Blending Psychotherapy and Spirituality

In my last post on meditation, I suggested that there's not a lot of harm that comes from meditation and mindfulness training, so maybe it doesn't need the kind of scientific scrutiny that we might expect from a clinical drug trial. However, in Toward a Psychology of Awakening (2000), Buddhist psychotherapist John Welwood documents three traps: spiritual bypass, narcissism, and desensitising, that arise in part because we've leant too far to either psychology or spirituality instead of using both. He also discusses them in brief in a paper, "Principles of inner work: Psychological and spiritual" (1984).

Both psychotherapy and spirituality are about "developing a new kind of loving relationship with one's experience," and both help us break free from our conditioned reactions. But spirituality doesn't address our early mishaps that affect our perceptions, and psychotherapy doesn't address the need to transcend our personal feelings.

When he first trained as a therapist, Welwood was concerned that psychotherapy has a narrow view of human nature, but then realized how much it can help once we no longer demand answers from it. It can help free people from negative childhood conditioning, particularly from dismissive or engulfing parenting, by working with our needs, scripts (now narratives), fears, self-respect, etc. A lot of us don't learn how to exist in the world well. Welwood claims that part of the problem is the "breakdown of extended families and tight-knit communities" so that children just get influenced by parents or just one parent instead of many people providing a variety of ideas that can help a child figure out where they fit in the group. As far as I understand this point, with only one or two major influences, children might accept lessons without question, then have to "spend a good part of their lives freeing themselves" from this singular impact in order to find their own sense of self. It's somewhat unintuitive, but a larger group influence helps a child find their individual self by differentiating from others more clearly at a younger age. But whether we find it at 5 or 50, it's necessary to have this "stable self-structure" before trying to go further.

But without a spiritual element, we have "too literal-minded and serious … too small a vision of what a human being is." Psychotherapy can focus too much on content and not enough on the human being. It's changing more recently, focusing less on content and more on how we are with our experience. Welwood wants to stop trying to overcome emotional content and instead open up to it. If we can't open up to anger, for example, we end up trying to be nicer (people pleasing) or overmonitoring our behaviour to avoid triggers, which can create more stress. Yet there's even more ground to cover than just this.

Mentalizing, Mindfulness, and the Drive for Evidence

 In reading about attachment theory, David Wallin's description of Peter Fonagy's work was intriguing, so I went down that rabbit hole. 

Fonagy developed Mentalization-Based Treatment (MBT) to improve emotional regulation, as distinct from Jon Kabat-Zinn's Mindfulness-Based Stress Reduction (MBSR). Fonagy sees our mental development as relational, but in order to have empathy for others, we need awareness of our own feelings, which can be helped with mindfulness work. However, in looking at the evidence of efficacy of these separate modalities, I question the attempt, since Freud, to make psychology into a natural science. Each of the various ways to help are useful, but there's an element of the unknowable in the way when we treat them scientifically.

According to Wallin, Fonagy's focus was on developing the understanding of the mental states of others, which he calls mentalizing, to let us understand the depths of ourselves and others. For instance, it can help heal old wounds if we understand that dad's rejection of us might be due to his depression and not our behaviour as a child. Other people's reactions to us aren't just caused by us, but there are always multiple factors at play affecting how people behave. It seems very similar to Theory of Mind. He met Bowby in the 1980s, and studied adults' behaviour relative to their own descriptions of childhood attachment, and found, when comparing severely deprived to well-connected adults, that a weak attachment was correlated with a weak "reflective functioning" (the ability to understand behaviours in terms of their thoughts, feelings, and mental states). From this, he says psychotherapy should be the "effort to restore or kindle patients' capacity to mentalize," to simultaneously feel our feelings and reflect on their meaning. To help people develop mentalizing requires a relationship that mirrors and guides emotional responses.

The Necessity of Feeling Seen

Attachment theory is part of the vernacular now. Even the Norwegian show Porni mentions it, and the dramatic eldest daughter blames her mom for her “relational damage”! We’ve largely accepted the questionable idea that mom’s attentiveness in childhood creates our attachment patterns for life — the gist of the theory as it’s largely understood, but what’s usefully generalizable from the actual studies? There are many criticisms of the theory, yet some university psych courses applaud it without reservation. I’m dubious about it, but I also don’t want to entirely throw this baby out with the bathwater.

