What is Transformative Psychotherapy?
Montage by Victor Bloomberg, August 23, 2015
I sometimes describe psychotherapy this way, “Talk-therapy can be focused on adaptation to daily life or transforming patterns of living that developed from past experience.” Let’s look at the effects of injury and healing in order to understand personal change, adaptive and transformative.
The Impact of Psychological Injury on a Person
I-You denotes human encounter and I-It signifies objectification. A person is injured when they are treated like a Thing, whether by another or through oneself. The injury can be done to the bodily self, as when a worker is maimed or killed by employer disregard for safety. The injury can damage social relationships, as when a parent works multiple jobs that pay poverty wages and then has less time with their children. The injury can be psychological, as when emotional abuse causes unrelenting anxiety.
How a Psychotherapist Helps an Injured Person
My theoretical frame posits that there is a polarity in the quality of emotional experience, an emotion response cycle versus a spasm. The emotion response cycle flows from safety, trust and respect (I-You); a spasm flows from insecurity, doubt and disregard (I-It). Transformative psychotherapy generates a recurring emotion response cycle.
Psychotherapy provides intertwined I-You encounters that release pain stored from prior injuries. The release of pain allows new perspectives, codified in stories that contain a different explanation for past events and new beliefs about oneself. When a person grasps for words that rise to the occasion, but those words are a little bit out of reach, the psychotherapist can offer words that fit the occasion.
How Healing Happens
I-You is the experience of the client being seen as a person while relating with the psychotherapist, this opens the perception of the client to see their own self in the same way. The more regularly I-You occurs in session, the more I-Me (through which a person perceives and experiences their own humanity) becomes the norm.
Think of the emotion response cycle as a wave that occurs spontaneously when the present safety of I-You exists paradoxically while reliving a past I-It injury. The past injury is retained in a knot. The knot is a pain point in the brain or elsewhere in the body; the pain is felt in thoughts, sensations, emotions. The knot is loosened by I-You relating, the energy is released spontaneously during the split awareness (past injury and present safety). Once the energy waves subside, the person can weave a new image, give a new explanation and different significance to the past injury.
Transformative psychotherapy seeks resolution of root causes for problems that recede and recur, tone down or amp up. Transformation is evidenced by new behaviors (ad hoc and routine) which maintain and promote the experience of self and others as persons rather than as things. There is an ever-present challenge, the Thing-Person Swing.
What is a “Thing-Person Swing”?
My theoretical perspective is that transformative psychotherapy mobilizes awareness of a Thing-Person Swing, regardless of whether or not the awareness is named as such. Buber (1970) describes a boundary that floats, fluctuates between I-It and I-You. My model, Thing-Person Swing, recognizes I-It as a source of problems and I-You as a resolution.
My view is that I-You is not a static achievement. There is oscillation once the developmental ability to see another as a person is achieved. An infant cannot perceive a parent as a person and a toddler can. The newborn senses the caregiver as a thing that satisfies or frustrates:
“When mothers tell me about children, I usually get them to remember what sort of things happened at the very beginning… They tell me about all sorts of objects that become adopted by the infant… But this first object is established as part of the furniture of the cot or the pram before the word ‘ta’ can be said or could make sense, before the infant makes a clear distinction between the me and the not-me, or while the making of this distinction is in process.” (Winnicott, 1993, pp. 15-16)
My theory recognizes that not all emotional events have the same significance. There is a unique quality of an emotional event which is essential for transformative effects. The unique emotional quality is available through, and only through, I-You experience. The client in psychotherapy can be helped out of their I-It orientation. Then, what happens?
What is the “Emotion Response Cycle”?
I have introduced the concept of an emotion response cycle through which healing occurs versus spasms through which emotional injuries are sustained. Three critical factors drive healing versus injury. Two are safety and trust. The third strand (imagine a triple helix) is respect. Respect is grounded in I-You experience. Psychotherapy nurtures respect through storytelling and emotional sharing that recurs in an iterative fashion. Interacting with the psychotherapist, unacceptable emotional pain is converted into meaningful experience, the path to satisfaction of motivational needs (Maslow, 1943) becomes imaginable for the client. The interacting and the sharing are cyclical, iterative in the sense that meaning builds upon experience. Psychotherapists from different theoretical perspectives shared these thoughts:
● That helps to build trust. (Transactional Analysis)
● You know there’s that feeling of safety, building that rapport. (Psychodynamic)
● As the relationship goes on, getting a chance to demonstrate my genuine caring for them, then from there we build on that. (Relational)
● So we weren’t directly talking about the experiences, but continuing to build on that theme. (Cognitive)
● I think of it as this relationship that we’re building and we’re trusting in. (Psychodynamic)
● We worked and were able to build that relationship. (Relational)
All of the clinicians “build” regardless of the different approaches that they use. My view is that building occurs through a repeating emotion response cycle. What is it and what is actually happening?
