The simple paradox I explore in this entry is the intersection of psychotherapy, which is often at its best when it is goal focused, and meditation, where the instruction is to be present without thought and to not seek a desired end. Let’s see how we can understand the seeming contradiction suggested here. After all both psychotherapy and meditation can be helpful and without out being at odds with each other.
I posted a blog entry from summer ’14. I explore the intersection of therapy and meditation and one simple paradox in particular: Psychotherapy, which is often at its best when it is goal focused, and meditation, where one is to be present without thought and to not seek a desired end. Let’s see how we can understand the seeming contradictions suggested here.
In my psychotherapy practice I am an enthusiastic proponent and practioner of Control Mastery Theory which was originated by Joe Weiss MD and researched in conjunction with Hal Sampson PhD and the San Francisco Psychotherapy Research Group. The earliest tenants of the theory began perculating in Joe’s mind as a medical student. His thinking gained traction as a response to the the main orthodoxy of psychoanalysis 1950’s and 1960’s which dominated Joe’s intellectual and practice milieu.
Control Mastery Theory grew out of Joe’s clinical work in which he noticed that patients often functioned in ways not predicted by, if not at odds with, major aspects of Freudian theory. Joe’s seminal observation as a very young man was encapsulated in the observation of when people cry at the happy ending, eg of a movie. Traditional psychoanalytic had a cumbersome explanation involving instinctual forces overwhelming defense mechanisms.
Joe had a simpler, more penetrating observation, that when people felt safe they could face emotions such as sadness without being overwhelmed. Overtime he added many observations that added coherence and depth to his vision of how the mind worked and how a psychotherapist might be positioned to help clients in therapy.
One of Joe’s major ideas is that that clients come to therapy with a plan on how to get better. On the face of it, this statement might seem confusing. One might think if people planned to get better would they even need therapy?
The plan concept makes more sense when we realize that plans as well as many aspects of mental life often operate unconsciously. For example, let’s say a client who grew up with a very critical father, comes to his first therapy session late. The client may not realize it, but he has created a situation where he is going to learn quickly about whether the therapist possesses traits similar to his father. If the therapist reacts with a sense of irritation to the client’s tardiness, it could signal that the therapist might share a need for perfectionism like his father. Or he could be hard to please. Or he could be seen as controlling etc.
In Control Mastery Theory terminology what is taking place in this vignette is a test the patient is conducting in relation to his new therapist. Because the test is unconscious, the client does not recognize he is conducting testing by entering the therapist’s office late for the very first time. That is, it is highly unlikely that he is consciously thinking, “I think I’ll show up late see if this therapist has any traits like my father.”
As a result of this and other unconscious tests, the client may form an impression of the how the therapist operates and by extension if this might be a person the client can find as helpful. Sometimes the impression is immediate. The patient might leave the session saying to himself, “I have a good feeling (or bad as the case may be) about this therapist.” Or it may take many months and repeated unconscious testing for the patient to get a clearer idea.
For her part the therapist may not know exactly how she is being tested. A CMT therapist does recognize realize that testing is a ubiquitous phenomenon both in therapy as well as in life outside the consulting room.
Many therapists pass all kinds of patient testing just by being inquisitive, respectful or non-judgemental. CMT trained therapists, following Weiss’s theory try to learn what kinds of testing a patient might exhibit in therapy by gaging the unconscious plan for therapy revealed by the testing. So a patient with a critical and rejecting parent might engage in behavior or statements that could give the therapist cause to criticize the client like the parent.
The therapist who understands that a dynamic such as this is being re-enacted is alerted to the patient’s plan for therapy, which initially might be to test if the therapist will traumatize the patient in a similar fashion as the parent had.
In CMT parlance one way the therapist helps his client is by passing the client’s unconscious test. Anything the therapist says or does which passes the test is said to be “PRO-PLAN.” In the case of the client who came late to therapy, the therapist did not act irritated or even subtly belittle the client was on some level being pro-plan for that particular patient.
I could hypothesize a case where a client with very neglectful parents might require attention be paid as to why she was late for a first appointment. If she feels the therapist glossed over her tardiness, it is possible she might conclude that this particular therapist is too reminiscent of her parents. The unconscious plan for this particular patient might be to give careful consideration to her actions and utterances so that she can feel reassured that she is taken seriously.
We see from these examples how highly case specific are the needs, tests of the therapist, and the unconscious plans for therapy and specific stance and interventions the therapist must have to be Pro-Plan for each patient seen in treatment.
Meditation, which is the practice of mindfulness, instructs the participant to focus on the flow of breath and to leave the contents of thoughts out of that fundamental awareness. Over and over if one becomes aware of a thought, one is instructed to “let it go” and return to awareness of breathe.
Thus meditation encourages and helps cultivate awareness of the present moment by returning one’s attention to the present moment. The quieter the mind, ie by being devoid of thoughts, the more one can be present.
Even if one is not a meditator, it is possible to see how the meditative state encourages a quiet mind. A quiet mind is less like to be a highly reactive mind. Often therapists help to quiet their client’s minds by understanding and empathizing with the hurts and traumas which give rise to powerful feelings and internal states that are painful in nature.
When meditating there is no goal to achieve in the sense of trying to cultivate a particular state. People learning meditation are told not to expect any particular result. Being in a state of “presense” leads one to awareness of subtler and subtler realms.
So for the purposes of this article a therapist, who is practicing traditional goal oriented therapy, whether it be down-to-earth short term problem solving or 4 time a week psychoanalytic personality restructuring, may initially see meditation or even a mindfully based psychotherapy as potentially relaxing but not particularly efficacious or helpful. For some therapists their feelings about mindfulness might be because it is viewed as lacking structures where goals are one type of structure.
For the therapist without a meditation or spiritual appreciation sitting quietly, whatever benefit the meditation holds for the practioner, is just not psychotherapy.
For a practioner of Control Mastery Theory the idea that having no plan for meditating could be somehow “pro-plan” for a therapy client would require the therapist to be curious about the nature of the experience of the meditator.
From the point of view o f curiosity it might not be a particularly great leap to see how No Plan (of meditation) could be Pro-Plan (in the CMT sense). Many therapists who understand meditation, often recommend it to their clients either as adjunct to the therapy being conducted or perhaps to facilitate states where becoming aware of stress and finding a way to be present and thus be able to let go becomes a way to access new feelings. Or at least consider a different orientation the constant chatter of the mind.
Joe Weiss never wrote about about meditation or “presence.” In fact he was largely oriented to plans as being an essential component of human nature. He saw critiques questioning whether people in therapy conduct unconscious planning as being naive in certain way. Scaresly a day goes by where even the Dalai Lama has no plans, even if his plan is to spend the day in contemplation. We can also imagine that there those in his employ who take care of his plans when he doesn’t.
Joe also felt that having a bad plan was preferable to no plan. While this point can be debated, I feel confident having known and consulted with Joe over many years that no part of Control Mastery Theory or therapy would be hostile to meditation or meditatively oriented therapy. In fact I could imagine a fine and mutually informative conversation, which would be a great idea for a conference. Such a conference would have to be planned, hmmm.
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