A Practical Integral Psychotherapy

[This was originally posted at my Integral Options Cafe blog. I am not a therapist (yet – I start a PhD program in clinical psych at the Institute of Transpersonal Psychology next fall). I'm still trying to understand what might constitute an “integral psychotherapy,” and these are some preliminary thoughts. I welcome and encourage a discussion of these ideas, and pointing out, especially by those of you who are practicing therapists, where I might be naive in my views.]

Integral Psychotherapy

When I read Ken Wilber's Integral Psychology many years ago, I thought I had found the holy grail of psychology models. In some ways that is true – Wilber's book offers a theoretical framework by which to look at various pathologies within a developmental model. Some therapies are more effective for certain pathologies than for others, depending in large part on the source of the pathology developmentally (for example, early childhood or existential). Understanding the spectrum of development and the available theories of treatment allows the therapist to tailor the therapy to the pathology. In essence, no one approach works for all clients.

As I have started “studying” some forms of therapy that are currently in use (self psychology, relational psychotherapy, internal family systems therapy, object relations therapy, and so on), what has become painfully clear to me is that Wilber has never worked a day in his life as a therapist. Theoretical frameworks are all well and fine, but they are generally useless in the therapy room. For all his understanding of theory, I can't recall a single instance in Integral Psychology in which Wilber speaks about the relationship between the therapist and the client, which from my experience is the foundation that must come before any theoretical model.

One book that I have recently started is Relational Psychotherapy: A Primer, by Patricia A. DeYoung. Until very recently, I had never heard of relational psychotherapy [thanks Susie!], but having just begun this book, it feels to me like an actual integral psychotherapy.

The last time I was in therapy, the single most beneficial moments came when I was able to express some fear or anxiety and Maude (my therapist) was able to hear me and respond with empathy – not pathologizing my feelings in any way, but being totally present to what I was expressing.

In relational psychotherapy, empathy on the part of the therapist is the key to the therapeutic relationship. Without empathy, there cannot be the safety for the client to become open and relearn old and dysfunctional relational patterns.

The second key element of relational psychotherapy is the understanding that whatever fears, anxieties, and other difficult feelings the client has are not merely within the client, but rather were learned and are still expressed within relational patterns – where the self interacts with others. Whatever challenges the client is facing are not inherent in the client – they occur in the boundary between self and other.

DeYoung says:

[W]hat's wrong is neither entirely inside the client, in his psychological makeup or dysfunctional patterns, nor entirely outside in the world, in forces that impinge on him. Instead, according to a relational model of psychotherapy, the problem exists in those spaces or activities where outside influences and inside responses interact to create the shape and feel of a “self.”

Re: A Practical Integral Psychotherapy

Hear Hear William,

I resonate with your post.


Clare

Empathy and Challenge

Hi WH and hi Clare too,

I think you raise a really important point, which is, what is a practical integral psychotherapy? I think this is really what this pod could aim to discover. My curiosity is definitely about how therapists are applying the model and the benefits they are seeing.

I also really resonate with your emphasis on empathy and the therapeutic relationship. Certainly, empathy and it's pre-requisite–presence are high order capacities.

My opinion with reagards to Wilber is that I think we need to keep in mind that Wilber's work is what he calls a map, not the territory. I've heard Wilber paraphrased as saying that his theory is the view from 10,000 feet. (I may have that slightly wrong but that the general idea. If anyone knows the actual quote please feel free to throw it in.) Or put another way his work is the theory, ours is the practice.

That said, Wilber's model includes the humanistic psychologists, specifically Carl Rogers with his emphasis on empathy, congruence and unconditional positive regard, which you also, I think rightly, highlight in your post.

I think it would be a great place to start to examine our own beliefs and experiences about empathy and relationship from an integral perspective. I would offer that each of the psychological theories that Wilber includes has a distinct view of the client/therapist relationship with differing focuses ranging from transference/countertransference to safety, to creating enough distinction between client and therapist personalities. I was also really intrigued by Jon's assertion that transference/countertransference is largely a subtle realm phenomenon. An full spectrum analysis of the therapeutic relationship would be very interesting indeed.

I would like to put forth an idea/question to see if it sparks further interest and debate.

Rollo May one of the great existentialists was asked to judge a client-centered therapy session. His response was “that he often felt that there were not two distinct people in the room. When the therapist only reflects the patient's words, there transpires 'only an amorphous kind of identity rather than two subjects interacting in a world in which both participate, and in which love and hate, trust and doubt, conflicts and dependence, come out and can be understood and assimilated.” May was concerned that the therapist's overidentification with the patient could 'take away the patient's opportunity to experience himself as a subject in his own right or to take a stand against the therapist, to experience being in an interpersonal world.'”

