Friday, October 09, 2009

Transformational Bias in Integral Psychotherapy?

I don't know that there is a transformational bias in integral psychotherapy, but I definitely experience such a bias on occasion in how I look at clients - and I am sure that it does not serve the client's best interests. I want to explore that possible bias here.

This musing/exploration was inspired by a discussion in my individual therapy class this week, a case study on a man named "George." I'll provide details below.

First, let's define some terms so that we are clear on what I am talking about here.

Integral Psychotherapy:
Integral Psychotherapy is a term that has been developed independently by both by practicing psychologists and psychotherapists who are also students of Sri Aurobindo and the Mother (such as Brant Cortright, Alok Pandey, and Soumitra Basu) and by Ken Wilber and the Integral Institute. It is therefore used in two different contexts, although both within the context of integral thought: referring either to the synthesis of western psychology and psychotherapy with the teachings of Sri Aurobindo and the Mother, or to to the application of Wilberian Integral theory to psychotherapy and personal development.
I am using the Wilber version here, as outlined in Integral Psychology. Essentially this entails the use of his quadrant model, developmental lines and stages, as well as states of consciousness and personality types - all of which is generally referred to as AQAL. For an overview of integral psychology, check out this article by John Rowan, or this video featuring Jeff Soulen.

A horizontal change in surface structures or patterns; the shuffling and stabilizing of
those surface structures. (Includes agency and communion as primary expressions.)
Essentially we are talking here about change within a stage - an expansion of tools or perspectives within a given developmental stage.

A vertical change in deep structures. The emergence of deeper forms of agency and wider communions. A shift to any higher level in a holarchy. (Includes Eros and Agape as driving forces.)
Most often, transformation is talked about as an upward shift in developmental stage, though not exclusively.

Both of the preceding definitions are taken from the AQAL Gloassary - see the glossary for meanings of other terms in the definitions

For the purposes of this discussion, transformation will be seen as the transition from a lower, less complex perspective to a greater, more complex perspective. The stage model I will be referring to will be Robert Kegan's subject-object model of complexity of mind, mostly because the case study under examination lends itself to that particular model more than others.

The Case:

I'm going to abbreviate the case study we were given in class for the purposes of this blog post, so here are the particulars:
George is a 54-yr old man whose wife made an appointment for him two months after he had found that his father (who was living in a guest house on their ranch) had shot himself to death with a shotgun. Since then he had become withdrawn, had lost his appetite and lost weight, had stopped going into work at the business he had taken over from his father years early and expanded considerably, and had began to sleep poorly and have nightmares when he did sleep. George was an only child and his mother had passed away two years prior. He was married with two sons and an 18-year-old daughter still living at home.

George stated he had been a hard worker his whole life, but recently had no desire to get up in the morning, and even less desire to go to work. In fact, he was questioning whether or not he wanted to continue with the family business at all. He felt like simply riding and raising horses (he can afford to do this due to his success as a self-made business man).

While George felt sincere grief and some responsibility over his father's death, he recognized that his father's health was failing and that his father never wanted to be a burden on anyone. More troubling to George was his lack of interest in the family business and his considerable guilt over not caring about it any more.

He seemed to be questioning what he wanted to do with his life at this point and was experiencing dissatisfaction and restlessness.
So the assignment was to discuss the treatment plan we would develop for this man. There was some disagreement as to whether we treat the depression or the grief first, and what to do about the potential PTSD (too early to diagnose in many opinions). We concluded that dealing with and resolving the grief would most likely reduce and/or remove the depression, which is how it played out in the real world.

So I'm sitting there thinking, "WAIT! There is a huge opportunity here for this man to evolve a bit."

I could clearly see that this death was a transformative crisis that had opened George to a potential new way of being in the world, a more authentic and more complex perspective. George was deeply embedded in what Kegan calls the interpersonal stage and now refers to as "socialized mind." He followed his father into the family business, as had one of his two sons. He was a man of responsibility and loyalty to his family. Those qualities are great, but he also seems to be constrained by self-imposed limits on what he can do in life.

This perspective had been shaken by his father's death. He no longer had interest in the family business. He did not seem to want to follow the same path his father had followed (who had continued going into the business every day even though he did not actually work). He was restless and not satisfied with how things were going in his life. He was thinking about raising horses and spending more time riding.

There was a tremendous opportunity here for George to shift from socialized mind to "self-authoring mind." Even if there was not a full stage-shift, he was in that liminal space often created by loss when one is open to change (see this article on the ritual structure of change for an understanding of liminal space in the change process) and could have certainly broadened his perspective with the right guidance.

As I sat in class thinking these thoughts, it occurred to me that he did not go to therapy to evolve. In fact, he had no intention of going at all and did it simply because his wife of 30 years wanted him to go.

As an integrally-informed (student) therapist and as someone who has done a tremendous amount of self-work in seeking transformation, I have a bias toward transformation over translation - and I think that many integral folks do. Even Kegan, a well-known father of the integral psychology movement, seems to express this bias in his books (all of them are designed to help people evolve through stages by identifying language and immunities that block evolution).

But is this the best thing for the client?

In George's case - and to an extent I see him as a fair John Doe representative - I'm not so sure that what I would have wanted for him was the best thing for him. I suspect that the outcome generated by our professor (his therapist) was more appropriate to his needs and life.

Is there a bias toward pushing clients into transformation among those who practice integral psychotherapy? I don't know, but I certainly can entertain that bias - and it's something I need to look at closely. It is not my job to "grow" clients (as Don Beck has been known to say regarding his Spiral Dynamics Integral model). It is my job to serve the client as best I can.


Karl Higley said...

Wow. Well said.

I've been sensing something for a while now, and you just put some great words to it. I'll probably suggest this as a discussion topic here in the DC integral meetup.

william harryman said...

Thanks Karl!

Unknown said...

Great post! Thanks for sharing your personal insights as a therapist and student. I am looking forward to more like this.

Kind regards