Blogging on Good Therapy

I received a message about nonpathological based therapy from an anonymous mental health professional.  He wrote the following commentary about me and my likeminded colleagues:

“Without saying so explicitly, you are implicitly judging psychopathology as an indicator of some pervasive ‘badness’ that is incompatible with the goodness of a human being. The trouble doesn’t lie with psychotherapists who recognize psychopathology, but with therapists who judge psychopathology as bad. It is no solution to blind yourself to 100 years of literature on psychopathology and it is no solution to blind yourself to the ‘whole’ human being, pathology included, who is sitting right before you. The solution is to face up to the covert declaration that you’ve made regarding psychopathology, namely, that allowing yourself to see patients’ pathology would make them bad in your eyes.”
 
I believe this well meaning and bright individual is jumping to conclusions about what it means to work nonpathologically.  I thought it would be useful to others who may jump to the same conclusions to share my response to him.  Here’s what I wrote:

“Dear Dr. Anonymous, Your first sentence which suggests that I and my community of “nonpathologizing” therapists are somehow judging psychopathology as some pervasive badness, couldn’t be farther from the truth.  Actually, it’s just the opposite.  S— happens in life and no one gets through life unscathed.  Protecting ourselves with depression, phobia, addiction or any other defense comes with the territory of being human.  We are all vulnerable, we all suffer, and we all develop strategies to survive.  What I am declaring is that “pathology” is adaptive and is possible to heal, change, and transform.

It is my experience that parts / strategies / ego states / defenses/ pathos are truly benign at the heart of it, not malignant.  A quick example of this is how the man with the high profile 100 hour a week job who endlessly strives to be the best, to be the most successful,  may really be attempting to cover and compensate for childhood feelings of worthlessness.  In my view the striving part of such a man is a “good” part in that it’s trying to help.  The man couldn’t have survived his worthless feelings without it.  Yes, the striving is destructive to him and his family, but it’s all he knew how to do….  This is one example of thousands.   So this is why I describe my approach as nonpathologizing, because it sees the good intention behind what you label as “pathology”.    Thus, it’s not that I’m blind to pathology… I may disagree with you about the origin of pathology and the potential for healing pathology, but I am not blind.
 
Furthermore, recognizing ”pathology” in another human being does not make one bad in my eyes, as you write.  In fact it’s just the opposite.  Seeing protective parts, defenses, and wounds within people opens my heart and evokes compassion.   The only hope people have of healing is developing understanding, compassion, and acceptance for their defenses and wounds.  If a therapist can’t open their heart to their client’s defenses and wounds it becomes less likely the client will be able to open their heart to themselves.”

Is there anything you would add in a response to the anonymous professional?  Please comment and let us know.

Have you ever felt upset about something and just wanted somebody to listen to you?  I know my dear wife has asked me on a number of occasions to “just listen.”  Even I, as a therapist who helps and guides others to listen to each other day in and day out, can find it hard to relax the impulse to do something about it.  Yes, part of it is because I care.  But more of it is because it can be hard to sit with how I feel to see another suffer….  And trust me,  I intimately know the misunderstood feeling I have when someone’s anxiety gets triggered by me expressing some minor suffering I’m experiencing.  I know the feeling of wishing my uncle could just listen to me or give me a hug when he, instead, tells me what I should do, or worse, tells me some universal truth like, “It’ll get better.”  I know he’s only trying to help me and trying to shield himself from his own discomfort at seeing his nephew not perfectly ok, and I love him for it regardless.   I know this doesn’t sound like it has much to do with therapy, but I believe it does; and on a deeper level than just a therapist not solving their clients problems.   The realm of the intra-client relationship, the way one relates to his or her /inner world/ego states/parts, is where I believe the truth that solving one’s problems with a little “s” actually interferes with Solving one’s problems with a big “S,” shows itself quite profoundly.   Let me explain by telling a story:

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“Enlightenment consists not merely in the seeing of luminous shapes and visions, but in making the darkness visible. The latter procedure is more difficult and therefore, unpopular.” ~ Carl Jung

Disclaimer: Please be informed that although I am opinionated on the subject of medication and psychotherapy as forms of treatment, I am not a physician and do not prescribe medication.  I am not authorized to make, nor do I make, prescriptions or recommendations to anyone about the use, type, frequency, and dosage of medication. The following is commentary on my experience and knowledge about the differences and interactions between medication and psychotherapy as mediums of healing. If you are in need of information about medication or if you want to alter the use, type, frequency, and dosage of your medication, I strongly advise you to consult with your prescribing physician. Doing otherwise could be harmful to your health and could endanger your life.

