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The qualities of a good therapist, from the client's perspective

Posted by a.marlow on January 16, 2013 at 9:20 AM Comments comments (0)

How does one go about offering therapy to someone suffering from an eating disorder? It's one thing to have a detailed understanding of the neurochemistry or psychoanalysis of anorexia; it's another thing to put that theoretical knowledge into practice. One thing that comes across when we compare therapists working from Freudian, Jungian, Kleinian etc. backgrounds is that the particular theory being used is far less important than the quality of the relationship between therapist and client.


So what qualities must the therapist embody in order that his/her therapeutic intervention is experienced as something positive by the client? A recent article by Gulliksen et al. in the International Journal of Eating Disorders has suggested that successful therapy, at least from the point of view of the anorexic client, involves a therapist who is generous in affection and understanding, respectful of the client's perspective, patient about change in the client's behaviour and in the development of the therapeutic relationship; actively interested in the client's personal qualities and thought processes and possessed of a sense of humour; who focuses on the client's strengths and who supports the client through difficult situations; who has experienced knowledge of eating disorders, and who is authoritative and self-confident about their expertise.


On the other hand, clients tended to view negatively those therapists who disregarded their feelings and opinions, who were passive and seemingly uninterested in the client's problems, and who pampered them, showing an attitude of pity and sympathy that could end up perpetuating the disorder.


None of this should come as a surprise, but it is sometimes more difficult in practice than in theory to embody these qualities. Moreover, before rushing to embody all of these attributes without giving them a second thought, one major weakness of the study must be considered: it only looked at how these qualities impacted upon the client's feeling of satisfaction with the treatment, not at whether these qualities led to concrete outcomes of weight gain or improved mental well-being.


Source:

Gulliksen, K. S., et al., 2012. Preferred Therapist Characteristics in Treatment of Anorexia Nervosa: The Patient’s Perspective. International Journal of Eating Disorders, 45, pp. 932-941


A Bohmian approach to psychopathology

Posted by a.marlow on December 16, 2012 at 1:00 AM Comments comments (0)

Despite the reservations of Lane in the previous blog post, the question of if, and how, quantum physics relates to the workings of the brain remains a poignant one- so poignant, in fact, that it has spawned a whole academic journal devoted to its answer, Neuroquantology. It is an article from this journal that forms the basis of today's blog.


David Bohm was a quantum physicist who uniquely decided to see what the implications of his discipline would be for deeper philosophical questions of reality and of mind. It is against this backdrop that Pylkkänen seeks to find what implications these, in turn, may have for how we treat psychopathology, or mental illness.


Mental illness, he observes, is often characterised by a breakdown of unity or wholeness. It is therefore pertinent to note that Bohm's quantum ontology underlines the primacy of wholeness, in comparison to biological, social and psychological explanations, which seem to take the whole to be the sum of its parts. From a quantum perspective, we should not view apparantly separate events and objects as being truly individual, but rather as being parts of a greater whole, like vortices in a stream of water; and from this perspective, it is possible to view the mind, as a whole, as a stream of consciousness, out of which emerges the relatively autonomous entities of thoughts, beliefs, desires and perceptions. If we take this view of the fundamental nature of mind, then "mental disorder results in part when this wholeness is lost", perhaps by giving too much emphasis to various natural divisions within the stream of consciousness. Moreover, if each part of the mind is a manifestation of the whole stream of consciousness, then each individual mind is a manfiestation of the whole social environment in which it is found, and we can say that mental disorders are not simply the private affair of a disordered individual, but rather the manifestation of a more widespread social phenomenon.


Pylkkänen also observes that many mental disorders are characterised by a lack of information, mistakes about information and failure to respond adequately and accurately to information. From this perspective, Bohm's concept of "active information" might be helpful.


For Bohm, a particle whose behaviour is governed by the laws of Quanum Mechanics can be viewed as simultaneously possessing the characteristics of a particle and of a wave. A typical experiment that shows the wave and particle nature of, say, an electron is the double slit experiment, where a series of electrons are fired through two slits and exhibit both particle properties (in that they arrive at the detector in the form of a single spot) and wave properties (in that the place where they land is determined by the mathematics of wave behaviour, so that when many electrons have been fired, their pattern forms that of a wave). For Bohm, this is explained by saying that the electron travels through one of the two slits and appears at a point on the photographic plane, while its accompanying field goes through both slits and interferes with its tragectory so that the collective pattern of the particles exhibits a wave formation. This accompanying quantum field is said to contain "active information" about the environment around the electron, giving rise to a "quantum potential" that influences the individual electron's movement. Crucially, this active information should not be seen as something imposed from without, but rather as a core part of what the electron, as a union of field and particle, actually is. Bohm came up with the concept of "soma-significance", where a process in which information and meaning have a tangible effect on matter is called a "signa-somatic". Based on this general idea, Pylkkänen goes on to suggest that:


 

"it is possible that the information that is experienced in consciousness is carried by some much more subtle medium, analogous to the quantum field, but capable of much more complex properties, including qualia, subjectivity and conscious experience"


This 'very subtle' field might act as an influence on the bain's neocortex by means of the quantum field. Moreover, Bohm went on to suggest that, if the quanum potential constitutes active information that can give form to the behaviour of physical particles, so might there be a superquantum potential that gives form to the quantum potential and that does not obey current laws of Quantum Mechanics; there might also be a super-superquantum potential that performs the same function, and a super-super-superquantum potential, and so on. In this way we could include mind as a subtle principle of organisation into Quantum Theory.


