December 30, 2015
Mark Forman, PhD
Lessons 7-9 here continue to focus on subtle issues confronting trauma survivors who take up a long-term meditation practice. A reminder: It is unlikely that all nine of these lessons will feel relevant and applicable to you. So take what works and leave the rest!
Lesson #7: Extreme states of traumatic dissociation are fairly easy to distinguish from deep states of meditative experience. However, milder dissociative states can be difficult to tease entirely apart from many early and intermediate states of meditative experience. With time, attention, and practice these will become separable.
Dissociation is a state of emotional suspension – feeling numb, removed, and disembodied. When dissociation occurs during traumatic events it has a protective function. A rape victim might experience “leaving her body” during an assault. A solider sees time slow down and the scene around him become unreal as a battle is engaged. Experiencing separation from the reality of a trauma while it is happening blunts some of its impact. However, dissociative states can be retriggered in the person (see Part I) long after the initial trauma.
This happens at different levels of intensity. At the moderate-to-extreme level, dissociation can be felt as the experience that the world is unreal. Psychiatrists and psychologists call this state derealization. Dissociation can also be experienced in the temporary feeling that our personalities are unreal, that we don’t have real selves. This is called depersonalization. It is possible to experience derealization and depersonalization at the same time.
At an even more extreme level, dissociation can be experienced as losing self-consciousness, also known as dissociative amnesia. Once triggered, a person can act but does not recall events or actions. This is more rare than depersonalization and derealization.
For example, this occurred to a client of mine who suffered extreme trauma as a child when she was recently deposed for a legal case. When the opposing lawyer had cause to ask her about her childhood, my client dissociated. She answered the lawyer’s questions clearly and accurately for over a half-hour (the court transcript showed this), but recalled nothing of that section of the trial. She left her self-awareness, triggered by the traumatic subject matter. Experiencing this type of dissociative amnesia is very much like having been black-out drunk.
With this as background, we might ask: How does traumatic dissociation relate to the insights that many meditative traditions encourage and that sound superficially similar? The meditative and spiritual traditions also describe seeing the world as an illusion and the self as an illusion. They often recommend learning to let go of self-consciousness (sometimes call forgetfulness of self). What exactly is the relationship between these different classes of experience?
The good news is that these extreme traumatic dissociations and deep meditative experiences are highly distinct. Extreme dissociative states are almost always accompanied by painful anxiety. There is no sense of understanding or insight. Derealization and depersonalization are frightening, uncomfortable, and alienating. Trauma survivors dislike these states and don’t want them to return. And when trauma survivors experience dissociative amnesia – such as what happened to my client in the courtroom – they are typically disturbed by the gap in their memory and want to know what happened to them.
In contrast, deep meditative insights are calming and cognitively interesting. When we spend time in meditation, and see that the world is not what it appears, we will feel peaceful and free. When we see that our personalities aren’t real in in the way we think, we are usually moved and fascinated by the understanding. And in very deep states of meditation, when we “lose our self-awareness,” we don’t truly lose consciousness. We have a continuity of consciousness and a sense of coming home rather than being alienated or lost. We have the feeling of paradoxically being more rather than less when we let go of self in the meditative definition.
The much trickier distinction – and the place where we can become confused – is between milder traumatic dissociative states and a large family of preliminary meditative awarenesses.
Mild dissociation involves a more slight numbing – a graying or flattening of emotional experience where there once was depth and color. Mild dissociation as a state can persist for long periods. And it does indeed also have a calming effect, especially when we compare it to having to feel the raw, traumatized feelings underneath.
Many grades of meditative experience share a family resemblance with these milder dissociated states. When we are meditating regularly, we may feel less emotional and let go of things more easily. We might be distracted by powerful meditative experiences and philosophies and feel pulled far away from everyday life concerns (i.e., the things that occupy other people’s minds). We may lose interest in socializing, media, news, or in the lives of friends or lovers. Meditation practice in the beginning and intermediate phases can often lead us to “zone out” out of life more than to “dial in” (paraphrasing my fellow Integral Psychotherapist Keith Witt).
But if this happens to you, how can you tell if it is a form of traumatic dissociation asserting itself or if it is just natural consequence of certain phases of meditative practice? In my experience, there is no simple distinction. The two can be similar in tone and behavioral expression and are likely to intermix. Indeed, the desire to deepen the calming effect of mild dissociation may sometimes drive us to practice in the first place (though we would not likely see it that way). We may practice in part because we really want to get away from it all, including ourselves.
Here are some proactive thoughts about how we can approach this.
The first thought– and hopefully by Part III this is easy to anticipate – is that we need to practice states that counteract dissociative tendencies. These states are most reliably found in activities that keep us engaged and embodied – therapy, exercise, sexuality, relationship, family, work, service, and spending time with others. (Many spiritual traditions often include some of these activities for this very reason).
Meditation – at least in earlier expressions – teaches us how to move our energy “up and out” or “up, out, and back.” This is in service of developing our witnessing capacity, of making subject into object, as we discussed in Lesson #5. Embodied activities push us to do things differently: to bring our energy “down and out” or “down, forwards, and out.” These activities counter a common result of meditative practice; they keeps us off balance (in a good way) and help us stay more integrated as we grow. This may also insulate us in the long run from getting stuck in extreme states of meditative detachment.
Second, as suggested above, we must keep practicing meditation – more probably than we initially hoped we would have to. If we stopped our meditation practice every time we get worried we are dissociating, or if were are not able to tolerate states that have a dissociative flavor, we will never get as as far as we need to. As long as we engaging trauma-related psychotherapy on a periodic basis, in the long run deeper meditative insights offer us the chance to break through multiple forms of dissociation and may lay bare the traumatic emotions that have been buried in us (see Lesson #4).
The deepest meditation teaches us to be less like a “ghost” floating above it all, and more like a “light” shining in all directions simultaneously. But it takes time to get there.
Lesson #8: What are sometimes dismissed as “bliss states” and “spiritual materialism” are developmentally important. These are key for trauma survivors, who are left developmentally uneven by their trauma. These bliss states should be engaged as they arise in order to incrementally mature the body-mind.
Some meditative traditions will caution you to not to get attached, or to even to avoid cultivating, what might be known as “bliss states”: the deeply pleasurable and expansive states that can result from more intensive meditative practice. Similar warnings are made around avoiding “spiritual materialism,” which is getting too attached to “spiritual trappings” – experiences, ideas, teachings, or metaphysical worldviews. In Biblical terms, we might liken this to the idea of not creating false idols.
While there is an important component of wisdom in this, this can become a very problematic teaching for trauma survivors.
The reason is developmental.
When we are traumatized, we often try to compensate through a hyper-maturation process – growing up as quickly as possible. This is more pronounced when a parent or caregiver is the perpetrator of the trauma. We try to step into the role of being our own parent. We try fill the space left by the highly damaged and immature one we had by growing a parent in our heads.
As a consequence, some higher functioning trauma survivors experience themselves as “old souls.” When they are young, they actually feel more comfortable around older people as opposed to people their own age. There is an upside to this. Because part of them was forced to take a fast-track towards maturity, trauma survivors sometimes develop unusual gifts. This can later show in them becoming great healers, artists, therapists, or teachers.
But any kind of hyper-maturation comes with consequences. Only certain parts of the self mature. Other parts are left painfully behind, stuck in negative childlike states without the means to heal or grow. A trauma survivor therefore becomes deeply uneven from a developmental perspective. They may swing wildly between parts of self that present as deeply mature and wise and parts of self that are young, impulsive, and emotionally overwhelmed.
