Origins of Medicine, Surgery & Psychotherapy

     “Alchemy, descended from shamanism, is the ancient art and science of elemental transformation. … alchemy grew historically out of the work of shamanic miners, smiths, and metallurgists. They were the masters of fire, who knew how to extract metals from stone, blend them into alloys such as bronze, and make tools, weapons and ornaments. In the archaic and classical period the knowledge of metalworking, because of its obvious connection to power and wealth, was preserved in secrecy and handed down in craftguilds from master to student. Such technical knowledge was regarded as magical by ordinary people, because it seemed to involve inexplicable mastery of natural forces. The crafts of masonry, which uses mineral stones in building, and medicine, which uses mineral and botanical extracts in healing (as well as metal tools in surgery), were parallel and associated secret societies. All three movements developed an esoteric or inner component, concerned with practices of psychic and spiritual self-transformation.
     A popular misconception is that alchemy was solely and futilely concerned with the transmutation of base metals to gold. In actuality, it is clear from alchemical writings that the main focus of most alchemical practitioners was healing and what we would nowadays call psychotherapy: the transmutation of the physical and psychic condition of the human being – starting with oneself. The worldview of the archaic and classical eras was holistic – the physical, psychic, spiritual, and cosmic dimensions of life were seen in their wholeness, not as separate fields.
     … the sacred science of the alchemical tradition came to be revived by two twentieth-century scientists: C.G. Jung, who identified alchemical symbolism as the language of the psyche; and Albert Hofmann, who uncovered a secret link between psyche and matter in the form of mind-expanding substances. Medieval alchemists in the Western tradition called this link the ‘water-stone of the wise,’ blending fluidity and solidity. Buddhist alchemists of the vajrayana school called it the vajra – the ‘lightning-diamond’ – blending luminosity and hardness.
     My suggestion is that the language of alchemy, both Eastern and Western, updated with contemporary scientific concepts, can provide the appropriate paradigm for a worldview that integrates rational science and intuitive wisdom." 
 

        Ralph Metzner. “Ecology of Consciousness. The Alchemy of Personal, Collective, and Planetary Transformation.” Reveal Press, 2017. 
 

“Black Sun”, from Splendor Solis, a German alchemical treatise, 1582

Awakening the Heart

     “The most powerful agent of growth and transformation is something much more basic than any technique: a change of heart.” John Welwood 

     “But what does it mean to ‘awaken the heart’? No doubt this phrase may sound strange to those reared in traditional Western psychology, which speaks of the goals of therapy in much more technical terms, such as ‘ego strength,’ ‘reality testing,’ or ‘impulse control.’ The word ‘heart’ has a rather sentimental ring in our culture – it seems to belong in love lyrics and Hollywood movies, but hardly in the context of psychotherapy, which has been striving since its beginnings to achieve a certain technical expertise and scientific respectability. In our culture, ‘heart’ is considered to be something quite distinct from ‘mind,’ the latter usually referring to our rational, thinking capacity.
     In the Eastern traditions, however, the word ‘heart’ does not mean emotions or sentimental feelings. In Buddhism, the words ‘heart’ and ‘mind’ are part of the same reality (citta in Sanskrit). In fact, when Buddhists refer to mind, they point not to the head, but to the chest. The mind that the Eastern traditions are most interested in is not the thinking capacity, but rather when the Zen master Suzuki Roshi called ‘big mind’: a fundamental openness and clarity which resonates directly with the world around us. This big mind is not created or possessed by anyone’s ego; rather, it is a universal wakefulness that any human being can tap into. 
     The rational thinking apparatus we know so well in the West is, in this perspective, a ‘small mind.’ 
     The mind which is one with the heart ('big mind') is a much larger kind of awareness that surrounds the normally narrow focus of our attention. We could define heart here as that ‘part’ of us where we can be touched – by the world and other people. Letting ourselves be touched in the heart gives rise to expansive feelings of appreciation for others. Here is where heart connects with big mind. For we can only appreciate others if we can first of all see them clearly as they are, in all their humanness, apart from our ideas and preconceptions about them. In seeing and letting ourselves be touched by the humanness in others, we come to realize that we are not so different from them (at heart). This gives rise to real compassion, considered by many Eastern traditions to be the noblest of human feelings. Awakening the heart, then, involves a double movement: both letting others into us, which allows us to appreciate their humanness, and going out to meet them more fully. (As we say: ‘I took her into my heart,’ or ‘My heart went out to him.’) Heart is not only the open, receptive dimension of our being, but also an active, expansive opening out to the world.”

