Role of psychotherapy in a post postmodern context

Durwin, thanks for tossing out this topic for discussion…

I’d like to clarify that coaching absolutely is not a form of psychotherapy. The International Coach Federation has set very clear guidelines about this, and the public needs to be clear that the two professions have different functions and purposes (both within the broad field of human development, though). Here are some general guidelines on the basic differences, for anyone who’s interested:

1. Past vs. future: Therapy focuses on the past and generally assumes the client has a problem that needs solving; coaching focuses on the future and assumes the client is whole and capable of having a wonderful life.

2. Fix vs. create: Clients seek a therapist as a source of fixing or eliminating their problem; clients seek a coach to help them get more out of their lives or create new possibilities in their lives.

3.Professional vs. collegial: Therapy clients see the therapist as an expert who holds the answers and techniques to fix their problems; coaching clients see the coach as a partner to support their growth and efforts to create an even better life than they have now.

4. Limited vs. open way of generating new clients. Therapists are limited in the ways they can generate clients and how readily they can approach others about their services; coaches can be free and open about seeking clients and discussing their services.

Also, I’d like to mention that for people seeking a model of psychotherapy that isn’t about regression, check out Internal Family Systems Therapy (http://www.selfleadership.org/ifsmodel.asp). It’s a very powerful, healing approach to therapy that helps clients put their Higher Self in the driver’s seat while also giving other parts healing attention.

hi Durwin,

I’d agree that coaching often represents therapy too narrowly, but there’s still an important difference – there are lots of concerns that would be inappropriate to take to coaching, as well as lots of concerns that I believe would be much better served by coaching – from my experience, it has a lot to do with how much of oneself a client has access to, as well as what kinds of topics the client wants to work on – and the way the practitioner works is quite different, as well – I’m not talking about just anyone who decides to call him/herself a coach, but rather someone who has gone through a professional program – coaching is a specific mindset and way of working that’s quite different from therapy

I agree with you Kira that there are some differences between the ways psychotherapists and coaches approach clients and work with clients but I have to agree with Durwin that the major divisions you've made are too superficial, and in my experience, not that accurate. For instance, I see a therapist (integral therapist) whom uses both past and future reference points in our work. Neither of us see the work as her trying to fix my problems, rather we define the relationship as co-creative. I think therapists actually have an advantage in being able to integrate a lot of coaching styles while also being able to move flexibly into psychodynamic work if needed.

Again, I'm not trying to say there aren't differences but I wanted to point out how the dichotomies you've set up above are very biased toward coaching as “better” than psychotherapy, like coaching is for the functional healthy people and psychotherapy is for people who are broken and need fixing. You might want to be more aware of that bias before making such generalized claims.

Vanessa, I agree with what you’re saying – the differences I posted above are the general “party line” in coaching, not my own distinctions – and they’re meant to apply much more to traditional psychotherapy (i.e., therapy for “mental illness”) than some of the newer forms of therapy (integral included) – the point I was trying to make (and obviously didn’t make clearly!) is that coaching isn’t a subset within therapy – it’s a different model with its own methods, aims, and paradigms – it has evolved out of a number of things, including some forms of therapy, but it’s not a type of therapy, and certified coaches are ethically bound to not allow coaching sessions to turn into therapy sessions

there are some forms of therapy that have a lot in common with coaching (e.g., solution-focused therapy) – and there are a lot of therapists who use somewhat of a “coach approach” (a coaching style) in their work – but the basic coaching model is not therapy – it’s not about exploring past roots and emotional states of current challenges, which are keystones of most therapy approaches

Yeah, I definitely can see that in comparison with traditional psychotherapy, coaching is very different. I suppose what I had taken from Durwin's post was a desire to bridge the gap with more integral approaches to both counselling and coaching. That said, it seems that coaching is a bit restricted in that department as you've pointed out (i.e., coaches are ethically bound not to address certain issues), so perhaps that bridge won't be crossed so easily.

