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System, Method and Experience in Psychotherapy and Consultation

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Therapists and teachers often describe their approach to psychotherapy as a system or method, such as cognitive-behavioral or psychoanalytic.  Many other approaches, when you look into them, are some sort of inspired hybrid, such as Emotion-Focused Therapy, Internal Family Systems or Acceptance and Commitment Therapy.  My approach to therapy, like my approach to consultation with therapists, doesn’t rely on a system or a method, although it is methodical and systematic in its own way.  It places experience, and the observation of experience by client and therapist, first.  In my work with each client in psychotherapy, and each therapist in consultation, I am focused on exploring the experience of the client, the experience of the therapist, and the experience of the therapeutic pair.  This is a highly reflective process, and it includes the exploration of behavior and its meaning.  Psychologist George Kelly–a teacher of one of my teachers–said, “Experience is not what happens to us, it’s what we do with what happens to us.”

I had a very unusual introduction to psychotherapy, because of coincidences (or, if you prefer, luck, or grace) in my life.  While still an undergraduate at Goddard College, in Plainfield, Vermont, I met, and became an apprentice to, Eugene Eliasoph, MSW, LCSW, co-founder and co-director of the New Haven Center for Human Relations.  Gene was a therapist, psychodramatist and leader of therapy and personal growth groups.  For a year, II was able to participate in Gene’s groups, along with licensed therapists and Yale post-docs, and receive undergraduate credit for an off-campus field experience.  Goddard’s educational philosophy, influenced by John Dewey, prioritized experiential learning and the role of students in pursuing what they wanted to learn, on campus and off.  Even then, I was finding my own way.  

Psychodrama, for readers unfamiliar with it, is a way of exploring situations in our lives, in groups, by acting them out rather than talking about them.  The person whose situation is being explored is the “protagonist,” the leader is the “director,” and group members play the various people involved in the situation.  There is a role in psychodrama called “auxiliary ego,” which Gene often asked me to play.  The auxiliary ego, also called a “double,” is sent by the director to join with the protagonist (or other member of the psychodrama) and express what the person might be thinking or feeling, but not saying.  This was part of my introduction to psychotherapy.  The experience of the person I was doubling with was more important than any theory, method, concept or system.  My task wasn’t to label what the person was struggling with, or analyze how they were doing it, it was to find my way into the person’s experience and express it in a way that helped move the exploration forward.

In his other therapy and personal growth groups, Gene included me as a “model member,” who was there to learn and participate authentically.  Gene had a lot of knowledge and experience about facilitating therapeutic and personal learning in groups, and later became President of the American Society for Group Psychotherapy and Psychodrama.  His focus was always on the experience of the people he was working with, and he had a way of being and working with them that helped them feel encouraged and secure enough to explore issues that might otherwise have felt too vulnerable and disorienting to get into.  He had psychoanalytic training, at both Austin Riggs and William Alanson White, as well as psychodramatic training with J. L. Moreno, the creator of psychodrama; all of which informed his work.  But he also bought his own life experience to his work.  Among other experiences, as a soldier in W.W. II, he had been captured and escaped, and this contributed to a deeply existential view of human nature.  He had also been influenced by the writings of Harry Stack Sullivan, which he had studied at William Alanson White (which Sullivan had helped found), on the importance of interpersonal relationships.  Gene was also a jazz musician, as I was at the time–he on clarinet and me on guitar–and we shared a love of improvising together within a structure.  This is similar, in some ways, with the experience of psychodynamic psychotherapy (for a unique consideration of this dimension of therapy, see “The Musical Edge of Therapeutic Dialog,” by Steven Knoblauch, https://www.amazon.com/Musical-Edge-Therapeutic-Dialogue/dp/088163297X).     

I later came to understand part of Gene’s systematic approach in the psychoanalytic concept of the “frame” of psychotherapy.  The frame is the set of mutual roles and responsibilities of client and therapist, which creates a safe relational space, at least compared with most other relationships in our lives, within which clients can let down their guard and accept help in exploring intimate and difficult issues.