The larger quote is from Current Psychotherapies 6th edition year 2000 editors Corsini and Wedding.
The internal quote is from The Problem of Evil: An Open Letter to Carl Rogers by Rollo May, 1982 in The Journal of Humanistic Psychology

So my question revolves around an idea, which is relevant in therapy, in personal relationships, and in relationships with spiritual teachers. How do we know when to empathize and when to challenge/confront? Certainly, empathy is essential, however, sometimes empathy can be taken as collusion and we don't want to collude with clients' erroneous beliefs or their behaviours that are causing them difficulty. How much can you look after someone's ego and still give them an opportunity to grow?

I recently had an experience where I was given some no-holds-barred feedback about some work I had done. My ego was crushed. It's still lying on the floor in a million pieces, and right now I feel like I'm looking at it wondering if I should bother to pick it up and put it back together, or not. Clearly, a short term depression has set in. But the strange thing is, I feel oddly less defensive, more open, more loving, more humble. For me at least,  moments of clarity and fullness of heart often follow experiences of loss, pain and ego-shattering failures. I feel stronger. And I have the opportunity to reflect on why I didn't do a better job, how I tend to castigate myself when I don't do well, and how I expect a very minimal effort to be rewarded with praise it doesn't deserve.

I wouldn't want to deny my clients the experience of realizing they are not prisoners of their ego desires. And at the same time some clients are very fragile. Serious depression is a real possibility and the therapeutic relationship can be destroyed by a lack of empathy.

I think it's simple to say that we need to be aware of both challenge and empathy. Simple enough to say we should have empathy for a client while at the same time challenging them. But, I think, in practice this very fine balance requires incredibly skillful means. I'd love to hear how exactly you/we as therapists negotiate it.

There is an interesting discussion on integral naked between Diane Hamilton, Sam Bercholz and Viddyudeva about this topic. I think you can find it on Integral Naked listed under Guests/Viddyudeva/A Cry for the Middle Way

Also Willow Pearson has a beautiful and thoughtful article about therapeutic presence called Integral Practice for Psychotherapists: Therapeutic Presencing. You can find it on her website www.lionessroars.org under Psychotherapy on her menu. Then, in the left hand column there is a link that reads: Integral Practice for Psychotherapists.

Blessings,
Katherine

Re: Empathy and Challenge

Hi Katherine,

Thank you for the thoughtful comments.

Durwin's response to the original posting of this topic was:

I hear your concerns about the challenge of going from the 50,000 feet of integral theory to the 5 feet of therapist and client. I think many of us who are interested in integral theory have struggled with this.

Re: Empathy and Challenge

Bill,

Nice text. As for me, it has alwys been clear that Wilber had no experience in the client-therapist relationship, in a professional way. This is not a problem for me, as I think it is not what he’s working on, as Katherine rightly said.

But, this becomes a hindrance when Wilber and I-I start to dig in psychotherapeutic tools, like the 3-2-1 process. This is supposed to be “great” shadow work, but I think it is a bit weak. This process completely avoids the relationship in the therapeutical process as you have both mentioned above.

Katherine,

When to empathise and when to challenge?

Great question. I personally challenge self destruction and self glorification, or when people under evaluate themselves or over evaluate. Now the question is who decides what is over and under evaluation? Well, it is absence of a dynamic process for me which is the symptom of it. Stucked in non dynamic guilt (under evaluation) and stuck in non dynamic anger or inflation (over evaluation).

Be well,

Patrick

Re: A Practical Integral Psychotherapy

Hello there:
A brief update on where I am at: I have just started a new job that I plan to have serve as my clinical internship for my counselling psych doctorate.  I wish I were in a transpersonal psych program right now, so that I might have an excuse to rest in formlessness :).  But of course, grass is always greener…

My job is half-time school counselling at an elementary school with a large population of children dealing with neglect, abuse, refugee status, behavioral problems, learning problems, socioeconomic problems…and I am really loving it there. 

I love it because I feel that my clinical interests have been re-awakened by the chance to work with children, who more easily evoke compassion from me (I'm so hard-hearted otherwise :).  Plus, finding my way to this position marks a healing from an earlier career trauma (another story).  The result of this experience is that I am more sensitive than ever to the impact of trauma on people's lives.  So: integrally-informed trauma therapy v. important in my eyes.

I wrote a paper on integrally-informed pragmatic psychotherapy, which I am happy to send to anyone who is interested.  It is an ok paper, not a great one.  But if you want to read it, you could e-mail me directly at durwinfoster@gmail.com">durwinfoster@gmail.com.

Cheers,
Durwin

Re: A Practical Integral Psychotherapy

Hi everyone,

Patrick I'm interested in your take on the 3-2-1 process. Could you tell us more about that?

Also, I like what you were saying about challenging under and over evaluation. I often find that a challenge of over evaluation can send the client straight into guilt, which strains the relationship. I wonder if the challenge of  overevaluation often calls for another challenge of the ensuing underevaluation and vice versa.

BTW the mandala is beautiful.

Durwin,
Congratulations on your new job. Glad you're loving it.

Thanks for the offer of the paper. I have a feeling I'll be challenging your underevaluation of it.

Best,
Katherine