Know Thyself: The Role of Awareness in Psychotherapy

Awareness is Ever-Present

To be aware is to witness. And our witnessing selves are always there when we dream, [1] in daily activities, when feeling emotions, and in states of excitement or distress. We are constantly aware, though our focus may be clear or muddled. Without awareness, there is no consciousness. But awareness is hard to see. It is ever-present, like the air we breathe.

Although always present, awareness may not be remembered. For example, we may walk around a table while moving from one room to another. But we let our perception of the table recede from consciousness without storing memories that are easily retrieved. The encoding of memory depends in part on the intensity of experience, whether this intensity is influenced by the strength of a sensory perception or an emotional response.

We are self-aware when we attend to representations of experience — whether drawn from memory or visualizing a possible scenario. In psychotherapy, we train awareness on our lived experience to realize our hopes and goals and live more satisfying lives.

Every form of psychotherapy has methods to enhance awareness. This reflects the central role of improving the quality of awareness in the process of mental healing.

Know Thyself

“Know Thyself” is a maxim that dates back to ancient Greece, where it was inscribed at the temple of Apollo at Delphi and central to the teachings of Greek philosophers. [2] Mindful awareness is central to the enlightenment traditions of the Far East, where it is the central component of meditation. Contemplation, or the training of awareness on essential matters, has a rich tradition in Christian mysticism. These are just a few examples to demonstrate that throughout history, enhancing awareness is recognized as a fundamental value.

Knowing oneself is the start of a healing process. With self-observation, we encounter discrepancies between our ideal selves and the lives we are living. This challenges us to develop the capacity to remain aware despite strong emotions, so we can respond in ways that better promote well-being and personal integrity. With increased capacity to remain aware, we build a sense of continuity. Our sense of self is a more consistent narrative, and we find more inner stability when navigating a turbulent world. When challenged, the ability to fall back into basic awareness of ourselves and our surroundings can even improve our chances of survival. Even if we’ve gone off the beaten track, once we’ve found ourselves, we may still be in the woods, but we’re no longer lost. We’re more able to objectively witness our surroundings and better cope with what our situation requires. [3]

The Use of Awareness Practices in Psychotherapy

Today’s psychotherapies employ awareness practices under many names. The current third wave of cognitive therapies [4] teach secular versions of Buddhist mindfulness practice. Enhanced mindfulness helps people increasingly act in accord with their values instead of reacting with escape and avoidance behaviors that typically make problems worse. To improve self-observation, clients practice mindfulness exercises, such as watching the breath, moving the body with awareness, and acknowledging experience without the filters of value judgments. They also fill out diary cards that record mood, thoughts, actions, and emotional responses to difficult situations. The diary approach is central to early cognitive therapies, such as the cognitive behavior therapy (CBT) of Aaron Beck, M.D., [5] where clients fill out automatic thought records, recording their inner responses to situations. They are then instructed to counter habitual assumptions, reducing the anxiety and depression generated by helpless and hopeless expectations. These diary exercises force the training of awareness on life experience to learn from it.

Cognitive therapists also employ individual sessions, groups and classes where they teach the use of these methods and suggest responses to help people improve mood, reduce anxiety, and grow beyond behavioral limitations. Cognitive behavioral methods are particularly helpful for people who are easily overwhelmed by fear and other strong emotions and may find themselves too easily propelled into harmful actions to escape such feelings. Linehan’s dialectical behavior therapy (DBT) also has a longer-term component. DBT begins by addressing the most urgent problems, such as self-destructive behaviors, before attending to longer-term healing. But it eventually can help people form more adaptive lifestyles and work through early trauma.

