In 1985 R. D. Laing, M. D. conducted a public interview with a homeless woman diagnosed as paranoid schizophrenic. The several thousand psychotherapists witnessing the event were dramatically split in their assessment of the encounter, some denouncing and some praising it. No comments were made suggesting that the interview was a transpersonally-inspired one, nor was there an in-depth examination of the responses of the therapist and client. This article offers such a discussion using a model of clinical supervision in which client adaptations are assessed to understand what is therapeutic (or not) in an encounter. It gives one author’s view of R. D. Laing’s approach, and demonstrates how both therapist and client bring intrapersonal, interpersonal, and transpersonal concerns to a session of transpersonal psychotherapy.
Long-time practitioners and students of transpersonal psychotherapy have a strong body of theoretical materials (Almaas, 1990; Assagioli, 1991; Boorstein, 1980, 1997; Grof & Grof, 1990; Quinn, 1997; Scotton, Chinen & Battista, 1996; Tart, 1975, 1996a; Wilber, 1985), an emerging volume of published research (Lukoff, Zanger & Lu, 1990; Lukoff, Turner & Lu, 1992; Lukoff, Turner, &Lu, 1993) and research constructs (MacDonald, LeClair, Holland, Alter, & Friedman, 1995; MacDonald, Friedman, & Kuentzel, 1999) to further their work. Many of these materials contain case studies, but few are moment-by-moment clinical transcripts.
Recorded clinical dialogues offer us another kind of canvas on which to paint impressions about the nature of genuinely effective psychotherapy. By studying the actual phenomena in these dialogues we can witness and assess immediate client and therapist reaction to one another and attempt to differentiate therapeutic from non-therapeutic activities. In the long run, of course, client response over time is the ultimate clinical supervisor. But even in the short run, observations can be made that suggest how the moments of psychotherapy are being received.
A most remarkable session of transpersonal psychotherapy on the record like this occurred in a cavernous convention center in downtown Phoenix, Arizona on December 13, 1985. Several thousand of us at The Evolution of Psychotherapy Conference watched on a large screen as R. D. Laing, M.D. interviewed “Christy,” a woman who was described as paranoid schizophrenic, homeless, and not taking her medication. The two were sheltered off-stage in a small curtained ‘room’ made for the occasion, perhaps to diminish the impact of thousands of observers on them. A live video feed was shown to us as the session unfolded.
At the close of the interview, many of the professionals in the audience were angry and baffled, and many were enraptured and in tears. Several arose to excoriate that session that Laing held with Christy, and others including Salvadore Minuchin spoke in its defense. Said a later author (Amantea, 1989, p. 56) describing the clash: “It is a conflict as old, really, as the one that finally split Freud and Jung. It is the one that rages between those who choose to see psychotherapy as a rational science, with scientific parameters, and teachable techniques; and on the other hand those who see it as a process which is either instinctual, or, even more bizarre, a mystical transference of thoughts and feelings between client and therapist.”
One challenger’s voice echoed in that large hall and in my mind over the twenty years since: “I was wondering what you thought really went on therapeutically in that interview?” she asked. “What do YOU think went on therapeutically?” Dr. Laing shot back. Clearly he was not foolish enough, as I am here, to speculate on such a significant topic. But he did offer some ideas about the videotape of the session four years later, when the verbal text of the meeting was published (Laing, 1989a, pp. 141-142):
The main point is in the rhythm, the tempo the timbre and pitch of the words that are in the paralinguistics. This is between Christy and me, a music of words... [and] kinesics concerted movements involving arm, hand, finger, leg, the positions of our bodies in the chairs, set at 90 degrees to each other… You are publishing the libretto (the verbal content) without the music (the pitch, timbre, rhythm, tempo, the paralinguistics) and without the choreography (two symmetrical chairs placed precisely as intended), and the ballet (kinesics)… The point is that the rapport, which seemed to many so “mysterious,” “mystifying,” or “mystical” (the “love” to which Salvador Minuchin referred in his remarks) is there on video for all to see and to analyze in detail. There is a lot of technique there.
