Click here to contact Linda and/or see her GoodTherapy.org Profile

“Hold fast to the Great Form within
And let the world pass as it may
Then the changes of life will not bring pain
But contentment, joy and well being”
Tao Te Ching, Verse 35

My client walks in and begins crying; covering her face, she is looking down, searching for some thing, some words to identify her experience. She speaks in anxious circles, words revealing nothing but the space that she cannot find comforting. She admits that her life is “dominated by thoughts” and that she is constantly mining for a jewel that will explain what is going on. As she seeks to find meaning, to understand, I feel her pain and suffering, but am also aware that I do not want to add to her experience with probing questions that would distract her. And I don’t wish to take away from her experience by offering soothing words that would only serve to temporarily mute her inner noise. Instead, I just sit with what is revealing itself, with what is arising in the present moment. In this being together, it is understood that nothing needs to change, that there is no pressure to interpret or to understand.

She squirms while watching me as we sit in this process of not adding to or taking away from her experience. She reports as she sits looking down, “It’s like I wake up and am in this body, and I wonder, ‘Is anything there if I’m not obsessing?’” She elaborates, “I’m looking for a mental formula that proves I exist, but I can’t find it!” She is genuinely curious about her experience of confusion. In this act of being present to one another (without an agenda that something needs to be different) there is a sense of completion despite her conflict, her anxiety, and her questions regarding what signifies an experience of being alive. This sense of completion arises from not needing to change or to maintain a condition. Just like in meditation, we view our thoughts, our emotions, and our sensations as passing conditions and don’t need to do anything about them.

The two main benefits of meditation are the attainment of another way of perceiving and relating to reality and more enjoyment in life in general. These benefits are cultivated by quieting the mind through concentration and insight practice. Sitting quietly, we place all of our attention on watching the breath go in and out. A few seconds later, we notice our leg feels stiff, our nose is running, there is a pain in our forehead. We are wondering what’s for dinner. We notice we’ve been thinking with a sense of dread that there may be a problem in our relationship. As soon as we see we are distracted, we gently pull our attention back to the breath. There is no attempt to explore or understand any of the experience that distracted us. Instead of analyzing any “thing,” that arose, we work with the structure of the mind itself by strengthening its ability to not attach to the passing phenomena of experience with any emotional reactivity. The ability to learn how to rest and to feel at home in our body is cultivated in the practice of meditation. This practice is an invaluable adjunct to the psychotherapeutic process.

“Hold fast the Great Form within/and let the world pass as it may” is a description or an attempt to describe the indescribable. Mystics and seekers throughout time and from diverse cultures have sought to know the answer to “What is the Great Form within.” The Dalai Lama, during a mind-life symposium studying the effects of destructive emotions on brain functioning, was asked about whether every state of mind would have neural correlates. His answer is important, “There is no reason to believe that the very subtlest state—called ‘innate mind,’ the very essential nature of awareness itself, which is its luminous nature—would have neural correlates because it is not physical, not contingent upon the brain.”* Yet, this state, which is not a thing, and “not contingent upon the brain,” can have tremendous influence on our experience. Mind training affects a sense of moment-to-moment calm, a resting in the spaciousness that holds everything. Immediate contact with this spaciousness offers the experience of complete simplicity where nothing is missing and nothing needs to change. This process: just sitting and doing nothing, paradoxically transmutes any pain or suffering into quiet calm.

My client and I are sitting sensing that there is no urgency to do anything. I return to her “mental formula” statement in which she was curious about a formula for existence. In the spirit of contemplative inquiry, I ask her, “Where is your I?” She looks at me without answering and then laughs, nervously. She is noticeably uncomfortable, but she just sits with her discomfort. I ask her where the boundary is between her sense of self and the outside. She closes her eyes, but again remains silent. It’s as if she’s processing that her mind can’t figure out the answer, and I’m with her feeling into the confusion. She closes her eyes again and breathes. She then reflects, without much need to hear an answer, “Is just being aware my I?” This sense of her sitting without a need to identify an “I” with her body or her mind, and allowing for the sense of the inexplicable, relaxes her.

Pure awareness is beyond our ability to understand, to know as a thing. Therefore, unlike the client above, it is possible to become more anxious before we learn to accept the space of not knowing. This is not a problem. In therapy sessions there is a constant reinforcement of noticing the present moment—whatever is being experienced. We also notice that things that activate us have a history and a story associated with them, but we are not interested in participating with the thoughts and the stories as much as we are interested in letting them arise and then letting them go. Our attachment to these stories can create increasing anxiety, but we just sit together and allow an increase in tolerance for the sensations within the body. It is not infeasible that a client might even get angry and say, “This isn’t what I expected. I don’t know what is happening.” So, we allow this and ask if they can notice that they are not their confusion, not their anger. This is very hard, but not impossible, for someone who is not practicing some form of contemplative discipline. Yet, if they can just witness the passing of time and the moment-to-moment shifts they begin to rest in the sense that the ground of their witnessing is not changing. That ground is what we are looking to touch and hold in this process of feeling very identified with the emotion of confusion and anger. Familiarity with this ground and this baseline of neutrality helps when there is a perceived potent assault on our sense of safety.

The challenge in psychotherapy is to blend what is happening in therapy (all the conditions that are being experienced) with the openness of our essential nature, pure awareness. In any moment in time, we feel either contracted or expanded, and whatever arises is used to enhance the experience of effortless being, of freedom and spaciousness in the present moment. The client enters the psychotherapeutic process because he or she is experiencing discomfort and emotional reactivity. The therapist responds from the space of curiosity monitoring the absence or presence of freedom and spaciousness in the present moment. The dance becomes the inquiry between the conditions that a client believes keeps him or her in discomfort, and what is immediately available in the present moment. We use whatever arises to reveal the presence of pure or neutral awareness, and we see how different conditions can be viewed from unconditional presence, the essential nature of pure awareness.

*The Dalai Lama’s quote is from Daniel Goleman’s book Destructive Emotions: How Can We Overcome Them? (New York: Bantam Books, 2003) p. 206

©Copyright 2010 by Linda Jame, LCSW. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Linda and/or see her GoodTherapy.org Profile

Click here to contact Beth and/or see her GoodTherapy.org Profile

As a psychotherapist specializing in grief and loss and as a hospice bereavement coordinator, I am saddened by how underutilized hospice care is. This is largely because of people’s misconceptions about hospice: Many people hear the word “hospice” and think it means a place where a loved one goes to give up and die, alone and on too many medications. Nothing can be further from the truth. Hospice is not a place, but a valuable service that supports dying patients and their family members to maintain hope, dignity and quality in all domains of life — physically, emotionally and spiritually — at this important stage in the lives of patients and their loved ones. The services provided by hospice allow a patient to spend his or her final days among family and friends, as alert and comfortable as possible and away from the hospital and dehumanizing high technology equipment. Hospice is about life. When there is nothing more that can be done to cure a disease, there is still much that can be done to enhance the patient’s life and to support the patient and the family.

