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Psychotherapy as an Ethical and Spiritual Exercise
Tapio Malinen, M.A.
Tapio Malinen, M.A., Psychologist, Private Practitioner, Teacher
in Psychotherapy, Helsinki Psychotherapy Institute, Finland. Address:
Sundintie 26, 06650 Hamari, Finland. Email: tapio.malinen@tathata.fi.
Telephone: 358-(0)400-595074.
Abstract
This article describes how precious the practice of psychotherapy
can be, and how priviledged we are as therapists in practicing
this activity. In this paper psychotherapy is seen as an ethical
and spiritual exercise, as an existential enterprice that can
change the therapist´s entire experience.
Seen and experiencing our work in this way can change the domestic
into exotic, and the job of the therapist can thus be a meeting
point for the real, beautiful and good in a unique manner.
The article is also offering the reader small examples of experiental
exercises that they can use to increase their connection to spirituality
or to help them be more present in their work. Their aim is to
function as a guide for therapists who are seeking this type of
connection in their dayly work.
Key Terms: psychotherapy as a ethical practice; mindfulness;
a spiritual exercise; the unskilled skill of precense; therapist´s
well-being.
Psychotherapy as an Ethical and Spiritual Exercise
“The true value of man is defined based on to what extent
he is liberated of himself.”
- Einstein
“Words hide all that is not words.”
- G.Ågren
A recommendation to the reader! You are recommend to read this
article like we can read poetry. When we read poetry, we can be
poets. We remain passively allert, letting the words be active,
listening to how they echo on every level, how they sound, how
they move us, how we are moved by them. We wait attentively, without
conclusion, for the poem to find us. In this openness the words
can be a catalyst to the real formulation which takes place within
the reader.
Introduction
“If I planned to go to a conference, and if I knew forehand
what I would be thinking at the end, then I wouldn´t go.
It is like that with my work. If I knew where we would be at the
end of the session, I don´t think I would do this work.
And if I had not changed at all after the session, then my actions
probably would not have a very big impact on the people who came
to me.” This is what Michael White answered in an interview
(White, 2000, p. 138), when he was asked what goals mean to him
in psychotherapy.
“Therapy is a spiritual path on which we suddenly realize
that we are something full-bodied, as it were something with guts,
something that makes you suddenly realize that you are breathing...
that your awareness encompasses time and as it is embraced with
it, that something is beautiful or absurd, or magnificent, or
ridiculous, and every inch of you is moving through space, and
knows, and doesn´t know that it knows...” This
is how the New Yorker poet and psychotherapist Dvorak Simon described
her work in the mid 90s in his article Doing Therapy as a
Spiritual Path (Simon, 1995, p. 2).
Both of these comments share a mutual thought: therapy does
not just have an impact on our clients but it is action that has
its effect also on the therapist. An idea like this is not brand
new. The philosophy of classical antiquity was originally directed
at an ordinary man, so that he would have the opportunity to become
more of a man. Philosophy was considered to be “a spiritual
exercise” and the philosopher was not meant to only learn
how to speak or debate, but also to live a philosophical life
(Hadot, 1995). For example the so called Socratic dialogue was
such a spiritual exercise the purpose of which was to help the
hearer to examine oneself and to take care of oneself. All spiritual
exercises had this basic idea: to make a person to revise their
attitude and beliefs, to have a dialogue with oneself. The purpose
was not to assume abstract knowledge but the “metamorphosis
of personality”. According to Hadot mindfulness was the
key to all of these spiritual exercises (Hadot, 1995).
In an even older wisdom tradition, in Buddhist psychology, research,
in another words meditation, does not just produce scientific
knowledge but also gradually changes the scientist. One of the
basic elements of this psychology is “sati”. This
concept is in language Pali and it signifies a skill to observe
experiences as they present themselves from moment to moment.
There has been much focus in the past 10 years on the professionalization
of therapy, that the art of therapy has been overlooked. Given
an opportunity for therapists to focus on the experience of therapy
itself as a spiritual enterprice seems particularly relevant and
valuable in our time of constant demands of outer productivity
and effectiveness. This opportunity can also give us the experiense
how to maintain our sense of significance and getting on under
these demands.
The benefit for this type of spiritual exploration has been
pointed out lately through a growing body of research that demonstrates
how the cultivation of “sati” significantly encances
the well-being of health care professionals (Sapiro & Carlson,
2009; Didonna, 2009; Hick, 2009; Germer & Siegel & Fulton,
2005; Brown & Ryan, 2003; Bien, 2006; Mace, 2008). We are
starting to acknowledge that mindfulness and spirutual issues
are a valuable part not just of the lives of our clients, but
also for ourselves as therapists (Walsh, 2009; Carlson & Erickson,
2002).
