Michael Soth - Articles & Papers:
The 'integrative project' as a phase within the development from holistic-humanistic to integral-relational Body Psychotherapy
Michael Soth - Articles & Papers: | |
The 'integrative project' as a phase within the development from holistic-humanistic to integral-relational Body Psychotherapy | |
| Soth, M. (2007) "The 'integrative project' within the development from holistic-humanistic to integral-relational Body Psychotherapy" - in: UKAPI Journal Volume 4, Issue 2 | |
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After clarifying some principles of an integral notion of development, I discuss the 'integrative project' as a significant phase within the development of Chiron Body Psychotherapy. I describe it as a quantum leap beyond Chiron's original 'habitual therapeutic position' which was built on disavowed 'medical model' assumptions, and describe 'integration' in terms of the multi-dimensional bodymind whole. Touching briefly on the two phases that followed - the 'relational turn' and the 'fractal self' - I prepare the ground for a considerations of the deficiencies and critiques of the 'integrative project' within the Chiron context. I suggest that drawing from a diversity of modalities, approaches and paradigms does not necessarily alert the integrative practitioner to enactments which occur a) via therapeutic thinking, feeling or action or b) when switching between modalities, and that an 'integral' awareness of parallel processes may be required to do justice to the client's unconscious construction of the therapist and the therapeutic space.
The Chiron Centre for Body Psychotherapy is winding down its activities as a HIPS training organisation after about 25 years of involvement in the psychotherapeutic field in the UK. Over this time we have developed Body Psychotherapy beyond its origins and traditional framework, and the integrative project has been an important aspect of this development. 'Integration' had specific meanings and connotations in the context of Body Psychotherapy, as well as particular developmental functions in the evolution of Chiron. In a book to be published in 2008, edited by Linda Hartley, some of the Chiron trainers and practitioners reflect on the development and current state of our work. For my contribution to this book, I wrote an overview of the phases of that development, describing the quantum leaps and transformations which occurred over the 25 years, trying to focus on the substance of the revisions in terms of theory, technique and meta-psychology. Here I want to outline some of the gifts and some of the pitfalls of the 'integrative project' at Chiron, and the leap beyond integrative into integral-relational Body Psychotherapy.
As in an individual's journey, in reflecting on past developments I look for transformative phases as crises and turning points which structure the process. One question which arises is: what qualifies a change to be classified as a quantum leap ? What is best described as slow, incremental change and what constitutes a paradigm shift ?
This apparently simple question gets us into tricky meta-psychological territory concerning our implicit assumptions around 'development'. Let me make explicit some characteristics of my current notion of 'development'- a notion which itself has developed and changed quite radically over the years.
Although I will present the development of Chiron work as a sequence of theoretical shifts, it is important to remember that this is a linear abstraction imposed on the messiness of the actual developmental process. A journey has been made, and in looking back on the path we identify particular stations along the way which we can now connect in our mind as if the route had been there all along. However, as the poet Antonio Machado reminds us: "You traveller - there are no paths, only wind trails on the sea!".
With hindsight we may recognise that certain stations were necessary preparations for what was to follow. But there is a difference between recognising an overall meaningful unfolding and the presumption to therefore be able to predict, manage or control the process.
My own notions of development have themselves developed, from a fairly idealised linear conception (imaged as a journey up the mountain of 'truth' to some pinnacle of self-realisation), to the less predictable, multi-dimensional, contextual-relational and paradoxical view I have of the process now. This parallels in some ways the increasing complexity and differentiation in the development of Wilber's integral meta-model (Reynolds 2006) over the last three decades (which I refer to although I have some problems with it).
Fig. 1
These principles inform both my therapeutic thinking about my clients' changes as well as my own, and in this chapter I am aiming to present some reflections on my professional development within the context of Chiron in a way intended to be consistent with these principles.
An integral perspective suggests that development occurs incrementally within an established structure (via 'translation', Wilber 1984), until forces both from within and from without the system push towards a breakdown of that structure. At that point development occurs in more radical fashion (via 'transformation', ibid), and an emergent process may allow a new structure to organise itself - in terms of human identity: a more embracing sense of self.
