Thursday, July 5, 2018

THERAPEUTIC PRESENCE

Did your training as a psychotherapist or counsellor emphasize the importance of being a caring therapeutic presence? Did your training discuss how to cultivate and enhance your therapeutic presence? My training certainly did not. If course theories and techniques of psychotherapy are also important. However, over 40 years of experience in private practice have taught me that cultivating and being a caring therapeutic presence is essential. Without that our theories and techniques are much less effective. It is important for us to remember that the literature on effective psychotherapy consistently has reported that when clients are asked, "What was most helpful to you?" their response is some version of: "My therapist genuinely cared about me as a person"; "My therapist was really there for me,not just using techniques."
It is not easy to find adequate words to describe therapeutic presence. A vital aspect of it is our intention to have our whole self engaged in the session as much as possible on that day with that person. It means physically being there not exhausted or distracted by other objects in the room. It means cognitively discerning what therapeutic perspective and technique will be most responsive to the needs of this person today. It means being emotionally engaged with an open heart trying to sustain an empathic compassionate connection. It means being spiritually open trying to access guidance and wisdom from our own personal Higher Self and whatever other sources of assistance that might be available.
To be that kind of caring presence for many hours each day with a wide range of clients over many years is a profound challenge. Perfection is not possible. However, there is lots of good news for those of us who are trying to be that kind of presence. First of all, brain research has indicated that taking the time before each session to have the intention to do so activates the neocortex which then aligns other parts of the brain so that the probability of deep presence occurring is enhanced. Second, brain research has also validated my experience of over 40 years of doing this work. The more you cultivate therapeutic presence the more brain patterns develop and then get strengthened over time. So gradually the capacity to be that kind of presence becomes easier to access and then you also have a deeper reservoir to draw upon.
Cultivating and accessing a caring therapeutic presence is the work of a lifetime. There are several helpful pathways for each of us to explore. Because this is a brief blog I will just mention some of them and then describe one in more detail. For a thorough elucidation of this topic I would suggest reading, "Therapeutic Presence: A Mindful Approach to Effective Therapy" by Shari Geller and Leslie Greenberg(2012). That work inspired and informed this blog, broadened my understanding particularly of the brain research,and validated my years of experience.
Our own personal psychotherapy is an essential pathway that will help us become more conscious of our personal issues that might be triggered by our clients and are reducing our effectiveness. Also being attentive to our own self-care is vital so that we are not tired from or distracted by the responsibilities of the multiple roles of our lives. Because we are often not good at taking care of ourselves I have written elsewhere(see blog and book chapter on Recharging) on what are some of the psychological blocks that you may have to good self-care. In addition we need to work on developing more compassion - particularly self-compassion - so that we can be more open-heartedly compassionate towards our clients. We may also need to cultivate being a more compassionate presence in our everyday lives. An important question for each of us to explore is: "To what extent am I more present to my clients than I am to other people in my life?" I am not saying that we should be therapists with our family and friends. Rather I am saying there are probably many brief moments in each day when we could be a more compassionate human being. Why that is important is that the brain research indicates that the more that we cultivate presence throughout our lives the stronger those brain patterns become. We then have a deeper reservoir to draw upon during sessions.
I now want to share several practices that I have incorporated into my life that have helped me to develop and deepen a more caring therapeutic presence. Five minutes before I begin my morning or afternoon's work I sit in my therapist's chair and ask my Higher Self and other sources of guidance for help in fulfilling my intention for my clients to be a source of compassion, peacefulness and strength. I follow that with meditational breathing imagining with the out breath that I am letting go of whatever might be blocking me from being present that day. For a few minutes between clients I do the same. This is a practice I have been doing for many years. It is a way of acknowledging to myself that I am consciously moving from the ego realm of ordinary life into a different level of consciousness where my therapeutic self resides. It is fascinating for me recently to learn that brain research is now validating the importance of taking the time to set my attention which then calls into alignment other brain patterns.
In my meditational practice I have developed a relationship with certain nature places that have helped deepen my capacity to be present to my clients. This was certainly not my original intention in developing that aspect of my spiritual practice. However, it has evolved in such a way that is helpful to my work. Often I sit in meditation with my back up against an old ash tree with its thick roots exposed above the ground. For me the tree symbolically represents strength, stability, rootedness. That individual tree has become a living connection to the archetypal "Tree of Life". I also have a poster of a giant redwood in my office. When I look at the poster it reminds me of my local ash tree - and my actual experience of having meditated inside a redwood tree - and connects me at that moment to my intention to be a reliable source of rooted strength for my clients.
I also sit near a local pond and meditate. For me that pond symbolically represents stillness, peacefulness, equanimity. When I sit there I am trying to cultivate those qualities in my own consciousness not only for myself,but also so that I can project - perhaps even transmit - the energy of those feeling states for the people in my life. I have a painting of a pond in my office. When I look at it before I begin my work and during sessions it connects me to my intention to be a source of peacefulness.
I am extraordinarily blessed to have a small brook that is thirty feet behind our home and flows through our property. When I stand or sit by it I ask the brook to help me more connect to the flow of life. There is so much to learn about what the Taoists refer to as "the watercourse way" that is relevant for the human journey. Increasingly, witnessing the ways of the brook have helped me to be more in the flow of a session with each particular client on that day. To be able to let go of my need to control, influence or even know what's going on in a session and simply trust the process. What a challenge for my ego! Yet the brook is a good teacher. Having spent so many hours in the presence of that old tree, the pond and the brook have helped me to cultivate those qualities of a rooted strength, peacefulness and trust in the flow of life. I am then able to offer the presence of those qualities to my clients.

