Skip to content

Posts tagged ‘Integral Psychology’

Appreciate Everything (Consciously)

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.

The Dance of Diagnosis

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.