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.

© Copyright 2009 by Gary Seeman. All Rights Reserved. Permission to publish granted to GoodTherapy.org.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Socrates had it partly correct!

    Socrates had it partly correct!

    May 21st, 2009 at 2:19 PM

    an unexamined life is a life not worth living…Socrates i think…maybe Plato. how true…but isn’t it just as equally about examining our emotions and somatic feelings, as it is our cognitions…i’m so sick of cbt this and cbt that…it’s a very limiting approach and only referenced over and over because its been over researched exclusively by PhD professors who know how to teach psychology, but don’t know the art of doing therapy. anyhow,,not to poo-po your article, it’s a great article and i appreciate you mentioning the other types of therapy…but cbt, what a superficial bore lacking long term results for most people…i would guess.

  • Tiffany

    Tiffany

    May 22nd, 2009 at 1:47 AM

    This was a very nice article. Very informative. About the kundalini yoga, I think very few of us are actually successful with any kind of meditation technique. It takes years and a lot of time to master this.

  • Shannon

    Shannon

    May 22nd, 2009 at 3:46 AM

    What happens when people have such a distorted image of who they are and all the while thinking they are self aware but really all they are aware of is the fictionalized version that they have created for themselves? Are most therapists trained to see beyond that? Because otherwise they would just be treating a lie. I don’t know what good that would do for the patient but I can really see some people going through therapy, lying the whole time and coming out no better for it in the end. Seems like a waste of time and money on their part to me but I know that there have to be people who are narcissistic enough to do that.

  • Gary Seeman, Ph.D.

    Gary Seeman, Ph.D.

    May 22nd, 2009 at 10:34 AM

    To “Socrates had it partly correct,” many people who don’t know about CBT and its evolution think of it as a formulaic, symptom-based therapy only. I suppose that a beginning therapist using a cookbook CBT approach could offer a very limited means of therapy. As a therapist with an integrative approach, I find it useful to apply the therapeutic approach most likely to help a particular individual. For people who are overwhelmed by their emotions and who have difficulty implementing changes in their lives, cognitive therapy can be especially helpful, as it encourages them to challenge types of thinking that they may unconsciously be using to talk themselves in depression or anxiety that then makes it harder to cope with their real-life issues. The early promoters and researchers of cognitive behavior therapy weren’t the first to call attention to the need for some to engage thinking and analysis to achieve more balanced lives and self-knowledge.

    The Socratic means of knowing thyself, for instance, is an early model for cognitive therapy, where Socratic questioning is a favorite tool. Scholars from the world’s great religions issues commentaries to discern meaning and ways to apply scriptural teachings to daily life.

    In psychology, the Swiss psychoanalyst, C. G. Jung, discerned four personality functions: thinking opposed to feeling, sensation opposed to intuition as dialectical opposites to each other. Here again, if someone is overwhelmed with feeling, they would lack consciousness and need to explore the thinking function.

    Current cognitive therapists do case formulations that include feelings and bodily sensations as foci of change work (see the writings of Jacqueline Persons, Ph.D.). Dr. Marsha Linehan’s Dialectical Behavior Therapy is described in her book, Cognitive Behavioral Treatment of Borderline Personality Disorder is a sophisticated and multi-faceted approach to helping those who are easily overwhelmed by strong emotional reactions and trauma responses and who can be self-destructive. It’s not a cookbook approach by any means but is one of the most sophisticated approaches to therapy I’ve seen.

    You’re right, of course, in challenging anyone who says that CBT is the only valid approach and who eschews attending to emotions, somatic feelings, and so on. As one who is very much into the healing “art” of psychotherapy, I’ve found cognitive approaches to be very helpful for some people.

    To Tiffany: I’ve found that some of my clients are able to benefit from meditation very quickly. They don’t need to meditate to the point of great accomplishment to benefit from learning that they can start to direct their own attention even in the face of the feelings, thoughts and sensations that the mind constantly produces. Many pain management patients, for instance, gain significant relief in an 8 week course of mindfulness meditation, using the methods of Jon Kabat-Zinn. (I learned this recently listening to an audiobook, and the reference doesn’t quickly come to mind.)