Vanessa, I don’t think it’s so much that coaching is restricted compared with therapy – I think they’re like two circles with an area of overlap in the middle – there are certain questions that coaching is better designed to address and other questions that therapy is better designed to address – and there’s an area of overlap in the middle – I’d love it if we could be in the same room with a chalkboard to flesh this out, but just for starters, let’s imagine a continuum of questions from the therapy end to the coaching end (I’m just tossing this out as brainstorming)

* the far end of the therapy side might be therapeutic issues that the client isn’t aware of, and therefore wouldn’t actively seek therapy for, such as schizophrenia – perhaps character disorders would be in this category, as well

* closer in but still on the therapy side might be things like depression and various “neurotic” disorders – maybe addiction issues, too

* in the middle might be various things related to existential life questions and concerns related to meaning and purpose

* toward the coaching end might be life design, life balance, and wellness topics

* at the far end of the coaching end might be more task-oriented and accountability things like designing specific life changes (career, etc.), as well as work productivity

to some extent, I think it’s a little akin to having a screwdriver and a pair of pliers – they’re designed for two different things but, for example, they could both work like a hammer in certain circumstances – that’s not the best metaphor, but what I’m trying to say is that they’re different tools, to some extent (and within each field, there are many tools) – there’s some overlap but also some life concerns where I believe that one or the other would be much better suited for the task – I also think it depends on lots of other variables, such as the client’s personality, capacity for insight, degree of need for reparative experiences, etc.

Durwin: I like your idea of having both fields in the name, and I think it’d be fun to do some brainstorming (perhaps in a pod?) about differences and overlap

That's a nice summary, thanks Kira. And I think the bad metaphor works(-:

Hello Durwin and Vanessa and Kira,

I came across this discussion and found it interesting and would like to add a couple of observations;

1) Psychotherapy is an umbrella term which covers, in my opinion, any work designed to enable the client to incorporate shadow material from levels 1-5 into awareness so that the bound cathexis/energy, once freed up will a) replace self-limiting verbal or preverbal beliefs about self, others and world with new beliefs more Kosmically congruent and therefore labellable as “healthy”    b) allow this freed cathexis to be taken into the service of the new belief system so that the client begins to live differently in cognition, affect and action.
Psychotherapy may be “Instrumental” in that, as a therapist (which I am) I may use techniques to help “fix” the “broken/dysfunctional client” according to a mutually-agreed contract or “relational” in that the transferential relationship is itself the healing medium. Quality therapy uses both modes in tandem although one or the other is typically stressed.
The lower the level, the more relational; the higher the level (up to the existential) the more instrumental for reasons probably obvious but poddable in a we-space..lots to say here.

Thus when each of you talk about  psychotherapy as one lumpen thang, you take risks of overgeneralisation; using an object-relations relational approach for a client with a borderline (level 2) manifestation  looks unlike and indeed is very different from using an existential approach (level4/5) to enable somebody with a midlife crisis come to terms with the inevitability of her/his death. Much of the latter instrumental kinds of methodology, particularly in the NLP psychotherapy landscapes, overlap considerably with coaching. On the other hand, depth psychology (I prefer a term more like Low Level Psychotherapy) looks nothing like coaching.

So, folks, I have a healthy respect for everything said above this missive but would caution around the possibilities of overgeneralisation. For an integral spectrum of levels therapists target, see John Rowan's “The Transpersonal”


2) Regression. Here's an old chestnut. A brief word for now. Please not to assume that all therapists wantonly dredge up the past to free up cathexis. Some do. I don't personally do this all the time but I may do sometimes..quality therapy requires comedic timing and enquiry at the right time…consider that the Here-and-Now relationship is the black tadpole on the yinyang symbol, the Then-and-There is the white….within each is the other as minitadpole; the H/N contains the T/T which is the transferential relationship, the T/T contains the H/N which we might think of as the life script. Both may be at play in the therapy room, spinning grey yinyang…..this is a far cry from this straight-arrow Cartesian regression concept….

Anyway, could chug on but this envisaged paragraph has turned into something lonnnger. Hope it proves of use. Thanx for yr time in reading this. Jon x

Hi Durwin, thanx for the reply and you are quite right to point out the rigidity of my polemic. I agree with you that the relational/instrumental saturate each fulcrum. What I experience is that the instrumental becomes more hidden as one responds to low-fulcrum transactions in that I apprehend and process my countertransferential material and predicate noninstrumental-like responses to my clients..and this itself is intrapsychically-confined instrumentalism on my part.

