Psychotherapy as a Practice of Everyday Life
By Don Hanlon Johnson
On March 23, 2000, Inner Eye announced the initiation of collaboration between CIIS and Tokyo mental health service agency Japan Institute of Psychotherapy (JIP) that would explore U.S. and Japanese contributions to the field of psychotherapy. Somatic Psychology professor Don Hanlon Johnson and Haru Murakawa '90 (East-West Psychology) are the project coordinators. In an update on the project Don says, "Haru and I just returned from a trip to Japan. I gave the lecture that formally opened the JIP at the Green Goddess Hotel in Tokyo on January 7, entitled 'Psychotherapy as a Practice of Ordinary Life.' We also visited the Toshiba Foundation, which is helping to fund a San Francisco visit in summer 2001 by Dr. Hayao Kawai. Dr. Kawai is the first Jungian analyst in Japan and director of the International Research Center for Japanese Studies in Kyoto."
In July 2001, several seminars, co-sponsored by CIIS and the San Francisco Jung Institute, will be held in San Francisco. Dr. Hayao Kawai will participate in two seminars, one on clinical sand play therapy and another that will be an intramural seminar for analysts and candidates. He will also give two public lectures/symposia. The first will address Asian spiritual traditions and Jungian psychology. The second will cover the topic of Japanese culture and Western psychology.
Below is the text of Don Johnson's lecture.
I link psychotherapy and everyday life in addressing the situation at the beginning of the 21st Century. I do that because it has taken nearly a century for the field of psychotherapy to find its own way apart from medical psychiatry and religious counseling with which it has been typically confused. It has finally shown its unique value as a way for adults to deal with the complex challenges of life in the world as it faces us now, at a point when religious and nationalistic conventions no longer contain the crises of ordinary life and death. And it found its way to its uniqueness first of all in America, for reasons I will detail, and offers the possibility of a rich dialogue with the much older wisdom traditions of Japan.
Only someone who had missed knowing anything about the 19th and 20th centuries by living in the wilderness, away from schools and books, would not know that it is foolish for a person in one culture to enter another unfamiliar culture and pretend to teach something of value on the supposition that it is superior to what they already have. Japan is an ancient culture of beauty, healing, and spirituality. I come from a young and rough people whose culture is only now being cobbled together. Like so many Americans, my ancestors were uneducated farmers and craftspeople who came to California during the Gold Rush, ferociously intent on leaving behind the languages and customs of an Old World where they suffered too much. I was the first in our lineage to attend college. Our culture is a patchwork, taking shape and gaining depth only very slowly over centuries, as it does in any culture. I dare to make these remarks with that wary sense of being from a world so much more undeveloped than yours, thinking that there may be something of value in our adolescent culture for Japan's ancient world. Perhaps Japan's relationship to the U.S. is like that of parents to our children; despite our age and experience, we can always learn something from the raw expressions of youth. Because children are as yet relatively unfettered by the bonds of convention, they are able to make surprising new formulations, come up with outrageous ideas that would not be allowed within the adult world of established ideas.
The influence of traditional Japanese culture on America is enormous, especially in the field of psychology. The cultivation of a quiet and discerning mind, a central element in the practice of psychotherapy, has been developed and articulated among Japanese teachers and scholars to a level far beyond what we have accomplished. The rich attention to aesthetic detail, the nurturing of the nonverbal aspects of imagination and sensitivity are elements in old Japanese culture which have deeply impacted American psychologists. My remarks about the American contribution are made within this sense of respect for the depths of the Japanese wisdom practices.
I want to address the peculiar nature of psychotherapy as a useful if not essential component of learning how to be an adult in the 21st Century. Psychotherapy is a distinctively new thing created within the past century with conceptual roots in philosophy, religion, and biomedicine. But a commonplace mistake has been to confuse this new practice with those older practices from which it evolved.
