“Which You Are You?” by Pat Williams

I’m not a “one size fits all” psychologist—quite the opposite—but one of my favorite one-stop teachings about human nature and therapy is “Which You Are You?” by Pat Williams.  Originally released as a spoken CD by Human Givens Publishing, in the United Kingdom, “Which You Are You” is now available as an mp3 from the Human Givens website, https://www.humangivens.com/category/cds-mp3s/mp3s.

Journalist, playwright, author, storyteller, and therapist, Williams speaks, in “Which You Are You?,”  both as a therapist to other therapists, and as a deeply thoughtful person sharing an important understanding of human nature (see her interview at http://www.brightontherapypartnership.org.uk/pat-williams-interview/, and her memoir http://portobellobooks.com/king-kong-our-knot-of-time-and-music).

Williams begins “Which You Are You?” with a kind of “human given:”  “Every one of us, and we see it the minute we think about it, has many ‘minds’ rather than just one…These divisions in our psyches are a matter of daily personal experience.  We are unmistakably made up of many self-contained personalities, some of which are helpful allies, some delinquent or even at war with each other, and some of which we are utterly unaware.”  Although “we think of ourselves as whole,” our real condition is a continuous transition of “what psychologists call sub-personalities.”

The basic idea is not new.  “Unsurprisingly, the knowledge of sub-personalities is in fact centuries old, found in many traditional religious and esoteric practices, and presented in various forms,” including the differing characters of the Hindu gods, and the beliefs of ancient Greeks, “who saw humans as intrinsic to the dramas of the many gods above.”  In medieval times, “people believed that they could become possessed by a whole bestiary of demons, devils and imps…capable of causing disabling mental states…We find it too in the Gospel according to Mark, when Jesus meets a man possessed by demons.  When asked for his name, he replies, ‘My name is Legion, for we are many.’”

Coming up to the present, “When we come to relatively modern times, and look at Western psychology, we find Freud describing personality as a continuing struggle of elements within a divided mind, and Jung talking, even before Freud, about divisions in the psyche.  We see the ideas surface in Maslow’s work, and in (Roberto) Assagioli’s, where the work is to unify the sub-personalities.  It’s there in the work of Gurdjieff, and in quite a bit of the psychological literature in recent decades.”

Multiplicity of personality reflects the structure and function of the brain.  Williams introduces “Multimind,” the 1986 book by psychologist Robert Ornstein, saying  “I think he may be the first in modern times to make the connection that our multiple selves, some of which are valuable allies, and others of which can give us a great deal of trouble, are actually a reflection of how we are made.  Given the machinery of the brain, it could hardly be otherwise.”  https://www.amazon.com/gp/product/1883536294/ref=ox_sc_sfl_image_1?ie=UTF8&psc=1&smid=ATVPDKIKX0DER

This dovetails with my own view of personality; not surprisingly, since “Multimind” is foundational to it.  My “elevator speech” about therapy is:  “Personality exists in parts, as neural networks in the brain, adapted to the conditions in which we grew up.  When circumstances change, and the parts and configuration are no longer adaptive, we have to revise and reconfigure them.  That’s what therapy is for.”

Williams notes the look of surprised recognition in her therapy clients when she describes this view of personality.  “The fact that we are a congregation of minds, many (of which) have no idea of, or even interest in, what another of their number is doing, is so familiar that we take it for granted.”  She invokes Walt Whitman:  “Do I contradict myself?  Very well then, I contradict myself.  I am large, I contain multitudes.”

The “small minds” are “states of locked, internal focus; in other words, trance states.”  This recognition helped generate a metaphor in Williams’ work with a client, which she has since used often with other clients.  This woman loved opera, and Williams drew the distinction between opera, in which there can be several characters on stage at one time, following directions, and the “opera of our lives,” in which “we normally can have only one character on stage at a time, and sometimes it’s the wrong character” for the situation, “hogging the spotlight and refusing to stop singing or get offstage.”  Similar metaphors—a ship and its crew, for example—have provided ways of helping clients to achieve a distance from their problem, and take “greater, sometimes almost exquisite, control over their own states of mind.”