Whenever a previous identity is challenged and eventually transcended, an experience of loss and death occurs - this is a necessary ingredient in transformation. Certain cherished assumptions and identifications will need to be shed. The new identity recognises these losses - with the benefit of hindsight - as manifestations of an outgrown partiality. From the perspective of the original identity, however, these losses may appear as betrayals and compromises, as a 'watering down' of essential principles. Both as a community of practitioners and as a training organisation we had to struggle with these questions and the tension between stability and the continuing transcendence of that stable identity.
Because a detailed enquiry into transformative process often reveals some degree of swinging from one extreme into another (as part of the breakdown of the old identity - Jung's 'enantiodromia'), I use a third term 'contradiction' alongside 'translation' and 'transformation' to characterise that particular phase of the process. For the sake of clarification, we may liken this conception to Hegel's three steps of thesis - antithesis - synthesis, with the latter corresponding to Wilber's notion of 'transcend and include'. Inasmuch as 'synthesis' constitutes an 'integration' of 'thesis' and 'antithesis', these notions also can inform and clarify our understanding of 'integration' itself as a process that goes through phases and that can, therefore, be incomplete. The question as to what constitutes an 'incomplete' paradigm shift, and what may be possible criteria for 'completion', will occupy me as a background theme throughout this paper.
When applied to the last 25 years of Chiron's development, the principles above generated the following overview over the phases and quantum leaps, with the 'integrative project' being of central importance.
Fig. 2
This distinction is debatable, as in some ways we may consider each phase as just a further incremental extension of the previous one. However, in my view this would fail to take into account the radical discontinuities involved in each of the suggested shifts.
The shift from the humanistic-holistic towards an integrative perspective, for example, was not simply one of increasingly including the theories and techniques of other approaches. There were profound paradigm clashes at stake which we needed to engage with both professionally and personally. The more we took on board an object relations perspective, the more we had a language to become precise about not just the client's inner world, but also our own, including which aspects of our internal dynamic we were projecting into the field of psychotherapy (anthropologists have been criticised for projecting their own psychology into the 'blank screen' of the culture they are studying - as psychotherapists we are subject to the same phenomenon in relation to the field of our profession and its traditions).
As my theme here is only that part of the development which we can suitably call the 'integrative project' (rather than the whole sequence of phases and quantum leaps), I cannot expand on this here, but see the forthcoming book (Soth 2008) for my experience of the deconstruction of holistic-humanistic idealism 1.
In the late 1980's we were recognising the tribal parochialisms and schisms of the fragmented psychotherapeutic field as a weakness of the profession. What emerged first was an attempt to escape the limitations imposed by the dogmatic and self-replicating sub-cultures of the therapeutic schools through drawing eclectically on a range of techniques from across the various approaches. Whilst this eclecticism heralded the first dawning of a deeply needed integrative impulse, it was soon recognised that it came with its own set of problems: the benefits derived from the increased flexibility and creativity gained by the eclectic therapist were often outweighed by the client feeling like a confused guinea pig. A chameleon-like therapist, selecting the most effective technique pragmatically from a wide and contradictory range of tools, does not necessarily provide a reliable relationship or safe therapeutic space.
We recognised that particular techniques had evolved and were consistent with the underlying paradigms, value systems and attitudes of particular therapeutic stances, and that it was disturbing to pretend that one could simply 'mix and match' approaches in a utilitarian fashion. The integrative project emerged as an attempt to overcome these shortcomings of eclecticism, but in my opinion its different branches have only partially succeeded in responding to this valid critique.
The inherent structure and coherence provided by the dogmatism of the traditional therapeutic schools gave the practitioner operating within each framework a holding and consistency which integrative therapists tend to lack. I remember one of my psychoanalytic supervisors admitting to me towards the end of our work together that - whilst she partially admired the passion and impetus of my integrative impulse - she certainly did not envy the degree of internal conflict, confusion and uncertainty that came as part of the package. Whilst there are certain dangers of inexperienced analysts practising in restrictive textbook fashion, she acknowledged, most experienced practitioners would have come to terms with the limitations of their own approach and learnt to work appropriately within them, thus feeling supported and held by a tradition and a framework which they could rely on to have stood the test of time.