What does a therapist practice in therapy?
The words “practice” or “exercise” are
used to denote a special meaning in this article. When psychotherapy
is understood and experienced as a spiritual exercise through
which the therapist’s way of looking at the world and experiencing
it changes, it is not just about external action. Psychotherapy
is seen and experienced rather as creating a mental state in which
we practice humanity. We are not working for some goal that awaits
us somewhere out there. We practice because practicing itself
is life as fullness, something we want to do for the sake of it
itself (Kabat-Zin, 1999). Every encounter with a client becomes
a part of the therapist’s own learning process. Psychotherapy
becomes the practicing of existence, and the internal experience
that is brought to life like this will at best change the basic
tone of our minds and the entire basic tune of our existence.
Our work can thus be a meeting point for the real, beautiful and
good in a unique manner.
This does not mean that we as therapists could not set goals
for ourselves and aim at achieving them. It is more about acknowledging
therapy as a process and also living through this process as mindfully
as possible. It is good to remember that without plans our work
can easily become scattered and ineffective. However, practicing
as a way to change the quality of our experience and deepen our
understanding always takes place in the present; it is being in
the present. Thus planning is not goal oriented. We can easily
get stuck on goals and forget that the goal and the process that
takes us to the goal are parts of the same reality – just
like “good” and “bad” are parts of the
same reality or heads and tales the different sides of the same
coin (Loori, 1194). Once we realize this, our attachment to the
goal fades off and we acknowledge the present. At that time every
step is living and it can be experienced as fullness.
Nowadays goals are underlined to such extent that traveling
often loses its meaning. Without the “pollution” of
purpose, practicing psychotherapy can in the best case deepen
into action which changes our entire existence. Through this we
will become increasingly aware of the moment in which we are living
and of the qualities of experience and possibilities connected
to this moment. Hence our work becomes practicing mindfulness.
At the same time the whole idea of practicing will disappear and
a gradual transition towards a mindful life begins. In another
words, when we do things mindfully, our skill will eventually
turn into a non-skillful skill. Such practice is also closely
connected to the ideas of knowledge and learning that support
our work, the ethics of our actions and to the proaspect of who
or what is the therapist’s “self” (Malinen &
Thomas, 2009).
Shu-Ha-Ri
The traditional understanding of knowledge is based on the idea
that there is a reality existing independently from us and of
which we can acquire objective knowledge through so called scientific
research methods. In this dualistic setting another person is
an object which we can objectively explore. Knowledge is then
something that exists independently outside us, and it can be
transferred as a block from the expert therapist’s head
into the client’s. This so called modern understanding of
knowledge and the power practices involved with it are still dominant
in the Western therapy culture.
According to the postmodern understanding of knowledge reality
is created within social relations. Knowledge is existence constructed
within historical and social relations. The increase of knowledge
signifies the emergence of new power relations and courses of
action (Järvilehto, 1997). One cannot transport knowledge,
because no-one can transport existence onto another person. As
Harlene Anderson states: “Therapy cannot be taught, but
one can learn it.” Learning therapy is not an action in
which knowledge is passed on, mould, worked on and transferred
in paragraph-like teaching packages, but instead it is co-operation
between the teacher and the student, partnership with conversations,
that adds to both parties’ performance. There is always
an existential aspect to learning based on wisdom, and for example
practicing the skill of psychotherapy is seen as existential and
changing the therapist’s entire experience. In the Eastern
tradition a skill and the other parts of life are not separated.
Hence for example teaching is never just about technical preparation,
but rather about guiding the student deeper into the different
existential experiences brought on by the rehearsing.
Timo Klemola has described in his book The Philosophy of
Skill – The Skill of the Philosopher the three stages
of learning as understood in the Japanese tradition (Klemola,
2004). If a teacher is a master of skill, she is more than a technical
example, she is an example through her entire personality. The
first level of learning is “shu”. This concept
can be translated as “protect”, “defend”,
“comply with”. This means that the student complies
with given instructions while repeating the basic interventions
of the school. In addition to that she learns the ethical virtues
of psychotherapy: respect, appreciative curiosity and the attitude
of not-knowing. This first level of knowledge usually lasts from
three to five years.
After this the student enters the second level of knowledge.