 This is a huge topic, and I’ll hardly do it justice here. There are a few excellent books on it, but part of the problem with how we understand the studies might be that the most nuanced books seem to be the most academically written, and likely the least read. As it morphed into popular consumption it may have strayed further from the original intention. On top of the reading, I went to a couple workshops on attachment to find the magic solution to all our relationship ills, and my big takeaway is this (for free!): if you’re a bit distant, consider being open to getting closer, and if you’re a bit clingy, try to step back a bit. It’s good advice to notice and change patterns that are a problem, absolutely, but I’m not sure it merits the number of workshops, courses, and self-help books that it’s provoked. At worst, some books actually counsel people to avoid any “avoidant or disordered people” as if there’s no saving them from their dastardly origins. Therapeutic discussions of childhood misconnections definitely have helped people better understand themselves, but I think this theory produces such volumes of celebration and condemnation because, in difficult relationships, it feels like the answer, but to parents, it feels like blame.

Attachment Theory Criticisms 

Heidi Keller’s The Myth of Attachment Theory (2022) is an extremely thorough takedown of the theory. If attachment notions make you feel like a crappy parent, this book is vindicating. She explores the offense of putting it all on moms both because of the narrow focus on a single person as well as on singular causation, but her best work is in exploring the creation of a norm of interaction from upper-middle class, western assumptions around what it means to be sensitive to a baby’s needs, an analysis that was made at the time as well: 

On Approaching Death

 CW: As the title suggests, there will be discussion of death and dying and some mention of suicide in this post.

I thought nothing of following up my last post on Irvin Yalom on the meaning of life with Yalom on the meaning of death, until I started writing here. The very reality of being a bit wary of broaching the subject reveals the strength of societal taboos against admitting that we’re all going to die. Until it’s staring us in the face, we delude ourselves into thinking we will get better and better, mentally and physically, despite that our brain starts to shrink in our 30s, and our joints and organs will start to give out not so long after. We work hard to keep death clean and sanitized so the reality doesn’t seep in too much, and we try to do all the right things to keep death at bay: exercise, various special diets, wearing masks to avoid viruses. We can fix some evidence of erosion with meds and surgeries, sometimes miraculously, but some people even hope to keep their brain going long after their body dies.

Yalom on Approaching Meaning

About 45 years ago, psychiatrist Irvin Yalom estimated that a good 30-50% of all cases of depression might actually be a crisis of meaninglessness, an existential sickness, and these cases require a different method of treatment. We experience this lack of purpose as boredom, apathy, or emptiness. We are "not told by instinct what one must do, or any longer by tradition what one should do. Nor does one know what one wants to do," so we feel lost and directionless. Instead of addressing meaninglessness as the problem, though, we've been merely addressing the symptoms of it: addictions, compulsions, obsessions, malaise. In today's context, it might suggest that even social media issues could be problems with a lack of meaning. 

The last sentences of his lengthy tome, Existential Psychotherapy, sum up his solution: "The question of meaning in life is, as the Buddha taught, not edifying. One must immerse oneself in the river of life and let the question drift away." How he lands here is an intriguing path through a slew of philosophers and psychiatrists. Even without symptoms of a problem, attention to meaning is necessary as it gives birth to values, which become principles to live by as we place behaviours into our own hierarchy of acceptability. 

"One creates oneself by a series of ongoing decisions. But one cannot make each and every decision de novo throughout one's life; certain superordinate decisions must be made that provide an organizing principle for subsequent decisions." 

Yalom doesn't, however, suggest coming up with a list of values that can become meaningful to us, but that we immerse ourselves in life to become more aware of which values we already have. 

WHAT'S THE POINT? IT'S FOR US TO DECIDE

According to Yalom, we've hit this crisis point in meaninglessness because we have the leisure to think and because our work is no longer clearly purposeful, both of which are relatively recent experiences for such a large proportion of civilization. It's no longer just the philosophers of the day asking, What's it all for? What's the point of it all? He takes the existential position that it's up to us to figure it out. 

