The Art of Presence in the Therapeutic Encounter: Including the Un-included

The Art of the Clinician’s Presence and Spirituality: Encompassing the Whole Person in the Therapeutic Encounter

      The clinician’s sense of spirituality and state of presence is controversial, if not lacking, in many settings. Social Work schools do not focus on the clinician’s spirituality and the essence of presence in the therapeutic encounter. Rather they acknowledge the possibility of countertransference onto a patient. Even though counter transferential recognition is essential in the therapeutic relationship the main purpose of self-healing is only slightly encouraged. As an experienced practitioner in the mental health field, I have seen that not only stress and burnout are experienced in the interpersonal interaction with patients and within the system, but also, sanism and ableism towards both patient and distressed clinician/wounded healer.

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Heal Self first

    The therapist’s own untapped, unresolved issues and humanness prevents an egalitarian, objective, compassionate, and empathic interpersonal healing relationship. The old proverb of “Physician heal thyself” or to paraphrase “healer heal thyself”, needs to be demonstrated to provide ethical social work practice in the context of a medical model and culture. Throughout my own healing work, I have  incorporated  spirituality,  meditation, Reiki,, CBT, forgiveness, and mindfulness  in order to presence in an ethical therapeutic encounter with an anti-sanism mentality.  This assists the whole person, not just the overt symptomatology.

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Open mindedness along with compassion and empathy allows us to see the whole person

        My goal here is to explore ways a clinician can care for self to reduce sanism, ableism, stress, and burnout within the institutional and Social Constructionist culture of pathologizing and medicalizing nonconformist behavior. As the practitioner empowers self, the language and the separation of us and them (referring to the labeled mentally ill patient) transmutes into a we within the therapeutic encounter. Establishing an egalitarian relationship not only assists in delivering ethical and efficient treatment, but, it also gives the recipient a sense of agency and meaning within the community. The individual is able to understand that he or she is not the given diagnosis, but an integral being within society.

        Many individuals in the system continue to wear a badge of dishonor and shame, reminded by the community and some practitioners that they are ill, dangerous, and incapable of productivity in society. The intolerance and control of human difference is brought about with the rejection of deviant nonconformist behavior in the community. Deemed possessed, insane, parasitical, hyperactive, idiotic, or mentally ill, these persons are excluded and marginalized by the majority.  Working in the mental health field I  question the mental health of many of the workers who are in power positions and who dictate the system.

       What does it really mean to be different in the context of overall society?  Do nonconformists embody and act out society’s repressions?  Is it solely the responsibility of the individual seeking services to heal or is it the collective effort of the community to assist with the healing? Where is the line drawn between natural and healthy reverie and the supposed symptoms of schizophrenia and psychosis? How can Social Work schools move away from the pathologizing and medicalizing mentality which leads to the oppositional process of sanism and ableism?  Is there such thing as mental illness or is it a communal effort to mute the deviant?

      This website will enable me to expound on the oppression and violation of the nonconformist’s human rights through medicalization, institutionalization, and marginalization.  Along with the downside of the medical model in treating patients with schizophrenia, psychosis, addictions, and other conditions I will discuss how holistic modalities can enhance well-being and foster empowerment. This can be accomplished with an active, empowered, healthy, and balanced social worker, who is the gatekeeper to the institution and the patient’s strongest advocate.

          Given the vast culture of medicalizing overt symptomatology, perhaps it is utopian to change the mentality of the medical model.  There is more to a person then just behavior and erratic thoughts. The medical model focuses on placating behaviors, with a paradoxical effect, for the needs of the community and institution. Numbed, at times violent  (due to a secondary effect of akathisia), and cut off the individual is indoctrinated into a system that reminds him that he is too sick to participate in society (Metallica can explain this better with “Welcome Home”) and needs to depend on the placing system.  Learned helplessness and sanism  does not heal or integrate the individual back into the community.  A more comprehensive model is needed to allow the individual to fulfill his human rights and achieve responsibility for his self healing and empowerment.

The holistic approach is one such modality that cultivates healing and a sense of agency. Some practices like:  Reiki, meditation, spirituality, holistic techniques , CBT, cognitive restructuring, stress reduction techniques, balancing the chakra system , the Hearing Voices group, and my color meditation are just a few techniques that allow healing. In some severe cases, practiced with short-term medication protocol, holistic techniques can assist with the individual’s personal growth, confidence, and ego shift facilitating health and reintegration.

           The Hearing Voices and the Intervoice groups are exceptional social restructuring programs. Scientific and theoretical advancements refute Kraepelin and Bleuler’s invention and notion of schizophrenia. However, modern psychiatry continues with the same loose notion of this invented diagnosis’ organic  etiology and the use of medication to not only stabilize the symptomatology, but, also to continue with the validity of the profession (Whitaker, 2002).  According to the Hearing Voices Network,  it is said that one in four people hear voices or have experienced some type of extra sensory perception (ESP) in their lives. Most either deny such occurrence or feel it is too insignificant compared to others whose realities are permeated by voices and disembodied entities (still known as schizophrenic and psychotic individuals).

         For those who deny ESP it is difficult to conceptualize what an individual voice hearer experiences, or , find compassion or empathy for the voice hearer’s subjective reality. In order to come closest to what may be experienced, there are some interactive sites that simulate this phenomenon. The simulations, either on-line or those offered by the pharmaceuticals, provide a glimpse into what some individuals with ESP experience on a daily basis. Of course, the pharmaceutical’s goal is to sell numbing molecules, but, my intent and purpose is to empathize with someone else’s reality.

