Buddhist philosophy · Buddhist psychology · clinical mindfulness · integrative psychiatry · mental health · mindfulness · mindfulness interventions · nondual mindfulness · psychological inquiry · psychology · psychotherapy · somatic psychotherapy

Intersubjectivity and Interdependence

Recently, a colleague shared the following, “I am more and more tuned into the reality of separateness, gradations, distinctions. I think we are being hoodwinked by this idea of universal oneness. This feels particularly true when working with patients, where I find most significant change occurs from investigating distinctions and details.”

While I agree that in-depth exploration is critical for insight, contrasting that process with notions of universal oneness rings hollow for me. And that common mistake may simply be due to widespread misinterpretations of ‘oneness’; most especially the Buddhist concept of emptiness or interdependent co-arising. Although emptiness is a concept, therapeutic dynamics provide a real-time example of how interdependent co-arising actually manifests in human experience.

The Intersubjective School of Psychoanalysis hypothesized an intersubjective field continually mediating bidirectional knowing between psychotherapist and patient. Intersubjectivity enables a psychotherapist to empathically use their entire psychophysical system to receive and mirror a patient’s cognitive-affective-somatic material. That form of empathy or therapeutic attunement, is the primary process through which a patient feels known. So, although a psychotherapist may deliberately direct patient inquiry, intersubjectivity tells us that both parties are equal participants and influencers in the therapeutic container’s ebb and flow.

Acknowledging that apparent interdependence does not discount or negate the appearance of two separate participants. Each exists from their own side in a relationship of mutual influence. Nagarjuna, the progenitor of the Middle Way School of Indian Buddhism argued that emptiness rests on two principles: (1) things/selves in the world appear nominally, and (2) because of their impermanence, interdependence and insubstantiality, these entities lack any essential (svabhāva) nature.

For example, take the device you are reading this blog on. If it was self-existing, it could not be broken down into its parts—cover, screen, content, matter, particles, quantum information and so on. It is no more than a so-called object, interdependently linked to nominal parts similarly lacking any essential nature. Though the device does have conventional or relative existence, it also cannot be found to ultimately exist separately from its myriad parts.

Similarly, though the therapeutic dyad includes two separate beings, the therapy itself is an intersubjective, co-created process. Co-creation widens the menu of possible perspectives and makes possible successful interventions that decrease systemic reactivity and increase capacity for in-depth inquiry. Mutual influence and co-creation till the soil that yields embodied awareness and cognitive-affective-somatic openness. Such that self-fixation and its concomitant feelings of separateness fall away; and along with it the oh, so ubiquitously harmful distorted notions of self and world. Clearing those obscurations of mind is not only the optimal path to less cognitive-affective-somatic distress, but also increased tolerance and connectedness with all other beings.

health · healthcare · mental health · psychological inquiry · psychology · psychotherapy · wellness

Psychotherapist as provocateur

Provocateur: a person who provokes dissension; agitator.

Effective therapeutic change must include pivotal moments of therapeutic provocation. Yet we all know patients most love psychotherapists that make them feel good. But honestly unconditional positive regard only goes so far and therapy that focuses on producing good feelings is ultimately unhelpful and frankly dishonest. Why? Because real change rests on the hard work of facilitating mental clarity, humility, uprightness, and fierce compassion—not just in the patient but also in the mental health professional. To accomplish that task, a psychotherapist must be willing to call patients on their blind spots, their hubris, avoidance, and plain old bullshit.

Yes, that can be uncomfortable and possibly confrontative. Therefore, a therapeutic professional has to look deeply at their own blind spots, avoidances, hubris and bullshit with courage and compassionate regard for basic human suffering. We are fallible humans too.

Some of that blind spot work involves honest assessment of whether one is clinging to pleasurable feelings that arise from being a patient’s good gal or savior. Ouch! Even writing that sentence elicits feelings of disgust when I consider how much harm is done to a patient when a psychotherapist is lost in their own ego fixation. That is the worst form of therapeutic unconsciousness.