Avoiding the Sausage Machine

click to read

I attended an excellent masterclass on "Trans-Inclusive Philosophy" with Sophie Grace Chappell last week, put on by The Philosopher magazine. She wrote Epiphanies and Transfigured, and this paper will be coming out in a collection soon. She discussed system-building in a way that lit some lightbulbs for me. I was waiting for the video to be posted before writing about it, but, in lieu of that, here's my transcription of it. 

She starts by responding to a call to build a theory of what gender, transgender, and gender identity are, and she clarifies the problems with gate-keeping off the bat. People will demand that before anyone's allowed to claim they're trans, they first have to define male and female, and she likens this to saying before you can sit on a chair and drink some tea, you first need to establish the necessary and sufficient conditions for chair and for tea, which is just ridiculous and very dangerous.

More interesting to me is her second argument, that defining what counts as transgender butts up against bigger problems with any system building. She prioritizing experience over theory because any attempt at an overarching trans theory will inevitably leave someone out. She has her own idea of what fits her, but it won't fit everyone, and other people might have great definitions for themselves, but they don't entirely fit her, either. 

On Weaponizing Empathy

Lots of people struggle with boundaries; luckily there are many little sayings along the lines of "not my circus, not my monkey" that help people remember not to get worked up about someone else's problems.

It's a useful strategy to notice when you're getting too invested in other people's lives. It's really handy to be able to let go of how people perceive you or whether or not they like you. We have a strong need for belonging, and we can sometimes be easily guilted into taking on the burdens of others just to get a little taste of perceived connection. So, sure, if it's not your fault or responsibility, then it's not your problem. 

There's a "Let Them" poem (by Cassie Phillips) that blew up then got somewhat plagiarized into a book deal for Mel Robbins. (I actually only clicked on that video because I somehow thought it was about the very funny comedian Mel Giedroyc! The thumbnail looked a bit like her, and, apparently, I didn't actually know her last name! But then I got hooked by the content.) Robbins' daughter used the phrase "let them" to talk her mom out of nosing in to her son's plans for prom. This is a great philosophy to shut down the busybodies in your life, but I can't imagine those two words flushed out into an entire book, and you could get this, and so much more, from books on Buddhism or Stoicism. I'm clearly not the target audience.

Accepting Difference

I recently watched the lovely film, A Real Pain, about two cousins (played by Jesse Eisenberg and Kieran Culkin) who travel to Poland to visit their departed grandmother’s home. In the first 20 minutes of the movie we’re shown two dramatically different personalities, both neurotic in their own way, but one more inward and the other laser focused on other people. It’s in our vernacular to understand the characters as introverted and extraverted, but there is still disagreement over what that means and, more importantly, what to do with that information.

I think we’ve veered off course since Jung’s Psychological Types, now over a century old, the precursor to the Myers-Briggs Type Indicator (MBTI) and more recently the Five-Factor Model (FFM) or “Big Five.” There are lots of other personality inventories like John Holland’s six Personal-Orientation types, Arthur Brooks’ mad scientists, cheerleaders, poets, and judges, and Martin Seligman’s top five strengths, but MBTI and FFM seem to have sticking power.

Developing the Capacity for Rational Choices

"As the world falls around us, how must we brave its cruelties?" -- Furiosa 

Imprisoned climate activist, Roger Hallam, recently wrote about the necessity of expanding emotional well-being as we face bleak events happening around the world. While climate scientists try to "help people through the horrific information that they are being given," they also need a way to manage their emotional reactions. We can no longer afford to merely distract ourselves from the inner turmoil. Beyond climate, we could very well be entering into a period of much greater conflict at a time of even more viruses, some destructive to our food system. When the watering hole gets smaller, the animals look at one another differently.

To move forward with compassion, at a time when divide and conquer strategies have created polarization and infighting, seems to require an effort from each one of us.

Hallam writes,

"We might want to think about why saint-like people are enormously influential, even powerful. . . . They see the world as dependent upon the mind. . . . They are not enslaved by the world; their minds are intent, driven even, to change it. They do not see this as an end in itself."

The Psychology of Diving into Polluted Water

We need external organizations to monitor for safety without any conflicts of interest! And we need to stop throwing people into dangerous situations as if human beings are expendable, expecting more and more to be available to fill their spot like it's flippin' D-Day!! 

