Therapeutic Principles

Therapy is so vast that I fear to make any strong statement about it. So, it may be better to give some guidance that is still open.

Writing a few principles derived from different paradigms seems like a good way to start. This way, I can share some of the intuitions that guide me when I feel lost in my work.

They are different and shed light on various angles of my practice. In my case, ideas come to my head as I need them. I think this happens because I have done what I mentioned above; I entered the transitional space of the theories and lived with them for a while. Then, when I enter a mental puzzle that shares that tone, my mind seems to remember the theories attached to it.

So, I do not actually remember things. I wrote this list as I was practising, and afterward, I would say to myself, ‘Oh, this is something I used today,’ and then I would write the name.

Most of the ideas for Crea-Therapy emerged because I needed to stop working for a year due to health reasons. When I came back, I noticed my mistakes and lack of practice. So, I was conscious of trying to shape my skills again and started writing the things that made sense. It is as if they were new but came from before.

As I started writing these notes, I noticed I had many implicit ideas that I had not put into words before—they were part of my embodied practice. Many just came to my mind during sessions as I needed to understand my clients. I felt like my unconsciousness was helping me to come back to work.

The one core condition: Gendlin

From the work of Carl Rogers, we got a beautiful analysis of the therapeutic practice. He devised a few core conditions that could help therapists work better.

Over the years, I have found that implementing the six conditions is quite complex and sometimes contradictory. I think we can hold them all at high levels of development. Still, I have heard so many practitioners complaining that they cannot be unconditional in their love, with self-recrimination and suffering, that I was convinced something was wrong.

Until I read a paper by Eugene Gendlin, someone who worked with Rogers, when I understood the problem, Gendlin argues that person-centred has become a tradition of negatives, where you need to be unconditional in your regard and if not, you are wrong. And as you have six things to focus on, it feels quite oppressive and does not leave space for exploration and play.

He says we should focus only on one condition: psychological contact.

This means that we can attain the other conditions if we keep close contact with our clients and understand their feelings from moment to moment. As long as we do that, we can be empathetic, understand our clients, and, therefore, have an unconditional regard for them.

Conversely, if we lose sight of our psychological (and relational) contact, we start to make mistakes. Maybe a big part of the problem is that we start trying to fulfil these conditions, and our attention gets diverted. If I try to be unconditional, I may lose sight of my frustration with the client and push it down. Then, I lose my coherence, authenticity and empathy as I repress my frustration with the client.

Many confuse positive regard with having loving feelings towards others. In my experience, that creates many problems. Part of the practice is accepting our feelings, which are not always positive. I see unconditional positive regard as something more abstract, a disposition of acceptance and understanding, a bit more cognitive than love and compassion. This disposition allows us to keep contact with others, even if we are angry, frustrated, loving, etc. It is more cognitive because it comes from the realisation that once you understand others, you start ‘kind of’ loving them or ‘kind of’ loving your problematic areas. The ‘kind of’ here is crucial because it goes beyond hate and love. I still hate my trauma when I love it from this more immanent/abstract place.

Digesting experience: Bion

Bion is a psychoanalytic author who tried to create a mathematical model of the unconscious. This abstraction allows me to understand some therapy processes in a way that I can apply to multiple contexts.

In simple terms, we have experience in raw form that needs to be digested. When it cannot be digested, we have problems that come from the unconscious.

It is how therapy works; clients come with a non-digested experience, and we help them digest it better.

In Bion's terms, we have Beta elements inside that are somewhat chaotic. If we have many, that creates stress and unconscious expressions. We also have the Alpha Function system, which helps us digest those elements. Tomas Ogden called the alpha function the container. It allows the therapist to digest their own and others' experiences. Then, the Alpha function creates Alpha Elements that are more tidy and integrated inside.

Bion's perspective is quite cybernetic, as it describes functions and objects; many authors use a cybernetic spin in psychoanalysis.

To conclude, as we help others digest the experience, they grow in their capacity to do so and then can do it themselves.