It is called “ha”. In English that means
“tear”, “break”, “come undone”,
“destroy”. These concepts refer to the therapist breaking
free from the first level. What is learned is reorganized, elements
that are unfitting to the person in question are abandoned and
one’s own limits and possibilities are acknowledged. At
this point learning new things does not mean adding something,
but quite the opposite: letting go of something, which for its
part requires courage, realization and internal certainty. Once
one understands the theory and is ready to apply the principle,
it is the time to separate oneself of those, so one can live and
carry on discussion again normally. At this point it is not so
much about “what to do” than about “how to be”.
The final and the highest level of skill in this three-staged
process is “ri”. It is about liberation,
separation, a preparation of kind. This does not however signify
the end of studying, but mental independence of other teachers.
Now the therapist is only dependent of her own continuous rehearsal
and research. She is usually at this point an experienced senior
member with a working experience of 25-35 years after becoming
a therapist, and aged 60-70 (Lehtovaara, 2003). At this stage
the techniques of therapy are increasingly created through the
person’s own personality, are less mechanical and their
limits are understood better than before.
The road is built of the steps we take
Dvorak Simon considers solution focused psychotherapy techniques
spiritual practices which help the therapist to absorb the values,
attitudes and courses of action needed in therapy work (Simon,
1996). She presents an anecdote about this, one that has become
very significant to me during my career. In it Jay Haley, a central
character in the development of strategic family therapy, lives
in a Japanese family. Every afternoon as the father of the family
comes home the daughters bow at him respectfully. As Haley asks,
what is it in their father that evokes such respect, one of the
teenage daughters answers: “In our Dad? There’s nothing
to respect in him! But if someday we met a person we could respect,
we’d already know how to bow!”
Dvorak says that struggle is unnecessary in talking about change.
She thinks that therapists can relax and sit back, since our clients
are essentially ok, and they have an unlimited amount of alternative
stories. We can peacefully rest in the miracle which is created
when we are together with our clients in what is as it is, and
when we let the infinite possibilities of life become real as
we move from the known towards what is possible to know and feel.
As we “bow” for example in a solution focused way
we practice respect, thankfulness, openness, awareness of the
consequences of our actions and compassion all the time. The spiritual
growth which takes place after hundreds and hundreds of “bows”
signifies the therapist’s gradual clarification of values,
responsibility of oneself and of others and nature, sensitizing
one’s concept of beauty and decrease of negative ways of
thinking and acting. As therapists we do incredibly privileged
work: we can practice all the time – no more and no less
than – the full execution of our humanity!
Psychotherapy as an ethical practice
In order to function ethically in our work, we have to be aware
of those factors which underline our actions. This calls for constant
awareness, mindfulness which we cannot achieve without practicing.
It is clear, for example, that if we cannot be aware our emotions,
we can easily commit hasty deeds. In the next paragraph I examine
Buddhist ethics as an example of an ethic which is based on practicing
the body and the mind. At the same time I will aim at showing
that ethics is not a matter to be taken too lightly!
Instead of ordinary morality and the ethic codes related to
that, Buddhist ethics highlights the practice of the mind in a
manner which makes us more aware of the processes which are crossing
in it: feelings, thoughts, desires and motives, which are all
factors defining our actions (Segall, 2003). Exactly like human
vision without equipment is an insufficient tool to examine the
moon, planets and stars, Buddhism considers an unpracticed mind
to be an unreliable tool while researching mental objects, processes
and the nature of consciousness.
In academic philosophy studying the so called ethic of content
usually means contemplating on ethical theories. The goal of such
courses is not to teach how to live a “good life”,
but what is meant by the concept of “good life”. Buddhist
ethics is not only chasing conceptual thinking, but “the
special practicing and researching of an open heart” in
that inter subjective space which in an open dialogue is built
between the therapist and the client (Swim et al., 2001). This
so called process ethics is based on practicing the mind and solving
existential, fundamental questions in an experience based
manner. Questions like this are, for example (1) What is
the meaning of practicing as the modifier of the quality of experience
and of deepened understanding? (2) What is the place of a human
being in the world, in the entity of being? (3) What is the nature
of “the self” or the ego? (4) What is the place of
compassion in being with fellow men? (Klemola, 2004).
When two people forget about themselves, they will see
each other
We work and live mainly in an ego-centered experience: we think,
plan, reminisce, and imagine all the time. Our minds are full
of different thoughts, feelings, recollections, representations.