When a trauma survivor approaches meditation this may express itself as wanting to skip the basic teachings and move right towards the advanced teachings. When this is done by a person who is more psychologically normative, they take a small risk. But when trauma survivors do this, they take a much larger risk of bypassing and reinforcing the original trauma.
Most centrally, trauma has a way of cutting us off from – or making us blind to – our deeper needs, setting up patterns of self-denial. But developmental needs are our deeper needs. In order to grow spiritually and otherwise, we need to slow down and take things step-by-step so that our younger parts can begin to catch up (or form a healthier, more conscious relationships) with our more adult-like parts.
This brings us back to bliss states. Bliss states are a just normal part of meditative development. They happen naturally as we practice. We also become spiritually materialistic in a natural way. It just happens. We will get attached to ideas, traditions, powerful experiences, and so forth that are new and exciting and offer novel ways of seeing the world. There is no way around it developmentally speaking.
Of course, these bliss states and deep metaphysical ideas are not going to heal all our wounds, nor offer us permanent, stable spiritual answers. But this does not make them unimportant or meaningless. There is a lot to learn between the start of the journey and the end of the journey. Imagine what you would miss if you traveled the world and just shut your eyes through the whole middle of the trip? Let things proceed as they will and stay honest. You will know when it is time to let go. There is no need to rush the process.
All authentic things and experiences are something to be grateful for, to cherish, and they put back small missing pieces when you encounter them. Don’t deny the actual good things that have come to you and you will regain much of the wholeness that your traumatic experience took from you.
Lesson #9: Deep meditative experiences can be triggering when they dissipate or seem out of reach. If you have abandonment trauma, these states too can seem to “abandon” you.
In theory, anything a traumatized person experiences can become a trigger for them. Not everything will, of course, but if something has enough of an emotional or symbolic charge, it is possible to relate to it through the lens of our trauma. Sex, money, food, health, relationships, children, work, and spirituality are all potential candidates. It just depends on us as individuals.
Here I would like to discuss one such traumatic reaction that can confront meditators.
If we practice long enough with the right guidance and support, we will experience deep, peaceful, and powerful states of spiritual illumination – even if they are very brief. They only need to peak for seconds to make an impact. However, we will also inevitably have periods when we lose contact with these experiences and the insights we derive from them, without an obvious way to get them back. This is very often called a “dark night of the soul” – a term taken from the writings of the great Christian mystic St. John of the Cross.
Dark nights can be difficult even for otherwise very stable, emotionally balanced individuals who experience them. Having felt that they were coming close to home in Spirit, they then feel wayward, confused, and lost. In truth, dark nights happen in deepening cycles of expansion and contraction as we practice. There is more than one dark night to be confronted.
But for a traumatized person – and particularly one with abandonment trauma – dark nights can trigger these typical spiritual reactions as well as ones that are more primal. Spiritual states are emotionally charged, they mean a great deal to us when they occur. From the perspective of the abandoned person, these states aren’t just one more experience that come and go. They instead become another demonstration that the world is emotionally unreliable and does not seem to care. A mostly automatic set of thoughts may come, generating from the hurt, childlike parts of the ourselves: “God/Spirit doesn’t love me because he took this state away” or “I am bad because I no longer understand what was just so clear to me.” And so on in ways that are specific to ourselves and our abandonment.
If you have abandonment trauma and know it, you will be able to notice this reaction fairly easily. Your trauma will get activated when you move from expansive phase of your spiritual growth to a contracted or flat one. It will be a reliable experience.
If, on the other hand, you don’t know that you have abandonment trauma and you have been practicing for any length of time, you likely have already spiritualized your traumatic reactions (i.e., turned something more psychological into something that sounds like a spiritual story). You may have assumed that your pain at feeling separated from Spirit is just that, when it actually about feeling separated from Spirit plus the heavy weight of your childhood loss. It is a compounded pain.
What we need at these moments is to turn towards reassuring teachings – to scriptures or words of spiritual advice that uplift and remind us that all will be okay in the end. We should consider staying away from teachings which are meant to push students or call out students’ shortcomings, as we will already being feel self-critical. We should probably also stay away from teaching which are absolute unless we find that comforting. Absolute teachings – such as the idea that the deepest realizations are not states – will seem abstract to the younger parts of us that feel abandoned by the state we have been thrust out of. Those teachings have a deep purpose, of course, but during dark nights they they can be seen through a trauma-distorted lens. And during these times we need to meet the trauma and engage healing on its own level.
We also need – even more than at other times – to seek out the company and support of others. Particularly our spiritual friends. We need to respond to our interpersonal abandonment by reaching out for healthy interpersonal attachment. We need to give ourselves what we might not have had in the time of the original trauma.
November 27, 2015
Mark Forman, PhD
A Trauma-Sensitive Approach to Meditation – Part II (of III)
Welcome to the second part of this three-part blog series, A Trauma-Sensitive Approach to Meditation. If you have not had a chance to read through Part I, I would strongly recommend reading that first. Part I lays out important, basic information about trauma and meditation in a way that will make these next lessons more understandable and applicable.
Here in Part II we will build on what we have discussed before and dive into deeper subtleties, particularly issues that confront individuals with longer-term meditation practices. Part III – to be published in the near future – will continue with these subtler issues.
Lesson #4: Meditation can calm us, but it can also remove defenses. This can lead to an intensification of felt trauma during meditation sessions as well as over a long-term course of practice.
The most typical result of any single meditation session (or tai chi practice, or prayer practice, etc.) is that we leave feeling calmer than when they first started. We may also notice a lift in our mood. With longer term practice, these calming and mood-heightening impacts become more consistent and attainable.
However, there are other times when meditation has the opposite effect. It can leave us feeling unsettled and uneasy as opposed to calm and happy.
Why is this the case?
As our practice deepens, and we learn to watch our thoughts pass and concentrate intently, our everyday psychological defenses relax. We are less distracted by thoughts, plans, and fantasies. Our bodies learn to relax as well. By slowing these mental and physical processes – like allowing muddy water to settle until it becomes clear – we learn to enter into a more direct, unmediated experience of ourselves and the world.
But as long-term meditators know, the relaxation of the mind-body does not only lead to positive thoughts and feelings. Painful feelings or aspects of self will also occasionally emerge. When they do, we might find we have fewer psychological defenses than we did in the past to cushion the impact and suppress the pain.
This has a special implication for trauma survivors. The implication is not, however, that you should worry about beginning a meditation session untriggered and emerging triggered. That is not a common experience, since traumatic reactions most often require an external stimulus to begin. It is more likely that when we begin our sitting already triggered, the traumatic reactions will become intensified as we move into that session. Meditation tends to make everything feel and appear unvarnished.
We might then notice traumatized feelings more intensely during our sitting – although we will not necessarily understand it as “trauma” unless we have worked and been supported to understand our traumatic reactions. The increased intensity might come across in other ways. The feelings of fear become heightened, the numbness more pervasive, the self-judgments louder and more painful, and the resentments more fierce.
This lesson also suggests that we practice being unsurprised when this occurs. It will happen to us. But if we are aware of our trauma and its nature ahead of time – which is the outcome of good, supportive psychotherapy – we can learn to see these felt intensifications as opportunities. We can learn to track our traumas and traumatic patterns more closely. We can get to know our true underlying needs and learn to care for ourselves more compassionately in response. We can also learn to apply lesson #3 as discussed in Part I of this blog-series – learning to be mindful of when and for how long we sit when we are knowingly triggered.