In Bion’s, these objects are not individual, but they can pass through between therapist and client; therefore, a therapist can digest a client's ‘identificative projection’. In concrete terms, the therapist may start dreaming dreams of their clients or enacting some of their conflicts. This idea is more complex, so please do not delve here if it feels too weird or mystical. But it is the abase of many psychoanalytic versions, like relational psychoanalysis, intersubjective psychoanalysis, and others. It has also been developed as contextual phenomenology, therapeutic enactment, analytic third, and relational space.

Weaving the Unconscious: Lacan

I will use the late Lacan idea that the unconscious works like knots, which he used when he started studying topology, replacing his linguistic model.

In simple terms, unconscious structures form knots between different registers. When those knots are not well-formed, we have weaker structures; when they are broken, we have worse symptoms.

In therapeutic terms, I like these images when I am working with clients and helping things make sense. Sometimes, I narrate an experience with concepts, or with symbols, or maybe with some emotional resonance. One of my working models is that we are weaving unconscious structures by naming things and linking them to what the client brings.

The three registers of Lacan are the Real, Imaginary and Symbolic. These three need to create a Borromean knot; a common image of it is in Celtic knots, where you see three points and a little space form in the centre. These knot breaks if one link does so, as the four spaces are created with only one string.

This is a metaphor for our mental structure, which emerges from one substance and creates sub-domains.

The three registers refer to areas of our experience, or at least that is how I read it.

Real refers to a raw experience that has not been symbolised or converted into a meaningful experience. Looking at my living room now, I see a couch and a carpet. By doing some phenomenological work, I can focus on the textures instead of the couch. In this way, I strip my experience of some symbolic structures, getting closer to Real expertise.

In trauma and horror, we tend to experience the Real. Something in our experience does not fit into any scheme, symbol, or word. As we cannot tie a knot, that experience remains isolated in the unconscious and creates problems in the weaving of our experience.

We therefore need to weave these raw Real into a knot that encompasses the Symbolic and the Imaginary.

The Imaginary is easier to explain, like the front end of a website. It is how we see the world, the experience we can name to our friends, like ‘I see a couch and a carpet’, and you understand what I mean by that. Weaving into the Imaginary happens when we use concepts and narratives to make sense of an experience.

Weaving the Symbolic is more of a traditional psychoanalytic space. I see it as our dream-like experience, our metaphoric mind. A couch is a couch and also a space for gathering and resting. A couch may represent therapy if it is a chaise long or may represent something sexual. It has metonymic and metaphoric connections that move symbolically in our unconscious.

Weaving this area in session happens more in implicit communication than explicit communication. You may ask about dreams and analyse those, but when I ask a client, ‘How are you feeling on the couch?’ or ‘Would you like a blanket now that you are feeling fragile?’(with less words, probably), I am carrying a human symbolism around a couch that goes beyond the Imaginary and Real. I habitually understand these concepts more holistically, so I see the Symbolic as also an embodied space that starts with significative interactions in the world. It may also carry social symbolisms and relationships with the big Other and with structures of Desire in Lacan’s ideas. I will not delve into those here.

A theory for life and chaos: Valera

Francisco Varela is a neurobiologist who also practised Buddhism, read lots of philosophy and was friends with many neuroscientists, as well as with the Dalai Lama. He organised a series of events where the Dalai Lama talked with leading neurobiologists, which led to the current adoption of Buddhism among most Cognitive Behavioural therapists.

Varela started working with an essential question for our times: what is the difference between living systems and machines? This led to the development of a biological theory of human understanding in the book The Tree of Knowledge.

I feel the need to introduce Varela, as he is not one of the famous authors on psychotherapy. He married a therapist and developed multiple concepts that bridge the divide between psychology, therapy, philosophy, and biology.

A brief model of complexity is that chaotic systems create some recurrences that then create more complex emergencies. Varela used complexity theory to develop most of his ideas. One of the main differences in biological systems (vs mechanical) is their self-emergent properties and self-maintenance of that emergence. This means that life self-organised from molecules, self-organised again to create reproduction, and self-organised again to generate behaviour and consciousness.

