Change as process and Interpersonal Psychotherapy (IPT)

This post aims to summarise a paper on Interpersonal Psychotherapy:

Lipsitz, J. D., & Markowitz, J. C. (2013). Mechanisms of change in interpersonal therapy (IPT). Clinical Psychology Review, 33, 1134-1147.

Psychiatrists Klerman and Paykel, in 1969 at Yale University began to investigate the clinical efficacy of tricyclic antidepressants accompanied by and separate from, what they described at the time as ‘supportive psychotherapy’. The expectations for success for the psychotherapy component  of the treatment for depression were not high – randomised control trials were just beginning to be used with Beck’s Cognitive Therapy, with Beck’s own-designed manual for the same, as yet otherwise, pscyhotherapy remained largely untested. Successful outcomes in time-limited treatment beyond the original research group which provided support mostly for middle aged American women in extended family environments (Weissman, 2006), have included bipolar disorder (Frank et al., 2005), social phobia (Lipsitz, Markowitz, Cherry & Fyer, 1999), posttraumatic stress disorder (Bleiberg & Markowitz, 2005) and others.

The driving assumption in developing IPT  was the sense that there would be an accompanying interpersonal disturbance connected to the mental health concern – something rarely recognised with psychopharmacologic or Cognitive-Behavioural Therapy (CBT) approaches. The early development was influenced by:

– writings from Harry Stack Sullivan (1940), on the interpersonal nature of psychiatric illnesses, and the way that interpersonal behaviours form significant emotional events for people, Sullivan includes interpersonal relationships as a basic need and an understanding of the structure of the self as articulated by ‘reflected appraisals’ from others, with the therapist role illuminated as participatory rather than expert;

– ideas of Adolf Meyer (1919) and his analysis of the person’s relationship to their environment by using life charts to track the course of illness in a person’s life which later evolved into recognition of enduring social conditions and chronic stressful life circumstances;

– and the work of John Bowlby (1969) on attachment, with individuals making strong affection bonds as a function of complex biologically informed systems, with separation or threat of separation giving rise to emotional distress and depression, for people.

In common, all theorists place human relationships as central to emotional health and illness. Until the emergence of IPT, there was a strong focus from interpersonal psychoanalysis and attachment theory on the internalised effects of early childhood experiences, even in later life. This meant the therapist had to access these early life experiences to effect change. Epidemiological research at the time on stress, social support and illness had revealed that the current interpersonal context was highly informative for the onset and repeat course for psychiatric disorders. An increasing focus on ongoing dynamic interpersonal interplay was emerging at the same time in relational theory, setting groundwork and structure-form for the possibility, of interpersonal psychotherapy.

IPT focuses on four interpersonal change processes – 

1) Enhanced social support including awareness of social circles of support, emotional regulation within the social context and identification and recognition of roles inhabited and relationships so nurtured. Therapy functions transitionally as a safe space within which to explore a motivation to change, different possibilities within self expression during change, and identity shifts on the other side of change. The person may come to be able to appreciate the importance of social support in their own life and to be able to more easily ask for help when it is needed, from others, and also to understand that the present concern is not the individual’s fault, so enabling a needed shift from the presently inhabited role. There is evidence for example, that establishing daily social routine has a positive effect on diminishing the disruptive aspects of bipolar disorder and bipolar episodes (Frank et al., 2005);

2) Decreased interpersonal stress includes a focus on the effects of negative interpersonal experiences that extend beyond the impact of a lack of social support. Noting that although not all stressors are interpersonal but many are, the type of approach taken to enable diminished interpersonal stress will vary according to the type of interpersonal situation chosen as focus by the person, but may for example include perspective taking for family situations of high expressed emotion (EE), and psychoeducation regarding the impact of the expectations of others with regards to role transitions, role disputes and perhaps too, grief;

3) Facilitated emotional processing – IPT distinguished itself from Beck’s Cognitive Therapy by it’s focus on affective states and the way that these are interpersonal in character, rather than placing an evaluative framework around them. Intensive work on recognition of emotional responses, acceptance and validation of the same and finding constructive means for an ongoing appreciation of emotional responsivity can yield long term broad benefits, for people, including greater attunement to own feelings and other’s responses;

4) Improved interpersonal skills, acknowledging that improved interpersonal functioning is a general universal and often unstated goal within all psychotherapies, IPT seeks to adapt interpersonal skills already possessed by the person, to assist in diminishing the discomfort associated with the presenting concern. This may secondarily yield symptom relief via improved social support and decreased stress, and requires no particular methods or didactic approach, rather employing communication analysis and role play where appropriate;

IPT is thus activated within a ‘pragmatic, coherent, and affectively charged’ focus on a central interpersonal issue in the person’s life.

The interpersonal issue has intersubjectivity and absence as defining features, mapped in four possible ways:

– grief – bereavement following the death of a loved one, which remains unresolved in a personally satisfying way in present interpersonal contexts;

– role transition – where major life change, loss or absence of some previous role disturbs ongoing intersubjective interaction in a discomforting way;

– role dispute – overt or covert conflict in an important relationship, an absence of accepted roles, between subjects;

– interpersonal deficits/role insecurity – where interpersonal interaction is impoverished or uncertain in some way not identified and handled within the first three roles – there is an absence of recognised role, socially among and with others.