Lesson #5: Traumatic reactions are amongst the fastest moving and most seamless of all psychological “objects”: Hardest to see, hardest to interrupt, and hardest to let go of. Learning to see and let go of traumatic reactions as you would other thoughts and feelings requires an extra level of effort and mindful capacity.
A central goal of most forms of meditation is to learn to see thoughts, feelings, and emotions as “objects” in our awareness. To see something as an “object” is to see that our essential “I” is different from “it”. We learn to see something as a part of who we are, but not as fundamentally who we are. This realization creates a small bit of psychological space for us to be in. This can relieve a great deal of suffering in the moment and allow for more choice over how we are feeling.
Let’s discuss this idea a bit more indepth prior to considering its implications for trauma survivors.
This idea of separating our “I” from “objects” is found in many ancient scriptures on meditation. It is in the very first lines of the famous Yoga Sutras. Another well-known yogic practice is that of neti, neti – which means “not this, not this.” A yoga practitioner repeats neti, neti within the mind as a reminder that our deepest spiritual identity transcends anything we can see, think, feel, taste, or touch. This is sometimes referred to as the process of disidentification – to separate our more fundamental identity from our identification with other things.[i]
If the process of “disidentification” sounds too abstract, know that it is essentially the same experience as what we often call “letting go.” Disidentifying is about learning to release and to surrender control of the things we can’t control, and this includes many of our own thoughts and feelings.
But what is especially important is this:
We do not learn to let go all at once! It happens in steps. First we have to see something – to actually know it is there inside of us. Once we can see it, then how easily we can let go depends on how deep down it goes. The more superficial is always easier to let go of. Deeper material is harder. There needs to be a gradual process. It would be too much for us if it happened all at once.
This brings us back to the issue of trauma. I believe – having worked with both spiritual practictioners and trauma survivors, and spiritual practitioners who are also trauma survivors – that traumatized elements of the psyche are the most challenging of all types of thoughts and feelings to see as objects. And they are difficult to let go of even when we do see them. Their hooks in us run deep. In fact, many meditation practitioners can learn to see and let go of fundamental patterns of self while still remaining unconsciously embedded in their trauma.
How is that possible? Shouldn’t a strong meditator be able to see something as powerful as traumatic reactions operating in the mind and body clearly and easily?
The answer is no. Reflecting back on Part I, let’s recall that traumatic reactions are survival reactions. They are designed by nature to move swiftly, without conscious mental interference. They help us react in situations where we do not have time to think. But after the initial trauma, post-traumatic feelings are triggered seamlessly – in the sense that we often do not realize we are triggered until after it has already happened. We might recognize that a partner has said something that triggers our abandonment trauma long after the comment was made. We might recognize we have been going into our stressful job in a “fight-or-flight” state for weeks before we notice that is happening.
Importantly, traumatic reactions are hard to see and let go of regardless of when the trauma occurred in our lives. If the trauma happened later in life, the power of the trauma can make us forgot what we were like before it happened. Our sense of self changes, and we start shifting seamlessly and unconsciously into triggered states. They become normal to us and therefore hard to notice.
If the trauma happened to us early in life, the situation is that much trickier. Our sense of self actually develops intertwined and overlapping with the traumatized thoughts and feelings. It is very difficult to identify what is our “true self” or healthy self and what is “false self” or traumatized self. Many components of our personality that we take for granted or see as normal will later be revealed to be direct extensions of our trauma. It takes time and effort to tease this all apart.
So what to do? First, we need special instruction to see these traumatic reactions, to actually “catch them” in our mental and physical awareness as they are arising. This includes meditative practice to strengthen our mindful watching of ourselves as well as therapeutic investigation to learn the physical, emotional, and psychological features of our traumatic reactions. This is much like learning to see a skilled magician’s sleight of hand while he is doing a trick. It is easy enough to catch if an expert magician is teaching you what to look for, but it is difficult to the point of bewilderment without support.
In the end, we need to have a real respect for the gradual unfolding and learning to let go that occurs for most trauma survivors. We shouldn’t try to rush. We may hear of individuals being quickly “cured” of their traumatic reactions. But this is something akin to spontaneous remission for a cancer patient; it doesn’t happen very often. For most of us there needs to be a steady, long-term lessening of traumatic reactions as we learn to see them as objects, practice letting go, and learn self-care. Our triggered periods will become shorter, our emotional recovery will become quicker, and we will learn to catch the triggered feelings coming on before they take full hold. Our trauma will still exist, but become less and less a major force in our lives.
Lesson #6: Patterns of self-judgment due to trauma can sound like the “voice of God” in your head. Meditation – as a part of a larger spiritual worldview – can be easily be co-opted and used against you by this voice.
One of the most typical results of trauma is the creation of a strict voice of self-condemnation in the mind of the trauma survivor. A trauma survivor feels guilt, self-hatred, and self-judgment. I call this the voice of God. It is not what is meant by the real “God” of course, but one that is made up in our minds. The voice of God is not unlike the notion of an inner critic or a superego, but it is an intensified version of these.
How to identify the voice of God? It has some key characteristics.
First, the voice has a severe, unyielding way of seeing the world. There is a clear line between good and bad and right and wrong. While reality itself is morally complex and grey, and the nature of the world uncertain, the voice of God tells us it is not. The voice is clear in its vision of the world and has decided it is not good.
Second, when triggered, the voice of God within us makes the same judgment of ourselves as it does of the world – we are either good or bad. This internal evaluation of good vs. bad can hijack even those of us who have cultivated a more complex and developed sense of self. In other words, it is possible to develop far past the voice in a certain sense and yet still – under stress or triggering – have the voice of God determine how we feel about who we are.
In other words, on a good day, we see ourselves in more complex shades of grey. On a semi-bad day, we tiptoe around our voice of God so that we don’t upset our delicate inner balance and reap its wrath in self-judgment. On a very bad day, the voice of God overwhelms us and we can’t hear or feel anything else.
Third, the voice of God typically comes across to us as ageless or timeless. This is very often different from other traumatized parts of ourselves and part of what makes this voice particularly confounding. Typically when you ask a trauma survivor how old a certain emotional reaction or belief is – how old their fear, or anger, or sadness is – they can name the age of the emotion and when it first developed. Trauma survivors have 2-year-old emotional reactions, 7-year-old emotional reactions, 14-year-old ones and so on.
But the voice of God seems old and wise and is large and booming. The voice seems to expand everywhere, making other voices and instincts inside of us seem small, weak, and insignificant. The voice of God has a metaphysical-bullying quality.
Fourth – and this is truly a key point for meditation – this voice seems to be the one that can drive our spiritual longing and practice, particularly earlier on in our path. Our meditation practice becomes the way in which we are going to become good, to reach the impossible standard the voice of God sets for us. From the point of view of our triggered voice of God, it is only when we become enlightened – and leave behind our “lower” selves and impulses etc. – that we will become good. And as long as we are not enlightened we are bad.
Thus, meditation – how well we are doing it, how often we are doing – can be highjacked by this voice. Our meditation and spiritual practice can become (to at least a certain extent) an exercise in traumatically-derived self-punishment.
The important thing to know is that if we can locate this voice, over time it can be made smaller and less important. We should still keep meditating even if we notice we are doing it to try and become “good!” Meditation itself – if we are paying attention – can teach us the truer and deeper nature of meditation as we go along, which has nothing to do with this voice. And we can indeed learn to see the voice of God as an object and let it go. As we enter deeper states of meditation, we will be exposed much more directly to God as God is – not our traumatized version of what we think He (oe She or It) sounds like.