Several parts of this blog have been inspired or influenced by my recent reading of: Therapeutic Presence: A Mindful Approach to Effective Therapy by Shari Geller and Leslie Greenberg.

Wednesday, January 24, 2018

EVOLVING AS A PSYCHOTHERAPIST

As I reflect upon my over 40 years as a psychotherapist I can now see there were stages in my evolution. I have also witnessed similar patterns in the therapists I have supervised and in colleagues that I've known for many years.The evolution has not been completely linear. There were certainly moments of creativity during my imitation period and there continue to be moments of imitation during the this later more authentic epoch.
IMITATION AND IMMERSION
In my earliest years as a psychotherapist I usually simply imitated what my therapist had done with me.At times it was pure mimicry - using the same words, gestures and tone of voice. My first therapist was a psychoanalyst. When I realized that I needed more training and supervision I went for four years of point-doctoral study to the same institute where he had trained. For those four years I read extensively and almost exclusively the writings of Freud, his followers and the neo-Freudians of the next generations of psychoanalysts. I immersed myself in that tradition.
If Freud witnessed how I worked now he would probably turn over in his grave or more likely excommunicate me for betraying him, the psychoanalytic tradition and my teachers. Yet I strongly feel that period of imitation and immersion was essential for the foundation of my lifework as a psychotherapist. I also acknowledge that I still use some of those concepts and techniques - they are now expressed through the unique synthesis that is my more authentic self.
Imitating our therapist or supervisor or favorite author was not a negative, it was necessary. We read extensively or entered a training program and assimilated ideas and techniques within a particular theoretical framework that we were initially drawn to or exposed to. It was important to immerse ourselves so that a solid foundation got built through practicing certain techniques and internalizing ideas within that paradigm.
Perhaps it might be fitting to describe that initial stage as an apprenticeship.
During this early period of our development some of our initial expressions of creativity and movement toward a more authentic self often show up as acts of rebellion or subversion. My second therapist was the head of this analytic institute. In therapy with him I refused to lie on the couch. In the atmosphere of that psychoanalytic institute that was a very rebellious act - an early signal that I was going to follow my own path.
With some of my early patients who were adult children of alcoholics I went against what was then a cardinal rule of psychoanalysis - to remain neutral and not disclose yourself. I revealed that my father too was an alcoholic. My patients deeply appreciated that empathic linkage. I took a further step and submitted an article describing my unorthodox ways of working with that population of patients. Somewhat to my surprise it was accepted by a respected psychoanalytic journal.
MASTERING THE CRAFT
As we practice the techniques that we have assimilated we learn: what works for some clients and not others; what ideas explain issues that our clients are struggling with and what does not; what ways of working are a good fit for our personality and what feels inauthentic.
In order to further evolve in the craft of psychotherapist it then becomes essential to intentionally expose ourselves to other theoretical perspectives and to expand our repertoire of techniques and strategies. This stretches us in that we are not rigidly adhering to a particular framework and broadens what we can offer our clients. As we explore and incorporate these other pathways what occurs - often unconsciously - is an internal reorganization of theoretical perspectives and a synthesis into a new therapeutic self. I explored Jungian,humanistic, cognitive-behavioral, psychosynthesis and many other perspectives. Increasingly we then find it hard to answer the frequently asked question,"Are you a Jungian, cognitive-behaviorist, Freudian...? What would you call yourself?"
BECOMING MORE AUTHENTIC
Many therapists over a number of years are able to develop a high level of mastery of the craft of psychotherapist. They expand what they can offer their clients by synthesizing the ideas and techniques of these other approaches. Yet they tend to stay within the boundaries of the known and familiar rarely breaking out to try something radically new, something that is their own unique insight or technique.
From my perspective it is important in the later stage of our evolution as a psychotherapists to consistently take more risks - to say or do more things with our clients that are authentically our own, that we have not consciously heard or read about others doing. To be more creative. This is not to say that we haven't been creative before or that these ideas are not influenced by others.
Sometimes these creative movements emerge from a personal life experience. For example, my ideas and strategies for helping my patients with self-forgiveness evolved from an identity crisis precipitated by my initiating a divorce. Nothing in my professional experience provided a clue how to forgive myself for the overwhelming guilt I felt for causing so much pain to people that I loved. I then developed ways of helping my patients to forgive themselves that were inspired by my personal journey.
Another, the technique of The Council, emerged from a weekend retreat in an isolated cabin that I took when I was turning 60. I had decided to imagine that the different parts of my personality were on this retreat and were addressing the question,"What is happening in my inner life as I enter my 60's?" I took a yellow legal pad - the same kind that I am writing on now to compose this blog - and unexpectedly I wrote pages and pages of thoughts and feelings. That led to the concept of The Council - a very effective tool that I now utilize when patients are facing a major life decision or entering a transitional moment in their lives.
Two medical crises, one was a very aggressive cancer in my mid-60's and the other seven months ago shortly after my 75th birthday, wherein I almost died liberated me to be more self-disclosing in unexpected ways. My patients dealing with their own medical crises or issues of aging and dying have been profoundly grateful for these moments of empathic connecting.
At other times these creative moments just spontaneously arise during a session where we suddenly find ourselves saying something to or doing something with a client that we've never thought of or done before. And its on the mark! It's exactly right for that person and that moment. Afterwards we find ourselves wondering,"What just happened? Where did that come from?" It is our creative and courageous - going beyond the boundaries of what is familiar and known - response to that moment.
These moments off letting go and being receptive to "something" flowing through me have increased since about ten years ago I started to more actively cultivate my relationship with my own personal Higher Self.In addition to my conscious efforts to engage my Higher Self during my contemplative walks in nature I started a practice of meditational preparation before starting work. Before I begin seeing my first patient I spend at least five minutes in meditational breathing and asking my Higher Self, "Please help me to be a vehicle of compassion and heart wisdom." Also, "Help me to connect to other sources of wisdom and healing beyond myself. Help me to be open to the assistance of the Higher Self of my patients." During sessions, particularly at moments when I feel uncertain what to say or confused by what is happening or overwhelmed by the amount of emotion that my patient is expressing, I ask my Higher Self for help. These "prayers" have helped to create a receptive space in my ordinary consciousness so that these creative moments of inspiration from multiple sources of consciousness can occur. At these times I feel more fully alive and authentically present to the moment.

Many of the ideas expressed in this blog have been influenced and inspired by writings about creativity in Oliver Sacks recent posthumous book,"The River Of Consciousness."