I remember many years ago reading Irvin Yalom’s, The Gift of Therapy. This manual on how to skillfully accomplish self-disclosure blew my mind and showed me the value of continually assessing the best interests of a patient and acting solely on that. Sometimes I don’t know or I can’t decide what is in their best interest. That is when I ask them directly.

Often asking involves provocation in one form or another. Provoking by questioning a blind spot or naming an oft-discussed avoidance. Even directly pointing at hubris, assumptiveness, or outright disownment of responsibility. This kind of provocation for the purpose of clear-seeing can frustrate or even anger a patient. Anger shows they trust you. So rather than backing away in fearfulness, lean in to skillful inquiry.

It’s like surfing a wave of habit reactivity on a surfboard of mutual curiosity about the patient’s feelings. All while inviting them to join you on the surfboard of openness to accomplish shifting reactivity to responsivity. Not rejecting; not accepting—this is the way to model equanimous provocative inquiry that leads to wisdom and transformation.  

And best of all, this process allows a psychotherapist to model fearlessness and facilitate movement away from defensive eruptions and into intentional, deliberate engagement with confused or distressful thoughts and feelings. For me, that movement produces the most change. Change born from a patient skillfully facing their own internal provocations and realizations with or without the psychotherapist.

integrative psychotherapy · mental health · polyvagal theory · psychological inquiry · psychology · psychotherapy · Somatic Experiencing · somatic psychotherapy · Trauma · trauma healing · trauma therapy

Uncoupling excitement from danger

Though this Somatic Experiencing® intervention is not discussed widely in SE™ circles, I consider it one of the most critical steps for resolving long-standing systemic trauma response. A history of early (0-6 years of age), repeated, traumatic experiences are easily identifiable in adult autonomic nervous system (ANS) dysregulation. The primary sign is minimal capacity for sympathetic nervous system (SNS) arousal.

SNS arousal is not bad nor it is an indication of something wrong. For instance, awe-inspiring, meaningful, interesting, or joyful experiences are arousing. The body needs SNS arousal to accomplish any activity that does not fall under the category of ‘rest and digest’ homeostatic function. Many forms of overcoupling are common in early developmental trauma (EDT) response—including overcoupling of SNS arousing states of excitement and danger.

To a very young brain, most experiences are novel. Inherent in novel experience is a quality of excitement. That means interest, exploration and play are often encoded in memories of EDT events that most adults would only consider frightening, egregious, and morally corrupt. Very young children don’t feel danger until they are directly threatened, disturbed, terrified, abandoned, or physically harmed.

This intermingling of novelty, excitement and danger can be difficult for adult survivors of EDT to accept–especially when memories are laden with disgust, shame, terror and anger. A good example of excitement/danger overcoupling is in sibling sexual abuse where a tween sibling frames perpetration on a much younger sibling as ‘play’. Initially the novelty and attention can register in the young victim’s brain as an exciting experience with no negative valence. Yet, that can shift to fear, confusion and resistance at any point during a particular perpetration event or with successive events. Overcoupling of excitement and danger increases with each successive perpetration. Eventually novelty and excitement fall away and what remains is high-dorsal vagal freeze—(a parasympathetic nervous system (PNS) safety response)—because small children can rarely run from or fight off an older perpetrator. Proliferation of successive events increases excitement/danger overcoupling in SNS dysfunction.

Obviously the first intervention is helping a patient conceptually understand excitement and danger overcoupling, and then facilitating increased capacity for presencing the body-mind system’s low threshold for excitatory body sensations, thoughts and feelings. That is the ideal time to introduce SE™ pendulation skills for initiating parasympathetic deactivation, which eventually actuates healthy SNS/PNS cycling.

I feel such joy when this work results in a patient report that includes something like, “This week I actually felt excited and just let it happen without worrying something bad would occur or I’d become so overwhelmed by good feelings. It is so freeing to not be scared of my emotions… even the good ones!”

In summary, early repeated traumatic experiences impede our natural capacity to tolerate systemic aliveness. Uncoupling excitement from danger allows the ANS to move more readily, willingly and easefully between SNS activation and PNS deactivation.