Integration distinguished itself from eclecticism by recognising the profound differences and contradictions between the approaches, and the often irreconcilable conflicts between them on a philosophical level. Before integration could be possible, practitioners would have to deeply immerse themselves in the respective theories, belief systems and practice communities of contradictory approaches, in order to appreciate them 'from within'. The attempt to integrate the diverse approaches into some over-arching meta-model would not work, without severely damaging the integrity of each approach, or appropriating one theory into another whilst fudging some of its inherent principles. The search for another ground or position - beyond theory and technique - from which to integrate led to a recognition of 'common factors', shared by all approaches but transcending theory.
For us at Chiron in the early 1990's, the most significant and influential integrative attempt in this direction was Clarkson's model, suggesting that beyond the particular theories and their implicit relational preferences, working alliance, reparative, transference-countertransference, authentic and transpersonal elements were part and parcel of every therapeutic relationship across the diverse approaches, whether they were conceptualising these elements or not (as all readers are familiar with this model, I will not expand on it here). The five modalities (as extended at Metanoia throught the cultural sixth) might be present or significant in varying proportions, but they could now all be considered valid and necessary. Clarkson's model formulated an integration which had implicitly been inherent in Chiron from the beginning - all six modalities had an important place within the Chiron training.
What we appreciated about the model was its explicit naming of the modalities, but more importantly - as it was based on likening the client-therapist relationship to kinship bonds - it opened the door to relational metaphors as a foundation for the integrative project. Rather than focussing on the client's needs and pathology only (which then was assumed to require a particular theory and intervention), Clarkson helped therapists pay attention to the phenomenology of the relationship, including the therapist's relational stance and attitude. Whilst these modalities were formulated and are being used largely as deliberately chosen therapeutic stances in the context of a treatment plan - which I would consider an important but partial perspective, as will become clearer later - Clarkson's model has nevertheless provided one of the main conceptualisations that helps many therapists, including Body Psychotherapists, break the mould of their original training and reach across different approaches and theories in an attempt to find a wider, more integrative range of understanding and responding to clients.
The tradition of Body Psychotherapy had its own avenue into 'integration', based on the often over-simplified and over-idealised notion of 'bodymind integration'. As an idealised notion, 'bodymind integration' was seen as the antidote, the simple logical opposite, to the 'body/mind split', diagnosed as the root of all neurosis and the problems of modern Western civilisation. Body Psychotherapy validly recognised the dissociation of the mind from the body, and the body's repression and control by the mind, (implicit in Freud's work with hysteria and notions like 'embodiment', the 'organismic self' and holistic paradigms), but elevated 'bodymind integration' and the healing of the 'body/mind split' into something of a 'holy grail', the normative goal and objective of 'good' Body Psychotherapy.
However, perceiving and assessing the whole that is the bodymind does not have to precipitate a biased, one-sided, goal-oriented agenda-driven procedure (although that is how many traditional Body Psychotherapists did use the notion of 'bodymind integration' - as something they saw themselves as responsible for bringing about (Soth, M. (2006)). Whenever we have a notion of anydifferentiated 'whole', with its sub-systems and inter-linked elements, we can sense and can analyse its organisational coherence. Our right-brain intuitively perceives its shape and pattern, its Gestalt: the system can be integrated or fragmented, conflicted or synergistic, in a creative or dis-integrating phase of its life-cycle, depending on the inter-relationship of the constituent elements. As therapists we tend to have a well-developed intuitive grasp of how the client's system is organised (a more detailed description of the bodymind whole would distinguish physical, emotional, imaginal and mental processes as dinstinct, but linked and inter-related aspects, both in terms of subjective experience and interpersonal expression). In Body Psychotherapy training we aim to enhance and develop that sensitivity and perceptiveness so it becomes a self-reflexive, trained capacity rather than a humanly given, largely unconsciously functioning gift.
In 1999 I tried to re-formulate the concepts both of 'body/mind split' and 'bodymind integration' in such a way as to remove their objectifying and idealising connotations and bring them into the relational sphere. Rather than using 'bodymind integration' as a normative objective, I proposed to use it as a tool of intersubjective perception and involvement (Soth 1999). I was rejecting some of the objectifying tendencies inherent in the Body Psychotherapy tradition (which in practice actually perpetuate dualism and body/mind splitting - Soth 1997), but was salvaging and building on some meta-psychological principles implicit in Reich's 'functionalism':
a) that the developmental psyche-soma history of the person is 'recorded' both psychically and physically: it is encoded in memory on a psychological-mental level and embodied as emotional anatomy on a somatic level (Reich, Boyesen, Pert). The body's 'character armour' is the frozen landscape of fixated developments and traumatic history, giving substance to the notion of 'body memory'.
b) that the organisation of subjective, psychological experience is reflected in the organisation of the bodymind system as a whole, and vice versa (i.e. body, mind and psyche are different sides of the same coin).