Religion and philosophy are the most ancient ways of dealing with the challenges of living. Throughout the histories of Europe and Asia, monastic practices and philosophical reflection have been fundamental ways of dealing with the meaning of life. They have been and remain powerful and essential aspects of developing one's soul. And yet, from the perspective of this moment in history, these old traditions of Buddhism, Shinto, Christianity, Islam, and Judaism, and even older shamanic traditions, have shown themselves inadequate in dealing with crucial areas of human development.
One such area is that of authority. The absolutist patriarchal notions of authority permeate every tradition, often leading to the extremes of cults like that of AUM in Japan and the Jonestown community in San Francisco, to mention only two more recent instances of a long history of fanatical behavior in the name of spiritual ideals.
At a more everyday level, the spiritual traditions have not had much to offer families going through the hardships of negotiating a marriage, and the challenges of successfully being parents. There are a host of commonplace problems—addictions, depression, conflicts with fellow workers, dealing with chronic illness—for which religious traditions have offered general help, but not the specific kinds of help that have developed within the field of psychology.
Medical psychiatry, psychotherapy's closest relative, is based on diagnoses of objectively defined disease entities, developed within the older more established biomedical models originating in Europe. It utilizes the brilliant array of discoveries about the cellular mechanics of human consciousness, in particular the increasingly sophisticated analysis of the organic roots of mental disturbances, and a variety of human dysfunctions, and the substances that might ameliorate their ill effects. It has made its advances, however, by a very deliberate and systematic elimination all of those aspects of the person that are viewed as subjective and idiosyncratic. The human being studied in biomedical psychiatry is the objectified human being, an object like all objects, more complex, of course, with its unique biological systems. But the daunting human world of personal experience, dreams, imagination, hopes and despair, will power, are not on the agenda.
Psychotherapy, by contrast, has come to show its uniqueness as a form of education for adults in their developing unique personalities. As essential as learning mathematics, reading, and writing, psychotherapy is for learning how to deal successfully with the challenges that any adult has to face: learning to care for oneself and for other people, especially one's loved ones; gaining control over one's intense emotions so as to be able to work effectively; being a good parent; coping with addictive tendencies; dealing with aging, sickness, and death.
Its beginnings were in late 19th century Vienna, Zurich, and Berlin. The radical and revolutionary insight of Sigmund Freud was that in addition to so-called mental diseases and spiritual malaise, there is what he called "the psychopathology of everyday life." He recognized that the realm of unconscious processes—dreams, fantasies, projections, raw impulses—is part of the makeup of every human being, even the most polite, seemingly well-ordered and successful. If those processes are kept in check and organized within a highly ordered social system, the adult appears to be a rational person. And yet, despite all the surface controls, the unconscious creeps out, willy nilly, in addictions, irrational fears, explosions of anger, suicidal and homicidal feelings, and on the social level, wars, torture, abuse of various groups of people perceived as other.
From Freud's radical perspective, the psychotherapist is not so much like a doctor as like a wilderness guide, helping the confused adult find his or her way through the poorly marked trails and scaling the rock faces of a territory that is known only in the broadest of outlines. Psychotherapy is just as important for learning how to be an adult—learning to love and work, in Freud's formulation—as are all the subjects that occupy the schools.
It was hard to see clearly the radical nature of that seminal insight for the reason that in prewar Vienna the institutions of education and healing were shaped by medicine and the Catholic Church. Deviations from formalized acceptable behavior were categorized by that society as sinful or sick, to be treated by religious or medical strategies, in the hands of priests and physicians. Psychoanalysis became the preserve of those few who were educated enough to recognize the unique significance of this new approach, and wealthy enough to travel to Vienna, Zurich, or London.
It was in the youthful United States that Freud and Carl Jung's foundational insights found a home where the new and unique character of psychotherapy could flourish on its own terms. We have a strong populist tradition that looks with skepticism at the old European institutions of medicine, law, and religion. The emphasis in the New World was on the freedom to assemble and discuss, town meetings, community control, personal freedom, and innovation. There were a plurality of healing methods warmly accepted: the folk traditions brought from Europe, midwifery, the healing traditions of Native Americans, and new experiments, not subject to medical scrutiny, such as chiropractic and osteopathy. Freud and Jung's view of psychotherapy as a means to personal freedom, a liberation from the bonds of family prejudices and fears, addictive tendencies, mechanical behavior, fit in well with the spirit in this new culture. Moreover, the emphasis on dialogue and free association—the heart of American democracy—created a climate of widespread direct verbal expressiveness which was unknown in Europe.
