate these emotions without becoming dysregulated? A therapist's ability to remain emotionally grounded validates the client's experience and models a pathway toward greater regulation, while the therapist's dysregulation may lead to misattunements and ruptures in the therapeutic relationship.

Misattunements and relational ruptures are inevitable. However, the way therapists respond to these disruptions often becomes one of the most meaningful aspects of the client's therapy. A substantial body of research suggests that better outcomes are achieved if therapists engage in repairing alliance ruptures (Eubanks et al., 2018), as the process of "rupture and repair" validates the client's emotional longings and provides a relational experience in which their desires, needs, and values are legitimized. By taking responsibility for the repair process and their own part in the co-created rupture, therapists model emotional competence, foster the alliance, and demonstrate how one can recover from shame and restore connection. However, to be able to offer the repair work, a therapist has first to bring themselves into an emotional state which makes it possible, with an awareness of the probable meaning the client will make of the therapist's words and actions. In this sense we bear more responsibility for the repair than the clients do. Seeing our responsibility in misattunements can be experienced as a momentary dip in our dignity. But we need to "know" and have confidence that we will get over the shame and our own sense of dignity will be restored.

A key element of emotional skill development is the therapist's sensitivity to the client's dysregulation and the ability to sense little relational reaches. Therapists must honor and contain these moments without overwhelming the client, allowing emotional regulation to develop incrementally. Dignifying begins with the emotional resonance of the therapist with the client. For instance, helping clients tolerate anger or shame without "blowing up the place", or recognizing signals of positive affection from the client toward the therapist, requires both the therapist's patience and the ability to modulate their approach. If a client makes a reach, and the therapist does not want to hold that reach, that is invariably shameful to the client (Wheeler, 2000). Therapists must be attuned to the relational impact of their own actions, watching for signs of misattunement and understanding the emotional costs these moments can have on the client. In some situations, therapists must regulate their emotional process, sometimes even move against their survival instinct, in order to meet the client in their suffering (e.g., in a depressive field we have a natural wish and tendency to escape instead of meeting the client in the depth of depression; cf. Roubal, 2025). For the therapeutic relationship to become a space where clients can experiment with emotional regulation and relational skills, the hard work for therapists lies in their commitment to dialogue, attuned presence, and aesthetic sensibility.

Holding the client well: the therapeutic relationship

The need to be held by relational threads is fundamental to survival and possible thriving. That is why so many patients suffer difficulties with loneliness and isolation in individualized and disembodied digital societies (cf. Office of the U.S. Surgeon General, 2023). Under such circumstances, any meaningful relationship, the therapeutic one included, plays a vital role as a protective factor and a source of resilience. As noted in the introduction to this section, the therapeutic alliance and the mitigation of social isolation belong among the recognized common factors of successful psychotherapy (Tschacher et al., 2014).

The psychotherapy relationship is a unique space where the longing to be held can be recognized: through emotional attunement and co-created dialogue, it becomes a secure ground where clients experience being seen and validated in their complexity and uniqueness. For some, this relationship may be the first experience of being deeply respected and valued, thus offering necessary environmental support to re-establish self-esteem, which becomes an important corrective and dignifying experience. Such an experience remains available to our clients even as they face emotional difficulties or rejections in their external communities.

Given the relational nature of our minds, we co-emerge and co-regulate together; we form and are formed in contact with the other. While our commonalities make connection possible, the uniqueness of each of us "makes connection interesting, novel and provides us a chance to learn something new" (Jacobs, 2019, p. 204). To offer a sense of recognition and competence to our clients, we need to be willing and able to enter a dialogue in which we may learn something new about ourselves and the world, in other words, to commit to the existential nature of the I-Thou encounter (Buber, 1970). We must allow the possibility that the clients' way of being or their perspective can change us as much as they need to allow us to assist change in them.

Psychotherapists often meet clients in moments of impasse, when their mind and emotional process are stuck and they feel powerless, exhausted, unable to see options or a future. The therapist's attuned and responsive presence acts as a co-regulating force: the presence of another mind co-constructing a new reality may help the mind in the impasse to regain new capacity, metaphorically speaking, to "repair" its functioning using the capacity and emotional process of another mind available to it (cf. Roubal, 2025).