For example, a fragmented sense of self is reflected in a fragmentation of bodymind experience, both internally and subjectively as well as communicated externally and relationally. A coherent sense of self is reflected in a coherence of body, mind and psyche (and this does not in my mind imply a privileging of coherence over fragmentation, assuming that a coherent self is 'better' than a fragmented one. I will come back to the dichotomy between unification and multiplicity, integration versus dis-integration later).
c) that the organisation of the whole is reflected also on each of its constituent levels (e.g. the conflicts between physical, emotional, imaginal and mental processes, i.e. the structure and shape of the whole, are also manifest on each separate level), and ...
d) that therefore what happens on one level is reflected - as we will see later: via parallel process - on all other levels. Dissociation, for example, manifests as a disconnection between body and mind, but that disconnection is also reflected on each level, e.g. on a physical level between head and chest, or on a mental level through forgetting what was just said a minute ago.
A process of psychological integration is inextricably linked with an integration of the bodymind, indeed - in this holistic way of thinking - they are seen like the paradoxical wave and particle dimensions of light. One aspect of such integration is a subjective sense of embodiment, Winnicott's "indwelling of the psyche in the soma". Another aspect is an inclusiveness in terms of all the diverse aspects and bodymind levels of human experience which together contribute to a person's sense of self and being in the world.
Integration, therefore, can be thought of in terms of the congruence and coherence (or incongruence and fragmentation) of the various levels of the multi-dimensional bodymind. And integrative Body Psychotherapy could be formulated in terms of the range of human experience which it sets out to address and engage in the room - both in terms of the client's experience and our own, theoretically and practically. The whole spectrum of bodymind processes (see Fig. 3) is seen as matrix of communicative channels through which intrapsychic and interpersonal experience is organised.
The notion of the multi-dimensional bodymind whole and its integration or dis-integration can, of course, be applied to any human process, clients and therapists. What if we apply it specifically to ourselves as integrative therapists ?
If our own emotional history as therapists - with both its wounds and capacities - is manifest in our bodymind presence (which is readily intuited by our client's right brain), there is nowhere to hide and it becomes essential to accept and inhabit ourselves as 'wounded healers'. As the name 'Chiron' suggests, this was always a significant point of reference throughout the development of our work. But within the culture of our organisation, it was understood more as a humanistic background value and attitude rather than taken through to specific aspects of the moment-to-moment client-therapist interaction. That became possible only later on, once I began to think in terms of enactment and re-enactment (Soth 1999).
Nevertheless, the notion of the 'wounded healer' acquired more substance during the integrative phase of Chiron's development, allowing a formulation of the complex connection between the therapist's person and role, and the possible integration of these 2.
It is well-understood throughout the integrative community but not always explicitly formulated, that attempts at integration which focus only on the practitioner's professional expertise (knowledge and skills) are bound to be limited. A therapist's professional integration depends largely on their own inner integration. One's inner integration, as for example conceptualised through Jung's individuation process, is a function of one's own process as a person which in turn depends to a large degree on the relationship to one's shadow and wounds. The image of the 'wounded healer' thus inspires an integration of the therapist's personal and professional selves which is a precondition for any thorough integration of the diverse therapeutic theories and approaches.
Applying Reich's concept of 'character' to how the therapist's person fills the professional role (or - in other words - how the practitioner imagines and constructs the role through their personal psychology), at Chiron the notion of the therapist's 'habitual position' became central in our thinking about therapy itself as well as therapy training.
When we want to characterise a particular psychotherapeutic approach, traditionally we tend to define it in terms of its theory and technique. However, closer inspection reveals that this convention harks back to psychotherapy's 19th century origins and is rooted in what postmodern epistemology calls the 'myth of the given': the assumption that our scientific theorising and resulting technical applications are based in an objective perception and understanding of reality as 'out there'. It is assumed that - like doctors - therapists base their interventions (their technique) in dealing with a particular 'case' on a quasi-scientific application of established general principles (theory), translating accurate perception and diagnosis into an appropriate 'treatment plan'.