Social psychologist, Dr. J. Offir, wrote a great thread on how hard it would be for Olympic competitors to not jump in the Seine despite how sick it was obviously making them: 

This was obviously a policy failure that we watched unfold in real time. ("Wait! Stop! Come back!" says Willie Wonka.) But it also demonstrates how people selectively trust authority figures when those leaders are saying what we want to hear. (This pattern of behavior has also been on clear display during the pandemic: people were suspicious of leaders whom they perceived as restricting freedoms, due to psychological reactance, but once those experts said to unmask and go to the mall, the same folks who had been disbelieving suddenly found faith in authorities' messages again. Ask people why they aren’t masking, and many will give you some variation on "the CDC said I don't need to.") 

The Art of Helping

"A little learning is a dang'rous thing;
Drink deep, or taste not the Pierian spring:
There shallow draughts intoxicate the brain,
And drinking largely sobers us again."
~ Alexander Pope

Is it, though? 

We're in a mental health crisis and people need more access to help. How much learning is necessary to help one another, and is it dangerous to listen and offer another perspective or even some suggestions without an advanced psych degree? In old movies, people told their stories to bartenders, hairstylists, or cab drivers for the price of a beer or trim or trip to the airport. They just needed a captive audience willing to listen to their worries Now we want people with credentials as if that will provide more certain results.  

But not all credentials are created equal. 

Last year BetterHelp got in the news for allegedly sharing confidential health data to social media sites, and was fined $7.8 million. TV writer Mike Drucker wrote:

"EVERY BETTERHELP AD: 'We're like therapy but cheaper and easier! We have people for every problem so you get care just for you!'
ACTUAL BETTERHELP: 'We're gong to set you up with a confused therapist that will ghost after two sessions. Also we told Facebook about your assault.'"

More recently, the New York Times had an article on scams in the wellness coaching industry, describing scenarios in which the new recruits were bilked out of massive amounts for "tuition" made up of a few hours of videos, and then were never helped to find clients. 

"Business is booming. . . . The number of coaches increased 54% between 2019 and 2022. Because the industry lacks standardized accreditation, it's most likely larger -- one of the dangers of life coaching is that anyone can claim the title of life coach. . . . [One coach] has spent an extraordinary amount of money on the certification and clung to the dream that had been sold to her . . . found herself short of clients and scrambling to make any income. . . . There is a problem in the industry of coaches who coach coaches to become coaches. . . . Life coaching attracts people who are vulnerable to exploitation."

No Going Back

Conflict, climate, and covid are showing us the worst of ourselves, but it might be what we need to find our collective humanity.

Tiberius wrote:

"The old world is no longer dying, it is dead. There is no going back to how things were after this genocide has been live-streamed in high definition and Technicolour for the world to see and our leaders to endorse. The bloodthirsty status quo has been revealed to too many people, and some cats will simply not go back into their bags. 

I know what the inside of skulls look like now. I know how bodies burn and how limbs come off. I know that children never look more devastatingly innocent than when they’ve been killed by a vicious army using the world’s most advanced weaponry. I know this because I’ve seen so many of them now—so many more than the sum of all the living children I will likely ever know. I know how much pain a person can bear and still exist in this world—just ask any Palestinian still alive. There are so many images I will never forget that everything outside of Gaza seems as meaningless as what colour socks I wear. 

Covid Info for Therapists

Many people are seeking out therapists to help them with the mental health issues that are a result of Long Covid.

Some of their experiences have been horrific. I've written about my own experience with a mildly annoying therapist who wanted to treat my "germophobia" with some CBT and a 5G repeller! The gaslighting is bad enough when you're trying to get help for dealing with administrators that turn a blind eye to the ongoing pandemic, but it's so much worse when you're seriously ill with a virus people still try to deny. The AIDS protests and ME/CFS activists have paved the way for Long Covid sufferers, but it's still frustrating that we have to do it all again! You'd think we could learn from the past 40 years. 

And little is worse when you're sick than being told that it's all in your head. 

Luckily, two burgeoning Marriage and Family Therapists, Olivia Belnap and Erin Batali, created a lovely and informative slide deck designed for therapists to help understand clients with Long Covid, and it could be shared with any prospective therapist to ensure they're on the same page before you start therapy. Beyond that, it would be useful for anyone in healthcare to scroll through to make sure they understand the seriousness of this. Or anyone really. 

