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Wisdom In Psychotherapy - Page 3

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Intelligence. As Socrates put it, “The narrow intelligence flashing from the keen eye of the clever rogue” isn’t wisdom. Yet, being able to think clearly and logically (fluid intelligence) and having access to the knowledge needed to address the needs of the moment (crystallized intelligence) are necessary for wise action. As therapists, this means knowing something about psychopathology, lifespan development, diagnostic assessment, therapeutic methods, and cultural differences. It also means being able to hold multiple theoretical viewpoints lightly.

To get our advanced degrees, we need to master a wealth of information about human psychology. While often important, many times it’s not the knowledge itself, but our ability to not be too attached to a particular theoretical viewpoint that’s the real resource. Too easily, we can become like the Greek god Procrustes, who lived in a fortress near a major thoroughfare and would regularly invite passing travelers to spend the night on his grand iron bed. If the traveler was too long for the bed, no problem—he’d cut off his feet. If the traveler was too short, he’d stretch him out to fit. This is what our minds do when we’re too attached to a hypothesis about a client’s distress. We ignore information that doesn’t fit and elaborate on any information that supports our idea. As developmental psychologist Jean Piaget put it back in 1952, we readily assimilate information into our existing schemas, but find it difficult to accommodate our models to new data. And this makes us not so wise as therapists.

I once supervised a psychology intern who was treating a young adolescent with social anxiety. The teenager avoided parties and didn’t want to attend classes that required participation. The treatment team recognized this as a classic case of social phobia. They instructed my supervisee to construct a program of incremental exposure—a well-established, empirically validated approach. The intern dutifully followed the protocol, but the girl continued to resist, and the intern didn’t feel comfortable pushing her. The team suggested that the intern was colluding with the girl’s fear, reinforcing experiential avoidance, and worsening her condition. This went on for weeks. Eventually, the intern abandoned the social anxiety treatment for a few sessions and just talked with her client. The girl broke down crying, revealing that she’d felt misunderstood by her mother, and now by her therapist. The intern listened empathically, and the girl started doing better socially. Sometimes we need to admit when our model isn’t working and be open to shifting gears.

Not knowing is all the more difficult given current pressures to be goal focused and effective. It doesn’t fit easily with following empirically supported protocols. I’ve never tried it, but I imagine that managed care companies wouldn’t approve too many more sessions if I wrote on their form, “Still don’t know—trying to stay open minded” as my diagnosis and treatment plan.

Transcending Conventional Concepts. This is the aspect of wisdom most emphasized in Eastern contemplative traditions. In Buddhist psychology, it involves gaining direct understanding of the three marks of existence: impermanence (anicca), unsatisfactoriness (dhukka), and no-self (anatta)—and is an explicit aim of mindfulness practice.

Impermanence (anicca). This is simply the awareness that everything changes or, more accurately (since “things” are culturally conditioned constructs), that all phenomena are in constant flux. This is how any physicist or biologist would describe the universe—atoms and energy in constant movement—but it’s not how we usually see the world.

How might psychotherapy be different if we actually understood this? For starters, we wouldn’t be so surprised by illness, aging, and death, not to mention divorce, job loss, and car accidents. I’m amazed by how often I resist change as a therapist. I don’t want my client to feel worse, to be disappointed, or to leave treatment. I don’t want to be reminded that I and everyone I love will die, perhaps unexpectedly and too young. Everything changes and the wheel of fortune is always turning: what goes up really does go down. Remembering this during a session can be eye opening. It can help us see the big picture and not be so driven by our fears or wishes of the moment, which is an asset in whatever kind of treatment we’re doing.

Unsatisfactoriness (dhukka). This is a reality of the human mind. It’s what has been poorly translated as “life is suffering,” giving Buddhism the reputation of being a gloomy spiritual philosophy. A more accurate translation might be that life is difficult for everyone, and we repeatedly experience dissatisfaction. My favorite articulation of this principle comes from the great Western philosopher–sage Rosanne Rosannadanna, who pointed out, “If it ain’t one thing, it’s another.”

The realization that our minds are like Goldilocks—always complaining that things are too cold, too hot, too big, or too small—can be liberating. It can help us appreciate that it isn’t our external circumstances that determine our happiness or misery, but our reactions to those circumstances. This operates even during good times. Being reasonably intelligent, in the midst of eating our ice-cream cone or making love, we realize that the experience won’t last, and we start angling for ways to hold on to it.

Sonja Lyubomirsky, a Positive Psychology researcher at the University of California, Riverside, has concluded that our sense of happiness or well-being is 50 percent genetic: we’re born with a certain predisposition toward happiness or unhappiness. Another 40 percent of the variance has to do with our attitude toward experience—basically whether we’re able to be in the moment, appreciate what is, and not compulsively fight to try to make things other than as they are. Remarkably, only 10 percent of the variance accounting for our happiness has to do with whether we experience good or bad fortune—whether we’re lucky or unlucky in work, love, health, or wealth. This is really shocking, given how much time and energy we devote to trying to assure good outcomes and avoid disappointments.