However, what significantly influences the way a therapist' s theory and technique arrive on the client's end of the therapeutic relationship, is a third factor: the therapist's underlying or implicit relational stance (Fig. 4). This stance, although rationalised through the practitioner's models and beliefs, is often taken for granted and outside awareness, both intrapsychically and in its impact on the client.
As 'wounded healers' and 'reflective practitioners', we can turn our own psychological theories upon ourselves, not only in the sense that every therapist is also a client, but to reflect on how we function within our therapeutic role when at work. It is in regard to our implicit relational stance as therapists that Reich's holistic characterological understanding of habitual positions and their developmental origins can make a profound contribution.
In Reich's understanding, rigidly-held positions, on all bodymind levels from muscular to cognitive, indicate the presence of a defensive character armour which has both repressive and protective functions. He sees all perceiving and thinking as arising in the context of character and the emotional wounding at the root of it. Beliefs, assumptions and world views of all kinds arise through a personal, subjective history and are conditioned by it. Our current view of reality, however convincing it appears to us, carries the scars of that emotional history, all the more so if it is denied and unconscious.
Applying this to ourselves as therapists, the five steps of character formation (Johnson 1994), as an adaptation to internalised developmental wounding, can be seen to inform a therapist's implicit relational stance and 'habitual position' (which is not meant to imply a static, singular position - it is more accurate to think of the habitual position as a relationship with at least two poles, like Masterson's 'relational units', or sets of interrelated stances or a matrix of attractors in a complex system; there are certain theoretical inconsistencies and weaknesses in character structure theory which I cannot adress here). Body Psychotherapy, following in the footsteps of Reich gives us some tools needed to apprehend the defensive uses of our own theory and practice, manifesting in therapists' habitual patterns of relating to ourselves and others and contributing to the rigid dogmatisms maintaining the schisms within the psychotherapeutic field.
What attracts students to a particular psychotherapeutic training are not just the beliefs and values, but also the defensive uses which these beliefs can be put to. Certain aspects of the implicit relational position may also be shared throughout an organisation, and this was the case at Chiron: we inherited a tradition which philosophically was firmly opposed to the exploitation, neglect and objectification of the body, but which actually perpetuated objectifying assumptions through its shared relational stance.
In terms of the sub-cultural background of Chiron's origins, we were firmly rooted in and committed to humanistic values of equality, transparency, authenticity and were opposed to power-over, imposed authority and hierarchy. We were influenced by anti-psychiatry, and like Laing questioned pathologising labels and diagnosis altogether, being more interested in growth and transformation than - as we saw it at the time - pessimism and illness.
However, the Reichian tradition - we began to realise - had always had a strong bias towards the therapist as expert-doctor (Soth 2006), and had followed standard medical procedure in terms of examination, diagnosis, application of theory and prescription/treatment. For most of us, our everyday practice was pervaded by 'medical model' implications and interventions, even whilst we were forcefully opposed to any notion of therapy as 'treatment' on a meta-psychological level. These contradictory stances co-existed side by side, but split off from each other, in the background, communicating themselves as subliminal double-messages to our clients.
In pursuing the integrative project we had come across incisive critiques of these 'medical model' assumptions (Hillman, Buber, Gadamer), but whilst some aspects of our identity had been deconstructed through integration, the 'medical model' had remained a secure, albeit ambiguous, pillar of our habitual stance. On the contrary: to some extent every new theory and technique we were learning about and integrating was feeding into our expert knowledge and skill, thus enhancing our omnipotent 'doctor' status, making it more comprehensive and powerful and thus more compelling.
Ultimately it is through engagement in relationship - with clients and with each other - that these habitual constructions of the therapeutic position were confronted and thus revealed their limiting consequences. In practice, we were holding on to attitudes and beliefs which were not commensurate with the depth characterological work we were professing to offer, and actually undermined and restricted the relational space necessary for such work to occur. I locate the 'relational turn' at Chiron in the mid-1990's, although it took another 10 years before I published a coherent account (Soth 2006).
