My Philosophy and Principles Underlying an Integrative Approach to Psychotherapy.

As an act of integration itself this essay will weave together both my literal and figurative philosophical ethos for practicing psychotherapy. I will discuss how the practices of Wonder, I-Thou dialogue and Phroenesis inform my relational approach to working with clients and continuous development. A case example* from my clinical practice will hopefully demonstrate these tenets. Finally, I will conclude with how a fictive case example developed my sense of sympathy and deepened my understanding of creativity’s role in psychotherapy.

*details of the client have been change for confidentiality.

Chapter Contents

• Interating Self
• Thy Knowing Self and Thy Unknowing Self
• Use of Self and Overcoming Assumptions
• I-Thou
• Phronesis as Therapeutic Know-How
• Creative Defenses
• Therapist Creativity
• Conclusion
• References

Integrating Self

My earliest memory of ‘hearing’ a thought in English for the first time occurred during a feud among my family. The thought was “Okay John, you know what to do”. I began to cry and my whole family stopped fighting. I was too young to comprehend my age. Ironically, I was unable to verbalise my distress, despite how articulately the thought manifested. Yet I seemed old enough to trust the cry’s effectiveness implicitly. It’s a total guess as to how this trust and knowing became introjected, whatever transitional relating set this dynamic in motion remains inversely unknown. I can only wonder how many dramas like this had previously re-played. Such is the aporia of the unconscious and the fallibility of memories. However, as a “fun” exercise let us see how this phenomenon might be differentially understood;

What can be inferred above is a demonstration of a role, having become continuously re-acquainted with this role as I’ve aged, we may interpret through various reflective lenses the function of these re-emergence on such emotions in adulthood. Such emotions may connote an adapted Child Ego state. Similarly, with Karpman’s drama triangle, the crying communication might be interpreted as an enactment of the Rescuer role; one who interferes from a willingness to help. Alternatively, this infant organisation might also be understood as an outgrowth of a Winnicottian caretaker/false-self character structure. Each tradition has something worthwhile to offer, which evoke some idea of an emotionally learned schema, albeit the complexity of personhood may not be so simply rendered.

I propose a function of a therapist is not to diagnose a role enacted but to observe the circumstances which shift a self-state’s position, and so too to track our own shifts in observation. With increases in the fundamental picture of the other person, ultimately there is an increase for potential connection. Additional theoretical lenses add their distinct tincture to my sense-making. Rather than adhere to a singular theory for definitive correctness, I advocate for integrations to be held tentatively inasmuch as multiple frameworks may increase our adaptive sense of self-coherence for the time they serve us. Merleau-Ponty (2002) argues there is no singular thought which can encompass all thought. We may transpose this logic and argue there is no singularly consistent understanding of ‘self,’ as self through the integrative framework is not aspectually singular, nor is its developmental organization conceived as being instantiated singularly (Lapworth & Sills, 2010. p.44).

Thy Knowing Self and Thy Unknowing Self

As a person attempting to cultivate wisdom through an ecology of self-transformative practices, psychotherapy and philosophy have been two in which to respectively strengthen the overcoming self (Shmelev, 2015) and to overcome one’s foolishness (Vervaeke & Ferraro, 2013).

I view integration as a bridging practice of this ecology. The integrative therapeutic approach has been compared to Anthropology regarding the responses of astonishment, curiosity and sympathy which the study of human difference and ‘otherness’ may evoke. These reactions range from ‘horror and repudiation’ to ‘excitement and world-revising inculcation’ (Books & Feyerabend, 1987; Shweder, 1991). In Theaetetus, Plato distills these polarities of horror and excitement through the word ‘wonder’ as Socrates posits ‘philosophy begins in wonder’ (Llewelyn, 2001; Burton, 2014). As such, wonder may potentiate one becoming wiser. A certain Child Ego state may have asserted their ability to know, yet as a trainee therapist more often than not I am confronted by circumstances of not-knowing. The Socratic paradox being that wisdom, therefore sense-making, is found through the reflective insight and perspectival knowing that one knows nothing. Critical examination of self and world is essential in the change process (Grant, 2019)

Therefore, the challenge of self-development is accented by the need for changing one’s own behaviour. Yet transformation requires significant alteration of apprehending oneself and the external situation. Achievement relies on addressing one’s self-deceptive patterns (e.g. assumption, foolishness, enacted roles) that prevent change from occurring (Vervaeke & Ferraro, 2013).

What follows is an example of how I practice weaving philosophical tenets into both developing oneself, tackling assumptions and the practice of therapy in relating to the client.

Use of Self and Overcoming Assumptions

The problem that initially occupied me with ‘Use of Self’ is the existentialist idea of the unbridgeable gap of self-experiences that are distinct and fundamentally isolated from one another. One of my clients sought therapy upon learning he may have autistic spectrum disorder (ASD) and is currently awaiting diagnosis. In this waiting, ASD has become a framework of re-evaluating his life and making sense of past experiences and his current identity, knowing now he may not be neurotypical. For my client it seems ASD is an egosyntonic lens that offers explanation for why he becomes quickly anxious and has often felt misunderstood throughout his life. On the basis that such future-diagnosis may be true, I erroneously and regretfully assumed an even greater alienation may beset us as I am ‘neurotypical.’ Though with enough bracketing, it was possible to not allow that prejudice to full ascent.