Further, life will present us with choices and opportunities to challenge the voice of God – to break through his prohibitions and live a life beyond a traumatized, narrow vision of right and wrong and good and bad. This requires a true leap of faith, and it is made possible by knowing this voice in ourselves and learning to question it.
For all of this to happen, we need to take a multi-faceted approach to this voice. Spiritual and psychological practice. There is no wasted work from either angle, and moments when we let go of this voice can become joyful beyond compare.
Lessons #7-9 coming soon in Part III!
Endnote for Part II
[i] Disidentification is only part of the process of spiritual growth. There are other steps and lessons. Later in our we come to identify with the world in a different way. But disidentification is necessary step in that process.
October 2, 2015
Mark Forman, PhD
A Trauma-Sensitive Approach to Meditation – Part I (of III)
The purpose of this three-part blog series is to provide support for those of you who may have suffered trauma and who want to either deepen or begin your meditation practice. This blog is also meant to aid psychotherapists and coaches who want to be able to support traumatized clients who are meditating or who are considering starting a practice. Hopefully, what we’ll cover will be useful for both beginner and advanced meditation practitioners.
We’ll focus on four major topics:
- What is trauma?
- What is triggering?
- The potential benefits of meditation for trauma survivors
- 9 lessons related to trauma and meditation (We’ll address lessons 1-3 in blog 1, and lessons 4-6 in blog 2, and lessons 7-9 in blog three)
While this blog series will emphasize some of the challenges traumatized individuals face when practicing meditation, I want to assure readers that I am strongly pro-meditation for the traumatized and non-traumatized alike. As a long-term practitioner of meditation as well as someone who lived through childhood trauma and its aftermath, I have experienced for myself some of the profound benefits of meditation despite running into a number of these issues in my own practice. I therefore see these challenges not as immutable roadblocks to healthy meditative growth, but as opportunities that, once recognized, can be used to cultivate greater discernment and self-compassion.
For those interesting in knowing more about this work:
This blog series addresses topics found in greater detail in my next book, Advancing in Integral Psychotherapy. The working draft of Advancing, along with the previously published Guide to Integral Psychotherapy, are the core texts of the Certified Integral Therapists (CIT) Training Program where we teach this material (and much more) to psychotherapists as well as professional coaches. We are now enrolling for our 2016 cohort.
What is Trauma?
We can begin with this definition: Trauma is “the psychological damage resulting from uncontrollable, terrifying life events” (van der Kolk, 1987, p. 1). Here, however, we need to understand that what someone experiences as “terrifying” is relative to the age of the person and the specific situation. Some events, such as experiencing a high speed car crash, are terrifying to most everyone. Being trapped in a stalled elevator for a few hours might be terrifying for someone with a fear of closed spaces, but only be boring and frustrating for others. Walking into your mother’s room to find her her passed out drunk might be deeply frightening to you if you are a child, but probably not if you are an adult.
Further, fear and terror are not always related to a single event, but can build up over time. If a spouse is physically abusive, the first violent incident may evoke as much anger and confusion as fear. But if the physical abuse occurs repetitively, the violence and anticipation of it may easily develop into feelings of terror.
We might therefore sharpen our definition of trauma in this way:
Trauma is the persistent – but usually reversible – change to the mind, body, and nervous system that occurs as a result of overwhelming fear or stress. This definition accounts well for the fact that traumatic incidents can be single events or they can involve stresses that accumulate over time to a breaking point.
A second key question on the topic of trauma is this: Have you experienced trauma? Is this blog meant for you?
There is no easy way to answer this question for everyone. However, we should be aware that we are going through something of a renaissance in terms of the culture’s view of trauma and its treatment; therapists are emphasizing it more in their treatment and lay people and institutions are becoming more aware of it as a public health and public mental health problem.
In reality, this is a good news/bad news situation. The good news is that as awareness of trauma is raised, individuals feel less stigmatized, treatment options tend to expand, and people are more likely to receive appropriate care. The bad news is that when clinical concepts such as trauma become popularized, they also tend to become over-diagnosed by professionals, over self-diagnosed by lay people, and often over-medicated as well. This, ironically, can lead to important mental health issues being taken less seriously.
The fad-like spread of mental health diagnoses has taken place in the recent past with ADD and bipolar disorder for example, where ADD has come to mean something like “a little scattered” and bipolar has come to mean “my mood can be a little erratic”. (Both conditions when diagnosed properly are more serious than that). This is now happening to a certain extent with the notion of trauma, which is starting to signify that one has been “a little shocked” by something.
The best way to avoid the cultural-hype and gauge your trauma accurately is by taking a look at the objective history of your own life. Trauma is intimately tied to very serious, real-world events, and the events that tend to cause it are predictable. Here are two short check-lists to consider:
In childhood, the most common causes of trauma are:
- Emotional abuse
- Physical abuse
- Sexual abuse
- Experiencing significant health issues, accidents, or fear of death (i.e., war, violent neighborhoods, natural disasters, car crashes, etc.)
- Having a parent with severe mental health issues or an addiction
- Witnessing domestic violence
- Loss of a parent through death or imprisonment
In the adult years, the most common causes of trauma are:
- Rape or sexual assault
- Physical assault or being a victim of other crimes (i.e., robbery, stalking, etc.)
- Emotional, physical, or sexual abuse in romantic relationships
- Major negative change in life circumstance (i.e., bankruptcy, homelessness, incarceration, etc.)
- Death of a spouse or child
- Experiencing significant health issues, accidents, or fear of death (i.e., war, dangerous neighborhoods, natural disasters, car crashes, etc.)
If you think you have been traumatized, and have one or more of these events in your life, there is a good chance you share some of the key characteristics discussed in this piece and that that will impact your meditation practice.
Next we need to explore the concept of triggering. Triggering refers to the self-protective reaction that occurs when a person is exposed to a reminder of a trauma. Triggered mental states are marked by reactive/impulsive behaviors and often unyielding, vehement emotions. In general, the more severe or repetitive our previous traumatic experiences, and the earlier they occur in our life, the greater the intensity and complexity of our triggered responses (see van der Kolk, 2005; van der Hart et al., 2006).
Therapists divide responses to trauma into four categories that appear to be hardwired in us by evolution (see Fisher, 2001). They are sometimes referred to as the “Four Fs”. They are:
1) Fight responses, which are angry responses towards self or other
2) Flight responses, which are panicked or anxious
3) Freeze responses, which are dissociated or depressed
4) Fawn responses, which are clinging and submissive
All of these responses arise for a good reason: They can highly protective and adaptive at the time of the trauma and can help prevent bodily or psychological damage. However, problems arise when the original trauma is not worked through or emotionally discharged. Ongoing traumatic reactions in the present when there is no threatening situation can have a deep negative impact on ourselves, our loved ones, and our functioning in the world (Levine, 1997).
Here are a few additional points which are key to understanding triggering:
Triggering reminders need not be obviously related to the original trauma, such as when a person with combat-related war-trauma is triggered by hearing a gun shot in his neighborhood. Instead, triggers may also be tangentially related, symbolic, or just emotionally consistent with the original traumatizing situation. An example might be having a loud (but otherwise typical) argument with a significant other that triggers earlier traumatic interactions with an angry, abusive parent. Another would be financial struggles which trigger early feelings of instability due to having an unreliable, alcoholic parent.
