Chapter Seven
The new insights into the structure of psychogenic symptoms, the dynamics of therapeutic mechanisms, and the nature of the healing process are of great relevance for the practice of psychotherapy. Before discussing the implications of modern consciousness research for the future of psychotherapy, it may be useful to summarize briefly the current situation as outlined in preceding chapters.
The application of the medical model to psychiatry has had serious consequences for the theory and practice of therapy in general and for psychotherapy in particular. It deeply influenced the understanding of psychopathological phenomena, the basic therapeutic strategies, and the role of the therapist. By extrapolation from somatic medicine, the terms “symptom,” “syndrome,” and “disease” are quite routinely applied not only to psychosomatic manifestations, but also to a variety of unusual phenomena that involve changes in perception, emotions, and thought processes. The intensity of such phenomena and the degree to which they are incompatible with the leading paradigms of science are seen as measures of the seriousness of the clinical condition.
In consonance with the allopathic orientation of Western medicine, therapy consists in some external intervention aimed at counteracting the pathogenic process. The psychiatrist assumes the role of an active agent who decides which aspects of the patient’s mental functioning are pathological and combats them with a variety of techniques. In some extreme forms of its therapeutic methods, psychiatry has reached, or at least approached, the ideal of Western mechanistic medicine represented by the surgeon. In such approaches as psychosurgery, electroshock treatment, Cardiazol, insulin, or atropine shock, and other forms of convulsive therapy, medical intervention occurs without the patient’s cooperation or even conscious participation. Less extreme forms of medical treatment involve the administration of psychopharmacological agents designed to change the individual’s mental functioning in the desirable direction. During procedures of this kind, the patient is entirely passive and expects help from the scientific authority who takes all the credit and all the blame.
In psychotherapy, the influence of the medical model has been more subtle, yet significant. This holds true even for Freudian psychoanalysis and its derivatives, which specifically advocate a passive and nondirective approach by the therapist. Ultimately, therapeutic change depends critically on the therapist’s intervention, such as relevant insights into historical and dynamic connections in the material presented by the patient, correct and well-timed interpretations, an analysis of resistance and transference, the control of countertransference, and other therapeutic maneuvers, including the proper use of silence. Both the theory and practice of psychoanalysis offer the possibility of relegating much of the responsibility for the process to the patient and attributing the failure of treatment, or lack of progress, to the sabotaging effect of resistance. Yet, in the last analysis, clinical success reflects the skill of the therapist; it depends on the appropriateness of his or her verbal and nonverbal reactions during the therapeutic sessions.
Since the theoretical constructs of the individual schools of psychotherapy and their techniques differ considerably from each other, the appropriateness of the therapist’s interventions can be evaluated only in relation to his or her particular orientation. In any case, the conceptual framework of the therapist will confine the client explicitly or implicitly to a certain thematic area and a limited range of experiences. As a result, the therapist will not be able to help those patients whose problems are critically related to realms or aspects of the psyche that his or her system does not acknowledge.
Until recently, most psychotherapeutic approaches were limited almost exclusively to verbal interaction. Powerful emotional or behavioral reactions of clients were therefore seen as undesirable acting out and violations of the basic rules of therapy. In addition, traditional psychotherapies focused exclusively on manipulations of mental processes, neglecting the physical manifestations of emotional disorders. Direct physical contact was thought to be contraindicated and was discouraged. As a result of this strict taboo, body work was not practiced even in neuroses with intense muscular tensions or spasms and other forms of dramatic involvement of the physiological and psychosomatic processes.
The new comprehensive approach to self-exploration and psychotherapy, based on observations from modern consciousness research, differs from the traditional systems and strategies in many important aspects. I have developed this approach with my wife, Christina, and we have been practicing it in our seminars under the name of holonomic integration or holotropic therapy. Altogether it represents a unique package, although many of its constituent parts appear in various existing schools of psychotherapy.