In my view, the relational turn constitutes a quantum leap beyond the integrative phase, because beyond having deconstructed hidden habitual postions and then acquired greater relational flexibility between an integrative diversity of therapeutic stances, I now recognised that any position I take as a therapist is influenced by the client's unconscious construction. Any habitual position on the therapist's part can be considered a defensive mechanism against pressures arising out of the transference.
With hindsight it is easy to see that we were part of a wider movement and that similar ideas (e.g. the 'countertransference revolution') informed the cutting edge in other approaches. There were advantages to remaining relatively undisturbed and unpublicised: we were exploring the relational dynamics through our inherited bodymind perspective and were coming at it fresh, without the often confusing historical baggage and dualistic terminology, and could thus develop a holistic phenomenology of the therapeutic relationship from the ground up (Soth 2005).
As I have suggested elsewhere (Soth 2007), we were thus beginning to address - in a two-pronged approach - what I see as the two main dualisms pervading the last 100 years of psychotherapy, restricting our practice and our theorising: the doctor-patient and the body-mind dualism. As in our clients, underneath the bewildering surface fragmentation of the psychotherapeutic field lies a continual avoidance of painful and unresolved legacies, reaching all the way back to the origins of the profession in the dualistic, positivist, reductionist zeitgeist of the late 19th century. I have called this the 'birth trauma' of psychotherapy (Soth 2006).
Over the last 100 years these dualisms have been challenged and comprehensively de-constructed, but in that process they have often only been contradicted rather than 'resolved' or transformed. Both the relational reaction against 'medical model' assumptions (which often reacts against the medical model conception of therapy as treatment only by postulating it as relationship only), and the holistic reaction against mind-over-body-dualism (which often reacts against the dualistic conception of mind-over-body as split only by postulating it as whole only) often get stuck in anti-positions. A complete paradigm shift in terms of these dualism would require more than an anti-thetical contradiction: it would require a third position or synthesis, which - as I have suggested (Soth 2007; see also Pizer, S. 1998) - is characterised by the capacity to hold the polarised positions in a paradoxical embrace (therapy as treatment and therapy as relationship; body/mind split and bodymind whole).
Fig. 5
It is only when we transcend these dualisms (rather than merely contradict and fight against them through a decidedly anti-dualistic philosophy Soth 2006), that some of the paradoxes inherent in psychotherapeutic work can be embraced as necessary and creative. Much of the fragmentation pervading psychotherapy theory and training is structured by an avoidance of the paradox at the heart of therapy: that the helping relationship we aim to provide involves both the healing as well as the replication of the client's wounding in and through therapy, what we call enactment, or - if we think in developmental terms - re-enactment. For the client the equivalent subjective experience is that the transformation of their pain - a transformation which they both seek and avoid (often largely unconsciously) - can occur through the whole bodymind's surrender to the pain in this relationship here and now.
From a therapeutic stance which can sustain and live the embrace of this paradox, we notice that our therapeutic thoughts, feelings and actions become the vehicle for enactments, and that our struggles in the countertransference with and against these enactments parallel the transference (the client's conflict becomes the therapist's conflict - Soth 2005).
When we recognise that our conflicted therapeutic impulses - feeling torn between different approaches and principles moment-to-moment - reflect and parallel the conflicts in the client's inner world, we are inclined to take the multitude of therapeutic theories and techniques less serious and are less identified with their literal 'truth' or validity. Through apprehending the enactment dynamics as parallel processes between transference and countertransference, between inner and outer, body and mind, individual and collective, interpersonal and intrapsychic dimensions as they get communicated, externalised and internalised in relationship, we appreciate the wholeness underlying (and co-existing with) the reality of fragmentation, in the client, in ourselves and the field we belong to. Parallel process is the 'glue' which turns a heap into an integral whole, allowing a glimpse into what I have called the 'fractal self', thus extending the notion of 'wholeness' implicit in Reich's original impulse and bodymind functionalism into the relational domain and beyond.
An awareness of parallel process helps us stay connected with how multi-layered and multi-dimensional polarised issues hang together and reflect each other across all the levels from the biological to the emotional, psychological and mental, and beyond the intra-psychic into the interpersonal and collective domains. It thus helps us to engage in an 'integral' manner which does not take refuge in privileging or absolutising certain domains at the expense of others, which only ever leads to one-sided, biased and unworkable solutions.
