Bring back knowledge!

I went to the dentist recently and was profoundly grateful to find a skilful, experienced and probably highly trained dentist. I really wouldn't have been happy with someone who said that they knew all about dentistry because they had been on a whole weekend course in how to do it, had had couple of fillings themselves and had even read a books on it!

When it comes to psychotherapy, it seems to be very different. Many people seem to believe that they know what psychotherapy is and how it should be done and are perfectly happy to set up as therapist; others are happy to go. It is based more on belief, fashion and conviction than on knowledge or experience. I suppose that this is part of a post-modern, pluralist world suspicious of expertise and hegemony. Reluctantly, after nearly thirty years as a therapist, I have come to the conclusion that most people really don't know what psychotherapy is; they confuse it with personal growth or development or some particular ideology that they subscribe to which often boils down to willpower or belief. They are offered self-help books, quick-fix courses and the encouragement to become powerful, discover themselves and follow their own truth. If fits with a culture of instant change, instant expertise lack of respect for experience (as if human distress has really changed that radically).  There is scant understanding of the difference between the pre-personal; the personal and the transpersonal that Ken Wilber writes of. 

What many will say is that the State should licence therapists but this requires us to trust the government. No thanks!  In Soviet Russia, Freud's works were secretly printed and circulated underground. The present government's love affair with Cognitive Behavioural Therapy (CBT) is only slowly coming to an end. The alternative is for people to become more discriminating.

To evaluate a therapist, as well as trusting your intuition ask them how long they have seen some clients for; (warning;  less isn't better some people take quite a time). Ask they about how they deal with suicidal clients,  how they understand dissociation and embodied trauma; what their experience of long term therapy as a client was like, if they have good regular supervision; their understanding of ego-strength and how it can be built. Ask about what they can do between sessions and what support is offered.

Negative K

I was a teenager in the late 60’s and am from the humanistic tradition of psychotherapy.  It is a tradition based in optimism about what we may be and the sense of basic goodness at the heart of every person which, although it may be corrupted by pain and distress; can be recovered. At its best, I still believe, it represents the deepest spiritual truth; at its worst it is a naïve optimism about people and life and possibilities.  Anyone who has worked as a psychotherapist for a long while is likely to come up against the notion of damage and what can and can’t be repaired in people.  Miracles are always possible and radical change certainly happens.  In the past I have tried with clients to support a realistic idea of what can be changed with the metaphor of the difference between an open weeping wound and a scar. Nothing can create perfect skin but therapy can help change an open wound into a scar; healing doesn’t eradicate all traces of the past, it makes life possible;  the trauma is still discernible but no longer dangerous.

However, clinical experience sometimes takes us to look at the sense that some clients have of damage. Perhaps this is the “Basic Fault” (see M. Balint) that can’t be repaired.  Wilfred Bion, a brilliant  and original developer of psychoanalysis, came up with a theoretical formulation of the functions of Love, Hate and Knowledge in both positive and negative forms.  Negative Knowledge (K minus) is the core part that actively doesn’t want to know and destroys knowledge and awareness.  Its forms can be very destructive of any goodness in the internal world and of any attempts to help. There are many other ways of conceptualising this.  Unless you have led a charmed life as a person and as a therapist , you will have met people who seem impossible to help and who perform the alchemical task of turning gold into shit.  They twist everything good into a force against themselves or others who try and help. 

Melanie Klein gave another way of understanding this through her use of the concept of envy.  Where someone perceives good qualities in another they try and destroy them rather than emulate them or use the gifts being offered. If they receive any goodness into themselves then they turn and try and destroy that through self-attack. The very qualities and experiences which could help them,they seek to destroy. It is very primitive and very real in some people.  I am sure there are Christians that would say that it is the Devil at work. Jungians may say these people are in the grip of an archetype such as The Witch or The Judge. Other forms of understanding this in different cultures can be of possession of the person by a spirit that requires exorcism; a variety of shamanic process. In its positive form this is sometimes called soul retrieval.  Shamanism and psychotherapy are close together as an increasing number of books now recognise such as Christa Mckinnon’s  Shamanism and Spirituality in Therapeutic Practice , recently published. 

The irony is that this work all requires some sort of positive therapeutic relationship; and that is precisely what negative K seeks to destroy. Sometimes therapy and life requires a process of hanging on to this relationship even when results and common sense suggest otherwise. In this respect working as a therapist is an act of faith against a sea of unknowing, unreason and darkness.  The struggle to maintain the therapeutic relationship and get agreement to name and work on the trauma ( which can be very effective using energy psychology methods), is sometimes the bulk of the work. As a committed therapeutic relationship is now against the cultural norm of instant gratification and moving on; this is particularly hard.  The boundary in therapy and life between commitment and masochism is sometimes very hard to discern!

Pleasure

I met a pleasure based psychotherapist recently. When Janov's Primal Therapy came along I seem to recall that he said that a therapist was a dealer in pain. So is therapy about pleasure or pain and trauma?

Nobody would go to a therapist to talk about how happy they were or what a great childhood they had; but it is one of the more interesting questions in therapy the extent to which we have to go in to past pain and trauma to clear it out. In our culture we have the "no pain, no gain" school of development. A deeply Puritan culture like the British is very suspicious of happiness. I can lead straight in to the arms of The Devil. In most therapies, both humanistic and analytic happiness could well be covering something up; even a manic defence against deep sadness. Of course this can be true but it is also true that many defences, particularly somatic ones, tend to block access to all deep emotions; pain as well as joy.  This is simply because all strong emotions and body sensations are close together in their emotional anatomy and neurology. On a fairground rollercoaster the riders play with the edge between fear and excitement; screaming with fear as the car descends and then cueing up for another go! A father playing with a young child may throw them up in the air and catch them giving squeals of joy, excitement, fear overcome by return to safety. Deep sobbing and deep belly laughter are quite similar to observe from the outside. In the intense autonomic activation of orgasm, pleasure and crying can come together. Those in to BDSM are experts on the edge between pleasure and pain and how both can lead to altered states of consciousness.