When I reviewed the videotape (Laing, 1985) myself, I observed some of those kinesics, the relationship between nonverbal body motions and the verbal communication, but I confess to seeing little of the ‘music’ that he describes above. There is a pacing or mirroring in Laing’s responses that is noteworthy, where silences and topics that arise from the client are intimately respected. This kind of mirroring response is encouraged in many conventional psychotherapeutic disciplines. What more could be happening than that, and to what end?
Although I never discussed any of my ideas with Dr. Laing, I have read, felt, watched, listened, written, and talked about that session for nearly twenty years. I propose that the meeting can be best understood through the consideration of three factors: the progression of Laing’s theoretical positions, the theories of transpersonal psychology, and a method of clinical supervision employed primarily in psychoanalytic and psychodynamic psychotherapy.
Biography and Theoretical Positions
Born in Govanhill, Glasgow, Scotland, UK in 1927, Ronald David Laing was raised in what are said to be materially privileged yet emotionally bleak circumstances (Ticktin, 2005), close to his father and less so to his emotionally distant mother. He studied medicine at Glasgow University, as well as the traditions of phenomenology and existentialism. As a psychiatrist in the British Army, he began to question the value of orthodox treatments of the time (drugs, electroshock, insulin coma therapy) and instead spent his time listening and talking to patients, an act that he considered from an interpersonal standpoint.
After military service he began to focus on the importance of interpersonal relations in the treatment of chronic schizophrenia, and received analytic training (with Marion Milner and Donald Winnicott as his supervisors). He began publishing the first of many influential books in 1960 (Laing, 1960; 1967; 1970; 1990), and was acclaimed in public as a kind of psychological guru and prophet. It was in his book The Politics of Experience (1967) that he espoused the idea that real sanity involved the transcendence of the ego through spiritual practices and meditation. During these years, however, his personal life began to disintegrate, and he left his first wife (and two children) in 1965.
He went on to found The Philadelphia Association, a setting to provide true asylum for people in states of distress that would ordinarily call them to a psychiatric hospital. It was his hope that madness would represent not a breakdown but, potentially, a breakthrough into a more authentic way of being. He later studied Theravedic Buddhist meditation, conducted sessions in LSD therapy and rebirthing, and moved closer to humanistic and transpersonal psychology. He died of a heart attack in 1989.
One clear view of Laing’s theories links him primarily to existential-humanistic practice, especially in that he considered the whole (as opposed to the part) of the human being, the human being in his or her particular world or life-context, and the human being in relation to existence or creation. Kirk Schneider emphasizes how Laing considered the variety of stances or angles from which he could perceive a client. He tried to perceive, through strong contact with the face of a client, minute impacts of culture, family, and biology, as well as minute impacts of existential issues, such as engulfment, chaos, and obliteration. “Laing’s chief therapeutic concern it seems to me… was honesty in communicating, in understanding, in healing… honesty directly tied to phenomenology… and to maximal disclosure of experience (Schneider, 1999, para.6).”
Laing would try to understand where in the worlds of human experience (biological, cognitive, sexual, interpersonal, spiritual) the client was stuck, and how to gain access to that “stuck place,” through a “disciplined naiveté.” A list of his technical activities includes presence, attunement, finding the opening, being courageous, and taking our interconnectedness seriously. He would provide three basic conditions in his therapy: presence and attention (to hold and illuminate that which is palpably relevant within his client and between himself and his client); invoking the actual (assisting the client into that which is relevant, charged) and vivifying resistance (assisting his client to overcome the block to contact that which is relevant).
To gain a sense of the way Laing viewed the therapeutic context, consider these remarks (Leviton, 1987, p. 40) published two years before he died:
EastWest Journal: Implicit in this discussion must be some model of psychological balance and integration, or what others would call sanity. As a psychiatrist, what state of mind are you trying to steer your clients towards?