One of the first American psychoanalysts was a man named Trigant Burrow, who, although little known himself, had a great impact on Carl Rogers. Burrow, analyzed by both Freud and Jung, returned from Europe in the early 1900s troubled by what he saw as a European authoritarian residue contaminating psychoanalysis. He initiated a series of attempts to find a more peer-like style of counseling, which, while recognizing the need for skill in the therapists, would maintain respect for the adult resources within the patients themselves, not treating them as helpless children. Burrow was the first to emphasize peer group counseling with an emphasis on very specific bodily experiences. His spirit proliferated in many versions of psychotherapy: Carl Rogers, Harry Stack Sullivan, Heinz Kohut, Eugene Gendlin, and countless others. They all shared a vision of psychotherapy as a means towards gaining freedom from the mechanisms of past history and addictive patterns, with an emphasis on experience and individuality.
Yet even with this fresh American transformation of European psychoanalysis, it took decades to purge out old notions of emotional disturbance inherited from the old morality and religion. Psychotherapy was seen as for "sick" people, those with "nervous disorders," or those who suffered a "nervous breakdown." It was with some shame and secrecy that people saw psychotherapists. Anyone who had consulted a psychotherapist was thought to be unfit for public office. But slowly psychotherapy has come to be viewed more like elementary school education, an education in how to deal with the inevitable problems of becoming an adult, dealing with relationships with one's family and community, raising one's children, coping with depression, chronic illness, approaching death, etc.
Certainly, there is a place for crisis intervention, and psychotherapy will always continue to play an important role in that area. But more and more, with extended life spans and the inadequacy of religion by itself to provide guidance for the larger population, psychotherapy is a major help in becoming a healthy, well-functioning adult, an effective worker, and a kind parent. Psychotherapists in the present era function more like postgraduate educators, providing the basic tools needed to negotiate an adult life.
Given the uniqueness of psychotherapy as distinct from medicine and religion, the question arises of how to provide a training for the effective practice of psychotherapy. Because American universities are so much more flexible than the European—our curricula, even in the most traditional colleges, are changing all the time in response to new insights and research—we have had the opportunity to experiment with that question in very effective ways.
European graduate students in psychology, for example, have often enrolled in our program in San Francisco because they have not had the slightest training in how to work with people. They have exceptional intellectual knowledge about history, literature, and science, and of the specific fields of psychopathology and developmental psychology that are so necessary for practicing psychotherapy. But they don't have the faintest idea of how to apply all that marvelous knowledge.
I had the opportunity some 15 years ago to be one of three scholars chosen to draft new laws governing the education of psychotherapists in California. It was widely recognized by legislators, academic scholars, and public health officials, that a traditional education in abstract experimental psychology, and in abstract themes of the field of clinical psychology, was not at all sufficient. What was needed was a systematic education in a variety of so-called human qualities, which included such abilities as:
- listening carefully,
- observing nuances in non-verbal expression,
- communicating honestly with one's clinical supervisors and peers,
- warmth and empathy,
- flexibility in relating to different people differently, and in giving up ideas that were not workable,
- noticing one's projections and biases.
But a widely held assumption gets in the way of designing an appropriate training for psychotherapists. It holds that those human qualities and others like them are not learned educable abilities, that their acquisition cannot be accomplished by formal schooling. In this assumption, people come by those qualities or they don't. They are due to the luck of one's genes or parents or something beyond the educational process. And yet, it is the very development and proliferation of clinical psychology in the U.S. that has shown the falsity of this assumption. Clinical psychologists have successfully developed widespread replicable methods for learning such skills of being fully human. These methods are widely articulated in the psychological literature, established in clinical and educational research, and replicable. They are now widely taught in university and clinical settings, as well as in private institutes that offer such trainings. They have become part and parcel of what is thought to be a reputable education to practice as a licensed psychotherapist.