The Services of Hospice

Hospice care is available to anyone who has a life-threatening condition or terminal illness with a prognosis of six months or less if the illness or condition were to run its normal course, as certified by the patient’s attending physician and a hospice medical director. Nonetheless, many people stay on hospice for more than six months, as long as they continue to meet the foregoing requirement at the end of each certification period. In addition, in electing hospice care, the patient elects palliative or comfort care, rather than curative or life extending treatment. In fact, as discussed further below, palliative or comfort care is a hallmark of hospice care, and hospice clinicians are expert in providing effective pain management.

In keeping with the hospice movement’s mission to provide care in all domains of life, each hospice’s program provides support to the patient and his or her family through the interdisciplinary team, consisting of the medical director, nurses, social workers, home health aides, chaplains, bereavement counselors, volunteer coordinator and volunteers. Also available, if necessary for comfort and quality of life related to the hospice diagnosis, are dieticians, speech, occupational and physical therapists.

What Does Hospice Care Look Like?

After a patient is admitted to the hospice program, each member of his or her clinical team–a registered nurse, social worker, chaplain and home health aide or certified nursing assistant–meets with the patient and his or her family and assess initial physical, emotional, social and spiritual needs and develop a plan of care for the patient, which may change as the patient’s condition changes. It is noteworthy that the patient and family or other caregivers are involved in formulating and changing the plan of care. Psychosocial needs are assessed by the social worker, including any needs for community services, and assessing the need for volunteers to provide companionship or other support, including massage, music or art therapy, or respite for family caregivers. The chaplain will provide spiritual support and also help the patient resource those in his or her spiritual community, as needed. The chaplain, in coordination with the social worker, will also help with funeral or memorial arrangements. The home health aide will assist with bathing and grooming. The need for pre-bereavement support will also be assessed, which is provided by the bereavement coordinator and grief counselors.

Bereavement support is provided for at least one year after the patient’s death to family members and others affected by the death. Many hospices provide this service for thirteen months, to guide the bereaved through the first anniversary of the death.

The Importance of Managing Pain

The management of pain–physical, emotional and spiritual–is one of the most important missions of hospice care. Unrelieved physical pain results in unnecessary suffering in the terminally ill. In a hierarchical needs system, the first step in managing global pain is to manage physical pain. Unfortunately, misconceptions about pain and pain control continue to interfere with the acceptance of hospice care. Some picture loved ones dying in hospice alone and in abject pain. The picture of the terminally ill dying in pain is, unfortunately, historically accurate. Before the advent of the hospice movement, under-treatment of cancer-related pain was common, and the terminally ill did often die alone in hospital beds. “[T]hey were often handled as bundles of physical symptoms or simply as failures of the medical system, But lost in all this ‘expert treatment’ was a human being with fears, questions, desires, needs and rights” (Callanan & Kelley, 1997, p. 25-26).

Fears about over-medication and addiction also discourage the wider use of hospice services. Addiction is very rare in the use of narcotics to treat pain. Hospice clinical staff is specially trained in the effective use of narcotics and other pain-relieving drugs, as well as drugs to counteract the side effects (such as nausea and constipation) of those drugs. In addition, anti-anxiety and anti-depressant drugs are used as needed to enhance the terminally ill patient’s quality of life.

It is impossible to work with a person’s emotional and spiritual pain if he or she is experiencing unrelenting physical pain. Unrelieved physical pain can lead to feelings of hopelessness and fear, and can also cause the patient to isolate him or herself from family and other support. With this in mind, Cicely Saunders, the founder of the modern hospice movement, developed the concept of “total pain”: “an understanding of pain as the complex interaction between physical pain caused by disease and pain caused by mental, emotional and spiritual malaise” (Brown, 2008, p. 190). If the patient is in chronic pain, he or she may give up hope of a peaceful and dignified death. Effective pain control allows the patient to maintain a sense of autonomy and control and focus on quality of life issues, unfinished business and spiritual concerns. Thus, the interdisciplinary team approach of hospice is indispensable for the treatment of “total pain.”

Hospice chaplains, social workers and bereavement counselors, as well as those in the hospice patient’s spiritual community play an important role in maintaining the patient’s quality of life and helping to relieve spiritual and emotional pain. Those facing death commonly search for essence and connectedness (Stephenson & Draucker, 2003, p. 57). Concerns about essence include questioning whether one’s life and death have meaning and purpose, questions about values, doubts and beliefs. Concerns about connectedness stir questions about how one is connected to family and others in one’s life, as well as to a higher being, and also bring to the surface the individual’s unfinished business in his or her relationships.

Listening to a dying patient’s fears and concerns is at the heart of the services provided by hospice (Callanan & Kelley, 1997, p. 28). Fears cited by hospice staff in working with the dying include fear of the process of dying, fear of loss of control, fear for loved ones, fear of dying alone, fear that one’s life has been meaningless, and fear of the unknown (Callanan & Kelley, 1997, p. 27-28).

Conclusion

Impermanence and death are part of the natural order of things, not something to be hidden away in fear and despair. Death and dying are integral parts of human existence, and indeed, of human development and growth. As Elizabeth Kubler-Ross has observed: “If you can begin to see death as an invisible but friendly companion on your life’s journey… you can learn to live your life rather than simply passing through it” (Kubler-Ross, 1975, p. x). Hospice care is available as a companion on that journey, enabling patients and loved ones to embrace this special and sacred stage of life with dignity, autonomy and peace.

References

Brown, G. (2008). Courage: Portraits of Bravery in the Service of Great Causes. New York: Weinstein Books.

Callanan, M. & Kelley, P (1997). Final Gifts: Understanding the Special Awareness Needs and Communications of the Dying. New York: Bantam Books.

Kubler-Ross, E. (1975). Death: The Final Stage of Growth. New York: Simon & Schuster.

Stephenson, P.L. and Draucker, C. B. (2003). The Experience of Spirituality in the Lives of Hospice Patients. Journal of Hospice and Palliative Nursing 5(1), 51-58.