IPT has three phases – firstly, evaluating the conditions for the issue and looking at an interpersonal inventory for present life circumstances and past relationships; secondly, providing a case formulation which includes as well as the grounds for interpersonal psychotherapy itself a transitional sick role which is intended to alleviate responsibility for current difficulties so that  a different perspective might become available for them and a linking might be made to the information in an interpersonal inventory, and then treatment planning which includes planning for the end of therapy from quite early in the process, reviewing progress made in the interpersonal context and anticipating future possible setbacks, developing strategies to handle them, together.

IPT explicitly works to instill hope and create positive conditions for change. It employs the medical model, specifically to work with the client’s interpretation of the current issues as faced, identified as the present sick role, emphatically validating the person’s current distress, and then working with them to enquire as to the healthy role they might like to inhabit. It thus is described as trans-diagnostic – looking to interpersonal considerations rather than particular symptoms, thought and behaviour that the psychotherapy community might otherwise  expect to be associated with a particular disorder.  An internal flexibility in adaptation thus enables the integration of IPT approaches regardless of the presenting problem – the structure of the therapy remains the same, regardless.

Although research on stress and social support indicates a causal role for the interpersonal context, IPT retains a reciprocal relation between the psychiatric concern and the interpersonal connections in question, seeing both the ‘sick role’ and other people as contributory to the current interpersonal container. In a diathesis-stress (vulnerability) analysis, this entails a focus on what maintains the stress in a person’s life in biological, psychological or behavioural registers.

Recognising distinctions between therapy change process, interpersonal change process and the change mechanisms themselves illuminated by Doss (2004), IPT is distinct from most individual therapies insofar as it does not locate a problem within an individual, but rather works to keep focus on relationships to other people and the indiviudual’s relationship to the current concern, to enhance the life situation of the person and alleviate what it is that the concern might address. Whereas practices outside of the therapeutic context for individual therapies involve solo homework, for example, identifying unhelpful cognitions and affects that might have occurred throughout a day, IPT keeps attentive to the interpersonal situation and the occurence of emotional responses within the interpersonal situation, working so as to reduce discomfort and increase capacity in psychoeducation, rehearsal and personal awareness. Therapists and clients can explore out-moded role-concepts, interpersonal approaches, emotional expression, with greatest efficacy where the therapist maintains focus on the interpersonal context (Frank et al., 2007).

Core assumptions for IPT include that the focal interpersonal problem has sufficient salience so that resolution includes improved social support and diminished interpersonal stress in a meaningful and everyday way, via improved emotional processing, which is interpersonal in essence, and better social skills. Clinically, people often present with more than one identified concern, and further work is needed to establish the extent to which other factors such as self-esteem or self-mastery may play more of a role than the interpersonal re-orientation, persay. There are difficulties associated with attempts to identify the extent of interpersonal change, for example, it is non-linear, and it may be the case that there is a heightening of distress related to factors outside of the chosen area that meaningfully influence therapeutic outcomes.

References

Bleiberg, K. L., & Markowitz, J. C. (2005). A pilot study of interpersonal psychotherapy for posttraumatic stress disorder. American Journal of Psychiatry, 162, 181-183.

Bowlby, J. (1969). Attachment and loss v. 3 (Vol. 1). New York: Random House.

Frank, E., Kupfer, D. J., Thase, M. E., Mallinger, A. G., Swartz, H. A., Fagiolini, A. M., … & Monk, T. (2005). Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Archives of General Psychiatry, 62(9), 996.

Lipsitz, J. D., Markowitz, J. C., Cherry, S., & Fyer, A. J. (1999). Open trial of interpersonal psychotherapy for the treatment of social phobia. American Journal of Psychiatry, 156, 1814-1816.

Lipsitz, J. D., & Markowitz, J. C. (2013). Mechanisms of change in interpersonal therapy (IPT). Clinical Psychology Review, 33, 1134-1147.

Meyer, A. (1919) The Life Chart, in: A. Lief (Ed.) (1948) The Commonsense Psychiatry of Dr. Adolf Meyer. New York: McGraw-Hill.

Stack, S. H. (1940). Conceptions of Modern Psychiatry. New York: McGraw-Hill.

Weissman, M. M. (2006). A brief history of interpersonal psychotherapy. Psychiatric Annals, 36, 553-557.

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German Idealism via Zizek

The big four of German Idealism, via Zizek.

Kant

Where Kant introduces the question of a difference between ontic reality and an ontological horizon, he ruptures philosophical history – previously no analysis was available of appearance as illusion versus appearance as phenomenon. With Kant there is no longer any need to derive immortal Platonic truths hiding beyond the reality that we know, rather the concern emerges as discerning the conditions of possibility of appearing of things as an occurence.

The implications of Kant’s critique of all metaphysics is far-reaching, for in these conditions it is possible to notice that one cannot directly access or get at truth, and further, philosophy is no longer defined by its truthful explanation of the totality of being, but rather the successful accounting of how illusions are illusions, and also how these are structurally necessary and unavoidable, not just accidental.