Regarding KWs notions of structure-building for borderline-manifesting clients whose Kosmic addresses reveal identification with the pranic/phantasmic/emotional body…wellll…this looks like it could involve heavy amounts of instrumentalism..”Lets look at how you could get yr life in order right now by x,y,z..”..but a closer reading of the seminal works of Masterson and Mansfield suggest that doing this sets the client up for failure when that client acts upon impulse (fulcrum 2 is a rug, fulcrum 3 is the rational furniture sitting on the rug..client goes through the motions of acting upon the delayed-gratification  weight of the furniture..but is not identified with Fulcrum 3..so goes into fuckit uproar and gives the carpet a hefty tug…result; failure and hollow shame…) and this can be very damaging to the course of therapy in that it engenders despair and apathy for periods of time notwithstanding the termination of therapy..

An alternative is to process the clients transference and respond in a precisely-calibrated manner (not easy; decadesworth of learning here I feel) in order to optimise the moment in which the client discovers that all the things s/he hates about me are also the things s/he loves about me..split healed: the client  has automatically transformed to identify with Fulcrum 3 resulting in spontaneous self-structure generation. This is weighed more in favour of the transferential on the surface level..with instrumental going on in my own psyche.

And at the rule/role level…yes!..very instrumental here, lots of groovy exercises to challenge toxic LR cultural messages introjected to UL self-effacement…and all suffused with underlying reparative countertransferrentially-processed relationship.

Soundtrack; Phillip Mansfield; “Split Object/Split Self” and anything, really, by James Masterson, the Godfather of  Success With Borderline Stuff.

Hope this proves of use.

Jon x

I gotta jump back in here – this is all very interesting, although I'm fairly ignorant of the specifics of integral psychology and am not a very abstract, i.e., 50,000-foot-up view, person

Jon, I'd like to go back to something you said in your first post:
Psychotherapy may be “Instrumental” in that, as a therapist (which I am) I may use techniques to help “fix” the “broken/dysfunctional client” according to a mutually-agreed contract or “relational” in that the transferential relationship is itself the healing medium.

this is precisely one of the things that I find to be a great difference between therapy and coaching – I had an experience of this just a few days ago, so it's quite fresh in my mind – my therapist came to the session with an agenda related to her perception that I needed to “get” something – she made her point (in an excessively verbose way) a couple of times – I made it clear that I wasn't interested in exploring it, and she brought it up two more times before the end of the session – now, you could say she's a novice therapist (she isn't) or was “off” that day, or you could say she reeeeally thought I needed what she was trying to offer – but no matter what was going on with her, there's something I believe is built into the therapist-client dynamic that assumes the therapist knows more and is some kind of expert – i.e., the therapist has the map, and the client's job is to follow his/her lead

the day after that session, I had a “session” with a fellow Internal Family Systems student – he was in the therapist role, but he isn't a therapist, and we've agreed to have our sessions be entirely experimental – he didn't take the expert role at all, but instead was simply exquisitely present to wherever my process wanted to go – he asked questions designed to open things up and then respectfully and compassionately witnessed whatever came up, much like what I do as a coach

I found the second experience MUCH more “therapeutic” than the first one – I had some big “ahas” from it, felt sublimely seen and heard, and found it to be incredibly healing – this isn't to say that some people gain great benefit from working with a therapist, who may hold one or more maps, but that I see these as two different approaches to working with people (with some overlap, of course) – I'd be interested in your/everyone's thoughts about these approaches to working with people

Thanks for sharing your experience here Kira. I too, in the past,  have had experiences with therapists who come to sessions with preconcieved ideas about where they are going to take me, and I too have found it unhelpful.

I think essentially though, maps and relational presence don't have to be mutually exclusive. Maps can be extremely helpful, especially an integral map. But the trouble comes when the maps act as a screen between therapist and client rather than a background reference point that can be touched base with if necessary.

The way I describe this is when a therapist doesn't really want to “touch” the client. That is, they in some way keep them at an arms distance, hiding behind their maps and intellect and perscribing cures without actually touching the client's suffering in a totally present and compassionate way. I would argue that this “touching” requires the therapist to enter into more mystery, more unknown space, even if only for a moment, and that is why it is really difficult for therapists who feel they are supposed to have the answers for their clients. Most of the time, I would argue as clients, we just want to have someone touch our suffering without recoil, without explanation. That to me is the gift that a therapist can really offer. It allows us to feel seen, and to feel that we are part of the process rather than the screwed up client that needs fixing.

