Category Archives: Psychotherapy

Psychedelic group psychotherapy

Posted on by
Reply

Just over a year ago, I wrote about the power of community to support psychedelic journeys. It’s well established that psychedelic experiences are characterized by a sense of connectedness, but sharing that journey with others can enhance those feelings. Community is fundamental to indigenous psychedelic healing, and it’s fundamental to the ACER integration program.

Seating in a circle: Room set up for a group psychedelic integration session.
Group psychedelic integration

Two recent research articles move the discussion forward. The first, ‘(Dis)connectedness, Suicidality and Group Psychedelic Therapies‘ (McAlpine & Blackburne), notes that social disconnectedness is a significant risk factor for suicidal thoughts or behaviours. They consider the “potent synergy“ of psychedelic group therapy and suggest that “such a collective space … has the potential to not only awaken a renewed awareness of social support but also to establish a sturdy framework of communal care”.

The second one takes a different route but comes to the same conclusion. ‘Psychedelics and neonihilism – connectedness in a meaningless world’ (Plesa and Petranker) highlights the tension between the “contemporary neoliberal” context most of us live in and the connectedness at the heart of psychedelic healing. The predominant psychological model reinforces this neoliberal ideology because it’s “based on the individual as self-contained, as atomic – a self which fashions itself as separate from the other” (Bhatia, 2020). Plesa and Petranker suggest that psychedelic group psychotherapy could help us overcome modern experiences of meaninglessness. It may offer “a collective confrontation of meaninglessness as a radical departure from individualizing therapeutic practices that further reinforce neoliberal forms of individualization, responsibilization, competition and self-governance”.

I’ve focused on psychedelic experiences here, but any of the embodied pathways of connection can disrupt the alienation fostered by neoliberalism because they reveal that we are fundamentally interconnected.

The Psychedelic Connection

Posted on by
Reply

I’ve been very involved in work and research on psychedelics over the last year or so. I’ve mentioned psychedelics in a few of my posts here, but I wanted to flag up a couple of presentations. The first is online next week: I’m talking about Sacred Ecology: The Psychedelic Connection at the Embodied Spirituality event.

Back in 1996, I wrote Sacred Ecology. Now, nearly 30 years on, I’ll be exploring that territory through a psychedelic lens. Psychedelic experiences can be profoundly spiritual, often inducing mystical experiences. What does this tell us about the power of awe, nature connection and the future of therapy?

I started working as a Facilitator on psychedelic retreats in The Netherlands last year. This involved spending hours supporting people on their psychedelic journeys as well as helping them to prepare for and integrate the experience. Nature connection is widely recommended for psychedelic preparation and integration and as this is a particular interest of mine, I’ve begun to develop and refine this approach. In this presentation at the University of Exeter, I talk about the work I’ve done on psychedelic retreats and explain how we might apply ecotherapy to integration.

Psychotherapy – doing or being?

Posted on by
2

There are dozens of different approaches to psychotherapy. My bookshelves overflow onto the floor with books about ACT, CBT, ecotherapy, Gestalt, psychoanalysis and more. But are all these approaches just the decoration on the cake?

Not long after completing my initial training in psychotherapy, I became aware that most other therapists had been taught specific approaches to many of the most common mental health challenges. They’d done modules on what we call ‘presenting issues’ like bereavement, anxiety, depression and whatever else. I felt somewhat confused, as my extensive training – a Masters degree and then Focusing-Oriented Therapy – hadn’t covered any of that. We’d considered some of the key approaches, but in each case highlighting their limitations and the danger of a theoretical ‘frame up’; fitting the client’s unique experience into the frame of a theory.

a big pile of books about psychotherapy

Keen to be a better therapist, I started to learn about all the things I thought I’d missed. I learnt about the techniques I might use to help with specific presenting issues. Then I ‘caught up’ on classic CBT and some of the newer approaches that have emerged from it. But the curious thing is I don’t use techniques very much and I’m beginning to suspect that my original training had it right all along: Psychotherapy isn’t about doing but simply being. What I remember most from my training are the hours we spent in group work and the years of personal therapy. We were being developed as people rather than taught techniques because theory, though fascinating, is just the icing on the cake.