It uses the extended cartography derived from psychedelic research that has already been described. This map of the psyche is broader and more encompassing than those used in any of the Western schools of psychotherapy. In the spirit of spectrum psychology and the “bootstrap” philosophy of nature, it integrates in a comprehensive way the Freudian, Adlerian, Reichian, Rankian, and Jungian perspectives, as well as important aspects of the work of Ferenczi, Fodor, Peerbolte, Perls, the existential psychologists, and many others. Instead of seeing these schools as accurate and exhaustive descriptions of the psyche, it includes their concepts as useful ways of organizing the observations of phenomena related to specific levels of the psyche, or bands of consciousness. By including the archetypal and transcendental realms of the psyche, the new system also bridges the gap between Western psychotherapies and perennial philosophy.
An important feature of the theoretical model associated with the new therapeutic approach is the recognition that human beings show a strange paradoxical nature, sometimes manifesting properties of complex Newtonian-Cartesian objects, at other times those of fields of consciousness unlimited by time, space, and linear causality. From this vantage point, emotional and psychosomatic disorders of psychogenic origin are seen as expressions of a conflict between these two aspects of human nature. This conflict seems to reflect dynamic tension between two opposite universal forces: the tendency of undifferentiated, unified, and encompassing forms of consciousness toward division, separation, and plurality, and that of isolated units of consciousness to return to the original wholeness and unity.
While the movement toward experiencing the world in terms of separation is associated with increasing conflict and alienation, experiences of holotropic consciousness have intrinsic healing potential. From this point of view, an individual experiencing psychogenic symptoms is involved in an ultimately self-defeating struggle to defend his or her identity as a separate being existing in a limited spatiotemporal context against an emerging experience that would undermine such a restricted self-image.
From the practical point of view, an emotional or psychosomatic symptom can be seen as a blocked and repressed experience of a holotropic nature. When the resistances are reduced and the blockage released, the symptom will be transformed into an emotionally highly charged experience and consumed in the process. Since some symptoms contain experiences of a biographical nature and others perinatal sequences or transpersonal themes, any conceptual restrictions will ultimately function as limitations of the power of the psychotherapeutic process. A therapist operating in the framework described in this book seldom knows what kind of material is contained in the symptoms, although with sufficient clinical experience in this area a certain degree of general anticipation or prediction is possible.
Under these circumstances, the application of the medical model is inappropriate and not justifiable. An honest therapist should do anything possible to undermine the “surgical ideal” of psychiatric help that the client might bring into therapy, no matter how flattering the role of the all-knowing expert might appear. It should be made clear that in its very nature the psychotherapeutic process is not the treatment of a disease, but an adventure of self-exploration and self-discovery. Thus, from the beginning to the end, the client is the main protagonist with full responsibility. The therapist functions as a facilitator, creates a supportive context for self-exploration, and occasionally offers an opinion or advice based on his or her past experience. The essential attribute of the therapist is not the knowledge of specific techniques; although these represent a necessary prerequisite, they are quite simple and can be learned in a relatively short time. The critical factors are his or her own stage of consciousness development, degree of self-knowledge, ability to participate without fear in the intense and extraordinary experiences of another person, and willingness to face new observations and situations that may not fit any conventional theoretical framework.
The medical model is thus useful only in the initial stages of therapy before the nature of the problem is sufficiently known. It is important to conduct a careful psychiatric and medical examination to exclude any serious organic problems that require medical treatment. Patients with underlying physical diseases should be treated in medical facilities equipped to handle behavior problems. Those clients with negative medical diagnosis who prefer the path of serious self-exploration to symptomatic control should be referred for psychotherapy to special facilities outside of the medical context. This strategy would apply not only to neurotic patients and people with psychosomatic disorders, but also to many of those patients who in the traditional context would be labeled as psychotic. Patients dangerous to themselves or others would require special arrangements, which would have to be determined from situation to situation.
