WHY MEANINGFUL CHANGE IS SO DIFFICULT: INTRODUCTION 1.1: TO THE MANUAL

Why Meaningful Change Is So Difficult
Introduction 1.1: To The Manual

One lesson that my long experience as a psychotherapist has taught me is that no one thing works all the time.  Even the very best researched methods, called “evidenced-based practices,” never approach 100% success rate. However, the following combination of approaches has worked best for me, particularly with clients in complex situations and/or with serious mental health disorders.  Though each case is different, here is how I generally try to appreciate and integrate MIND, BODY, SOUL, SYSTEM, AND STORY into my practice.

First—MIND: I find it crucial to make a good connection with my clients, so that they feel seen, heard, and validated.  This is called “building good client-therapist rapport,” “joining,” “evidenced-based relationships,” or “good mentalizing.”   Unless there is a “good-enough” connection between client and therapist, the container necessary for the correct balance of support and challenge is impossible.  Mentalizing’s emphasis on holding the client’s heart and mind in one’s own heart and mind is a good summary of the crucial use of the MIND dimension to begin and to continue good therapy for complex problems. It parallels what the great Jewish theologian Martin Buber called “I-Thou” relationships. These deep relationships are crucial to any efforts to make fundamental changes in one’s life.  A deep connection in therapy is the foundation for meaningful work in therapy.  Then, continuing to notice and validate the client’s thoughts and feelings are the building blocks of deeper work.  This includes noticing both (1) what gets in the way of the self-chosen change a client wants as well as (2) what supports and helps that change. The work expands (1) by developing strategies to deal with obstacles and (2) by strengthening and building on the supports.

Second—BODY:  For too much of the history of psychotherapy, including my own earlier practice, the importance of the bodily dimension in deep change has been minimized at best and completely ignored at worst. Somatic Experiencing (SE)® and other body-centric approaches to psychotherapy are finally getting well-deserved, wide-spread attention.  Particularly with complex trauma, consulting “the wisdom of the body” is crucial because unresolved trauma is carried in the body.  For trauma and for many other complex therapeutic challenges, an embodied psychotherapy is absolutely essential.  While SE® has thousands of specific interventions, the beginning steps in SE® body work are to: “(1) establish an environment of relative safety, (2) support initial exploration and acceptance of [bodily] sensation(s), and (3) establish ‘pendulation’ and containment: the innate power of rhythm.” (Peter A. Levine (2010). In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness, Berkeley, CA: North Atlantic Books, p. 74)

Third—SOUL:  Before the early 1990s, psychotherapists were trained to avoid any discussion of religion or spirituality in therapy sessions.  The motivation for this training was primarily to avoid therapists’ imposing their own viewpoints on clients.  Except for substance abuse professionals, grief counselors, and pastoral counselors, religion and spirituality were off limits for the vast majority of psychotherapists.  An unintended consequence of this overly rigid boundary, however, was that many clients wanted to talk about the resources in their own spiritual traditions that helped them cope in times of trouble.  Many of these clients also wanted to integrate psychological and spiritual health into a personal whole.  In response to evidence of these deep desires of clients, beginning in the 1990s, numerous approaches were developed to encourage clients to talk about their own spiritual resources that helped them get through difficult times.  Further work helped clients integrate these skills with other forms of coping and resilience.  James Hillman called it “The Soul Code,” and Thomas Moore called this integrative work “The Care of the Soul.” With the growing evidence of the beneficial effects of meditation and other practices, integrating soul work into psychotherapy in a manner respectful of clients’ belief systems is now standard practice for good psychotherapy.  However, specific skill training in the integration of psychotherapy and spirituality is often lacking in graduate programs and in other training curricula.  Hence, how to add “SOUL” to good MIND and BODY work is still a challenge.

Fourth—SYSTEM:  Beginning in the 1950s, then exploding in the late 1960s and 1970s, several family system approaches to psychotherapy introduced the then radical idea of treating whole family units.  To do this family work effectively, the first pioneers in family psychotherapy soon found that they had to think differently—to think in a systemic, non-linear way instead of trying to replicate individual psychotherapy with more people in the room.  With the dying of the original, dynamic pioneers of family therapy, there has been pressure to return to treating only individuals and to use family work mainly as an adjunct to individual work with the “identified patient.”  But thinking only in individual terms misses the profound systemic forces that shape much of the context or matrix of our lives.  Returning to the original energy of the family system pioneers is needed to understand the matrix in which we live—both in understanding the systemic forces that hinder individual change and in utilizing the systemic healing factors that are needed to change positively both individuals and society.  The current Black Lives Matter movement is a clear example of one manifestation of the crucial need to notice and to consider the systemic dimension of any efforts for deep and profound change.

Fifth—STORY:  As my diagram above shows, I believe my fifth dimension—the core story or narrative that each of us believes about our lives—emerges organically at the intersection of the other four dimensions. In today’s world, it is increasingly clear that there is a world-wide battle between two warring narratives.  One narrative coalesces around FEAR.   If anyone who is different is seen as dangerous and to be feared, then there is a natural flow of demeaning language, isolation, domination, violence, and annihilation. Alternatively, there is also a counter-narrative, the narrative of LOVE and COMPASSION for self and for others.  Dr. Martin Luther King, Jr.’s writings about “The Beloved Community” are one example of such a narrative. The most concise summary I know of such a narrative is “all flourishing is mutual.” (Robin Wall Kimmerer (2013), Braiding Sweetgrass, Minneapolis, MN: Milkweed Editions, p. 382) If there is growth of one’s WISE MIND, WISE BODY, AND WISE SOUL and if one joins with other like-minded persons in struggling for WISE SYSTEMS, then a powerful, unifying, positive narrative emerges.  Therefore, in effective, in-depth psychotherapy, listening for and noticing a growing life-enhancing narrative is the fifth and most unifying of all the dimensions of change.

Why meaningful change is so difficult to start and to sustain:

Considering the five dimensions of meaningful change described above—MIND, BODY, SOUL, SYSTEM, AND STORY, each dimension separately is daunting and complex.  But because all five dimensions overlap and interlock with one another, the complexity increases exponentially in the challenge of making lasting and transformative change.  The purpose of this website is to foster the spirit of noticing, without being judgmental, what a client is experiencing in each dimension—MIND, BODY, SOUL, SYSTEM, AND STORY.  In the noticing process, it is crucial to listen for and to understand the context or matrix in which the client has developed both constructive and destructive strategies that contribute to where the client is at the present moment. After deep listening and connecting, the therapist can reflect back what the client has taught the therapist about the primary yearnings, passions, and pains at the core of that client’s identity.  When this is sufficiently affirmed and validated, then the second step is this: to notice, in each dimension, what is the true path towards which a client is drawn.  One sign that a client is on “the true path” is a natural, organic increase in energy.  Another sign is an increasing ability to validate one’s self without invalidating others and to validate another without invalidating one’s self.

To summarize, the two main questions of 5-D therapy for meaningful change are:

• What do you notice? (in MIND, BODY, SOUL, SYSTEM, AND STORY) and
• To what are you drawn? (in MIND, BODY, SOUL, SYSTEM, AND STORY)

My theory is that integrating all five dimensions in this way has the best chance of leading to meaningful, even transformative, change and to a life of greater energy and vitality. This is also what the world needs now in this liminal moment in time. –Lou Irwin, LCSW