To a large extent, the research backs this up. The Dodo bird hypothesis claims that all bona fide therapeutic approaches have much the same outcomes: “Everybody has won and all must have prizes,” just as the dodo insisted in Alice in Wonderland (Wampold et. al 1997). In fact, the therapeutic relationship is more important than the approach we use: It’s more about who you are than what you do.

Given all that, I’m wondering about the constant flow of new approaches. Almost every month I hear about some new technique which will transform my therapeutic work and will give my clients a unique healing experience. Do I need to sign up for the latest course or would I be better off spending more time just developing my capacity to be present?

Fathers and Sons

Posted on by
Reply

How does a young man test his strength? Like a young stag, he locks horns with his father in a challenge. One of three things can happen next, depending on what kind of man that father is. An aggressive, arrogant father will push back hard and the youngster will be defeated, humiliated and possibly injured. A weak father won’t have the strength to do anything but fall back, leaving his son feeling mild contempt and perhaps confusion. But a strong and grounded father will steadily hold his ground, not pushing against his son but not yielding either. In this ideal case the youngster feels his father’s strength and his love. He can push against his father, testing his own emerging manhood. In this way he comes to learn something crucial about what it is to be a mature male.

My own father wasn’t ideal in many ways but somehow he was good enough at holding his ground against my adolescent challenges without defeating me. When a young man challenges his father, he’s effectively asking a question; “What is it to be a man?” If he gets the wrong answer – arrogant aggression or weakness – he may end up living the rest of his life in response to it.

In my work as a psychotherapist I sometimes see what happens when that adolescent encounter is mishandled. There are weak men, lacking self esteem and often searching for someone to replace their mother. Maybe their father’s answer to their challenge was capitulation, which told them that a man is a weak creature, born to servitude. Or perhaps his father was punishing, telling him that he has no right to challenge authority. The flip side of this weak soul is equally damaged. This is the son whose father taught him that being a man means beating the other guy, even if the contest is unfair. In an attempt to make sense of the way his father crushed him, he builds a strong defense and comes to fear vulnerability more than death itself.

I don’t meet the men whose fathers had the wisdom to stand with firm gentleness, offering strength to push against. They they are the lucky ones who know their place in the world, who feel comfortable in their own skin and know what real strength entails.

How to manage the psychedelic revolution

Posted on by
1

The media is full of news about psychedelic therapy this week. There’s the opening of the new Awakn clinic in Bristol, which uses Ketamine to support psychotherapy for depression, anxiety and addiction. Another organization – Small Pharma – are trialing DMT in the UK as a treatment for people with depression. In the USA, Oregon has decriminalized all drugs and Washington D.C. now permits the cultivation and possession of “entheogenic plants and fungi.” It’s perhaps no exaggeration to say that we are at the start of a revolution and things have moved fast since I wondered if psychedelic psychotherapy might be the next big thing in psychiatry a mere 18 months ago.

You’d be forgiven if you have a deja vu feeling about all this; back in the 60’s Timothy Leary and others were proclaiming a psychedelic revolution. Sadly it all went badly wrong, as revolutions so often do. What happened back then and can we learn from the mistakes of those excited pioneers? The main problem was that there was no context for psychedelic experience. Many indigenous cultures have been drawing on the healing power of psychedelics for generations and they provide a supportive context to hold the experience. It’s not simply ‘Tune on, tune in and drop out’!

Context is vital at several levels. Stan Grof, a leading thinker in the field, suggested that psychedelics are “non-specific mental amplifiers of the psyche” (2000), which means that the location and your mindset are key. The psychedelic experience needs to take place in a carefully managed setting and ideally with someone who is there to support you. Most people who work with psychedelics know about set and setting, but there’s a larger context that’s sometimes neglected. Preparation for the experience can make a huge difference and integration afterwards can unpack the deeper significance of the journey. Without integration it’s too easy to miss the potentially life changing lessons of your psychedelic experience. Then there’s the wider social context. You’ve had this extraordinary experience that may well have been mystical in it’s profundity. How do you take that into the rest of your life? Do you have friends or a mentor who understands and supports you? Does your culture affirm or dismiss your experience? While many indigenous peoples have all of these levels of support integrated into the culture, Western Postmodernism most certainly doesn’t!