Later on in my academic and professional education, I was exposed to lots of theories, methods, and systems of therapy.  They all seemed to me to have some truth, mixed up with expressions of the personalities of the founders and their followers, and their attempts to achieve stature and the appearance of theoretical consistency.  This is a problem that started with Freud and continues to this day.  I’ve worked around it by studying neuropsychology and neurocognitive science, as well as spiritual psychology, and developing a model of how psychotherapy works.  That model, under continuous revision, is based on brain structure and function, neural networks and their interaction, the experience and behavior of multiple self-states, the social and economic dynamics of human communities past and present, the dynamics of identity and meaning, and how all those processes are instantiated in the client’s issues and the psychotherapeutic relationship.  (See my review of Pat Williams’ “Which You Are You?” https://psychatlarge.com/a-review-of-which-you-are-you-by-pat-williams/).  I call it an “expanded psychodynamic” model, and it easily incorporates what I find useful in psychoanalytic, cognitive, and other therapeutic approaches.  It enables me to be methodical and systematic without being confined within any method or system.

For more on consultation to refine therapists’ perceptions and skills, see my earlier blog post at https://psychatlarge.com/consultation-to-refine-therapists-perceptions-and-skills/

 

Finding the Key: Rote Memory, Perception of Meaning, and Neural Networks

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What we remember of what we have learned can depend on how well it was encoded when we learned it.  For example, if we learn a word list for a test, we might be able to recall some of the words after half an hour or so, but we can recognize more of the words we missed if we are given a list of words to choose from, some of which were on the list.

So, if I learn a list of words—say, “cat, tree, chair, piano, table, box, pail, clock, glasses, radio, door”—and then say as many as I remember after half an hour or so, I might remember “cat, tree, piano, box, radio, door.”  Then if I am shown a list of words that have all the words on the list in it, as well as a bunch of other words that were not on the list as distractors, I might recognize, “chair, table, pail, clock, glasses.”  The words I remembered without any prompting would be the ones that were better encoded when I first learned them, and the words I didn’t remember at first but recognized from the list of possible words would be words that were were not so well encoded.

Now, encoding, like any other learning process, requires the formation of neural networks; tens or hundreds of thousands or more of neurons in the brain, distributed across various parts of it, interconnecting and forming this memory.  The words that were better encoded, the ones that I remembered without prompting, had neural networks (called “neural nets” for short) with more neurons, and perhaps involving more parts of the brain.  The ones that I didn’t remember but could recognize had fewer neurons in their encoding networks, perhaps distributed over a smaller portion of the brain.

That’s a rote memory example.  Now let’s think about the understanding of meaning in language, by looking at a teaching story.  I first came across this story in the Nasrudin stories gathered and edited by Idries Shah, but I’ve since come across it in business, educational, and other contexts, without Nasrudin appearing as a character; which is an interesting example of cultural assimilation.  Nasrudin is down on his hands and knees outside, when his friend comes along and asks what he’s looking for.  “I’ve lost my key.”  So his friend helps him look, but they can’t find it.  “Are you sure you lost it here?” asks the friend.  “No, I lost it at home,” says Nasrudin.  “Then why are you looking for it here?” asks his friend.  “There is more light here,” answers Nasrudin.

Now, this story can be meaningful in a lot of different contexts.  For example, in a military, business or educational context, it can mean that conventional thinking is not going to be able to solve the problem of how to succeed in a particular operation or project; or of what the military calls “lessons learned;” understanding, after the fact, what went wrong.  I use this story in my work—in psychotherapy, diagnostic evaluation, consultation and supervision—to indicate that the way my client or student has been thinking about a problem may not lead to a solution.

What happens in the brain when a little story like this, a set of words that may not have much meaning for us except as a sort of joke showing how stupid people can be, suddenly illuminates an important problem in human thought and behavior, that has direct application in our own lives?   Surely there is a huge expansion, extension, interconnection, of neural networks, recruiting many more neurons and involving much more of the brain than the original encoding of the story.  Thus, the perception of meaning in metaphor can be understood as a significant event within the brain.

(See “links,” under the “resources” menu, for collections of Nasrudin stories)