Schelling

In producing his treatise on human freedom and the three versions of the ‘ages of the world’,  Schelling reveals a whole new universe, the universe of pre-logical drives, a dark ‘ground of Being’ which is ‘in God more than God himself’ – here, the origin of Evil is not located in a Fall from God, but rather, completely within the very heart of God. So, in humans, where this Evil is always subordinated to its partner Good, an assertion which is against a divinely recognised ‘divine will’ will automatically appear in this form of opposite, this form of evil. For Schelling (so different from Hegel), the void which for Hegel sits within the poorest version of being (which equals nothing) for Schelling the void is the negative affirmation of the positive’s desire. Schelling’s void is a ‘living nothing’, a yearning and a hunger of a void to be filled by positive being.

Höderlin

For Höderlin, the trans-subjective order of being does not have a gap or void in it’s ground (as was introduced by Schelling), rather, subjective self-consciousness strives to overcome a lost unity with the Absolute. It’s way to do this is to create a narrative linking substance and subjectivity – which notably is the exact inversion of a subjective identity (I=I), where the very from (the narrative reconciliation) undermines the possibility of a unitive identity.

Hegel

Takes Höderlin’s tragic gap which separates the reflecting subject from pre-reflexive being and locates it entirely within the subjective being itself. Here, then, it is our very division from absolute being which unites us with it – so, it is not only that we have a (narrative) identity which holds identity and non-identity, but also that there is a narrative division which holds (or better, divides) division and non-division. Being then no longer is an inaccessible pre-reflexive ground, being rather is the result of self-relating division – where division divides itself from itself. The loss supplemented by narrative is inscribed into being, it’s very self.

What Hegel makes available, in this neat twist of Höderlin,  is this: our very failure to be able to reach a full truth is evidence of that truth – the ontological failure of truth is not an epistemological obstacle, but a tag to epistemological reality.

Zizek (of course) rounds off explaining about the shocking obscenity which is an inevitable feature in The Aristocrats joke and how this pales in comparison to the shocking reality of a dialectical reversal. He also explains in the just-below notes about the shocking experience of reading a Catherine Malabou (among other French authors) where, after reading the work, literally nothing remains the same, pointing to a kind of whole world rupture-revolution via immersion.

Zizek, with great love of antagonism, one could suspect.

Zizek, S. (2012). Less than nothing: Hegel and the shadow of dialectical materialism. Verso Books.

Critical Realism – towards an ontology of absence

A summary of the emergences contained within what is described as the school of critical realism, in preparation for a talk on ‘Vulnerability in Absence’, at the ASCP 2013 Conference in early December, 2013, UWS, Sydney, Australia.

Critical realism can be appreciated as underscored by five unfoldings:

– Transcendental realism in ‘A Realist Theory of Science’ (1975) – engaging a field beyond what Bhaskar describes as the epistemic fallacy – the reduction of knowledge to being, an outcome of the scientific Enlightenment;

– Critical naturalism in ‘The Possibility of Naturalism’ (1979) – overcoming the dualisms inherent in the human sciences by presenting the grounds for a third reconciling position. So, positivism and hermeneutics were united under realist approaches to science;  relationism is the groundspace by which collectivism and individualism are conjoined;

– Explanatory critique from ‘Scientific Realism and Human Emancipation’ (1986) – taking three forms, as immanent critique [identifying theory/practice inconsistency], omissive critique [identifying an absence suggested by the inconsistency], and explanatory critique [in addition explains why the deficient theory is believed];

– Critical realism(CR) (extending to: dialectical critical realism, and transcendental dialectical critical realism) (1989) – asking the Kant-inspired question, ‘what has to be the case, in order for scientific knowledge to become possible?’, retroductive strategy requires an acknowledgement, according to Bhaskar, that the word, as we find it, is structured, differentiated, and changing. Dialectical CR was thus graced in an appreciation of the fact that for the world to be structured, differentiated and changing, a thematisation of absence was essential.

– MetaReality (2002) – proposal of a principle of non-duality co-present and permeating the dual world of contradiction within which we live. This non-duality is a potentiality or order of enfolded being at a different order of sensibility from that of conscious thought, itself.

Ref: Bhaskar, R. (2008). A realist theory of science. Taylor & Francis US.

The implications of Madhyamika view and Buddhist emptiness for the interpretation of self-process and self-concept in Western psychology.

An ‘inadvertent rediscovery of the self’ (Hales, 1985) occured for Western psychology after the cognitive revolution of the 1970s & 1980s, shifting the focus of the field from behaviourism to internal attribution models of self (Heider, 1958) and to motivation theories such as self-efficacy (Bandura, 1977) and self-determination (Ryan & Deci, 2000). A comprehensive account of the self is enhanced when self is viewed as a process, for example, as ‘a reflexive phenomenon that develops in social interaction’ (Gecas, 1982), or as the process of meaning making engaged in narrative identity formation (Singer, 2004). Accounts of self-as-process can be considered distinct from those of self-concept, which is the product or outcome of a self-process (Gecas, 1982). From its earliest inception, Buddhism’s emphasis on mental training (Dambrun & Ricard, 2011) has relied on accounts of self grounded in process (Kakol, 2002). A survey of Buddhist systems from the perspective of the late-developed Madhyamika Buddhist school reveals an evolution of self-concepts and self-processes, where later systems critique earlier approaches (Kakol, 2002). At a time when benefits of self-process approaches are beginning to be realised by Western psychology, for example in inclusion of narrative approaches in personality (McAdams, 2006) and in embodied mind and enactive cognition models (Varela, Thomson & Rosch, 1992), a map of alignments and distinctions between Madhyamika and Western approaches to self-process stands to reveal a probable trajectory of emergent self-process models in Western psychology, as the cultures come into deepened contact. This essay will chart methods, systems and Buddhist concepts not often addressed in Western accounts of the Buddhist ‘self’.

