Category: Expert

Maria Gonzalez-Blue on Person-Centered Expressive Arts Therapy

Posted on by rezendevknowfully.com

Formula for Compassion

Victor Yalom: Maria, as I understand it you’re a person-centered expressive arts therapist. A good place to begin would be to ask you, what is person-centered expressive arts therapy?
Maria Gonzalez-Blue: I'll start with what the person-centered approach is, because that's the foundation. Expressive arts then becomes a tool that's been integrated into the person-centered approach, which was, of course, defined by Carl Rogers. The person-centered approach is based on the humanistic principle that, within every organism, there is an innate movement that will always move that organism towards it greatest potential, if it's given a nurturing environment where that potential can grow. The nurturing environment was defined by Carl Rogers as one that includes the elements of empathy, congruence, and unconditional positive regard.
VY: Carl Rogers is certainly well known by our readers and he's had an enduring influence in our field and in many fields to this day. We’ve just been doing some work with Sue Johnson in emotionally focused therapy, and she gives a lot of credit to Carl Rogers. We’ve also just been filming some videos on motivational interviewing, which also has strong Rogerian roots. What, for you, are the essential components of Rogers’s person-centered approach that you hold near and dear to your heart as you teach and as you work with clients?
MG: I see his emphasis on empathy and unconditional positive regard as a formula for compassion. It requires therapists to consider those things any time they sit before clients, students, or other individuals. If I enter a session knowing that I want to bring these elements in, it forces me to bring them home to myself, as well. I have found that it becomes a way of life and makes you a better person, because you're always conscious of when you're not being empathic or when you're being judgmental.

In my work, what I've seen is that when you listen to someone truly carefully, instead of listening to your own ideas and expectations—when you set all judgments aside, incredible things happen. People contact information that's long been repressed. It seems a simple thing, but I find it has a profound effect on an individual to be listened to with such caring. 

The Intention of Tolerance

VY: Coinciding with the publication of this interview, we’re releasing on video an interview that Carl Rogers did in the ’80s. When discussing these concepts, he clarified his conception of unconditional positive regard. He said something along the lines of, “It’s not that we can always achieve unconditional positive regard, but it’s fortunate when we can have that with our clients.”
MG: Right. And that's what I tell my students all the time: what's important is to hold that intention. Certainly we're human beings—we're judgmental. If we can simply go into an environment with that intention, that is far reaching.
VY: I think that’s an important clarification, because otherwise, people can hear that and think it’s Pollyannaish. It’s an impossible ideal to attain. As you say, we’re human. We have our judgments. We have different feelings for our clients and for different people in our lives.
MG: We have to start with tolerance. I think this is why I am so dedicated to this process, because I feel we need this so much in the world. You can at least start with tolerance.
I don't think it's necessary to accept or condone everything and everyone you meet in a session. But you can keep in mind that somewhere in that organism, there is a desire towards growth.
I don't think it's necessary to accept or condone everything and everyone you meet in a session. But if you can keep in mind that somewhere in that organism, there is a desire towards growth, then that's the part that we as person-centered therapists hold: that seed in there that wants to move towards wholeness. Accepting that that is there requires trust and faith on the part of the therapist. And if the therapist can hold trust and faith, then that can affect how clients feel about themselves. If you as a therapist aren't judging them, then maybe their own self-judgments can start falling away.

Not Just Parroting Back: Reflecting as Witnessing

VY: Another one of the core techniques of this person-centered approach that I think has had a vast influence but also been misunderstood is this idea of reflection—repeating back what the client says. Some people have made fun of this as parroting or being too mechanical. What are your thoughts on that?
MG: That mirroring back of language, for people who haven’t really experienced it or been part of it, is often seen as mocking the individual. But that’s really not the case. Reflecting back the language that a client is using can also be useful, but we don’t always use the same exact words. Often, as clients are rattling off issues, problems, and feelings, they’ll say something that they’ve never said before; in their sharing, they’re coming to insights, they’re making connections without knowing they’re making connections. If you, as a therapist, can reflect back what you’re hearing, then those connections that are being made come to consciousness. Clients are speaking from a kind of flow of consciousness, and
I like to see myself as a mirror that’s reflecting back the wholeness that I see in them.
I like to see myself as a mirror that’s reflecting back the wholeness that I see in them. So that reflection is really important.

What’s also important is that you want to understand. Part of being empathic in Carl Rogers’s process is to see clients’ experience from their own worldviews. If you can really hold that idea that you want to understand, it’s also a way of saying, “Is this what I’m hearing you say?” And that gives them a chance to say, “No, that’s not it.” But, if they realize that that’s not it, then that gives them a frame of reference of what might it be. It’s a stepping stone.
VY: Right; as clients talk, they'll say things they didn't even know existed inside them. And of course, that's always the goal in any kind of therapy—that people will discover new things about themselves. If they're repeating things that they already know, then not much new is happening.
MG: Exactly. It’s like the therapist is walking through the woods side by side with the client, discovering things together. There’s something about that witnessing that can ground those new discoveries in a way that people can’t really do on their own.
VY: That’s a nice image. I’ve seen videos of Carl work and, of course, many other master therapists from different orientations. And what comes through is not his technique or the words he utters. Instead, you get a such strong sense of him really being with clients, listening deeply, committed to hearing and understanding them. I think it’s the intention. It’s the spirit of it, rather than the words that come out, that really is profound.
MG: And for many people, this has never happened. Even your best friends, and particularly family members, have all kinds of biases. They know you as this certain person. Sometimes your best friends want to help you, so they give you advice that may have worked for them, but may not work for you. But when you want to hear your clients, when you want to really see their worldviews and understand them, something shifts.

The Blank Page: Exploring the Unknown with Art

VY: Tell me about the expressive art component and how that is integrated into the person-centered approach.
MG: We just talked about a client discovering buried material, stepping into unknown material that strikes a surface, which is a good segue. Often, clients who enter therapy are approaching unknown territory. Either they’ve left a job or a relationship, or their life doesn’t feel right anymore, so they know what’s not working, but they don’t know what’s ahead.

The blank page, whether it’s in visual art or movement, is a great way to enter this unknown material. Art is really the language of the unconscious; it allows symbols to come forth. People make discoveries of potential and understanding, which become new resources to enter this unknown material. I believe that there’s a time and place for everything, so I’m not critical of any therapies. But talk therapy has its limits; art does not. It can be limitless. It can also be contained.
VY: I should add at this point that person-centered expressive arts therapy was developed by Natalie Rogers, Carl's daughter, who's a psychologist and psychotherapist in her own right, as well as an artist. And I know you've worked and trained with her professionally over many decades.
MG: Yes, we've worked substantially together, we've taught together, and we've played together. And what Natalie really brought in to weave those two things together was what she came to call the "Creative Connection." It's actually an intermodal process where we work with different modalities in sequence. A person might be exploring an issue through a visual arts piece. We don't diagnose or interpret art; instead, we ask the artist to explain what came through as a feeling, what is in the art that he or she wants to discuss.
The art doesn't have to be analyzed or intepreted. It's an image that has its own language.
The art doesn't have to be analyzed or intepreted. It's an image that has its own language. So the work is processed through listening, really respecting what the artist has to say about it. If the client wants reflections that a therapist might have, I might add something that I sense in the art without trying to analyze it—maybe noting the energy or the color, the person's body language in the making of it. I like to observe body language; sometimes you can tell energy is moving through.
VY: When you say artist, of course, you’re just referring to a client who’s engaged in the expressive arts process.
MG: The person who made the art.
VY: Yes. I don’t want to our readers to think that only artists can be involved in expressive art therapy.
MG:
We are all artists of our own lives.
We are all artists of our own lives. Expressive arts therapy is not looking for an end product, necessarily. It's really about the process and what comes through in doing the art.

Introducing Expressive Arts into Sessions

VY: Can you say how you use art? As you said, people are often going through changes. They're talking about concerns in their lives, some situational issue or an emotional reaction to that, feeling depressed or anxious. How do you go about introducing the expressive arts into a session?
MG: Pretty early on, I observe the client. I bring my intuition into my sessions. I watch body language. Let's say I have a client who is really kinesthetic, moving a lot while she's talking, making certain gestures—for example, she's talking about an issue, and she keeps putting her hand on her heart or keeps holding a part of her body. I might ask her if she'd be open to movement work. And whenever I introduce anything, I do it with a lot of asking permission, asking how it feels, so she doesn't feel like they're being directed. But she's given the opportunity, the invitation, to explore something.
VY: One of the other names of the Rogerian approach is non-directive therapy.
MG: Exactly. And what's important about that is that it makes clients ultimately responsible for their own processes. So I might ask if she would feel comfortable just holding that posture for a bit. Often what happens is the client may hold that gesture, perhaps holding her heart. And then I see more come into it—maybe her shoulders lift up, her facial expression might change. So I say, "If it feels right, why don't you go with that movement and see if there's more there?" And that's a subtle invitation to enter a movement process.
VY: And how might that evolve? A client might get up and move around or dance?
MG: She might get up and move around. She might move where she’s sitting. And if a client feels shy, sometimes I say, “Would you feel more comfortable if I move with you?” Because the body has its own wisdom. What’s happening here is that we’re tapping the body’s wisdom to help inform the person, maybe of something that’s repressed, or something that really wants to come alive. Then I just might check in and say, “What’s going on? What do you want to share about that movement?” At that point, people can easily start describing what they’re feeling, what they’re understanding. Sometimes they have their whole stories come forth. It’s like opening a door into the body.
VY: So, in this case, movement might in turn elicit some emotional reaction or some image or ideas that then they’ll go back and process verbally?
MG: That gives them better understanding. They might process it verbally. If there's time, they could do some freewriting. And I might suggest making some quick "I am" statements to see what comes. It also could go into some art—whatever the client is feeling. I'll usually have chalk pastels and oil pastels. I'll ask, "Would you like to take a color and see if you can draw that shape, or just see what comes through?"

There's so much happening when you tap this deeper language. Using pastels has been a really successful way to draw shapes, draw feelings. Sometimes I start my workshops by having people draw their breath going in and out, and it's such a abstract concept that no one has to feel that there's a right or wrong way to do it.
VY: I’ve seen Natalie say, “Would you like to work with color?” And my sense is that that’s a way of de-emphasizing that this has to be some artistic creation. It’s more just an experience of taking some colors and playing with them.
MG: Yes, it’s very much a meditation. In fact, I use the word “scribble” a lot. I tell people, “When we’re done, you can just throw this away. It doesn’t have to be put up in an art gallery somewhere.” It’s really about what’s happening when clients go into the stillness to just be with themselves in the process, but with me as a witness.
VY: Just so our readers can get a better idea, can you give an example of how this is used in individual therapy?
MG: I have a new client, and this client is an artist. It's funny; I work with all people that are creative, and people come from all different walks of life. But I typically don't work with artists. We talked for a while; she's had some major changes in her life, and she was feeling a block from her artwork.

I talk with clients, too. It's not like it's all expressive arts. In fact, in some cases I may not bring the arts into it if it doesn't feel relevant at the moment, or if it doesn't feel in the flow. But in this case, I asked her if she would like to do some artwork before she went further to her issues. I had her work with pastels. I had her, first of all, just look at the colors and see if there was a color that she was attracted to start with. I let her know, "This does not have to be an art piece. This is a process." I always try to make that clear.

And what unfolded was that she drew aspects of her life in very basic, rudimentary forms. And there were some surprises already, in what she saw there. This was after she came with the issue of block in her artwork. Then we turned to process a little bit more, her sharing her story, which I won't go into. I listened to her carefully. As she talked, she was able to make some discoveries of elements of her life connecting to ongoing issues that she was aware of.

I had her do a second piece towards the end, and the interesting thing was that she was drawn to all the same colors, but this time in her drawing, everything seemed connected, whereas before they had seemed to be these small, disconnected pieces on the paper. Now there seemed to be flow—all the same colors, but everything seemed integrated. You could see movement. A change had happened, and it's not something that's easy to articulate. But using the arts, she could see it. And she could feel it in her body.
It's not something you can read in a book. You can explain details, but until you feel the changes firsthand, you don't get it fully.


Like you say, it's hard to articulate a lot of this because so much is happening at the cellular level, the emotional level. I think all of us who facilitate the person-centered approach have felt like it's not something you can read in a book. You can explain details, but until you actually live it, experience it, and feel the changes firsthand, you don't get it fully.
VY: Coinciding with this interview, we’re publishing a video (LINK) of Natalie working with a client for two sessions. Having a chance to watch that, I certainly got a clear sense of the power of this approach, and how shifts can happen in a short amount of time.
MG: And what I have noticed is that the shifts tend to stick. I'm still in touch with students I had long ago from our training program, or past clients. Person-centered therapy can help to build that self-trust and the trust in the natural movement towards growth. I really try to encourage my clients to know this, and I think that it helps life changes to be healthy ones.

Using Art in Groups

VY: Natalie's first book on this topic was The Creative Connection, and I know she just recently published a follow-up to that, The Creative Connection For Groups. I know you also work with groups. Do any examples of work you've done recently pop to mind?
MG: There's a group process that really stays in my mind, where I saw the profound effect of person-centered and expressive arts therapy. I was doing a seven-day training program. What we like to do is invite feedback every day. It always feels like a bit of a risk to open yourself to feedback, but I find that it's really important because people need to feel that they're safe and that whatever they're feeling or going through is okay and a process.

So I was doing a training, and during a morning feedback session on our second or third day, something arose between two women. It was something about a transportation conflict; one of them was very upset that the other hadn't waited for her at the airport. I said, "Let's go ahead and take some time," and asked people to say how they felt, without blaming, if they could. That's not always possible.

But the people in the training were versed enough in the person-centered approach that they were open to hearing whatever needed to be said. Both these people spoke, and then a couple other people started speaking. The conversation got quite heated. I let it go for a little bit, and then I intervened and said, "I'd like to make a group agreement, because many people are not involved in this conversation. It's important for you to express how you're feeling. But I know there are people who also want to do some work. So can we put a time limit on it?"

So we compromised, and the conversation continued about transportation and what one person said and the other person said. At some point I said, "Okay. The time is up. Do you want to keep going, or shall we do some art?" And, of course, all the other people said, "Let's just do art." So I laid out a huge mural sheet and put on some music that was kind of driven, because I could tell there was a lot of heat in the conversation. We got out paint, and people started just drawing on this mural.

And as a witness of this process, I could see the energy shifting. At first, the drawing people were doing was kind of intense and stark, big. But by the end, people were starting to write poems, affirmations about themselves and their desires. Some spontaneous singing started happening. By the end of that process, I could feel that everything had shifted.

Ultimately, what I know is that in a process like that, those surface feelings that come up are not about the people themselves, but about inner issues that people are grappling with. And to give it space to be there is really, really important.

Collectively, we like to hide that negativity, hide our anger, come to the table with a smile. But something really beautiful happens in the community when people are allowed to be "negative" in a group and have that held—when you see that that's okay and no one's judging you for having those feelings.

The next morning when we had our check-in, it was totally different. People were sharing personal feelings about their woundings and discoveries, but it had nothing to do with the group anymore. So it's really very amazing to see.
VY: Are you suggesting that people may have an easier time expressing some negative feelings through expressive arts than they might be able to put into words?
MG: Yes, because a lot of times the words can be hurtful, or the words aren't even there. It's just this strong energy moving through the body. If you can put that into some artwork, it becomes a creative fire. You can move that strong energy through and see what's underneath it. And that's exactly what happened with that group process.

Building Bridges: Art in International Group Work

VY: You've trained a lot internationally and you've cofounded an expressive center. Is it in Argentina?
MG: That’s right, in Buenos Aires. We have person-centered programs now in many countries.
VY: Any thoughts or comments about doing this work internationally?
MG: The beauty of the person-centered approach is that it lends itself to meet any group, any culture, exactly where it is. You design any program you do towards who you're working with. I don't go in with a structured program. I have a sense of where we might go, but it's always fluid. So with every culture, first I get to know the culture. I hear from them. I hear what they might need.

In Argentina, I knew a little bit about the background of a violent dictatorship in the '70s. So I went into that culture with a lot of humility. What I found was that the culture needed a very tight structure in the beginning. Everything needed to be on time. I needed to be perhaps more directive than I usually am. That just meant that if we were working with a certain modality, I would try to keep everybody with a certain modality, whereas working in an environment where there's already a lot of trust, I might just say, "Whatever modality you want to work with, you can."

But, what I found in Argentina was I needed to hold a tighter structure at first to develop trust. It's a culture that hasn't been able to trust their government in the past, so self-trust then comes into question. The beauty was that their hearts were so tender and beautiful that by the end of the ten-day program, everyone wanted to come back. Everyone wanted to go deeper into the work.

The person-centered approach really has a potential to bring great things into our planet, to bridge cultures.
The biggest thing that I want to underline in working with other cultures is that I think the person-centered approach really has a potential to bring great things into our planet, to bridge cultures. I think it's really important as a way of being with cultures that's accepting, that can bridge us into healthier places.
VY: It seems the arts are an international language. Have you had a chance much to work with groups of people from different cultures in the same group?
MG: Yes. In fact, CIIS (California Institute of Integral Studies) is very multicultural. The art becomes the universal language then. A closeness happens with these groups. What happens in group process is it’s almost like they start dreaming together when the art images start to appear. After the group has been together for a while, these same symbols end up appearing within the group as if they’ve just had the same dream. It’s a wonderful bridge.

The Spinoza Problem: An Excerpt

Posted on by Psychotherapy.net Team

Prologue

Spinoza has long intrigued me, and for years I’ve wanted to write about this valiant seventeenth-century thinker, so alone in the world—without a family, without a community—who authored books that truly changed the world. He anticipated secularization, the liberal democratic political state, and the rise of natural science, and he paved the way for the Enlightenment. The fact that he was excommunicated by the Jews at the age of twenty-four and censored for the rest of his life by the Christians had always fascinated me, perhaps because of my own iconoclastic proclivities. And this strange sense of kinship with Spinoza was strengthened by the knowledge that Einstein, one of my first heroes, was a Spinozist. When Einstein spoke of God, he spoke of Spinoza’s God—a God entirely equivalent to nature, a God that includes all substance, and a God “that doesn’t play dice with the universe”—by which he means that everything that happens, without exception, follows the orderly laws of nature.

I also believe that Spinoza, like Nietzsche and Schopenhauer, on whose lives and philosophy I have based two earlier novels, wrote much that is highly relevant to my field of psychiatry and psychotherapy—for example, that ideas, thoughts, and feelings are caused by previous experiences, that passions may be studied dispassionately, that understanding leads to transcendence—and I wished to celebrate his contributions through a novel of ideas.

But how to write about a man who lived such a contemplative life marked by so few striking external events? He was extraordinarily private, and he kept his own person invisible in his writing. I had none of the material that ordinarily lends itself to narrative—no family dramas, no love affairs, jealousies, curious anecdotes, feuds, spats, or reunions. He had a large correspondence, but after his death his colleagues followed his instructions and removed almost all personal comments from his letters. No, not much external drama in his life: most scholars regard Spinoza as a placid and gentle soul—some compare his life to that of Christian saints, some even to Jesus.

So I resolved to write a novel about his inner life. That was where my personal expertise might help in telling Spinoza’s story. After all, he was a human being and therefore must have struggled with the same basic human conflicts that troubled me and the many patients I’ve worked with over the decades. He must have had a strong emotional response to being excommunicated, at the age of twenty-four, by the Jewish community in Amsterdam—an irreversible edict that ordered every Jew, including his own family, to shun him forever. No Jew would ever again speak to him, have commerce with him, read his words, or come within fifteen feet of his physical presence. And of course no one lives without an inner life of fantasies, dreams, passions, and a yearning for love. About a fourth of Spinoza’s major work, Ethics, is devoted to “overcoming the bondage of the passions.” As a psychiatrist, I felt convinced that he could not have written this section unless he had experienced a conscious struggle with his own passions.

Yet I was stumped for years because I could not find the story that a novel requires—until a visit to Holland five years ago changed everything. I had come to lecture and, as part of my compensation, requested and was granted a “Spinoza day.” The secretary of the Dutch Spinoza Association and a leading Spinoza philosopher agreed to spend a day with me visiting all the important Spinoza sites—his dwellings, his burial place, and, the main attraction, the Spinoza Museum in Rijnsburg. It was there I had an epiphany.

I entered the Spinoza Museum in Rijnsburg, about a forty-five-minute drive from Amsterdam, with keen anticipation, looking for—what? Perhaps an encounter with the spirit of Spinoza. Perhaps a story. But entering the museum, I was immediately disappointed. I doubted that this small, sparse museum could bring me closer to Spinoza. The only remotely personal items were the 151 volumes of Spinoza’s own library, and I turned immediately to them. My hosts permitted me free access, and I picked up one seventeenth-century book after another, smelling and holding them, thrilled to touch objects that had once been touched by Spinoza’s hands.

But my reverie was soon interrupted by my host: “Of course, Dr. Yalom, his possessions—bed, clothes, shoes, pens and books—were auctioned off after his death to pay funeral expenses. The books were sold and scattered far and wide, but fortunately, the notary made a complete list of those books prior to the auction, and over two hundred years later a Jewish philanthropist reassembled most of the same titles, the same editions from the same years and cities of publication. So we call it Spinoza’s library, but it’s really a replica. His fingers never touched these books.”

I turned away from the library and gazed at the portrait of Spinoza hanging on the wall and soon felt myself melting into those huge, sad, oval, heavy-lidded eyes, almost a mystical experience—a rare thing for me. But then my host said, “You may not know this, but that’s not really Spinoza’s likeness. It’s merely an image from some artist’s imagination, derived from a few lines of written description. If there were drawings of Spinoza made during his lifetime, none have survived.”

Maybe a story about sheer elusiveness, I wondered.

While I was examining the lens-grinding apparatus in the second room—also not his own equipment, the museum placard stated, but equipment similar to it—I heard one of my hosts in the library room mention the Nazis.

I stepped back into the library. “What? The Nazis were here? In this museum?”

“Yes—several months after the blitzkrieg of Holland, the ERR troops drove up in their big limousines and stole everything—the books, a bust, and a portrait of Spinoza—everything. They carted it all away, then sealed and expropriated the
museum.”

“ERR? What do the letters stand for?”

“Einsatzstab Reichsleiter Rosenberg. The taskforce of Reich leader Rosenberg—that’s Alfred Rosenberg, the major Nazi anti-Semitic ideologue. He was in charge of looting for the Third Reich, and under Rosenberg’s orders, the ERR plundered all of Europe—first, just the Jewish things and then, later in the war, anything of value.”

“So then these books are twice removed from Spinoza?” I asked. “You mean that books had to be purchased again and the library reassembled a second time?”

“No—miraculously these books survived and were returned here after the war with just a few missing copies.”

“Amazing!” There’s a story here, I thought. “But why did Rosenberg even bother with these books in the first place? I know they have some modest value—being seventeenth-century and older—but why didn’t they just march into the Amsterdam Rijksmuseum and pluck a single Rembrandt worth fifty times this whole collection?”

“No, that’s not the point. The money had nothing to do with it. The ERR had some mysterious interest in Spinoza. In his official report, Rosenberg’s officer, the Nazi who did the hands-on looting of the library, added a significant sentence: ‘They contain valuable early works of great importance for the exploration of the Spinoza problem.’ You can see the report on the web, if you like—it’s in the official Nuremberg documents.”