Let’s start with emotion and its connection with thought. According to Ruud (2019, para. 1), “[The] amygdala (part of the limbic system of the brain) plays a large role in emotion and is activated before any direct involvement of the cerebral cortex where memory, awareness, and conscious ‘thinking’ take place.”
Emotions are physiological signals that we use to navigate interactions with others (Geller & Porges, 2014; Porges, 2011; Somatic Perspectives, 2011). And similar signals can flow from different reflexes. We all know that there are tears of sorrow and tears of joy.
The release of tears is not inherently healing. Acceptance (of the experience, the emotions, and their significance to one’s sense of self) is crucial to understanding whether released emotions injure or heal. My perspective builds on the work of Karen Horney (Ingram, Ed., 1967):
“There are… many patients who feel strong emotions… And these feelings, even though they are really felt, often have no therapeutic effect… There must be some difference in the value of such intense feelings, a value determined by whether or not such feelings were hitherto suppressed [and now they are felt] without embellishment, and without any interest in the reasons for the feelings – just the experience of the emotion itself… All of this – experiences of liberation and intense emotion – points to an aspect of therapeutic effect… Put in theoretical terms, it means accepting his ‘actual self.’ Nothing has changed… just the experience of such acceptance.” (pp. 97-99)
Emotions are signal waves that signify something is important. Psychotherapy can, through the telling and re-telling of stories, open up emotional waves of varying degrees of intensity and duration, such that the experience heals rather than sustains the status quo or injures. The quality of emotional experience that heals is acceptance.
How is unacceptable pain converted into meaningful experience? I-You realm of relating is the key. Relating is grounded in safety, trust and respect; it supports the acceptance of the here-and-now which in turn builds the strengths needed for acceptance of the there-and-then. Such relating supports an emotion response cycle through which healing occurs.
My model is similar to a sexual response cycle (Cleveland Clinic, 2017). The sexual response cycle (excitement, plateau, orgasm, and resolution) provides insight into the waves of all emotions. The wave pattern is similar for laughing, crying, yelling, etc. The results of the waves differ radically based upon whether the experience is accepted or rejected. Metaphorically, acceptance yields an orgasm and rejection produces a spasm, regardless of the emotion.
Neuropeptides are released after pleasurable sexual activity (Safron, 2016, “The neurophenomenology of orgasm”). These are also released after other activities that produce deep, intense satisfaction. Post reverie, all sorts of creative, integrative thoughts flow.
Think of a time when you cried and the person with you was supportive and safe. Afterward, you felt better and might have better been able to talk about it. This is an example of a completed emotion response cycle.
Now think of a time when you cried and the other person was aggressive or punitive or dismissive. Once the tears stopped there was not a feeling of well-being and talk was not fruitful. The tears flowed from spasms.
Neural nodes, synapses, can become inflamed (Bukalo et al., 2013; Gallego-Delgado et al., 2020; Uchizono, 1975). The inference that I draw from these observations is that spasms result from bio-electrical/chemical storms and they add to nodes of inflammation. When current upsets resemble past injury, spasms can be triggered. The waves of pain leave a wake as does a moving boat; the nodes can emit signals after the triggering event ends. There are nodes that contain hot-spots from past injuries which generate emotional signals.
Can anything be done about neural damage rooted in past trauma? Brain damage is located, at least in part, in its white matter. White matter is “a vast, intertwining system of neural connections that join all four lobes of the brain (frontal, temporal, parietal, and occipital), and the brain’s emotion center in the limbic system, into the complex brain maps being worked out by neuroscientists” (Filley, 2005, para. 5.) The structure of brain white matter can be changed through learning (Draganski et al., 2014; Nudo & Dancause, 2012; Scholz et al., 2009) and therein lies a hope provided by psychotherapy.