The embrace of Buddhism in Western psychology begins at least from Jung’s 1938 Terry Lectures, with explicit adoption of Buddhist terminology for the self (Steffney, 1975). From this time on, notions of Buddhist ‘self’ employed in Western discourse have frequently referenced highly esoteric texts and mystical formulations of self, where self or its absence is described in quite obscure ways – for example as ‘thoughts…without a thinker…feelings without a feeler’ (Mosig, 2006) or as an ultimate emptiness both of self and phenomena, described as ‘no-self’ (Muzika, 1990).

Yet Buddhist practice in cultural context embraces self-concepts not dissimilar to everyday Western views of self. Instruction on moral conduct (Sanskrit: sila) relies on self-concepts that include the agency to engage everyday ethical practice (Wallace & Wallace, 1997). Insight meditation instruction (Sanskrit: samadhi) may require high speed search for the characteristics of self, such as personal likes and dislikes (Brown, 2006). Both sila and samadhi are understood as essential for the realisation of wisdom (Sanskrit: prajna) or ‘no-self (Wallace & Wallace, 1997). Comparing to Western psychoanalytic theory, self-representations employed in the samadhi compassion practice of exchanging self for others (Sanskrit: tonglen) are not distant from self-formulations of object relations theory, which explains self as a consolidation of experiences of continuity, formulated in graded differentiations of internalised self-images (Kernberg, 1977). In tonglen, self-images are formulated sequentially as internalised representations of self, self-as-enemy, and self-as-friend, from both own and another’s perspective (Halifax, 2012).  Here, as practitioners learn to negotiate boundaries between self and other, self-concepts are employed in a practice that reveals self-as-process, enculturating liberation from fixed self-concepts, a result equal to a positive outcome, for Western psychoanalytic therapy.

However for some commentators the Buddhist idealised end state of no-self sits at odds with Western psychoanalytic approaches to ‘healthy’ psychological development, which include boundary awareness, perspective taking, critical thinking and integrated psychohistory as essential self-elements (Engler, 1983). Engler also proposes that psychopathology may be present for Westerners drawn to Buddhism, where failures in early development creates preference for diminished boundaries between self and other (Zetzel, 1971), and an attraction to Buddhist authoritarian style of instruction, with associated poorly developed self-responsibility and susceptibility to regression in negative transference reactions (Kernberg, 1977). Yet these observations miss the point of Buddhist psychology, which not only relies on boundaries between self and other in practices such as tonglen, but also is less about adoption of ‘healthy’ self-concepts and self-elements than it is about reducing suffering by revealing the process through which self-concepts are derived, thus permitting liberation from psychopathology, itself.

In this way, where Western psychotherapy employs intersubjectivity to reconstruct earlier experience in order to reveal the mechanisms through which the self may be arresting its own development (Muzika, 1990), Buddhism asks that insight be applied self-referentially, to deconstruct the self (Epstein, 1995) and arrive at a view of unbounded, effortless awareness, free of self-restriction (Brown, 2006). In this process of self-referencing for the purpose of deconstructing self-concepts, Buddhist practice can be understood to work with strong forms of self, even as transcendent phenomenal experience of ‘no-self’ or selflessness may arise as an outcome of practice.

Question can be raised about the appropriateness of attributing a monolithic definition of ‘self’ to Buddhism as a whole. The concept of emptiness is rarely addressed in Western psychology’s accounts of Buddhist approaches to the self, yet emptiness is crucial to shifting from opaque self-concepts to transparent no-self experiences for Buddhism generally (Metzinger, 2003). Emptiness can be understood as lacking in inherent, individual existence (Hopkins, 1977). As later tenet systems evolve by critiquing earlier systems regarding conceptions of emptiness and selflessness, distinct understandings of self-process and self-concepts emerge by mode of inclusive transcendence (Kakol, 2002). Examples from the tenet systems follow.

Earlier systems such as the Vaibhasika and Sautantrika schools recognise selflessness as removal of subtle constructions of self, characterised by uniting separate existences of mind and body for the latter, and as lacking independent, permanent existence for the former (Hopkins, 1977). Later developed tenet systems point to more subtle gradations, including recognising a lack of distinction between subject and object as the ground of all reality for the Yogacara system, and for Madhyamika, realising self and phenomena as occasioned fully by the causes and conditions giving rise to their respective existences, with infinite causes and conditions associated with each moment, so that self and phenomena can be described as radically open and always incomplete (Kakol, 2002).

A parallel to this evolution in meaning of self-as-process can be drawn for Western psychology. The mind-body dualism of the Sautantrika self-system is reflected in the early psychology of Descartes, who held the body was divisible but the mind wholly indivisible, and thus the mind must be separate from the body (Bogen, 1986). The Vaibhasika realisation of a lack of independence for self from others is echoed in Freud’s earliest insights into essential and unconscious family relationships that form the basis of ongoing relational capacity, with some commentators suggesting the work of psychoanalysis lies in unmasking individualism (Poster, 1979), exactly replicating revelations incipit in Vaibhasika teachings. The Yogacara system resonates with Western psychology’s recent enactive mind accounts of self-process, where for both systems an individual’s reality is understood as constructed within the meaning derived through intimate embodied interactions with surrounds, beyond subject-object distinctions (Varela, Thompson &  Rosch, 1992).