I felt stunned. “‘Exploration of the Nazis’ Spinoza problem’? I don’t understand. What did he mean? What was the Nazi Spinoza problem?”

Like a mime duo, my hosts hunched their shoulders and turned up their palms.

I pressed on. “You’re saying that because of this Spinoza problem, they protected these books rather than burn them, as they burned so much of Europe?”

They nodded.

“And where was the library kept during the war?”

“No one knows. The books just vanished for five years and turned up again in 1946 in a German salt mine.”

“A salt mine? Amazing!” I picked up one of the books—a sixteenth-century copy of the Iliad—and said, as I caressed it, “So this old storybook has its own story to tell.”

My hosts took me to look at the rest of the house. I had come at a fortunate time—few visitors had ever seen the other half of the building, for it had been occupied for centuries by a working-class family. But the last family member had recently died, and the Spinoza Society had promptly purchased the property and was just now beginning reconstruction to incorporate it into the museum. I wandered amid the construction debris through the modest kitchen and living room and then climbed the narrow, steep stairway to the small, unremarkable bedroom. I scanned the simple room quickly and began to descend, when my eye caught sight of a thin, two-by-two-foot crease in a corner of the ceiling.

“What’s that?”

The old caretaker climbed up a few stairs to look and told me it was a trap door that led to a tiny attic space where two Jews, an elderly mother and her daughter, were hidden from the Nazis for the entire duration of the war. “We fed them and took good care of them.”

A firestorm outside! Four out of five Dutch Jews murdered by the Nazis! Yet upstairs in the Spinoza house, hidden in the attic, two Jewish women were tenderly cared for throughout the war. And downstairs, the tiny Spinoza Museum was looted, sealed, and expropriated by an officer of the Rosenberg task force, who believed that its library could help the Nazis solve their “Spinoza problem.” And what was their Spinoza problem? I wondered if this Nazi, Alfred Rosenberg, had also, in his own way, for his own reasons, been looking for Spinoza. I had entered the museum with one mystery and now left it with two.

Shortly thereafter, I began writing.

Chapter One

AMSTERDAM—APRIL 1656
As the final rays of light glance off the water of the Zwanenburgwal, Amsterdam closes down. The dyers gather up their magenta and crimson fabrics drying on the stone banks of the canal. Merchants roll up their awnings and shutter their outdoor market stalls. A few workers plodding home stop for a snack with Dutch gin at the herring stands on the canal and then continue on their way. Amsterdam moves slowly: the city mourns, still recovering from the plague that, only a few months earlier, killed one person in nine.

A few meters from the canal, at Breestraat No. 4, the bankrupt and slightly tipsy Rembrandt van Rijn applies a last brushstroke to his painting Jacob Blessing the Sons of Joseph, signs his name in the lower right corner, tosses his palette to the floor, and turns to descend his narrow winding staircase. The house, destined three centuries later to become his museum and memorial, is on this day witness to his shame. It swarms with bidders anticipating the auction of all of the artist’s possessions. Gruffly pushing aside the gawkers on the staircase, he steps outside the front door, inhales the salty air, and stumbles toward the corner tavern.

In Delft, seventy kilometers south, another artist begins his ascent. The twenty-five-year-old Johannes Vermeer takes a final look at his new painting, The Procuress. He scans from right to left. First, the prostitute in a gloriously yellow jacket. Good. Good. The yellow gleams like polished sunlight. And the group of men surrounding her. Excellent—each could easily stroll off the canvas and begin a conversation. He bends closer to catch the tiny but piercing gaze of the leering young man with the foppish hat. Vermeer nods to his miniature self. Greatly pleased, he signs his name with a flourish in the lower right corner.

Back in Amsterdam at Breestraat No. 57, only two blocks from the auction preparations at Rembrandt’s home, a twenty-three-year-old merchant (born only a few days earlier than Vermeer, whom he would admire but never meet) prepares to close his import-export shop. He appears too delicate and beautiful to be a shopkeeper. His features are perfect, his olive skin unblemished, his dark eyes large, and soulful.

He takes a last look around: many shelves are as empty as his pockets. Pirates intercepted his last shipment from Bahia, and there is no coffee, sugar, or cocoa. For a generation, the Spinoza family operated a prosperous import-export wholesale business, but now the brothers Spinoza—Gabriel and Bento—are reduced to running a small retail shop. Inhaling the dusty air, Bento Spinoza identifies, with resignation, the fetid rat droppings accompanying the odor of dried figs, raisins, candied ginger, almonds, and chickpeas and the fumes of acrid Spanish wine. He walks outside and commences his daily duel with the rusted padlock on the shop door. An unfamiliar voice speaking in stilted Portuguese startles him.

“Are you Bento Spinoza?”

Spinoza turns to face two strangers, young weary men who seem to have traveled far. One is tall, with a massive, burly head that hangs forward as though it were too heavy to be held erect. His clothes are of good quality but soiled and wrinkled. The other, dressed in tattered peasant’s clothes, stands behind his companion. He has long, matted hair, dark eyes, a strong chin and forceful nose. He holds himself stiffly. Only his eyes move, darting like frightened tadpoles.

Spinoza offers a wary nod.

“I am Jacob Mendoza,” says the taller of the two. “We must see you. We must talk to you. This is my cousin, Franco Benitez, whom I’ve just brought from Portugal. My cousin,” Jacob clasps Franco’s shoulder, “is in crisis.”

“Yes,” Spinoza answers. “And?”

“In severe crisis.”

“Yes. And why seek me?”

“We’ve been told that you’re the one to render help. Perhaps the only one.”

“Help?”

“Franco has lost his faith. He doubts everything. All religious ritual. Prayer. Even the presence of God. He is frightened all the time. He doesn’t sleep. He talks of killing himself.”

“And who has misled you by sending you here? I am only a merchant who operates a small business. And not very profitably, as you see.” Spinoza points at the dusty window through which the half-empty shelves are visible. “Rabbi Mortera is our spiritual leader. You must go to him.”

“We arrived yesterday, and this morning we set out to do exactly that. But our landlord, a distant cousin, advised against it. ‘Franco needs a helper, not a judge,’ he said. He told us that Rabbi Mortera is severe with doubters, that he believes all Jews in Portugal who converted to Christianity face eternal damnation, even if they were forced to choose between conversion and death. ‘Rabbi Mortera,’ he said, ‘will only make Franco feel worse. Go see Bento Spinoza. He is wise in such matters.’”

“What talk is this? I am but a merchant—”

“He claims that if you had not been forced into business because of the death of your older brother and your father, you would have been the next great rabbi of Amsterdam.”

“I must go. I have a meeting I must attend.”

“You’re going to the Sabbath service at the synagogue? Yes? We too. I am taking Franco, for he must return to his faith. Can we walk with you?”

“No, I go to another kind of meeting.”

“What other kind?” says Jacob, but then immediately reverses himself. “Sorry. It’s not my affair. Can we meet tomorrow? Would you be willing to help us on the Sabbath? It is permitted, since it is a mitzvah. We need you. My cousin is in danger.”

“Strange.” Spinoza shakes his head. “Never have I heard such a request. I’m sorry, but you are mistaken. I can offer nothing.”

Franco, who had been staring at the ground as Jacob spoke, now lifts his eyes and utters his first words: “I ask for little, for only a few words with you. Do you refuse a fellow Jew? It is your duty to a traveler. I had to flee Portugal just as your father and your family had to flee, to escape the Inquisition.”

“But what can I—”

“My father was burned at the stake just a year ago. His crime? They found pages of the Torah buried in the soil behind our home. My father’s brother, Jacob’s father, was murdered soon after. I have a question. Consider this world where a son smells the odor of his father’s burning flesh. Where is the God that created this kind of world? Why does He permit such things? Do you blame me for asking that?” Franco looks deeply into Spinoza’s eyes for several moments and then continues. “Surely a man named ‘blessed’—Bento in Portuguese and Baruch in Hebrew—will not refuse to speak to me?”

Spinoza nods solemnly. “I will speak to you, Franco. Tomorrow midday?”

“At the synagogue?” Franco asks.

“No, here. Meet me here at the shop. It will be open.”

“The shop? Open?” Jacob interjects. “But the Sabbath?”

“My younger brother, Gabriel, represents the Spinoza family at the synagogue.”

“But the holy Torah,” Jacob insists, ignoring Franco’s tugging at his sleeve, “states God’s wish that we not work on the Sabbath, that we must spend that holy day offering prayers to Him and performing mitzvahs.”

Spinoza turns and speaks gently, as a teacher to a young student, “Tell me, Jacob, do you believe that God is all powerful?”

Jacob nods.

“That God is perfect? Complete unto Himself.”

Again Jacob agrees.

“Then surely you would agree that, by definition, a perfect and complete being has no needs, no insufficiencies, no wants, no wishes. Is that not so?”

Jacob thinks, hesitates, and then nods warily. Spinoza notes the beginnings of a smile on Franco’s lips.

“Then,” Spinoza continues, “I submit that God has no wishes about how, or even if, we glorify Him. Allow me, then, Jacob, to love God in my own fashion.”

Franco’s eyes widen. He turns toward Jacob as though to say, “You see, you see? This is the man I seek.”

Violet Oaklander on Gestalt Therapy with Children

Posted on by rezendevknowfully.com

An Unorthodox Notion

Rafal Mietkiewicz: Violet, what makes me curious is that you are trained as a Gestalt therapist and people connect you with Gestalt therapy, but Gestalt therapy was mainly considered, at least here in Europe, to work primarily with adults. How did you find your way to do Gestalt therapy with the kids?
Violet Oaklander: I was already working with emotionally disturbed children in the schools when I got interested in Gestalt therapy. One of my children became very ill and died. I was very depressed. My friend was going to Esalen Institute to be in a group for a week with Jim Simkin, so I went with him, and I was so impressed with what happened to me. It made such a difference for me that when I came back, I started training in the Los Angeles Gestalt Therapy Institute, and while I was training, I thought, “How could I apply this to children?”It seemed very organic to me. Fritz Perls talked about the body and senses and all of that. I found that it fit my work with children and child development. And of course, over the years, I started using a lot of creative media, like drawing and clay and puppets and music, because that’s the only way it would interest children. But behind that, the basis of my work was Gestalt therapy theory and philosophy. And I developed it more and more as time went by. That’s how it got started.

RM: That’s what you wrote in your book—that children already know, but they are wearing special glasses, so you just take the glasses off?
VO: Yeah. I have many stories working with kids. I’m trying to think of when I first started. When I first began, I was working in the schools with maybe a group of 12 children. And they were older—maybe 12 and 13 years old, all boys. These were kids that didn’t make good contact; they didn’t connect very well with other children.I started doing things that were sort of different. I would have them finger paint. I’d line up the desks so it was like a table, and they’d stand around the table finger painting. At first, they didn’t want to do it. “It’s for babies.” But while they were finger painting, they would talk to each other, make really good contact. And of course it was important to establish boundaries—what they could not do and what they could do. So that was very clear.

Another thing I started doing was bringing in wood, and they would build things. These were children who weren’t allowed to hold a hammer or a saw because they were very disturbed children—it was dangerous. But I saw other classes had wood and got to build things, so I got that. And they had rules: they couldn’t swing the saw or the hammer, or else they had to sit down that day.

I wouldn’t let them build guns, but they could build boxes and birdhouses, and they would work together because they had to share the tools. You would not believe they were emotionally disturbed children. They were making such good contact and really enjoying this. I did many things like that.

RM: You look like you really enjoy your work.
VO: Oh, yeah. I even had the old empty chair. I had two chairs in the front of the room, and when a kid would get really upset and angry, I would have him sit in the chair and talk to the empty chair.And the child that he was angry at might be in the room there, but he would be talking to the empty chair. And then I’d have him switch and say, “Well, what do you think he would say back to you?” and it was so amazing because he would realize that he was projecting. They didn’t know that word—they didn’t have that insight. But they could see that they were projecting their own stuff on the other boy.

It would be so amazing. They would come into the room and say, “I need the chairs.” They would talk to a teacher who had yelled at them outside. They would talk to that teacher, and then they would begin to see that the reason the teacher yelled at them is because they did something they weren’t supposed to do. They knew this, but when they sat in the empty chair, they’d say, “Well, I yelled at you because you hit this other boy!” And then I’d say, “Now, what do you say to that?” They’d say, “Yeah, I guess I did. I did do that, yeah.” It was just little things like that that I began to do, to experiment with some of the techniques.

After I left teaching and I was in private practice, I thought a lot about what I was doing, and I started developing a therapeutic process that was based on Gestalt therapy, beginning with the “I-thou” relationship, and looking at how the child made contact, and then building his sense of self and helping him to express his emotion.

RM: It seems like you combine a bunch of techniques and approaches in your work—like expressive art therapy or child group therapy.
VO: Yeah. We do a lot of sensory work. I mentioned finger painting—anything they can touch. Clay is incredibly sensory and evocative. If it seems like they need to do some movement, we do that. Sometimes we play creative dramatics—charades—because to show something, you have to really be in touch with your body. We might start with fingers: “What am I doing? Now, you do something.” And they think of something and they have to use fingers to act it out.And then maybe we do a sport—they have to show with their body what sport they’re playing, and I have to guess. It might be obvious, but they enjoy doing that anyway—maybe catching a ball or hitting with a bat or tennis racquet. They have to get in touch with their body to do that.

The projective work with drawings and the clay is also very important, because this is how they can project what’s inside of them and then own it. One example is a boy who had a lot of anger but he kept it inside. He presented himself as just very nice and sweet, and nothing was wrong with his life. It was only after I asked him to make something, anything—I usually say, “Close your eyes and just make something, and then you can finish it with your eyes open”—he made a whale, and told a whole story about how the whale had a family—a mother and a father and sister.

What I always do after they tell the story is try to bring it back, so I said, “Well, does that fit for you? Do you have a family like that?” He said, “No, my father lives far away because he and my mother don’t live together. I never see him.” “Well, how do you feel about that?” And then we started talking about his father, which he would never have mentioned, and all this feeling came up. It’s very powerful.

The First Session

RM: How do you approach the first session with a child?
VO: I always meet, if possible, with the parents and the child the first session, because I want the child to hear whatever the parents tell me. I don’t want the parents to tell me things and have the child not know what they told me.Even if the parents are saying bad things about the child, the child needs to hear what I hear from the parents.

Usually in the first session, I have a checklist, and very often I would put it on a clipboard. First I would say, “Why are you here?” and all that. Then I would ask the child these questions. “Do you have a good appetite? Do you have bad dreams?” A whole list of questions.

Sometimes the parent would chime in, but mostly it’s to the child. It was a way of really making a connection with the child. Of course, if they were very, very young, four years old, maybe I’d still ask these questions, but not everything—and use language they could understand.

That’s always pretty much the first session. But if there are no parents involved—because I saw many kids who were in foster homes or group homes—the first session is an important one to establish some kind of connection or relationship. Sometimes I’d ask the child to draw a picture on that first session. I’d ask them to draw a house-tree-person. But I wouldn’t interpret it. It’s not for interpretation. It was to say to them when they were done, “Well, this picture tells me that you keep a lot of things to yourself. Does that fit for you?”—because maybe they wouldn’t draw many windows. And they usually would say “yes.” Or, “This picture tells me that you have a lot of anger inside of you. Does that fit for you?” If they’d say, “No, I’m not angry,” I’d say, “Oh, okay. I just need to check out what I think it tells me,” and we would have that kind of a session.

I did that once with a very resistant 16-year-old girl who at first said she wouldn’t speak to me. And when we finished, she wanted her sister and her mother to come in and do that drawing. So it’s a way of connecting.

But we don’t always do that. If it’s a child who is very frightened—I had a girl, for instance, who was very severely sexually abused for many years, and it finally came out when she was about 11, and she was removed from the home. So she was in a foster home, but the foster mother was very devoted to her and came in, too.

But she was very, very frightened and didn’t want to talk to me. So in the beginning we would take a coloring book, and we’d both color in the book. And we wouldn’t really talk about anything. I’d say to her, “Should I use red for this bird? What do you think?” and just begin to connect with her that way. Pretty soon I was asking her, “Well, what do you think the bird would say if it could talk?”—that kind of thing.

Pay Attention

RM: It’s my guess that you don’t really diagnose kids in clinical terms.
VO: No. I mean, sometimes I would have to for an insurance company. But it’s a matter of seeing where they’re at, where they’re blocked. I had one boy who walked very stiffly all the time. He was 11 years old. And I thought, “Maybe we need to do something to help him loosen up before we even talk about his feelings”—that kind of diagnosis.
RM: So, you don’t find clinical diagnosis useful in therapy?
VO: Not very much, no.
RM: You trust in what you see and what you feel about the kid.
VO: What I see, yeah.If, for example, the child has a lot of difficulty making a relationship with me, that’s what we have to focus on, because I can’t do anything unless we have that relationship. Sometimes children have been very hurt and damaged so early, they have trouble making a relationship. So we have to figure out how we could do that.

I used to see a lot of adolescents who were arrested by the police because they had committed a crime. I was involved in a program where they would send these children to counseling. It was a special program they were trying. So this one girl came in. She had to come—she had no choice. She was 14. She wouldn’t look at me, she wouldn’t talk to me. She just sat there. Naturally when a child does that, it makes you have to come forward more. Well, it didn’t work. So I thought, “Maybe I cannot see this girl. Maybe I have to refer her to another person.”

I went out into the waiting room the next time she came, and she was reading a magazine. I sat down next to her and I said, “What are you reading?” She flashed the cover at me. I said, “I didn’t see it,” so she held it up.

RM: And that was the beginning of contact.
VO: Yeah. Already we were making contact. And it was a music magazine about different groups. I said, “I don’t know anything about that. Could we look at it together?” So we went into my office and looked at the magazine, and she was telling me about the different groups. It was mostly heavy metal. And she was all excited, telling me about the groups and which ones she liked.We tried to find the music on the radio because I said, “I don’t know what it sounds like.” We couldn’t find it, so she said she would bring in a tape. The next week, she brought it in and we listened together. Some of the songs were so amazing—all these feelings and anger. So we just started working with that. And we had a relationship.

But we need to do that—start with where they are. Pay attention. I wasn’t paying attention in the beginning. It was only when I thought, “What am I going to do?”

RM: So apparently the child therapist must be very in touch with his own senses. I guess it’s more important than clinical knowledge.
VO: I think you’re right. You have to know things, but that’s most important—to be in touch with yourself. It’s not easy to be a child therapist. An adult comes in and says, “This is what I want to work on,” or, “This is what’s happening.” When a child comes in, she doesn’t have a sense of what she needs to do. And you have to talk to parents, and you have to talk to teachers, and that kind of thing, too. So it’s different.
RM: Do you do something particular to help bring each session to an end—to help bring the child back to “regular life?”
VO: I think the job of the therapist is to help the child express what’s going on inside. But I notice that most children will only express what they have the strength to, and then they get resistant or they close down. They take care of themselves better than adults that way.But if they do open up a lot, we have to pay attention to what I call “grounding” them. I have a policy that children have to help me clean up whatever we’ve used. So we start cleaning up and then I’ll say, “Well, that was hard. Maybe we’ll talk some more about it next time, but where are you going now?” or “What are you having for dinner?” or “What did you have for dinner?” We talk about regular things to help them come back to ground.

RM: I know that Gestalt therapists hate “shoulds,” but using a paradox, are there any “shoulds” that a good child therapist should obey?
VO: Nothing comes immediately to mind, other than things I’ve already said. But speaking of “shoulds,” it’s worth noting that children have a lot of “shoulds.” People don’t realize that, but children are very hard on themselves. They’re split—there’s a part of them that’s very critical of themselves and then a part of them that, of course, rebels against that. Sometimes we help them understand that, especially if they are adolescents.
RM: Do you touch or hug your clients?
VO: Sometimes, but I’ll always ask them. I might say, “Can I give you a hug?” I don’t just do it. I have to ask them. Or I might put my hand on their shoulder. I can tell if they pull away that that’s not a good thing to do. Or sometimes we shake hands. We do a little bit—not a lot.

Working with Parents

RM: Do you often talk to parents?
VO: Oh, yes. This girl that I just mentioned, she lived in a foster home, and they didn’t care about her, so they weren’t interested. They just did what they had to do. But yes, parents come in. Every three or four weeks they have to come in with the child. Sometimes we just have a family session and I don’t see the child individually. It depends. You have to just decide which is the best way to go.
RM: We have agreed that it’s important for therapists to be in touch with their own feelings. What other qualities should one have to be a good child therapist?

VO:

You have to understand child development so you have a sense of if the child is not at the level she needs to be at. You have to understand the process. You have to be in touch with yourself. You need to know when your own buttons are being pressed—in psychoanalytic vocabulary, they call it transference. You have to understand when you have some countertransference, and to deal with that and work with that.

RM: In your Child Therapy Case Consultation video, a therapist is presenting a case of a child who is acting aggressively. You state at one point that kids can’t change their behavior with awareness. Is this why you often use art or have kids smash clay or other activities, versus just talk therapy?
VO: Yeah. What I mean is children don’t say, “This is what I’m doing to keep me from being happy or satisfied.” Even adults have trouble being aware of what they do to keep themselves stuck. So, with children, these drawings and clay are powerful projections. And it’s the way they can articulate what’s going on with them, without bypassing the intellect, but coming out from a deeper place. And at some point, they will own it. They will say, “Oh, yes, that fits for me.”When children feel stronger about themselves and they express what’s blocking, their behaviors change without having to force it or say anything. I mean, what makes children do what they do? All the behaviors that bring them into therapy are really ways of not being able to express what they need to express—of not being heard or not feeling good inside themselves.

RM: How do you measure progress in your work with children?
VO: It’s important to help the parents see the small changes, and not to expect complete reversal. And, of course, we have to work with the parents, too. Often the parents have a lot of difficulty with their own anger, and we have to work to help them understand how to express these feelings without hurting people around them. We can often do that in family sessions—help them to express what they’re feeling and what they’re wanting and what their sadness is about.One of the things I’ll say to parents is that I don’t fix kids. But what I do is I help them feel better about themselves. I help them express some of their deeper feelings that they’re keeping inside, and help them feel a little happier in life. We do many things to make this happen. And that’s what you have to look for. So when a parent comes in a month later and I say, “How are things going at home?” and the father says, “I think he’s a little happier,” then I know that this father has got it, and he’s seeing some progress here.

I am thinking of this was a boy of maybe 14 who was stealing, and the father wanted to send him to a military school because he couldn’t control him. There was a lot of reason the boy was like that, but that doesn’t help to understand the reason. It’s good to understand the reason why he’s like that, to help him change and be different.

So that’s how I look at progress. When they’re doing better out in life, they’re going to school and have some friends, and doing some of the things they have to do at home, and doing their schoolwork, then you’re seeing progress. They may not be altogether different, but they’re functioning in life.

The other thing that’s important is that it has to be at their level. Children can’t work everything out. They have different development levels. So the girl who was very severely sexually abused, we did a lot of work about that. But when she was 13, she had to come back into therapy for more work—things came up. They reach plateaus. They have to go out and be in life, and then maybe more things come up.