I am suggesting that psychotherapy can alter white matter through purposeful, safe remembrance. Psychotherapy provides real-time security that allows pain from past experience to surface, it prevents re-injury from shame, punishment, abandonment, betrayal and other forms of rejection aimed at the person and the experience. Acceptance as described by Karen Horney, allows and generates new meaning which is retained in the white matter.
One way to think about it is that nature and nurture gives each of us our start in life. Trauma causes damage. Healing is re-naturing through nurturing.
My model builds upon Gestalt psychology. Gestalt psychology provides a “[field theory] perception [that posits] neural… processes with which the perceptual facts are associated, are located in a continuous medium [and] events in one part… influence events in other regions in a way that depends directly on the properties of both in relation to the other. [It] provides a ‘field theory’ of cognition” (Köhler, 1973, p. 55). My model uses a field theory of emotion that incorporates findings from neuroscience and Gestalt psychology.
Talk-therapy invariably involves a client who tells their story. In the model that I have presented, the storytelling is iterative and the clinician’s responses elicit details through safe, trustful, respectful relating. The transformative potential is manifest in the spontaneous sharing of emotions; the therapeutic action is expressed in the re-telling of the story. The re-telling modifies the explanation of events, self-identity of the client and their beliefs; altogether the changes allow the client to experience pain and pleasure as sources of healing, empowerment. This is Big Change.
A person who fundamentally sees self and others as persons can routinely reset the relationship through that perspective. Also it is possible to see the relationship from a communal perspective.
The perspective, I-You in a community, can lift the veil of oppression (internalized and socialized). The concepts “internalized” and “socialized” might be grasped intuitively. But let’s address the duality directly.
Oppression defines some people as human and other people as subhuman Things. The racist can see a member of their group as a person, then swings to perceive others as Things. Do you think such a person is stable in I-You when among their kin, within their tribe? Might such a person view another in their close orbit as a Thing to dominate, control? Might that be a perversion of the Golden Rule: Do unto others that which has been done to you? I am describing internalized oppression. It begs the question, “Why is it so common?”
Oppression is internalized, incorporated into self-defining beliefs, because it resonates and is congruent with the individual’s earliest development. Winnicott formulated Me/Not-me. Me/Not-me consciousness is deduced from the observations of newborns and their subsequent development (Winnicott, 1993.) Buber formulated I/It and I/You. Infants are not born with a capacity for empathy. Empathy is learned; empathy is central to a communal ethos. Throughout a person’s life, there is a back-and-forth of perception. I see the other person as a fellow human or not:
“The market ideology demands the “objectification” of the people, who are to be treated as disposable objects easily replaced, which in turn facilitates their exploitation as labor that is increasingly devalued. This ideological stance requires a maximum of ephemeral human relations, fragile and poorly conducted... the disregard for other human beings evident in the violence plaguing the planet like an epidemic of horrific proportions.” (Freire et al., 2014, p. 74)
The internalized oppression is inseparable from its socialized forms. After all, we are social creatures, primates. Each of our individual experiences occurs in the context of a social setting.
A transformative psychotherapy will rattle the client’s personal cage, because empowerment of an oppressed person releases emotions that were previously suppressed. Now here is the dilemma. How can disequilibrium or disruption, which is essential to empowerment, be created without causing new damage?
If disruption is created, it damages, but if it is co-created there is the possibility of empowerment. The determinative factor is collaboration that "embraces self-love as a force for emancipation" (Lawrence, 2020.) An essential healing factor of psychotherapy is the mutuality of experience.
The experience of psychotherapy engenders healing. It releases emotions that were imprinted when trauma originally occurred and thereafter were reinforced by re-traumatization. Psychotherapy works because the clinician nurtures safety, trust and respect in service of healing. As emotional waves are released in the healing experience, the client can form fresh perspectives.
Summary of Change through Psychotherapy
I use the image of Yin-Yang for adaptation-transformation. It’s not an either-or polarity. There often is a back-and-forth in the clinical emphasis. A Relational Therapist said this about transformative work:
“I think what works is that if the client really feels heard and that’s really modeled for them then they can really hear themselves. They can be okay and not so judgmental in their head. It allows them to not be so afraid. It affects change. It’s a relationship, the feel in the room. I always felt it meant you are in the room and there's safety and trust. Actually there was a feeling going on. There's safety and the client can start to relax. Trust in themselves grows. That affects change.”
I have come to define personal transformation as ongoing learning that alters beliefs. Learning that heals is necessary for a life dedicated to empowerment and emancipation from oppression (personal, social, societal).