I think it takes a much more advanced and practiced therapist to engage both presence and prescription in a flexible and co-creational way. My therapist describes it as the art and science of psychotherapy, when the map meets the mystery.

Durwin— this is interesting. I’m mostly on board with what Jon is saying. Also, not all psychotherapies are on board with the “fix the dysfunction through expert advice” mentality. My field of art therapy (& expressive therapies) looks upon the therapeutic alliance as one being more of guide/teacher, not fixer. We help create a space (not unlike that created through mindfulness and/or creativity) for unconscious/latent material to emerge We help guide the client through finding their own meaning and reintegrating this imaged autonomous “Other” back into self, thereby moving closer towards Self with the resolution of unconscious/suppressed/implicit values, beliefs, memories, issues, trauma, etc. This is completely in keeping with the post-post modern supposion of not one true point of view or truth, and the malleability/slippery slope of meaning and meaning creation. Take a look at work by Michael Frankin, Peter Levine, Joyce MacDougal, and I’ve got a few others that address this post-post-modern concern (just can’t locate the articles right now). The client is not seen as screwed up and needing fixing…rather, is stuck somewhere and in need of guidance and assistance in sorting it out. In a quick review of the use of art in mental asylums and institutions, it is clear that there is a creative part of the self that strives and moves towards resolution, health, and growth (its just the mechanisms and other such reasons that are not well understood yet – like trying to understand why mindfulness does what it does).

In the art therapy room, we see regression also (not necessarily repression) because so much is pre-verbal or non-verbal or somatic initially, just not accessed. Old material is brought out into the open (and present-moment awareness) and then processed in a guided, client-generate meaning approach. Through the art, and with our training, we are able to be present with the client, and with awareness in their symbolic, metaphoric world for that hour. Its remarkable – and the reason we are trained the way we are. Like Kira said, we follow the client’s lead, are guided by their inner movement, and trust that the process will go where it needs to. Sometimes we do throw in an intervention to jumpstart or help the process, but this is also done with attention to what is in need of being addressed. We are trained to be present, aware, empathic, and non-judgmental to the client and the process. (Kira– glad to hear your experience was filled with Ah ha’s!)

Anyway, Durwin, the meaning of the imagery can change over time as well – sometimes, over time, the picture has to be returned to and added to. Consider this movement of the psyche finding new resolves, complexity, and details. Holding on of psychic material, letting go, movement, and so on, are done visually. Also, art therapists have to be highly aware of counter-transference due to the loaded nature of images, colours, etc. Again, post-modern issues being addressed. (the process is more complex thn I am describing here, but hopefully it is enough to give you a bit of the picture).

To address your initial question about the role of therapy in today’s world– I think this also depends on redefining the Self – what does Self mean now in a post-modern world and how do we ammend our mental health treatments to address this understanding of the human condition. (this is exactly what my thesis is addressing – the one that I am just completing now). cognitive therapy is undergoing a possible 3rd generation with its infusion of mindfulness and other somatic modalities (yoga for example); art therapy is coming into its next evolution through re-embracing the transpersonal and spiritual (going back to its shamanic roots in a post-modern way), and 2,500 year old Buddhist ideas are being re-incarnated, so to speak, in a western body (context).

Joanna, I’m so glad you mentioned the importance of art therapists being highly aware of countertransference – I’ve studied art therapy, co-facilitated art therapy groups, and practiced it for my own growth for many years – I’ve heard art therapists say over and over how important it is to not impose meaning on clients’ images, and I’ve witnessed them doing just that over and over again (e.g., “that image looks so desolate and empty” when to me it represented stillness and spaciousness) – as with all therapies, I think extreme mindfulness and self-awareness are called for on the part of the practitioner, and I think there’s always more to learn about how we impose our own (often, but not always, unconscious) agendas on clients

Vanessa, I very much appreciate what you said about some therapists not wanting to “touch” the client (i.e., the client’s raw experience) – I think the impulse many therapists have to want to “fix problems” instead of sitting with and witnessing challenging moments (or life issues) comes from an unconscious resistance to really experiencing another person’s life, and/or from a need to distance from discomfort – when I’ve been able to “just” sit with things as they are and be present to them (whether as coach, therapist, or client), amazing wisdom and healing energies have emerged

Hello everybody.

I have just read the above with interest and a sense of personal congruence on most ideas and values expressed.