The inclusive monism of Yogacara was transcended by inclusive relativism in Madhyamika, a system unparalleled in the West (Kakol, 2002). The Madhyamika practitioner navigates a middle way between extremism and nihilism, or samsara and nirvana on the way to realising no-self (Hopkins, 1977). In the navigation, Madyamika invokes self-process, in the form of the self who navigates (Metzinger, 2003). With realisation of emptiness of emptiness, where samsara and nirvana are seen as not-two, Madhyamika draws on a principle of ‘views’. Closed views contain self-concepts that, bound together, would be self-contradictory. Open views however are unbounded and thus, non-contradictory, but also remain always incomplete (Kakol, 2002). In structure, open views bear some similarity to narrative accounts of personality which give credence to enduring traits, contextualised adaptations and whole life story as non-contradictory elements of personality (McAdams, 2006). However, Madhyamika’s open views include a further twist, where realisation of each view ‘event’ reveals a creative synthesis which contextualises constructs into perspectives that are understood as contingent upon all other events that have already occurred and are yet to occur (Kakol, 2002). Interpreted in the light of self-process, a Madhyamika ‘view’ not only maps the assumptions of postmodernity in recognising the context, construct and perspective that occasions each unique self-process (Sleeth, 2006), it stretches self-as-process to infinite and eternal potential which is dynamically co-determined in ongoing interaction. Western psychology can be seen as yet to produce any equivalent to the Madhyamika open view.

As demonstrated in this essay, to the extent that Buddhism has evolved distinct concepts and processes of self via inclusive transcendence, no monolithic reconciliation of Buddhist ‘self’ to Western psychology is available. Charting the inclusive transcendence of Buddhist interpretation against the development of Western psychology’s understanding of self-process and self-concepts, and looking to the degree to which Buddhist practice in context draws on easily accessible self-concepts for Westerners, there is every possibility that ongoing dialogue between Western psychology and Madhyamika Buddhism may yet see the emergence of a Western psychological self-process informed by concepts of emptiness and view, adequately embracing realms future and past, beyond limitations of context, construct and perspective, in the here and now.

References

Bandura, A. (1977). Self-efficacy: Towards a unifying theory of behavioural change. Psychological Review, 84, 191-215.

Bogen, J.E. (1986). Mental duality in the intact brain. Bulletin of Clinical Neurosciences, 51, 3-29.

Brown, D.P. (2006). Pointing Out the Great Way: the Stages of Meditation in the Mahamudra Tradition. Massachusetts: Wisdom Publications.

Dambrun, M., & Ricard, M. (2011). Self-centeredness and selflessness: A theory of self-based psychological functioning and its consequences for happiness. Review of General Psychology,

Engler, J.H. (1983). Vicissitudes of the self according to psychoanalysis and Buddhism: a spectrum model of object relations development. Psychoanalysis and Contemporary Thought, 6, 29‐72.

Epstein, M. (1995). Thoughts Without a Thinker: Psychotherapy from a Buddhist Perspective. New York: Basic Books.

Gecas, V. (1982). The self-concept. Annual Review of Sociology, 8, 1-33.

Hales, S. (1985). The inadvertent rediscovery of the self in social psychology: Theoretical and methodological implications. Journal for the Theory of Social Behaviour, 15, 227-232.

Halifax, J. (2012). A heuristic model of enactive compassion. Current Opinion in Supportive and Palliative Care, 6, 1-8.

Heider, F. (1958). The Psychology of Interpersonal Relations. New York: Wiley.

Hopkins, J. (1977). Tantra in Tibet: The great exposition of Secret Mantra Volume 1. Surrey:  George Allen & Unwin.

Kakol, P. (2002). A general theory of worldviews based on Madhyamika and process philosophies. Philosophy East and West, 52, 207-223.

Kernberg, O. (1977), Object Relations Theory and Clinical Psychoanalysis. New York: Aronson.

Metzinger, T, (2003). Being No One: The Self-Model Theory of Subjectivity. Cambridge: MIT Press.

McAdams, D.P. (2006). The role of narrative in personality psychology today. Narrative Identity, 16, 11-18.

Mosig, Y.D. (2006). Conceptions of the self in western and eastern psychology. Journal of Theoretical and Philosophical Psychology, 26, 39-50.

Muzika, E.G. (1990). Object relations theory, Buddhism, and the self synthesis of Eastern and Western approaches. International Philosophical Quarterly, 30, 59-74.

Poster, M. (1979). Critical Theory of the Family. London: Pluto Press.

Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55, 68-78.

Singer, J.A. (2004). Narrative identity and meaning making across the adult lifespan: An introduction. Journal of Personality, 72, 437-459.

Sleeth, D.B. (2006). The self and the integral interface: Toward a new understanding of the whole person. The Humanistic Psychologist, 34, 243-261.

Steffney, J. (1975). Symbolism and death in Jung and Zen Buddhism. Philosophy East and West, 25, 175-185.

Varela, F. J., Thompson, E. T., & Rosch, E. (1992). The embodied mind: Cognitive science and human experience. Cambridge, The MIT Press.

Wallace, V.A. & Wallace, B.A. (1997). A Guide to the Bodhisattva’s Way of Life. Boston: Snow Lion Publications.

Zetzel, E.R. (1971). A developmental approach to the borderline patient. American Journal of Psychiatry, 127, 867-871.

Shadow’s screenplay

Birthed from the Jungian archetype of shadow – archetypes as psychic forces having their own source of instincts and impulses, shadow as an unconscious aspect of the personality which does not recognise itself, Integral shadow offers a simplified model of psychodynamic principles (Ingersoll & Zeitler, 2010). Per the ‘Integral Psychotherapy’ account, shadow is that which we lie to ourselves about, and push out of awareness. Shadow is proposed as a barrier to deep relationality, a veil to legitimate authenticity, and as dis-integrative, in a general sense, throughout Integral literature (Forman, 2010).

An approach called the 3-2-1 process brings a perspective process to working with shadow, to make it visible, make it’s bases known, and to liberate it’s lifeform. ‘Face it, talk to it, be it’, as proposed here at Integral Chicks, as a means to uncover shadow’s covert operations, and to change our capacity to engage it’s presence. http://www.integralchicks.com/2010/06/the-3-2-1-shadow-process/

Collective shadow work takes a similar process and brings it to a group environment. Thomas Hubl with his transparent communication has worked extensively in the global Integral community to shed light on relationality as it is illuminated, in this form, as here reported by Chris Dierkes from Beams and Struts:

‘So imagine one person in the group is struggling with a shadow around anger and someone(s) else in the group is clear in this area. The clear person can attune to the contraction and can see through the symptoms to the light trapped within. This person then seeks to hold deep presence and compassion for the person with the shadow and in this way it, as Hübl says, facilitates a process for that movement to be released and fulfill itself. As the topics shift to different dimensions of life, the roles may reverse. We all have shadows in certain areas and all have gifts/clear awareness in others.’

Source: http://www.beamsandstruts.com/essays/item/934-inner-ecology-thomas-hubl-on-the-shadow

One term surfacing recently is ‘group shadow’ – the idea that, in our group interactivity, unconscious projections actually arise at the level of group awareness. The question of how to address something that is arising between us, but is largely functioning just beyond our awareness, has been pursued across different community conversations, but as far as I am aware has remained as a puzzle, a kind of Gordian knot – how do we handle it if we can’t collectively see it?

From here emerges two seemingly disparate modes of engagement.

The first stems from an insight revealed with Janice Macpherson’s review of Rene Girard’s concept of scapegoating. With roots in rituals of ancient Greece that saw villagers tie ribbons with their bad news, their problems, their failures and their worries recorded on them to a goat which they then would send out of town, scapegoating was chartered as movements through the Old and New Testaments, by Girard, in a shifting interpretation of ‘sacrifice’. While in the Old Testament several stories evidence a successful ‘scapegoating’ – where one individual is charged with a community’s projections and ousted from that same community, thus portraying a worthy sacrifice, what the New Testament works to do is to give an account of Christ as a failed, yet far more triumphant, scapegoat, one that is resurrected ultimately, in recognition of his role as the coming of the Lord.

The whole mechanism of scapegoating is thus upended, with the inception of the New Testament, according to Girard. Not only were the live animal sacrifices of ancient Greece transcended, but now God’s revelation occurred not at the exclusion of evil, or the scapegoat, but at the transformation, the resurrection, of the scapegoat, perhaps the greatest one of all time, Jesus, as Christ.

There is a richness to be noted here – what happens when someone is willing, actually, able, to carry the group shadow, the scapegoat label, to allow for a thoroughgoing metanoia, or transformation, of our hearts and minds? What might be available, when we can engage in this dance, collectively, consciously?

This brings me to the second thread, emergent, that of narrative therapy, and of the beginning process of a narrative therapy approach, which is that of externalising.

Externalising is a process that is almost the inverse of shadow work. Shadow work at a personal level asks that we take that which we have projected outside of us, and return it to it’s internal home. Externalising, on the other hand, asks what have we buried inside us, which, brought out into the open and explored, could become less of a sore or a suffering and become perhaps seen as a diamond, a unique offering unfolding from our individual and very particular experience, on the earth.

Externalising asks that we take a label that has been projected onto and even into us, bring it out into the open, and explore the ways that we do relate to it, and then the new ways that we might like to relate to it (Carey & Russell, 2004).

as an example, where someone (or maybe a group) scapegoats me and tells me I’m angry, there are really endless ways I can respond to the projection of anger, beyond facing it, talking to it and be-ing it. I can:

– walk out on the projection (from the concept of agency)

– eclipse the projection (from astronomical concepts)

– dispel the projection (from magical concepts of life)

– go on strike against the projection (from industrial action concepts)

– become de-acclimatised to the projection (from geographic travel concepts)

– set myself apart from the projection (from the concept of individuation)

– defy the projection (from notions of resistance)

– disempower the projection (from notions of energetic strength)

– dissent from the projection’s influence (from ideas of protest)

– educate the projection (from concepts of teaching)

– escape the projection (drawing on liberation)

– reclaim the territory of self from the projection (from land rights concepts)

– undermine the projection (geological concepts of life)

– refuse invitations to co-operate with the projection (concepts of civility)

– depart the projection’s sphere (concepts of travel and journey)

– engage in redress against the projection (concepts of justice)

– come out from the darkness cast by the projection (concepts of light)

– disprove the projections claims of identity (concepts of judicial authority)

– repossess self from the projection (concepts of commercial ownership)

– take life out of the hands of the projection (concepts of puppetry)

– resign from the projection (concept of employment)

– coach the projection (concept from world of sports)

– steal identity back from the projection (ideas of theft)

– tame the projection (concepts of domestication)

– harness the projection (concepts of equine training).