R.D. Laing: That is the last chapter I haven’t written yet! I’ve thought about this for many years and I still haven’t come up with a satisfactory answer. Maybe it’s because it’s difficult to put into words or maybe because I haven’t got it clear myself. Let’s say someone ought to have autonomy, not a schizoid autonomy, but rather a balance within themselves, a center. Then we must divide the realms that exist between people into intrapersonal, interpersonal, and transpersonal which is difficult to lay out systematically because there is no coherent psychological theory that brings the transpersonal, or rare experience, into coherent psychological play. Psychological health must be wholeness, with the complete, untrammeled functioning of all aspects of the mind. Despite the credibility given in some circles to transpersonal reality, it is, to a considerable extent, not part of our culture. It’s a subculture that some people believe in but very few people actually experience. It’s something unusual although practically everybody has some story about coincidences or synchronicities but it’s on the side, not like a constant backdrop to everything all the time in the West. If you accept once and for all transpersonal reality, then you can’t just put it into an appendix or footnote. It has to be built into the whole psychological system. Mental health has to have something to do with all functions operating coherently and harmoniously…
Laing was here offering a brief yet comprehensive version of psychological health and wholeness that is summarized in what is known as the fourth force of psychology (after psychoanalytic, behavioral, and humanistic): the transpersonal force.
Early definitions of transpersonal psychology grew out of humanistic psychology, generated by psychotherapists and researchers who wanted to acknowledge the role of spirituality and religion in the development of the human being. Transpersonal psychotherapy came to be seen as “…an open-ended endeavor to facilitate human growth and expand awareness beyond the limits implied by most traditional Western models of mental health … The therapist may employ traditional therapeutic techniques as well as meditation and other awareness exercises derived from Eastern consciousness disciplines.” (Vaughan, 1979, p. 101).
“All forms of psychotherapy can be seen as a process of altering or modifying the patient’s self-image,” stated A. H. Almaas (Almaas, 1992, p. 39-40), who brought ego psychology and object relations theory into the field of transpersonal psychotherapy. He noted that in conventional psychotherapy certain boundaries of the self that promote pathology are recognized, modified, or dissolved to suit a more healthy self-image. This was accomplished by bringing them to consciousness and checking them with reality to encompass more and more of what is “real”. “In our perspective,” he wrote, “this means more openness and spaciousness in the mind… (and) if we (continue this process and) go beyond this limit of trying to achieve a “normal” condition… the person’s experience of himself becomes more and more open and spacious until this openness culminates in the direct experience of the nature of the mind: space.” Almaas is here pointing towards that state which is beyond conventional definitions of a healthy ego, and a healthy mind.
Precursors to transpersonal psychotherapy are seen in traditions of human functioning that describe a developmental arc (Wilber, 1985). In these traditions the human being is understood to be essentially a spiritual entity. These precursors are seen cross-culturally and are variously described in Hindu, Buddhist, Jewish, and Christian traditions (Huxley, 1944). They are observed in shamanic (Walsh, 1996) and Native North American traditions (Sander, 1996).
Although less-frequently addressed in transpersonal literature, the Sufi tradition inside Islam articulates one such developmental progression, and the steps (Shafii, 1988, p. 175-207) that were outlined centuries ago pointing towards higher forms of human capacity. These are steps that include and yet go beyond a healthy ego, personality, family, career and community. These steps are described by many Sufi teachers as being seven levels of the self (Frager, 1997), offering stages beyond “normal” human development, accounting for the entire spectrum of psychospiritual human functioning. Contemporary efforts (Almaas, 1990) to link Sufism and object relations theory also differentiate ‘personality’ from ‘essence,’ and attempt to describe techniques of ‘metabolizing experience’ that shift a person from his or her conditioned behaviors (a.k.a. personality) into an experience of his or her co-existing essential features.