Picking up on this thread of “fixing” the client as if s/he were a car whose bonnet you flip up and fiddle with as a karmachanical expert..yep, to my mind, we often encounter the resistance of the therapist …to a truely open relational field shorn of those natty  conceptual clipboards one could hide behind (as well as unconsciously wop the client over the head with if they do not play your game)...  I believe therapists need oodles of therapy…lots of it…20 years at least…this is not just a job!!!!….An AQAL perspective to my mind pegs the therapeutic encounter as a bodhisattvic act in which the personal sandbags of the therapist need to be retranslated from the shadow realm into awareness in order that the therapist maximises his/her potential to set aside personal issues (proactive countertransference) in order that the self/Self be used creatively in anothers healing…and this is what being a bodhisattva entails in and out of the therapy room. Not seeing this at existential/centauric level and I think being a therapist may a job which may not need further personal development beyond doing a bit of reading.

 Purely cognitive therapies tend to have a large relapse rate (eg in the UK in 1996, a 78% relapse rate for recovering alcaholics using CBT) due to the eruption of lower-fulcrum energy/cathexis which CBT is not,  by its very nature,geared up to deal with. If we are gonna do the therapy thing right, we need to take pipecleaners to our engram-blocked tubes and scrub those blockages away. Otherwise we will set the agenda and hide behind our clipboards.
 
A good example of a clipboardless therapist is David Brazier, also a long-standing deeply-wisdomed Buddhist. See ” Zen Therapy.”

There is the argument that we can see stuff the client cannot and must bring it to the clients awareness. I agree with this point but we cannot do it by forcing the unknowable object (Cf Bollas “The Unthought Known”, that lower-fulcrum prerational preverbal phantasy-essence) into awareness, that transformation up/downlevel cannot be done. No; what we think we know about a client is an energy which may derive from our own stuff (proactive countertransference) as well as the clients (reactive countertransference plus what the client is actually narrating). Our task is to sift out what is what in quality supervision, take our proactive stuff to therapy, process our reactive c/t with the client, from which dialogue-or silence-or whatever comes the client's understanding….so Kira, I understand well what you say when you talk to a peer, feel heard and understood and exhale  whatever has been held in…aaahaaa…its cognitive insight and also a release of whatever emotion has been held in n the fear that we are not gonna be taken seriously (i.e. to be taken as fully human). Those pesky clipboards more often than not are ratifications of agendas of supremacy that recreate the original family situation.  Good reading here; Richard Erskine; “Beyond Empathy”.

As a final word…maybe it would be interesting to explore the LL culture of the therapist and of the client…what happens when they differ, when they are the same, when they prevent, on either side of the relationship, the necessary healing…

Blessings to all, Jon xx

thanks for your thoughts, Jon – just a quick comment about your last paragraph – I think it’d be fascinating to explore the LL culture of therapist and client to discover when they might be blocking healing – I certainly have worked to do this type of detective work in intimate relationships and have found it illuminating – but when I’m paying a therapist, I don’t want my session time to be spent working on their stuff – I have no doubt that therapy sessions bring up therapist stuff to work on, but with the relationship being a paying one, I don’t believe it’s the client’s job to work on helping the therapist get clear – I’ve brought up concerns to therapists about their biases in the past – some have gotten it right away and self-corrected – but when they don’t, it’s generally a signal to me that I need to find a different therapist

Agreed Kira..and some of those personal issues get shored up by the culture sans doubt.  And I have sometimes found it useful to tell a client what I am feeling or to gently suggest an agenda in specific circumstances but this would rarely, if ever happen unless I had a strongly bonded relationship with the client….in which I felt sure the inner child of the client was informed intrapsychically by the grown-up that I was not attempting a hijack…but these cases are rare….

Sounds like you've had some pretty challenging experiences in the space and I support you in speaking out.  J. x.

Ah, Vanessa, I adore your comments about your own experience of psychotherapy.  Three things you said are the foundations of what I've looked/longed for in therapy:
- The co-creative framing of therapy as a exploratory journey done in concert,
- With a therapist skilled in being able to engage in presence and prescription, guiding the travels to our suffering “without recoil, without explanation”,
- So that I feel seen enough to be safe in allowing our shared map to meet my/our/the mystery.

Thanks for all of that.  I found it really helpful to see you candidly speaking from the same place as me.