Modern psychotherapy began with psychoanalysis, the talk therapy originated by Sigmund Freud. Psychoanalysis employs free association to help people become aware of the thoughts and memories constantly emerging in a stream of consciousness. This includes awareness of thoughts and feelings toward an analyst who is minimally self-revealing. The intimacy of disclosing our most private thoughts to an unknown analyst promotes a fantasy relationship and thus reveals the earliest personality characteristics shaped by interaction with parents. The technique of sharing one’s experience without censorship is not new. Note the similarity between the Catholic tradition of confession and the psychoanalytic uncovering of emotionally charged memories. As it is currently practiced, psychoanalysis has been updated from Freud’s theories and is now informed by scientific observation of early child development.

Psychoanalysts also interpret dreams to enhance awareness of the emotional context of experience that may otherwise escape observation. Carl Jung, an early psychiatrist and student of Freud, had a special talent for dreamwork. (For more, see my article on dreamwork [6]) Like Freud, Jung recognized a universal symbolism in dreams that resembled ancient myths. He eventually found Freud’s theories too limiting, because he sensed a universal consciousness that impacts people beyond the conditioning of child development. As a result, his dream interpretations are informed by religious symbolism and observations of the individual’s interactions with what he termed “the collective unconscious.”

There are many approaches to analytic work. Post-Freudian psychoanalysis focuses more on the person and their childhood conditioning, with some branches emphasizing the formation of self in relationships and others the impact of inner narrative, while others focus on inner identities taken in from outer experience. Jungian analysis is a good fit for people with artistic, intuitive, spiritual or mystical leanings. There is even a developmental Jungian school that combines an emphasis on early child development and the wide-ranging insights of Carl Jung. Each of these approaches takes a different slant to build the capacity to remain aware despite strong emotional responses and trying circumstances.

So what’s the best method? The choice of therapy depends on the needs of the individual. For instance, the psychoanalytic method of intimately revealing oneself to a non-disclosing analyst is designed to bring strong, early feelings to the surface. Clients typically meet with their analysts more than once a week, and the process often takes several years. This requires significant investments of time and money and is not typically covered by health insurance. It is also best suited to those who are not prone to acting out their strong emotions for a variety of reasons, including trauma responses, biological tendencies to have very strong emotional responses, unstable or depressed mood, distractibility, or impulsivity. Such clients need to start with therapy that focuses on enhancing the ability to regulate feelings and actions. People who have trouble controlling addictions can also benefit from self-help groups that provide a community of support and healing. Groups such as Alcoholics Anonymous enhance awareness by working a 12-step process designed to break through denial with the help of a sponsor. (For more, see my article on alcohol and relationships. [7])

Most people enter psychotherapy to get help in better adapting to challenging life circumstances. They want to better understand themselves and their actions and get better at solving problems. For rapid and cost-effective relief from dysfunctional moods and behaviors, they may first try the cognitive behavior therapies or solution-focused brief therapy. Problems with identity or self-esteem may not easily resolve with brief therapies that focus mostly on reactive thinking, feeling and actions. Long-standing depression and problems regulating actions may also require longer-term approaches.

Many psychotherapies integrate the methods and insights of different therapy approaches. These are appropriately identified as “integrative psychotherapy.” For instance, an exploration of cognitions can be supplemented by interpreting the origins of such thoughts in one’s family of origin to relieve self-blame. Someone seeking a deeper sense of inner peace may do dreamwork without undergoing the time and expense of psychoanalysis. In general, longer-term psychotherapies have been shown to be more effective than brief therapy. [8] [9]

Integrative psychotherapies may include a variety of additional approaches to enhance self-awareness. These include:

•Journaling, where one reflects on one’s experiences by writing about them outside the therapy session. Such insights can make therapy more effective.

•Bibliotherapy, including self-help books, especially those recommended by one’s therapist because they are particularly insightful and based on sound research.

•Art therapies and sand tray, where one creates images or arranges figures and objects that bring the playful imagination of childhood into greater awareness for self-discovery and healing.

•Mindfulness-based stress reduction (MBSR) as taught by Jon Kabat-Zinn, which helps people manage physical and emotional pain. [10]

•Meditation classes, especially those teaching mindfulness meditation, or shamata (calm abiding) and vipassana (insight) meditation.

