My Theory in a Nutshell
Montage by Victor Bloomberg, January 5, 2023
There is a quality of emotional experience which is essential to transformative psychotherapy. Think of a time when you cried and the person with you was supportive and safe. Afterward, you felt better; you might have better been able to talk about it, gaining a new perspective. The term that I use is emotion response cycle and the cognition that heals occurs during the post-wave repose. Emotion response cycle is my term, based upon a model of the sexual response cycle (Cleveland Clinic, 2017.) Now think of a time when you cried and a person responded aggressively, punitively or dismissively. Once the tears stopped there was not a feeling of well-being and talking was not helpful. In this situation, the tears resulted from spasms.
The healing release of emotions is intertwined with learning. This question does not apply: Which comes first, the chicken or the egg? Emotions and learning ebb and flow, build and crest, churn and settle. With this in mind, let’s look at transformative learning from the field of higher education:
“The central focal point and power of transformative learning is a fundamental change in perspective that transforms the way that an adult understands and interacts with his or her world. Reflective thinking is the foundational activity that supports and cultivates such perspective transformations.” (Wang et al., 2016, p. 43)
Transformation is observed in the psychological development of the individuals and their changed social relationships. Talk-therapy can lead to it.
We can connect our clinical methods to three distinct goals:
1. Crisis intervention to stabilize.
2. Strength-based problem-solving to improve a situation.
3. Experiential process to change beliefs about oneself.
The third goal is associated with transformative psychotherapy. The first pair are woven in. The greater our success in personal growth, the fewer our problems will be that require solution-focused counseling and there will be fewer crises that are avoidable.
“Avoidable crisis,” what’s that? Avoidable crises arise from reflexes, habits and choices that can be changed.
Unavoidable crises, I am sure that you do not need me to give an example. A crisis of any kind, we all know, can motivate a person to seek psychotherapy. Once a person has stabilized and their situation has improved, there can be motivation to continue. The goal has expanded beyond a specific situation. It is a transformative goal.
I’ve listened to psychotherapists talk beautifully about transformative psychotherapy. Three clinicians described it in different ways:
“She draws with Cray-Pas and then paints over it… blocks them out. And then she goes back in with the Cray-Pas. And not only is it rich and beautiful and textured, but there are layers and layers… and little by little her images have changed… she had always been drawing and painting these eyes. With her history it made sense to be vigilant. The eyes turned into fish swimming in the water with a beam of light shining down. Talk about a transformation! In this kind of process, the images often appear in the work before people acknowledge what it is. It’s an amazing thing.”
“The healing happens… because we develop, ideally, a safe attachment… That challenges a lot of what they believe about themselves. So there I am somebody who sees something other than what they see in themselves, ideally something more positive, strength-based, resilient. This relationship is trustworthy, it’s consistent and it's transparent. And I, client, feel valuable in it, I feel valued, I feel seen, I feel important. And when I have one of those experiences in my life, duplicating something is easier than creating from scratch. Now that I know what that feels like, I shift just a little bit in my belief about myself… And then they begin interacting in the world differently.”
“I give them an opportunity for reflection on their own journey… to sit with that realization and see how it settles in their body. I want them to have a little more body awareness of how they process things. Our lives, emotional and psychological, are not all in our head, it’s in our bodies as well. That is also a clue about where we’re at during various points in our lives, how our body is reacting. It’s all connected, mind, body, and I use the term spirit as that other awareness that isn’t as tangible. That is part of what being human is.”
These three clinicians have touched on qualities inherent in personal growth. But there is an overarching context that is missing. Personal healing often coexists with ongoing injury caused by personal transgression, social injustice and societal oppression.
One way to view transformative growth is the individual’s orientation to oppression that is structural, systemic. Such oppression comes into view as we bear witness to the inescapable impacts that our clients encounter; we are at our clinical best when we respond to manifestations of “internalized oppression.”