Finally, Heinz Kohut, an important forerunner of the relational psychoanalytic tradition, offered an inspiring articulation of the forms the longing to be held may take in our consulting rooms. Kohut (1984) suggested three types of needs to be met in therapeutic relationships. According to him clients are: 1) seeking twinship, a sense of being human among other human beings; 2) looking for someone who recognizes them for the values and skills they hold, someone who has a "gleam in the eye" about their strengths and potential; and 3) longing to have someone in their life who is strong enough to hold them in difficult moments. Finding ways to meaningfully recognize and affirm these needs is an important support provided in the therapeutic relationship.

Sense of dignity

A sense of dignity is both a resource for and a result of managing the other two domains. The attention to dignity and the premise of relationality place the therapeutic relationship into an "inescapably ethical context" (Jacobs, 2019, p. 205). In relational assumptions we acknowledge the shift from the modernistic ethics of individualism to post-modern relational, field, and especially intersubjective ethics embracing humanistic, egalitarian, and non-authoritarian clinical values (Bloom, 2013). Here the thoughts of Levinas and Buber are worth considering. For Levinas (1979), when we encounter the other, their vulnerability and uniqueness are revealed, which demands that the therapist respond ethically, with respect for the humanity and uniqueness of the other, avoiding reducing them to an object of treatment or a category such as a clinical diagnosis.

Martin Buber's dialogic attitude is, in the first place, an attitude of welcome (Jacobs, 2017b) toward the client. Meeting a client with a welcoming attitude means having the capacity to see them in dignity, to acknowledge them as they are, and to be available to enter an I-Thou dialogue characterized by presence, genuine unreserved communication, and inclusion, the ability to perceive "the patient's side of the relationship, as a bodily touch to know how the patient feels it" (Buber, 1967, p. 173). Adopting a welcoming attitude is inherently a validating and dignifying offer of a shared relationship. These perspectives hold that ethics in human relationships (and the therapeutic relationship is primarily a form of such) arise from the fundamental recognition of each other as fellow humans, seen with ethical sensitivity, while bearing in mind that the distribution of power and responsibility in the therapeutic relationship is not equal.

A therapeutic approach that holds the above described ethical, dialogical stance is in itself a dignifying process: it is the therapist's way of being with that implicitly affirms dignity. When we care to know and hold a patient's experience, no matter how divergent it is from our own ideas about what they should feel or think, we are engaging in a process that restores dignity. Meeting a patient with our warmth, our respect, our care, however subtly we may express it, all these are the dignifying streams of a welcoming attitude (cf. Rogers, 1957, whose concepts of empathy and unconditional positive regard cover similar ground in person-centered terms). Building an empathic bridge of understanding toward the client is thus part of the dignifying process, while dignity itself names a quality of the client's self-experience that such understanding helps to grow. The welcoming attitude at the same time preserves the therapist's differentiation: we can empathize and still hold our ground, and when we meet, for instance, aggressive or abusive behavior, we set boundaries in a dignifying manner, welcoming the person while taking a stand facing their actions.

Working through dignity issues almost always involves addressing shame, as experiences of not managing oneself or one's relationships are inherently shame-inducing. Therefore, the resolution of shame is foundational, a ground upon which dignity is restored. When individuals find this ground, they can not only experience their worthiness but also regain the ability to exercise the freedom to make choices, navigate setbacks, and engage meaningfully with their world. A dignifying process for a patient also occurs when we can recognize and articulate how the way they were or are poorly held by their community is not their fault. It involves acknowledging the impact of debasing life circumstances: the inability of people around them to hold them and/or adversities brought by inequality, poverty, or discrimination based on race, gender, or sexual orientation. The restoration of dignity empowers individuals to reclaim agency, rebuild connections with their communities, and live authentically and with integrity.

The search for dignity in a psychotherapy situation is a vulnerable one. For many of our clients, just the fact that they "have to go to therapy" places them in a position where their dignity is at stake. Moments when dignity is threatened in the therapeutic relationship can lead to emotional dysregulation: what has earlier been considered "resistance" in therapy can now be seen as a positive force (cf. Wollants, 2012), protecting a person from the experience of shame, from being hurt again by yet another person, the therapist. The therapist's role is to help clients navigate these moments of peril without the therapist taking offense, thereby supporting regulation (see section 3.1). The therapist learns to recognize the moments when shame starts to grow and to "back off". In these moments they proceed with care and gentleness, saying, "It's okay, we're touching something important," and allow moments of vulnerability without overwhelming the patient. By respecting the patient's intentionality and carefully following this loop of engagement, a dyad is created that can effectively hold the patient, supporting their journey toward restored dignity.

Vicious circle or the spiral of growth

Following a gestalt therapy situational perspective (cf. Wollants, 2012), we consider mental (un)health a result of the dynamic interplay between people and their environment. In providing psychotherapy we focus on and are part of a person's interactions with the world. Mental health can be described as "a dynamic state of internal equilibrium" (Galderisi et al., 2015, p. 231) emerging from these interactions.

Fulfillment or non-fulfillment of the three longings contributes to this equilibrium with positive or detrimental effects embedded in every interaction of a person with their world. In that sense the proposed framework creates a bridge between an individualist perspective of mental health and the relational and situational perspective that is central to many psychotherapeutic modalities such as gestalt therapy, relational psychoanalysis, and humanistic and integrative approaches. Fulfillment of the longings is not a matter of individual process but a phenomenon arising from interaction, including psychotherapy.

Figure 1 depicts this interplay: the three longings form one interacting whole rather than three separate needs. Belonging forms the relational ground of the weave: it is within being held that emotional capacities develop (section 2.1) and that a sense of dignity is first conferred (section 2.2). Emotional competence is the agentic strand: it allows a person to sustain relationships, to set boundaries, and to hold on to dignity when it is threatened (section 2.3). The sense of dignity, in turn, is both a resource for and a result of managing the other two domains (section 3.3): it registers, like a sensitive indicator, the current quality of a person's interactions with their world. Once experienced, dignity empowers further reaching out and further regulation, while the shame of living in indignity limits the capacity to reach out and dysregulates the emotional process. Because each pair of longings is connected in both directions, the whole can be imagined, as Figure 1 suggests, as a constantly rotating gymnastic hoop around a pole of mental (un)health: from the moment we are born, every life experience influences its trajectory, either lifting it upward toward health and agency or driving it downward into suffering and struggle. In every experience we have and co-create, we can therefore ask: Are we/the other at the moment held well in the relationship? Is the encounter acknowledging dignity or inducing shame? And are we able to navigate the experience emotionally and maintain self-regulation and co-regulation?

Figure 1: The Three Longings Interaction

When the circulation runs downward, a vicious circle develops. Without being seen and held well by others, a person's sense of dignity suffers. Persistent distress causes issues with emotional regulation, an inability to move out of states of hypoarousal, rigidity, hyperarousal, or chaos (Siegel, 2019), which can manifest, for example, as outbursts of anger, severe anxiety, or depression. In turn, these dysregulated emotions contribute to further relational difficulties and further dips in dignity, caused by feelings of inadequacy, lack of competence, and failure, reinforcing a spiral of worsening mental health resulting from difficulties of person/world interactions.

Importantly, both movements can begin at any point of the system. Developmentally, the way we are held comes first: belonging is the ground on which regulation and dignity grow. In the ongoing flow of life, however, any of the three strands can take the lead. A downward turn may start with a violation of dignity, as when a public humiliation dysregulates and isolates; with a loss of holding, as when bereavement, exclusion, or migration shakes both regulation and worth; or with an overwhelmed emotional process, as when illness, trauma, or exhaustion strains relationships and erodes the sense of competence and dignity. The upward movement mirrors this: it may begin with an experience of being met with recognition, with a relationship that finally holds, or with a newly mastered emotional skill, and whichever longing is answered first lends its momentum to the other two. The circulation can thus be entered at any point, in life as well as in the therapeutic situation. Often, individuals caught in the downward movement seek psychotherapy as a first step toward transforming a vicious circle into a growing spiral.