The good news is that there are organizations and individuals working to create these supportive contexts. There’s a lot to learn but we’re drawing on cutting edge scientific research and, with deep respect, indigenous wisdom. I’ve recently started working as the Director of Ecopsychology at the Synthesis Institute. Synthesis have been running psychedelic retreats in The Netherlands for several years and are now exploring a new approach to help manage depression. My role is to bring the powerful holding and healing of the natural world to this work. Ecopsychology has a lot of offer, especially with preparation and integration but this potential has been largely untapped. Although a special issue of the European Journal of Ecopsychology on the psychedelic experience came out in 2013, it was before the current renaissance in psychedelic therapy.

Psychedelic therapy is complex and requires an interdisciplinary approach that’s very unfamiliar for Western medicine. We need new frameworks, and it’s notable that the psychedelic experience and nature connectedness are two of the embodied pathways of connection; perhaps the EPoC model can help inform the way forward?

So it’s exciting and challenging times! We have a wealth of wisdom and research to draw on as we negotiate this journey. With the revolution well underway, I believe our community can rise to the challenge of creating a holding context for what may be the most powerful experience someone will ever have.

The Therapy Turf Wars

Posted on by
Reply

“My therapeutic approach is better than yours!” All too often therapists with one particular approach criticize one – or all – of the others, and I’m sick of it. CBT is frequently involved in these turf wars, partly because it’s the favourite of the NHS. Some CBT therapists imply that their approach is vastly superior to all others, ignoring the evidence that supports the effectiveness of other schools of therapy. Humanistic therapists frequently respond in kind, suggesting that CBT is shallow, simplistic and unable to tackle deep rooted issues.

Ruby Wax is an especially irritating ‘turf war’ critic. Ruby is a passionate advocate of Mindfulness Based Cognitive Therapy, an approach I have a lot of respect for. Sadly Ruby feels it necessary to dismiss several of the most important ‘rival’ schools of therapy with funny parodies. Carl Rogers developed the Person Centred Approach (PCA) that unpins most Counselling in the UK today. According to Ruby the PCA is about repeating “whatever you said back to you like a parrot but with love” (Wax, 2013). She goes on to dismiss Gestalt, Existential and Psychoanalytic approaches. Ruby; it may be funny, but it’s not clever!

Triggering my ire today is a book about the Human Givens Approach, which claims that the PCA, Psychodynamic school and CBT are all “piecemeal approaches” and that none of them “are sufficient on its own” (Griffin and Tyrrell, 2007). Their solution is, of course, the Human Givens Approach! The research evidence suggests that PCA, Psychodynamic and CBT can all be effective in certain circumstances. CBT is backed by a robust research base and a Person Centred Approach is one of only four therapeutic modalities approved for the treatment of depression under the NHS.

All this frustrates and saddens me. The Human Givens Approach has a great deal to offer and I’ve integrated it into my own therapeutic practice. But I’m galled that those who developed it feel the need to dismiss other approaches as inadequate. It sometimes feels like I’m back in the school playground hearing one kid saying “My Dad’s bigger than your Dad!” Viewing all this though a psychodynamic lens, I wonder if some therapists have unresolved childhood issues?

The parable of the blind men and an elephant
We need a wide perspective

Given that the human mind is the most complex system in the known universe, is it really plausible that one school of therapy will have the definitive and complete answer to every individual’s unique mental health problems? Maybe one day, but most certainly not yet. Meanwhile I’m adopting a pluralistic approach, learning as much as I can about as many different paths to healing as possible. I try to take a wide perspective, asking myself the question; for this particular client, at this specific moment, which therapeutic lens is going to be the most helpful? This is usually called having an ‘integrative’ approach, but I think I’m best described as a pragmatic therapist: My only interest is what works?

Beyond relationship? The power of therapy outdoors

Posted on by
2

The relationship between client and therapist is considered by many to be the single most important factor in successful therapy (Loewenthal, 2014). But what happens to that relationship when the therapy takes place outdoors? If you haven’t experienced therapy outdoors, you might wonder why it would make any difference to the therapeutic relationship. Isn’t it just like conventional therapy, but outdoors?