Triggering may also occur even if the survivor does not consciously remember the trauma. This is possible when the trauma happens prior to age 4 or 5. Past that age, people almost always remember traumatizing events. (The idea of repressed traumatic memories is mostly a myth, and we should be very wary of any claims that we can hypnotically or otherwise recovered). In other words, very early traumatic experiences can be “stored” in other forms of memory besides what is known as episodic memory (see Forman, 2010, Chapter 3; Poulos, et al., 2013). If you believe you might be a victim of early life trauma, speaking to family members or caretakers who remember that period of your life will usually lead to the best and most helpful information.
Triggers – it also must be emphasized – need not always be negative. Many trauma survivors are triggered by positive experiences. While this may seem counterintuitive, trauma survivors often have a great deal of difficulty acclimating to happiness as a psychological and physiological state. Thus good feelings may serve more as reminders of what went wrong than as a chance to feel upbeat. For trauma survivors happiness, intimacy, and love can trigger significant amounts of unprocessed grief, anger, or fear that the source of the positive feelings may leave (such as being abandoned by one’s romantic partner).
Finally, it is important to understand the temporal dimensions of triggering. Short-term triggering can last minutes, hours, or days. But because of the way that traumatic reactions are incorporated into the individual’s mind and body, triggering may also be chronic. In other words, we can have lower-grade fight, flight, freeze, and fawn reactions that occur over years or even decades post-trauma.
It would not be a mistake to say that some of you reading this blog who have experienced trauma are triggered right at this moment but are not consciously aware of it because of how deeply normal the triggered feelings have become. You will just know that you are somehow uncomfortable or vaguely in pain. Your trauma may also have been masked and labeled by its symptoms – depression, anxiety, ADD, or other more commonly understood mental health issues. Without work specifically on the underlying trauma, it will be difficult for you to resolve these symptoms.
The Potential Benefits of Meditation for Trauma
Now that we have discussing triggering, let’s briefly consider how meditation may be able to help. We can do this in a simple way by considering trauma in its cognitive and somatic (bodily) impacts.
Traumatic triggering has a number of cognitive manifestations: guilt, negative self-evaluations, fearful anticipation, angry judgments of others, and flashbacks in memory. Meditation, by teaching nonattachment to thoughts as well as non-attachment to self-concept, offers trauma survivors an additional route to cope with these reactions. It teaches us to let reactions go and pass rather than reactively clinging to them. (The more intense the triggering, the harder this is by the way).
Meditation also increases our ability to focus, pay attention, and be mindful. This can be a serious challenge for trauma survivors when they are triggered. Triggered states are what is known as hypofrontal. This refers to the frontal cortex of the brain, which is responsible for effective thinking, planning, and regulation of emotions.
In hypofrontal states, the frontal cortex actually loses effective functioning (Koenig & Grafman, 2009; van Harmelen et al., 2010). This is the common experience people have of “losing it” in a triggered state of fear, anger, dissociation, or grief. This also accounts for why trauma survivors so often struggle with addictions and compulsive behavior. In triggered states they lose the ability to think straight and look impulsively to outside compulsions or substances to help them regulate their emotions. Meditation may counteract this by directly strengthening the capacity to focus and even increasing the physical thickness of the frontal cortex. This can help us stay more present during triggering and support us to make more appropriate self-soothing choices (see Lazar et al., 2005).
We can also see the potential of meditation to treat trauma through a somatic lens. Traumatic reactions have a very distinct physicality – feeling or “body memories” that come forth quickly and without conscious intermediary thought (see Levine, 1997; van der Kolk, 2014). These are often highly uncomfortable and can even rightly be called physically painful. Meditation teaches us the capacity to relax the tensions underlying some of the reactions and to enter positive states of bodily experience. While even deep meditative experience will not fully erase these trauma-related body memories, it can offer a means to learn to regulate our nervous systems and to enter restorative states of pleasure (Benson & Klipper, 1976/2000).
Combining its cognitive and somatic components, meditation can be said to encourage a state of alert, present-centered, and calm wakefulness in experience. We can summarize the goals of meditation this way:
- To learn to be in the present as opposed to the past or the future
- To learn to be alert without moving into fear, clinging, or hyper-vigilance
- To learn to be relaxed without moving into numbness, sadness, or dissociation
Meditation would seem to be one of the best – and perhaps the most direct – ways to learn this kind of state.
A Trauma Sensitive Approach to Sitting
All this said, meditation is not a panacea for trauma. Instead, a traumatized person’s practice of meditation must take into account additional issues.
Here I would like to offer some lessons I have learned from working with traumatized clients, taking part in many meditative practices and groups, and from my own personal experience as a trauma survivor. Naturally not every lesson below will apply to you if you are a trauma survivor or to a client of yours if you are a therapist or coach.
Lesson #1: Meditation by itself is never enough. As a trauma survivor, you will also need to do multiple forms of psychotherapy.
We will begin with the most basic lesson – and probably the most familiar to readers – about trauma and meditation:
While meditation can be profoundly helpful in the face of trauma, meditation by itself is never going to fully erase the presence of trauma in the mind or body or teach you all the tools you will need to cope with or heal trauma. If a spiritual teacher or tradition tells you that meditation or another spiritual practice can deliver total healing from trauma, I would recommend ignoring that specific teaching. As a trauma survivor, you will learn to need to question teachings that are spiritually absolutist in this way. We will touch on this more below in a later lesson.
The wiser approach is to take for granted that you will need to engage therapy at least intermittently post-trauma in order to heal. The support for trauma recovery will be much higher in a therapeutic contexts than in almost any meditation community, who will tend to leave you to your quiet, solo practice. They will typically not account for traumatic reactions in how they teach their practices. Meditation communities may you offer you wonderful ideals and goals about how you want to live in the world, but you will need to add therapy in order to help actualize those ideals.
It is also almost certain – unless your trauma was relatively minor – that one period in one type of therapy is not going to be enough. I have simply never met or worked with a serious trauma survivor who could get all they needed from one therapist or from one form of therapy.
The good news is that much is out there to be tried, and you likely have years in front of you to try it. There are cognitive approaches to trauma, such as trauma-focused cognitive-behavioral therapy (TF-CBT), somatic approaches such as Somatic Experiencing (SE) and Sensorimotor Psychotherapy (SP), approaches that focusing on traumatic memories such as EMDR, integrated-experiential approaches such as Evocative Psychotherapy (EvoPsi), and even emerging approaches that utilize psychedelics substances such as MDMA and psilocybin (e.g., Catlow et al., 2013; Mithoefer et al., 2013). With some searching you will certainly be able to find an approach that is right for you at this stage of your life.
Finally, it is important to emphasize that most psychotherapies have a strong interpersonal element which is lacking (for obvious reasons) in meditative practices. And relational healing is deeply pertinent to most forms of trauma. The sad truth is that fully 80% of childhood trauma takes place at the hands of a parent or caretaker (van der Kolk, 2005) and much adult trauma also takes with people we know (i.e., emotional or physical spousal abuse, date rape, etc.). It is not simply what you learn from your therapy in terms of skills or self-awareness that will help you heal. It is also the safe, supportive relationships that will you form with them.
Lesson #2: Having a devotional meditation practice or another form of devotional spiritual practice can be crucial for healing.