        John Welwood ed. “Awakening the Heart. East / West Approaches to Psychotherapy and the Healing Relationship.” Shambhala, 1983.

Motivation to Change - Self-determination Theory

     "Self-determination theory (SDT) provides empirically informed guidelines & principles for motivating people to explore experiences & events, and from that reflective basis, to make adaptive changes in goals, behaviors, & relationships.  

     ... a central task of psychotherapy is to support the client to autonomously explore, identify, initiate, and sustain a process of change 
 

     ... when more autonomously engaged in the therapeutic process — that is, when they have a more internal perceived locus of causality for treatment — people will be more likely to integrate learning & behavior change, resulting in more positive outcomes. 

      (Listed below are the) varied types of motives that bring people to therapy, along with their correlates & consequences. These motives, with corresponding regulatory processes, vary along a continuum of relative autonomy, and people typically have varied degrees of each type of motive. 

          • First, persons can be pressured or coerced by external factors, a process referred to as external regulation. This is especially apparent in the treatment of children, & in therapies connected with the legal system such as substance abuse. 

          • Second, introjection is evident when people initiate treatment because of 'shoulds,' guilt, or seeking social approval & thus pressure themselves to change. 

          • Third, clients may have the more autonomous experience of identifying with the goals of therapy & volitionally pursuing change. 

          • This volitional identification will be transformed into integrated regulation when it is brought into congruence with all of the person’s values & perceptions. 

          • Finally, clients may even come to treatment with considerable intrinsic motivation, reflected in an open curiosity and interest in what can occur. 

     ... the less autonomous the motive the more SDT predicts poor engagement in therapy & lowered long-term, or maintained, success. 

     Testing ... the degree to which individuals enter treatment for more controlled (i.e., external or introjected motivation) or autonomous reasons (i.e., identified, integrated, or intrinsic motivation) ... revealed that the more autonomous individuals were in their motivation for therapy, the more important they believed the therapy to be, the less distracted they were during therapy, the less tension they experienced about therapy, the more satisfied they were with the therapy, the greater their intention to persist, the higher their self-esteem, the lower their level of depressive symptoms, and the greater their life satisfaction. People’s controlled motivation, in contrast, positively predicted tension, and negatively predicted the importance of therapy, the intention to persist, and self-esteem."

       Ryan RM, Deci EL. "A Self-Determination Theory Approach to Psychotherapy: The Motivational Basis for Effective Change." Canadian Psychology 2008; 49(3): 186–193.

Blomidon Estate Winery, Nova Scotia

Mindfulness - a Key Common Factor of Psychotherapies

     "Mindfulness means significantly more than simply paying attention or attention without distraction. A defining characteristic of the quiet attention of mindfulness is its essential quality of nonattachment to any particular view. The psychological freedom with which this attention is associated is not simply a freedom from the views of others (eg family, peers, culture, or government authority). Rather, it is an emancipation from one's own habitual view of self and the world. As J. Krishnamurti, a noted teacher of Eastern psychology to the West, has observed, "Freedom lies ... in understanding what you are from moment to moment", and involves a disciplined, quiet mind.

     Such emancipation could be viewed as a cornerstone of successful therapy from many schools. It provides the capacity to look freshly at one's psychological schemata of self and other. It also is receptive to new information, and thus, is able to conceive and explore alternatives."

 

       Martin J. "Mindfulness: A proposed common factor." Journal of Psychotherapy Integration 1997; 7: 291–312.

Meditation, Disidentification & Mental Health

     "Refinement of awareness may be a central process mediating the therapeutic benefits both of meditations and of psychotherapies and may also be a necessary precondition for a further important meditative process: disidentification.
      Disidentification is the process by which awareness (mindfulness) precisely observes, and therefore ceases to identify with, mental content such as thoughts, feelings, and images.  
     This process is similar to Piaget’s 'decentration,' Safran’s 'decentering,' Bohart’s 'detachment,' Deikman’s 'observing self,' Tart’s 'dehypnosis,' Teasdale’s 'metacognitive awareness,' Wilber’s 'differentiation & transcendence,' and Kegan’s 'de-embedding.' Robert Kegan suggested that the process of disidentification 'is the most powerful way I know to conceptualize the growth of the mind . . . [and] is as faithful to the self-psychology of the West as to the ‘wisdom literature’ of the East.' 
     Consider, as a practical example, the thought 'I’m scared.' Meditators report that if they are clearly aware of such a thought, then they do not identify with it (assume it to be a valid statement about themselves). Rather, they simply observe it, recognize it as merely a thought, and are unaffected by it."