Every professional who has conducted psychedelic therapy or experiential nondrug sessions is well aware of the enormous emotional and psychosomatic energies underlying psychopathology. In view of these observations, any exclusively verbal technique of psychotherapy is of limited value. A verbal approach to the elemental forces and energy reservoirs of the psyche can be likened to an attempt to empty an ocean with a sieve. The approach recommended here has a distinct experiential emphasis; talking is used primarily for preparing clients for experiential sessions and for retrospective sharing and integration of the experience. As far as the actual therapeutic procedure is concerned, the therapist offers the client a technique or a combination of techniques capable of activating the unconscious, mobilizing blocked energies, and transforming the stagnant state of emotional and psychosomatic symptoms into a flow of dynamic experiences. Some of the techniques that are most suitable for this purpose will be described in detail later.
The next step, then, is to support and facilitate the emerging experiences and assist the client in overcoming resistances. On occasion, a full unleashing of the unconscious material can be quite challenging and taxing, not only for the subject, but also for the therapist. The dramatic reliving of various biographical episodes and sequences of death and rebirth are becoming increasingly common in modern experiential therapies and should not present any major problems for a professional who has been adequately trained in this area. It is important to emphasize that the therapist should encourage and support the process, no matter what form or intensity it assumes. The only mandatory limits should be physical danger to the subject or to others. Major therapeutic breakthroughs can frequently be seen after episodes of complete loss of control, blackout, excessive suffocation, violent seizurelike activity, profuse vomiting, loss of bladder control, emitting of inarticulate sounds, or bizarre grimacing, postures, and sounds that resemble those described for exorcist seances. Many of these manifestations can be logically related to the biological birth process.
Although reliving early childhood memories and the trauma of birth are being accepted these days even by rather conservative professionals, a major philosophical reorientation and fundamental paradigm shift will be required when the process moves into the transpersonal realms. Many of the experiences that occur in this process are so extraordinary and seemingly absurd that an average therapist feels uncomfortable with them, finds it difficult to see how they could be of any therapeutic value, and tends to discourage them explicitly or implicitly. There is a strong tendency among professionals to interpret transpersonal phenomena as manifestations of biographical material in symbolic disguise, as expressions of resistance against painful traumatic memories, as experiential oddities without any deeper significance, or even as indications of a psychotic area in the psyche that the client should shy away from.
Yet, transpersonal experiences often have an unusual healing potential, and repressing them or not supporting them critically reduces the power of the therapeutic process. Important emotional, psychosomatic, or interpersonal difficulties that have plagued the client for many years and have resisted conventional therapeutic approaches can sometimes disappear after a full experience of a transpersonal nature, such as an authentic identification with an animal or plant form, surrender to the dynamic power of an archetype, experiential reenactment of a historical event, dramatic sequence from another culture, or reliving what appears to be a scene of a past incarnation.
The basic strategy leading to the best therapeutic results requires that the therapist and the client temporarily suspend any conceptual frameworks, as well as any anticipations and expectations as to where the process should go. They must become open and adventurous and simply follow the flow of energy and experience wherever it goes, with a deep sense of trust that the process will find its own way to the benefit of the client. Any intellectual analysis during the experience usually turns out to be a sign of resistance and seriously impedes the progress. This is because transcendence of the usual conceptual limits is an integral part of the adventure of in-depth self-exploration. Since none of the transpersonal experiences makes sense in the context of the mechanistic world view and linear determinism, intellectual processing during transpersonal sessions usually reflects an unwillingness to experience what cannot be understood, what is incomprehensible within the conceptual framework available to the client. Seeing oneself and the world in a particular way is an integral part of a subject’s problems and in a certain sense is responsible for them. Determined reliance on the old conceptual frameworks is thus an antitherapeutic factor of prime importance.
If the therapist is willing to encourage and support the process, even if he or she does not understand it, and the client is open to an experiential venture into unknown territories, they will be rewarded by extraordinary therapeutic achievements and conceptual breakthroughs. Some of the experiences that occur in this process will be understood later within vastly expanded or entirely new frameworks. However, on occasion, a far-reaching emotional breakthrough and personality transformation may be achieved with no adequate, rational understanding. This situation sharply contrasts with the one so painfully common in Freudian analysis—a sense of detailed understanding of the problems in terms of one’s biography, but therapeutic stagnation or very limited progress.