Through parallel process we begin to understand how pathology maintains itself, both individually and collectively: how patterns of uncontained conflict and denied pain replicate themselves through being enacted, internalised and externalised from one person to the next, across all our relationships and down the generations like falling dominoes, in the hope of finally finding containment somewhere.
Without a recognition that the supposedly 'helping relationship' needs to be 'unhelpful', that it needs to involve re-enactment of the client's wounding, and that the practitioner needs at times to be helplessly available to participating in these patterns so they can transform themselves, therapists and their profession are part of the problem of such blind replication.
Through encouraging us to keep experientially participating in enactments and to surrender to them, the integral view of 'fractal self' facilitates an experience of a prioripassionate relatedness (Spinelli, E. 2007) from which a potential 'third position' beyond polarisation and fragmentation can arise, whatever the particular conflict or issue. Beyond the specific paradoxes central to our profession, it thus opens the door to inhabiting a fundamental sense of paradox in all existential struggles and relational contexts.
From such a perspective, it also becomes apparent how the pathologies of our profession maintain themselves. This may help us engage with the established splits and faultlines running through psychotherapy as we know it.
As suggested in Fig. 1, in my opinion the 'relational turn' heralds the possible transcendence of the 'integrative project' and a paradigm shift beyond it into an 'integral-relational' perspective. Again, rather than thinking of this shift as an incremental extension only, I emphasise the discontinuity, the necessary dis-integration of the previous perspective. In this last section, therefore, let me suggest what it is about the integrative project - at least in its manifestation within the Chiron context - that had to die.
Papers in previous issues of this journal have addressed some of the pitfalls and complexities of the term 'integration' (Prall, Spinelli). 'Integration', although badly needed originally (where would we be without it - perish the thought!), over the years has inevitably become a buzzword, evoking similar idealisations as 'bodymind integration' did for Body Psychotherapists. If understood with some finality, as Werner Prall has pointed out, it leads itself ad absurdum, as it ends up denying the very diversity and dialogical attitude which it depends upon as its raison d'etre. The tension between unification and multiplicity must not be erased or diminished by idealising or absolutising one over the other, else we lose the essence of the integrative impulse. This critique addresses the potential reification of 'integration' rather than seeing it - as Prall illustrates - as a continuing dialectical and diversifying process. Ernesto Spinelli has questioned how our integrative ideas match up with our lived reality both as persons and as therapists, and challenged the wishful thinking which underestimates and denies the degree of dis-integration inherent in our own lives and practice. He sees our 'divided self' at the root of our integrative impulse, but the danger of conceptualising integration in individualistic terms (an essentially solipsistic notion) leads to a denial of the contextual, relationally embedded nature of the self. These are strong and valid critiques.
But I think we can go a step further: it is not just that 'integration' is an idealised notion which can be used to deny and perpetuate our sense of actual dis-integration. We can understand dis-integration (as in practice many therapists do, see Field) as a necessaryprocess essential to psychotherapy, as an aspect of the integrative process which needs to be valued and embraced.
If integration is understood and practiced as an 'anti-disintegration' procedure, it becomes dangerous to itself and the essence of the therapeutic process. If, however, 'integration' can be understood as a third position, embracing both disintegration and integration as complementary processes, then the meaning of the term moves closer to a perspective which I prefer to call 'integral'. For me, this term, borrowed from Wilber, implies a) the embracing of paradox as the 'gateless gate' between the dualistic polarities, and b) a relational notion of multi-dimensional parallel process which ties together the many dimensions and multiplicities. This, I propose, is best understood as a quantum leap beyond the integrative project, rather than another facet of it.
Whether we conceive of integration as a comprehensive, non-partisan spectrum of therapeutic possibilities in terms of Clarkson's model, or a multi-dimensional bodymind model comprising the whole spectrum of intra-psychic and interpersonal communication, this pluralistic validation and appreciation of many channels and modalities represents a quantum leap beyond the traditional dogmatism inherent in the fragmentation of the field. However, unless we pay attention to the therapist's implicit relational stance and relational enactments, our integrative endeavours may remain limited to the realm of theory and technique. Within such limitations, it is perfectly possible to passionately and comprehensively work towards integrating the theories and techniques of all available approaches whilst maintaining an unquestioned underlying 'medical model' position - this might on the surface do justice to the theories of the various approaches, but not their inherent spirit which requirescontradictory and irreconcilable differences in terms of relational stances.