Internalized oppression is a concept that most people can grasp on vaguely or intuitively, if at all. My approach draws upon a formulation of Herbert Marcuse (2002, p. 202), “Multi-dimensional language is made into one-dimensional language, in which different and conflicting meanings no longer interpenetrate but are kept apart; the explosive historical dimension of meaning is silence.” In session, it is common that a client uses one word for a tangle of thoughts and emotions; we untangle the threads. The ball of yarn includes the connection between personal troubles and social issues (Mills, 1959.) Sometimes, personal transformation leads a person to actively engage in action to create social justice (Brown, 1973; Freire, 1998; Jacoby, 1975; Martín-Baró, 1996). The perspective requires a belief, “I can make a difference” and the motivation to do so. The same belief and motivation applies to changing one’s personal conditions. The belief and motivation requires self-love, “I am a human being, my dignity is inseparable from my spirit.”
The contrast to self-love is self-loathing and it often manifests by a destructiveness directed at others. The polarity is discussed in “I and Thou'' by Martin Buber (1970) who calls the duality “I-You and I-It.”
There is a polarity in the quality of emotional experience: an emotion response cycle versus spasms. I-You is essential to the emotion response cycle. I-It yields spasms. The emotion response cycle flows from safety, trust and respect (I-You); spasms flow from insecurity, doubt and disregard (I-It). Transformative psychotherapy generates a recurring emotion response cycle by generating safety, trust and respect.
Healing occurs when emotions are released and then the individual relaxes and, while in repose, thinks anew (freed from some toxicity of the past injury.) With interns and clients alike I call this “surfing” which is shorthand for emotional response cycle. In contrast, injury and a spasm flow from insecurity, doubt and disregard.
In his seminal treatise, Buber provides a nuanced explanation that informs my understanding.
“For the real boundary, albeit one that floats and fluctuates, runs not between experience and not-experience, not between the given and the not-given, nor between the world of being and the world of value, but across all of the regions between You and It, between presence and object.” (p. 63)
I refer to Buber’s “floats and fluctuates” as the Thing-Person Swing and I emphasize the essential influence of the “world of value” such as beliefs, schemas. Schemas (core beliefs) “[are different from] underlying assumptions (conditional beliefs) and automatic thoughts [that are temporary]” (Padesky, 1994, p. 267).
The role of beliefs in the Thing-Person Swing is important to transformative psychotherapy. Imagine a client believes that an entire population is subhuman, a type of Thing. As soon as Thing classification is applied, the client is in I-It orientation. For its potential to be realized, transformative psychotherapy cannot ignore the belief. Please keep in mind as background context Buber’s “I and Thou” and my concepts of an emotion response cycle and the Thing-Person Swing.
I have chosen three theories – Psychodynamic Psychotherapy, Interpersonal Psychotherapy, and Cognitive Behavioral Therapy – to provide additional foundation for discussion of my theory. My purpose is to give you the heritage that I have drawn upon to form my own theory.
Psychodynamic Psychotherapy
“Psychodynamic” is a term used by clinicians who are not trained by a psychoanalytic institute, their theory and methods deviate from psychoanalysis, even as they use key psychoanalytic principles. An intern asked me, “When do I use psychodynamic ideas and how do I know they work?” I replied, “Theory guides your recognition of patterns, but interventions are guided by client priorities and clinician experience.”
Psychodynamic theory and methods developed from psychoanalysis. For this reason, I begin with a brief discussion of psychoanalytic theory and methods.
Psychoanalysis is aligned with ideas and practices established by Sigmund Freud (Brandell & Schechter, 2014). Psychoanalysis relies on the interpretation of transference.
“[An] unconscious idea, as such, is quite incapable of entering the preconscious, to which it transfers its intensity, and that it can exert an influence there only by establishing touch with a harmless idea already belonging to the preconscious, to which it transfers its intensity… This is the fact of transference.” (Freud, 1938, p. 507)
The interpretation is focused on repression. Repression is indicated by resistance. Interpretation is a way of surfacing conflicts in the unconscious; free association is a cornerstone method.