The short answer is, it depends. A few outdoor therapists strive to control the impact of the immediate environment, but most engage with it, often finding that nature becomes a kind of co-therapist. When nature enters into the therapeutic relationship, things get interesting! The client begins to form a relationship with the natural environment as much as with the therapist. The therapist is no longer “the professional with the answers and advice”, but instead becomes an “expert at facilitating therapeutic conversations” (Jordan & Marshall, 2010).

Ecotherapist Martin Jordan suggested that when we work outdoors “the myth that the self is somehow separate from nature becomes exposed as the fallacy it is” (Jordan, 2009). This complicates our understanding of the relationship between therapist and client even more. Once again – as so often in this blog – the question arises of where ‘self’ ends and the ‘other’ begins. But if the ‘self’ becomes “entirely entangled with the Other”, we might “risk losing the difference and thus any possibility of relationship” (Harris, 2013b).

David Key, an ecotherapist I interviewed for my MSc research, brings these questions to crisis point. David said:

“What actually happens when people go out into wild places, the thing that’s therapeutic, is something … I don’t know, it feels like it almost isn’t about relationships, it’s almost a Becoming […] that actually goes beyond relationship. […] Relationship is the process, not the product”.

This extract illustrates what I most like about this interview: you can hear David working with complex ideas and trying to force language to express something that refuses to be named. His ideas seemed to evolve as we spoke. David rhetorically asked “How do we as human beings even conceptualise the therapeutic relationship that the land or the sea offer us?” We can’t, but the attempt to do so is hugely illuminating.

The full interview was published in Self & Society: An International Journal for Humanistic Psychology (2015). The article is entitled “What impact does working outdoors have on the therapeutic relationship? An interview with ecotherapist David Key“

Wired to survive?

Posted on by
1

According to evolutionary neuroscience we’re not wired to be happy or content but simply to survive. It’s a new science, so such judgements are subject to review, but it certainly seems that our bodymind system easily becomes dysfunctional in modern industrial societies.

Paul Gilbert is a clinical psychologist and developed a new therapeutic approach called ‘compassion focused therapy’ (CFT). Paul has identified three basic bodymind systems; one is focused on potential threats, another on finding resources, and the third on calm contentment & soothing. When the threat system is active our attention becomes like velcro for danger signs and teflon non-stick for anything positive: If you’re on alert for wolves then the fact that the moon looks fabulous is pretty irrelevant! Short-term that’s fine and once danger has passed we naturally shift to either the search and reward mode or the calm contentment system. As long as there’s a cycle between these three systems, we’re fine.

Adapted from Gilbert, 2019

Because the threat system has survival value it can override the other two and it’s activated whenever there’s a perceived danger. The threat system works on a ‘better safe than sorry’ basis so will trigger whenever we feel that a situation isn’t safe. Many people live in situations which don’t feel safe; low income, precarious or stressful work, discrimination, difficult relationships or just keeping abreast of the news. That means that the threat system is often over-active and many people don’t spend enough time in the regenerative contentment & soothing system.

Compassion focused therapy draws heavily on mindfulness to help people learn to rebalance themselves. By becoming mindful of when we’re stuck in the anxiety provoking threat system, we can learn to shift into calm contentment. Self compassion is hugely helpful in this, and though we all have compassion, we may not practice it much. In our culture it can be seen as a sign of weakness or a distraction from the busyness of our lives. But in fact compassion is a form of courage that inspires us to act. With practice we can develop more compassion for ourselves and others, healing within and making the world a better place in the process.

It’s worth noting that mindfulness is the key strategy in CFT. Mindfulness, like so many of the other approaches to alleviating mental distress, is an embodied pathway of connection. If we really are wired to survive, perhaps early humans developed the embodied pathways of connection as a route to a deeper thriving? Practices like mindfulness, ritual, dance, psychedelics and the deliberate use of trance emerged early in human evolution. These same practices are retained by many indigenous groups and have therapeutic value for them. The same is true for all of us: These ancient healing practices can take us beyond mere survival mode to a vibrant, joyful existence.