As a trauma survivor, psychotherapy should be the first tool you use to help you learn to form healthy, positive relationships. However, I would also strongly suggest that you take up a form of meditation or spiritual practice (such as centering prayer or chanting or ritual) that has a devotional element to it; something that moves your emotions in connection or surrender to a greater Other – be that a spiritual teacher or leader, saint, or God/Spirit Itself. You can take this as a main practice or a supplement to your main practice. Because loneliness and isolation are such major factors in trauma, with the wounds of early trauma going particularly deep, it is important for most trauma survivors to relate to spirituality personally, not just impersonally.
In other words, many popular forms of meditation – particularly those derivative of Buddhism – will emphasize being in the moment, concentrating on a mantra, following your breath, noticing your thoughts, scanning your body and so on. These are deep and wonderful practices, but they are not particularly heartful practices. And from a neurophysiological perspective, these are unlikely to produce marked increases in oxytocin and vasopressin, which are the hormonal keys to the feelings of bonding and attachment. But there is a strong argument to be made that devotional spiritual practices will produce this effect (see Grigorenko, 2011; Holbrook, Hahn-Holbrook, & Holt-Lunstad, 2015).
While such states are not substitutes for interpersonal relationships with other people, feelings of “spiritual attachment” are comforting, healing, and grounding to trauma survivors and can make the obstacles to healthy real-world relationships more passable. It will feel good to surrender yourself not just to some-thing larger than yourself, but to some-one (so-to-speak). If you are uncomfortable with this, I would suggest trying it anyway. Spiritual development without a corresponding development in your ability to feel safe and attached with others will leave you unbalanced as a person. More on this in a later lesson.
Lessons #3: Sitting when traumatically triggered must be done with great care or temporarily avoided. Don’t be a hero.
Almost everyone who tries to learn to meditate struggles at first. Meditation calls upon us to sit with quietly with ourselves, turn our attention inward, and become more aware of internal objects (thoughts, feelings, sensations, breath, etc.). The common challenges of meditative practice are well-known: Becoming easily distracted, impatient, frustrated, bored, or feeling insecure about how well we are doing. Most teachers and communities give a great deal of encouragement and reassurance to beginners to keep them motivated through these awkward, early phases of practice.
But psychological trauma introduces an additional challenge, especially when we are triggered. The turning-of-attention-inward required by meditation is something many trauma survivors have had special reason to avoid. Most trauma survivors are all-too-aware of looming painful memories, intense feelings of loneliness, self-punishing internal dialogue, and potent non-verbal moods. And most will go to great lengths to quell or distract themselves from these states.
If we are looking for an analogy, the difference between sitting with traumatic reactions occurring in one’s mind as opposed to sitting without them can be likened to the difference between guiding one’s boat through mildly stormy seas versus sailing headlong into a hurricane. Most meditation teachers and instructors are not aware of this, and proceed to teach meditation without any special instructions for those with trauma.
What to do? As a trauma survivor, issues of timing – when we sit to mediate and how long to sit – become very important. Trauma survivors who meditate do best when they are aware – and when therapists can help them become more aware – of the underlying emotional context they are sitting in on a given day. Trauma survivors must learn their triggers and trigger-and-recovery cycles extremely well so that they can approach sitting with their traumatic reactions in mind.
Along these lines, here are a few concrete suggestions:
- Consider meditating for shorter periods, such as 10-20 minutes. This approach encourages us to learn to sit with traumatic feelings in small doses without overwhelming ourselves or eventually dissociating.
- A somewhat contrasting perspective is this: The first portion of any particular meditation period is when the most uncomfortable emotions and thoughts tend to arise. The longer you sit, the calmer you are likely to become. However, you have to learn to gauge for yourself when you have the stamina to push through for a longer sit. A general rule is: Don’t be a hero. Approach yourself with care and compassion.
- Consider using a more active form of meditation if you are triggered, such as internal repetition of a prayer or mantra, moving meditation, noting out loud, or chanting. This is as opposed to more passive/receptive approaches to meditation which may just leave you swimming in a sea of traumatic reactions. The more activity you can provide yourself in the meditation, the more you will be distracted (in a positive sense) from traumatic reactions.
- Consider skipping meditation and doing another form of self-soothing care for a day. If you are on a lengthy retreat, you should think about taking some meditation periods fully off to rest or unwind. Again, don’t be a hero.
On a good day – or during a non-triggered period – a trauma survivor will likely experience the same calming, positive benefits from meditation that a non-traumatized person will. However, on a hard day, and during extended periods of triggering, additional care is necessary.
Meditation is almost never an easy practice, but nor is it intended to be about sitting through unrelenting emotional pain, numbness, or dissociation. If we ask our clients (or ourselves) to simply push through – or if they are unaware that they are consistently sitting in triggered states – then over the longer term we run the risk of having them associate the trauma with meditation and meditation teachings. This negative association may interfere with some of the benefits of meditative practice, or eventually cause a trauma survivor to stop sitting altogether. A trauma-sensitive approach to meditation, which sees trauma as a special type of internal state which must be negotiated, is a wiser approach.
Lessons 4-6 coming soon! Stay tuned!
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January 2, 2015
Mark Forman, PhD
First generation Integral applications are about the general application of quadrants, levels, lines, states, and types to a field – we might call this “big-picture” Integral application. Second generation Integral applications utilize this foundation and branch out to address more focused and granular application issues.
In the Certified Integral Therapist (CIT) Program, we work to ground our attendees in first generation Integral applications to psychotherapy and then augment them with second generation Integral applications. We believe we teach them in a unique, practical, and sophisticated way.
To provide a taste of the second-generation Integral concepts and applications in the CIT program, let’s address the idea of spiritual bypass: A now widely popular concept in the field of spiritual and transpersonal psychotherapy. In a recent interview, the creator of the concept, John Welwood, defined spiritual bypassing this way:
“[Spiritual bypassing is] a widespread tendency to use spiritual ideas and practices to sidestep or avoid facing unresolved emotional issues, psychological wounds, and unfinished developmental tasks.
When we are spiritually bypassing, we often use the goal of awakening or liberation to rationalize what I call premature transcendence: trying to rise above the raw and messy side of our humanness before we have fully faced and made peace with it. And then we tend to use absolute truth to disparage or dismiss relative human needs, feelings, psychological problems, relational difficulties, and developmental deficits.”
While this is a wonderful definition – and Welwood’s work is rich and ground-breaking – I would suggest that the concept of spiritual bypass can be made clearer for clinical work. One reason we need more clarity is that spiritual bypass appears to be so common; it doesn’t simply arise as a problematic situation in some. In fact, I have met very few people, let alone serious spiritual practitioners, who don’t demonstrate a version of this at one time or another.
Just think about this for a second. How often do we hear people say phrases like “God doesn’t give you anything you can’t handle” or “Money is just a form of energy” or “Everything happens for a reason” or “Sexuality is really just spiritual” or “Death is just a transition” – and yet are clearly using these ideas to avoid confronting difficult and uncomfortable areas of life? Using spiritual concepts we don’t fully understand but that we want or would wish to be true is as human as it comes.
In the CIT program, we begin to clarify this topic by applying Integral concepts including states, stages, and types. And when we do, we see that what looks and sounds like “spiritual bypass” is not simply one thing, but is actually several different things, each of which has a different psychology and requires a unique clinical response.