What medical professionals call “symptoms” (anger, anxiety, hopelessness, self-criticism, etc.) are important messages to us that something is happening inside which needs our attention. Therapy is the process of a person listening to, getting to know, and learning from the symptoms they’ve been experiencing. Because we naturally spend so much time focused on the outside world for survival and pleasure, looking inward is not the typical way we solve problems. Therapy helps people to turn inward, be present, and attend to their internal experiences in order to transform and relieve symptoms.

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I love this quote from Carlos Castaneda:

“Look at every path closely and deliberately. Try it as many times as you
think necessary. Then ask yourself and yourself alone one question.
This question is one that a very old man asks…Does this path have a heart? If it does, the path is good. If it doesn’t it is of no use.”

But what does Carlos mean by “heart” and why does a path need one? 

When I think about following the heart path I’m reminded of a wonderful story a therapist friend told me some time ago.   My friend, when in her 20’s, worked at a summer camp teaching art.  One of her students contacted her years later to tell her how impacted she was by the joyful relaxed feeling she had during art class. This student decided when she left summer camp that in the future she would always base every decision off how she felt in her body.  So, during the course of her life whenever she had to make a choice between two things, she choose the one that made her feel closest to how she felt in summer camp.  Her life had been a joy because she followed her heart rather than all the “oughts,” and “musts”

Anyway, I love this story because it’s a treat to see a young person figure this out so early in life….  So many of us have lost touch with our hearts.   And some of us are fortunate to have life nudge us back into our hearts once in a while, it can be painful, but worth it.  I’m reminded of a painting given to me by a friend which I have in my office by Brian Andreas called different plans.  In the painting there is a poem that reads:

“I don’t know how long I can do this, he said.  I think the universe has different plans for me & we sat there in silence & I thought to myself that this is the thing we all come to & this is  the thing we all fight & if we are lucky enough to lose, our lives become beautiful with mystery again & I sat there silent because that is not something that can be said.”

Wow, I love that every time I read it.  For me, nothing speaks to the power of cracking our hearts open to our true path more than that.  Thanks Brian.

So, what gets in the way of following our hearts?  And how do we resume following our heart?  I have some ideas about both of these, but will hold off until my next post to share more.  Any thoughts you’d like to share? 

There are many models of therapy to choose from.  We believe there are a handful of common denominators present in all forms of “good therapy.”  These elements are described below:

Non-pathologizing

Viewing a person as greater than his or her problems is the hallmark of non-pathologizing therapy.  It does not mean problems do not exist, it means NOT viewing the problems as the whole person or the whole person as the problems.  Working nonpathologically does not negate pathology, it depathologizes it.  So for example, rather than labeling a person who’s angry as an angry person, non-pathologizing therapy views one’s anger as just an aspect of the person, but not all of who the person is. We do justice to a person’s true nature when we remember that behind the layers of protection, no matter how self-destructive or hurtful to others one has been, there is a loveable and vulnerable soul at the very core.

Empowering

Empowering therapists maintain the belief that people can grow, heal, and transform. This hope is held no matter how intense one’s defenses and wounds are. People can heal if they want to and if they can contribute to their own growth whatever is sufficient and necessary to that end. When a therapist views a person as fundamentally flawed or incapable of change, the person is more likely to feel and become flawed. Yet, one is more likely to discover one’s true nature when therapy sees beyond wounds and defenses. Some people may not heal in this lifetime, but let the therapist not be an additional barrier to whatever other obstacles may be presenting.  

Collaborative

Collaborative therapy can be established when a therapist encourages a client to become the co-therapist. Therapists who work collaboratively trust the client to know herself (or have the potential to know herself) better than anyone else, and trust the client to know what issues to address and what direction to go in therapy.  This orientation puts the client in the driver’s seat of therapy. The spirit of collaborative therapy is summarized in the words of Albert Schweitzer who once wrote, “Each patient carries his own doctor inside him…. We are at our best when we give the doctor who resides within each patient a chance to go to work.”

Self

Self is a state of being that a therapist can embody when with his or her clients.  It’s defined by Richard Schwartz and IFS therapy as a state of calm, curiosity, compassion, creativity, confidence, courage, connectedness, and clarity.  Self is considered a requisite of good therapy because it is this state that allows a therapist to work collaboratively without pushing, without pathologizing, and without retraumatizing.  For more information on Self please visit the Center for Self Leadership.