How might insight into unsatisfactoriness change our daily experience as therapists? Personally, when I’m conscious of my mind’s capacity to make itself miserable no matter what my circumstance, I lighten up on needing sessions to go a certain way. Vacations are wonderful teachers in this regard. When I observe my mind worrying that it might rain when I’m in the Caribbean or that there might not be enough snow for good skiing when I’m in Vermont, I appreciate the hopelessness of finding happiness by getting my ducks in a row. Being aware of the mind’s tendency to be dissatisfied helps me let go of concerns about success and failure. It changes how I view my clients’ difficulties. I’m less likely to worry about their problem du jour and more apt to look for larger patterns of mind and behavior—such as clinging to pleasure and resisting pain—that have caused them suffering in the past, and are likely to do so again.

Understanding dhukka likely will have different implications for different sorts of treatment. If I’m aiming at increasing awareness, helping my client see the futility of finding happiness through getting a promotion, winning the lottery, wooing a romantic partner, or acquiring high-status friends, it would fit well with treatment. I might relay Joseph Campbell’s famous observation that many of us climb the ladder of success only to discover that it’s leaning against the wrong wall. I could then help my client look for pathways to happiness that aren’t subject to the hedonic treadmill—sources of fulfillment where we don’t need more and more just to regain our previous state of well-being. Learning to savor, engage more fully in intrinsically rewarding “flow” experiences, express gratitude, connect with loved ones, and find meaning in service to others (whether directly or through, art, discovery, or other avenues) might become goals of treatment. However, if I’m trying to help a client accomplish more concrete aims, such as quitting smoking or becoming more assertive, focusing on the fundamental futility of accomplishing goals could take the wind out of our sails. In that case, it might be better to keep these sorts of reflections to myself.

No-Self (anatta). This is the most challenging aspect of Eastern wisdom for most of us in the West to grasp, but is arguably the key insight in Buddhist psychology. It doesn’t mean that our bodies don’t exist or that we don’t have a name, zip code, or social security number. It refers instead to the fact that we’re interdependent organisms, constantly exchanging molecules with the rest of the world—part of the web of life. Our thoughts of being a separate “I” are misunderstandings, born of living in a narrative stream starring “me” (actually, mine stars “me”; yours stars “you”). If we observe our experience carefully, try as we might, we never find the little homunculus inside, the little man or woman who is “me,” but just discover an endless stream of sensations, thoughts, and images. We realize that the mind and brain are, as neuroscientist Wolf Singer puts it, like “an orchestra without a conductor.”

What are the implications of this insight for psychotherapy? For one thing, glimpsing it helps us lighten up on self-evaluation. Our work is so complex, and so subjective, that our sense of competence fluctuates wildly. As a psychologist friend once said, “I find I’m only as good as my last session.” Obviously, concerns about our competence can be significant impediments to treatment.

My worries about competence can make me need to be seen as kind, intelligent, caring, or compassionate. They can make me cover my tracks, not admitting that I forgot what my client told me last week, that I confused the names of medications, or that I don’t know as much about a particular disorder as I feel I should. Glimpsing no-self can help us better follow Rudyard Kipling's suggestion that hangs over the entrance from the locker room to the courts at Wimbledon: Meet with Triumph and Disaster, and treat those two impostors just the same. Whether in tennis or therapy, attachment to success can contribute to failure.

Appreciating no-self can help us be more present in the consulting room, as it helps us take what arises in our hearts and minds less personally. If a client does something that makes me angry and I’m stuck in my usual narrative starring “me,” I’m likely to think, “I can’t believe he did that after all I’ve done for him.” If, by contrast, I have a glimpse into no-self, I’m likelier to notice tight muscles, an increased heart rate, and retaliatory images arising and passing, without getting so stuck in a narrative about injustice. When we can experience emotions as cognitive scientists describe them—instances of simultaneous bodily sensations, verbal narratives, and images—we can bear them at greater intensity with less reactivity.

This is helpful when hearing about our clients’ fear, pain, anger, or other difficult emotions. Since clients can really be with and explore only those emotions that we can tolerate, our capacity to bear their distress is critical. Zen traditions describe this aspect of wisdom metaphorically. If I were to dissolve a tablespoon of salt in a glass of water and try to drink it, I’d have difficulty—the water would be too salty. But if I dissolved that same tablespoon of salt in a clear, clean pond, I’d have no trouble taking a sip. Appreciating no-self helps us develop a mind like that pond.

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  • Comment Link Wednesday, 27 March 2013 12:44 posted by Eugene Usner

    Wonderful explanation on Wisdom and Psychotherapy---Can We Afford It? My response, we cannot not afford it. I have been a therapist for 40 years with the opportunity to attend workshops and training with the above mentioned masters. When I supervise social work interns, they have barely heard of these masters. The importance of the therapeutic relationship has been minimized in lieu of "evidenced based therapies". As the old saying goes "just follow the money". As another saying goes" you get only what you paid for". Thanks for a most enlightening and well written article about the value of wisdom and psychotherapyt. I do hope someday society and our culture will value psychotherapy without stigma. Valueing both the wisdom of the therapist and evidence based research should be the goal.