(Source: adapted from Michael White, ‘Maps of Narrative Practice’)

The list could probably go on, and one exercise could be to go through the list and feel into which ways of relating to a projection would work for you – what feels right? What might feel more right or less right for different kinds of projections?

One way to explore this in the context of illuminating group shadow would be to create a situation where a volunteer might be willing to be a scapegoat – carry a group shadow projection, created consciously by the group itself, and then form a working dynamic, a dialogue, based on the chosen form of interaction. How might the group like to coach the anger? In what way would they educate it? How would they ‘steal’ group identity back from it?

Working to keep language grounded in collective descriptors (working to reduce the use of ‘I’ and ‘me’ while engaged in the practice) (Denborough, 2011), group shadow, otherwise invisible, may become tangible through mechanisms of association, in this context. Working less to roleplay than to adequately account for an internalised sense of the collective meaning, in this way, we might find ourselves newly relating to each other, with new insights about the shape and interplay of the state-stages, in our newfound collective embodiment.

Part of my inspiration in posting this has been to notice what suddenly becomes available for me when someone is actually willing to stand there and ‘hold’ my projection, for me, someone who will openly respond for themselves what goes on, when I ‘do the doing’, of the projection. A new kind of intimacy is shared and borne, in that vulnerability, the willingness to play the parts and follow the lines through to their conclusion (it is rarely a logical conclusion, at that).

Shadow’s screenplay. An upending and revolution, of shadow. Collectively.

Is there another way to have a revolution?

References:

Carey, M, & Russell, S. (2004). Externalising: commonly asked questions. http://www.dulwichcentre.com.au/externalising.html

Denborough, D. (2008). Collective narrative practice: Responding to individuals, groups, and communities who have experienced trauma. Adelaide: Dulwich Centre Publications.

Forman, M.D. (2010) A Guide to Integral Psychotherapy Albany: Suny Press

Ingersoll, R.E. & Zeitler, D.M. (2010). Integral psychotherapy: Inside-Out/Outside-In. Albany, NY: SUNY Press.

White, M. (2007). Maps of Narrative Practice. NY: W.W. Norton & Company.

Self-care – a guide to flourishing, for volunteers

Setting out as a volunteer seeking to provide support to not-for-profit humanitarian organisations calls for particular qualities which include openness, commitment and flexibility – qualities which tend to shine in each volunteer I have had the pleasure to know and to work with. Volunteering overseas also exposes us to

– situations which we’ve never encountered before,

– cultures which are likely to be fundamentally different in structure and interpersonal orientation,

– a swathe of travel-related stresses – learning how different money systems, transport and communications networks (where they exist), and ways of interacting with others actually takes place.

As an added factor of concern, the work that will need to be done when volunteering for humanitarian causes may be stressful, in and of itself. This blog post aims to address ways that volunteers can provide for their own self-care as they enter into their projects and roles, both exciting and challenging. This paper will address self-care from an integral perspective, based on a 2008 Journal of Integral Theory and Practice paper by Vivian Baruch entitled: ‘Promoting Thriving for Therapists: An Integral Perspective’.

From the article:

‘An integral perspective on self-care entails understanding the three words inherent in an Integral Life Practice (ILP). Integral means comprehensive, balanced, inclusive; Life includes the whole of our existence, the body, our emotions, relationships, work, as well as the various levels of conscious awareness potentially available to experience; Practice is what we actually do to develop ourselves, which enhances our capacity to help and be of service to others, the actions we undertake to fulfill our potential.’

An integral approach to self-care thus implies we can be proactive about setting in place practices and mindsets which will enable us to more fully attuned to present situations that we find ourselves in, growing our capacity to be of service to others, as we walk the path of volunteering in an unknown context.

‘Compassion fatigue’ is a term most often used in relation to experiences of professionals working in the caring professions, whom may find themselves feeling tired, burned out and possibly even depressed (Lloyd, King & Chenoweth, 2002). These symptoms can come into being as empathy and workload, and personal boundaries are broached, and volunteers, whom often find themselves in exceptional and unusual circumstances can be identified as being particularly susceptible to the onset of compassion fatigue, with the particular personality types drawn to volunteering often resulting in a deeper sensitivity to the same concerns and symptoms.

Common attributes of those that thrive as therapists as identified in the 2008 article by Vivian Baruch on an integral approach to self-care include balance, diversity, robust selves, empathy to self and pro-activity. These same qualities may be seen as present in well-functioning volunteers:

Balance: creating clear boundaries between volunteer work and personal life; taking regular breaks and calling on stress-reduction techniques and self-awareness exercises.
Diversity: volunteers can seek diversity within work activities to maintain freshness including interpersonal contact; seeking solutions for diverse problems and addressing possible projects outside of usual work practices back home.
Robust selves: Centering an awareness of self as able to meet obstacles as challenges; volunteers might also find they can embrace diverse perspectives on problems they face.
Empathy to self: recognising situations where the volunteer might feel vulnerable or perhaps like they are not coping, reaching out to others to ask for help is essential to receiving needed support. It might be that a conversation, a short break from the situation, a focus on relaxation and diverting attention for a short while is just what is needed to return a passion for the work to the volunteer. 
Pro-active: Well-functioning doesn’t just happen by itself – volunteers need to look out for ways they can support their own self care and actually act on these. 