The sub-personalities don’t become the whole focus of therapy in William’s approach; bringing up the metaphor when needed makes it more powerful.  The “observing self,” described by psychiatrist Arthur Deikman, “equates with the director of the show,” while “positive and negative trance states and emotional arousals are the characters.  Clients are thus separated from their problem,” and their resources for self-awareness and self-regulation can be “recognized, named, and brought into play.”  Williams encourages her clients to name the various parts of themselves—playfully, not too seriously— that claim the stage.  One of my clients, using this method, identified “The General,” who comes onstage whenever he feels slighted, while another client identified the “C.O.O.” (chief operating officer), who takes over in the absence of a C.E.O. (chief executive officer).  Another metaphor I’ve found useful in therapy is that of an orchestra and conductor, used by neuropsychologist Elkhonon Goldberg to describe the role of executive functions (the conductor) in his The New Executive Brain. https://www.amazon.com/New-Executive-Brain-Frontal-Complex/dp/0195329406/ref=sr_1_1?s=books&ie=UTF8&qid=1514583481&sr=1-1&keywords=the+new+executive+brain+frontal+lobes+in+a+complex+world

“Naming anything…brings a measure of control,” Williams says, “and this is certainly true in the case of the characters.  Naming the character requires the client to move into his or her observing self to take a look.”  Williams highlights the “power of naming,” to shift the locus of control.  “Once you’ve named them, then whenever you feel disturbed in some way, you can quickly identify which small mind is creating this impact, and become aware that you need to move it out of the way.”  Williams then gives several examples, from her work with clients, of how identifying sub-personalities, such as “Valerie Victim”—essentially states of mind established long ago in response to circumstances that no longer apply—were usurping control and undermining them.  By helping her clients identify their sub-personalities and then learn to direct them, Williams helps her clients reclaim control over their inner lives; for example, by replacing “Valerie Victim” with “Confident Connie.”  Each character brings its own style, varying in attunement to our current situation and needs, replacing the one on stage before.  “Whenever a new character arrives, the one before is forgotten,” Williams says; recalling, for me, Elkhonon Goldberg’s description of consciousness as, “a neural network operating at a sufficient intensity for a sufficient period of time.”  When one neural network replaces another, consciousness changes.

Williams describes self-undermining states as emerging from “An over-alert amygdala, pattern-matching traumatic memories to vaguely analogous situations…The whole point of drawing attention to these switches is to help people break out of imprisoning trances, and also develop an ease and flexibility which allows them, deliberately and consciously, to shift between states, or to pull back into the observing self.”

Because we have this kind of personality structure, we are always vulnerable to one self-state coming forward to dominate the others.  “We all know people in whom one character, self-pity maybe, or a dominator, is more or less permanently on stage.”  Williams gives several examples from her work with clients of the importance of our becoming capable of identifying such controlling selves, moving them off stage, and replacing them with selves who are more attuned to, and competent for, the situation we are in.

The metaphor of an opera can be effective in couples work too. “Even if two people love each other, some of their characters may still be slugging it out.”

These inner characters—states of self—have their own attitudes and histories, plusses and minuses.  Sometimes the state we need isn’t available in our internal array, so we have to import it, as it were, from outside; from people we know who can be, for example, good at interviews.  “Identifying with the psychological skills of others…connects us with the same potentials in our own minds.”

“Which You Are You” envisions the goal of our being in the right state for whatever situation we are in.   “What you’re learning is that you can bring whatever character you need on stage, allowing you to handle a situation skillfully.  And you’re also learning how readily a mismatch between a part and a situation can generate problems…What an extraordinary sense of control and personal power, when you know and appreciate all the different parts of yourself.”

It’s important not to be too perfectionistic or serious about this.  “In all of this…a light touch is crucial, an essential safeguard against self-absorption or pretentiousness.”  Keeping it light helps us regain our balance.  “When we have identified sufficient characters in the dramatis personae, we can look at any of them evenly, without judgment…Lighthearted naming lessons tension and helps pull us back into the observing self…Any of the characters can be allies, just as long as we have them rather than them having us.” And, “Any character will hold up the show…if something else is needed…I have never seen anyone, after encountering their ‘opera,’ exclusively identifying with any character, although they may have done so…before that.”  Williams quotes Nietzsche, :  “Woe to the thinker who is not the gardener, but only the soil of the plants that grow in him.”