I want to emphasize the peculiar new elements that we, in the U.S., have seen as critical for the education of competent and effective psychotherapists. The emphasis is not on any particular school of psychotherapy, but on the development of those basic human qualities which are necessary no matter what the method. And cultivating the kinds of flexible and curious spirit that makes one capable of learning from the unique events of clinical practice, on examining what works and what doesn't work for particular clients in discussion with senior practitioners and peers.
The training we have designed for our collaboration between American and Japanese teachers, designed for Japanese psychotherapists, is focused on these elements:
Clear, direct, and honest expression. A psychotherapist's skill progresses primarily through honest and direct communication about the actual course of therapy with peers and skilled practitioners. This is not an easy task: some of us are afraid of exposing our weaknesses, which are in fact the rich soil of continuous learning. Others of us are afraid of retribution, that if we express our honest feelings and doubts, those in authority will look down on us, even to the point of dismissing us from our position in a clinic or school. The role of group process in the training of a good psychotherapist is not primarily a matter of learning techniques for use with clients, but a basic foundation for continuing to improve one's therapeutic skills. Particular emphasis in this program will be devoted to authentic communication with peers with an eye towards developing skills so that participants will be able to work effectively with each other throughout the long duration of the program, and to build an effective and personally satisfying community of working clinicians.
An emphasis on the non-verbal foundations of personality: gesture, movement, breathing patterns, dreams, feeling, emotion, with an eye towards helping therapists to be more fully present to their clients, instead of being absorbed in their own ideas of what should be done. Emphasis is on exploring the body as the dwelling-place of psyche and communal learning. In the U.S., there has been a remarkable flourishing of research in the importance of nonverbal behavior, and the meaning of nonverbal expressions. A well-known researcher in early child development, Daniel Stern, argues that the transition from preverbal to verbal behavior in the infant is a crucial stage. Failure to negotiate this transition in a way that maintains a sense of connection with the preverbal modes of expression leaves an adult with a profound sense of alienation. Much of the success of psychotherapy consists in knowing how to help people recover lost connections between the preverbal realm of body memory and feeling, and the later stages of intellectual notions.
The heart of the practice of psychotherapy, in contrast to biopsychiatry, is systematic and careful attention to the experienced relationship between the therapist and client during the course of the session, with particular attention to the ebbs and flows of the empathic bond. This is a radical theory that challenges an older notion of the ideal therapist's role as a detached observer. There will be special emphasis in this training on developing the empathic link between client and therapist, on boundary development, and power issues.
Great emphasis in the training will be on the development of flexibility in adapting to the needs of individual clients, rather than staying wedded to a particular approach.
Finally, the gap between experience and language. Crossing from highly personal experience to speaking about it is dangerous, fraught with temptations to buy ready-made phrases and the ideas of experts outside oneself, giving into the desire to please the other, to do what is right. A great work of the psychotherapeutic process is helping people slow down enough, learn to respect themselves enough so that they formulate carefully what it is that they feel moved to say. While the rush into speech and rational thought can lead to superficiality, the tendency to remain quiet in the realm of experience serves to diminish the capacity of non-verbal knowing to move into the larger world of community, challenging false, inadequate, and flimsy intellectual notions. Our training will put great emphasis on helping psychotherapists to learn how to speak carefully and close to the bone about their experiences so that they can help their patients do the same, and so that they can work profitably with their peers and supervisors in advancing their own skills.
This new millennium presents all of us with severe challenges; our personal and collective souls are in great jeopardy. I think that you better than Americans will understand when I say what I mean by soul is not some individualistic ethereal thing, but that dimension of ourselves which is connected with the whole, the seat of inspiration, imagination, love. That soul is in jeopardy when the forests are cut down, the water and air polluted. When countries like ours need so much oil to light these vast hotels and drive so many huge vehicles that we must support the destruction of tribal peoples to get the oil on which they have built their ancient cultures. At such a dark time, we need to combine forces to resist these dangers to our common humanity, a shared battle for the human soul.