Becoming a Child Therapist

RM: Does it happen often that, when therapists work with a kid, the therapists’ trauma from childhood appears?
VO: Absolutely. That’s something one has to really know about—be in therapy, have a therapist. I have several people who come to me for supervision who are very experienced therapists, and that’s the reason they come. I think it’s really good for a child therapist to have somebody to talk to and consult with because it’s very difficult sometimes. You can’t always see what’s going on.
RM: How long does it take to be fully trained as a child therapist?
VO: Oh, gosh. For many years, I did a two-week training. People would come from all over the world. And sometimes they would get it in those two weeks, and other times they didn’t, so I don’t know. Two weeks is not enough, but it was the most that people could give of their time. Sometimes they’d come back two or three times to the training, but those were people who actually got it the most, because they were so committed to learning more.I can’t define a time. They have to have the experience of working with children first, I suppose, and understand about children. You have to have patience when you work with children. If one thing happens in a session—if they say, “I’m like that lion. I get so angry, just like that lion,” or whatever—if they say one thing, sometimes that’s it for a session. You have to be patient.

RM: What are the most frequent mistakes that therapists make when they work with kids?
VO: Usually what happens is therapists get stuck. They don’t know where to go next or what to do next.
RM: But why do they get stuck?
VO: Maybe they’re just not able to stand back and look. Sometimes, in a supervision or consultation, I’ll give a suggestion, and they’ll say, “Oh, of course, why didn’t I think of that? Of course, I know that.” They get too close to it and worry about doing the right thing. They’re afraid to make mistakes, really. I always tell them, “No matter what you do, you can’t really go wrong.”
RM: If you were to give the best advice to the young therapists about working with children, what would be this advice be?
VO: I might say if you’re working with children, you have to like children!

If you’re working with children, you have to like children!

What Keeps Me Going

RM: My last question is personal. How do you manage to keep so vital?
VO: You know, I’m 84.
RM: You don’t look it.
VO: I don’t know. I am who I am, I guess. I’m still working some. I have this foundation (The Violet Solomon Oaklander Foundation), and we’re having a conference this weekend at a retreat center, and I’m going to do a keynote. So every now and then I still do something like that, or conduct a supervision. That’s what keeps me going. I do a little writing. I read a lot.I lived in Santa Barbara, California, for 21 years. And my son, who lives in Los Angeles, decided I was getting too old to live there by myself. So he tore down his garage and he had a little cottage built, and that’s where I live now, in this little cottage behind their house.

I miss Santa Barbara. I had a lot of friends. I’d be more vital if I was back in Santa Barbara. But I am getting older, and I had a little heart attack this year—little. I’m okay. But I was in the hospital a few days. So it’s good that I’m near my son and my daughter-in-law.

RM: It is obvious for me that you, at 84, have still have so much to give to the others.
VO: Thank you very much for those nice words. I will, as long as I can.That’s what keeps me vital: just doing as much as I can, as long as I can. I just have to learn to take it easy.

Sue Johnson on Emotionally Focused Therapy

Posted on by rezendevknowfully.com

Foundations of EFT

Victor Yalom: Sue, it's great to be with you today. We might as well start with the basics. Can you just say a bit about what is emotionally focused therapy or EFT?
Sue Johnson: EFT is an approach that was developed in the '80s to work with couples, that now has a very strong empirical base. It's been tested. There's lots of outcome data. We know that we get results with lots of different kinds of couples. We know how we get results. As its name suggests, it's an approach that focuses very much on how people deal with their emotions and how they send emotional signals to their spouse, and then how this emotion becomes the music of their interactional dance.

It's an attachment-oriented approach. Attachment is a broad theory of personality and human development that focuses, also, very much on emotion. It's an attachment approach, so it assumes that we all have very deep needs for safe connection and emotional contact, and that when we don't get those needs, we get stuck in very negative interactional patterns; the dance music gets very complicated.
VY: Of course, humans are complex creatures. Emotions are an essential component, but we also have cognitions. Why do you focus on emotions?
SJ: We focused on emotion, in some ways, because they were pretty much left out of interventions, particularly systemic interventions—interventions that looked at relationships. Emotions were really considered the enemy. They were the things that people had difficulty with. Particularly, anger and conflict were considered the enemy. So there was a lot of focus on just teaching people skills to control emotion—to be nicer to each other.

And what we tried to do is say, "No, focusing on emotion and helping people send key emotional messages to each other that help the other person feel safe is the most important part of a relationship. It's the key part of the attachment bond. And we really need to teach people how to do that." So that's why we focused on emotion.

VY: And how did attachment theory become such a central component?
SJ: Really, couples taught us how to do EFT. We started looking at how couples got caught in being overwhelmed by their emotions, or numbing out their emotions, or putting very negative emotions out to each other, and getting caught in really negative cycles. But we didn't understand why these cycles were so powerful, took over the whole relationship and induced such distress in people. We knew there was something powerful here. And we learned how to help people get out of these negative dances and move into positive, trusting, more open dances with each other.

So we discovered how to do that, but we didn't really understand why this dance was so incredibly powerful, why it had the effect it did until
VY: And when you refer to the dance, you’re referring to the patterns that couples get into.
SJ: Yes, I think of the patterns of interaction in a relationship as a dance. And I like to think of emotion as the music of the dance. I think that is a shorthand way of talking about how powerful emotions are. It’s very difficult to learn skills and do a new dance that’s about tango when there’s waltz music playing. You end up going on with the music in the end. That’s what happens in relationships with emotion.
VY: What do you mean?
SJ: If I'm really hurting and really upset with you, and I'm vigilantly watching everything you do, waiting for some sign that I don't really matter to you and you are about to turn away from me, I discount the positive things you say, for a start. I wait for you to raise your left eyebrow and say something negative. And when you say that, I'm ready—I have all these catastrophic ideas and feelings in my body, and this felt sense of falling through space and insecurity. And I react like crazy. And you turn to me and you say, "But I was so sweet to you yesterday. Doesn't that count?" And if I'm honest, I would say no. So our emotional realities are very powerful.
VY: The kind of situation you just described is something that therapists often get tripped up on. When we’re in the room with a couple, things happen so quickly, even before we understand what’s happening and they’re off to the races.
SJ: That’s right.
VY: So how does the theory help us? How do you understand that?
SJ:
It really helps to understand that you're dealing with an attachment drama. You're dealing with dilemmas in human bonding.
It really helps to understand that you're dealing with an attachment drama. You're dealing with dilemmas in human bonding. So the emotions that you're dealing with are high-voltage emotions, because your mammalian brain sees these emotions—these situations—in terms of life and death: "Does this person care about me?" It looks like we're having a fight about parenting, but, in fact, if you tune into the emotions, oftentimes two minutes after the fight started—or two seconds after the fight started—the fight ends up being about attachment issues like, "Do you love me? Do I matter to you? If I hurt do you care? Are you there for me? Will you respond to me? Can I depend on you?"

I started to realize after we'd done the first outcome study that the logic behind these emotions was that they were all about attachment and bonding, and our deep human need for that secure bond.

Johnson's Flash of Insight

VY: How did that come to you?
SJ: It was a flash of insight, I’m afraid. It sounds corny, but it was one of those traditional corny "Aha!" things that just hit you in the head.
VY: How did that happen?
SJ: Actually, I was at a conference. We'd done the first outcome study of EFT. It had worked amazingly well. I couldn't really understand how it had worked so well, and I was at a conference listening to Neil Jacobson talking. And Neil Jacobson, who was really the father of cognitive-behavioral marital therapy, was giving a talk and basically saying that relationships are rational bargains, so what you have to do is teach people to negotiate. His theory was that you can negotiate almost anything, including affairs. And this was the theory of relationship underneath the behavioral approaches: you teach people communication skills so that they can problem solve and bargain better.

Afterwards, I and my colleague Les Greenberg, who originally helped me put together EFT for couples, were sitting in a bar, and he said, "He's wrong." And I said, "Of course Neil's wrong." And he said, "Well, why is he wrong?" And I said, "Oh, he's wrong because an adult love relationship is an attachment bond, and you can't bargain for basic responsiveness and safety and love." And that was it. And then suddenly the whole of John Bowlby, who I'd read, but who I'd never made the links—it was like somebody hit me with a sledgehammer.

I went home and wrote an article called "Bonds or Bargains," which ended up being in the Journal of Marriage and Family Therapy, even though Alan Gurman sent it out for review four times, and each time he got two people who hated it and who said that adult relationships were not attachment bonds like the bonds between mothers and children. They were adult friendships, and they were rational, and dependency was a problem, and we got over it. And the other half of the people said, "Oh, this is really new and interesting." And Alan Gurman finally said, "I can never get people to agree. They either hate it or love it. So, Sue, I like it so I'm going to publish it"—for which I bless him forever.

That was the first article—it came out in '86. And in '87 Hazan and Shaver, who were social psychologists, bought out their first little study of adult attachment. Bowlby always said adults had attachment, but we'd never really done anything with his remarks.
VY: So the interesting thing is you developed the theory and practice of EFT before you conceptualized the centrality of attachment in it, and it worked without that understanding.
SJ: It worked because, I think, we were Rogerian, and we understood how to create new interactions from a systemic point of view. But we didn't really understand why these new interactions worked so well.

And don't forget, also, in those days not much was written about adult attachment. Since then there have been hundreds of studies. It's a very rich literature now—lots of studies on adult attachment linking adult attachment to better health, feeling better about yourself, better ability to deal with stress. But in those days—in the '80s—nobody was writing about adult attachment. So there wasn't a literature sitting there that I could go to and say, "Oh, this is it." I just understood suddenly what I was looking at between adult partners, and how this paralleled the between the bonds between mothers and children, which many people still find very difficult to accept. They say, "No, they're totally different."
VY: It certainly goes against the strong sense of psychological independence that we cherish in the West and is so central to so many of our conceptions of psychological health.
SJ: Yes. I think what we've done is we've pathologized dependency. If you really think about it, though, how on earth do we get to be independent anyway?
Bowlby basically said for a child to really become independent, he has to be dependent first.
Bowlby basically said for a child to really become independent, he has to be dependent first. He has to be able to turn to other people and reach for them, and know how to connect with others in order to build this sense of self and in order to deal with how your self evolves and how big the world is. In other words, Bowlby basically said we're mammals. We need other people. A strong sense of self and the ability to be separate are tied to how connected you feel. They're not opposites—they're both the two sides of the same coin. We made a mistake in that.

In psychology and in therapy, we often see a little piece of the picture, and we go with that because that's all we can see. Then when the whole picture suddenly evolves, we can put things together in a different way.
VY: So you don’t like the ideas of co-dependency or enmeshment?
SJ: Well, enmeshment confuses anxiety about closeness and coercion, for one thing. It's a very vague concept, and a lot of it came out of watching families where adolescents were in deep trouble and the therapist was trying to help the adolescents assert themselves with the parents. There's nothing wrong with the word "enmeshment" if you put it in a very particular context.

Co-dependency came out of the addiction literature, and we used it as a global blame for people without understanding that we have amazingly powerful emotional links with the people we love. To say you shouldn't have those links is craziness. Those links are wired into our brains by millions of years of evolution. Bowlby says if you're a mammal, there's no such thing as real self-sufficiency. And there's no such thing as real over-dependency. But there are massively anxious behaviors around dependency.

What healthy people have is effective dependency, which means—and there's lots of research behind this now—the more you know how to turn to other people, the more you can trust other people, the more you can go inside of yourself and access, for example, your loved one's face when you're feeling upset or distressed, the stronger you are as a person, the better you feel about yourself and the more able you are to take autonomous decisions.
The more you know how to turn to other people, the better you feel about yourself and the more able you are to make autonomous decisions.
And I'm not making this up. I can quote you study after study, and you see it in therapy.
VY: I know that you can. And I know you can talk passionately and animatedly about the attachment literature for hours—
SJ: Yes, I can. It’s the best thing to ever hit psychology and therapy in the last hundred years, so there you go.
VY: Yes, you’re not one shy of opinions!
SJ: No. Life's too short to not put out what you think. And if someone can show you you're wrong, that's good.

EFT Techniques

VY: How did it change your thinking and the technique of EFT when you had that "aha!" moment and started to understand the significance of attachment in adult couples?
SJ: I think it helped me understand, on a deeper level, how powerful these emotions were that I was seeing in the couple. It helped me understand the power of fear in a couple—fear of abandonment, fear of rejection. It helped me understand the logic behind some of the apparently self-destructive positions people take in relationships.
VY: Can you give an example of the fear or the self-destructive positions?
SJ: For example, one of the classic ones in relationships is, "I feel lonely. I feel unsure that you care about me. I don't even know quite how to put that into words because I'm an adult—I'm not supposed to feel that way. But I somehow feel like I'm starving emotionally. And I decide that what I'm going to do is I'm going to make you respond. Ironically, I'm feeling all these feelings inside of abandonment and loneliness and fear, and what I say to you is, 'You never talk to me.'"
VY: What you're describing is what's underneath, unconscious, as it were—not what the person's actually saying, but what you posit is driving their behavior.
SJ: You don't have to posit it if you slow people down, and you say, "In the second before you get angry and tell your husband that he's ridiculous because he can't talk to anyone—in the second before you attack him to get his attention and to make him listen to you—what's happening to you?" If you just slow people down, there are enormously powerful universal patterns that you can see, and they fit very well with what John Bowlby saw in situations between mothers and infants.

There are only so many ways we have of dealing with our emotions. If I'm in a relationship with somebody and I want them to respond to me, and suddenly I'm not getting responsiveness and connection, I've got to reach for them and say, "Where are you? I need you." If somehow I'm afraid to do that or that doesn't work too well, then there are really only two alternatives. I get angry and shriek—children shriek or they get mad or they get aggressive with the mother, and so do we. We say, "Why don't you ever talk to me?" Unfortunately, if that gets to be a habitual pattern, I end up pushing you away. And in classic marital distress, the other person hears, "I'm being rejected. I'm disappointing. I'm messing up. I'm not pleasing this person. I don't know how to please this person. This hurts like hell. I want this fight to stop. I'm just going to stop talking."

So one person numbs out. And the more he numbs out, shuts down, shuts his partner out, the more his partner gets angry and pushes.
So one person numbs out. And the more he numbs out, shuts down, shuts his partner out, the more his partner gets angry and pushes. And that is the most classic dance of relationship distress in North America. It's a hot number. We all do it a lot.
VY: This is what you refer to as a cycle?
SJ: That's a cycle. And in Hold Me Tight, which is the book I wrote for the public a couple of years ago, it's one of the main "demon dialogues." What's important is if you understand that that drama is not about communication skills or your personalities, or that you're deficient somehow, but rather that drama is about both of you being caught in feeling disconnected from each other and not knowing how to handle it—if you understand that, what we first teach people to do in EFT is to basically understand they're scaring the hell out of each other. Then we teach them how to step out of the negative patterns, and then deliberately learn how to reach for each other—which is what mothers and infants and bonded partners and people who love each other in positive relationships naturally do—learn how to reach for each other and create loving, responsive, open emotional communication where they can get their needs met.
VY: Sounds nice.
SJ: It is nice. It’s fun to do, as well. As a therapist, it makes you feel like you’re actually really doing what you wanted to do in grad school when you decided to be a therapist.
VY: So how do therapists do that? The first thing, I guess, is to start to be able to identify, in your own mind, this dance—this cycle.
SJ: Yeah. At this point, we’ve been doing EFT for 25 years. We’ve set it out pretty clearly and we’ve even done research on what you have to do to make this work. First of all, you’ve got to create safety in the session.
VY: Okay, safety is number one. So how do you do that?
SJ: You do that by being empathic and by being emotionally present. Really, this is a Rogerian therapy. So you do that in the traditional Rogerian way, but I think it's more intense than Rogers really created because you also help the couple understand the drama that they're caught in. So you're a relationship consultant. You follow the couple's drama. You make it clear to them the steps they're doing in the dance.
VY: That's "Rogers plus," because you're not just reflecting back—you're starting to explain to them what you see that they're doing.
SJ: I think you have to do more than explain. You have to give them a felt sense.
You have to catch it as it's happening, and you have to help them see the dance they're caught in and how it leaves them both alone and hurting.
You have to catch it as it's happening, and you have to help them see the dance they're caught in and how it leaves them both alone and hurting. You also have to help them see that underneath this dance they're both in pain, and that this pain is just built into us. It's part of who are as human beings. So that is key. You have to create safety in the session. You have to help people explore their emotions so that they can talk about some of these softer feelings.

If you're always telling me that you don't want to hear me because I'm so angry, after a while all I show you is anger. And all I see you do is be cold and indifferent. And what we help people do is talk about the softer feelings that they don't even know how to name sometimes, and certainly don't know how to share. So the reactively angry partner will start talking about how "I feel lonely. I don't know what to do. I do get angry. I do get critical because underneath I'm so scared I don't matter to him."

And we will help her not only access that and work with those feelings, regulate them differently, integrate them so she can talk about those softer feelings—we'll help her turn and share with her partner in interactions where we scaffold the safety in. We help her share that, and we help her partner hear it—because one of the reasons you need a therapist is that sometimes you do give these clear emotional messages to your partner, and because of the negative music playing in the relationship, your partner doesn't even hear it. Your partner doesn't trust, doesn't respond to it.
VY: When you say you help them share these feelings with their partner—this is what you refer to as enactments, á la Minuchin, right?
SJ: Yes, although they’re much more emotional than Minuchin’s enactments usually were. To really summarize it, the EFT therapist creates safety, deepens people’s emotions using the attachment frame, to the soft feelings, the fears, the sadnesses, the hurts, sometimes even the shame underneath their reactive responses to each other, and then helps them send clear signals to their partner in very powerful interactions about their fears and their needs. Really, we teach people to help each other deal with these difficult emotions in a way that brings them closer.
VY: So if all goes well, you identify their pattern, you help them feel safe, you observe their pattern, you help them identify it, and then you help them start to express their deepest, vulnerable, unmet needs with each other. Then what happens?
SJ: It's basically the prototypical corrective emotional experience. And the reason it's so powerful is that we have these key change events in the second stage of EFT. In the first stage, we de-escalate the negative patterns so that people can stop and say things like, "Hey, we're caught in that thing again—that thing where I get angrier and angrier and you get more and more silent. This is the place where we both get hurt." And they start seeing the dance is the problem.

So they can have control over the negative interaction pattern, but that's not enough. I think lots of couples therapies get people there one way or another. The important bit for me is the second stage, where we actively use an attachment frame to help people to distill their attachment fears and their attachment needs, which in the beginning of therapy they are often not even aware of. And then we help them share that.

When that happens and the other person can respond,
sometimes for the first time in people's lives they actually feel that another person is there for them, that the other person cares, that they matter to someone.
sometimes for the first time in people's lives they actually feel that another person is there for them, that the other person cares, that they matter to someone. This is a huge event. It starts to redefine the relationship as a secure bond. And it's incredibly positive for people because we have mammalian brains.
VY: It can be. But take the example where one of the partners gets to the point where they can be incredibly vulnerable and open and express their unmet needs, and the other partner has their own intimacy issues and blocks, and that’s too much for them, and they reject it or they withdraw.
SJ: First of all, the therapist is there dealing with that. Secondly, you titrate the risks people take in EFT. You don’t ask people to take huge risks before they’ve done Stage One. So ideally you don’t let people get into that position. But, nevertheless, if someone shares and the other person can’t respond, the good EFT therapist will go in and help that person slow everything down. See, emotion’s fast. If you want people to regulate it better and integrate it and deal with it differently, you’ve got to slow it down.
VY: Yeah, and I’ve seen you work and you’re very good. You track people very carefully, and you’re very good at slowing it down.
SJ: Yes. So in that case, I would turn to the person. I would say, "Could you help me? Did you see your partner just turned to you and said, 'I am scared. I am. And that's when I get into my tank, but inside I'm always so terrified that you never really chose me. I never understood why you married me. I'm always terrified by the fact you could leave me any minute'—did you hear your partner say that?"

You'd be amazed at what people hear sometimes. I had one man who basically said, "I heard that she can leave me any minute." So you have to slow it down. You have to help people get clear, and then you have to say to the person, "What happens to you?" And often people don't know what to do with it, so they'll go cognitive. They'll say, "Well, she had a very difficult family, and it's really not my fault." And you say, "No, I'm going to slow you down." So you help people focus on what matters. You support them. And I help the person hear it. I might say "My sense is that's hard for you to hear."And then the person will slow down and focus and say, "Yes, I don't see her that way. It's so strange for me to really see that she's afraid of me. I can hardly take it in. I see her as so powerful. I don't even know what to do with it. It confuses me. I actually feel dizzy. I feel like there's no ground under my feet. I've been with this person for 30 years. I never see her as—you mean she's vulnerable and scared? I don't know what to do with that."

So you listen to him. He's going to the leading edge of his experience. I'm keeping him there and helping him process it. Then I help him distill that and say, "Could you tell her, please?" And he says, "It's so hard for me. I don't quite know what to do with this new message. I don't know what to say when you tell me that. And I almost don't know whether to trust it. That you would be scared of me—that's so strange for me." And that's fine.
VY: This is where, as a therapist, you have to be very grounded to stick with it.
SJ: Yes.
VY: And really go slow with them, be patient, but also persist in insisting that he not withdraw.
SJ: Yes, that's right. And we're pretty systematic now. We've got training tapes, we've got a workbook, we've got the basic 2004 text. It's laid out in a lot of detail, and we have a whole procedure for training therapists and registering therapists. You can watch people do this on a tape. But you're right. EFT takes a lot of focus, and you have to be able to work with people's emotions, and help them stay with them and develop them and deepen them. You also have to be able to track interactions, and help them create these new interactions with their partner.

So it's a collaborative therapy. You're doing it with people, but it's certainly not a laid-back reflective therapy. It's a therapy where you're dancing alongside your client, and the music's going, and you understand the music, hopefully. But it's an active therapy, because there's so much going on.

Training Couples Therapists

VY: I understand that you’ve put a lot of thought into how to train therapists and set up a systematic program of training, ranging from your externships to supervision, et cetera. What do you find are the most difficult things for therapists to learn?
SJ:
I think our profession has developed a profound distrust of dependency, and we don’t understand it.
I think our profession has developed a profound distrust of dependency, and we don’t understand it. We still are hung up on, "We have to teach people to regulate their own emotions, be independent and separate, and define themselves." I think that’s one thing. We don’t really understand people’s deepest needs.
VY: So just conceptually having a shift in this idea of dependency, autonomy—that gets in the way.
SJ: Yes. You’ve got to be able to accept that we’re interdependent and we need each other. Otherwise, you’re going to have a hard time with EFT. You’re not going to be able to listen to and validate people’s needs. You’re going to blame them for their needs. But the second one is you have to get used to staying with emotion and deepening it. There’s a beautiful quote by Jack Kornfield. He writes about Buddhism and he says something about, "I can let myself be borne along by the river of emotion because I know how to swim."