Williams, like Deikman, has a spiritual perception at the core of her understanding of personality.  The approach that she’s describing “leaves the essence of what we are, the heart of us…always intact.  Who we are can perhaps be thought of as partly material, partly transcending that, but it is always safe, because it is the bit that nobody can ever get at…Awareness of our many minds opens up a trail leading well beyond the bounds of therapy.”

In addition to being “an invaluable, commonsense way of helping us begin to know our many selves,” this approach helps us to know others too, Williams says.  “Societies and nations have their multiminds too, and operas of their own.  I sometimes think that if we were able to identify and manage their characters, with the same purpose, clarity and success that we can learn to manage our own, how different perhaps the life of human communities might be.”

I LOVE this presentation, because it contains so much useful information about our minds and how we get stuck and can get unstuck in our lives.  “Which You Are You?” illuminates human nature and experience as they are, rather than trying to fit them into some dogmatic theoretical, philosophical or other package, as so many presenters on therapy and human nature do.  Much as I love it, however, I have two hairs to split, and a bone to pick, with “Which You Are You?”

First, Williams uses the word “psychodynamic” as a synonym for “psychoanalytic,” as many psychoanalysts and others do, in order to differentiate her approach.  But if we understand “psycho-dynamic” as I prefer to, to include any model of mind in which parts are engaged in dynamic (energized) relationships, “Which You Are You?” fully qualifies.

Second, there sometimes seems to be a nuance of difference between how Williams uses the term “observing self” and how I understand Deikman to have used it.  Deikman was an investigator of the mystic tradition as well as a psychiatrist; the subtitle of his “The Observing Self” is “Mysticism and Psychotherapy.”  https://www.amazon.com/Observing-Self-Mysticism-Psychotherapy/dp/0807029513/ref=sr_1_1?s=books&ie=UTF8&qid=1514583673&sr=1-1&keywords=the+observing+self+deikman  He distinguished between the “object self,” which can be viewed like any object, and the “observing self,” pure awareness, which cannot be seen as an object.  When Williams advises her client that “They (the sub-personalities) come and go, you are always there…You are the same person you always were, and that’s all we can say about it,” she is drawing from this well.  Yet she also sees the observing self as a director, switching selves on and off the stage, which seems to me to be an object function.   This is something that I’ll need to meditate on.

Third—this is the bone to pick—Williams’ case examples seem to suggest that therapy can be done on a short-term basis with complex clients through the application of metaphors of self that include multiple parts under some sort of direction, in the context of a supportive and guiding therapeutic relationship.  In therapist peer study groups I facilitate, when we’ve discussed “Which You Are You,” my colleagues welcomed its description of mental life and use of metaphors in therapy, but didn’t see how that would lead to successful brief treatment with most of the clients with whom we are working.

In “Which You Are You?,” Williams is speaking from the Human Givens approach to therapy.  Human Givens is a short-term treatment approach which encourages the therapist to get right in there and deal with what’s happening with the client.  That’s great, but I haven’t seen, in the Human Givens approach, a recognition that clients can present with multiple complex issues that may have to be discovered and dealt with in therapy over time; reflecting clients’ need to develop psychological capacities they didn’t possess, to the necessary extent, when entering therapy.

“Which You Are You?” presupposes a fairly highly developed ability, on the part of our clients, to detach from their sub-personalities and observe them in action, given therapeutic guidance.  Many of our clients, however, don’t come to therapy with much of that ability, so the dynamics of the sub-personalities, as they affect the issues that the client has come to therapy for, may take time to become evident to client and therapist; sometimes a long time.  For example, a client with whom I’ve been working for over five years, with an early traumatic history that itself had taken some years to emerge in therapy, has only recently begun to identify a kind of vigilant guardian self that has been firmly in control throughout much of his life, protecting him and others at the cost of greatly restricting his experience of self and others, and his capacity for relationship.  Another client, with whom I’ve worked for over ten years, listened to “Which You Are You?” perhaps three years into his therapy.  He immediately grasped the principle of the of the selves, and it has contributed often and meaningfully to the value and depth of our therapeutic conversation, but it hasn’t shortened it.  It’s great when therapy can be brief and successful, but it’s by no means, well, a human given, that it will be.  The parts of our personality are neural networks in the brain, and so are the abilities to observe and redirect them.  It can take time to grow the neural networks to observe, adapt and redirect the neural networks that are the sub-personalities.