       Walsh R, Shapiro SL. "The Meeting of Meditative Disciplines and Western Psychology. A Mutually Enriching Dialogue." American Psychologist 2006; 61(3): 227–39. 

 

Lessons from Combat Trauma

     Shay, an experienced psychiatrist, writes (in italics) about his experiences treating many Vietnam vets with PTSD. 
     I suspect that a surprising proportion of us, though never having physically been in an actual war, have nevertheless accumulated, not the same, but similar trauma over a perfectly imperfect lifetime. And have probably never received any timely counseling.

     “The child’s inner sense of safety in the world emerges from the trustworthiness, reliability, and simple competence of the family.”
     Children who grow up feeling unwanted, know no safety - have definitely been traumatized: http://www.johnlovas.com/2013/11/attachment-to-people-memories-concepts.html

     “… moral injury is an essential part of any combat trauma that leads to lifelong psychological injury. Veterans can usually recover from horror, fear, and grief once they return to civilian life, so long as ‘what’s right’ has not also been violated.”
     Children expect unconditional love, but none of us receive it. The greater the gulf between what we ardently need and what we feel we receive, the greater the sense of betrayal - the 'moral injury': http://healthyhealers.blogspot.ca/2013/07/the-inner-child-unconditional-love-and.html

     “Another veteran in our program wrote: ‘In my wildest thoughts I never expected or wanted to return home alive, and emotionally never have.’ 
     The sense of being already dead may contribute to the berserker’s complete loss of fear … It may also be the prototype of the loss of all emotion that defines for combat post-traumatic stress disorder the prolonged states of numbness – the inability to feel love or happiness or to believe that anything matters.” 
     How does a child appear when the expected source of unconditional love repeatedly says wildly hurtful things to the child? S/he may not reveal any change in expression. But there's inner amazement & profound confusion - 'Is this a Martian pretending to be my mother?' Also internally, there are earthquakes & aftershocks, with new layers of concrete hastily lathered around the heart.

     “What I want to emphasize here is the rapid transformation of grief into rage. For many of the (Vietnam) veterans in our treatment program for combat post-traumatic stress disorder, replacement of grief by rage has lasted for years and become an entrenched way of being. Much therapeutic effort aims at reawakening the experience of grief, which we regard as a process of healing, painful as it is.” 
     “I believe that the emergence of rage out of intense grief is a biological universal and that long-term obstruction of grief and failure to communalize grief can lock a person into chronic rage.” 
     I suspect many 'angry young men', as well as women, express their grief through rage.

     “There is growing consensus among people who treat PTSD that any trauma, be it loss of family in a natural disaster, rape, exposure to the dead and mutilated in an industrial catastrophe, or combat itself, will have longer-lasting and more serious consequences if there has been no opportunity to talk about the traumatic event, to express to other people emotions about the traumatic event, to express to other people emotions about the event and those involved in it, or to experience the presence of socially connected other who will not let one go through it alone. This is what is meant by communalizing the trauma.”
     It may not be until the late teens, when children of dysfunctional parents move away from home, and finally have the courage & safe opportunity to explore, and perhaps vent their grief.

       Jonathan Shay. “Achilles in Vietnam. Combat Trauma and the Undoing of Character.” Scribner, NY, 1994.

 

Role of Transpersonal Approaches

     "All transpersonal approaches are concerned with accessing and integrating developmental stages beyond the adult ego and with fostering higher human development. Because of this concern, most transpersonal theories deal extensively with matters relating to human values and spiritual experience. 

     This focus sometimes leads people to confuse the interests of transpersonal psychiatry with the concerns of religion. Transpersonal psychiatry does not promote any particular belief system, but rather acknowledges that spiritual experiences & transcendent states characterized by altruism, creativity, & profound feelings of connectedness are universal human experiences widely reported across cultures, and therefore worthy of rigorous, scientific study. 

     Inattention to these experiences and the roles they play in both psychopathology and healing constitutes a common limitation in conventional psychotherapeutic practice and research."

       Kasprow MC, Scotton BW. " A Review of Transpersonal Theory and Its Application to the Practice of Psychotherapy." The Journal of Psychotherapy Practice and Research 1999; 8:12–23.