Varela saw consciousness as a chaotic system that synchronises to create consciousness and then needs to desynchronise to allow a new moment of consciousness (all this based on EEG experiments). Every moment to moment, we have a pick of synchronisation in our brain, followed by another desynchronisation through the brain.

Life follows a similar pattern of chaotic cells that slowly create groups with properties more complex than the original components. It creates emergencies, meta-stable planes that nest one inside the other. These describe the capacity we have to create organs with individual functions out of cells with the same genome. After a while, life starts desynchronising and coming back to chaos.

In therapy, we see the same process. From chaos, we start seeing some patterns. Patterns of relating with one another. Patterns of speech. Patterns of dreams.

Those patterns start to talk to us about some meta-stable properties of the system (our client, our relational space). Meta-stable means that the parts are created, which are properties that can be seen from a more abstract plane. They are stable only from that vantage point, as you can only see organs if you zoom out from the cells. These emergent planes are fragile, only sustained by the systems below them. This means they dissolve if the parts stop collaborating.

If we apply emergent theory to our practice, we can see that our relationship with the client can dilute or evolve. Our interpretations may create a coherent whole or start crumbling into chaos. Therapy lives in a subtle, fragile space of chaos and emergency, and we need to tune into that beautiful fragility emerging between us to follow its evolution.

The chaotic base of consciousness is scary and also gives me hope.

Because what holds our problems may be repeating something from the past, it does not allow chaos to refresh, new emergencies to take shape, or new developments to unfold.

Meta-stable structures are fragile, and we only need to question some constitutive parts for the whole to scramble. Conflicts are, therefore, delicate, and we must be careful when we break them, being there to hold our clients as a new form slowly emerges.

I find it hopeful that we do not need to challenge the whole problem. Instead, we may start changing the problematic dynamic by isolating one part and then letting the entire system re-organise in a new shape. Chaos may be scary, but it is also the source of new creations and complexities.

This trust on the part helps me to understand why therapy can be so varied and still effective. Whenever we focus on one area, we do not neglect the whole; we isolate a piece to change and then let the system re-adjust. One part talks to the whole.

Fear of Breakdown: Winnicott

We fear a breakdown.

Do we?

Winnicott had a striking proposition: we do not fear the breakdown, but we fear a breakdown that has already happened in the past that we cannot remember.

We need to re-live the breakdown to stop fearing a nameless, memoryless trauma.

Winnicott narrates moments when he would hold his clients physically, as he noticed many needed to re-live early life traumas. He did not have a paradigm that separated mind and body; quite the contrary, he saw the true self as a spontaneous gesture from the body's tissues.

This view resonates well with current trauma practices that have been arguing for a more embodied way of working with trauma and therapy in general.

The now-famous book The Body Keeps The Score has shed light on the importance of considering that trauma may not live in our consciousness and may stay hidden in our tissues.

This idea also brings an important and challenging concept: we need to re-live, re-enact, to process our past. It is not enough to have a cognitive, verbal understanding of our trauma because the fear of breakdown can be paralysing in our lives. We do not live our whole lives by understanding it. We do not heal trauma by narrating it.

What I am bringing here is a Winnicottian concept: the True Self. The idea is that we have some instincts that need to be present for us to feel ourselves. That there are fears that stop us from feeling ourselves.

The contrary of this fear is to have a creative life where our unconscious instincts are present in our daily lives.

As I wrote in one of my first papers, Winnicott shifts the order of priorities when he writes about therapy and creativity. We may wonder if therapy must be a Creative practice instead of creative practices being a tool of psychotherapy.

A life without fear of our minds is a life when we can trust our instincts and body feelings. A life where we have our traumas as such and not as a fear of a future that has already happened.

This therapeutic principle may be resumed as follows:

Search for your client's creativity and spontaneity as healthy traits. Explore fears as if they had already happened. Be open to re-experiencing trauma to process the unnamed.