As the client speaks, the therapist assesses, categorizes and
plans. When we practice mindfulness we can – if we so wish
– be aware of our inner speech, representations, and exist
in the present moment as it is, without distorting our perceptions
with our own theories or presuppositions. This means that we are
not only quiet outward, but that for a while our inner dialogue,
our way of talking to ourselves all the time has calmed down.
Practicing silence develops clarity, the ability to receive and
concentrate, in another words the qualities effective psychotherapy
always requires. This is not easy, but just like any other skill
it can be trained. Silencing our minds is also a political action:
at this moment we need less greed, anger and ignorance, instead
of more 5-year-plans or expansive profit thinking.
Anatta, egolesness, is one of the most central concepts of Buddhist
psychology, and one that a meditating person can directly experience
after meditating for a bit longer. According to it “self”
is not an internal entity, but a process which is constantly formed
by the changing sensations, thoughts, feelings, perceptions and
mental events (Fulton, 2008). It is about a process in which the
experience of the place of the “self” is gradually
changing. When “self” is forgotten in practicing therapy,
we do not ourselves guide our actions, but it is done by the situation
or the practicing itself. At that point there is no difference
between the doer and the doing, and the deed is characterized
by flexibility, security and influence. If we understand self
as a mere concept or image, not as an independent entity which
has to be protected and satisfied at any cost, things will not
shock us as much.
The idea that we need a strong ego in order to succeed in our
work and lives is due to the way we confuse attachment for ourselves,
for our own image and the strength of mind, determination, which
is imperative in realizing deep efforts (Richmond, 1999). It is
not worth it to prove oneself to the extent of causing damage
to oneself! The effort to always present self in a positive light
creates fear. Instead, surrendering to a cause makes one bold
enough to free oneself of anxiety.
Within presence, in the current moment our work does not unravel
from the therapist’s ego, but from the relationship between
the world and a person. When we as therapists experience ourselves
more and more as parts of the stream in our inner lives, the stream
in which the world and life express themselves through us, it
is possible to see things the way they are and not like we would
want or imagine them to be. When ego centrism decreases, the conflict
between subject and object is surpassed: something more profound
and more real than the everyday consciousness gets the possibility
to emerge.
There are two mind sets in human action which have to be in
balance in order for us to feel harmony, inner strength, joy and
devotion. They are the sets of doing and being. We do not often
take note of the mind set of being and its perfection in amidst
all the doing (Holmberg, 2004). A busy lifestyle is always throwing
us with centrifugal force away from the state of equanimity within
ourselves. In a performance oriented society the mind set of doing
becomes easily too dominating at the expense of the mind set of
being. The therapist’s and our clients’ internal well
being depends, however, on our ability to balance our need to
do and our inner capacity to be.
The unskilled skill of presence
The greatest battle in life is not against aging or time, it
is against becoming bored, against the routines, the illusion
of isolation and an unlived life. These wither our existence:
there is no more joy in the everyday life, nor excitement, joy
of working or happiness. Our life becomes a grey path,
spiritually withering place of performing necessities and routines.
When a therapist experiences her work as a spiritual practice
in which perceptions, feelings and thoughts become recognized
and then let go into the space of our consciousness, our spiritual
longing to experience the present moment strongly and freshly
is satisfied. Mindfulness dismantles and removes alienation and
the separation between a human and the world. When we in therapy
practice the full execution of our humanity we can in our work
stand before reality from moment to moment feeling amazement!
What does this mean from the standpoint of the therapeutic process,
the therapeutic system and relationship?
When practicing mindfulness the therapist’s power position
is effective but we are not in the center of the process. The
client will learn to recognize that a person is not the same thing
as her thoughts or feelings; she is more than just her conception,
image or story about herself. In addition to the members from
the client’s club of life(1), also issues experienced as
sacred can be invited into the therapeutic system. Thus it is
possible to build new stories which are richer and more meaningful
than before. The greater a space we are able to identify ourselves
with and also let this identification go the freer we are.
When a person is able to accept their experience in the present
moment, without reacting to it automatically, without rejecting
it or clinging to it, she is in a living contact to each moment.