Yalom's Gift

I recently binge-watched all of Group, a show inspired by a novel by Irvin Yalom, The Schopenhauer Cure. So I revisited Yalom's non-fiction to see how closely the series aligns to his actual practices.

The Gift of Therapy is a fascinating read from 2017 in which Yalom dives openly into his existential psychotherapy practice, explaining the four givens that affect how we think, feel and act that need to be explored at depth: death, isolation, meaning of life, and freedom (xvii). In the introduction, he jumps right into death denial revealed through a belief in personal specialness (xiii). Our current culture of selfies is likely rife with this! An existential perspective is best for clients who despair from "a confrontation with harsh facts of the human condition" (xvi). We didn't see much of this type of discussion in the show. In fact, the therapist didn't talk much at all beyond reminding the group to be honest and forthcoming.

On Group Therapy 

Yalom clarifies the distinction between group therapy and individual therapy in that group is more useful when "patients fall into despair because of their inability to develop and sustain gratifying interpersonal relationships." He offers two instructive points: a just-right structure to alleviate anxiety yet not miss potential revelations if turn-taking is too regulated, and the importance of individual summaries at the end of session recognizing that each person has a different experience of what happened. Yalom also writes and shares his own summaries of each session to group members to maintain continuity from one session to the next.

The Questionable Mindblind Theory of Autism

There was a cute social media post recently that asked kindergarten kids what gifts would be best for 30-year-olds. Of course there were lots of hearing aids and hip replacements in the mix. And it struck me that this could be a good exercise to gently raise awareness of our own stereotypes. Considering what give you would suggest for ___  type of person (slotting in an age, race, gender, ability, etc.), might be a way to flush out the tiny prejudices we might harbour about individuals that are part of a group. We always need reminders that we are each individuals despite all the group affiliations we have. This is especially true when we're talking about people with Autism Spectrum Disorder (ASD), who can be dramatically different from one another. This is a super long one with headings to help!

Covid Defences Matching Game

Match statements from friends, family, colleagues, bosses, and/or random strangers with "opinions," to defence mechanism! 

Dr. Mike Hoerger, a clinical health psychologist in the US, noted several psychological defence mechanisms being used to downplay the risk of Covid. This is his entire thread, well worth saving here for future reference. Each definition is followed by slew of examples to help the matching process and then a bits of textbook explanation for further clarification.

1. Denial - Pretending a problem does not exist to provide artificial relief from anxiety. 

Examples: "During Covid" or "During the pandemic" (past tense); "The pandemic is over"; "Covid is mild"; "It's gotten milder"; "Covid is not like a cold or the flu"; "Masks don't work anyway"; "Covid is NOT airborne"; "Pandemic of the unvaccinated"; "Schools are safe"; "Children don't transmit Covid"; "Covid is mild in young people"; "Summer flu"; "I'm sick, but it's not Covid"; Taking a rapid test only once; Using self-reported case estimates (25x underestimate) rather than wastewater-derived case estimation; Using hospitalization capacity estimates to enact public health precautions (lagging indicator); Citing mortality estimates rather than excess mortality estimates or citing excess mortality without adjusting for survivorship bias.

On Hearing Others

Louis Cozolino's beautifully written book on neuroscience has an explanation near the end about our necessary interconnectedness. 

Communication from one body part to anther happens when messages throughout our body are transmitted by neurons, but the transmission doesn't happen inside the neurons but between them, in the synaptic gap that separates the dendrites of one neuron from the axon terminal of the other. 

Then there's this bit that I love from Cozolino's book: It doesn't stop at our epidermis. The communication continues outside of our individual bag of bones into others nearby. The space between us, you and I, is a synaptic gap. The transmission of messages is continuous, not just inside our bodies but between them. So, maybe it's silly to think of ourselves as separate beings. We're one giant blob of a being, but some of the transmission circuits are damaged. Inside the body, damaged circuits manifest in a variety of ways, like Alzheimers' and Parkinson's. Between bodies, it feels to me like our systems are struggling to function from the lack of dendrites able to receive our signals. 