       In order to understand what a voice hearer experiences, Anderson Cooper  presented a report wearing headphones throughout the day. Through both headphones he heard conflicting, demanding, and demeaning voices. Phenomenologically Cooper understood that the constant chatter deterred daily living activities. The incapability of keeping up with the demands of society allowed Cooper to feel and empathize with those with divergent realities. Unfortunately, there is no empathy in society and the institutional system.

      On the contrary, the main feeling is one of fear and disdain of the unknown territories of the mind.  Marginalized and pathologized, these persons are yearning to interact with the rest, but, are in reality left alone, either by choice or by force, to agonize in their perceived realities. Since there is no definite organic or biochemical cause for the ESP phenomena, perhaps they are more attuned to the collective unconscious then most individuals. The community and the institution try to normalize those who are different. Through the interactive simulator and reports from experiencer, perhaps we can find the compassion to empathize and find commonality in our subjective realities. With commonality and empathy an entire society can grow and find collectivity among all in the community. What is the degree of separation between voice-hearers and those individuals who have constant racing thoughts, mind chatter, daydreams, or vivid imagination?

        After a great struggle and many proposals later, I started a Hearing Voices group in the Adult Partial Hospital. This is the first time a group of this type was allowed in an allopathic institution and the only one in Bergen County. As a  pilot group much learning will take place. I will follow the trajectory of this group through an anonymous empowerment self report questionnaire to be completed by each patient at the end of the course cycle.

        It is said that the human mind, along with the workings of the body, is a mysterious complexity that according to western ideology, cannot be fully defined, measured or palpably studied.  Yet, this  imperceptible interrelationship of mind, body, emotions, and spirit define our sole subjective experience within the world. Eastern philosophies,  without the use or necessity of sophisticated technology, has managed to conceptualize overall health as an energetic, cognitive, spiritual balance of mind, body, emotional, and transcendent  systems.

      Accordingly, dis-ease is a disharmony of the aforementioned systems. The key to balance and health is being able to acknowledge and accept repressed residual experiences that cause overt negative thinking and behaviors.  This cognitive and behavioral negativity compounded by the use of substances (legal or illegal) to placate self,  disintegrate the aura allowing other environmental influences to complete tissue and mental breakdown. My Color Technique, which I explain in-depth in Intuitive Presence:The Color Technique, Empathy, and Compassion for the Pained Other post  gets to the heart of the repression with the recipient localizing the discomfort in the body and identifying its color. Months of regular psychotherapy to reach this repression is acknowledged in a few minutes after the meditation is completed. The recipient acknowledges, accepts the repressed experience and then chooses to keep it or shift, forgive, and empower.

        Most individuals choose to forgive and empower themselves, thus, attaining self-responsibility for growth and overall health. Not only does the color meditation assist the individual to achieve empowerment, but also, it reveals inherent spiritual abilities unexplainable in scientific terms.

      Some labeled schizophrenic, psychotic, delusional, or having ADHD possess the ability to have otherworldly experiences that most do not have access to or refute. There is no scientific explanation for hearing voices or having an extra-sensory perception, yet, those who possess a contrary socially contrived perception of existence, are medicated, numbed, and institutionalized. Why does society fear or repel those who have different realities, when reality is subjective?  Perhaps society is not yet ready to embrace what Jung refers to as the shadow self and nonconformists are marginalized due to the conformists’ denial of the shadow, yet, real aspect of self.

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When chakras are balanced there is health; when the chakras are unbalanced there is emotional, physical, and spiritual illness and distress.

     According to Eastern philosophy, each part of the body corresponds to a different spiritual, emotional, and physical experience that many westerners refute as unreal. However, as the chakra belief system affirms, if it is balanced, it allows humans to commune with other unseen spiritual or electromagnetic energies, repair tissue, and maintain homeostasis. One may ask if this is just magical thinking or if there is any validity to this belief system that modern technology cannot, as of yet, measure or study. Studies of crypto chromes are in the early stages of revealing that humans may be able to sense electromagnetic energy. Or in the case of synesthesia, a neurological phenomena and closely related to my color meditation, a socially acceptable definition of internal and external reality can be altered.  According to some other theories it is said that the pineal gland is the seat of the soul and many mystical experiences are attributed to this pea sized gland. Interestingly, the NASW has a course   dealing with and acknowledging spiritual psychic phenomena between the practitioner and client.  With my own experiences as a Reiki practitioner,  I can attest that there is more to an individual than mere organicity and poor coping skills.  As Pierre Teilhard de Chardin eloquently stated,”We are not human beings having a spiritual experience; we are spiritual beings having a human experience.”

     Somewhere along the Judeo-Christian and scientific path, natural or supernatural abilities were inhibited, demonized, and stifled rendering spiritual humans incomplete.  Insomuch, operating under the current medical model the spiritual or extra perceptual aspect of the human is labeled, stigmatized, and medicalized rendering the individual numb and ill.  The extraordinary aspect of the Hearing Voices group is that the belief of spiritual or expereintial ESP is not refuted or discouraged.  Group members speak freely of their experiences and beliefs.  Collectively, they explore ways to cope and integrate back into society (voices and all!).

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Perhaps humans are physiologically and neurologically equipped to perceive energies around us. And perhaps, through the teaching and adherence of different dogmas, social constructs, and communal fears,  we are taught to suppress our natural ability of experiencing  altered states of consciousness.   And perhaps this suppression is what creates physical and mental ill and dis-ease.

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….for visiting my site and hope to hear from you soon!

One comment on “The Art of Presence in the Therapeutic Encounter: Including the Un-included

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