In the procedure I have been suggesting, the therapist supports the experience no matter what it is, and the client lets it happen without analyzing it. After the experience is completed, they may try to conceptualize what happened if they feel inclined to do so. However, they should be fully aware that it is more or less an academic exercise with little therapeutic value. Each of the explanatory frameworks they will come up with has to be treated as a temporary auxiliary structure, since the basic assumptions about the universe and about oneself change radically as one moves from one level of consciousness to another. Generally, the more complete the experience, the less analysis and interpretation it requires, since it is self-evident and self-validating. Ideally, talk following the therapeutic session takes the form of sharing the excitement of discovery, rather than a painful struggle to understand what has happened. A tendency to analyze and interpret the experience in Newtonian-Cartesian terms is quite exceptional under these circumstances. It becomes too obvious that such a narrow approach to existence has been shattered and transcended. If philosophical discussion occurs at all, it tends to take the form of considering the implications of the experience for the nature of reality.
In view of the rich spectra of experiences characterizing the different bands of consciousness available in psychedelic therapy or through nondrug experiential techniques, it is useful to conduct systematic self-exploration in the spirit of the “bootstrap philosophy of nature.” Many of the existing theoretical systems can occasionally prove adequate for conceptualizing some of the experiences and organizing one’s thinking about them. However, it is important to realize that they are only models and not accurate descriptions of reality. In addition, they are applicable only to the phenomenology of certain limited sectors of human experience, not to the psyche as a whole. It is, therefore, essential to proceed eclectically and creatively in each individual case, rather than trying to squeeze all clients into the conceptual confines of one’s favorite theory or psychotherapeutic school.
Freud’s psychoanalysis or, occasionally, Adler’s individual psychology seem to be the most convenient frameworks for discussing experiences that focus predominantly on biographical issues. However, both of these systems become utterly useless when the process moves to the perinatal level. For some of the experiences observed in the context of the birth process, the therapist and the client may be able to apply the conceptual framework of Otto Rank. At the same time, the powerful energies manifesting themselves on this level might be described and understood in Reichian terms. However, both Rank’s and Reich’s systems require substantial modifications in order to reflect correctly the perinatal process. Rank conceives of the birth trauma in terms of the difference between the intrauterine state and the existence in the external world and does not take into consideration the specific traumatic impact of the second and third perinatal matrix. Reich correctly describes the energetic aspects of the perinatal process, but in terms of jammed sexual energy instead of birth energy.
For experiences on the transpersonal level, only Jungian psychology, Assagioli’s psychosynthesis, and to some extent Hubbard’s scientology, seem to provide valuable guidelines. Also a knowledge of mythology and of the great religions of the world can prove of invaluable help in the process of in-depth self-exploration, since many clients will experience sequences that make sense only in a particular historically, geographically, and culturally determined symbolic system. On occasion, experiences will be understandable in the framework of such systems as Gnosticism, Kabbalah, alchemy, tantra, or astrology. In any case, the application of these systems should follow the experiences that justify it; none of them should be used a priori as an exclusive context for guiding the process.
Although the dynamics of the intrapsychic process is of fundamental importance, any psychotherapy that would focus exclusively on the individual and treat him or her in isolation would be of limited value. An effective and comprehensive approach must consider the client in a broad interpersonal, cultural, socioeconomic, and political context. It is important to analyze the life situation of the client from a holistic point of view and be aware of the relationship between his or her inner dynamics and the elements of the external world. Obviously, in some instances environmental conditions, cultural or political pressures, and an unhealthful life regime might play an important role in the development of emotional disorders. Such factors should be identified and dealt with if the circumstances allow it. However, in general, self-exploration and personality transformation should be the primary concern as the critical and most easily available aspect of any therapeutic program.