Here are four categories that we use in the CIT program to expand the clinical concept of spiritual bypass. Of course, any individual may have to deal with more than one of these categories of bypass at the same time:
Expectable Bypass: Built into every stage of development is some capacity to objectively confront reality as it is and another tendency to add subjective elements of fantasy to it – to project or imagine what we would like life to be like[[i]]. This tension might be irreducible, since I would argue that humans require some reality and some fantasy even through to the very highest stages of growth. Whatever the case, we can expect that people will bypass certain hard truths or difficult challenges as a regular matter of stage capacity and as a normal part of development. It is entirely expectable. Our position clinically should be that everyone will do this from time-to-time, and that our challenges to clients showing this tendency should be deliberate and focused, not automatic. Such bypassing might not be a problem at all, but just a natural psychological tendency at work.
States-Driven Bypass: When a person has a powerful spiritual opening, or takes up an intensive spiritual practice, they often engage in a different type of bypass. They are likely to experience deep altered states and be so compelled by the states themselves that they will minimize many important aspects of life (such as money, relationship, sexuality, and so forth) in order to pursue a maximal ability to experience further states. This might be best likened to a biological drive, like hunger or thirst, which can capture and significantly alter an individual’s life trajectory. This drive will likely run its course in months or years – depending on what depth of states and insights are eventually attained – but this path is not pathological in-and-of-itself. We have to understand this as a unique clinical situation when we see it and support the client appropriately. This category of bypass is most related to the states element of Integral Theory.
Problematic Bypass: This is perhaps the classic form of spiritual bypass, in that a person is clearly using spirituality to avoid very pressing needs or aspects of self when they could likely do otherwise[ii]. This problematic bypassing is most likely driven by current crisis, early trauma, or by long-standing mental health issues such as depression or addiction. The person needs to escape themselves because their everyday experience has become so painful. While this problematic tendency can run its course over time, clinical support, challenge, and intervention are very often needed. This category of spiritual bypass is related both to states (such as traumatic states or depressive states) as well as often stage elements of Integral Theory. That is, the tendency to problematically bypass is somewhat (though not entirely) more common at earlier stages.
Narcissistic Bypass: In this form of bypass, there is the melding within the person of strong narcissistic tendencies or narcissistic personality disorder with spiritual ideas, beliefs, or experiences. Here, significant narcissism can be understood as signaling an arrest at an early stage of development but also as being a “character style,” tendency, or type that one brings to each new stage. In this category, the person’s spirituality becomes a preferred vehicle for their narcissistic tendencies and allows them to avoid deep, underlying feelings of emptiness, shame, or unprocessed emotion. Lacking spirituality, it is likely that the person would find another outlet for their narcissism, so spirituality, while very significant in other forms of bypass, may not always be deeply felt by the person in this case. It may simply be his or her contextual or preferred mask. This is perhaps the most severe type of bypass and the most difficult to address clinically, since the person will often not see the existence of the problem or its negative life outcomes.
Hopefully readers will see the power of second generation Integral concepts and how these categories are directly applicable to working with spiritually interested clients. Each suggests a very different clinical response. This is something we see again and again: Utilizing the basic distinctions of Integral Theory, and bringing them to new areas of human psychology, opens up whole new vistas in our understanding of people. If you are interested in fully grasping this new way of seeing and being with others, please join us for the 2015 CIT Training!
[i] It is important and also possible to mesh the ideas of subjective and objective such that we see that they mutually influence and interpenetrate one another. So too do the concepts of fantasy and reality. Yet for many situations, and for much of our development, these concepts are useful to see in a polar way.
[ii] In the case of states-driven and problematic bypass, sometimes people are able to gain much greater equanimity and mindfulness during their time bypassing which they are then later able to apply to difficult life issues. In this sense, sometimes a bypass is a needed break from life issues in which the person is able to develop specific facets of the self. When bypassing is helpful and timely in this way versus when it has become a problem itself is a clinical, case-by-case judgment.
October 16, 2014
Mark Forman, PhD
The field of Integral Psychotherapy is young and in the process of defining itself. In that way, it is good to return to the question again and again: What is Integral Psychotherapy?
If we want to start with a theoretical definition that stays fully in line with the Integral model, we can begin with this:
Integral Psychotherapy is a psychotherapy that is AQAL. It attends to all-quadrants, all-levels, all-lines, all-states, and all-types as they show up in the client’s life as well as in the therapeutic space.
I believe that any therapy that attends to AQAL – in the very many ways that can be done – qualifies as an Integral Therapy. The only limitation with this definition is that to understand what this means in practice requires a solid background in Integral Theory and the ability to see how the five elements – quadrants, levels, lines, states, and types – show up in real persons, in real time. This is a very achievable goal, but it does take familiarity, study, and training (this is the training we provide in the CIT program).
Because of this, I don’t always use this definition of Integral Psychotherapy when there is not time to unpack it or when it is likely to come across as too abstract (it often will).
So the challenge has been to find a more grounded, accessible, and simpler definition. For this purpose, I have come up with the following. While it lacks the theoretical precision of the above, I think it gets at the essential heart of what we are trying to do.
Some problems were created in relationship and can only be healed in relationship.
Some problems are spiritual and can only be healed through spiritual means.
Some problems are caused by action and can only be healed through action.
Integral Psychotherapy attends to relationships, spirituality, and action – and will take you in whatever direction you need to go.
First, by relationship we mean the forces of family, romantic partners, and culture. Solving problems in relationships means that we help clients to more fully engage their interpersonal and relational worlds – by encouraging them to both grieve interpersonal hurts from the past and to proactively seek to love and connect with those who are willing and capable of loving them in the present. In addition, we recognize that many issues that are too painful to hold in daily life are best held in the healing relationship of therapy itself.
This tenet of Integral Psychotherapy recognizes the dimension of the other and our intrinsic connectedness to others.
Second, by spiritual we mean the deepest interiors of who we are, particularly our deepest existential issues and beliefs about ourselves and the world. At each phase of life, core feelings of longing, hope, and fear re-express themselves. In Integral Psychotherapy, we help clients to address these core existential issues in a way that matches their life stage and psychospiritual capacity. We help people learn to be at peace with themselves, within themselves.
This tenet of Integral Psychotherapy recognizes the dimension of the self and our innate individuality.
Finally, by action we mean the impact of the world and its forces upon us. The forces many be social, economic, related to the natural environment, or coming from our own biology. Whatever the genesis of these forces, there are times we have to act, to move, and to “do” in response to them. We cannot be passive bystanders or fear taking steps, but must discern the correct path and be willing to risk changing our behavior – and not just our thinking – if we want our lives to improve.
This tenet of Integral Psychotherapy recognizes the dimension of the world and the outer reality in which we live.
Addressing the client in their relationships, in their individuality, and in the world – while denigrating nothing and leaving nothing out. Integral Psychotherapy understands that each of these dimensions is essential and indispensible to us if we are going to live a full and satisfying life.
August 27, 2014
Mark Forman, PhD
There is no such thing as a perfect therapist. Even the best have strengths and weaknesses. Some excel at working with a client’s thoughts and cognitions, some with emotions, and some with gut-level feelings and intuitions. Some are wonderful at facilitating insight, others at encouraging emotional catharsis, and still others with catalyzing behavioral change. Of course, it is possible to become skilled at many of these dimensions of therapeutic practice – and perhaps to become outstanding at several – but the truth is that the human psyche (which includes the spiritual) is far too vast and multidimensional for any one person to master.
Recognizing this, Integral Psychotherapy encourages a strong attitude of appreciation towards the wide variety of ways in which therapists work with, relate to, and conceptualize growth and change. There is something of value in every perspective, from the most medicalized to the most spiritual. The world – and its seven billion individuals – require a growing and diverse meshwork of healers and helpers in order to bring it what it needs.