The Intuitive Therapist

Posted on by
1

If you’ve ever watched a filmed therapy session or heard Susie Orbach’s In Therapy, it might seem like there’s not much going on. The client says something and then the therapist says something. What you can’t sense, unless you’ve been there, is the deeper process going on throughout the session. As a therapist I want to be 100% present in the moment and sensitive to every nuance of our complex interaction. I also want to be aware of everything the client has ever said to me, how they might be feeling and how I’m feeling. I need to consider if, based on half a dozen theories of therapy, there’s any pattern in all that. If there is a significant pattern, I need to decide when and how to say so.

When I was training to be a therapist I despaired of ever being able to process all that and stay present with the client. I was so busy thinking about what they’d just said that I kept missing something crucial! It seemed impossibly hard. And I was right; trying to consciously think through the complexity and depth of therapy is impossible.

Most of the vast bulk of Uluru lies below ground

I’d assumed that I had to think everything through consciously, but actually about 95% of our cognitive processing happens in the other than conscious mind (Thrift, 2000). I talk about this a lot in my PhD thesis on embodied knowing, but it took me a while to appreciate how this happens in therapy. In therapy – and in everyday life – my “body senses the whole situation” (Gendlin, 1992). The wisdom of the body draws on sensory perceptions, emotions, memories, past experience and much more to decide what to do next. It’s a massive understatement to say that “your body knows much that you don’t know” (Gendlin, 1981).

Malcolm Gladwell talks about this “power of thinking without thinking” in Blink (2005). The book is full of wonderful stories about people who know intuitively what’s going on in very complex situations. There’s the art expert who can unerringly sense a fake but can’t tell you how, and a fire chief who’s gut feeling saved his entire crew from disaster. In each case the ability to correctly intuit what to do emerges from a powerful embodied knowing that’s been developed through training and experience.

In a typical therapy session I’m not constantly pondering what the client had just said: My focus is on staying present. Meanwhile my embodied mind – which has a huge range of input and a vast capacity to process that input – does the work. Drawing on this embodied wisdom is the essence of Focusing Orientated Therapy.

It’s not what you know …

Posted on by
1

… it’s the way that you know it. I sometimes have a name ‘on the tip of my tongue’. I’m sure you know that odd feeling; you both know and don’t know at the same time. We make sense of these experiences by talking about an unconscious knowing that we can’t always bring into full awareness.

But there’s a curious flip side to this: You can ‘know’ something consciously without really ‘getting it’ at a deeper level. My therapy clients will sometimes comes to a realization – an ‘Ah ha!’ moment – when they grasp something in a new way. “I knew that already, in my head, but now”, they add with a touch to the heart or stomach, “I know it here”. The difference is profound.

I first wrote about this 25 years ago in Sacred Ecology:

“Besides the cerebral knowledge we all possess, the words & ideas stored in our heads, there is a deeper knowledge held within the tissue of our bodies. It is a somatic, physical knowing which comes from direct experience. This is the knowledge of faith, of emotion, of the gut feeling”.

I later discovered that I was describing embodied knowing and went on to do a PhD on the subject (Harris, 2008).

Conscious knowing is just the tip of the iceberg

Embodied knowing is fundamental to my work as a therapist. In many cases a client knows exactly what’s needed, but doesn’t have conscious access to that knowledge. At other times someone will know something consciously, but lack an embodied grasp of it. The therapist is rarely – if ever – the expert. Our role is facilitating the client’s journey of growth and self discovery, which typically involves integrating their embodied knowing.

There’s another vital aspect to this which takes me back to where I started. In Sacred Ecology I wrote that we need to understand our deep relationship with the other-than-human world at the level of embodied knowing. Unless you’re avoiding the news, you’ll know, in your head at least, that there’s a climate crisis. The facts are clear and have been for years, but nothing much gets done. Action on climate change is characterized by denial and broken promises and time is running out: We may have less than 18 months to avoid catastrophic change. But unless we get that at a gut level, really feel what it means, we’ll remain in what Zion Lights calls ‘passive denial’. You may know the facts about climate crisis but, painful though it is, you have to experience the reality in your body. That wisdom of the body is like taking the red pill; there’s no going back.

When I wrote Sacred Ecology I believed that myth & ritual offered the best route to the wisdom of the body. I’ve since recognized that there are many pathways to embodied connection. These include practices that are already advocated, like mindfulness and nature connection. We need to focus in on these pathways and learn how to use them more effectively. This is embodied ecology and may be our best hope for a future.