Cooper (2016.-pp.43–47) states despite humans having comparable biological embodiments, our unique ‘selves’ transcend this shared constitution. Here, the paradox of understanding another is particularly pronounced as Yalom (2020) further states that our unique individuality is fundamentally alone. Thus, between two unique, disparate ipseities, there remains an “unbridgeable gap” which emphasizes this aloneness and alienation. As he spoke of his early childhood experiences (e.g. the fear of his sister’s emotional explosiveness, isolation as a resource for emotional regulation, noticing himself excel at school, feeling different yet changing his outward behaviour for want of fitting it), similar experiences in my own adolescence allowed for sympathising with him.

Spinoza’s ‘scientia intuitiva’ with the client is what would resolve my mistaken sense of alienation. As Saunders (2016) defines it, with scientia intuitiva we see through our extended world and grasp intuitively the essence of substance itself. My interpretation is that despite unbridgeable gaps (Yalom, 2020), we can intuitively recognise a human’s experience, thus we may connect.

During our first session together, my client carefully outlined his justifications for over-explaining himself to his mother “for fear of being misunderstood.” I recognised my own history of being misunderstood and this here-and-now sense of being explained-to. Yet it was the latter impression which guided my intervention; “I feel like I am having all this explained precisely, I’m curious if you fear that I too will misunderstand you?” Following an uncommon pause in his speech, deeper disclosures unfolded, which may not have happened had I not used my own experience of the here-and-now to introduce a dialogue into his monologue.

This occurrence may also be viewed through the ‘triangle of insight’, whereby a present relationship (within the therapy room) was linked to a past-relationship (back then) (Lapworth & Sills, 2010. p.44). Although the reparative power of such an encounter is unknown at this early stage of the relationship. Alternatively, countertransference may manifest itself as Rescuing (Baldwin, 2013. p.21) thus I am to be circumspect in distinguishing my process of being misunderstood from his, hence the intervention being based on the self that experienced the explanation.

I-Thou

This example recalls to me Buber’s I-Thou experience: a relationship of acceptance practiced in a participative experiencing. By holding therapeutic space, we introduce an opportunity of bearing something experienced as unbearable (Biricheva, 2019). My client’s aforementioned “fear” and “being misunderstood” seemed to arrest his thought toward either immediate resolution or escape from that unbearableness. I tentatively speculate that trying to expedite the understanding process, was to place conditions of worth upon himself.

Fear was made tangible through his experience of being misunderstood. Despite his solitary experience, there are various situations in which acceptance may be afforded. To identify with the client entails using the machinery of the self for a participatory knowing to gauge their perspective However, empathy risks a contagion, if we get too excited, we may lose connection to the client (Vervaeke, 2020). I view therapy not as a symmetrically empathic relationship as I do not share my ‘story.’ It is for me to set the condition of empathy and knowing what experience of self to share, so the client would not have to experience these difficult feelings alone. Through dialogue of face-to-face encounter, we find one’s ‘self’ in the other and being an ‘other’ with others.

Thus, dialogue has a characteristic of mutual discovery, to engage without domination or argument, but to discover the self in the process of discovering you the other (Scott, 2011). Dialogue is critical for providing a means of recognizing and transcending our own preconceptions. Growth-orientated discussion via ‘dialogos’ address differences by bringing you into inter-ontological communication, which affords one becoming reflectively aware of their participation in a co-emergent relationship (Vervaeke, 2020).

Image courtesy of DKDK Zone

Phronesis as Therapeutic Know-How

The question remains, how does one know what intervention would be useful? Phronesis is an Aristotelian ethical and intellectual virtue of ‘practice wisdom’ which emphasizes the ability to deliberate well and make appropriate judgements, with the desired goal of society’s well-being. Such practical and procedural wisdom emerges via learning, experience, reflection, critical dialogue, and testing hypotheses (Massingham, 2019).

Erskine (1991) too uses ‘hypothesis’ aptly as it highlights that in trying to understand another person as we may work off a supposition that maintains a free-floating teleology of defenses and organising patterns. This subverts explanations becoming fixated as our own understanding may be updated the more a client continuously reports their subjective and phenomenological experiences.

My intended cultivation of phronesis underlies the enhancement of fluency and efficacy of interaction in the here-and now with the client. As such, The technical eclecticism for attunement to clients’ changing process requires a pragmatic mind for observing how clinically efficacious or relevant interventions can be applied or combined (Safran & Messer, 2015).