I think therapists have been traditionally quite scared of strong emotion because we haven’t really known what to do with it. And at this point in psychotherapy in general, and in EFT, I think, there’s been a big revolution understanding emotion and human attachment. And we do know what to do with it. There’s nothing illogical about emotion. And, actually, there’s not very much unpredictable about emotion if you really know how to listen in to it. But many of us have not been trained in how to really stay emotionally present with somebody and track emotion, how to deepen emotion and use it. I think that’s the biggest one that people struggle with in EFT.
VY: So it’s just being more comfortable with emotion and trusting yourself to stay with it.
SJ: That’s a big part of it.
VY: That’s in terms of the comfort of the therapist. In terms of the techniques to help people work with it, what are the hardest things for therapists to learn?
SJ: I don’t think the techniques are hard per se. They’re a combination of Rogerian empathic reflection, validating, asking process-oriented questions like, "What’s happening for you right now? How do you feel when this person says this? How do you feel in your body? What do you tell yourself in your mind? Do you tell yourself this means this person doesn’t love you?"
VY: What I see is the skill that refer to as "slicing very thin"—tracking emotions on a very minute, moment-to-moment level. Not just asking someone how they feel, because many people, as you know, can't articulate that.
SJ: No.
VY: So you go at it from many angles.
SJ: Well, we know what the elements of emotion are. The elements of emotion are initial perception, body response, a set of thoughts, and then an action tendency.
VY: Now you’re sounding like a behaviorist.
SJ: No, I'm not. That comes from the emotion literature. A good EFT therapist will go and ask simple questions about the basic elements of emotion. Somebody will say, "I don't know how I feel right now." And the EFT therapist will say, "How's your body feel?" The person will say, "I feel tense." And the EFT therapist will say, "What do you want to do?"—because there's an action tendency in emotion. The person says, "I want this to stop. I want to get out of here." So you know what's happening—there's some version of fear going on. So the therapist will ask simple questions, and constantly empathically reflect to help people hold onto their emotional experience and continue to work with it.

Sometimes a therapist will interpret—add a piece. "This is very difficult for you. Could it be a little scary?" And then the therapist will help somebody hold their emotion, distill it. And then will create an enactment: "Could you turn and tell your partner, 'When we start to talk about this some part of me just wants to run away'?" You make the implicit explicit. You make the vague concrete. You make the vague vivid.

It's much better, from a relationship point of view, for me to turn and say to you, "Victor, I don't know what to do with what you've just said, but there's something a bit scary about it and I just want to run away." That's much better than for me to just feel that and not be able to talk about it, and turn and leave the room. If I turn and leave the room and you are a mammal and you're in a relationship with me, your brain says that's a danger cue. "This person who I depend on can walk away from me any time." And you start to get really upset—whereas if I turn and say to you, "I don't know what's happening with me. This is a bit scary. I just want to leave," you're probably going to feel compassion towards me.

It's all about helping people learn how to hold on to that emotional connection. Our mammalian brains experience emotional connection as a safety cue. There's lots of neuroscience behind this now, by the way. This emotional attachment stuff is creating a revolution in our field.

The New Science of Love

VY: I just heard David Brooks speak. He’s done a great job with his book, The Social Animal, summarizing a lot of the attachment research, but he also warned of the danger of over-reading brain science. He said something to the effect that brain science is in such a state of infancy that to draw any definitive conclusions from it can be riding the next wave of popularity, but to make precise conclusions from it is overreaching.
SJ: I agree with David Brooks that you can't draw conclusions. Sometimes when I listen to people and they say, "Oh, we change the brain in psychotherapy," I don't know. I just feel like saying, "Well, you know, eating an ice cream changes your brain."

On the other hand, when you look at research like my colleague, Jim Coan, has done, that if you lie alone in a computer in an MRI machine or you hold a stranger's hand, your brain goes berserk when you see a sign that you're going to be shocked on your feet. And when your partner, who you feel safe and connected with, holds your hand and you can see that signal that tells you you're going to be shocked on your feet, because you're holding your partner's hand and you feel connected to them your brain does not go berserk, and the way you experience the shock is much less painful.

Now, David Brooks is right. We're not quite sure what it all means. But it's fascinating stuff, and it's taking us into new territory. And, just by itself, that one study supports all the hundreds of studies that have been done on adult attachment and infant and mother and father attachment that says that we have connections with very special others, and that it's basically all about safety and danger. We use that connection as a safety cue. And what I just said has huge implications for couple therapy, psychotherapy in general, education for society. So, yes, David Brooks is right and we are in the middle of a revolution.
VY: Speaking of that, I hear you’re writing a new book on the science of love.
SJ: Yes, because we really do have a science of love. It's in its infancy, but it's a strong, bawling little infant. It's not a fragile child.
We really do have a science of love. It's in its infancy, but it's a strong, bawling little infant. It's not a fragile child.
When I think about it, in the last 15 years our understanding of our most important adult relationships has absolutely gone crazy. It is a revolution.

And it's so important. I was just looking in my local newspaper today, The Globe and Mail in Toronto, talking about how the Canadian government is struggling with the fact that there are rising levels of anxiety and depression and we can't deal with it in our healthcare system. Well, I know what John Bowlby would say. John Bowlby would say, "Absolutely, because we're facing less and less social connection, less and less community connection, and 50 percent of us divorce. We haven't learned how to create these safe, loving bonds. We need to belong." And the way to deal with that sort of thing, from my point of view, is not for the pharmaceutical companies to get better pills. It's for us to really understand our need for human connection, and start educating people for that and understanding how crucial that is in terms of basic mental health problems like anxiety and depression.
VY: Can you give a little sneak preview of your book? One or two morsels?
SJ: I'm going to talk about oxytocin, the cuddle hormone. I'm going to talk about how sex is an attachment behavior. I'm going to talk about how we're basically monogamous and that those people who say that we're not suited for monogamy are out of their minds. I'm going to talk about all the science behind what happens when you have one of those little arguments with your partner in the morning that ends up wrecking your whole day, so that when five o' clock comes along you're not even sure why you married this person. That's what I'm going to try to talk about.
VY: We'll look forward to that coming out. Thanks for taking the time to talk today.
SJ: You're welcome.

Alan Marlatt on Harm Reduction Therapy

Posted on by rezendevknowfully.com

Harm Reduction Defined

Victor Yalom: We're here to interview you today about your work with addictions, and specifically your contributions to the field of harm reduction. Just to get started, the name harm reduction gives a hint of what your approach is about, but maybe you could say a few words to introduce the concept.
G. Alan Marlatt: We are basically trying to support people that have addiction problems. If they want to quit, we'll help them do that. That's our relapse prevention program. If they would like to be able to reduce their drinking or drug use-harm reduction—we want to support them there too.

Many people with alcohol and drug problems are not getting any help, and I think part of the problem is they don't want to identify as drug users, or if they're using illegal drugs, they're afraid they're going to be arrested and put in jail or something like that. They're holding out. But if you talk about moderation, many people say that's an enabling strategy.
VY: Many professionals.
GM: And others. So it’s a very controversial topic, but basically my position is, “We’ll help you, whatever your goal is. You want to quit, we’ll help you. You want to cut back, we’ll help you. We’re not going to shut you out.”
A lot of the traditional treatment programs are saying, “Unless you’re totally committed to abstinence, we’re not going to work with you.”
A lot of the traditional treatment programs are saying, “Unless you’re totally committed to abstinence, we’re not going to work with you.”
Rebecca Aponte: If somebody wants help cutting back, is that something that they can work on with a harm reduction therapist for life?
G. Alan Marlatt: With some people it's for life. Let me give you an example of a case. This is a woman that was being treated by a psychiatrist for depression at the University of Washington. The therapist called me up and said, "I've been seeing her for about three months, and today I found out that she has this drinking problem. So, I said to her, 'I can't really help you or continue to treat you unless you go into alcoholism treatment, and I don't know how to do that.'"

VY: He doesn't know how to do alcohol addiction treatment.
GM: Right. Most psychiatrists don’t know how to do that; it’s not part of their training. So he wanted me to do an evaluation of her. When she came in to see me, she’d already been to the alcohol treatment center that the psychiatrist referred her to. I said, “How it’s going?” She said, “Everybody’s telling me something different. The psychiatrist said I was probably drinking a lot to kind of self-medicate my depression.” And that was partly true.

Then, when she went to the alcohol treatment center in Seattle, they said, “No, your alcoholism is causing your depression. Unless you are into our abstinence-based program, it’s just going to continue. Are you ready?” She said, “No, I’m not ready. This is the only thing that works for me and I know it’s causing other problems, but I’m not ready to give it up.”

So she was stuck in the middle. For a lot of these kinds of people, harm reduction therapy is the best alternative. So I said, “Let’s do harm reduction therapy. I can help you keep track of your drinking, and see what’s going on.” So she agreed to do that. A lot of people at that point will drop out. If all they have are abstinence-based alternatives, they’re not going to do it.

But she agreed to do it. She worked with me for three months and we kept track of her drinking. She reduced her drinking significantly.
VY: What was her goal?
GM: Her goal was to drink more moderately and to figure out what was going on in her marriage about drinking, because her husband said, "You're a chronic alcoholic and unless you stop drinking altogether, I'm going to leave you." That made her more angry and depressed. She tried to stop drinking, and then when he would go out of town, she would get loaded—this kind of thing.

We finally figured out there was a lot going on in terms of the marriage and her anger. Then I taught her meditation, which was the most helpful strategy for her. Then, one day she was going shopping and she saw her husband in a car embracing another woman and it just made her start drinking again. She said, "I can't do this anymore."

She went to a meditation retreat center in France—Plum village, the Thich Nhat Hanh Center. You go there, you take these precepts. One of them is no use of intoxicants while you're here. She said, "I took that and I thought, 'That's it. I'm never going to drink again.'" She's been now abstinent for five years.

So harm reduction was the bridge to get her there. If you say, "You've got to stop now," a lot of people go, "I can't stop now." But if you start getting them into a harm reduction program and they realize they can reduce their drinking and begin to figure out what their triggers are, they feel a lot more confident that if they want, they could quit. That's what happens a lot of the time.
VY: Getting back to the basics of it, what do you mean by harm reduction and how did it originate?
GM: I did a sabbatical at Amsterdam in the early '80s. That's where harm reduction originally developed, because they were the first country to realize that injecting drugs can increase HIV and AIDS—so why doesn't the government provide needle exchange instead of [the addicts] sharing needles, which spreads HIV much more readily? This was when HIV and AIDS really broke out and a huge number of people died. So they said, "If people are going to use, we want to help them stay alive. We want to reduce the harm." The needle exchange program was really the first type of that.

In Vancouver, Canada, where I grew up, there are many homeless people living in the lower east side that are injection drug users, and a lot of them are overdosing and dying.

What did the mayor's office do? After some persuasion from harm reduction specialists, they opened a safe injection center. This is where, instead of shooting up in the alley and not knowing what you're getting, you can go to this site. They'll give you clean needles. They'll allow you to shoot up there. There are nurses and doctors available if they need help. Since they opened that, the fatality rate has dropped. Of course, many people say, "Why is this happening? You're just enabling them to continue using."
VY: Right. "This is illegal and the government is helping them do something illegal."
GM: Exactly. The second program in Vancouver that just started and is also having good results is basically prescription heroin from doctors. Of course, that started in England years ago. Physicians there called it the medicalization approach. If they were dealing with a heroin addict, they could say, "Look, we'll prescribe you heroin while you're doing treatment because we don't want you to overdose from buying it on the street where you don't know how potent it is." These are harm-reduction kinds of approaches.

Another example is methadone treatment; that's harm reduction because you're reducing the rate of potential for overdose fatalities.

The Bar Lab

I was interested in applying it to alcohol problems, which means moderate drinking. Mainly we’ve been working with college students who are binge drinkers, because the NIH report has been showing about 1,400 to 1,500 college students die every year from alcohol-related problems—overdose drinking, car crashes.
 
At the University of Washington, there was a recent case of a student who died. A 19-year-old freshman was living in a dormitory, and a woman that was his friend just turned 21. What do you do when you turn 21? You want to have a party because you can drink legally—even though her friends were 19 or underage. So they go, “Where can we go and not be caught by the dormitory advisors and things like that?” If you catch you drinking and you’re under 21, you could lose your room. So one guy said, “Hey, there’s a balcony on the seventh floor. Let’s bring all our alcohol up here.”
 
 So they took their vodka and rum and everything else up. There were six of them. They said, “We’ve got to drink quickly just in case—otherwise we’ll get caught.” They all got loaded pretty fast, and the guy who died was sitting on the edge of the balcony telling a funny story, lost his balance—head-first down in the cement, killed on impact. His blood alcohol level was 0.26. In Washington state, 0.08 is the legal limit. He was triple that.
 
 We found out from his family and friends that he wasn’t a big drinker in high school. Once he got to college and all of his friends were drinking, he just went overboard.
 
 So harm reduction for college students means we’ve got to train you how to drink more safely, even if you’re underage—that’s when the highest risk occurs. We developed a program called BASICS—Brief Alcohol Screening and Intervention for College Students.
We’re teaching them, “Just like safe driving, this is safe drinking.”
We’re teaching them, “Just like safe driving, this is safe drinking.” Your blood alcohol levels, what’s going on, how alcohol affects you—we teach them all that. We bring them into our bar. We have an experimental bar on campus called Bar Lab. We give them drinks.
VY: This is like John Gottman's Love Lab.
GM: Yeah. This is the Bar Lab. It's a cocktail lounge on the second floor of the psych building. What we do there is bring students in and give them drinks. They can drink anything they want for an hour—usually about 12 to 15 students. They're usually getting pretty loose and playing drinking games. Then we tell them, "Guess what? None of the drinks that you had had any alcohol in them whatsoever. They're just placebos." They go, "What?"

We tell them, "Look, when you go drinking, three things are happening: what your actual drink is, number one; what the setting is, like a bar, there's music or whatever; and most importantly, what your set is—your expectancy about how alcohol's going to affect you. Those things make for big placebo."

So, people who go through this—we call it the "drinking challenge"—end up drinking about 30% less after they go through that particular program.
VY: How do you get them to agree to do the program?
GM: They get paid for follow-ups and assessments over a four-year period—only about $200, but still. We had an abstinence-based alcohol awareness program on our campus, and they would show car crashes and things like that—people who get killed. And they were trying to say to people, "You can't drink legally until you're 21." Who showed up for that program? Hardly anybody—maybe 2% of the students.

But if we go into the fraternities and the sororities and the dormitories and others and say, "Would you be interested in a program that would help reduce your hangovers and your driving, sexual problems and things like that?" They all go, "Yeah." So you bring them in.

So harm reduction is typically user-friendly. It's not saying, "You've got to stop or we won't talk to you." People with addictive behaviors—there's so much shame and blame and stigma. They don't want to show up. Instead, we're saying, "We're going to meet you where you are. We're not asking you to quit right away. We're just saying let's talk about what your drinking or drug use is like and see what you might want to do. We'll try and help you, whatever your goal is"—rather than confronting them and saying, "you've got to quit."

Moral Objections

VY: Why do you think there's such vociferous objection to the harm reduction approach?
GM: Many people buy into the moral model of drug abuse, the war on drugs—it's called a black-and-white model. Either you're abstinent or you're using. You're an addict. There's nothing in between. So the door is pretty tight. Kurt Olkowski, the new drug czar that we just got under Obama, said that the war on drugs has failed. Thank God, because the previous administrations under Bush and Nixon said, "Lock them up. If they're using illegal drugs, punish them." We now have 2.3 million people locked up in this country, which is more per capita than any country in the history of the world. Sixty percent of them are there either directly or indirectly incarcerated because of drug or alcohol problems.
VY: It's clear you take issue with the moralistic approach.
GM: Yeah.
VY: Is harm reduction a countervailing philosophy?
GM: It’s a public health approach.
VY: Is it a more scientific, research-based approach?
GM: Yes, it is based on research, and there are more and more studies coming out that show that it is really helpful. It's working. Our BASICS program for college students is now listed on the national registry for evidence-based practices. We've got about 2,000 universities that are now using it. That's really working. People don't like to call it harm reduction. They would call it an alcohol skills training program or something.

Alan Leshner, who's the director of the National Institute on Drug Abuse, published an article last year saying, "Drop the term 'harm reduction' because it creates so much controversy. Let's call it something else"—sort of like the word "communism" or something. Up until recently, if you were presenting a paper at the APA or any other conference where there was sponsorship from NIH, if you used harm reduction in the title, it was eliminated. They said, "No, we won't let you talk about it."

I've run into this a lot. I've given talks about harm reduction where half the people walk out of the room while I'm talking. Huge resistance.
VY: Why do you think that is?
GM: They're from the moral perspective and they think all the harm reduction technique is doing is enabling people. I received an award yesterday, and one of the people that gave me the award told me he remembered when I was first talking about harm reduction and people claimed I was murdering alcoholics and allowing them to die.
…when I was first talking about harm reduction…people claimed I was murdering alcoholics and allowing them to die.


What we’re doing, like in Housing First, is trying to keep these people alive. That’s what the research has shown. So I think harm reduction is going to take off under the new administration. Ninety percent of the people who have alcohol and drug problems aren’t getting any treatment unless they’re busted for something. How are we going to bring them in? We’ve got to allow harm reduction to be a middle way. 
VY: You're not against abstinence as a goal.
GM: No. We’re for both. We’re just trying to get more people in the door.
VY: You're for both abstinence and moderation.
GM: We’re for whatever your goals are. We’re going to help you do that.
VY: If someone has a goal of moderation, but is unable—some people apparently can't control their drinking—
GM: You’ve got to put them through a program, and then they finally get to realize that they can’t do it even though they’ve had the best program. If it’s not working, they’re much more willing to consider abstinence. You’ve got to try something.
VY: Do you agree with this idea that there is a subset of addicts that just can't do moderation?
GM: It depends on the moderation program. Now there are more pharmacology treatments coming in to help people moderate drinking, and many more cognitive behavioral skills training programs. A lot of people can't achieve moderation if they just try and do it on their own. If they get into a good program that teaches them the skills, like how to use a blood alcohol level chart—if you're a male or a female, how many drinks over how many hours, what your blood alcohol level is going to be—what are you going to do instead of drinking? You want to keep your BAL lower. A lot of the young people that we work with that do binge drinking—they drink two beers in 15 minutes. They don't feel anything so they drink two more, and things like that. We tell them to slow down. Drink two beers and wait half an hour. Then they can actually feel the effects of these two beers. "I don't really need any more," this kind of thing.

We're not telling them that it's all bad. We're just telling them it can be harmful.
Alcohol is biphasic. The initial effects are euphoric, but if you keep drinking, it gets dysphoric.
Alcohol is biphasic. The initial effects are euphoric, but if you keep drinking, it gets dysphoric.You start losing your coordination. You have blackouts and other kinds of problems. What is your limit here, where one more drink is not going to make you feel any better? You learn that. You stick with it. That's been working very well.
RA: Do you see a lot of parallels between the opposition to the harm reduction approach and the opposition to anything other than abstinence-only sex education?
GM: Totally, yes. It's the same issue because they're saying, "If you teach people about safe sex and condoms and things like that, that will enable higher amounts of sexual activity, so we should promote abstinence." But those programs are not working.

It's just like the DARE program—the drug abuse resistance education—totally abstinence-oriented. Now they're finding that kids who went through the DARE program in school are doing worse in terms of alcohol and drug use. Harm reduction applies, I would think, to what we call the 3 Ds of adolescence-the three dangerous drives—drinking/drug use, dating (sexual behaviors), and driving. So if you teach people how to do those things more safely, whether it's sex, driving or drugs, you're going to reduce harm. There's plenty of research to show that it's true, but the political resistance has been amazing.

For example, one of the big harm reduction programs we have done in Seattle is for homeless alcoholics, people living on the streets who are drinking. We worked with the Downtown Emergency Services Center, which provides housing for homeless people. There was a program in Canada called Housing First where they give people housing and let them drink in their housing if they want. Compare that to what they tried in New York, in which people had to quit drinking or they wouldn't get the housing, so almost everybody got expelled or kicked out because they couldn't give up drinking.

So the Seattle program, which we received a big grant on, basically asked, "What's going on?" We wanted to compare people who got housing right away with the people who were under waitlist control. The people we looked at were selected by the King County and Seattle government; they were people that had the highest health costs over the last year. These were very sick people; the average life expectancy for them is about 42 years. So the government referred these people, who either got the housing right away or were on the waitlist. In our program, they were allowed to drink in the public housing and the opposition in the media was huge. "What? We're using taxpayers' money and letting them drink? What is that all about? You're just enabling them."

One year later, we found that the people who got the housing had reduced their drinking. For many of them, having housing gave them more reason to live. As we published in the Journal of the American Medical Association, the most important thing was the health cost savings of four million dollars over the first year. All of a sudden, people said, "Maybe harm reduction saves money compared to what we were doing before." We keep getting these flips in terms of reactions to harm reduction.
RA: I've heard you mention before that therapists can unwittingly enable their clients' addictive behaviors by ignoring the addictions that are going on: treating the emotional issues that they bring into their sessions, but not talking about their alcohol or cocaine use.
GM: Yeah. A lot of people do have both kinds of problems, and they’re using alcohol or cocaine or whatever it is to self-medicate when they’re depressed or when they’re anxious. That’s still a big split between the mental health and the addictions fields, even though many people have both kinds of problems. How are we going to approach them and teach more mental health folks to think, “Hey, there are alternatives here”?

Harm reduction is one of them, and brief interventions have become very popular now. For example, Tom McLellan, who is the associate drug czar/psychologist that everybody knows, was saying we should train primary health care physicians at general hospitals, so that when people come in with whatever their medical problem is, if they have an alcohol, smoking or drug problem, do a brief intervention. It doesn’t mean confront them, but just say, “Hey, have you thought about doing something about this? I have some information for you. Try it out. See if it works.”

They include harm reduction programs to cut back as well as programs to stop. That is very radical, but it has been happening in trauma centers around the country. In the Seattle trauma center, if people are brought in from a car crash that involved drinking or something, Larry Gentilello, a physician there, would do a brief intervention, meet with the person once their medical care is handled. “Hey, there are some programs that could help you cut back or quit drinking. Are you interested?” A lot of them said, “Yeah.” The trauma center would give them the information, and provide the referral. That turned out so well that now all trauma centers around the country have to show that they utilize brief interventions in order to get their license. That includes harm reduction.

I think we’re going to see more of it because, first of all, it works.
The research is very strong. It saves lives. It saves money.
The research is very strong. It saves lives. It saves money.It gets more people on board.

Right now, most people with these problems are just staying out. They go, “All there is is Alcoholics Anonymous. I went one time. I don’t like it, and there’s nothing else that I know about.”

Harm Reduction in Psychotherapy

VY: Let's get into the nitty-gritty of how a typical psychotherapist, who doesn't specialize in drug and alcohol use, may deal with a patient struggling with an addiction. How do you start applying these principles in the course of counseling and therapy?
GM: First of all, you’re going to ask the person what’s going on in terms of their alcohol or drug use. What are the risk factors? We adopt a bio-psycho-social model. Biologically, you want to know maybe the family history and alcohol or drug problems. You want to know about whether that’s going to increase their risk. Then you would go on to psychological issues, what we call psychological dependency on alcohol or drugs. Why do they think it’s helpful, and what are their outcome expectancies about drinking or drug use?
VY: So you ask why they think it's helpful.
GM: Or harmful. We want to look at both sides. We want to meet them where they’re at, enter their world. We use a lot of motivational interviewing.
VY: Yes, it seems very similar to motivational interviewing.
GM: So we're trying to figure out whether this person is in pre-contemplation stages of change or contemplation, or looking at possible plans of action—and matching our intervention with that. You can determine that pretty easily. Have they thought of doing anything about this? What do they think of the pros and the cons [of their drug or alcohol use]?
VY: Can you give an example of how you match an intervention to where they are?
GM: If they're in pre-contemplation, we're just going to try to talk about, "Did you know that the amount of smoking that you're doing is going to increase your risk of lung cancer and emphysema? Are you aware of this?" We try and enhance awareness of the risks. And then if they're in contemplation—
VY: Which would mean they're contemplating quitting?
GM: Or they don't know quite what to do. They're going between the pros and the cons: "Maybe I could quit, but I don't know what's the best way to quit. Maybe this isn't the right thing to do." That's when we meet them and help them look at the reasons why they like drinking and what some of their concerns are about it, and then try and move them on to the preparation and action stage.