Psychotherapy holds unique potential to empower individuals by directly addressing these three interrelated longings, and the therapeutic situation itself offers multiple points of entry. In practice, psychotherapy often begins by supporting emotional regulation, creating a dyad in which the client is held with care. This secure therapeutic space, characterized by ethical, validating, and respectful engagement, lays the groundwork for restoring dignity. As the client experiences being held well, they begin to reclaim their sense of dignity, enabling them to act upon their values and regain agency. With a greater sense of dignity and emotional regulation, the client is better equipped to engage in healthy relationships outside the therapeutic dyad, thus contributing positively to their broader community. While the three longings form one interacting whole, dignity stands out among them as an orientation point for the therapist precisely because it is a resource for and a result of the other two domains. Working toward dignity is an ethical maxim: to offer a dignifying process of being met by welcoming, validating, and valuing attitudes, perceptions, and treatment.

While formulated from clinical experience, the framework of the three longings converges with several lines of research reviewed in section 2. The need to belong is established as a fundamental human motivation with broad consequences for health and well-being (Baumeister & Leary, 1995; Hagerty, Williams, et al., 1996); the regulation of emotion and the belief in one's capacity to manage one's own states are well-documented foundations of mental health and resilience (Bandura, 1997; Siegel, 2020; van der Kolk, 2015); the relational development of self-worth and the destructive force of chronic shame on the sense of dignity are described in detail in contemporary shame research (DeYoung, 2022; Jacobs, 2017b). Seeing these aspects of therapeutic situation in relation to each other and with potential for the spiral of growth, empowers and justifies interventions aimed at each of the domains.

Conclusion

This article has proposed a transtheoretical framework of three longings that bring people to psychotherapy: the longing for competence in one's own emotional process, the longing to be held well in the relational world, and the longing for dignity. What the framework adds is the attention to how these longings are in relation to each other. We can imagine that almost every experience we have, within or outside the consulting room, can support a person's health and agency as “well-being is a continual process of living” (DeYoung, 2022, p. 258), while a lack in any of the three areas can contribute to suffering. In the therapeutic process we address whichever of the three longings the situation is calling for, and that is the practical hope the framework offers: whichever longing the therapist manages to answer lends its momentum to the other two.

For us, dignity serves as the therapist's orientation point for intervention. As both a resource for and a result of managing one's emotional and relational worlds, the sense of dignity indicates how a person experiences themselves in the world and in the therapeutic relationship. While the importance of emotional regulation and relationality is well described in existing literature, the sense of dignity is rarely mentioned explicitly. Dignity often remains in the background of psychotherapeutic theories, and this paper argues for its active consideration in our delivery of care.

In practice, this consideration takes the form of an attitude of welcome. Having a dignifying attitude counts especially in the moments when the other cannot carry their own dignity. The ethical commitment of psychotherapeutic work urges us to treat people with dignity, to see them as more than just the behaviors they perform or their clinical diagnosis, and even when we experience difficulties with our clients, to intend a welcoming attitude toward them. The principles are simple; adhering to them in attuned therapeutic contact is the hard work. The consequent restoration of dignity always implies growth, and such growth extends beyond the therapeutic space.

The perspective offered here has its limits. As a conceptual position paper, it distils the clinical experience of the authors and is articulated from within a Western, relationally oriented tradition of psychotherapy. The framework as a whole awaits empirical examination, and we would welcome dialogue with colleagues from other modalities about how the longing for dignity manifests in their consulting rooms.

Conflict of Interest Statement

The authors declare there are no conflicts of interest regarding the publication of this article.

Note on Authors’ Contributions

Tomáš Andrášik: Conceptualization, Theoretical Grounding, Writing (Original Draft, Review & Editing). Lynne Jacobs: Original Conceptualization, Writing (Review & Editing). All authors contributed to the development of the article and approved its final version.

Acknowledgments

The seeds of these ideas were planted by the psychoanalysts Heinz Kohut and Robert Stolorow, and we gratefully acknowledge these psychoanalysts' impact on the thoughts presented in this article. We are grateful to the whole community of the Pacific Gestalt Institute Residential 2024 for holding the ground and providing support for the authors' dialogue that became a core resource of this work. We also thank Barbora Krčmářová and Thomas Strickland for their helpful comments on the drafts of the article.