“A psychoanalyst who might be asked to give very briefly the essential principles of psychoanalysis could say that the recognition of the significance of childhood history for personality development, the teachings of transference and resistance, and above all, the establishment of the unconscious as an integral part of the human mind constitute the essence of psychoanalysis.” (Fromm-Reichmann & Bullard, 1960, p. 105)
Karen Horney, a founder of the Berlin Psychoanalytic Institute, provided some of the earliest formulations that deviated from Freud (Horney, 1967). She focused on the emotions of an individual which have conflicting characteristics and the person’s adaptation to the conflicting impulses which occur beyond the conscious awareness of the person (Horney, 1939, pp. 23-25).
There are two other early psychoanalysts whom I see as bridges to psychodynamic psychotherapy. They posit conflict between unconscious impulses and the conscious self. But their methods do not rely on interpretation of resistance. They are Carl Jung and Harry Stack Sullivan.
Carl Jung parted ways with his mentor Sigmund Freud, partly over the purpose of psychoanalysis. Freud was interested in resolving symptoms caused by a patient’s unconscious conflicts (e.g., neurosis). Carl Jung began to work with awareness as a means to mobilize the unconscious for creative purposes, he introduced the method active imagination (Jung & Bennet, 1968):
“[Everybody] gets at it in his own way… imagination is active, purposeful creation… [Active] imagination, as the term denotes, means that the images have a life of their own and the symbolic events develop according to their own logic – that is, of course, if your conscious reason does not interfere.” (p. 192)
Jung considered the four functions of consciousness to be sensation, thinking, feeling and intuition. These serve a person’s interactions and understanding of the external world. He posited features of “personality which is still unconscious, which is still becoming; we are unfinished; we are growing and changing” (p. 22). It seems to me that Jung suggests that a person cannot realize their own potential, self-actualize, if their beliefs about themselves thwart their own desires; a person is often not aware of their own self-defeating beliefs, unconscious conflicts.
Harry Stack Sullivan was a psychoanalyst who described the relationship between patient and doctor to be the basis of treatment. The interpersonal experience is inseparable from the nature of transformative psychotherapy; the clinician is a “participant-observer” (Morgan, 2014; Sullivan, 1953). “What one observes is a situation, ‘integrated’ by two or more persons. The situation is an interaction, an integration, or rather an integrated interaction of two or more people” (Sullivan, 2018, p. 280). It’s my view that Sullivan laid the path that became psychodynamic psychotherapy, because interpretation became focused on the relationship not as a manifestation of resistance but rather as an experience of personal growth. Unconscious conflicts begin with the individual’s origin story, thereafter personal development is bound by the conflicts. Interpretation of the relating (rather than the transference) loosens the bindings.
Karen Horney’s focus on conflicted emotions, Carl Jung’s concept of active imagination and Harry Stack Sullivan’s views on the therapeutic relationship provide a foundation to understand Interpersonal Psychotherapy (also referred to as Humanistic Psychotherapy.)
Interpersonal Psychotherapy
Humanist Psychotherapy firmly established the interpersonal approach. It focuses on a person’s individuality. The emphasis is on a person’s ability to use strengths to find wisdom, growth, healing, fulfillment (Humanistic Therapy, n.d.) Therapy is “person-centered” and therapeutic results are achieved in the context of the relationship (Rogers, 1995; Rogers, 2012.) Authenticity, empathy, and “unconditional positive regard” manifest effective use of self in the psychotherapy. Unconditional positive regard is an attitude of unqualified acceptance of the person, empathy is understanding of feelings and experiences, and “congruence” is Roger’s term for authenticity (Tilliman, 2016, p. 13)
Rogers published his ideas about client-centered therapy in the aftermath of World War Two (Rogers, 1946; Rogers, 1951). In my view, the approach’s effectiveness can be understood to provide conditions for the emotion response cycle.