In the BASICS program with college students, we just meet with them twice, one on one. In the first session, we give them feedback about their risks. They've filled out all these questionnaires so we know about family history and expectancies. We know about their cultural factors. We give them feedback in a friendly way. We could say, "Hey, you said that 80% of the students at this university drink more than you—actually, you drink more than 75% of the students."
VY: You're giving them some data.
GM: Giving them feedback, but in a friendly way. So they're getting a lot of feedback and awareness. And in the second session, it's the action plan. "What are we going to do about this?" We don't tell them what to do. We collaborate with them. What have you thought about doing? One young woman said, "In my sorority we usually drink and get drunk Thursday, Friday and Saturday nights. I was thinking of maybe not doing it Thursday night." We would support that—something that they come up with.
RA: Although it's not something that's necessarily spoken to directly, it sounds like this approach has a high sensitivity to the shame around addiction.
GM: Oh, yeah—shame, blame, guilt, stigma, moral issues. We're trying to let people know what their level is, how many other people have this kind of problem, and what kinds of things could help them. If they would like to quit, we'll say, "Great, we can put you in an abstinence-based program." Most of them are saying they just want to cut back. They're very positive about these kinds of skills we teach them. After we bring them in a bar lab and give them placebo drinks, then we teach them about blood alcohol levels and give them charts. We have them keep track of their drinking for two weeks so that we can see which days and what situations, whether they drink by themselves—which is more dangerous than social drinking—things like that.
We just give them a lot of feedback, but not in a punitive moralistic way: "What can you do to change? We'll try and help you."
We just give them a lot of feedback, but not in a punitive moralistic way: "What can you do to change? We'll try and help you."
VY: You're not coming at it from a moralistic way, but you do have some stance. You have an idea that if people are drinking in a way that you define or you think is destructive, you would like them to change that.
GM: Sure, yeah. It’s pragmatic. That’s where we’re coming from. It’s not moralistic.
VY: One thing I noticed in the video I saw of you with this black male, you got into really nitty-gritty details. He said he wanted to quit, but you really drilled down into, "What does that mean, to quit? What's your first step?" He said, "I'd go to the program." "What do you have to do to go to the program?"
GM: Right—break it all down into different steps. Also, we found that what triggered his relapses was, whenever he had cash, he'd go down to "buy a pack of cigarettes," and, "There's my beer"—these kinds of things. We're trying to teach people cognitive behavioral strategies around things that can set you up for relapse. Whether you're doing harm reduction or abstinence, there can be occasions where you just do way too much. What are the steps that lead up to that? We're using a lot of mindfulness and meditation to get people more aware of their choices.

Victor Frankl wrote this saying: "Between every stimulus and response, there's a space. In that space is our power to choose our response."So we use this idea in our work, and it's turning out to be very helpful, especially for people trying to stay on the wagon.
VY: How have you integrated mindfulness? It seems like a hot topic that's integrated into many approaches these days.
GM: Yes, mindfulness-based stress reduction—Jon Kabat-Zinn's work inspired us. I'm a good friend of his. Zindel Segal's mindfulness-based cognitive therapy for depression is very effective. Ours is mindfulness-based relapse prevention. All these programs are group-based, outpatient weekly programs for eight weeks.

We've gotten funding from the National Institute of Drug Abuse to evaluate the program, and we're finding that it's working pretty well for people with chronic alcohol and mental health problems. Of course, it's voluntary, so if people don't want to do it, that's fine, but a lot of people, once they talk to their friends who have gone through it, they go, "Hey, I'd like to do that." It's relaxing. It's stress reduction. It also gives you a different perspective on craving.

In the last study, we found that people in the control group, the more depressed they were, the more their craving went up—this was in an abstinence-based program—but if they went through mindfulness when they were more depressed, craving did not go up. The depression and craving was kind of disassociated. We're very enthusiastic about that.
VY: How do you explain that?
GM: Because mindfulness gives you a little bit of a different perspective, so you don't over-identify with situations like when you're depressed or feeling like you have to self-medicate to feel better. It gives people more of a choice. It doesn't mean they always do it, but a lot of times they do.

If you think of addiction treatment, the 12-step program, which is very popular, is basically Christian-based. The word God shows up in six of the steps, although they say the higher power could be anything. But a lot of people don't connect with that. The mindfulness program is more based on Buddhist psychology. It's a whole different approach. It's also very consistent with harm reduction—the middle way and things like that. It basically tells people there is another way. Instead of the 12-step program, you could do the eightfold path in Buddhism—right mindfulness, right activity, all that kind of stuff. So I think it's an alternative.

Carl Jung originally said that a lot of people with addiction problems are kind of like frustrated mystics. They're looking for an altered state.
Carl Jung originally said that a lot of people with addiction problems are kind of like frustrated mystics. They're looking for an altered state. Many of them are hooked in the spirits in the bottle, where they're really looking for another spiritual approach. I think mindfulness is another pathway. A lot of people relate to that pretty well.

The Disease Model of Addiction

RA: Do you have a problem with the disease model, from the standpoint that it classifies a person as an addict in a way that integrates into their self-identity?
GM: Yes. Phillip Brickman identified four models: the moral model, the disease model, the spiritual model and the cognitive behavioral model.

The disease model says, "You have a disease and it's due to factors beyond your control: your genetics and your physiology and it's all the same disease for everybody, so we're not going to give you any individualized treatment. We're going to put you in a 12-step program"—which also buys into the disease model. The theory is that there is no cure whatsoever. All you can do is arrest the development of the disease by maintaining abstinence. If you have one drink, it's a relapse. In AA, you have to go back to the beginning again.

In harm reduction, we take the attitude, "Hey, lots of people have slips. Let's look at what happened. You made a mistake. How can you learn from it?" We're not saying, "You've got to go back to the beginning."
RA: That's very shaming.
GM: It's very shaming, yeah. I asked a lot of the disease model people, "Why do you say that there's no cure?" They said, "If there was a cure, people could go back to drinking. We don't want them to do that."

Even though the research at NIAAA—the National Institute in Alcohol Abuse—shows that quite a large percentage of people who have what we would call alcohol dependence, alcoholism, later moderate their drinking and do fine.
… a large percentage of people who have what we would call alcohol dependence, alcoholism, later moderate their drinking and do fine.
They don't want to say that. The disease model says that's enabling. I'm much more in the cognitive behavioral model.
VY: So you don't buy into the disease model at all.
GM: I don't want to put people in jail and say that they're moral failures. Sure, they have a problem—but for me, the disease model is: if you're a heavy smoker or a heavy drinker, there are potential disease consequences. You could develop cancer. You could develop cirrhosis. Is what you're doing a disease?
VY: Is the act of reaching your hand out and picking up a drink caused by a disease?
GM: It's a habit with potential disease consequences. In one of my most recent books, The Complete Idiot's Guide to Changing Old Habits for Good, we talk about changing old habits for good. Habits are what's driving this. It has disease consequences, totally. We're talking a huge health problem. But just to say the whole thing is a disease—what's the point?
VY: You haven't convinced everyone, obviously.
GM: No, of course not. But we’re out there. There are more and more people coming over to the cognitive behavioral model because, treatment-wise, that’s what is most effective.
VY: So you consider your approach consistent with the cognitive behavioral model?
GM: Oh, yeah. Many people call mindfulness a meta-cognitive coping skill, so it’s consistent with the cognitive behavioral approach. Plus lots of research shows that it’s stress reducing.

The biggest trigger of relapse is negative emotional states. People are upset. They’re angry. They’re depressed. They’re anxious. They want help from the drug. So meditation is an alternative way of giving them stress reduction. That’s what a lot of the patients that we’re working with are saying: “Wow, this is really helping. I’m meditating and giving myself a choice instead of giving into my cravings.” We’re showing a big reduction, as I mentioned before, between negative emotions and craving for relapse risk.

Consumer Choices

VY: I know back in the days, they tried to study and come up with an alcoholic personality or an addictive personality, and it seemed like there wasn't too much success with that.
GM: The main kinds of personality factors that keep coming up are sensation seeking—people that crave the high, altered state—and self-medicating—what they call coping. Those are the two main personality traits. Some people have both. That does increase the risk.

There are personality models. Right now, NIDA and other people are saying, "Addiction is a brain disease. It doesn't matter what drug you're using—it's all releasing dopamine in the brain. The pleasure centers are lighting up. We need pharmacotherapies that can reduce the effects of these different drugs or replace them, whether we're talking about methadone or any of these other kinds of things."
VY: What do you think of that?
GM: It may be helpful. Some of the medications do reduce craving on the short run. I think if we combine that with mindfulness, maybe the two of them would work together.
My position is, if you think something is going to work for you, try it.
My position is, if you think something is going to work for you, try it.It could be a pharmacotherapy. It could be psychotherapy.

In the addiction treatment field, there was Project Match that came up a few years ago. They were saying therapists should match patients with a particular type of therapy that the therapist thinks would work. In Project Match, they assigned hundreds of alcoholics to get Alcoholics Anonymous, cognitive behavioral therapy, or motivational enhancement interviewing. Those were the three groups. They followed everybody up for two years. They found—guess what?—there was no difference. All three groups did equally well.

What really worked the best was therapeutic alliance: if there was a good relationship between the therapist and the client, it worked.
VY: This has been the finding in all of psychotherapy research.
GM: Yeah. So I think instead of doing treatment matching, we should switch to consumer choice. People come in: “Hey, I’m interested in getting some help. What have you got?” There are some programs that are saying, “We’ve got a lot of different programs here. I’ll show you some videos. Here’s what’s happening with 12-step programs. Here’s a cognitive behavioral program. Here’s something on moderation management. Take a look and see what you think might work for you and have a backup.” Give people a choice of pathways.
VY: Back to being pragmatic.
GM: Back to being pragmatic. "If the thing you're trying doesn't work, there are other things you can try. Don't give up." The average number of serious attempts that smokers make to quit before they are successful is twelve. Twelve attempts! So people that have tried to quit smoking and say, "I can't do it. I've tried it three times"—I tell them, "You're not even there yet. Each time you learn something."

Therapeutic Mistakes

VY: What do you think are some of the typical mistakes that therapists make if they don't specialize in working with addicts?
GM: Like the psychiatrist I was telling you about earlier, a lot of them say, “I can’t handle this so I’m going to refer you to alcohol treatment. Until you get that under control, I’m not going to see you anymore.” That happens so much. It’s the wrong thing to do. People just get stranded. They get caught. They don’t know where to go.
VY: What would you tell the therapist to do?
GM: Integrative approach: look at addictive behaviors like any other behavior issue. Read about it, get some training, take some courses and things like that; don’t leave these people stranded.
VY: If someone's having problems with anxiety, you don't say, "I don't treat anxiety. You've got to go to an anxiety program." You integrate that into the treatment
GM: Not being able to see how the addictive behavior and the mental health problem relate to each other—thinking they're separate diseases. In reality, they're often extremely interactive. One is relating to the other—like the person with depression is trying to self-medicate and he gets caught in between. I think that is the main thing.

Sometime after that psychiatrist called me, I asked him, "How much training in alcohol and drug problems did you get when you were in medical school?" He said, "One half day." Christ. Of course they don't know anything about it.
VY: That's amazing.
GM: Yeah. That's the biggest issue—even in psychology. When I was a graduate student in the late '60s, I said to my professor at Indiana University, "People are studying behavioral therapy and they're doing all this kind of work with different behavioral problems. What about drinking as a behavior problem?' He said, "You don't want to get into that field." I said, "Why not?" He said, "The addictions field is very low prestige. Why don't you get yourself a real problem like snake phobias?" That's what was going on then.
VY: As a social policy health problem, there are a lot more people with problem drinking than with snake phobias, let alone snake bites.
GM: I said to my professor, “I don’t know anybody with a snake phobia, but I’ve got a lot of people in my family with heavy drinking problems. Why can’t we do something about that?”

The disease model didn’t really look at drinking as a behavior or as a habit. The big shift was to try to move it from strictly genetic into habits. “Smoking is a habit. It’s not a disease in itself, but it causes diseases.”
VY: That is changing, that field.
GM: It’s gradually changing. When I got into the field, people were saying, “Stay out.”

I Like to Drink

RA: There are some addictions that are considered controversial, like sex addiction. From your perspective, is it the object of the person's desire that is addictive, or is it the relationship between the person and what they're going after that's addictive?
GM: The new DSM-IV revisions have been including other kinds of addictive behaviors, like gambling, sexual addictions, shopaholism, things like that. From a cognitive behavioral perspective, there are a lot of similarities. There’s a lot of craving, whether it’s sex or gambling. There are differences in terms of the effects, of course, but I see there being lots of common issues.

One of the biggest things is the problem of immediate gratification. We call it the pig problem. “I want to hit the jackpot. I want to have a sexual experience. I want to get drunk.” All these kinds of things are very similar in terms of the neuroscience of what’s going on.

So I’m totally open to talking about addictive behaviors as including ones that don’t involve drug or alcohol use.
VY: You've been doing this for a few decades now, and addictions has been a career-long interest for you. What are some things you've learned that have made you a better therapist?
GM: I think having these experiences myself. I like to drink. I have drinking problems in my family. I wouldn’t consider myself an alcoholic. Many people in the addiction treatment field are in recovery so they’re saying, “Don’t use at all.” I’m much more user-friendly to these people because I do it myself. I’m helping to teach them that there are better ways to do this.

Since I’ve been more of a Buddhist psychologist, I took the bodhisattva vow, which is to reduce suffering in people that have these kinds of problems. If I can relate to them and identify with them rather than saying, “I am abstinent and you’re using,” it works a lot better.
VY: Thanks for taking the time to meet with us.
GM: You’re welcome. It’s been a pleasure.

Working with the Unemotional in Emotionally Focused Therapy

Posted on by Psychotherapy.net Team

It is pretty clear from research that focuses on how change happens in therapy, that emotional engagement is essential for significant change to occur. This is true in individual therapy (for example, research by Castonguay and by Beutler ) and it is certainly true in couple therapy (research by EFT therapists like myself). So what happens in an intervention like Emotionally Focused Couple therapy when one person emphatically denies or avoids emotion? The Boy Code insists that men are at their best when they are strong and silent. So, it is not surprising that male clients tend to deny their emotions a little more often than their female partners.

Process of change research and over 30 years of the clinical experience of numerous EFT, suggests that in fact, this does not seem to be a problem in EFT. Men who are described as “inexpressive” by their partners at the beginning of therapy seem to do very well in EFT. Now why is that?

First, it’s because as EFT therapists we have a map for emotions. For example, there are only 6-8 emotions that everyone on this planet can read on another’s face and assign a similar meaning to. The main difficult emotions that come up in couple therapy are reactive anger, sadness, shame and fear of rejection and abandonment. If you understand emotions, you can help people make coherent sense of them. Once you and your client find the order and logic in an emotion, it is much easier to deal with and work with. Emotions are the most powerful music in the dance called a love relationship and EFT therapists learn how to shape that music and use that music to guide partners into new dance steps.

Second, EFT therapists are emotion detectives. They know emotions are wired into our brains and they have simple, safe, systematic ways of helping folks access and explore them. So, Jim will say in session 8 of EFT, “I used to think I was just frustrated, angry in these fights with my wife; but now I see that mostly I am afraid. It’s a relief to get this – to understand my own feelings and to be able to ask my wife for reassurance rather than stomping around the house in a huff or zoning out and withdrawing into my loneliness.”

Third, tuning into your emotions, especially your fears and longings and shaping these into new messages to your partner WORKS. It is what securely bonded folks naturally do. It pulls our partner close to us and this connection sparks little floods of the cuddle hormone, oxytocin, in our brain. The calm contentment and a sense of belonging that oxytocin induces is the ultimate reward for our kind – little bonding mammals that we are.

When folks tell us, “I don’t have emotions”, we know that this person is working very hard and stressing out his body to suppress his feelings, so we gently explore how and why he does this. He always does it out of fear to avoid being overwhelmed, feeling helpless or ashamed, getting rejected or abandoned. The trouble is that when you shut down your emotions, you shut others out and then you are ………… all alone. No-one wants that. So if you show folks another path to take and support them, they will take it. Even people who do have to shut down as part of their jobs, firefighters, policemen, marines and surgeons respond to EFT. Even traumatized partners who swim in the turmoil of emotional storms learn to order those storms and use their emotions to tell them what they want and need and so find direction in their lives and with their partner.

The traditional route to change in psychotherapy is the haloed “corrective emotional experience”. Without this, any therapy is just an intellectual mist that evaporates once a strong emotion hits. The EFT experience is that even the most seemingly “unemotional” among us respond to corrective emotional experiences of being reassured and treasured. Who can resist this ? Who wants to?

Harry Aponte on Structural Family Therapy

Posted on by rezendevknowfully.com

Putting Therapy in Context

Rebecca Aponte: First, just so our readers are not confused, we should clarify that neither of us knows of any family connection, despite our shared last name.
Harry Aponte: That’s correct.
RA: You primarily practice family therapy. It’s interesting, because family therapy seems to be in danger of disappearing–it doesn’t seem like most therapists do it at all. What’s your sense of the state of family therapy today?
HA: I think family therapy has gone through its phase of fanaticism. It’s like so many other perspectives on therapy: it went through a phase where people made a new discovery, and they got infatuated with it, and that became the answer to it all. I believe the thinking about working with families has matured so that it’s not such an exclusive focus. People are much more flexible about working with individuals and couples as well as families, and people are more flexible in terms of being prepared to work with some unit of a complex family system without necessarily seeing all the members of the family, while maintaining a broader perspective so that they understand that the individual or the couple in the context of not only family, but also of community. So I don’t think it’s dead at all. I just think it’s matured to the point that it’s been incorporated into the very large and complex field of therapy.
RA: Do you think that the perspective of keeping the broader sense of community is as integrated into most therapists’ minds as it should be?
HA: Well, to answer the last part of that question, I think it should be. I believe that we have become much more sensitive and knowledgeable and insightful about the impact of the broader social system on people’s personal functioning: the effect of people’s social economic circumstances, the effect of culture, the effect of people’s spirituality, and how all of those affect in a very intimate way how people think of themselves, how they relate to one another, how they understand their reality. Any therapist who wants to engage with another human being at any level at all–to understand that person, that couple, that family–has a lot of factors to take into consideration. And I think that’s happening. I think people are much more comfortable with looking at their clients from a variety of perspectives at the same time.
RA: Is that something you would actively reflect back to a client–that you have their broader context in your mind–although they might not be thinking about themselves in a broader context?
HA: What I reflect back to a client is what I think will be helpful to the client. I’m not there to give the client a lesson on what therapy should be. I’m there to be helpful to the client. I need to take responsibility for having all of those perspectives in mind and taking them into consideration as I explore what the issue is and the roots of the issue, and what resources are in that client’s life for that client to be able to make the necessary changes to solve the issue. I don’t need to explain that to the client, but I do need to be aware of it and work with it.
RA: I’m asking some of these from the perspective of therapists who primarily see individual clients, because that’s probably the most common today. If someone does come to you as an individual, how might you bring up getting their family more involved in the treatment? Is that something you would suggest right away, or does it happen over time?
HA: I’m a pragmatist, so what I do is I listen carefully to what the client’s issue is, and I try to understand the issue, and I try to understand the context of the issue: who’s involved, who’s touching on that issue of that particular individual, as well as what resources are available to that person in their context. And I will try to pull in whatever and whoever is necessary. Even if I need not pull them in, it doesn’t mean that I’m not going to work from a suspended ego complex or perspective. It’s rare that I not ask clients about the history of their issues. And if I ask about the history of their issues, I’m asking about them in the context of their current relationships, their past relationships, including their development within the family of origin. All of that helps me to get some deeper sense of what they’re struggling with and why they’re struggling with it the way they are.

Structural Family Therapy Defined

RA: Let’s back up a bit. What exactly is structural family therapy? Is the distinction from family systems therapy important?
HA: Structural family therapy is an aspect of systems thinking. You have to understand the origins of structural family therapy in order to appreciate its contribution to systems thinking. The work originated, of course, with Salvador Minuchin, Braulio Montalvo, and other people who were working together at the Wiltwyck School for Boys in New York. They were working primarily with all these youngsters who were black and Latino, and who were institutionalized. These therapists began to include the families of these boys in their efforts to be helpful to the boys, because they found that working with them in an institution, outside of the context of their families, they were not achieving the success that they hoped to achieve. As they included the families, they found their success rate change significantly.Well, what happened? Because they were working with boys and families that came from seriously disadvantaged circumstances, they found themselves working with families that were, more often than not, poorly organized, in that they didn’t have the kind of structure that normally helps families to cope with the challenges that life brings. A typical story for a therapist working with the families I’m describing is you find that when you begin to talk with them, they interrupt each other, they speak over each other, and very often it’s unclear who’s really in charge of the family. And if there is somebody in charge, they may be so totally in charge that other people don’t have a voice in the family. You don’t have an organization there that can identify a problem and come together in a way that can solve it.

It’s really no different from what one would be thinking of in another kind of system, such as a business, where when you see a problem in how that business is operating, you’re going to be thinking of the structure and organization of the people who are working within that business. If they’re not effectively communicating with one another, they don’t have a clear hierarchy, and they don’t have clear responsibilities, you’re going to find that things fall through the cracks and the system fails.

Well, that happens with families, and it particularly happens with families that come from disadvantaged circumstances because they also come from disadvantaged communities that are poorly organized. These families, then, suffer the effects of their community, and they’re not able to organize themselves in a way that normally enables families to meet problems and solve them. Every family has problems, but when you don’t have an effective organization, then it’s hard to talk about the problem, it’s hard to identify the problem, it’s hard to cooperate together, it’s hard to find leadership within the family so that you can work towards a particular goal and solve the problem.

That’s the first experience of therapists who worked with families from disadvantaged circumstances. The gift that Minuchin and his colleagues gave us was that they focused on that organization. They understood individual dynamics; they certainly understood the contributions of other systems therapists at the time. But they were dealing with a particular population that had a significant issue around family structure, and that is an aspect of systems thinking. When you are dealing with families that are well organized that still have problems that they can’t solve, you tend to take the structure for granted. You cannot take the structure for granted when you’re working with these families that come from disadvantaged circumstances and who themselves are not organized in a way that’s effective.

RA: It sounds like one of the things that they found was that the pathology of the boys they were working with existed within this much larger environment, far beyond what would have been within the control of the boys or even the therapists.
HA: That’s correct.

An Ecostructural Approach to Family Therapy

RA: You’re talking about major social issues that are much bigger than families as well. How do you overcome those obstacles in a family therapy situation?
HA: Early on, I wrote about an ecostructural approach to family therapy–“eco” referring to the social ecology of the family, highlighting how so many of these families’ problems had their roots in the community they lived in. You have schools that have not only poor resources, but that themselves may have gangs organized within them, that are physically dangerous places for the children there, that make it difficult for the teachers to run the classrooms and create an effective learning environment.When you are working in some of these neighborhoods, the street itself becomes a place that is dangerous. It becomes a place where children just cannot go out and mix together and play together and do the kind of social learning that is important for their development. They’re dealing with drug dealers and other kinds of factors in the community, in the street themselves, that affect how these children think about themselves and how they think about the world. They have to cope; they have to survive. They may have to be more aggressive than children under other circumstances. All of that affects their personal development. And in these neighborhoods, you have problems with getting proper healthcare as well as educational resources. So you have a lot of social factors that are impinging in very direct ways upon the ability of families to function well.