How might an implicit 'medical model' position manifest in integrative practice ?
A common application of integrative ideas involves an assessment of the client as to which therapeutic theory, modality or technique would be most helpful at a certain stage in the process. The treatment plan is then constructed on the basis of assumptions concerning, for example, the client's pathology, therapeutic needs, motivation and capacity for psychological reflection. Instead of being restricted to the models and interventions of one particular therapeutic tradition, the integrative therapist supposedly chooses what's most appropriate from the whole range. Confronted with a vast diversity of clients and issues, we assume that this must improve the chances of selecting the 'right' approach for each particular situation, and that is undoubtedly true.
But who does the choosing ? What are our assumptions about the agency and subjectivity and relational engagement of the therapist who functions in this fashion ?
Admittedly, they would have to be using their empathic attunement and subjectivity to assess and judge and select the 'right' treatment, so we are implying that the practitioner must make use of their emotional, relational, non-objective personal as well as professional skills and capacities. But we are also implying that these subjective perceptions and impressions then have to feed into a quasi-medical assessment and reflection which in turn leads to quasi-medical conclusions and interpretations, meant to be as helpful to the client in the same way that a doctor's intervention is meant to be helpful. We are assuming that there is a 'right' intervention which can be supported by our theory and therefore anticipate a beneficial effect. Therapeutic perception, reflection, understanding and intervention are then conceived of in quasi-medical terms, drawing on the therapist's subjectivity, but observing standards of objectivity and implying the therapist's capacity for agency, choice and reliable, quasi-objective insight into what is 'helpful'.
Are these assumptions helpful in carrying out our 'impossible profession' ?
I don't think so - at best they are partial, at worst downright destructive to the actual phenomenology of the therapist's internal struggle. They do not do justice to my moment-to-moment experience when engaged in the therapeutic relationship. They do not take account of the degree to which the therapist's functioning is subsumed by unconscious processes, and actually shield us against an awareness of how we are constructed by the client's unconscious. They do not do justice to the paradox at the heart of the therapeutic endeavour. I take them to be remnants of the 19th century doctor-patient dualism, and unhelpful in sensitising us to the relational complexities and our subjective participation in enactments.
There is no space here to illustrate this in detail (see Soth 2008), but such assumptions imply a working alliance between the client's and the therapist's ego, as if there was some reliable part of the therapist that can remain untainted by enactments, capable of maintaining a 'helpful', reflective perspective on them. In my experience, this is a fanciful notion and wishful thinking. Enactments are unconscious, and pervade all of the therapist's subjectivity: they may show up anywhere in the therapist's bodymind process and anywhere in the therapist's personal or professional self, including therapeutic impulses and intentions presumed to be 'helpful'. Enactments happen via the therapist's reflections and interventions, not alongside or in spite of them.
This is especially true in moments when the integrative practitioner switches between modalities or paradigms: assuming that allparadigms have validity, the unconscious significance of the switch as an enactment can escape attention. In my opinion it requires an integral - rather than an integrative - perspective, to support such attention and to provide - through awareness of parallel process - the relational 'glue' that holds together the diverse, but potentially fragmented plurality in and through enactment.
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Soth, M. (1999) "Relating to and with the Objectified Body", Self & Society, 27(1), p. 32 - 38
Soth, M. (2000) "The integrated bodymind's view of bodymind integration" in: AChP Newsletter 2000
Soth, M. (2005)"Embodied Countertransference" in: Totton, N. (2005) New Dimensions in Body Psychotherapy. Maidenhead: OUP
Soth, M. (2006)"What therapeutic hope for a subjective mind in an objectified body? " - in: Journal for Body, Movement and Dance in Psychotherapy Volumes 1 and 2 (June & September 2006)
Soth, M. (2006) "How 'the wound' enters the room and the relationship", Therapy Today, December 2006
Soth, M. (2007) "The implicit relational stance and habitual positions", CABP Journal No 35, July 2007
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