 

     See "Critical Spirituality": http://www.johnlovas.com/2012/10/critical-spirituality-holistic-approach.html

 

 

Psychotherapy & Buddhism

     “It is through the mindfulness practices that Buddhism most clearly complements psychotherapy. The shift from an appetite based, spatially conceived self preoccupied with a sense of what is lacking to a breath based, temporally conceived self capable of spontaneity and aliveness is, of course, one that psychotherapy has also come to envision.”

        Epstein M. "Thoughts Without a Thinker. Psychotherapy from a Buddhist Perspective." BasicBooks, NY. 1995. 

Erez Marom   www.dpreview.com

Insight, Self-reflection, Psychological Mindedness, Evolution

     Meditation practice has long been known to bring about profound mental-health benefits.

     "The non-reactive, detailed, systematic, and impartial observation of one's own cognitions & emotions through the technique of meditation can be a source of personal insight & self-understanding. ... even among patients with little psychological mindedness, approximately 20% 'with a wide range of psychophysiological disorders, who joined stress reduction & relaxation programs involving mindfulness meditation, became interested in psychotherapy for further expansion of self-understanding.' Within this framework, they refer to meditation as a 'psychobiological form of introspection.'"
       Shapiro DH. A preliminary study of long-term meditators: Goals, effects, religious orientation, cognitions. Journal of Transpersonal Psychology 1992; 24(1): 23-39.

     "our perception, cognitions, & emotions related to our ordinary experiences can be distorted or biased to varying degrees. Depending on certain dispositional factors, these biases are sometimes pathological, but exist on a spectrum and may therefore be present without any clear psychopathology. Within this framework, mindfulness is described to reduce such biases through specific forms of mental training that develop meta-awareness of self (self-awareness), an ability to effectively manage or alter one’s responses & impulses (self-regulation), and the development of a positive relationship between self & other that transcends self-focused needs and increases prosocial characteristics (self-transcendence)."
       Vago DR, Silbersweig DA. Self-awareness, self-regulation, and self-transcendence (S-ART): a framework for understanding the neurobiological mechanisms of mindfulness. Front Hum Neurosci. 2012; 6: 296.

ARClark   www.dpreview.com

 

Therapeutic Presence

     "Therapeutic presence is defined as bringing one’s whole self into the encounter with clients, by being completely in the moment on multiple levels: physically, emotionally, cognitively, & spiritually.

     Presence involves 

(1) being fully in contact with one’s self in the moment, while being 

(2) open, receptive, & immersed in what is poignant in the moment, with 

(3) a larger sense of spaciousness & expansion of awareness & perception.

     This grounded, immersed, & expanded awareness is accompanied by 

(4) the intention of being with & for the clients, in service of their healing process.

     The inner receptive state involves therapists’ complete openness to clients’ multidimensional internal world, including their bodily & verbal expressions, as well as openness to their own bodily experience of the moment in order to access the knowledge, professional skill, & wisdom embodied within. Being fully present then allows for an attuned responsiveness that is based on a kinesthetic & emotional sensing of the other’s affect & experience as well as one’s own intuition, skill, & the relationship between.

     Therapeutic presence has been proposed as an essential therapeutic stance. Therapeutic presence can increase the therapist’s listening & attunement skills and provide a more effective way to respond to a client that is right for that person in that moment. Presence also allows the therapist to work at a relational depth, which further deepens the therapeutic relationship so the client can feel open & safe to work with difficult issues."

       Geller SM, Greenberg LS, Watson JC. Therapist and client perceptions of therapeutic presence: the development of a measure. Psychother Res 2010; 20(5): 599-610.

 

 

 

RumpelHund   www.dpreview.com

 

Self-defeating Behaviours - Repression & Addiction

     According to Buddhist psychology, we're all addicted to material things, our likes & dislikes, our opinions, etc, but most importantly, to our concept of self. It can take many years of reading and meditation just to get an inkling of the depth of these addictions.

     "For generations, psychologists thought that virtually all self-defeating behavior was caused by repression. I have now come to believe that addiction is a separate and even more self-defeating force that abuses our freedom and makes us do things we really do not want to do. While repression stifles our desire, addiction attaches desire, bonds and enslaves the energy of desire to certain specific behaviors, things, or people. These objects of attachment then become preoccupations and obsessions; they come to rule our lives.
     The word attachment has long been used by spiritual traditions to describe this process. It comes from the old French a-tache, meaning "nailed to." Attachment "nails" our desire to specific objects and creates addiction. In this light, we can see why traditional psychotherapy, which is based on the release of repression, has proven ineffective with addictions."