•Focusing, a method of tuning into one’s felt sense of truth. Focusing was originally developed by Eugene Gendlin after doing research on psychotherapy effectiveness with Carl Rogers. They found that “those who benefited most from therapy had the ability to sense vague, still unformed feelings in their body and connect this sensing … with words and images that described it.” [11]

•Bodily approaches, such as yoga or Feldenkrais awareness classes that enhance physical awareness and with it emotional well-being.

•Group therapies, where one’s self-awareness is enhanced by feedback from others and by hearing others’ similar experiences. One’s social interactions are also observed in vivo, so the therapist and group can address them.

Awareness Is Mind

To contemplate a term such as “awareness,” I often begin by looking it up in an unabridged dictionary. This helps stimulate my thinking along lines that I may not have otherwise seen. One unabridged dictionary equates awareness with consciousness. [12] Another describes awareness as “mind in the broadest possible sense.” [13]These definitions suggest a lifelong journey of self-knowledge.

Psychotherapy is a process of training one’s awareness on the quality of experience to improve one’s life. This is done by enhancing awareness, the ability to observe and witness. With awareness we gain increased ability to choose, becoming better able to observe our emotions and bodily states instead of being run by them. With better observation, we build more accurate and detailed maps of our world. If this quest is approached with dedication and effort, it guides us toward inner fulfillment and outer freedom.

References:

1. Meditative awareness can progress through brain states consistent with deepening stages of sleep until it deepens beyond these brain states per Goswami, S. S. (1980). Layayoga: The definitive guide to the chakras and kundalini. Boston: Routledge & Kegan Paul.
2. Information accessed online January 1, 2009 at: en.wikipedia.org/wiki/Know_thyself
3. Gonzales, L. (2003). Deep survival: Who lives, who dies, and why. New York: W. W. Norton & Company, Inc.
4. Chad LeJeune, Ph.D., personal communication, February 9, 2007. Dr. LeJeune was referring to the Acceptance and Commitment Therapy (ACT) of Steven Hayes, Ph.D. and the Dialectical Behavior Therapy (DBT) of Marsha Linehan, Ph.D. Noting the central role of awareness in her therapy, Dr. Linehan has said she regrets naming it with an emphasis on dialectics. (This was during an open public dialog at the annual convention of the American Psychological Association in San Francisco in August of 2007.)
5. Beck, A. T., Rush, J. A., Shaw, B. F., Emery, G. (1979) Cognitive Therapy of Depression. New York: The Guilford Press.
6. Seeman, G. (2005 ). “The transformative power of dreams.”
7. Seeman, G. (2008). “Is alcohol spoiling your romance?”
8. Seligman, M. E. P. (1995). The effectiveness of psychotherapy: The Consumer Reports study. In American Psychologist, December 1995 Vol. 50, No. 12, pp. 965-974.
9. Leichsenring, F. and Rabung, S. (2008). Effectiveness of long-term psychodynamic psychotherapy: A meta-analysis. In Journal of the American Medical Association (JAMA), Oct. 1, 2008, Vol. 300, No. 13, pp. 1551-1565.
10. Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York: Dell Publishing.
11. Jordan, S. (2005). An introduction to focusing. In Self and society. Vol. 33, No. 2. London, UK: Association for Humanistic Society. Downloaded January 2, 2009 from
http:// www.focusing.org.uk/intro_to_focusing.html
12. Weiner, E. S. C. and Simpson, J. A. (Eds.) (1971). The compact edition of the Oxford English dictionary: Complete text reproduced micrographically. Oxford, UK: Oxford University Press.
13. Gove, P. B. et al. (Eds.). (2000). Webster’s third new international dictionary of the English language, unabridged. CD-ROM. Version 2.0. Springfield, MA: Merriam Webster Inc.

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