Many therapies are very interested in trauma; particularly if that term is extended from single incident events such as an accident, or act of abuse or death of someone to include developmental trauma such as having a depressed mother when there would be many occasions when the required empathic attunement and caregiving weren't there. In the past going into the pain was seen as the only way. Now with modern energy psychology methods such as AIT(www.aitherapy.org) that I practice this is known not to be necessary. Just naming the trauma and finding the location in the body is often enough to clear it.

So as we block pleasure and pain, when a client comes in for a session reporting that they feel good. Unless I am very suspicious of this, I will only want to move feeling good to feeling fantastic. There has been more attention recently to positive psychology and to the concept of Flow,  (from Mihaly Csikszentmihalyi);  a state of being where we are not divided and distracted but fully engaged in life at that moment.

So while I will try as a therapist to stay fairly divided in my attention between pain and pleasure. I have a growing sense that working with pleasure and how to expand it and deepen it within our bodies and our neurology is a powerful way forward. This forms a large part of my book Tantric Psychotherapy that I am working on at the moment (see www.tantricpsychotherapy.com )

Exciting Times for Psychotherapy

When I started training as a psychotherapist in the 1970's "proper" therapy was psychoanalytic and they  generally wouldn't even acknowledge the existence of any other ways of working. Behavioural schools had been around and were used a bit (after all it works for training dogs) and were looked down on and Humanistic approaches were completely ignored even though they had been around for nearly twenty years. Gradually things have changed; dialogue started. Many conditions, such as anorexia were very hard to improve from just one orientation. Deeper understanding of the therapeutic relationship showed how different approaches focussed on different strands of the relationship. Different therapies came from different social and political milieu and also reflected the preferences of the founders. For example Freud was a doctor, a medical researcher, and came from a scientific and rather mechanistic understanding of the human being. He was also quite a shy person. His methods and his theories reflect this. In the middle of his working life came the Great War, which also affected his understandings of human nature.  Some humanistic approaches came from America in the nineteen fifties and sixties.  A very different world.

Now the dialogue has turned into a real debate with real listening and with many people training and working across modalities. Discoveries in neuroscience, greatly speeded up by the development of brain scanning, have allowed us to see the brain in action and more fully understand the roots of our behaviours.  The move towards recognising the essentially human nature of the therapeutic relationship with two fallible human beings in one room has allowed the subtleties of the interactions to be studied and understood. Increasing respect for human subjectivity has gone along with the knowledge of the mind and body and how they are really two sides of the same coin.

For many therapists,  the move towards integrative approaches to therapy and the inter-subjective revolution are more than enough; but there is more.   Neuroscience has validated the work that body psychotherapists have been doing for half a century or more to reduce trauma. The basic practice of mindfulness from the Buddhist traditions have been incorporated into therapies like Mindfulness based CBT and DBT. Research has supported traditional practices and given them respectability in the West; where we want to know why something works before we will accept the evidence of our own senses.

And there is even more when we move to the edges of conventional psychotherapy.  Remember that psychotherapy comes from Psyche meaning Soul  and Therapiea meaning healing. Healing the Soul which is also reconnecting the Soul to its source and in to Nature is a shamanistic practice. Most shamans use plant substances to help with healing; sometimes through journeying to other realms.  LSD and Ecstasy have been used in psychotherapy in the past; and until recently in Switzerland.  Natural substances such as ayahuasca can speed up the process of therapy by a considerable factor when used in a clear professional capacity. The recent dropping of the Government's attempt to prosecute the Santo Daime people in Britain may give some support to those who want to extend its use to therapy. This of course won't be welcomed by those trying to make psychotherapy as respectable a possible - an impossible task as psychotherapists hear the secrets of people's unhappiness with life and therapy deals with what is not acceptable in the world. 

The other big revolution, also not discussed in psychotherapy circles comes under the name of Energy Psychology; the collection of approaches that use the meridians, energy lines and chakras of the body for psychological healing. Some have fallen more under the heading of alternative therapies and some are more clearly under the banner of psychotherapy. The former include Emotional Freedom Technique (EFT), Tapas Acupuncture Technique (TAT),  Thought Field Therapy (TFT) and the latter; developed by a Jungian therapist,  Advanced Integrative Therapy (AIT). All can have great results in skilled hands. AIT, with which I am most familiar, speeds up the process of long term therapy by about a factor of three. They are not magic methods; just a refinement of what Freud intuited, that energy flows in the body and how it is blocked and channelled is important. AIT removes the block caused by trauma which are held in the body. The silence of the psychotherapy world with all of this is deafening. 

However, things are changing fast. The current issue of both the major professional journals in Britain have interesting leads. Therapy Today has an article on Yoga as Therapy; and the current issue of the UKCP journal The Psychotherapist is mostly on The Theory of Love.  Perhaps things are really beginning to change and fresh air of change is blowing through the world of psychotherapy even as other changes are making what is available on the NHS more and more scarce and restricted. In this blog I want to open the windows wider. Join me!