When a therapist is able in a relaxed, uncategorized and uncritical
manner to face things as they are instead of mechanical reacting,
she is building a space between people for the richness of present
moment (Rasinkangas, 2007). When we maintain our attention in
the present moment, we can be sure about one thing: no matter
what we focus on in this moment, it will change, and give us a
chance to practice the skill of acceptance regarding whatever
emerges in the next moment. Tapio Koski, who has examined the
philosophy of running, makes an essential question for this point:
“How to practice in mindful and persistent way, but at the
same time without trying anything special?” (Koski, 2005,
p. 212)
_ _ _
(1) The metaphor of club of life comes from
Michael White. It evokes the image of person´s life and
identity as an association or a club. The membership of this
club is made up of the significant figures of a person´s
history, as well as the identities of the person´s present
circumstances, whose voices are influential with regard to how
the person constructs his or her identity. (White, 2008)
Conclusions
As a therapist I am like my reader and my clients. We are connected
to each other by the basic features of the conditional existence:
suffering, the impermanence of everything and the fact that nothing
has a permanent, innate nature. Not even the therapist’s
professional self. Things and events are “empty” in
that they do not possess any immutable essense, instrinsic reality,
or absolute “being” that affords independently. The
self is a process that arises when conditions support it and vanishes
when conditions do not (Fulton, 2008). This recognition of the
fundamentally dependent nature of reality – called “dependent
origination” in Buddhism - lies at the very heart of the
Buddhist understanding of the world and the nature of our human
existence. No phenomenon exist with an independent or intrinsic
identity: things and events in the world come into being only
as a result of the interaction of causes and conditions. When
selves are empty, arising in response to immediate experience,
we are all intimately connected and “each can only inter-be
with all the others” (Nhat Hanh, 2001, p. 55). The therapy
meets the family, but is created by the family; the family meets
the therapist, but is created by the therapist. The therapiast
creates himself or herself creating the client, and the client
creates himself or herself creating the therapist. As people we
are also likely to aspire to similar goals: balance of the mind,
peace and happiness (Rosenbaum & Dyckman,1996).
Practicing psychotherapy can be seen and experienced as an opportunity
to make every word and moment count: the encounter with a client
becomes a spiritual encounter for the therapist. By maintaining
mindfulness, avoiding ensnarement in transient states of desire
and aversion that might divert the therapeutic endeavor and by
employing compassionate speech, therapist is not just
learning in terms of becoming a better therapist, but in terms
of becoming more fully human. Capabilities cultivated my mindfulness
to notice the details of our behavior moment to moment is a way
of developing clarity about what is happening. This awareness
can itself be profoundly transformative. According to Olendzki
(Olendzki, 2003) Buddhist emphasis on ethics in behavior is not
a prescription for right behavior as opposed to wrong behavior,
but rather an intivation to notice the details and the nuaces
of one´s own behavior. Thus the wholesome skills gained
through mindful awareness of experience naturally flow into the
skillful execution of behavior. In the ethical exercise of doing
therapy, it turns out, that well-being itself is a skill that
can be learned.
The most essential in psychotherapy are not the terms and concepts
one uses to talk, but the thought-provoking space which is co-created
between people. Sometimes it is like a soft, peaceful windless
wind that brings you to a stop and revitalizes you. It also reminds
us of the fact that our work can at its best be inner touching,
in which the person touching and the person being touched are
in the end revealed as the inseparable parts of the same mystery.
Appendix A: Deep Breathing
Extend yourself a little bit. Inhale, count to three and experience
the inhaling. Hold your breath for three seconds. Exhale, count
to three and feel how the next inhale deepens and your exhaling
slows down. Note how the inhaling makes you peaceful and exhaling
brings softness. During the next inhale you can smile a bit internally
and while exhaling experience how your body becomes softer and
softer. While you inhale this moment is all there is. While you
exhale this miraculous moment is all there is. Do this exercise
at least two time a day.
Appendix B: Recalling
Bring yourself back to this moment by either redoing the earlier
breathing exercise or by some other manner appropriate to you.
Then recall a moment or moments when you have felt clearly being
in the present – experienced strongly your life force and
acknowledged what happens within you and around you. Do not strain
it, just let images flow freely into your mind. Where have you
been at that moment, what has happened around you? What in your
experience caused this feeling of highlighted presence? What could
you do before meeting your client and during the meeting to arouse
and maintain full awareness and presence?
Appendix C: We-dentity
Feel your breathing again for a while. Then return to your
mind a client with whom you are working with at the moment. This
person is a human creature who suffers, who has hopes and dreams.
She has also tried to be happy and maybe only partly succeeded
in it. She has contacted you hoping that you will be able to lessen
her suffering. Think about how reading this article could change
your way of being with her. Hold on to this person in your mind
for a while and think how reading this article can connect you
through your client into your dayly life? Do not worry if you
do not immediately recognize this connection.
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