Relationship

Beyond technique and theory is the realm of the relationship: the ongoing human-to-human connection which provides the foundation for change. The relationship is the safe container which allows one to more fully and completely feel the presence of Self while in the presence of another. The therapeutic relationship benefits from a therapist who embodies Self and feels unconditional positive regard in the face of whatever the client may be experiencing. Without a therapeutic relationship there is no therapy.

Depth

Good therapy often times needs to go deep. There seems to be a split in the mental health field between approaches that emphasize cognitive solutions and those that emphasize emotional/ or body oriented healing. Both are important. However, our experience is that healing takes more than insight about a problem, cognitive countering, and surface behavior change. Rather than turning away from, countering, or compensating for our suffering, healing requires an exploration into the depth of the wounds that fuel extreme beliefs, feelings, and behaviors. To “counter and turn away from” is more of the same and only leads to more suffering. Also, healing requires feeling. As it is often said, “If we can feel it, we can heal it.” Many of our extreme beliefs, feelings, and behaviors are maintained because we have, in an effort to survive, avoided the wounds, pain, and burdens which lurk beneath. Good therapy helps one to process and complete whatever hidden and unhidden wounds one has harbored. Treatment without going deep can be like stitching up a wound without taking the bullet out; it’s more likely to remain sore and require ongoing attention. “Enlightenment consists not merely in the seeing of luminous shapes and visions, but in making the darkness visible. The latter procedure is more difficult and therefore, unpopular.” ~ Carl Jung

Sometimes We Can’t Help

We are limited.  We greet our clients with great hope.  We have spent countless hours studying or trade, doing our own inner work, mastering our technique, and learning to “Be” with our clients.  We have parts of ourselves that want to do good work.  We are compelled to help others release burdens and cope with suffering because we know how good it feels to do so.  Yet, there are times we can’t help.  We believe a good therapist never gives up hope that a person can heal in this lifetime, but also recognizes that he or she may not be the one to help, that the time may not be right, the client not ready, and that, for whatever reason, one may never do the work we envision them doing.  Good Therapy means letting go of expectations and outcomes for ourselves and for the people we work with, though, without giving up. 

If there is a principle of “good” therapy which you’d like to suggest, please feel free to share your ideas with us.  Click here to view the models of therapy list.

A common concern that many people have in therapy is a fear that if they go close to the old feelings they’ve exiled is that they’ll get overwhelmed and reexperience the original trauma.  It makes sense that anyone who has spent years avoiding  vulnerable feelings would be afraid of doing the opposite.  Nonetheless, I know there are many creative ways therapists help people to heal trauma successfully, without flooding or overwhelm.  I thought it would be interesting to ask others to comment on how they help people to go near the pain without overwhelming or making the trauma worse. 

Much of what I do to help heal trauma I learned from Richard Schwartz and the Internal Family Systems (IFS) model he developed.  In the IFS model the key to healing trauma without flooding or overwhelm is bthrough helping the client to approach the parts of them which carry the extreme feelings while he or she is embodying a state of “Self.”  Self is a state of curiosity, calm, compassion, courage, confidence, clarity creativity, and connection.  It’s described by Schwartz as “they eye in the hurricane” and has been demonstrated as accessible by even the most defended and wounded of us.  When we approach the wounded parts of ourselves from Self, the intense feelings harbored inside are modulated in a way in which they don’t overwhelm us.  I explain this to clients who need more information about how it works by comparing it to how a parent soothes a child.  Imagine a baby crying in a room.  A mother who feels anxiety or frustration in response to a crying baby is more likely to intensify the baby’s anxiety and feel overwhelmed herself.  But if a mother, in response to hearing her baby cry, feels compassion, and approaches the baby with this energy, the baby will feel it and will relax much sooner than a baby with an anxious parent.  This compassionate energy not only affects the child, but it has a way of making us immune to being overwhelmed.  Healing trauma works the same way.  When we approach the parts of ourselves that have been suffering and wounded in an open, calm, curious, and compassionate we will be shielded from the pain and the pain will not overwhelm.  Healing this way for the client is like simultaneously being the container and the contained…

There are many variations and techniques within the IFS model which help to prevent overwhelm.   I’m interested in hearing from you about what ways you use to avoid overwhelm with your clients, regardless of what model of therapy you use.  Please feel free to share.
 

Welcome to my column on Collaboration and Nonpathology in Therapy. In this column I hope to share my occasional insights into collaborative and nonpathologizing psychotherapy which mostly present themselves during therapy sessions. I hope in particular to raise awareness and sensitivity to the inadvertent and subtle ways we can alienate the people we work with. My hope is to facilitate more human and authentic connections between therapists and the people they work with.

Noah