       May G. "Addiction and Grace. Love and Spirituality in the Healing of Addictions." HarperCollins, NY, 1988. 

     See also: http://mindfulnessforeveryone.blogspot.ca/2013/07/361-beyond-stress-management-resilience.html

Stan W   www.dpreview.com

 

Mindfulness in Medicine, Dentistry, Psychology, Nursing, Physiotherapy, Social Work ...

     "The goals of mindful practice, according to Epstein, ‘are to become more aware of one’s own mental processes, listen more attentively, become flexible, and recognise bias and judgements, and thereby act with principles and compassion’."

        Dobkin PL, Hutchinson TA. Teaching mindfulness in medical school: where are we now and where are we going? Med Educ 47(8): 768-79.

phinhead   www.dpreview.com

Experiencing Meaning, Purpose & Wholeness through Meditation

     “All individuals during the course of their life, are faced with uncontrollable outcomes, undesirable events, and uncertainties. Some of these events may involve questions regarding the relationship of the individual to the cosmos’s seeming chaos; how to create (or discover) life’s meaning; understanding issues of good and evil; developing a stable, positive identity while recognizing the inevitability of illness, decay, and death. These issues represent, to a greater or lesser degree, that which is unknown, uncertain, ambiguous, even chaotic in the world. And these situations and issues, which are seemingly out of control, or appear beyond human control, may cause feelings of existential stress, frustration, surprise, fears, and vulnerability. 
     Psychological research has shown that meaning and purpose, whether as an independent construct or as part of a sense of control, are important for both emotional and physical well-being. Although not often directly examined, most Western medical therapeutics and psychotherapies are based on an assumptive belief system that views the universe as random and purposeless. 
     The spiritual context of meditation, whether theistic or nontheistic, challenges that belief system. One of the aspects of the meditative experience within the esoteric core of all contemplative religious traditions is an experiential view of the universe, at its deepest level, as a sacred, whole unity. The ineffable, nondualistic experiences of profound unity – meditation as an altered state – which has been called the ‘still completeness’ and the heart of religion, have been described in individuals’ encounters with the noetic across many different spiritual traditions.”

       Shapiro DH. Examining the content and context of meditation; A challenge for psychology in the areas of stress management, psychotherapy, and religion/values. Journal of Humanistic Psychology 1994; 34(4): 101-135.

hapster   www.dpreview.com

Hope, Expectancy, Therapeutic Alliance, Solution Focused Therapy & Chronic Pain Management

     It's wonderfully satisfying when patients enter the office in despair, and leave with happy smiles. This dramatic change results from forging a successful therapeutic alliance, and replacing desperation with genuine hope and expectancy. These are challenging YET essential components of effective chronic pain management.

     Solution focused therapy (SFT) practitioners adopt "a respectful, interested, non-blaming, non-judgmental and cooperative stance. The assumption in SFT is that the client is competent to figure out what they want and need, and is willing to do something about it. The practitioner's responsibility is to assist the client to discover these competencies. Any notions of client 'resistance' are dismissed by SFT as professionally self-serving. Instead anger, resistance and a lack of motivation or 'insight' are viewed simply as indications that the practitioner has yet to find a way of working with the client.
     (SFT) is not simply a psychotherapeutic approach but an alternative way of thinking and working with people."

       Wand T. Mental health nursing from a solution focused perspective. International Journal of Mental Health Nursing 2010; 19(3): 210-219.


     Change from psychotherapy "comes from four main sources. The first is extratherapeutic change, which accounts for 40% of the variance of change. These are personality characteristics of the client as well as factors in that person’s environment that lead to positive change. The second strongest influences are common factors or what might be known as the therapeutic alliance. Accounting for 30% of the variance, these include empathy, warmth, and acceptance. A third component of improvement is technique, which includes the specific routes a psychotherapy theory utilizes, such as dream analysis or thought stopping. This accounts for 15% of the variance. The fourth component is hope and expectancy, which accounts for 15% of the variance of change. Expecting that going to therapy will help actually helps. It provides hope for symptom relief as well as other positive changes in one’s life. ... 'At the same time, an emphasis on possibilities and a belief that therapy can work will likely work to instill hope and a positive expectation for improvement'.
     ... therapists need a cognitive set that expects change and conveys hope. It is this focus on the future and possibilities instead of the past and problems that helps lead to hope."
 
       Reiter MD. Hope and expectancy in solution-focused brief therapy. Journal of Family Psychotherapy 2010; 21(2): 132-148.

Photo: Tony Tomlin   www.dpreview.com