In fact, “Which You Are You?” has a lot to contribute to psychodynamic therapists who do long-term work, like me.  One contribution is to deliberately focus the therapy on the cultivation of, and access to, the observing self.  In my view, this is often more of an unintentional side-effect of therapy than a main focus, but it is responsible for much of the actual value of most therapy.  Another contribution is to help therapists avoid approaching our clients with theoretical presuppositions about what the parts are—ego, id, superego, Oedipal complex, archetypes, for example—and instead to keep an open mind to discovering them as the client experiences them, in the collaborative therapeutic relationship.

“Which You Are You?” is a favorite single source of information about how our minds work and what our experience is really like.  I regard it as a better source of information about what really happens in the psychological dynamics of our lives, and how we might reorganize them adaptively in therapy, than most of the books I’ve ever read about therapy, put together.

Advocating Psychotherapy–Sort Of–In the New York Times

(This column is Dr. Einhorn’s article in the current Cappstone, the newsletter of the Chicago Association for Psychoanalytic Psychology. Dr. Einhorn is Chair of the Advocating Psychotherapy project at CAPP. To arrange for a presentation about psychotherapy, contact Dr. Einhorn through the website contact link.)

In this time of the prevalence of a one-dimensional medical model of mental suffering and treatment, and the increasing marginalization of psychotherapy as health care reorganizes under intense economic pressures, a colleague has advanced, and perhaps also hindered, the cause of advocating psychotherapy, in a recent column in the New York Times (9-29-13). Op-Ed contributor Brandan A. Gaudano, clinical psychologist at Brown University, writing on “Psychotherapy’s Image Problem,” begins by pointing out that “In the United States, from 1998 to 2007, the number of patients in outpatient mental health facilities receiving psychotherapy alone fell by 34 percent, while the number receiving medication alone increased by 23 percent,” despite the fact that “a recent analysis of 33 studies found that patients expressed a three-times-greater preference for psychotherapy over medications.” “As well they should,” he continues, “…Medications, because of their potential side effects, should in most cases be considered only if therapy either doesn’t work well or if the patient isn’t willing to try counseling.” (entire article at: http://www.nytimes.com/2013/09/30/opinion/psychotherapys-image-problem.html?emc=eta1&_r=1&/)

Dr. Gaudano attributes “the gap between what people might prefer and benefit from, and what they get,” to the fact that “psychotherapy has an image problem.” And what is that problem? “Primary care physicians, insurers, policy makers, the public and even many therapists are unaware of the high level of research support that psychotherapy has. The situation is exacerbated by an assumption of greater scientific rigor in the biologically based practices of the pharmaceutical industries–industries that, not incidentally, also have the money to aggressively market and lobby for those practices.”

So far so good. We heartily agree with Dr. Gaudano’s comments, which are entirely in harmony with the perspective of CAPP’s Advocating Psychotherapy project. But when it comes to identifying what constitutes effectiveness in psychotherapy, Dr. Gaudano is beating the drum of randomized controlled trials. “For patients with the most common conditions, like depression and anxiety, empirically supported psycho- therapies–that is, those shown to be safe and effective in randomized controlled trials–are indeed the best treatments of first choice.” Referring to a recent survey that he completed with his colleague Ivan W. Miller, for the November edition of Clinical Psychology Review, Dr. Gaudano states that “It is clear that a variety of therapies have strong evidentiary support, including cognitive-behavioral, mindfulness, interpersonal, family and even brief psychodynamic therapies (e.g., 20 sessions).”

“Psychotherapy’s problems come as much from within as from without,” Dr. Gaudano states. “Many therapists are contributing to the problem by failing to recognize and use evidence-based psychotherapies (and by sometimes proffering patently outlandish ideas). There has been a disappointing reluctance among psychotherapists to make the hard choices about which therapies are effective and which–like some old-fashioned Freudian therapies–should be abandoned.”

Here, I am afraid that some of Dr. Gaudano’s comments tend to muddy the waters about what psychotherapy is and how it can be of value, at the same time that he’s trying to clear them up. For example:

•The use of randomized controlled trials (RCT) as the “gold standard” of outcome study is misleading. RCT requires the standardization of patients into relatively pure diagnostic groups (depression, anxiety, etc., with careful pre-screening to have as close as possible to “pure” diagnostic groups) and therapies into methods defined by techniques (cognitive-behavioral, interpersonal, etc.), overlooking the individuality of patients, therapists, and patient-therapist pairs. Such clarity, simplicity and replicability are not found in the real world, in which patients are usually quite complex, therapists have to adapt whatever methods they are using accordingly, and the interaction between patient complexity and therapist adaptability often has more to do with outcome than diagnosis or treatment method per se.