The Integral Quadrant model allows for each occasion of consciousness to be viewed as arising on a spectrum from individual to collective experience oriented in an internal or external fashion. In this way we are called to account for our experience in each moment as being made up of (at least) psychological, biological, cultural and social aspects, arranged like this:

from: http://www.evolutionaryleadership.com.au

An Integral AQAL or Quadrant approach implies that we must address each of these concerns to adequately account for the whole of our conscious experience. As a volunteer oriented to self-care, this can be seen to influence our view in the following way:

Upper Left: Psychological

What are my commitments and intentions in this volunteer role?

What can I do to take care of my emotional needs while I am here?

Are there ways to prepare my mind for what I will experience in this role?

Is there a sense that I benefit from meditation or a spiritual approach, and how can I address this while I am away on site?

Upper Right: Biological

What are the most effective actions I can take oriented to self-care?

Can I maintain a good diet and getting in some exercise while I am away?

Do I need to prepare to take special medications which will help best look after my body given the area I will be working in?

Lower Left: Cultural

What is my understanding of my responsibilities to others in this role and relevant to self-care?

Can I prepare myself for how relationships will be different in the different environment where I will be working?

What ethical standards do I expect to hold myself and others to, as I complete this assignment as a volunteer?

Lower Right: Social

In what way will my understanding of social systems in the community where I ordinarily live shape my expectations as I enter into this volunteer work in what is likely to be a vastly different community environment?

Can I promote a sense of self-care to others in the environment that they find themselves in, knowing it’s benefits for myself?

 

A simple way to address self-care as a concern is to choose one activity that brings a sense of care for the self alive, choose a frequency for engaging in the activity, and sticking to it. My training as a telephone counsellor on the crisis support line, Lifeline, involved reporting each week on the activity that we had chosen, and whether we had actually followed through in engaging it. That simple degree of accountability saw an incredible transformation in my own ability to engage in self-care activities, no longer sensing them as self-indulgent or trivial, but really coming to an understanding of how these little acts actually contributed to my ability to be a better telephone counsellor. 

These small changes, and big differences in sensing self as flourishing in a network of support providers, with wellbeing of self and others a concern that is never too far out of eyesight. ❤

References:

Baruch, V. (2008). Promoting Thriving For Therapists: An Integral Perspective. Journal of Integral Theory and Practice, 3, 85-105.

Lloyd, C., King, R., & Chenoweth, L. (2002). Social Work, Stress and Burnout: A Review. Journal of Mental Health, 11, 255-265.

Reality, Illumination and the Social

It is curious to read Berger and Luckman’s 1966 account of ‘The Social Construction of Reality’, where they articulate a transgenerational perspective on how we come to ‘know’ reality with a thought experiment.

The experiment takes a man and a woman from non-shared cultural backgrounds, and looks to how they begin to coordinate activities in order to survive. In the process, the authors propose that agreed on habits emerge – some agreed sources of food, a location for shelter, a series of interactions between themselves and the environment to coordinate the activities of survival and living and a shared language about it, where there was none before. Originally, all this is playful and co-creative, and at each decision point it is fully known by both participants how each choice and decision was made.

For the next generation, these processes as cognitions are less shaped as ‘this is how we decided’ but rather ‘this is what you do to…’, a series of principles, and by the third generation, the knowledge is codified as a series of customs, that by the fourth generation, are taken as reality itself.

It’s curious to encounter this mode of understanding our engagement with reality because the sense is that the speed of technological evolution now well outstrips a likely codification of processes at 120-150 years (four generations worth) of time – it may well pay to break out differing technological and social developments and have a look at the historical and likely trajectories to see if this illuminates the field in a different way.

Turning to the integral community, and looking to the enculturation of the benefits of ‘play’ in the communal discourse, it’s interesting to observe that this sits with the first generation, as an orientation in this map of the formation of a socially constructed reality. That is appropriate given the age of integral theory itself, but I wonder about privileging a transcend and include view of the whole cycle – looking to the relations between generations (and the reality of how they are held in our Western culture in everyday life) – looking to what this tells us about a model of the social construction of reality and how we might shift the accent, where we are placing our communal focus. To allow the stillpoint of seeing to inform new possibilities in being.

Perhaps it is time to deeply consider the nature of symbol, it’s codification in perspective or autopoiesis, and to generate a field that illuminates the inquiry and the answer contained in and expanding of the inquiry, regarding the social construction of reality. Freud wrote extensively on symbol and on repression, and yet there exists in culture today a double repression, in a way, a repression of knowing about repression, and how repression works, and how it interacts with symbol, in an account that serves to deepen our capacity for and engagement with ‘reality creation’ (note: not construction).

To seize the moment, and, you know, play with it.

References:

http://en.wikipedia.org/wiki/The_Social_Construction_of_Reality

http://www.amazon.com/Freud-Psychoanalysis-Symbolism-Agnes-Petocz/dp/0521021502

www.gwengordonplay.com/pdf/Gordon_Play_Final.pdf