Unlike Rogers, Maslow connected his theory with the heritage from psychoanalysis (Maslow & Murphy, 1954; Maslow, 1968). Maslow, in A Theory of Human Motivation (1943), discussed human suffering in terms of thwarting essential needs; the needs engaged by interpersonal psychotherapy are safety, love, esteem, self-actualization. Maslow also uses the term “full-humanness,” being and becoming to denote self-actualization (Maslow,1968, p. vii).
Maslow’s notion of self-actualization points to the idea that I want to convey with the term “transformative,” it connotes changed perspective and beliefs about one’s self, interpersonal experiences and the wider world. My view dovetails with the psychoanalytic heritage that Maslow acknowledges as important to his understanding of psychology. A person cannot realize their own potential, self-actualize, if their unconscious beliefs are thwarting their motivating desires. The concept “belief” leads me to discuss Cognitive Behavioral Therapy.
Cognitive Behavioral Therapy (CBT)
The psychotherapist who developed Cognitive Therapy, Aaron T. Beck, was a trained psychoanalyst; like Carl R. Rogers, he separated himself from it. His theory and methods are more widely known and practiced as Cognitive Behavioral Therapy (CBT) because clients became better emotionally and behaviorally when they “changed their underlying beliefs about themselves, their world and other people” (Beck Institute, 2015). CBT is closely related to Rational-Emotive Behavior Therapy (REBT) that “served as a sort of precursor to the widely known and applied Cognitive-behavioral therapy (CBT), and [it] is still commonly used as a treatment in CBT interventions” (Albert Ellis' ABC model..., 2021, para. 2).
CBT methods are specific to the diagnosis (Madewell & Shaughnessy, 2009). For example, the Veterans Administration provides training tailored for the treatment of depression, the manual’s core premise is that an event leads to an automatic thought which generates a reaction (Crane & Watters, n.d., p. 8).
Why am I including CBT in this discussion about transformative psychotherapy? Its theory and methods target behavior and cognition for specific sources of distress. Emotions are expected to improve when thinking and behavior change. CBT can bring forth and/or sustain transformative results, that’s why I’m including it. Here’s a story from my life to illustrate: There are times, having read my face or tone of voice or body posture, that my spouse says, “You’re not in trouble.” In the early days, I might snap back, “I know I’m not.” Now, I smile and say, “Thank you.” My own story is about a cognitive intervention in everyday life, rather than in session with a therapist. Previously I told you about a personal schema, a belief that I’m somehow not as good as others. That belief now is like a recessive trait. Recessive trait is an "inherited trait that is outwardly obvious only when two copies of the gene for that trait are present… The recessive condition is said to be masked by the presence of the dominant gene when both are present. (Gale Encyclopedia of Medicine, 2008.)” But the companion reflex lingers, that trouble is around the corner. The cognitive intervention interrupts the behavioral reflex.
Behavioral change and cognitive reframe are interwoven, congruent with and inseparable from the whole of our physicality which changes from a special kind of emotional release. There can be transformative results.
My Theory in a Nutshell
The potential for transformative change during talk-therapy is realized through the recurring I-Thou experience of the client interacting with the clinician. I-Thou is a philosophical construct about the perception by one person of another as a human being, the opposite is an encounter with an I-It object (Buber, 1970.) Intersubjective I-Thou experience engenders an emotion response cycle. Intersubjective refers to “shared meaning that emerges from, enacted within the social fabric of interaction (Garte, 2016, para. 1).” The emotion response cycle requires safety, trust and respect - this experience is nurtured by the psychotherapist. During the cycle, emotions are released and thoughts become fresh. Gains are consolidated in the client’s I-Thou orientation in relation to their own self: I am a Person, not a Thing. I-Thou is not achieved as a steady-state, rather it “floats and fluctuates” (Buber). Transformation is evidenced when the Person-Thing Swing favors I-Thou. The client becomes increasingly skilled at recognizing objectification in the here-and-now and in reflection. The skill is essential to leave Thing-Land and return to the Land-of-Humanity.