©Copyright 2010 by Beth S. Patterson, MA. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Beth and/or see her GoodTherapy.org Profile

Click here to contact Aylee and/or see her GoodTherapy.org Profile

Before we go further into the theory underlying Core Energetics, Core Evolution and other body-psychotherapies, I want to discuss the therapeutic relationship. This is a subject I feel very passionate about!

We use labels to try to understand something, or to communicate about our experience. Sometimes people come in and repeat to me what other therapists have told them, they may have a page full of western mental health diagnosis’ or they might say, “I am a rigid psychopath”. The latter refers to labels given to holding patterns way back in the time of Wilhelm Reich. These holding patterns also lead to personality traits, or what Reich called “character structure”. While still respecting Reich’s very important work, Core Evolution no longer uses these labels in this way. However, many practitioners still do.

The holding patterns will be the subject of future articles, but today I want to talk about how a client would come to own such a label and if it could have any value to them. Often clients will read a book and label themselves, although they may be trying to understand their experience, this may be an intellectual exercise, an idea they have in their head based on someone else’s experience or knowledge. The problem is that the label doesn’t describe what actually happens. The labeling can be limited in that the person may not really know, kinesthetically, what it means. It can also limit the wisdom of the body, the mind, and the emotions’ ability to have new experiences, obfuscating the change process.

I strongly believe that therapy is co-created between the client and the practitioner. While a therapist needs to have a solid theoretical groundwork that guides how she understands what happens in the sessions, its function is to provide a map for the work. I hope to use my knowledge in a way that provides a structure for understanding the therapy rather than dictates the client’s experience. I am aware that I cannot assume to understand the experience of another. Therefore we need to stay in constant communication, exploring and bringing into awareness what is happening for the client in their mind, body, and emotions each step of the way. This information helps the client to see how they do whatever it is they do in their life, and gives me information to guide the session. Awareness of what we do internally, how we structure our energy, and how it affects our thought patterns, feelings and behaviors, is a large part of what creates change.

A big reason that I employ physical exercise that can be provocative in groups and in sessions, is to open the system and help the client to explore beyond their normal experience and holding patterns. The things that come up during the session define where we go next. A recent group session encouraged members to explore what happens in their body under certain conditions. For example, if you have “been left by someone you love”, or if you have “been falsely accused”. How do you respond? We explored the attitudes “I can do it” and “I will not them get me”. Members were able to perceive their reactions in their bodies, the posture and the muscular and breathing patterns that ensued. They were able to identify the familiar attitudes that they personally carry through life, recalling the memories that created these reaction patterns. We walked around the room exaggerating the posture of this attitude and were able to see how the attitude was received by others and how we were affected by others’ attitudes. This type of exercises create a solid foundation of experience to recognize reactions going on within themselves and in their dynamics with others that had, until now, been out of full conscious awareness.

We are constantly exploring and tuning in so that clients have a way of recognizing when they are reacting to old belief systems and patterns based on past experience rather than what may actually be happening in the here and now. Along with other preparation provided in the therapy, this self-awareness can set the stage for new experience and different reaction patterns.

On the contrary, if I were just to tell you what (I perceive) you do, what the clinical name is for it, and how you may have come to it, this could, in the best case scenario, be a great relief to you because it can normalize your experience and give you some self-understanding. But even if it accurately describes your reaction patterns it would be limiting because if it remains an idea or a concept, you will not have the awareness to know HOW it is triggered, the mind-body awareness to know WHEN it is being employed, or the compassion for your system that will help you to change it in the moment. You may end up believing you are a victim of your physiology, clinging to the label rather than encouraging and allowing the innate knowledge of the system to find its way to a new repose. It is so important to realize that reactions come from experiences, and even though they then become patterns, this is not who we are at the core. When we identify with the reaction patterns and the labels we use to describe them we are very likely to reinforce the problem and to become stuck.

We have created a mental health system where labels are important for identifying the problem and for reimbursement purposes, but it is essential to not let that lock the client and practitioner into a way of working that 1) gives the practitioner power over the client by assuming he knows more about the problem than the client; 2) limiting the exploration of the problem and the treatment process based on the label and the idea that we are our labels 3) causes the client to identify with the label and the past experience rather than use it to facilitate change. We must be creative in the work and seek to find the deeper wisdom of the situation at hand.

©Copyright 2010 by Aylee Welch, LICSW. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Aylee and/or see her GoodTherapy.org Profile

Click here to contact Greg and/or see his GoodTherapy.org Profile

At times I can be didactic and preachy with clients. I fall into believing that I have some special knowledge about life. I believe that I’m expected to pass along little gems of wisdom in sessions as if I know what life is really about. My client and I collude in forgetting that this is my first life too, what do I know? Outside the consulting room I am not always so wise. I can lose my soft-spoken reflective stance and be as reactive and unreasonable as the next person. I would say it’s worse for therapists when this happens – we have the extra layer of shame that comes from feeling we should know better. What if a client saw me arguing with the bank teller, pushing my way onto a crowded train…

Who do you have to be to be a therapist?

I am coming to the realisation that some of the most significant and poignant moments in therapy are not really about the content of the discussion. Not really about behaviour change or unravelling the past. In fact, in a sense, not really about the client’s trouble at all. In the deepest moments of therapy I am freed by my client and my client is freed by me.

Leo, a 33 year old Finnish solicitor, was referred to me for anxiety and mild depression, the mainstays of modern therapy. His lack of eye contact during his previous CBT treatment earned him a tentative Asperger’s diagnosis. The referral letters from his psychiatrist and previous psychologist read like lab reports on a strange species. Leo is very sensitive and would have been hurt and angry if he saw those letters. I don’t blame him, so much of our language as so-called mental health professionals pretends that we are somehow superior to the client.

In our first meeting Leo was furtive and a bit suspicious so we spent time talking about what it was like to be together. He was despondent about therapy and quizzed me about my approach. I said I wanted to work from his own experience and understanding and I said a bit about Focusing, a form of self-awareness that a friend of his had found helpful. I encouraged him to ask me about what I thought and felt about him and over the first few sessions we gradually developed an honest and respectful rapport. I felt very accepting towards him and I told him so. We had moments of warmth and he eventually thawed as he came to really believe that I wouldn’t reject any part of him, even those aspects of himself that he continued to condemn as shameful and wrong.