Encouraging appreciation not only makes for better interrelations between therapists of different orientations and a more positive collective atmosphere, but it also helps us grow individually as therapists. We should work hard to remain open to the idea that there is something to learn from every therapist and every particular school of therapy. For just as a client who is not open to change is likely to remain stuck, a therapist who is not open to different viewpoints and methods will remain with unfulfilled potential. Our attitudes and worldviews – the mindsets we carry with us – can leave us open and emerging or closed and stagnant.
Being appreciative, however, does not mean that we cannot be skeptical and discerning. This is a crucial point. We simply need to appreciate things consciously – with consideration and critical awareness.
Indeed, by keeping in mind that all therapists and therapies have strengths and weaknesses – and by using the Integral model as one helpful tool to help guide us – we can actually be more discerning and more skeptical than we would be otherwise. We can see that it is not “mean” or “oppressive” to think critically or to notice limitations in what other professionals do – an unfortunately common idea in much of our postmodern psychospiritual culture – but rather it is simply natural, honest, and sincere to try and distinguish what is helpful from what is not. We should also be honest about our own limitations and the areas in which we do not shine.
Of course, being appreciative is not always easy. In certain cases, it does not seem like the best (or the most immediately available) stance. There are two situations in particular where I think we need to approach appreciation that much more consciously.
The first is when a therapist or school of therapy claims that their way or method always works, is always better, or that they own the one-and-only truth of what creates mental health issues and what we need to do to address them. This happens, sometimes overtly, sometimes more subtly. It does not matter from what perspective, from what line of research, or from what cultural background such a claim arises: Absolutism is highly suspect. History shows us that all methods, insights, and paths are partial. When we hear these claims, we need to work harder to see what is of value to ourselves and others and what is simply being passed on as dogma.
The second challenging situation is when a therapeutic school is formulated in such a way as to be dehumanizing, or has moved in that direction over time. This also happens more than one would hope. Dehumanization occurs when an approach to therapy attempts to cut away, repress, and marginalize aspects of human experience that are part of the hearts, minds, lives, and shared cultures of humanity. We cannot cut away thoughts, feelings, dreams, intuitions, or fantasies. We cannot cut away the shamanistic, the humanistic, the hedonistic, the existential, the religious, the economic, or the scientific. Whatever it is that we don’t like or don’t favor – we cannot simply make it go away. We should realize first that these repressive impulses come from our own disconnection with aspects of self, and that they encourage divisions within others as well, pushing them to exclude and fragment rather than to embrace and integrate.
Of course, saying that we should not marginalize any aspect of our shared humanity does not mean that all ideas or aspects of self or culture are equally well-honed, equally important, equally moral, or equally timely. Many will be overturned or reformulated in the future. It only means that, in our current moment, all have their place. And that when we push anything away with the hopes it will never return it creates unnecessary darkness and shadow. What we should do instead is to try and find any approaches’ essential core and reform it in a more healthy fashion. This will certainly lead to debate, but it does not make one unappreciative. To be appreciative is to honor the complex diversity that surrounds us and that is within us and to work to include it. To be appreciative is to steer clear from creating unbridgeable divides.
July 9, 2014
Mark Forman, PhD
Before most of us have even sat with a client in psychotherapy, we have to begin to confront the question of diagnosis – whether or not the client can be said to have a specific, well-defined condition offered in the DSM-V or ICD-9/10.
Unfortunately, unlike our sister field of medicine, where much clearer tests can be created and employed, mental health diagnosis is a tricky proposition. If we pay attention to the ambiguities of the research, to critical voices in the field, as well as to our own experience working with clients, we start to see that diagnosis in psychotherapy is fraught with complexities. What are the clear lines that separate addiction from non-addiction, a depressed person from a non-depressed one, and an anxiety disorder from typical, normal anxiety? Often the answers are murky and – journalistic overstatements to the contrary – there is little on the horizon in neuroscience that is going to provide us definitive answers.
Going deeper, we may begin to see that diagnoses are created and employed within a cultural context and a certain set of conventional beliefs about the right way to live. These ideals change and morph with the times and along with our class, gender, ethnicity, age, and geography. For example, in our relatively recent history being gay or lesbian was considered a mental illness (and in some places in our culture it unfortunately still is). Or just recently some regions of our country are beginning to accept the idea that smoking marijuana does not make one socially deviant any more than having an occasional drink does. And then there is a condition like ADHD. How much of it is a true diagnostic category versus a behaviorally-defined byproduct of our constrained modern ways of living and schooling our children? What do we say to the fact that ADHD diagnoses among children are rising at rates that seem fully out-of-step with any identifiable cause? (Getahun et al., 2013)
The combined issues that relate to each diagnostic category can be dizzying. So how do we approach this? And further, what to make of it when you have an actual client sitting in front of you? As far as I can tell, to manage what might otherwise be overwhelming, many of us get stuck in an unresolvable tension. The tension is something along these lines:
- Diagnoses describe verifiable and well-defined conditions that ultimately have a biological basis, whatever the environmental contributions might be. Providing a client with a diagnosis is therefore part of being a professional and offering quality, responsible care. This view is typically much more supportive of the use of medication to treat mental health issues.
- Diagnosis is a way that cultural norms are enforced, often to control and limit the lives of individuals. Further, lacking any medical tests for mental health conditions, the idea itself of “mental illness” is really just a misguided, socially constructed metaphor. We should instead look to the subjective and spiritual lives of the individual to see what is really happening and not to any supposedly fixed diagnostic categories.
The truth, of course, is at neither of these two extremes. There is evidence and good will – as well as overstatements – on both sides. So in order to provide the best possible care, and get closer to the truth, we have to decide what is the right approach for a given client given the circumstances. We have to dance with diagnosis and all its complexities. This means that, depending on the exact issue the client is struggling with, how severe their suffering is, as well as their level of anxiety about their condition, sometimes a diagnosis is the most compassionate and effective thing to offer and sometimes it is just the opposite.
Let’s think more about this. On the positive side, a well-delivered and accurate diagnosis provides the client a container. It offers a sense of safety and structure whereas before there was bewilderment and confusion. Recognizing that they are are “depressed” can be a huge relief to people who didn’t know what they were struggling with. Or taking on the identity of an “addict” can help a lot of people get organized to begin to take steps to change whatever has reportedly become compulsive in their lives. A proper diagnosis suggests all sorts of direct pathways to change; pathways that may be harder to accept when the issues are fuzzy and undefined.
At other times, however, giving a client a diagnosis stunts the process of growth by making what is truly complex far too simple. To diagnose a person with a host of early childhood wounds, a loveless marriage, or deep existential or spiritual issues as simply “depressed” is to see the cover of the book and never to read the pages.
Knowing as a therapist how to make things simpler when the client needs that simplicity by offering a diagnosis and knowing how to stand back from labels and let things unfold in all their complexity – that is the dance of diagnosis and much of the art of being a psychotherapist.
In order to learn this, I believe we first have to know ourselves: We have to see the side of us that needs labels and finds comfort, order, and direction in them, even as they are imperfect. And we also need to see the side of us that wants freedom and needs room to self-define and not be boxed-in by our culture, age, behavior, or by other peoples’ way of judging us. When we see both sides in ourselves, then we will begin to see this same set of holistic needs in others. We will have “ears to hear.” This complex listening, seeing all sides, and then discerning the most helpful and accurate direction – that is the Integral way.