And these families cannot just put all of their energy into nourishing the family environment. They have to be thinking about how to deal with protecting themselves vis-à-vis the community, so they put energy out there that should be put more into the family itself. They’re dealing with difficult environments, and that affects the ability of the family to function successfully.

RA: It’s a lot to think about.
HA: It is a lot to think about. And when you’re thinking about the environment, and you’re thinking about the family, you really cannot offer families coming from these circumstances a service that is exclusively focused on the family unit itself. You have to take a broader perspective that says, “I’m dealing with a child that’s in the context of a family, that’s in the context of a community. So when I then conceive of the work that I’m doing with these families, I have to take all of these into consideration and organize my services so that I can mobilize various aspects of that complex ecosystem to support the goals that I have with this particular family.”My point, though, is that this work with disadvantaged families gave a gift to the whole movement of therapy. It highlighted the importance of this complex social ecosystem– its effect on individual functioning–and the need to be more sophisticated about the dynamics of these various levels, in terms of understanding how they work, and in terms of working with them so that we can achieve our goals. It opened up a whole area of thinking that had to be taken into account. I think it’s been incorporated naturally, and I think people today think in those terms much more readily than they used to.

If we go back historically to the psychoanalytic movement, that was a very intense focus on the individual and what was happening in the individual’s psyche. And that provided critical and wonderful insight. Then we realized, “Well, that’s not the whole person. We need to expand our perspective.” So we expanded it to the families. Then we worked with this particular population and said, “My goodness, we really need to be thinking about the context in which this family is developing.”

So it just broadens our perspective. And we’ve learned ways of understanding these dynamics so that we can actually work with them, not just as sociologists, but as therapists who can be quite focused on trying to obtain a particular objective.

RA: Particularly now that therapy is not just the realm of white, middle-class clients, as historically it has been, there’s a more focus on tailoring therapy to fit people from a multitude of different ethnic and economic backgrounds. Do you have specific advice for therapists who have worked primarily with middle-class individuals, on branching out and working with people who have these bigger issues? One aspect is just being cognizant of the fact that there are many aspects of someone’s development and someone’s selfhood that extends beyond them. But what do you do with that awareness?
HA: I think what we’ve seen now, as a very normal part of therapist’s training, is the therapist being more conscious of the factors of values, world views, culture, spirituality, how these affect the way they see their problems, and how they view a solution that is acceptable to them. We have a much more complex society today than we had 50 years ago or further back, where there was a generally accepted norm of what a family is, how a family should function, and what is acceptable behavior.Today, we have a society that is much more fragmented and often in conflict with itself about what is acceptable in terms of lifestyle and behavior. That changes what one may consider to be a problem, and it certainly affects what we think of as appropriate solutions to problems. That thinking–which was expanding already back in the ’60s, when The Families of the Slums was written by Minuchin and colleagues about the work at Wiltwyck–all of that has been incorporated into everyday, normal therapy.

Nowadays, I don’t know what therapist training doesn’t include some courses that say, “You need to be sensitive to race and culture, and sensitive in such a way that you understand how race and culture directly affect not only how we view the issues and how we work with them, but the very nature of our relationship with our clients, and how we join with our clients.” Therapists will have their own culture, they’ll have their own values, as well as certainly their own personalities and life experience. But how do these therapists relate and connect to clients who are always going to be different in some particular way or another, in a society that says we need to be more accepting of the differences among us? So we’re working in a more complex world today as therapists than we did in the past.

The Person of the Therapist

RA: Certainly. And it sounds like you’re saying, too, that it requires therapists to be more sensitive to themselves and to their own world views, and really have a clear idea of their own personalities and backgrounds and how they appear in the therapy.
HA: If you’re not aware of what you’re bringing to the therapeutic relationship and the therapeutic process, you can’t take responsibility for it.
RA: Is that essentially what “the person of the therapist” means?
HA: That’s exactly what “the person of the therapist” means. The therapy of today is a therapy in which therapists are certainly much more actively engaged with their clients or patients than what would have been the model in the psychoanalytic world. And certainly, if you read the writings on structural family therapy, you would see how therapists use themselves very actively to influence the dynamics within the family, and how they engage with individuals within the family. What I’ve done with the “person of the therapist” model is to try to take that a little deeper and say to therapists, “It isn’t just a matter of how you use yourself.” It starts with understanding yourself, not only from a psychological perspective, but also from a cultural and spiritual perspective. As a therapist I have to get in touch with what’s inside of me–and not only what’s inside of me, but because these are living, active dynamics, I have to get in touch with what I struggle with in my own life, what I struggle with psychologically, what I struggle with in my relationships with people, what I struggle with spiritually. I need to understand that, I need to be in touch with that, because all of those factors are active when I engage with the client. They’re going to affect how I see the client, how I hear what they have to say, how I connect with that person, how I even conceive of how we’re going to try to find some solutions.These factors are active even beyond our normal awareness as therapists. We need to get the kind of training that makes us experts on who we are and what’s happening within us, so that even as we are working with our clients, we’re conscious of what’s going on within ourselves, and we can take responsibility for what we communicate about ourselves and what we try not to communicate about ourselves and how.

RA: How do you practice that? Does that mean therapists do their own therapy, or is it more self-reflective?
HA: It’s a specific kind of training. Traditionally–certainly in the psychoanalytic world–therapists needed to undergo their own therapy. But that objective was one that said, “I need to try to solve my own personal issues so that I am freer to work more effectively with my clients. I’m not going to put on my clients my own hang-ups.” That way of approaching the work of the person of the therapist was continued and picked up by Virginia Satir and Murray Bowen, but again from the point of view of, “Let me identify my issues and try to resolve them so that I will become a more effective therapist.”What I’ve been emphasizing is that all of that is absolutely important and useful, but the simple reality is that we never resolve all of our personal issues. We struggle with ourselves the rest of our lives. We need to go through training programs where we become aware of ourselves in the context of doing therapy, not to resolve personal issues, but the primarily to understand ourselves in vivo: When I’m engaged with my clients, what’s going on inside of me? How do I get in touch with it? How do I decide how to use what’s going on within me in order to understand and empathize better with what’s going on in the client? How can I relate in a way that’s specifically useful to the client at this particular moment in time?

So it’s an approach to preparing the therapist to use this instrument that is me, in a way that is much more effective. Then I can use all of what I’ve learned technically and theoretically of other models of therapy, and I can use it through the person that I am in a way that amplifies the effectiveness of my work.

RA: So this model rejects the psychoanalytic idea of being a blank slate or completely neutral, and focuses instead on the therapist’s personhood.
HA: It certainly does. The advantage that classical psychoanalysis had was that the analyst was sitting behind the couch out of the view of the analysand, and wasn’t engaging eye-to-eye with the patient. Today, most all of our therapy is eye-to-eye, and we feel each other. We and our clients are engaged personally in the therapeutic process, and that’s a simple reality. The question is, how do I engage personally within the boundaries of my professional goals so that I can be of use to this person?

The Role of Spirituality in Therapy

RA: You’ve mentioned a couple of times the role of spirituality in therapy. How do you bring spirituality into the therapeutic relationship in a way that’s safe for clients who might have different views?
HA: It’s not a matter of bringing it into the process as much as it is of being aware that it’s there. Spirituality is just a normal aspect of who we are. We all have a morality of one sort or another. We all have a world view–a philosophical perspective on life and what’s important in life, what’s meaningful about life, what our goals should be in terms of moral principles. And that will certainly affect how we think about the issues that come up for us. A simple example that’s very relevant today is the postmodern view of reality, where reality is something that you cannot know directly, but only through what you sense–meaning that you cannot prove a truth, so truth is only in the eyes of the beholder. That’s a spiritual perspective; that affects the way we look at life.And if you do believe there is a reality that we can perceive, and that there is an objective truth that we can relate to, that’s very different from somebody who comes from a perspective that says, “It’s really what you perceive, more than it is what you think is out there.” That affects how we think of our problems; that affects how we’re going to try to solve our problems.

RA: So you’re trying to understand how clients perceive themselves and their problems, and having knowledge of yourself is primarily to keep you from being closed off from their world view when it’s different from yours?
HA: If I’m going to understand them, I need to try to understand them from an emotional perspective, but also from a cultural and spiritual perspective. So I’m listening for all of that. But I can’t listen to that and understand it unless I am aware of that within myself.You cannot see spirituality in somebody else unless you can see it within your life. How is it real for me? How does it affect me? The better I understand that, the more insight I’m going to have, and the better I’m going to be able to see how it relates to their lives. So that becomes something I normally look for as people present their issues. It also influences what kind of questions I’m asking them, so that I don’t just assume what their moral stance is on things.

For example, when you’re working with adolescents and their families, and their sexuality is an issue–which is almost inevitable when you’re working with adolescents–what is their moral view about sex outside of marriage? What is acceptable? What is not acceptable? That’s going to influence the work that you do; it’s certainly going to influence the goals that you determine are part of your work.

RA: I understand that you worked for some time with Sal Minuchin, and I’m sure some of our readers would like to know what he was like. How was it to work with him?
HA: Sal is a fascinating personality. The man is intellectually so bright and so original in his thinking, but he’s also very much a dynamic human being, and that influences his style of therapy. He always engaged with the clients very fully and emotionally–not only intellectually. It made his model a very dynamic approach to life, so that it could be challenging to therapists who tended to be much more reserved in how they relate to people. But Virginia Satir and Carl Whitaker were also individuals who had dynamic personalities, and used that dynamism in the way that they conducted their therapy. Sometimes people lost perspective and confused the dynamism of the individual with the theory and the technique that they were trying to teach.
RA: What’s your sense of yourself as you developed your own personal style of working in this frame of mind?
HA: Sal was more likely to be confrontive than I would be. My particular personality and style is that I tend to be very direct with people, but I also tend to be more inclined to want to join with people and relate empathically with them. You would get a very different feeling with me than you would have from Sal. Sal, as you see in his writing, talked more about unbalancing the system, and he would often unbalance that system in a more forceful way than I would. I would also unbalance it, but not in the same style.

This really emphasizes the importance of knowing one’s self personally and saying, “I’ve got to work through the person that I am, and not through the person of the guru that I admire.”
RA: Absolutely. You’ve been doing this for quite some time now; do you have a sense of your personal evolution and what’s changed? Do you feel yourself becoming more confrontive over time or less so, or just more refined?
HA: I think what has changed is that as I’ve matured, I’m more confident about myself when I’m with people, and I’m more confident about what my thinking is, so that I can risk being direct with people about what I see and what my opinions are about what’s going on, always allowing for the feedback and room for them to challenge me back. But the challenge is not so much a matter of me confronting as it is a matter of being able to state, “This is the reality that I perceive right now. Now give me your reality and react to what I’m suggesting to you.” That doesn’t work with certain clients, but I find it tends to work with people who are looking for results, and they say, “I can see what you’re saying and I can see why you’re saying it, and it does or does not make sense to me, but now I can give you back some feedback and we can work actively together to make something happen.”
RA: Do you have a sense of where you feel yourself being pulled in the future?
HA: As I look towards the future, I’m now continuing to focus on the person of the therapist and trying to develop that further, not only as an aspect of training therapists, but also as an integrating principle in the therapeutic process: we are integrating our technical and theoretical thinking around who I am and where I am in my life, so that when I do the therapy, it becomes very much my therapy. Even as I’m learning from other people, I’m moving more in that direction. But that also says to me that the common factors work being done by people like Sprenkle is an important contribution. I’m looking more at the common factors among the various models of therapy, and including these factors among the various views of the use of self. I’m thinking about how to highlight those common factors to encourage therapists to extract the essential elements of the therapeutic process, rather than having to choose between various camps of therapy, which I think is such a waste of time.
RA: We’ve definitely covered a lot of ground. Do you have any concluding thoughts you’d like to share with our readers about any of the topics we’ve discussed?
HA: We ended on the note that I hoped we would end on, which is the importance of therapists training to understand themselves more profoundly than they have in the past, not only from a psychological perspective, but also from a cultural and a spiritual perspective, so that they can use all of themselves more effectively in their therapeutic work, on the one hand; and on the other hand, the usefulness of thinking about common factors among the various therapeutic models so that people will not blind themselves to the contributions of the various models because they need to adhere to some particular school of therapy. From my perspective, there is no model of therapy that does not offer us an insight that is useful to all of us. I think it’s important that we open ourselves up to learning from the various schools and approaches to therapy, and then take that and integrate it within ourselves so we become effective therapeutic instruments.
RA: I think that’s sound advice. I appreciate you taking the time to talk with me today. I’ve very much enjoyed it.
HA: Good, I’m glad you did. It was a pleasure, Rebecca.

Walking A Tightrope: Family Therapy with Adolescents and Their Families

Posted on by rezendevknowfully.com

Beyond the Comfort Zone

“Clyde is spiraling out of control,” she cried.  “He’s begun to hang out with a bunch of do-no good, do-nothing hoodlums.” She was worried that failure—or worse, tragedy—was aggressively recruiting her only child. “He is a good kid,” she attempted to reassure me, “but I worry about him being in the wrong place at the wrong time.”  Although he’d had no brushes with the law, she was terrified of any potential encounters he might have with the police—an encounter she intuitively knew could be a matter of life or death. 

“Mrs. Gilyard, like so many other parents of color, was raising her child with the police foremost in her thinking.”  While she and her husband enjoyed a solid middleclass lifestyle, both were African American and understood all too well the rules of the streets, especially regarding young black males. Mrs. Gilyard was worried because she understood that the urban streets were unforgiving for many young black males like Clyde. Unfortunately, Clyde, according to his mother, “knows everything and won’t listen to me or his father.”  In fact, Clyde had, in a very short period of time, according to his mother, transformed from a “very respectful young man” to a disrespectful, self-centered, impulsive shadow of the human being he used to be. “He’s moody, often refusing to talk for days, and all he wants to do is sleep, text message, hang out with his friends, and download music.  To be honest with you, Dr. Hardy,” Mrs. Gilyard said, “although he is my God-given son…” She paused. “I am quickly getting to the place where I can’t stand to be in his presence. I am not sure I even like him anymore. I can’t tolerate his nasty attitude. I have no patience with him. I’m worried that I might hurt him, or someone else will, if he doesn’t get some help.”

As our telephone conversation progressed, it seemed to have no end in sight. Mrs. Gilyard needed to vent and was oblivious to time or circumstance. I tried numerous times to gracefully end the phone conversation that was dangerously slipping into a full-blown noncontractual, nonconsensual therapy session, but Mrs. Gilyard was too consumed by her utter sense of desperation, now flirting with panic. 

I commented that although she seemed to have moments where she felt disdain for Clyde’s behavior, her dominant feelings towards him seemed to be worry, fear, and a deep motherly love for him. I went on to suggest that I imagined the situation with Clyde was taking a huge toll on her, as well as the entire family, and although she was seeking treatment for Clyde, I thought it would be helpful for the entire family to attend.  My comment and suggestion apparently surprised Mrs. Gilyard and immediately earned her ire. Her tone and approach to our conversation changed instantly.

“Why do we need therapy?” she demanded.  “I don’t think there is anything wrong with Claude and me, and I honestly don’t know what there is for us to gain from coming into therapy. We will do whatever to help Clyde, but he has to find himself and nobody else can do that for him. As his parents, we have to provide him with love, support, and guidance, but he has to be willing to accept it. Right now, his friends and his music seem to be all he cares about!   I don’t see how us coming to therapy is going to help him get what he needs.”

My interaction with Mrs. Gilyard suddenly shifted from the emotionally intense, unconditionally accepting reflective listening phase of engagement to one of the most delicate and thorny areas of family therapy: problem definition and who should attend the session. These issues are always critical dimensions of family therapy treatment. Mrs. Gilyard and I suddenly found ourselves on a major collision course.  She remained convinced that Clyde was the problem and that whatever was going on with him needed to be fixed inside of him.  In her world, problems were individual and the solutions were simple: you found out what was broken and you fixed it. From her perspective, Clyde was broken, like a malfunctioning carburetor in a car, and in either case the solution was a simple matter of targeting it and repairing it.  She seemed to be oblivious to the fact that even the best mechanic in world could not repair a faulty carburetor without having access to the car! This was where our worldviews collided.

I believe that all problems are essentially relational and that we all are relational beings living our lives in a relational context.  As a family therapist, I believe that problems are delicately and seamlessly interwoven in a nexus of relationships.  “It is difficult for me, if not impossible, to envision any human interaction problem without considering the relational context in which it is embedded.” So, unlike Mrs. Gilyard, I assumed that the problems were embedded in relationships and the relationships were embedded in problems.  In this regard, in cases such as the Gilyards’, it is my contention that family members contribute to the formation of a problem, the maintenance of it, or both. And if problems are embedded in relationships, so are solutions! Thus, having the entire family participate in therapy is essential. 

However, from the perspective of Mrs. Gilyard, Clyde was the problem because it was his behavior that was problematic. It was he who was broken, malfunctioning, or deviating from family and societal norms. Accordingly, Mrs. Gilyard believed that the best solution to the problem was to treat the problem: Clyde! The dilemma was that if I dismissed Mrs. Gilyard’s definition in favor of mine, therapy could not occur. Yet on the other hand, if I abandoned what I believe, how could I possibly assist the family without further problematizing Clyde? Before ever meeting Clyde, it was crystal clear to me that he was considered the problem and would continue to be until his deeds, attitudes, and behaviors complied with his mother’s wishes.  So in a sense, the only problem was the problem that was asserted by the family. And, if I insisted otherwise–i.e. that my definition of the problem should overshadow the family's viewpoint–then that would only result in creating yet another problem! This is the tightrope that all family therapists have to gently and delicately traverse.

            Despite Mrs. Gilyard’s claim that she would do anything to assist Clyde “in getting his life back,” attending therapy with him was not on her immediate list. Because I often believe that a family’s refusal or reluctance to participate in therapy is usually a result of a tendency to think individually and not relationally, and an underlying fear of being blamed and/or exposed, I knew I had to tackle both of these issues with Mrs. Gilyard if family therapy were to ever take place.

I tried to reassure her that a family session would not be about finger pointing or keeping score about who did what to whom. “It will be a place where we can develop a deeper and better understanding regarding how the family operates and how each of you is affected by what everyone does,” I explained over the phone. “You know, families cannot function well when each member attempts to do what they think is right or best without considering how it affects others.”

At this point, although unfazed and unconvinced, she at least seemed willing to listen more carefully.

“You, along with your husband, seem to be concerned, involved, and loving parents. I imagine the two of you have an infinite reservoir of information about Clyde that you have been collecting since his birth. You, quite possibly unlike any other person on the planet, have cherished early life memories of Clyde that you have probably safely tucked away in the secure closets of your mind. I know you and your husband need my help, and I am honored that you are willing to trust Clyde in my hands. But I need you and your husband’s help as well. I need the infinite knowledge and wisdom that you and quite possibly only the two of you have about him as well. My time with him will be limited no matter how much time we have, and it would be great to have the two of you as resources. You know, I am sure you have heard that old African proverb expressed a million times that it ‘takes a village to raise a child.’ Well, if Clyde is struggling as much as you say he is—and I have no reason to believe otherwise at this point—he needs a village. And we will be Clyde’s village!” 

After an impregnated pause and a chilling silence, Mrs. Gilyard, in a much softer voice, said with a slight sigh of relief and perhaps resignation, “Yes, you’re right.  Clyde is a part of me. He is like my third arm or leg. I do know him. Or at least, I used to.  I will talk to my husband. Doctor, I hope you—er, I guess I should say, I hope we can help my son.”

It Takes a Village

Exactly one week later following our phone conversation, Mrs. Gilyard made good on her promise. She, her husband of 30 years Claude, and their son Clyde arrived at my office for our first session. My initial interactions with the family were pleasant and polite as we engaged in light-hearted conversations about the weather and traffic. Throughout it all Clyde remained detached, appearing disinterested but respectful.  There was an understandable tightness to the family. They seemed tense. Mr. Gilyard was noticeably uncomfortable and asked several times in the first few minutes about how long the session would last and how many sessions would it take before they would “see results.”

I thanked the family for coming and their dedication to finding answers to issues that were plaguing them. Then I turned to Clyde. “I’ve talked to Mrs. Gilyard on the phone and know that she is worried a great deal about you.”

He smirked slightly but refused to bite the bait and respond to me verbally. I was encouraged by the smirk because it was a sign of responsiveness to being engaged—a private mental note I made certain to record.  I turned to Mr. Gilyard and asked, “Do you share your wife’s concerns?” Then, turning to Clyde again, “What do you think about all of this?” To increase the probability of participation throughout the therapeutic process, “it is imperative in family treatment to acknowledge all family members as early as possible and to invite their participation even if and when they passionately refuse.”

The room was quickly filled with a breathtaking silence and discomfort. Finally, perhaps as a function of her discomfort, Mrs. Gilyard broke the mounting minutes of silence that must have felt like hours to the family, by inexplicably saying: “You are so much smaller than I imagined you to be. I for some reason expected a bigger, older man.”

After many years of clinical practice, I am seldom surprised by the disclosures that are uttered within the private walls of therapy, but I was surprised by Mrs. Gilyard’s comment and wasn’t immediately sure what to make of it. I simply responded: ‘Oh, well… Thanks for your honesty… I always find it an interesting task to imagine what someone looks like based on their voice and telephone personality.” 

It was of note to me that Mrs. Gilyard elected to make me the focal point at the precise moment that I was attempting to engage Claude and Clyde about their perceptions about the family. Maybe this was coincidental, but I wondered if I was getting a snapshot of how hard Mrs. Gilyard worked in this family.  Since I had spent an appreciable amount of time with her on the phone, I really wanted to make a concerted effort to interact with Claude and Clyde. So I returned to father and son and asked, “What is going on with the family from where you sit?” 

Mr. Gilyard then turned to Clyde and said: ‘The doctor’s talking to you. Tell him what you think. And sit up, please. And Clyde, take off the hat. And put that thing away,” she ordered, gesturing toward his son’s iPod. Clyde sat still and stoically, dressed in a blue-and-white NY Yankee baseball cap that he had on backwards, stylishly coordinated with an elegant blue silk tee shirt, and blue-and-white Jordan sneakers.  He looked at his father and slowly removed his baseball cap, never uttering a single word. 

 Mr. Gilyard, after thinking for a few minutes, said he was worried about Clyde and believed it was getting harder and harder to reach him.  He noted that he didn’t share his wife’s short fuse with regards to Clyde’s antics but was bothered by his son’s lack of direction.  “He doesn’t take life seriously. He thinks it’s a joke, a game!  He has no sense of the sacrifices that his mother and I and many who came before us have made for his benefit.  He is reckless, impulsive, and irresponsible. He thinks only of today, this minute—this second!  He has no goals or interest in anything. He wants to sleep his life away,” observed Mr. Gilyard, his voice rising. “I am so afraid that he is going to wake up one day and suddenly discover that life is indeed short, precious, and waits for no one—a realization that will come much too late for him to do anything about it.” 