Cozolino says,

Goleman's Emotional Intelligence

Daniel Goleman's Emotional Intelligence: Why It Can Matter More than IQ, was originally published in 1995 but there's a more recently updated in a 25th anniversary edition in 2020. It's not quite updated enough, though. 

He added a new introduction, but no study or concept in the book was updated despite huge changes in our lives since then and tons of new studies with updated technology. It's kind of refreshing to read a book about the problem with kids today without a single mention of phones, but it feels a little sloppy. Goleman is a science journalist without a clinical practice in psychotherapy as far as I can tell. While his book is about how to be smart according to the front cover, it's also being used in psychotherapy. It's a fast, engaging read, but I have some concerns about the content and application.

The book outlines the need for emotional intelligence (EI) to be overtly taught to children, explains the psychoneurology of EI, argues for the primacy of emotional intelligence for success, adds in the need for emotional supports, and ends with a call for parents to be better educated as well. The principle underlying Goleman's text is that there are four specific domains, adapted from Salovey & Mayer, that emerge from the activity of our brain circuits that have more of an impact on our general well being than does our intelligence: self-awareness, self-management (formerly motivation and self-regulation), empathy, and skilled relationships. Goleman explains that people will be better off emotionally, relationally, and vocationally if they develop their emotional intelligence to identify and understand their feelings as they happen, manage them effectively, understand other people's feelings, and relate to others more positively. With a calm mind, people can make better decisions, which positively affects all other aspects of their life. Goldman has used these domains to help to develop educational programs to teach children Social-Emotional Learning (SEL) in the schools through the CASEL organization. I feel like it goes without saying that being able to manage our emotional experiences helps in other aspects in our lives, so I'm all in at this point.

Faulty Wiring

We're hard-wired for immediate survival, so we need reminders to help us persevere longterm.

Short-Term Wiring

For decades I taught a course, the Challenge of Change in Society, which used the lens of social sciences to try to understand world issues and explore how we ended up with our current challenges and how to enact change. I taught about how media provokes consumerism and how to counter that, and why to counter that, in our daily lives for the sake of the planet, the people, and our own well being. I often stepped outside of the social sciences to draw on thousands of years of philosophies and religions that have understood that happiness isn't the result of an accumulation of things. 

I practice what I preach for the most part. Curiously, though, by about mid-July each year, I'd forget everything I had been teaching and end up on a shopping spree until I'd come to my senses. Ten years ago I wrote about how much I need government policies to restrain my habits - that we all do - or else we'll literally shop 'til we drop, as a species, which is happening before our eyes.

Barring that reality, and knowing this would be an ongoing, lifelong issue, I got a tattoo on my Visa-paying forearm to remind myself that my actions affect the entire world. I borrowed Matisse's Dance and have the characters circling a re-forming pangea. We need to come together on this, collectively, to reduce ongoing suffering: 

Breathe, Grieve, Love, Repeat

We have very little direct influence over one another but we do affect one another in myriad ways that we often don't even notice.

I had a student once, about 15 years ago who I thought was a delight, as I did almost all my students. He was bright and funny and curious about history. He was also known to have significant gang involvement and may have killed someone by now or have been killed. Who knows. I can't barely remember anybody's name of the over 5,000 students I taught, so there's no looking him up. I likely had little impact on the general trajectory of his life, but I taught him a bit about the last century and solidified some writing skills. And maybe the fact that I warmly welcomed him into class on the rare times he showed up had a bit of an effect on him. I hope he's doing okay. 

About seven years ago I got into a big online argument about the meaning of a film, and it's was beautiful. We each had points and tried to persuade the other, and neither of us budged, and it got absolutely nowhere, but it was a delight to debate what we each saw in a work of art. Neither of us even considered name calling or threatening one another's life or getting all our buddies to destroy the other online. 

Remember those days?? It wasn't that long ago.

Because we can't always see how our actions will affect others in future, we have to take care with what we say and how we say it and watch for the direct effect on others. We have to be more careful online where we can't see one another's facial expression to check if they got that we were just joking or to notice the first sign that we're upsetting them. That concern with caring is waning -- I think largely because we don't get immediate facial feedback. But it's vital we get it back for the coming years.