Saturday, September 22, 2007

Integral Psychotherapy

When I read Ken Wilber's Integral Psychology many years ago, I thought I had found the holy grail of psychology models. In some ways that is true -- Wilber's book offers a theoretical framework by which to look at various pathologies within a developmental model. Some therapies are more effective for certain pathologies than for others, depending in large part on the source of the pathology developmentally (for example, early childhood or existential). Understanding the spectrum of development and the available theories of treatment allows the therapist to tailor the therapy to the pathology. In essence, no one approach works for all clients.

As I have started "studying" some forms of therapy that are currently in use (self psychology, relational psychotherapy, internal family systems therapy, object relations therapy, and so on), what has become painfully clear to me is that Wilber has never worked a day in his life as a therapist. Theoretical frameworks are all well and fine, but they are generally useless in the therapy room. For all his understanding of theory, I can't recall a single instance in Integral Psychology in which Wilber speaks about the relationship between the therapist and the client, which from my experience is the foundation that must come before any theoretical model.

One book that I have recently started is Relational Psychotherapy: A Primer, by Patricia A. DeYoung. Until very recently, I had never heard of relational psychotherapy [thanks Susie!], but having just begun this book, it feels to me like an actual integral psychotherapy.

The last time I was in therapy, the single most beneficial moments came when I was able to express some fear or anxiety and Maude (my therapist) was able to hear me and respond with empathy -- not pathologizing my feelings in any way, but being totally present to what I was expressing.

In relational psychotherapy, empathy on the part of the therapist is the key to the therapeutic relationship. Without empathy, there cannot be the safety for the client to become open and relearn old and dysfunctional relational patterns.

The second key element of relational psychotherapy is the understanding that whatever fears, anxieties, and other difficult feelings the client has are not merely within the client, but rather were learned and are still expressed within relational patterns -- where the self interacts with others. Whatever challenges the client is facing are not inherent in the client -- they occur in the boundary between self and other.

DeYoung says:

[W]hat's wrong is neither entirely inside the client, in his psychological makeup or dysfunctional patterns, nor entirely outside in the world, in forces that impinge on him. Instead, according to a relational model of psychotherapy, the problem exists in those spaces or activities where outside influences and inside responses interact to create the shape and feel of a "self."

This is very similar to the internal family systems model. Moreover, what Richard Schwartz is doing in internal family systems with being totally present and responding with empathy at all times (knowing there will be lapses, and that those lapses must become a part of the therapeutic process) -- responding from the Self, the internal witness -- is not much different than this model. I suspect there are a lot of very good therapists operating from a relational perspective without knowing it.

The true value of this model as an integral psychotherapy is that therapists are free to -- and are encouraged to -- draw from a variety of therapeutic interventions, while always being aware that the authentic relationship with the client is the primary concern.

The therapist must be able to be open and fully present and empathic for the relationship to flourish. Empathy is not a low-level developmental trait -- it requires considerable self development and a significant degree of developmental advancement. If we consider empathy a developmental line, it can be developed separate from other lines, but this is more difficult.

It seems to me that in order for a therapist to effectively employ this model, there needs to be some familiarity with the Self, with higher order compassion and empathy, and with the ability to stay present even when his/her own emotions are being triggered by a difficult client or a challenging moment in the therapy.

Knowing one's parts, or subpersonalities, would be incredibly useful in doing this kind of work. If the therapist is able to recognize when a part has been triggered in the therapy room, and if s/he has some experience in knowing how to stay grounded in the Self, rather than letting the part take over, then the work would be much easier.

Any version of an integral psychotherapy must first recognize the value of the empathic relationship with the client, the value of multiple tools for different issues, and that the self/other relationship (aside from certain severe psychological defects) is the fertile ground where most pathologies arise.

Hopefully, by the time I am practicing, there will have been more work done in this area.


Anonymous said...

Hi William: I hear your concerns about the challenge of going from the 50,000 feet of integral theory to the 5 feet of therapist and client. I think many of us who are interested in integral theory have struggled with this.
You might want to check out the special issue on integral theory that came out in Counseling and Values Vol. 51(3), April 2007. There are six articles that begin to bridge that gap. I said begin, because this will be something for all of us to work on together who are interested in what is implied for therapy by post-postmodernism.

We need a conference or something where we can get together in person and talk about this...

william harryman said...

Hi Durwin,

Thanks for your comments. How do I get a copy of that issue? Are there any papers I can download? I'd be willing to buy a single issue, since my brief search shows that it's an expensive subscription for a working stiff.

I think the idea of an integral psychotherapy conference is a great idea. I'd do whatever I needed to attend. I think there is a lot of work to do in bringing integral theory down to the level of daily work with clients.