As Mr. Gilyard’s lower lip began to quiver, and his right eye began to slowly fill with a single developing tear, I asked him to turn to his son and to tell him that he loved him and that he was worried about him.  The older man seemed stunned and paralyzed by my request.  Obviously overcome and perhaps even slightly embarrassed by his emotions, he could only say to me in a tone slightly above a whisper, shaking his head slowly and affirmatively, that Clyde knew. 

“But can you turn to him and tell him?” I asked again, to which he responded by repeating his earlier refrain: “He knows.” 

A New Conversation

“Once again, Mrs. Gilyard was in her familiar role of working overtime for the family while Mr. Gilyard was working hard to emotionally retreat from the interaction.” Maybe there was something to this dynamic: maybe Mr. Gilyard’s “low pulse” for engagement heightened his wife’s anxiety, which she ameliorated by becoming more actively involved in an interaction.  Her involvement in turn  reinforced his low pulse, and his low pulse heightened her anxiety and so forth and so on. 

Meanwhile, Clyde remained a central but peripheral figure in the family’s interaction.  He was the frequent subject of his parents’ reprimands, criticism, and attempts to speak for him. While it was Mrs. Gilyard’s good intention to make sure that Clyde was reassured of the love that his dad was having difficulty expressing directly, it was nevertheless counterproductive to what I was trying to accomplish with the family at this point. So I decided to re-engage Mr. Gilyard by simply turning my body towards him and pointing to Clyde. 

He started his interaction with Clyde by telling him, critically, why he needed to change. I immediately interrupted him. “I realize this is important fatherly advice you’re offering your son,” I said, “but I want you to suspend the advice giving for a moment and simply tell your son that you love him and that you’re worried about him.” 

For the first time during the session, Clyde looked at me and said, “Boy, you’re a trip! Just give it up. Why keep asking the same frickin’ thing over and over again? I know he loves me. There. Are you satisfied? Now can we move onto something else?” It was striking to me that this one seemingly benign and simple request sent so many reverberations through the family while giving me a front-row seat to the family drama that had necessitated the Gilyards coming to therapy.

I commended Clyde. “I like the fact that you’re so honest and direct. You didn’t feel like you needed to sugarcoat your feedback for me. I think I like you, Clyde!”  I hoped that my feedback would have some resonance with him and provide a small buffer against the barrage of negative feedback he was accustomed to getting from his parents.  Clyde responded with a very faint smile, a slight shrug of his left shoulder, but for the most part he continued to sit motionlessly and without much overt expression.

 The family’s process had been marvelously effective at maintaining their status quo. The climate in the room was much less intense and they seemed more relaxed, at least on the surface. Mrs. Gilyard scanned the room with a sense of anxious anticipation. She looked as if she was wondering, “What’s going to happen next?”  Mr. Gilyard retreated and seemed far away, while Clyde nervously patted his right foot and stared at the ceiling. I sat quietly observing the family as my eyes occasionally connected with Mrs. Gilyard’s. 

After a few minutes of silence, I commented to Mr. Gilyard, “It seemed like it was a little difficult for you to talk directly to Clyde a few minutes ago. Was it difficult?”  

“You know, Doctor,” Mr. Gilyard quickly responded,  “it is not difficult for me to talk to my son and I don’t really have a problem talking to him. It’s just sometimes it seems pointless because Clyde is going to do what Clyde wants to do. I feel like the things his mother and I say to him go through one ear and out the other. So sometimes my attitude is, ‘Why bother!’” 

I noted how frustrating and seemingly futile such a dynamic could be, especially when there are legitimate worries and wishes that they would like to seriously convey to Clyde. Then I made an observation to Mr. Gilyard, trusting that Clyde and Mrs. Gilyard were eavesdropping. 

“My early sense of Clyde so far is that he is self-reflective, contemplative, and a courageous communicator,” I said. “I have noticed the way that he has sat here very quietly but has been very attuned to what is going on here, though his words have been few.  Yet as you observed a few minutes ago, when he had something to say, boy, did he say it with force, conviction, and clarity. I think a good conversation is possible between all of you if you could each attempt to have the conversation differently. Trying to have new conversations the same old way you have been attempting to have them is not working for the family. If you continue to hold onto the old ways you have been trying to engage with each other, this process will take forever and Clyde will turn to his friends for the conversations he should be having with his parents!” 

Mr. Gilyard seemed intrigued, if for no other reason than my oblique reference to the timetable for treatment, which I knew was important to him. I then asked Mr. Gilyard, “So do you think taking a different approach to talking to Clyde is something that you would be willing to try?” 

 “I am willing to do anything that you think will help me reach my son,” he replied.  

“I appreciate your willingness to give this a try,” I responded.  “I would like to return to where we were earlier. When I listen to you, I feel a kind of underlying pain—almost haunt—that you have when you think about Clyde’s life. What I hear and feel from you is worry, fear, and pain, yet what gets communicated to Clyde, and probably what he hears, is criticism, rejection, and anger. I would like for us to try this differently this time around. Can you turn to your son and tell him you love him and that you’re worried about him?” 

Mr. Gilyard looked at me with a slight sheepish grin and nodded.  He then took a minute to collect his thoughts as he stared at something beyond the room in which we are sitting. Mrs. Gilyard fidgeted a bit and nervously rubbed her hands together.  I could tell Clyde was very tuned in, although he outwardly retained his cool pose of detached disinterest. 

The silence built and so did the intensity in the room. After a few more minutes, Mr. Gilyard turned to Clyde.

 “I don’t know why this has been so hard for me,” he said to his son. “I don’t want you to think it had anything to do with not loving you…because I do love you very much, my firstborn son.  I will always love you, and I am sorry if I have somehow ever given you the message that I don’t love you or that my love for you is conditional.”

“Can you also tell him about your worries?” I encouraged him.

Mr. Gilyard sighed. “I do worry about you.”

“Can you tell him about your worries?” I prodded. “The ones that keep you up at night.”

 “I guess I worry all the time. I worry about drugs, although I don’t think you would ever    be stupid enough to do drugs. I worry about you not giving your best in school and the ways that will hurt your future. I worry about…” “Mr. Gilyard’s breathing shifted; his words suddenly seem much harder to find.” His voice was beginning to break and he now seemed more hesitant to continue.

“You’re doing great,” I told him. “This is the type of conversation that you and Clyde have needed to have for awhile now. Please don’t hold back now. Tell him about all of the fatherly worries you have about him.”

 “I worry… I worry…” Mr. Gilyard began to cry. “About something awful happening to you. About you dying, and there is nothing I or your mother can do to protect you. I worry about the damn trigger-happy police. I am worried that life is short and I don’t know what I would do if anything ever happened to you,” he sobbed. “The streets are vicious. People are vicious. And no one seems to GIVE A DAMN about young black boys like you.” He pounded the coffee table with his hand. “I can’t tell you, Clyde, the number of times that I have awakened in the middle of the night sweating from the same bad dream—the same nightmare that you are lying on 22nd Street in a pool of your own blood which is OUR blood too.” He turned to his wife. “Tell him, Geraldine, how many times you have had to comfort me from the same goddamn dream. “ Mrs. Gilyard nodded in confirmation while I gestured to her to refrain from speaking at this point. Both Mrs. Gilyard and Clyde were now beginning to cry as well.

Clyde spoke. “I don’t know what’s wrong with you and Mom. All you do is accuse me of doing bad things and being a bad person. I go to school, I get decent grades, and yet I all I ever hear is, ‘You didn’t do this. You didn’t do that. This is going to happen. That is going to happen.’” Clyde was more animated than I had yet seen him, and his voice was raised; he was crying profusely .

“Clyde,” I said, “I am so glad to hear you say how all of this affects you. I would be surprised if your parents knew that you have been affected so much by their worries and criticism of you. Thank you for again being such a courageous communicator—you know, having the courage to say what needs to be said and not just whatyou think others think you should say. Your tears—who were they for? What were they for?”

 “I don’t know,” Clyde said softly.

“Clyde, honey,” said Mrs. Gilyard, “I am sorry that I have been so caught up in my own worries that I have not taken a second to think about how all of this has been affecting you.” She began to cry even louder as she walked over and draped one arm around Clyde while reaching out with the other for Mr. Gilyard.  As she held Clyde, sobbing, she repeated, “I am so sorry. I am so sorry.” I sat quietly, observing this pivotal and sacred moment for the family, and remained appropriately peripheral for the moment.

Mr. Gilyard broke the momentary silence. “Son, we didn’t mean to hurt you and put so much pressure on you. We don’t think you’re bad. We just worry about you.”

“I honestly don’t know why you are so worried,” said Clyde. “I feel like I can’t breathe without causing somebody—you or Mom—to worry.”

Finally I stepped in. “I want to thank each of you for all of your hard work today, and thank you, Mrs. Gilyard, for your hard work in getting everyone here today. Mr. Gilyard, I am so pleased that you were able to tell Clyde about your worries. Now he knows that there are real heartfelt worries beneath all of the criticism. My hope is that you and Mrs. Gilyard can be more diligent in expressing your worries without the criticism, and that, Clyde, you could remind yourself that somewhere beneath their criticism is an unexpressed worry. By the way, Clyde, I share part of your curiosity regarding the roots of your parents’ worries.” I turned to the parents. “I completely understand your worries about the police, school, and what happens if Clyde ends up in the company of the wrong crowd. I think it’s great that you are concerned and involved parents. But as I mentioned earlier, there seems to be a ‘haunt’ when it comes to your efforts to parent Clyde. It is particularly poignant with you, Mr. Gilyard.”

As I wrapped up our first two-hour session, I reminded the family that I am a firm believer in assigning homework between sessions. “Homework is a wonderful strategy for ensuring that families continue to work together outside of treatment and not rely solely on our weekly two-hour meetings to promote change.” The actual tasks to be completed are seldom as important as the spirit of cooperation, collaboration, and communication that is generated (or not) as a result of the assignment. The Gilyards’ first homework assignment was for each member of the family to generate a minimum list of three beliefs each of them had regarding why there was so much worry in the family. They should generate their respective lists separately and then share their beliefs in a brief family meeting that should be scheduled by Mr. Gilyard and must take place before our next session. Clyde was assigned the task of keeping track of whether all of the rules had been followed by all members of the family, including himself, of course. And finally, Mrs. Gilyard was assigned the task of taking a vacation day from all coordinating tasks associated with the homework assignment.

The Gilyards showed up for our next session on time, and not only had they completed the homework assignment but had done so by rigidly adhering to all of the specified terms. While the assignment failed to produce any revelatory moments for the family, it did lay down some important groundwork for several transformative future sessions.

A Haunted Past

“It was too much responsibility and too big of burden. How can you possibly protect your children from the perils of the world?  My parents were super parents and even they could not protect Clyde and Roger,” he often reflected.  “For many years of my life, the pain of losing my brothers was so painfully gut-wrenching, I couldn’t have imagined any greater pain had they been my children. And then Clyde was born. Everything changed. Suddenly I could imagine a greater pain than what I had already experienced. For a few years, especially the early ones, he actually helped to redirect some of the pain I felt about the loss of Clyde and Roger. Maybe he gave me something else to focus on that my own father never had after losing two sons. I know that both Mom and Dad never ever recovered from Clyde’s murder, and then when Roger was killed, they simply stopped living.” 

Mr. Gilyard’s protracted mourning and shame never allowed him to be honest with his son about his uncle and namesake. He created the story about Viet Nam because it allowed him to recreate his brother in an image that was more positive and less burdened by the all of the familiar stereotypes of black men. This, unfortunately, was a huge piece of his son’s burden—a burden he undoubtedly carried from birth. He was not only his fallen uncle’s namesake, but he was a psychological object of possible redemption for his father. Suddenly all of Mr. Gilyard’s worries made sense to me. How could he not possibly once again find himself facing the dawning of the period of adolescence, without re-living the traumatic loss of his two younger brothers?  How could he not worry about Clyde, the flesh of his flesh, possibly following the pathway of brothers Clyde and Roger? “After all, life had taught him a brutally cold and unforgettable lesson that young black boys don’t live beyond age fifteen”, and Clyde was now fourteen.

As our sessions continued, it was a bit unnerving to discover just how unkind the untimely death of young boys had been in the Gilyard’s family. Mrs. Gilyard also had a younger brother, Will, who was killed at age seventeen in a terrible car accident. Although Clyde knew of his Uncle Will, and the circumstances of his death, he did not know that his uncle was illegally intoxicated at the time of his death. According to Mrs. Gilyard, Will was a passenger in a car that was driven by his best friend who was also intoxicated at the time of the accident. As Mrs. Gilyard told the story of Will’s final moments, she wept as if it had just happened yesterday.  She maintained that had Will not been in a state of an alcohol-induced stupor, he could have possibly survived the tragic accident.  Clyde’s surge into adolescence had been a significant unintended catalyst for re-igniting the unresolved grief that haunted both of his parents. In a strange way, Clyde’s life was a powerful symbolic reminder of the Gilyards’ ongoing struggle to make peace with death and loss.

I continued to see the Gilyards for a total of eleven sessions, and I believe they made tremendous strides, though there was still additional work to be done. As a result of family therapy, the parents had a better understanding of how the tragic losses of their siblings were infiltrating and sabotaging their best efforts to be the type of parents that they ultimately wanted to be.  They were far less critical of Clyde, but still resorted to blame and criticism when they felt anxious about their son’s life.  The Gilyards had made significant progress in granting Clyde considerably more breathing room, and yet this was still a major challenge for them to completely master.  Our work together had also been instrumental in helping Clyde to see and experience his parents with far more complexity. While he strongly resented their “constant nagging,” he also now understood and felt more genuinely their love for him. From our sessions together, “he had the opportunity to experience his parents as human beings with real feelings—hurt, pain, and joy”—and not just as critical, robotic and detached enforcers of the rules. He was able to develop more compassion for his parents and them for him. The family sessions afforded Clyde the opportunity to both fight with them—something that the family excelled at—as well as to cry with them—something they were not very good at. Yet, on the other hand, and in spite of it all, Clyde also continued to live up to his reputation as an adolescent.  His failure to follow through with chores, spending too much time of his cell phone, and his frequent flashes of self-righteousness continued to be challenges for him and his parents. 

Providing the Map

Both Mr. and Mrs. Gilyard terminated therapy with the understanding that the difficulties that brought us together were much bigger and more complicated than what rap music Clyde listened to or “his no-good, do-nothing hoodlum friends.” While Clyde expressed a number of troubling behaviors that at times appeared depression-like, “his” problems were much more complicated and intricately embedded in family dynamics and history than he or his parents realized Clyde’s symptomatic behavior was as much an indication of a family system that was not functioning properly as it was a sign of his individual pathology.

While the issues that constituted the core of Mrs. Gilyard’s early concerns about Clyde were significant issues, they paled by comparison to the complex, systemic, and intergenerational issues that made the Gilyards’ task of parenting so challenging. Through my work with the family, I was able early on to get a poignant snapshot of how the family was organized and how they interacted. I was able to rely more on what I observed than what they told me. There is something powerful and transformative about the process of witnessing—having the ability to experience and re-live the stories of another’s life with them.  Had I complied with Mrs. Gilyard’s request and “treated” Clyde independently of his family, he would have probably continued to live his life in the shadow of his Uncle Clyde without him or the family acknowledging it, while the family simultaneously and unfortunately maintained that the uncle who had been murdered unceremoniously and without distinction on the streets of the inner city, was instead a Viet Nam veteran and hero.  It was interesting and prophetic that Mrs. Gilyard, before our first session, noted passionately that Clyde had “become a shadow of the human being that he used to be.” I guess he had.

During this pivotal moment of therapy, Clyde was able to bear witness not only to his father’s shame, humiliation and hurt, but to his pain and humanness as well.  It changed forever how he saw his father, understood him, and more importantly, experienced and related to him.  Mr. Gilyard, in return, was able to give his beloved son and the namesake of his twin brother a gift of humility and a context for better understanding his father’s worries. And Mrs. Gilyard was finally able to “catch her breath” and exhale. She, for once, would not have to over-function to compensate for Mr. Gilyard’s reticence and emotional blockage. Finding the lovingness in him as a father also allowed her to add depth to the lovingness that she had for him as a spouse, which had the unplanned consequence of further strengthening their marital bond as well. “This is the beauty of family therapy: when it works well, it helps families to recalibrate and to experience reverberations throughout the system even across generations.”  If Clyde someday decides to become a father, I believe that the shifts he experienced in the relationships with his father specifically, and with his parents in general, will impact how he parents.  As a result of the family’s involvement in family therapy, the generational and relational arteries that connected the lives of Clyde, Uncles Clyde, Roger, and Will, as well Mr. and Mrs. Gilyard and many others, have been refreshingly and painstakingly unblocked, but will require ongoing work to remain so. This, too, is part of walking the tightrope: helping families find ways to celebrate newfound highs while simultaneously keeping them grounded enough to confront the next new challenge.

Family therapy, especially with adolescents, is often about walking on a tightrope: dangerously and delicately walking the fine line between hazard and hope. The tightrope is ultimately about encouraging and exploring that undefined, often difficult-to-measure balance between clinically taking positions and imposition, between promoting intimacy and compromising safety, and between increasing intensity and fostering comfort.  Having a willingness to tiptoe along the tightrope often means that in my work with adolescents and their families, I have to stretch myself well beyond my zone of comfort and safety. As a family therapist I have to earnestly and relentlessly push myself in treatment to ask one question more than the question I am comfortable asking, and to take risks that might expose me to failure, while at the same time offering tremendous potential for the promotion of healing and transformation.  

A Psychotherapist Returning from Vacation

Posted on by Psychotherapy.net Team

It’s been twenty-plus years now of returning from some sort of summer vacation to resume seeing clients.  I wake up this morning, still unsettled from my dream life, reminded that my own anxiety, seemingly under wraps, is not too far from the surface. As I mentally ready myself to go back to work, images and memories seep in from prior years: early in my career nervously wondering whether any clients would return; other times eagerly anticipating seeing a specific client or two, looking forward to continuing our work; and now, a sinking feeling as I recall the years surrounding my divorce, wondering how I could possibly be useful when my whole world was a jumble.  In the San Francisco climate, where the summer fog is the strongest reminder of the changing seasons, August vacations serve as a marker of years passing.

My mind races back to my first clients: I was just starting out, not yet licensed, and had a small office at 20 Van Ness St., above Bull’s Restaurant.  The restaurant’s long gone, my office perhaps now occupied by a CPA or web designer, or vacant in this economy.  And my clients, where are they now?  How are they now?  Raza, or was it Rasha . . . a beautiful young Iranian woman telling me angrily yet excitedly that we had just launched Operation Desert Storm. This was pre-internet, and some information was still passed on via word of mouth.  Or Michael, still aching from his mother’s death, and trying to come to grips with being gay. I was pleased to discover that I could really empathize with his struggles, even though they were so foreign to my own. Or Joanne, whom I shepherded through memories of sexual abuse into a better relationship, and eventual marriage. When her memories first started emerging, we were both stung, confused, taken off guard.  But we both hung in there and plowed through somehow.  It was new territory for both of us, though I’m fairly certain she benefitted from our meetings. But how many of my clients did I really help?  The experience I brought to those sessions as a therapist and as a human being seems so limited as I look back now.  But perhaps that was partially compensated by my enthusiasm?  I would like to think so, to give myself the benefit of the doubt.

My dreamlife and the wisps of anxiety that remain if I allow myself to linger in bed suggest that I am still the same person as I was 20 years ago, and perhaps 20 years before that.  But I do know a few more things about myself, and about life, and that translates into being a better therapist….at least for most of my clients.  I know that significant change is really possible:  I’ve seen it; I’ve experienced it.  And yet I’m also humbled by the hardships that life can throw at us, that no amount of positive psychology or cognitive restructuring can easily neutralize.

This summer’s vacation has been broken into a few blocks.  This past weekend my wife and I had a quick getaway to the Delta region, just two hours away in current time, yet another world apart. We passed through “islands” surrounded by levees, pear orchards and vineyards below sea level, and the only surviving Chinese quasi-ghost town paying tribute to the first generation of farmers and miners who experienced hardships and loneliness unimaginable to most of the worried well of today.  No therapy couches to provide comfort; gambling parlors and liquor had to suffice as a distraction. 

But the morning’s coffee, nytimes.com, and the megabytes of emails provide a sharp transition back to life-as-usual.  Clients are calling.  Appointments need to be juggled. This is what I do.  I don’t grow pears, which in itself is no easy task, and subject to the uncertainties of nature . . . but hopefully I can help my clients grow.

Erving Polster on Gestalt Therapy

Posted on by rezendevknowfully.com

The Interview

Victor Yalom: We could get started by asking how you got involved in this business of psychotherapy, many years ago.
Erving Polster: Oh, I don't know where to begin on that.
Randall C. Wyatt: What first sparked your interest in psychology itself?
Erving Polster: I started college as journalism major. I had no thought of psychology but several things led me there. In high school I was a doorman in a movie theater in a very tough neighborhood in Cleveland. I came from a very lower middle class neighborhood, but there was no crime, and it was scandalous to do anything against the law. These kids at the theater were juvenile delinquents, yet they were terrific kids; I just really enjoyed them, and they enjoyed me, and we had a good time together. I got this sense of how different people actually are from what we might think they are. Later, I took a course in juvenile delinquency in the sociology department as a sophomore and really liked it. I realize now that the course in juvenile delinquency tapped into that same quality of how people may be different than they appear. I switched my major from journalism to sociology. I took a course in personality theory with Calvin Hall and he just flipped me over with his ideas, particularly his views of psychoanalysis, and the incredible power of the inner experience. I then went to graduate school in Hall's psychology department… so that's how I got into psychology.
RW: What then stirred your interest in Gestalt, what drew you in?
EP: In graduate school, I was psychoanalytically oriented as was the department and Calvin Hall. As a matter of fact I wrote my dissertation on ego functioning in dreams, which was previously said to be only for super-ego and id. I got involved with a workshop with parolees in New York, and it was really eye-opening about what you can do in therapy without being the distant intellectualizer pedantic. It showed me how to get down to the basics, to the raw experience that people have. And it also introduced being open in a group. These groups were very early in the game, I'm talking about 1953, and it was long before the encounter movement was in full swing in the sixties. It was a very eye-opening group experience, hearing people's internal experience, which was unheard-of in those days, except in very intimate situations.

RW: What was your initial reaction to that?
EP: Oh, I was spellbound by the possibilities of human experience. And it happened very quickly too, because the leader was very skilled in knowing where to go. There was one patient that I'd worked with before I got involved in Gestalt therapy. He was still working with me and our worked had changed, so I asked him, "What seems different in being here?" And he said "It's not so lonely anymore." And that was really a very eye-opening feeling as well, about the importance of the connectedness between the therapist and the patient, which was then quite rare.
In fact, I think when I started doing psychotherapy, I sat behind a desk. Coming out from behind that desk was a big change, metaphorically and literally.
In fact, I think when I started doing psychotherapy, I sat behind a desk. Coming out from behind that desk was a big change, metaphorically and literally.
VY: Was there some loneliness for you though in abandoning the bastion of psychoanalysis, and doing this on your own?
EP: It wasn't lonely because I was joined with a group of people. I loved being with those people and so, no, quite the contrary, it expanded my community, rather than subtracting from it.