In our twelfth session we decided to review our work. I felt it was really important to hear from Leo what he felt was useful in our meetings. He had certainly changed. His relationship with his boyfriend had become much more communicative, his behaviour at work had become more caring, and he had found a way of standing up to his father without losing his temper. As we reviewed his progress, Leo held out his hands to show me that he no longer bit his fingernails. I could see that the rough nails and bloody fingertips had healed into soft smooth flesh with trimmed nails. He smiled broadly. I smiled back, ‘Good for you. You seem very proud of that Leo’. He began to laugh, obviously delighted with the change. ‘What helped you to stop biting them?’ I asked. Leo took notes after our sessions so I was pretty sure he’d have a hypothesis about why this stubborn habit finally changed. ‘Well’, he said thoughtfully, ‘You remember that session when we really talked about this habit of biting my fingers?’ I nodded. ‘Three things happened there that helped me. You helped me talk about what it meant to me, that I was ashamed of my fingers because they showed people how anxious I felt and they would know I’m not like them. Then we talked about substituting a different behaviour that wouldn’t be so visible. Those two things helped a lot. I started to tap my fingers together instead of bite them and that helped me for a while. It was less noticeable and I felt less embarrassed. Now I hardly ever do that anymore either. But you know, the most helpful thing was that you showed me how you chew your lip, you were even doing it in the session. You said many people have a kind of thing they do when they are concentrating and you did too. That helped the most. I felt less weird about it and it was easier to stop. I felt it was Ok, biting my fingers didn’t make me different and wrong’.

I was surprised by Leo’s response. I repeated it back to him to make sure I’d understood. He said it again, ‘Yes, the most important thing in these sessions is the constant acceptance you show me, no matter how awful I think I am. I really believe you now’. We stared at each other. ‘You’re looking right at me Leo’. He smiled. I said ‘You know it feels like we can really accept each other’. Leo had allowed me to be myself. By accepting me with my own foibles he had freed me from having to be an expert on life, he’d allowed me to drop the role of mental health professional. He could have rejected me and my lip biting but he accepted me as the slightly anxious person I am and I could bear him seeing me like that. We had both overcome the trance of withdrawing from each other into pretending and hiding in order to belong.

We finished our contract three months ago and I continue to reflect on my time with Leo. By accepting each other we created a healing connection. We overcame the anxiety that kept us isolated in our separate selves, silently believing that we cannot be real and be accepted at the same time. Seen from this perspective therapy is the bridge that spans our isolation from one another. It is a place to welcome humanity, one by one, back into a community of belonging. A place where the vulnerable ‘I’ of separation becomes a ‘we’. Therapy is not a treatment any more than marriage, friendship, motherhood and fatherhood are treatments. I am coming to believe that therapy, when it works, is mutual redemption of the lonely ‘I’. Perhaps implicit in each phobia, trauma, addiction and compulsion, depression and anxiety, is the loss of our human belonging. But it isn’t that we as therapists are whole perfect beings sharing our wisdom about acceptance. We also seek connection and redemption from our own human exile and isolation. Otherwise how could we be helpful? It is only those who need redemption who can offer it. After all, wasn’t it that need to connect that motivated us to become therapists in the first place? And isn’t it in the consulting room that many of us allow ourselves a depth of vulnerability and courage that we seldom achieve in our daily lives?
(this account is based on actual client work but is heavily disguised)

©Copyright 2009 by Greg Madison, PhD. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Greg and/or see her GoodTherapy.org Profile

Click here to contact Greg and/or see his GoodTherapy.org Profile

To step back into the sphere of human being demands something other than therapeutic technique, objective evidence, and curative power. It requires the inspiration of art. All great art worthy of that description calls us to see the world and ourselves more clearly. The bibliotherapeutic impact of the work of JM Barrie rests in its ability to unnerve the shallows of life and to resuscitate the struggle back to authenticity.

James Matthew Barrie (1860-1937) was for some years the preeminent playwright of the English-speaking world. His new productions would open to certain success in London’s West End and on the main stages of the world’s capitals. He was also in great demand as an after dinner speaker to the great and the good. Now, apart from his most popular play, Peter Pan, Barrie’s name has slipped from the footlights into obscurity and along with him, a precious developmental view of human existence.

In the late 1980s I spent a year studying Barrie’s plays and his philosophy, under the tutelage of Professor Paul Swartz at the University of Alberta. Both Paul and I teetered uncomfortably at the edge of respectable academic psychology when psychology was just beginning its demise into a restrictive obsession with hard science. His interests perhaps better accommodated within a psychologically sophisticated English Department while my interests crossed into existential philosophy and psychotherapy, always with one eye on my emerging autobiography. Out of that year of scholarship emerged a published paper of our work together, The View from Betwixt and Between: JM Barrie and Humankind (Swartz and Madison, 1987). Now, twenty years later, I view that year of study and Barrie’s warnings, from the perspective of middle age and the feeling that somewhere along the line I accidentally sided with the wrong self.

Barrie believed that life is not unlike a three-act play, but with a second act that seems to be missing. The first act lays out a trajectory of possibility that if followed would allow us to grow into the person we were meant to be. The final act offers us an opportunity to wake up and realise that at some point in the midst of life we lost our way. In fact the second act of life is the longest and it is during this part of the play that the struggle for life occurs, largely unbeknownst to us. Barrie desperately wants to warn us about the second act, when we fall asleep for years. During the long sleep of the second act of life a ‘black speck’ grows within and in the fullness of time it pushes us out and takes over. An imposter takes over the entrancing adventurous life we were meant to lead and carries us into the shadows of the murky world of wrong-headed ambition and social cosiness.

In an address to the young graduates of Edinburgh University, Barrie warns about getting lost in the treacherous character of that middle act, ‘You may sometimes roam round the earthly tenement that once contained you, trying to get back. Perhaps you will get back. That sometimes happens… All I can assure you is that in that second act, now about to begin, something will get in which is either to make or destroy you’ (Barrie, 1930: 18-20).

To maintain the ‘entrancing life’ is a struggle; we have to fight for it. It requires the courage to attain a sort of ‘self-mastery’. Barrie himself had wanted to be an explorer, but instead his ‘familiar’ took him and he became a writer. As a writer, Barrie presents themes of immense psychological value, including the idea of the lost second act, the presence of a ‘familiar’ or interloper who takes our place, and the possibility (though unlikely for most of us) of grasping a ‘second chance’.

We are offered second chances to return to the authentic person we set out to be, but it requires considerable courage. Barrie repeatedly puts his philosophy into the voice of his main characters, here in the protagonist of Dear Brutus, ‘There is something we are born with, not Fate or accident, which are outside us, but something in ourselves that really plays the dickens with us and makes us go on doing the same sort of fool things, however many chances we get’. Can we cut this thing out? ‘It depends, I expect, on how long we have pampered him. We can at least control him if we try hard enough. But I have for the moment an abominably clear perception that the likes of me never really tries’ (1942: 1045).

According to Barrie, we can shape ourselves if we have the courage to control our human frailties, such as jealousy, worldly ambition, ignorance, contempt, resentment, arrogance. But the black speck ‘gets nearly everybody in the end if they don’t look out’. ‘We all seem to be touched by it, and are perhaps sent into the world to decide for ourselves whether we are worth saving. Above all things, don’t defer finding out what your particular speck is – for they vary very much – before it spreads’ (1938: 138).

‘Both the speck and the familiar work to disable the entrancing life. The speck is with us from the beginning, the familiar enters in the second act. Although Barrie does not seem to have sought to connect the two, it makes sense to think of the speck as opening to the familiar, as the germ of it, the base element that indulgence cultures into a surrogate self. We may understand the familiar as in turn advancing the spread of the speck, supplying the medium through which our particular liability metastasizes into the whole of our living. It is the speck acting through the familiar that corrupts our second chances into waste and repetition’ (Swartz and Madison, 1987:12).

Barrie was especially clear about the place that career plays in a human life. In contemporary society career and ambition have become disgustingly synonymous with life itself. Yet Barrie proclaims, ‘we have all become too self-conscious about the little parts we play – they are little parts even in our own little lives’ (1938: 52). The entrancing life and worldly success seldom coincide. Professions are shallow compared to the depth of the greatest moments in life, when we are pitched in battle for our very souls.

We can recognise, even from today’s increasingly superficial vantage point, that Barrie was describing to us how the crux of existence is increasingly shunted to the shadows, replaced by consumerist greed and the race to get ahead. For some of us, like the immortal Peter in Peter Pan, there is no second chance, ‘… the window was closed, and there were iron bars on it, and peering inside he saw his mother sleeping peacefully with her arm around another little boy’…. In vain he called, and ‘in vain he beat his little limbs against the iron bars’ (1913a:143-4). But those bars were up for life, there was no return.

The second act of Barrie’s plays are often set in a magical timeless place, like the islands of Peter Pan, The Admirable Crichton, and Mary Rose, or the enchanted wood of Dear Brutus. These are places of destiny, where each character faces a situation so extreme that we can see into their true nature. ‘Mistakes are repeated, illusions shattered, and a glimpse inward made available. This glimpse sows the possibility of a second chance’ (Swartz and Madison, 1987: 16). But for some of us the battle with the familiar enemy is stacked so against us that to struggle courageously and to lose is not entirely to fail. To struggle is itself, regardless of the outcome, an admirable stance.

Courage and the speck lay side by side. Whether we nurture the virtue or the vice is a choice for which we alone are responsible. If we open the door to the vice, something sneaks in ‘like a thief in the night’ whereupon it waits quietly until we become used to it and we suddenly realise that it has supplanted us and taken our place on the stage. When I think back to that year of study with Paul I know that the man I am now is not the one I was heading to be. At some point the course of that young man lost its navigation and if I were to follow back the line from the present it would not connect to him, but to some small black speck that grew into the imposter that has taken my place. We need to be constantly attuned to the great moment when we are to hear the faint call to turn from the inauthentic and all the glitz and glamour that the mundane world can muster.

The ‘second chance’ is really not to squander the first and only chance, to engage the foe and its socially-condoned allies, and to shape our own future rather than be shaped by it. Self-mastery is the constant struggle, beginning when we begin and ending when the verdict is inscribed on tablets of stone.

As a psychotherapist I not only see Barrie’s vision played out in my own life, I also see it clearly embedded in the deeper layers of the stories I hear each week in my consulting room. There is a shared humanness in the struggle to live an everyday life that is worthy of the human soul. In a profession that has arguably become too ‘outcome’ obsessed, too focused on symptomatic alleviation and technical intervention, Barrie reminds us that it is still legitimate to talk about the big things, the valiant struggle for self-navigation. Maybe it is also legitimate to consider that the profession of psychotherapy has its own ‘black speck’ and we now struggle to regain essential aspects of what this profession, also, was meant to become.

Barrie, JM (1913) Tommy and Grizel. London: Hodder and Stoughton
Barrie, JM (1913a) The Little White Bird. London: Hodder and Stoughton
Barrie, JM (1930) The Entrancing Life. London: Hodder and Stoughton
Barrie, JM (1938) To Rhodes Scholars annual dinner Oxford, June 20, 1928. In JM Barrie, McConnachie and JMB. London: Peter Davies: 134-8
Barrie, JM (1942) Dear Brutus. In AE Wilson (Ed) The Plays of JM Barrie (Rev.Ed) London: Hodder and Stoughton: 993-1060
Swartz, Paul and Madison, Greg (1987) Contributions to Psychohistory: XII. The view from betwixt and between: JM Barrie and humankind. Perceptual and Motor Skills, 65: 3-18.

©Copyright 2008 by Greg Madison, PhD. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Greg and/or see her GoodTherapy.org Profile

Click here to contact Greg and/or see his GoodTherapy.org Profile

Contrary to popular belief, Existentialism did not die out along with student riots, free love, and LSD. In fact in recent years it has made a resurgence in, of all places, psychotherapy and coaching. I am an Existential Psychologist practicing in Brighton & London UK, and here I will outline how existential philosophy can form the basis of an increasingly popular approach to helping professions.

Mention the word ‘existential’ and what probably comes to mind is an atmospheric little Parisian cafe along the Left Bank of the Seine, beret-wearing depressives huddled together smoking Gitanes and pontificating about the meaning of life. It’s a stereotype from the sixties associated with the philosophy and the political antics of such notaries as Jean-Paul Sartre and Simone de Beauvoir. What’s less known is that since the late 1980s there has been a resurgence of existentialism in the English-speaking world, most notably within the hotbed of North London psychotherapy society.

This so-called ‘British School’ of Existential Therapy bases its psychology on the philosophies of Martin Heidegger, Jean-Paul Sartre, Soren Kierkegaard, Friedrich Nietzsche, and other continental philosophers. Though each of these philosophers has something unique to say, they all stress individual responsibility, the freedom to choose our lives, and living in full awareness of the unavoidable limits to life, including of course mortality. What we decide to value and believe in life governs our conduct, allowing us to succeed and feel safe in certain ways while also creating difficulties in other areas of life.

Therefore our problems in living originate from conflicts within our outlook on life: For example, the belief “I cannot show any weakness” conflicts with the fact that “I need to be vulnerable in order to have a meaningful relationship”.

From this perspective, many psychological problems arise from our deeper assumptions about life or attempts to ignore the limits of life. Depression, stress, anxiety, despair, are not ‘illnesses’ per se but are all expressions of conflict and inconsistencies in our beliefs about life.

The existential therapist assists the client to actively explore their assumptions, their orientation to life, and to live in greater awareness of the vast range of possibilities open to them. A basic question in existential therapy is ‘why are we not more open to all the experiences life has to offer?’

Existential therapy is much more ‘of the world’ than many other forms of therapy. Like cognitive behavioural therapy, it looks closely at each person’s way of thinking and perceiving, our assumptions and choices. Like psychoanalysis, it looks at our relationships and how these reveal what we’ve made of ourselves. But unlike both of these approaches, existentialism emphasises the unknown in life, the mysteries that exceed all knowledge. For this reason existentialism has often been called the ‘Buddhism of the west’.

Exploring how we limit our own perceptions and the ways that we restrict our own freedom can help us to expand beyond a narrow range of possibilities. Every assumption (for example how we think others see us), every response (for example to crisis or boredom), can be quietly explored. There is meaning in everything.

The way we live everyday life, even the way the client interacts with the therapist in the consulting room can reveal so much. Existential therapists must also, like any human, grapple with how to create meaning in their own lives. In this respect existential therapy accepts that there are no experts on life and that we each must find our own answers to the paradoxes we encounter day to day. Together the therapist and client try to see the big picture, the context within which we act daily. Existential therapy and coaching sessions can take the form of lively dialogue and deep insight.

As well as the resurgence of existential psychotherapy, and the new field of existential coaching, in the past few years existential philosophy has also become the basis for a new approach to legal mediation. Lawyers are being taught existentialism in order to understand the psychological depths of clients involved in legal conflicts. Also, an existential therapy team now works with patients and their families in a large teaching hospital in London. Underpinned by existential philosophy, these practices are able to raise some of the paradoxical questions about human living that current culture, even within the psychology professions, tends to gloss over.

©Copyright 2008 by Greg Madison, PhD. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Greg and/or see her GoodTherapy.org Profile

Click here to contact Greg and/or see his GoodTherapy.org Profile.

In this article I would like to suggest that the time has come for psychotherapy to begin to contemplate the future. Not from the standpoint of current theory and contemporary debates regarding research and practice, arguments that are thickly stewed in mental health politics and the profit considerations of private health companies. Rather, I believe that psychotherapists may need to consider their professional role from a future point of view in order to contemplate what function, if any, we should have in the biotechnological revolution forecast to commence within the next few decades. If the futurists are correct, then ten years from now the most intractable issues that mental health professionals grapple with today will in retrospect be totally superfluous.

The world is bracing for an exponential advance in technologies that are predicted to fundamentally alter the very nature of human beings. If the profession of psychotherapy is to remain relevant, I think we must begin to prepare for this revolution. It is possible that in the not too distant future our clients will be presenting issues of deep unease and unbelievable excitement about the inscrutable new choices they will face in this post-human future. As therapists we have a responsibility, I believe, to hear these concerns within the context of their far-reaching psychological, ethical, and spiritual ramifications.

In May 2002 the Institute of Ideas, a public policy think-tank in London, hosted a debate entitled Post-Human Future. It offered a thought-provoking insight into the way that scientific ingenuity is likely to impact upon the fundamental givens of human nature. The exchange featured the philosopher Francis Fukuyama, author of Our Posthuman Future (2002), and the scientist Gregory Stock, author of Redesigning Humans (2002). Interestingly, the debate was not centred on whether or not foundational changes in the essence of humanity will occur, but whether those changes, considered inevitable, should be regulated according to ethical concerns. What safeguards, if any, should be in place when tinkering with the building blocks of human existence?

At that debate 5 years ago, Fukuyama, a typical philosopher, warned us to begin to think carefully about our technological advances before we find ourselves in a world we no longer recognise. He is certain that our future abilities will confront us with fundamental questions: What makes a human being ‘better’? Do we want to change human nature? If we alter the basis of human nature, what effect will this have on human rights? How do we balance what is beneficial for the individual (life extension, for example) with what is best for society (productive young work force)? Do we want a world where the genetically have-nations are populated with ‘enhanced humans’ while technologically poorer nations have ‘rudimentary humans’? For the first time in millions of years we could have more than one species of human walking the earth at the same time. According to Fukuyama, we need to face these fundamental questions now, and develop safeguards to maintain what we value most about ourselves.

As a scientist, Gregory Stock, on the other hand, while agreeing that the effect of biotechnology will be immense, displays a more laissez-faire attitude and cautions against regulating medical research. He says that we must be realistic. There is no way to slow down ‘progress’ in this area and it is inevitable that, for instance, human cloning will occur, and likely before it can be done safely. He believes that technology will address real suffering and that in one generation we will be able to retard aging and prolong vitality, manage emotions precisely, and test embryos for personality and temperament. He agrees that the interests of parents and individuals will need to be balanced with the interests of society but points out that this will be impossible to monitor, even with strict regulations. Parents will want their children to have the potential to compete and succeed as adults and if one country prohibits procedures to enhance children’s intelligence with memory chip implants for example, couples will likely travel around the world to avail themselves of the most advanced technologies elsewhere. Basically, Stock prioritises the clear benefits of future medical advances and downplays the dangers and utopian nightmares. And certainly there are clear and substantial benefits from such biotechnological research. We may be able to eradicate many if not all human disease and degeneration. We could, in principle, achieve open-ended lives, though we would still be mortal and able to die, just not condemned to it. For the first time in human history, death would in fact become a choice.

Three years after this debate in London, the futurist Ray Kurzweil wrote The Singularity is Near (2005), a book that advocates a major role for machines in the future of humanity. In addition to advances in genetics, Kurzweil sees human body and brain merging with robots so that we all become hybrids. According to Kurzweil, our intelligence will become non-biological and trillions of times more powerful than unaided human intelligence. He is certain that human aging will be reversed because nanotechnology will overcome the limitations of biology. Kurzweil is both radical and optimistic.

But in this flurry of ‘progress’ who is asking about the psychological impact of redesigning the human race? Will there be psychological and spiritual side effects to advances in genetic engineering? Perhaps technology will prolong and ‘enhance’ life, but can it answer the question of ‘how to live life’ or ‘what is a good life’? This of course brings us to therapy, which has always tried to deal with agonizing questions about how to live well.

The information from scientists and futurists makes it clear that it is not too soon for therapists to begin to contemplate the advent of this unrecognizable future. It is no longer science fiction. We need to ask what role does therapy have now in exploring the implications of such radical transformation in the essence of what it is to be human? If some philosophers, scientists, and theologians are beginning to embark upon cross-disciplinary dialogue regarding the new world ahead, shouldn’t we? Certainly as therapists we already deal with the everyday practical relevance of fundamental human questions, values, and assumptions. Perhaps it is time to begin to contemplate what impact genetic-cybernetic engineering will have on our understanding of our profession and our own personal concerns and how this contemplation may prepare us to open to the new range of questions, values, and assumptions that may soon be presented by our clients.

I suggest that we need to establish a kind of ‘Futurist Therapeutic Dialogue’, devoted to imaging the deeper impact of this prophesied revolution in human nature. First of all, we might explore what role psychotherapy could have now in preparation for the future. It may be useful to begin to consider what values will be challenged by some of the advances that scientists are anticipating. We could reconsider all of our current psychological theories in light of future humans who can perhaps live forever, who can change their hair and skin colour, alter their physiology at will, and change gender several times throughout ‘eternity’. Introduce such future possibilities as a topic of conversation to a group of friends and see how long it takes before you find yourselves facing profound questions, for example how we might begin to redefine ‘success’ and ‘failure’, how biotechnology will alter the future structure of families, create new forms of society, and force fundamental transformations in the meaning of relationships. Try to think of one psychological theory or therapeutic model that will not fragment when seen through the lens of this anticipated human future.

As professionals we might also want to try to predict what form our profession will take within this imagined future. I suspect that the onslaught of biotechnology and cybernetic enhancements will make psychotherapy as a ‘mental health profession’ redundant. There will be efficient technical responses to the difficulties of so-called ‘mental illness’, trauma, emotional stress, depression and anxiety etc. Our current range of psychopharmacological treatments will likely be a source of some embarrassment compared with the regulatory possibilities of future psycho-technology. Although many current technical-medical approaches to therapy leave me uneasy, the future ‘patient’ will likely be so malleable in terms of ‘nature’, ‘personality’ (an outmoded notion I’m sure) or physiology, that any concerns about intrusions into a person’s integral makeup may no longer even make sense. It is my guess that the more medical and ‘treatment’ forms of psychotherapy that are based upon alleviating symptoms, tempering pathology, and diagnosing ‘illness’ will be subsumed within genetic and cybernetic approaches, administered by psycho-technicians. However, it is my hope that the more relational, dialogical, spiritual and existential forms of therapy may have an increasingly crucial role in this brave new world and may become the essence of what remains of our profession. As the world becomes more focused on human technology, these forms of psychotherapy may play a part in sustaining what at least has been ‘authentic’ in human existence. For the sake of discussion I would like to outline some preliminary thoughts regarding possible issues we might face in the post-human profession of psychotherapy.

The heart of the misgivings regarding these profound changes is the way that they impinge upon our ideas about human nature. As therapists, we need to clarify what we mean by ‘human nature’. This clarification better positions us to help clients explore what they are protecting if they reject new ‘enhancements’ in an effort to remain ‘natural’. How will clients choose which advances are OK and which go too far in altering their sense of personal and species identity? For example, do human suffering, limitation, and death offer such pivotal meaning and value to life that some people will want to challenge attempts to eradicate them? As culture is man-made, man’s nature may also, at some future point, be man-made. And since each of these quandaries will affect us as much as our clients, therapy will potentially be based upon explorations that are entirely mutual in their impact and significance.

Psychotherapists, especially those working existentially, assume that many of our problems in living arise from the way we respond to, or deny, the givens of existence. But what if those givens themselves become choices rather than facts? For example, future therapists may be asked to explore with their clients a real choice between life and death, whether to die or not. But will our ability to understand such a choice evolve as quickly as our capability to technically generate it? We cannot comprehend the immense impact that ‘the dying of death’ may have on the human life-world. Our very language around death will have to be closely investigated before we can begin to use it to think clearly about what it would mean to ‘choose death’. At the moment we can only contemplate this fantastical future from our moribund worldview, tainted by death, but even now we can imagine how it would change attitudes toward suicide, the practice of bereavement counselling, and our understanding of grief, to list a few obvious examples. If a loved one chooses to die or is accidentally killed, the meaning of this death is certainly altered by the fact that the person could have, in principle, lived forever (or at least for hundreds of years). And what kind of relationships does a potentially immortal being have? Will the insecurities that prevent us from being open and caring towards each other been seen more clearly as unimportant or will we become less relational, lonely subjects drifting endlessly along our individual way, asking ‘what’s the meaning of it all’? The therapists of the future may be obliged to work phenomenologically, in a complete state of un-knowing with each client, discovering together, literally, who they want to-be, what they want to become, and whether there’s any meaning to it all.

All genetic counselling will become existential counselling (if it’s not already). Parents deciding to engineer their child’s emotional life will be expressing, quite explicitly, what they see as valuable in human existence and what they see as negative. Future therapists will also likely become genetic counsellors, assisting in the design of humans consistent with each individual’s values yet also challenging assumptions and biases regarding what is a desired attribute and what makes a person undesirable. Of course it would be arrogant to just assume that any form of therapy will still make sense after such a revolution in human being. But surely someone will have the role of seriously questioning the choices being made by individuals and human communities. Perhaps therapists will fall into the role of social critics, attempting to hold and support values and sensitivities that may easily be trampled in the rush of technological advance.

Can therapy become a profession that will help us think deeply about the implications of what we are doing as we do it; a hermeneutic practice that helps us contemplate the un-reflected assumptions we have about the meaning and purpose of human life on earth as that life itself is continually transformed? In the next twenty to thirty years, with the likely advent of ‘emotion technologies’, we will in all likelihood discard our identity as ‘health professionals’ and instead carve a niche alongside theologians, ethicists, and philosophers, with a common care for the Being of human souls: each of us trying to do our best, having to endure the necessity of making choices whose profound significance we will be unable to even partially fathom. At the very least, perhaps contemplating the future of our profession within such a changed world will give us insights into our current practice, revealing previously obscured assumptions about the way we live now, offering us new ways of interacting with the clients we are seeing today as well as tomorrow.

©Copyright 2007 Greg Madison, Ph.D. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Greg and/or see his GoodTherapy.org Profile.

Click here to contact Greg and/or see his GoodTherapy.org Profile

Leaving home can be a traumatic and exciting experience, especially if we are leaving to live in a foreign country. Research into the experiences of voluntary migrants has unexpectedly revealed that some of these people are actually using migration to express a deeply felt existential need. These ‘existential migrants’ discover more about themselves and feel more alive when confronting unfamiliar cultures. But by repeatedly exposing themselves to a vast range of different people and foreign places they can consequently end up living with a feeling of not being at home anywhere.

Alan is an executive in a large banking firm in the City of London. Six years ago as a recent business graduate, he left his native Maryland to ’seek his fortune’. After a year in New York and two years in the Netherlands, he arrived in London where he’s worked for the past three years. When I first met Alan he presented as an intelligent, curious and ambitious young man with a passion for travel. He was proudly self-sufficient and independent but this was mixed with a slight air of melancholy. Alan came to therapy in order to deal with an increasing feeling of restlessness at work, mixed with a recurring anxiety about his plans to buy a property in London. For the past couple of weeks he has been feeling homesick for family and friends in America but also increasingly preoccupied with the idea of moving to Lisbon, where he spent an exciting three-week holiday last summer.

It may be tempting to simply view Alan as typifying a breed of young international executive moving around the globe according to the demands of 21st century capitalism. However, even a cursory examination of Alan’s experience and his motivations for leaving home begin to offer another story. An exploration of Alan’s life reveals that while growing up he had always assumed he would leave Annapolis, in fact he never really felt ‘at-home’ in his home. This is curious. Why would he not feel ‘at-home’ in the only home he’d ever known?

Looking back, Alan gradually realises that he made many choices, including education and career choices, based upon the likelihood that each choice would hasten his departure and increase his ability to live in other parts of the world. This was such a natural longing for Alan that he was shocked when he discovered that many of his friends had no plans to leave Annapolis but instead were happy to plan their lives around friends and family and the familiar streets where they had grown up. In contrast, Alan always remembers being attracted to anything foreign. He experienced the familiar home environment as overly conventional, too homogenous, boring and even suffocating. Though he had good relationships with this family and a good social network, he always felt different from those around him and longed for the adventures he would have once he left his homeland. He remembers thinking ‘life begins when I leave home’. Alan’s current experiences reveal his long-standing dilemma regarding the attraction and repulsion of belonging and settling in one place. He lives with ambiguous feelings regarding home, a deep longing to belong coupled with the panic of having to conform to a quotidian life that he finds unconvincing and abhorrent.

Alan’s story illustrates a process of voluntary migration that has not been recognised until now. Unlike economic migration, simple wanderlust, or forced migration, ‘existential migration’ is conceived as a chosen attempt to express or address fundamental aspects of existence by leaving one’s homeland and becoming a foreigner. These individuals move cross-culturally, sometimes repeatedly, in search of self-understanding and adventure. Such people are actually seeking to resolve deeper ‘existential’ questions such as ‘who am I’, ‘how can I fulfill my potential?’, ‘where do I belong?’, ‘how can I feel at home?’ Most of these individuals leave their home cultures because they never felt ‘at home’ in the first place. For some, the choice to leave can eventually result in not being at home anywhere in the world, leaving these individuals to live within a sort of ‘homelessness’ that includes a complex mix of inconsolable loss as well as perpetual adventure and self-discovery. These individuals raise interesting questions about our definitions of home and belonging. Is ‘home’ where we are most ourselves or is home the very thing that exiles us from ourselves?

The research that revealed this process consisted of in-depth interviews with voluntary migrants from around the world now living in London. The study generated impressively consistent themes including the importance of independence, the need to live fully, the need for freedom within belonging, the value of experiences of difference and foreignness as a stimulus to personal awareness. Among these migrants there is a marked preference for the strange and foreign and a consistent contempt for the conventional and easy life of the settled community.

The concept of existential migration fits well with themes in existential philosophy, especially concepts that point to the foreignness and mystery at the heart of human existence. The concept also challenges aspects of psychological research into acculturation and relocation stress. Even if an individual has relocated to a new culture solely for business purposes, he or she may find that their taken-for-granted assumptions about daily life are suddenly challenged, exposing a kind of groundlessness to living. Upon return to the home country, that revelation is not always convincingly ‘papered-over’, resulting in a restlessness that needs to be acknowledged and explored.

As a process, existential migration may occur with anyone, though certain people seem more predisposed towards it as a primary orientation to life. But even for ‘existential migrants’ the day may come when their process becomes one of settling rather than migrating.

Talking about issues of home and belonging in therapy tends to be very emotional and poignant, but voluntary migrants value and even enjoy these dialogues. Paradoxically, voluntary migrants usually find that openly discussing their experiences of leaving home, often for the first time ever, results in a shift regarding their feelings of restlessness. The approach in these sessions does not assume that anything is ‘wrong’ or pathological in these experiences; perpetual migration is not seen as less worthy than being settled. These sessions are simply an opportunity to have a facilitated dialogue that delves deeply into the motivations for leaving and the feelings that have transpired along the way.

The concept of existential migration also offers a re-consideration of the psychological effects of globalisation. As more and more of us are expected to have mobile lives, a kind of global ‘homelessness’ may be on the horizon; perhaps we are heading towards a time when no one really feels at home anywhere anymore, signaling the end of belonging. It is exactly these deeper issues that the study of existential migration has revealed as issues for us all.

©Copyright 2008 Greg Madison, Ph.D. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Greg and/or see his GoodTherapy.org Profile

We’ll let you know when our other featured columnists begin their new series at GoodTherapy.org. Here are some of the columns to expect in the next few weeks:

Ethics in Psychotherapy by Cedar Barstow, M.Ed., C.H.T.

Integrating Spirituality & Psychotherapy by John Rhead, Ph.D.

Collaboration and Nonpathology in Psychotherapy by Noah Rubinstein, LMFT

Click here to contact Greg and/or see his GoodTherapy.org Profile

“The Human Being of Therapy” is a column that explores topics from the point of view of the common existential dilemmas that we all grapple with in life. These brief articles emphasize a democratic client-therapist relationship in which both people open up to their struggles to meet and connect, and their failures to do so. Also, more general topics about psychotherapy and modern life will be presented in an attempt to understand their deeper significance. Topics will range from the impact of therapist self-disclosure to the significance of moving to another culture, from discussions of research in psychotherapy to a whimsical exploration of a human future not limited by mortality. The column will take a stance that diverges from contemporary society’s emphasis on ’scientific knowledge’ and the tendency to view life experiences as diseases to be cured.

©Copyright 2008 Greg Madison, Ph.D. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Greg and/or see his GoodTherapy.org Profile