    To Shannon: A seasoned therapist observes small interactions and guides a person to attend to their experiences that may be discrepant with their personal narrative. With someone who is very narcissistic, the work is gentle and may take a long time and some of it takes place at the emotional level, letting the person be heard in safety, something they were deprived of in early life. As they relax, emotional issues surface for exploration, and they are encouraged to self-reflect. Dreamwork can also be especially helpful.

  • Gary Seeman, Ph.D.

    Gary Seeman, Ph.D.

    May 22nd, 2009 at 8:38 PM

    To Rita or anyone else who has serious mental health concerns about themselves or a loved one, it’s good you’re reaching out for help. It’s essential, though, to do more than ask advice on a blog but to actually consult a qualified mental health professional in person, someone who can do a proper evaluation with treatment recommendations. The mental health professionals best trained for diagnosis are psychologists and psychiatrists. The best way to find a psychologist is to consult your county’s psychological association, which can be found online or in your local yellow pages. (In my area, you would look for San Francisco Psychological Association, for instance.) The psychological association isn’t a commercial referral service but is the official organization of psychologists in your area. To find a psychiatrist, contact your local medical association. If you have mental health coverage in your insurance, they can provide you with a list of local, qualified psychologists and psychiatrists who are on their provider panel. Finally, if you believe that the situation may be an emergency, it’s best to call 911, contact your local law enforcement agency, or go to the nearest hospital emergency room.

  • Rita

    Rita

    May 22nd, 2009 at 7:38 PM

    I am worried about my child who seems to be creating terabithia for himself. He lives in a fictional world and cant seem to relate to the reality around him. Is this too much of self awareness and too little of the world around him. Its almost like he cuts us off like some kind of static disturbance. He lives in a make believe fairy tale which seems to consume everything he is doing and thinking.

  • Julie

    Julie

    May 23rd, 2009 at 4:27 AM

    I would be completely baffled by anyone in therapy who truly did not want to make a difference for himself. I have been through therapy and believe me it was awful hard work to just be going through the motions. There were of course sessions that I felt like I got more out of than others but in the end the end result was that I was a much stronger and self aware person. Anyone who does not really want this for himself should just stay out of the therapy mix!

  • Joanne

    Joanne

    May 25th, 2009 at 11:58 AM

    The greatest thing about therapy for me is that when I started I had no real awareness of who I was at all but now I am a completely changed woman. I know more about my past and how that affects my present than I could have ever known. Yes being self aware is important, but having the ability to become even more so is priceless.

  • Summer

    Summer

    May 30th, 2009 at 9:17 PM

    After being treated as a doormat for years, I mustered even self-confidence to hit therapy. I am a totally changed person today and very self aware of the person I am.

  • Gary Seeman, Ph.D.

    Gary Seeman, Ph.D.

    May 31st, 2009 at 8:32 AM

    I’m glad that therapy has been so helpful for those who have recently commented. Two themes emerge, increased awareness and strength. I believe these go together when a person opens up and grows in therapy and have recently written an article on this that’s posted on my website: “The Psychology of Mental Toughness: How Therapy Makes You Stronger.” That article can be found here:

    drgaryseeman.com/resources/Toughness.php

  • Gary Seeman, Ph.D.

    Gary Seeman, Ph.D.

    June 10th, 2009 at 8:40 PM

    To FMD:

    Thank you for your insightful comments, which I fully endorse.

  • FMD

    FMD

    June 10th, 2009 at 8:14 PM

    This sentence seems to summarize a big part of what my therapist is trying to help me with: “With awareness we gain increased ability to choose, becoming better able to observe our emotions and bodily states instead of being run by them.”

    She encourages me to try to be “curious” about the feelings and thoughts that come up for me. I am finding that even if I pretend to be curious about them either by thinking or writing, “I’m curious about…” before my thought it has a bit of an “as-if” effect. So maybe eventually I will actually become more curious and less “run” by my feelings/states/judgments/fear/etc.

    Thanks for another informative article.

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