Learning from Fritz Perls

RW: So, looking back, what contributions did you pull from Perls? What nuggets still stick with you?
EP: One thing I got from Perls is the power of simple continuity; if we stay with somebody step-by-step, and heighten their awareness so that there is an accumulation of vitality, that leads toward very strong and revealing experiences. That process is not required for depth, but depth comes through sequentially, rather than through proof and interpretation. Not that I think that one should never interpret, but I was impressed with how much leverage that continuity and heightening of experience had on the work.
RW: What are some memories and impressions of Perls as a person?
EP: Well, he was a very unique person. I was not accustomed to a person so full of uniqueness: how a person can be really clearly differentiated from others and still have some connectedness, some offering, some contribution.
Perls was a very brilliant demonstrator of therapy. There was a strange sense of daring and safety joined together. Perls was radar; he just knew where to go.
Perls was a very brilliant demonstrator of therapy. There was a strange sense of daring and safety joined together. Perls was radar; he just knew where to go. And he had a presence which was very supportive. There was a sense that, if you went where he wanted to go you would never be in trouble. He could be supportive, kind, and resonant, as well as opinionated and impatient. Perls was a "my-way-or-the-highway" kind of guy.
RW: It must have been quite different coming from traditional analytic training. Did he work with you in a group or individually?
EP: Well, when I rolled in, I had never seen anything like this. Many people in the group had been to Moreno's Psychodrama workshops. But it seemed valid and not out of tune with the people and where they were ready to go. So I felt very excited, but with a certain fear inside. It was very illuminating to experience within myself and see what was happening within others. In the beginning I thought "Hey, what's so new about this; this isn't all that different from psychoanalysis," but the more I could see it, the more I could differentiate it. It just "grew me up" as a professional, and expanded my sense of what could happen in people's minds.
VY: Do you have any specific memories of working with Perls that still stand out for you?
EP:
Well, I remember that I reached way inside myself, and wound up in a deep cry, and not just tears, but crying. And it's like the whole world was in there, and suddenly I felt his hand holding my hand, and it was Fritz.
Well, I remember that I reached way inside myself, and wound up in a deep cry, and not just tears, but crying. And it's like the whole world was in there, and suddenly I felt his hand holding my hand, and it was Fritz. It's a very touching thing to feel this kind of sense of appreciation of what I had been through, and not keeping his distance. It was a very mind-changing realization of people's need to connect, getting a feeling of interactive connection.
RW: So these experiences you had in the group with Perls and with others, I mean I’m not exaggerating, it transformed your work and you personally?
EP: Yes it did transform me. And I love psychoanalysis, don't misunderstand me. I was really taken with the theory; it just opened me up tremendously.

The Contact Boundary in Therapy

VY: You talk a lot about making contact, and you delved into that in your writing as well. Can you say more about the centrality of contact in Gestalt therapy?
EP: Well, there are a number of central principles, but that's as central a principle as any from my standpoint. For me it's the one that was the grounding through all the rest.
VY: Why is it so important to your work, and so important to you?
EP: I'm not exactly sure why it became so important to me. I just gravitate more to that concept than to others that are also very important to me-like awareness, experiments, and helping people to act their directionalism, to really behave in ways, rather than just knowing about something. But you are right that it is key to my work.
VY: Help us get a sense, or a picture of what contact boundary means?
EP: Well, contact boundary is said-by Gestalt therapy in particular in those days-to be almost like an organ of personality. Psychology deals with the interaction between self and other. Psychology is where the two meet, where the person and the universe meet, where the person and otherness meet. Contact boundary is where the person and world meet. The concept of "boundary" says that at the meeting point there is no distinguishing between self and others.

If you look at the real estate space between two properties… that boundary line does not belong to either side, yet it belongs to both, but it is such a narrow boundary, nobody cares about owning the boundary; the boundary merely delineates what is on each side of it. With human beings, the boundaries are a little looser, but it's still a matter of the rhythm between individuality and relationship.
RW: How does that contact boundary work between people?
EP: The contact boundary means there are two individuals on each side of the boundary; they're individualized, but they unite.
It is at that point of union that you get the fundamental of existence that is to be nourished by relationships. So it's built into the nature of people to have that point of meeting: the illumination of what life is about.
It is at that point of union that you get the fundamental of existence that is to be nourished by relationships. So it's built into the nature of people to have that point of meeting: the illumination of what life is about. So the quality of the contact is very important, because contact itself is inevitable. But you can have a lot of variations in the quality of the contact. That is going to be a survival factor in anybody's life: to relate to the universe through others.
RW: How does that contact play out, then, in the therapy? And what does it mean in therapy?
EP: Oh that's such a broad thing. Let me, I'll tell you the first thing that comes to my mind… which may not be representative at all. One client really, really liked me, and admired my way of thinking and things like that, but I said to him one day, "How does it happen that you admire me so much yet nothing that I ever say to you is right." He was a little stunned by that comment, yet the fact was that his contact with me was a very narrow contact; he couldn't accept anything I would say even though his evaluation of my "rightness," if he had to evaluate it, would be "good." But for a specific engagement he could not allow that "rightness" to exist. So that's a deficiency in the quality of the contact.
VY: So you’re always paying a lot of attention with clients to what the nature of the contact is.
EP: A lot of attention. But one doesn't have to pay attention to everything. I mean, it would be very self-conscious to do that. But in key moments you say, "Look now, somehow or another you say you are accepting what I'm saying, but there's nothing in you that makes me feel that you're feeling it, that you know about it. Rather it seems to be passing right through." So, we could examine what is present or lacking in the contact. That's not the best example at all, but my mind is blocking on giving you a good example. Maybe I will think of one later….
VY: So what about you draws you so much to the immediate contact?
EP: I don't know, I can tell you that I grew up very shy, very silent. I always had friends, but I wasn't the life of the friendship, and I wasn't the instigator. I was more of the reactive person. I'm still a silent person somewhere inside but I've gone beyond it. I can talk for hours if I have to lecture which still surprises me. My mother was a very loving woman and our family was very close. I saw people around me were in very good contact with each other even though I myself was very silent. And I must say that silence is not necessarily poor contact because I think people always thought of me as a good listener. I can remember my mother and my sister talking to me at great length while I listened to them. Somehow, they wanted to talk to me. I just listened. I didn't have that much to offer, but somehow they wanted to talk to me. So I don't know the answer to your question.
VY: You obviously…you really like the contact.
EP: Oh, I love it… I love it!
RW: You also talk about the concept of, I think you use the phrase “Healing through meeting.”
EP: Well, that's a Buberian concept. I've never used the word "healing" in particular, not that I'm against it!
RW: You’re not against healing, that’s a definite.
EP: No, no! (laughter) Buber used to talk about "healing through meeting." But yeah, the idea is to restore full function. The basic thing people have to do is to integrate with the world they're in. There's no way to be isolated and still live well.

What were you guys doing in the sixties?

VY: Let’s get back to the zeitgeist of the sixties and seventies that was kind of a formative time in your professional career. I’m sure there was a lot going on there.
EP: Yes, there was. I suppose you're asking, what was going on?
RW: What the heck was going on? I mean it was…
EP: What were you guys doing over there?!
RW: …it was rather revolutionary.
EP:
Yes, it was. It was a natural extension of the power of psychoanalysis, but put in a non-pathology setting, and among people who were joined together rather than only in a private relationship. So the encounter group movement threw the whole aura of psychotherapy into the public at large, and a certain portion of the public became interested and very aroused by it. Sometimes with great expansion of mind there came harm because of premature changes in life that couldn't be assimilated easily: people being too impulsive about their careers, their marriages, their relationships. I think there were some people for whom it didn't work well, but I think for most people that I've known about, it worked very well in terms of freeing their minds to see beyond the ordinary privacy arrangements people have about living. Their internal experiences became more acceptable by being acceptable to others.
RW: Was there was some sense that you were changing the world?
EP: There was some sense to that, but you would have to be megalomaniacal to believe that.
VY: Did you have that sense?
EP:
No, I didn't have that interest in changing the world. I was aware of the changes that were very big. I think I've probably thought about it in terms of "could we live better in this world?" I didn't think of it in terms of political change which you usually think of when you talk about changing the world. I thought about it as a developmental difference, an evolutionary thing, in terms of what people could accept within themselves. I thought people might become kinder to each other, have more creativity, enjoy sexuality more fully. I felt there was a better way to be in the world.
VY: In 1978 you wrote in Gestalt Therapy Integrated, “The times are right for change. The magnetic force of immediate experience is hard to beat.”
EP: That was 1973.
VY: Ok. So if times were ripe for change, looking back from this vantage point, did anything change?
EP:
Oh, yes. I think a lot changed. But unfortunately I don't see a shift in some of the fundamentals, with crime still very much a problem, terrible wars, violence between people. Yet we do have a lot of changes.
I think fathers became better with their children, more available and open. I think women are more assertive, more "self-actualizing", more happy sexually. When I see women run on the beach nowadays, they run with full grace and force, and freely.
I think fathers became better with their children, more available and open. I think women are more assertive, more "self-actualizing", more happy sexually. When I see women run on the beach nowadays, they run with full grace and force, and freely. And that was never true before; women's physical abilities were largely dismissed. There are a lot of changes: a lot more awareness of what's going on in the world, a lot less taking for granted. Even though in the general population we still have a tremendous amount of conformity, being led by the nose, not really examining the situations in terms of more than the symbols they represent, not getting down to the real causes. So when you ask is there any change, yeah, there is change, but a lot of things haven't improved; some have gotten worse.

I think every generation has its own view of its own problems. If you think you passed an old one, there's a new one, and we're challenged to stay up-to-date with what matters.
RW: So many changes happened in the sixties, all around the world. The changes which swept across our culture, like openness, freedom, authenticity-but then taking responsibility for that authenticity and freedom is another matter.
EP:
That was a big problem in the sixties. People didn't understand about responsibilities.
There was a certain anarchistic quality to it, as if "If I can do it, it must be okay." Well it's not!
There was a certain anarchistic quality to it, as if "If I can do it, it must be okay." Well it's not! There are lots of things that people do naturally and with full backing of their personalities that are exactly wrong for somebody else, and in the long run, wrong for themselves because they don't take account of the consequences.
RW: Do you think Gestalt therapy and Gestalt practices sometimes led to that kind of impulsivity: that whatever you feel is right, so just do it?
EP:
I think we had a hand in it. And I'm sad that that's true. But I think what a beautiful theory, there is much room for compassion and community, things most of us would want in a society. It very often got out of hand because it is very hard to coordinate freedom with taking account of the other. There's a basic paradox, like when I talked about the contact boundary before; the sense of union and the sense of separation. How do you coordinate those? It's hard to do simultaneously. If you are going to be free, where is there room in your mind to take account of the other? Well, there is room, but it's not easy to do it. It's very easy for people, whenever faced with paradox, to choose one side of the paradox over the other, so they become totally free and not care about anybody else, or else become conformist and lose their own direction.

Insight and Awareness

VY: Lets back up a bit and try to find out a little bit more about what Gestalt therapy is, or what it is today to you. You gave us some indication of the difference between Gestalt and psychoanalysis back in the fifties. Is there some way you can give us a summary of what distinguishes Gestalt therapy?
EP: When you have a broad theory, different people will take different things out of it, so you get a lot of variety. We have that in psychoanalysis too. The way I see Gestalt therapy is that it is a system that deals with contact, and therefore with how to join with others, how to coordinate with them, how to form community. And it deals with awareness, which unearths what people's needs and possibilities are. It nourishes their activity. Awareness is not only a confirming experience; it is also an inspirational experience, in terms of leading people into their behavior. I don't think of Gestalt therapy as programmatic as many people took it in the beginning-for example, that people in Gestalt therapy group members were not allowed to ask "Why?"
RW: Right. What? How? but not Why? Why is that?
EP: Yeah, no Why? They did that because Fritz Perls was aware of the intellectualization, of de-personalizing relationships. And the word why is one of the instruments of intellectualization. You ask why? and it leads you to intellectual answers. It doesn't have to, but it often does. Why? is a perfectly natural question to ask. Every child would ask Why? and Why not?-I mean, it's just stupid to exclude Why from one's repertoire.

Early on, Perls was against interpretation. But to explain things is a perfectly human thing to do. Why would you exclude that? You don't want to rely on it. Psychoanalysis went the other way, they did it too much. They didn't deal with the basics of experience as Gestalt therapy did. So for example, psychoanalysis was interested in insights; Gestalt therapy was interested in awareness. Now an insight, to me, is one form of awareness, but awareness goes beyond insights.
VY: How so?
EP: Well, like we're aware of talking to each other now, but that's not an insight, it's an awareness. I'm aware of moving my hands now. I'm aware of the words I'm saying. I'm aware of your smile. I'm aware of how you changed your smile. But I wouldn't call those insights. They're going on all the time. Insights go on occasionally, and are valuable, but not something to base a whole system on.

Punctuating Client Experience in Therapy

RW: In your therapy videos, I notice that you tend to punctuate client insights and awareness, at times dramatically. What is your thinking about that? Is that your natural style or a technique?
EP: Well, probably it's my own natural style, but it has a theoretical base in the sense that the registration of experience matters in terms of the experiencing having an impact. What you register matters in terms of how you relate to the world, and how you see yourself. There are some people where you don't have to say a word, and you know they're registering what is happening. So I wouldn't always punctuate, but there are certain times when I think punctuation is an amplification of what happens, so they really feel what is happening, and it is part of themselves, rather than a casual thing that went on.
RW: You wrote a book entitled Every Person’s Life Is Worth a Novel that makes the point of helping people fully appreciate the drama and experiences in their own lives.
EP: That's right: to recognize what is interesting in their lives, and not to take on somebody else's standards for what is worthwhile. So that's the idea of every person's life being worth a novel. Novelists base their work on what all of us actually are; they're not making it out of whole cloth. They're recognizing the nature of people's lives, and we ourselves tend to attribute to them the skill that would make our lives interesting. But the fundamentals are within us. And when we can recognize that we are living our life, that's very crucial for self-appreciation to come to fruition, because if we don't feel that value, then all the rest just dissipates. That's not an all-or-none matter of course for most people.
VY: I think you have a skill in conveying to people this kind of enthusiasm and interest in their own creativity and strength without being Pollyannaish.
EP: I don't feel like a Pollyanna. I'm particularly enthusiastic when I'm permitted that luxury of paying attention to what they're saying, and see that they're open to my paying attention. That's what they come for. Some people would not be open to my focused attention, so in another situation a person might wish I would get off their back. There are a lot of things I would say in a therapy setting that I wouldn't say to somebody at a dinner table. It reminds me of the time I did some work in a coffee house a long time ago at a church function. The guy who ran it said, "Here, just do whatever you do." He introduced me as a psychologist, and people gathered around. Some stayed for awhile, and others left, and some more would come; we had very interesting conversations. The main difference is that I would call their attention to what they were doing, which you would not do normally. It's too interruptive; it's not a good way to live. But the therapist has that invitation to pay attention to what's going on, rather than just living through it.
RW: At times, I imagine you might…
EP:
Let's suppose I said to you, "Randy, what are you aware of now as you're about to ask me these questions?" You'll say "Back off, I just want to ask you a question." That's perfectly how people live; it's the right way to live.
Let's suppose I said to you, "Randy, what are you aware of now as you're about to ask me these questions?" You'll say "Back off, I just want to ask you a question." That's perfectly how people live; it's the right way to live. But the therapist has the special permission to make up for the losses that come from those everyday things, so you can recover some of the awareness of what is not being expressed and make it a part of yourself. Excuse me for interrupting you.
RW: Well, I will tell you anyways. I was thinking that I wanted to know what happens when you are enthusiastic, when you say “Fantastic!” to clients, or when you punctuate their experience and help a client register something… and their response to that is to brush it away, they don’t take it in: how do you attend to that?
EP: Well, I don't expect people to fall into line right away (laughs). I don't make that kind of demand of them. If they want to pass it off, they pass it off.
RW: You will come back to it.
EP: Yeah. Look, I could imagine saying to somebody later on, "Every time I praise you, you seem to go dim in your face. You don't like my praise?" And maybe they'll tell me, or maybe they wouldn't, but it has to be well-timed. You would have to do it with the right person at the right time.

Beyond Technique-Driven Therapy

RW: You’re called a Gestalt psychologist, a Gestalt therapist, yet in many of the interventions in your psychotherapy video you come across as very different than what most people think of as Gestalt work. When you’re doing therapy, it doesn’t seem so cloaked in formal Gestalt technique, role playing, dream work, empty chair, and so on.
EP: To me, those formal techniques are scaffolds. They're very important in building the building. When the building is built, you take away the scaffolds. I think theories are a way of orienting yourself to what you do, and they help in directing you. But I could see somebody doing a psychoanalytic session, and explaining it in Gestalt terms or vice-versa. Yet, you would certainly distinguish between a Gestalt and a psychoanalytic session. So for me, my orientation is to the principles of Gestalt therapy. That guides my mind, so if I do something which is similar to what somebody else would do, that's no problem to me, because the theory doesn't decree the repertoire. No, that's wrong, the theory gives you a repertoire. It doesn't tell you what to choose out of the repertoire. So if I know that a part of my repertoire is to have a dialogue between two parts of the person's self, that's a part of my repertoire. Now I pick that out of the bag when it feels right for whom I'm working with. If I'm doing a dream, I may want somebody to play some part of the dream, or I might just say, "What does this dream remind you of in your everyday life?" Or, "Is there any more you want to say about the dream, or do you like the dream?" I wouldn't necessarily go through that rigmarole about playing out the parts.
RW: In the room with the client you seem to be tuned into the immediacy between you and the client. That seems to be much of the guiding force, as opposed to a series of techniques.
EP: Yeah, it is for me. But there will be other Gestalt therapists who'll be very distant in their actual relationship with the client, but they are very tuned into the awareness of that person — "What are you aware of now? What do you want now?" they can do very well, but it's a different way of operating.

Wise Words for Therapists

RW: Let’s shift to another track, which is that you consult with a lot of therapists. What do you see lacking in therapists’ work when you train them? What do you push them on? What do you seem to be returning to again and again to help them become better therapists?
EP: I see a lot of therapists falling back on the stereotypes of what a psychotherapist does. They are unwilling to say what they know, unwilling to develop their own way of doing things, their own style-to be idiomatic, in other words.
VY: What do you mean by idiomatic?
EP: Idiomatic meaning only that person can do it. That's an exaggeration, because after all, we do have much in common with each other. But still you get a feeling like "Alvin is the one doing that; that's the way he does it" versus a generic therapist.
VY: Therapists really sticking their neck out in showing themselves.
EP: Well, that wouldn't be necessarily sticking your neck out. Some things come naturally, but don't fit their image of what a therapist should be doing. Like Miriam, my wife. She taught a course where she asked the therapy students to list a set of characteristics of themselves that are characteristics of them as therapists. And they would usually give a very straight list, very technical, empathy, and so on. Then she would ask for another set of more personal characteristics. And they responded with things like "fresh and lively" or "enterprising in new things." And when they saw that list, it became apparent that the best part of themselves were kept out of the therapy.
How can you get by in any field if you hold out the best parts of your self? Do we have that much good going on that we can hold out our best parts and still do well?
How can you get by in any field if you hold out the best parts of your self? Do we have that much good going on that we can hold out our best parts and still do well? So the question is how to incorporate the best parts of your personal style into the technical knowledge; because there is technical knowledge. At times of course, one needs to hold back parts of one's personality which could be over-stimulating, or dominating, or too intrusive, for example. There are all kinds of problems in therapy which anyone's natural self has to take into account or make use of depending on the situation and people involved.
RW: It’s not just a matter of learning the techniques of therapy. It’s personal too.
EP: Yes, that's the work. I mean, that's what we have to learn: how to do that. It's a matter of how you learn the technique and bring your personhood in. I'm reminded of a friend of mine who has a cousin who's a well-known concert violinist. Her cousin was performing that night and was practicing all day long. My friend asked her, "Why do you do that all day long?" and the musician responded, "The reason I do that is because I want it to be part of my reflexes, so when I'm on stage I have room left over for my emotions."

And I found over the years that what improves my therapy a lot is trusting my reflexes, not trusting them cavalierly, but trusting them through habits, through experiences. I began to trust what I would have to say, and I didn't have to think, "Is this right?" all the time. But it has to be built into your system so that you have room left over for your idiomatic qualities.

Religion, Psychotherapy and Community

RW: Let’s talk about your new writings on life-focused communities, spirituality and everyday life. You have stated that psychoanalysis and other traditional therapies left out everyday life in their therapeutic work. Can you speak to that?
EP: Freud developed psychoanalysis as a physician. He dealt with pathology; that was his game, rightly so. But he happened to build principles in a way that dealt with how people's minds work. He also had guidance for them through the therapeutic process that was generally related to the pathology. He basically invented another religion. What it lacks for as a religion is the sense of community, the lifetime commitment. But how do you take it beyond pathology? There are a lot of ways to do it, but my contention is that what I would see as an extrapolation, a rightful extrapolation, would be to have large segments of people meeting for a lifetime. Not that everybody has to come all the time, but much like churches and temples, there would be that process that is fundamental in orienting them about life, and then guiding them through it.
RW: Well, how do you do it? What makes it different or similar to traditional communities?
EP: Yes, how do you do it? We have very different methods than the familiar religions do. First of all, you don't have to believe in God. You could if you wanted to, but it won't be based on God-orientation. It would be based on what God probably represents to most people, which is an indivisible union with otherness, the ubiquitous other, that also has guiding impact on the community in a way that can have some of that force. I mean the poetry of God is really quite magnificent. I don't know whether we can ever duplicate anything at that level. But the community — if it can be hallowed, if we could see the sacred aspects of psychotherapy — would be a step toward a very orienting and guiding system. There are things psychotherapists do which I call "in the sacred realm." because they are limited to what happens in psychotherapy, and they're dear to people. And religion does the same thing; it has sacred things, but our sacred things are different from theirs. So I proposed a number of qualities which represent part of the sacred experience, and showed how religion does it, and how psychotherapy does it. I just finished my new book on this which I'm sending off to my agent on Monday.
RW: When you were just speaking there about your recent work, you really came alive… (Polster’s laughter fills the room) …much more than talking about the zeitgeist. Did you notice that?
EP: Okay… no, I didn't notice.
RW: This whole concept of spirituality—which all the big theorists have either avoided or dismissed: Freud, Ellis, Skinner, and so on, you are trying to… (Polster’s laughter fills the room) …much more than talking about the zeitgeist. Did you notice that?
EP: I don't think "spirituality." That's the term I don't use.
RW: What would you use?
EP: Religion. "Spirituality" has a lot of airy-fairy qualities to the term, and I never know what people are talking about. I like to know what I'm talking about. "Religion" I know is a community of people that is oriented and guided in their lives in very concrete ways and with very concrete beliefs, that can be defined. Spirituality – I don't know what that means. When I talk about some things, spirituality would probably be included, but I don't use the word. I'm talking about the natural quality that we seek in life of indivisibility from otherness, and I'm sure some neurological findings would support that experience. So would meditations, and deep relationships, sexuality, that sense of indivisibility, but I don't think of that as spiritual; I think of it as indivisibility. The term spiritual is too broadly-used for me to know how to use it.
RW: What is the most satisfying, the most meaningful part of your career and your therapeutic work? What keeps you going?
EP: Well, so many things: engagement, absorption, and a way of making new things happen over and over again. Also, there is the sense of impact, the sense of being important to other people, mattering to them. I'm very absorbed with writing and love doing workshops. I become just so totally absorbed by it that I just go and go.
RW: I’m sure we could go on and on right now, but you have a flight to catch.
EP: That's right!
VY: So thanks for taking the time.
EP: