The Heart of the matter in therapy

The Heart of the matter in therapy

by Ben Bruce

February, 2011

I’ve been working for over 8 years now as a psychologist. In university it was hammered into us that we needed to use only empirical methods (sensory measurement evidence-based) – largely, this was restricted to Cognitive Behavioural Therapy. I have found that the scientific method is useful and also brutal in its efficiency, but also limiting and must be kept in perspective alongside the scientist-practitioner cum experiential/tacit-practitioner which combines philosophical and humanitarian wisdom with the work that we do with people. There are even shamanic principles, I have come to find, learning from indigenous peoples of the earth that have great merit in understanding and helping people.

When I was being conditioned (if not brainwashed into the empirical method as the only approach) I was struck by how much human beings were relegated to veritable computer systems with biochemical constraints, roaming about in a social system. I sensed this was based more on the limitations of those who were trying to understand humanity and the human mind. The complexity and the mystique of what it means to be a human being, the dreams, the play, the love, the courage and hope, the fear, the depth, the dance…. It all seemed to be neglected from the explanations of human behavior, and by extension the therapeutic interventions that were accordingly deemed ‘appropriate’. Our existence, our uniqueness as human beings was reduced to irrelevance.

Don’t get me wrong – I highly rate the use of approaches like CBT (cognitive behavioural therapy) and methods like applied behavioural analysis. Our understanding is growing all the time from the field of neuroscience, and a brain-informed therapy is definitely necessary. I use these methods and approaches all the time in my work. In fact I was so hell-bent this way in the past, I was completely reductionistic and would only look at scientifically based approaches to therapy.  I remember having a conversation and scoffing at the lack of verifiable data for therapeutic modalities like psychoanalysis, Jungian analysis, existential and humanist theories and interventions. This reflected my ingrained arrogance (thankyou to the institutions where I started) as well as my lack of real experience in the world of applied psychological counselling or clinical psychology: actually working with people who had problems and actually helping them in any significant and meaningful way. It is when I started doing this that my methods had to change and so I had moved on from being just a scientist-practitioner toward being an experiential-practitioner who also appreciated and respected science alongside a fascination for what was outside the realms of scientific measurement right now. I was then using an approach and a theory of being that was based on my own experience, not just text books, university or pharmaceutical company studies and other people’s meta-analyses and literature reviews. I was right about some of the lack of data, but only because such methods do not lend themselves well to empirical testing. This does not mean they are bullshit, just non-commensurate, perhaps overly-complex to being constrained to the rigourously tight testing parameters set as the gold standard, that usually only lends itself well to rather simplistic interventions. If something works, and you can’t work out why, it doesn’t mean it works any less. It is hard to break something down into a few discrete variables amenable to a ‘T Test’ or analysis of variance (ANOVA); empirical and quantitative statistical data collection. But this was (is) what we had, folks, an empirical psychology which has been oppressive. Boy, was I in for a shock when it actually came down to the business of counselling people, and treating their very human problems, and God forbid: they expected results! People actually expected me to help them even if their problems or indeed the methods required to be used to help them (which I frantically searched and scraped around for) were ‘non-empirical’ and ‘unconventional’. I learned an invaluable lesson early on that separates the practitioner from the academic: the academic talks about something and judges all according to his/her lofty theoretical or measurement-based perspective, whereas the practitioner has to actually do it. Getting your hands dirty is, after all, a dirty job for an academic. Again don’t get me wrong, I respect academia, so long as academia respects technician practitioners who are actually doing the job that they are studying.

So how do we actually get in there and help human beings? How do I get to grips with the patient sitting opposite me on the couch who has come to me, been referred to me, paying money to sit and talk to me? Human, being a word which defines our species, but does little besides providing a question mark over our soul and our hearts. I think that when we think of ‘humanity’ and ‘human’ we often think of advanced complexity alongside of frailty…well at least I do anyway. We think of an evolved and/or created species, depending on your disposition, with amazing potential and ancient history; we seem to know this, and then we reflect upon all the greatness of inspiring and wonderful people, alongside the ruthless, the ignorant and foolish; the sheep-like behavior that we see all around us. I don’t know about you, but I think about this type of thing all the time. We then think, perhaps, about the cosmos; the tiny blue sapphire and emerald planet Earth which spins around a ball of infernal heat and light, somehow suspended in orbital space, that when you move away from it, the planet becomes a tiny speck amidst ridiculously awesome expanses of space. We are brought to reflect on both our wonderful  exceptionality, our poignant ‘freak accident’ of existence, alongside of our insignificance within so much vast empty space with countless solar systems and galaxies just like ours all over the light years.

So then, relentlessly in this stupefying context (like it or not) we have the world of people with all our socio-cultural-political-relational eccentricities. We have things like therapy rooms. A psychologist, like me, sitting across from a person, a man, woman or child, perhaps a couple or a family, perhaps an organization in some situations. We have a paying customer and we have ‘me’ or someone like me sitting in this chair or standing on this stage and there we are: talking and hopefully, listening. We are assessing and appraising and questioning, and researching and learning and then we finally intervene. One could argue that even the listening, the contextual space, the questions of reflection are all a kind of intervention…. Either way, the intervention occurs, and then I realize that this cognitive behavioural bio-chemical outlook is just one lens, one way of looking at a person or group – and it often comes up extremely short at being able to truly change a person or group’s behavior. It comes up very short in providing any pivotal understanding; that meaningful moment or epiphany or multiple steps of ‘ahaa’ moments that inform a person to the point where change occurs right there and then. We could cally it: Information / awareness based spontaneous remission. Acceptance, or change: they both provide a sense of change and movement, regardless, in their own way, as the person relates differently to whatever problem brought them to the room: that ruse which is often nothing to do with the true underlying dynamic that they need to resolve, to understand, to change course, transcend and transform into some other way of being what they are. This all occurs within the ongoing developmental, human, relational, socio-cultural, psycho-spiritual existential march.

This is where I could do nothing other than resort and extend to psychodynamics, amongst other such ‘deeper’ approaches. This is a poor substitute word, as it requires the eco-bio-psycho-social-spiritual backing to make it meaningful, in my understanding, but psychodynamic is appropriate nonetheless. I need to look at the hidden depths of the individual and of the presenting matter and it is truly amazing what presents itself in this analysis and this dialogue. We truly are very symbolic creatures with amazing constructs and hidden depths. I always wonder at the ignorance that the person previously had of themselves, in terms of what was actually happening for them, and then I think  ‘didn’t they know this all along’ and then the patient often says ‘I can’t believe I didn’t think of this before’ or perhaps ‘it’s like I’ve always known this’. Either way, when something is true we question why and how we didn’t know it before and it’s like someone is telling you something you simply forgot but once knew. It is plain to the eye like daylight. Utilizing the psychodynamic method, we look at the surface and deeper cognitive mechanisms that may be involved in any problem; we can look at the underlying schema or scaffold that is propping it up. This may involve looking at family systems. We’re then informed by the theory of the unconscious mind: a huge part of the person’s mind and self which is largely outside of their present everyday awareness and which pops through every now and then in things like dreams, Freudian slips, episodes of anger outbursts, spontaneous thoughts and fantasies, etc. The person often doesn’t pay such spontaneous thoughts any creedance, any mind, and dismisses them. This part of the mind is constrained and repressed outside of the person’s main identity within the everyday world of the banahl. And so, as the unconscious represents everything else about the person and holds all the forbidden fruit (even though some of it is useful and necessary to look at and utilize, to understand at least), inner conflict emerges. As the ego, that socio-political interface of self, is constantly pushing this material down, yet it pops up anyways, bolstered by some quintessential life force called libido, strange neurotic manifestations of personality and behavior can result.

Now it isn’t always this deep and weird, but sometimes (or oftentimes in some part and to some degree) it is, and if so we need to examine it if we are going to help the person resolve….whatever is unresolved. Interestingly in this psychodynamic paradigm we are not just looking at ‘fixing’ a problem, we are looking at understanding, deepening and hopefully ‘resolving’ previously unresolved problems. This can be related to Mindfulness based interventions, where sometimes things can't be changed so we need to move toward greater acceptance, and in this acceptance our relationship with the problem therefore changes, and it effects us differently as a result. I have found that it can be somewhat superficial and disrespectful to dismiss a person's depths and ‘fix’ their problems for them as if they were children. Sometimes, ‘fixing’ a problem would be akin to removing a person’s inner depths, dreams and mysterious forces – and this removal is solely based on ignorance and fear. Rather, we can embrace these underlying energies and put down our hubris: that we think we know everything there is to know about humanity and the mind and the universe. So sometimes we don't/ can't get rid of a problem, rather we change our relationship to the problem so that it effects us differently. Afterall, a problem is only a problem if we view it in a certain way, and the resourceful opportunist may indeed see an opportunity and turn rags into riches, shadow into gold. For example, if a person had creative urges, wanted to sing and dance or paint and sketch, yet this conflicted with their expectations (from self and/or others) to live in a dry/ narrow sort of way or to do a conservative and practical task-oriented sort of job, then we have a true conflict. 'Getting rid of' the artistic urges is not the solution; rather, embracing the creative urge is, and potentially integrating it into the conservative career if possible; to be more of one's self rather than living an empty 2-dimensional life of someone else's dreaming. Of course it is possible and important to 'fix' and remove some problems - we need to look at everything in its own right.

Essentially the psychodynamic therapist offers interpretations: the more authentic, humble, self-aware, loving and warm, cultured, seasoned, intelligent, integrated, analysed, resolved and mature the therapist is, the better the interpretations will be. The school of hard knocks combined with a good university degree is often gold for a good therapist. He or she turns shadow into gold as well, in order to help others do likewise - and if you haven't done it yourself telling others how to do it might be a bit rich and hypocritical.

In addition to this the therapist needs to have a heart, to have compassion, to actually care about people and have the authentic intention of wanting to help them even if it seems that all doors are closed and all light is dim. With psychodynamics, the goal is to improve the client’s self-awareness and to integrate loose and frayed aspects of his life history, to help him or her come to terms with what has happened, is and will happen. This, of course, must all be done within a holistic approach, in my point of view, based upon warmth, compassion, boundaries, professionalism, integrity and most importantly authenticity. You need to be able to connect to the client, and they need to feel safe and also somewhat inspired to actually bother turning up to do therapy. You cannot be flakey or flimsy as a therapist or you will shatter. You must work on yourself as well or you will perish. Sounds extreme, but that has been my experience, as well as the experience of many others I have worked with and spoken to. You need to keep on top of your own issues as the people, the patients you see every day do of course affect you. Some patients affect you deeply and this needs to be taken care of, understood and worked through. This culminates in the archetype of the 'wounded healer', where the best healers truly understand what it's like to suffer and they have navigated their own ways toward resolution and wellness.

Much of the psychoanalytic method, and the evolved form of psychodynamics has truly been the baby thrown out with the bathwater. Many pseudo-scientific types have exiled the method to ruination. Extreme skeptics annoy me greatly as they sit on top of these phallocentric pedestals crowing like cocks ‘prove it! Prove it!’. The irony is they are just like the ‘skeptics’ who shouted for Galileo’s death when he proclaimed, as per Copernicus, that the world was round and we are a heavenly body orbiting the sun, rather than the previously held view that it was the other way around. Would they stop for one moment and ask themselves whether their skeptical approach, in fact their narrow minded arrogant disrespectful dismissal may hinder the creative and exploring type from daring to think out loud lest they be shot down in a hail of gunfire and shit!? I’ve often found extreme skeptics to have huge underlying problems with self-doubt and so they manifest this outwardly as other-doubt, and this defense mechanism does well to keep their little complexes ‘safe and sound’ and no one can get to them. It’s quite sad really. Now don’t get me wrong you black and white thinkers out there, I am immune to your rigidity and reductionism in summing me up right now, if you are doing so. I do actually, of course, appreciate and rely upon a healthy level of skepticism myself, alongside creative open-mindedness as well.  We need this integral ability in order to learn anything, or else we just pivot on the spot, fending off any attackers who would wish to slam dunk in the goal behind us. Yes – there is a lot of un-thought-out rubbish out there in any field, and there is also a lot of gold amongst it that we can overlook if we are not careful, and much of what could help us we sometimes dismiss out of sight because it appears ‘irrational’ when placed against the background of conventional methods: this is actually the casting of shadow across what ought to be superseded. The natural progression of knowledge, which as Karl Popper said: sometimes you must wait for the old guard of scientific knowledge hoarders to die before you can get a new idea to be approved. Yet, as many of us are insecure knowledge hoarders we may become attached to our worldview, our methods, our petite’ morts to give us the illusion of security and predictability. So naturally, fear comes up when we have our belief systems threatened, just as a child would be terrified if his mother was threatened by proxy.

Back to therapy. We need to understand that anything like CBT or other interventions, REBT, Brain-Based Therapy, Interpersonal Therapy, and other slightly more ‘creative types’ like EFT, TFT, Haikomi, Gestalt, Humanistic….these are all adjunctive aspects of the therapeutic conversation; a wonderful and amazing experiential triumph, a process which is ongoing, an interchange between two human beings which is extraordinary and unlike any other conversation one would normally have. In this space emerges answers, so long as we can utilize whatever therapeutic modality, style or technique is appropriate to the client and not the other way around. It is all adjunctive within the psychodynamic-integral intervention, alongside the eco-bio-psycho-social-spiritual understanding. That’s right folks, CBT and indeed medication is only adjunctive within a larger, more holistic intervention approach with a human being. When you try to reduce people to empirical building blocks, aka rubble, you get just that: a reduction. We need to appreciate the full complexity of the human being not only to help, but also to move us toward and unveil our full potential.

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2 Responses

  1. Daren Potter
    Wow have just read The heart of the matter in therapy and am tottally impressed. I think your holistic and human approach to what you do is commendable and you should be congratulated for it. I think anyone who can combine the academic with the more human aspect of psychology is going to be able to help poeple far more than someone with more narrow minded yet seemingly orthodox treatments. I must confess while i am not a quillified person i do have some idea that your methods have a positve outcome as someone close to me is currently seeing you. I just have one question, for someone who is hoping to enter that academic enviroment and study psychology for the next four years what advice would you have in regards to comming out the other side a open minded and hopefully better therapist Regards Daren Potter ( the wave! )
  2. Ben
    Thanks for your support Darren. So your question is 'what advice would I give for coming out the other side of training as a better therapist?'. Well I would suggest that you do therapy on yourself if you are to become a therapist. Working through your own psychology will help you be more present as a therapist, and for any unresolved issues you may have to 'get out of the way' and or to enrich through wisdom your dealings with others. Learn how to distinguish from learned knowledge and experiential knowledge, from didactic passive book knowledge to wisdom and lived experience. Always remember that what we learn about is true for that moment in time, or may be false and we have not found that out yet. Be critical in your reading and studies, that is: open minded, always being prepared to look at alternatives. Fanaticism is proof of insecurity, even with total loyalty to a particular modality in psychology. Beware of the politics involved in health care and 'mental health'. Apparently it's not always about the people but more about the numbers sometimes! Cast a wide net and learn about Eastern and Western spiritual traditions. Also learn about the Arts and Humanities. Also learn about science. Learn about music. Develop enriching friendships and relationships by being a reliable, honest, authentic and trust worthy person. Stop bullshitting yourself and then stop bullshitting everyone else. Learn how to cope with feeling ashamed as this is the compass of your conscience and comes up when you don't do the right thing. Learn how to sooth your own distress, to have self compassion and love for yourself, as well as for others - Be the man you want to respect. Act responsibly yet in a light hearted way. Never take yourself too seriously yet act meaningfully and commit to what you want/ believe in as you realize the brief nature of life in time. Read widely and do your own inner, personal work. Take up a spiritual / development practice, eg. zen buddhism or alchemy. It doesn't really matter exactly which /what you do, as they are all contemplative. Put things in their proper context. Also learn about and exercise your body. Develop your mind and your brain. Be fit on all levels. Learn how to observe yourself and reflect on your actions without judgement, but with a firm mindedness around how to be who you truly are and to act in accordance with your deepest values, ever pursuing greater meaning in your life. Never stop learning and remember to look after yourself and your own mental health! We're all in this together, yet we need healthy boundaries. People can be wonderful and/or toxic, it depends how we respond. The way you let people treat you is what they will then believe they can get away with. Explore the depths of your own psychology and existence. And remember... just one step at a time. Have fun!

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