These are a few of the ideas that form an intellectual background for a transpersonal psychotherapist. Lukoff & Lu (2005) note correctly that when we are working transpersonally we consider spirituality as valid human experience. We do not believe, as did Freud, that religion was merely wishful illusion; as did Ellis, that religion was irrational; or as did Skinner, that it should be disregarded.
The psychotherapist establishes a transpersonal context in several basic ways: by being personally educated in conventional and transpersonal psychotherapy; by listening for a client’s dreams, myths, ideas, and experiences that connote a relationship with the Universal (Metzner, 1998); and by working on oneself using transpersonal methods (Vaughan, 1979). Ram Dass/Richard Alpert (Alpert, 1975, p. 89), describing his encounter with R. D. Laing, noted that they had discussed the meditation practices they were doing, and were realizing that “…we were going to have to work on ourselves to get behind our own thinking minds, to be able to hear more clearly how it all is.” The transpersonal psychotherapist is working to get behind his or her own thinking mind: to return again and again to a point of view that, technically, will provoke the therapist’s own intuitions and insights that inform responses to the client and promote personal, interpersonal, and spiritual growth.
The content of the therapy considers material at the level of the ego (coping with life, identifying types of cognition, tolerating emotion); of interpersonal phenomena (family of origin, relationship patterns, successes and failures); of existential concerns (authenticity, meaning, and purpose); and of the transpersonal (the Divine, God, the Void, Allah: the larger trans-experiential impersonal cosmos). In some cases ‘depersonal’ psychotic material surfaces as well and is addressed (Grof & Grof, 1990; Lukoff, 1996; Lukoff & Lu, 2005).
If the transpersonal psychotherapist begins with the expansion of awareness as a goal, the therapy addresses the identification and disruption of maladaptive patterns of cognition, emotion, and behavior, using the client’s increasing mindfulness (a strengthened observing ego) as the basic tool. “Transpersonal practices enable the individual to see beyond the conditioned ego, to identify some deeper and more enduring sense of self, and to implement beliefs that consider individual existence as an expression of some wider reality or larger life force” (Clark, 1998, p. 351). It is this larger life force that we acknowledge.
When a client introduces a transcendent idea or an event of altered-state of consciousness into a psychotherapy session, a transpersonally-trained psychotherapist does not ignore the comment. Instead that new topic is accepted and considered, part of the ‘traditional, legitimate’ topics of symptom relief and ego strengthening that are relevant and of value to the effort that the client is making.
In this way, the transpersonal orientation makes room (pun intended) for the spaciousness, the wholeness of the experience of being human, and inspires us to become identified with the larger Being, that vastly interconnected one heart beat, one Universal Mind.
But a psychotherapist’s orientation does not guarantee successful work with clients. In the real world of conducting any form of psychotherapy, the method of clinical supervision (Hess, 1980) has since the analytic days been a recognized method of developing clinicians towards more effective and efficient functioning with clients. Its job is to assess, from actual session dialogue between a client and a clinician, what insights are being gained, what is being learned, what derailments are happening, and how to understand ‘what is therapeutic about that?’
Clinical Supervision of Psychotherapy
One method of psychoanalytically-inspired clinical supervision (Langs, 1979) is described as adaptational-interactional (Langs, 1980), and involves a number of basic practices, four of which are employed here.
The first is identifying strongly with the client. This is an effort to sense the experience of this person with these strengths and weaknesses, at this time and place in his or her life. The supervisor actively recreates, in his or her imagination, the emotions, the stance, the thinking that the client is and is not reporting.
The second practice of supervising this way is to observe how both client and clinician adapt to one another verbally, emotionally, and physically. The clinician adapts to the client using his or her own psychotherapeutic ground rules and goals, establishing a relationship and following technical lines of inquiry, constrained by his or her own countertransferential dilemmas. The client adapts to the clinician, reacts to what that participant says or does, and those adaptations tell us something about both parties, and whether or not the meeting is proceeding in a therapeutic or non-therapeutic fashion.