•The largest contributor to outcome in therapy is quality of relationship between client and therapist (as Jonathan Shedler described in his overview of studies, “The Efficacy of Psychodynamic Psychotherapy,” in American Psychologist (Feb-Mar. 2010). This is not to dismiss the importance of methods and techniques, or the value of a well-stocked toolbag for therapists with more than a narrow specialization. But the methods and techniques are applied within a relational context, which has as much to do with their efficacy as technical skill per se.

•The practice of treating psychodynamic, cognitive, interpersonal, etc., interventions as if they are separate is misleading. I’ve never seen any successful therapy in which unconscious factors in the patient weren’t elicited and transformed, in which the patient didn’t learn to think and perceive differently, and in which the interpersonal life of the patient wasn’t in some ways altered for the better through interaction with the therapist.

•A key mistake, often repeated in the history of modern psychology, has been to reduce our understanding of human behavior and experience to the currently available scientifically accepted methods. “Science” does not mean “whatever we can study with RCT.”

•While it’s good to see psychodynamic therapy included in the winner’s circle of empirically proven methods, the emphasis on short-term therapy overlooks the need of many patients for longer-term work. Symptoms may be resistant to treatment, and can change into a focus on underlying existential issues as therapy proceeds; all of which can take a lot longer than 20 weeks.

•Dr. Gaudano’s assertion that empirically supported therapies are superior to medication still takes place within the medical model, in which mental and emotional disorders are disconnected from the facts and experiences of people’s lives. “Safe and effective” are statistical abstractions within this model. In practice, what is safe and effective for one person may not be for another; thus the lengthy caveats about problems with safety and/or effectiveness in medication advertisements.

As to “psychotherapy’s image problems,” psychoanalytic authorities and institutions have certainly contributed to them, but so have proponents of “empirically validated” treatments. In fact, just about every form of treatment in the field of psychotherapy has been heavily influenced by gifted authoritarian empire-builders and their followers, resulting in a mine field of claims and counterclaims, in which conviction based on reductionist thinking at the expense of wider truth, together with contemptuous dismissal of alternative paradigms, is the currency of the realm. There is no “one size fits all” therapy, or therapist, or method of determining efficacy.

This mine field is the main “image problem” of psychotherapy. The basic method of therapy, in which two people meet to discuss, and try to understand and resolve or improve on, the mental, emotional, and relational problems of one of them, during which they form a particular kind of working relationship which evolves if the work goes well enough–and each of those relationships is unique–continues to be more powerful than the ability of any theoretical model to explain.

Neuroscientific advances will contribute to our understanding of what’s happening in psychotherapy. Neuropsychologist Elkhonon Goldberg, in his The New Executive Brain, states that “even relatively brief but sustained cognitive activity is capable of affecting brain morphology and is detectable in neuroanatomically specific ways” (p. 239). Goldberg is talking about kinds of learning such as new languages or music, but the application to therapy is clear. All this work between patient and therapist, when effective, cultivates salutary brain changes in the patient; and perhaps also, to a lesser extent, in the therapist. Research in this area is already proceeding, although the methods and conceptual frameworks remain relatively crude. Such research, when it reaches maturity, has the potential to reformulate how we understand schools and methods of therapy.

In wider perspective, we can see that therapy and medication, mental and emotional disorders, have all evolved within our society, where rhetoric and practice in politics, education, economics, medicine, the military, religion, government, and business, are characterized by misleading oversimplifications, dogma and ritual mistaken for knowledge and truth, turf wars, cult-like processes, and successive fads; each claiming superiority until it, too, is debunked. And the people, including professionals as well as consumers in each field, tend to be blind to the process itself, caught up in the cycle of fads, one after another. Why should psychotherapy be any different?

What’s needed, across the board, is better information and better informed consumers and practitioners. Now that’s a long-term process; it will probably take more than 20 weeks. But contributing toward it, in whatever ways we can, is the goal of our little Advocating Psychotherapy project here at CAPP.