Boswell et al. (2010) state that competent integration results from implicit and explicit understanding of change processes within and across theoretical orientations. A diverse clinical repertoire facilitates practical knowledge of what to do and what not to do. Therapeutic alliance through differing phases of treatment may strengthen when one can acknowledge certain limitations to interventions of one theoretical approach. Thus, attunement to a client’s characteristics can indicate (or contraindicate) when a divergent approach is more likely to be effective. The phronesis of the ‘healer’ is to have a rationality of appropriate caring (Vervaeke & Ferraro, 2013). To know what to care about, as a fundamental affective commitment, entails being open-ended and not ending the reception with inferential conclusion about the client.

Creative Defenses

As part of our course work we read the case of Belle from Susie Orbach’s ‘The Impossibility of Sex’. An inferential conclusion I faced from the case study of Belle was my own disdain towards her habitual behaviour of lying and conning. However, Orbach’s exemplification of Belle’s lie as a ‘creative fiction’ recalled in me how defenses are conceptualized through Gestalt theory as ‘creative forces’ an infant utilizes for managing their dysregulation during difficult interpersonal processes (Polster & Polster, 1974). Through this lens, defenses are viewed neither as inherently positive nor negative, rather as spontaneous adjustments for infants achieving their best outcome possible (Mann, 2010).

Orbach (2018) interprets Belle’s cons, deceit, dependencies and abandonments as her known way of coping, which are stated as unintentional yet expedient. Therefore, they are convenient ways of attaining an end she needs for managing feelings of emptiness, uncertainty and wanting to get away from herself. Erksine (1993) might describe them as Belle’s perceived need for self-protection. Coupled with a respect for defenses and contact orientation, I endeavor to weave these aspects for informing a compassionate attitude in relation to my clients, despite how repugnant I may personally find such behaviours of lying or conning.

I might ask of myself, how could my own ‘crying’ have protected me as lying did for Belle, or as over-explaining does for my client?

Orbach’s case of Belle exemplifies for me how within coping strategies there is an overlap of the presenting issue and resource that maybe were “functional up to a point” (Orbach 2018. p.) by maintaining their mental and physical stability during traumatic experiences (Erskine, 1993). Additionally, the case’s emphasis on repeating relationship patterns might lend itself to an Object Relations framework. Although fictional, there seemed to be a repetition of mastering a loss; Belle’s disengagement from dependency afforded a success of not needing someone who unconsciously is expected to hurt her, as her mother had. Finally, the repeat of the significant loss in the therapy itself seemed instrumental of the ending of therapy.

Therapist Creativity

As I have previously written, Gestalt theory deems Creativity and spontaneous adaptivity as crucial therapeutic factors (Yontef, 2006). Joseph Zinker states that creativity also applies to the practitioner, which involves their natural curiosity, spontaneous adaptivity of interpersonal processes, and willingness to experiment (Amendt-Lyon, 2003; Lobb, 2003a)

As a psychotherapist and musician, Frederickson (2013) compares the development of relational skills in psychotherapy to the deliberately practice required for music; both are a craft continuously developed. Through practice a therapist increases a ‘relational fluency’, freeing them to participate in art of therapy (Vaz, 2017). With knowledge, therapeutic relational interventions can be internalized and therefore improvised. Theoretical knowledge, while a prerequisite for wisdom is not a form of wisdom in itself (Vervaeke & Ferraro, 2013).

Artistry is possible when a craftsmen combines intuition with technical command for sensing the client’s intent, underlying patterns must be implicitly known to the therapist in order to attune to the client. Therapeutic relationship is co-created from this improvisational state where therapist spontaneously responds to a client’s habitual relating pattern for introducing an authentic new way of being and caring (Lobb, 2003b; Vervaeke & Ferraro, 2013). As for the aporia between a self that is knowing and not-knowing, for now I can judge whether integration is occurring if the patterns in practice are beginning to emerge naturally.

Conclusion

As a current snapshot of my trainee therapeutic practice, this essay illustrated how my literal philosophical practices for self-development inform my figurative philosophical outlook in working with clients. An attempt of framing of the Integrative approach as an autological expression of such inclusive ‘telos’ was made in interpreting myself and thereby extend that generative framework to clients in preservation of their complex personhood. A personal appeal for the integrative approach is its systemic assimilation of principles related to change and theoretical models of human functioning.

Philosophical practices such as Socratic wonder, Epoché, Scientia Intuitiva, I-Thou Dialogue and Phronesis where included to demonstrate how I have endeavoured to cultivate a wiser means in developing my therapeutic fluency and efficacy of interaction in the here-and now with my client and challenege misinformed assumptions, in ways that are congruent to my personal self-development.

Susie Orbach’s case study of Belle’s was significant for orientating myself as a therapist as it allowed confronting and re-integrating a personal bugbear with the behavior of lying. Secondly, it models how technical eclecticism may be applied or at least forecasted depending on the interpretive lens. In addition to its fictive construction, I’m reminded of the benefit of vicarious learning and drawing upon alternative sources for inspiring therapeutic outlook.

Finally, creativity was explored as a multiform expression for both client and psychotherapist. It is hoped that the various applications of ‘creativity’ evoke the necessity for on-going learning and development as an artful practitioner. My personal lesson hereon is; to improve oneself as a therapist is to improve competency for being in relationship with the other.

References

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