Pylkkänen suggests that a Bohmian understanding of information as an active organising principle could hold beneits for our understanding of mental illness. For example, depression could be conceived of as a state where negative information is overactive while positive information is underactive,  and anxiety could be a failure to deal with the active nature of information, with sufferers relying too much on their own self-agency, their own ability to control their thoughts, rather than acknowledging the autonomous influence their thoughts have qua information and dealing with it calmly.


In general, it is asserted that, from a Bohmian point of view, mind can be said to subtly influence the movement of particles such as electrons, and these electrons can in turn be said to control the more classical brain functions observed by neuroscience. Empirically, previous work by Pylkkänen has found that the quantum potential can increase the probability of synaptic exocytosis, leading him to conclude that "we could regard the “mind-field” as initiating a subsequent neural process which finally activates the motor neurons to produce the outward behaviour", active information being the trigger for classical neurological processes. It is also suggested that similar processes might be at work in the behaviour of dendritic fields or in microtubules. Moreover, to account for perception of the external world, it has also been suggested that the influence goes both ways: nerve matter communicating with the mental wavefunction about what is being perceived in the same way that mental wavefunction communicates with the nerves in order to express its will, creating a "new kind of feedback-control loop that is absent in dead matter" (Jack Sarfatti).


References:

Pylkkänen, P., 2010. "Implications of Bohmian quantum ontology for psychopathology", Neuroquantology, 8(1): 37-48

'Medical Constraints on the Quantum Mind'

Posted by a.marlow on December 15, 2012 at 11:10 AM Comments comments (0)

In recent years, the old philosophical problem of the nature of mind has become a subject of interest to physicists. Thinkers like Roger Penrose (author of 'The Emperor's New Mind' and 'Shadows of the Mind') and Stuart Hameroff have begun to suggest that the human brain works according to the same mechanisms as a quantum computer. Others have gone further, taking their thoughts to more esoteric levels and proffering that the human brain acts merely as a conduit, a transmitter, for an underlying and pre-existing quantum field of mind.


All of these ideas are fascinating- but there comes a time to move beyond the theory and the textbook, and to ask instead whether and how we may use these ideas in diagnosis, treatment and therapy; and, when this question arises, so too does the question of whether these theories even present an accurate picture of the human mind in the first place.


Into this quandary steps Nick Lane PhD, whose article in the Journal of the Royal Society of Medicine is the inspiration for this blog post. Writing from the perspective of a biologist, he pits the quantum view of consciousness and the biological view of consciousness against each other by viewing the fundamental requirements underlying each. A biological theory of consciousness simply demands an "extraordinary organisation of rather ordinary matter", while a quantum account would have to be based on "some very special properties of matter" in the form of "macroquantum effects". This is due to the fact that, while quantum physics almost perfectly describes the behaviour of matter at a subatomic level, Einstein's theories of relativity and Newton's laws of motion generally still hold water at the macro level; indeed, it is very rare to view the kind of effects generated by quantum mechanics at a micro level replicated at a macro level.


Lane admits that a complete and coherent view of consciousness based on the biological view is currently unavailable. He writes that:


"...all we must do is show that an enormously complex parallel processing system, comprising a hundred billion neuron-equivalents, coupled to a multifaceted and profoundly integrated sensory system, and an ability to remember and learn, is capable of giving rise to consciousness... That might take a while."


Yet if the biological account still fails to provide us with answers, Lane's view is that it is more likely to do so in the future than any nascent quantum theories currently on offer. What are these theories? Evan Walker proposes that consciousness is produced by delocalised electrons using cytoplasmic RNA as stepping stones and tunneling through synapses; Roger Penrose and Stuart Hameroff present a similar theory, except where microtubules take the place of Walker's RNA as the required intracellular structure. Yet Lane dismisses these theories, arguing that the probabilities of post-synaptic firing offered as evidence for Walker's viewpoint could just as easily be explained by conventional neurotransmission, and that the argument of Penrose and Hameroff (who claim that the key role of microtubules is shown by the way in which anaesthetic agents accumulate in them, implying that the ensuing loss of consciousness is related to an ensuing change in microtubule functioning)  is discredited by the fact that anaesthetic agents also have effects on ion channel function and calcium influx, that there is no expert consensus on how anaestetics work (or even that they all work in the same way), and that certain chemicals, such as colchicine, are known to explicitly affect microtubules without having any effect on consciousness at all. Another theory, suggested by Ian Marshall, proposes that consciousness is generated by a coherent, non-local order of protein vibrations- "the melody of proteins singing together". Yet, as Lane points out, this particular theory also lacks any confirming evidence.


Each of these theories share another weakness: they all require specific molecular stepping-stones in order to be viable. For Walker, this stepping stone is a particular set-up of RNA; for Penrose and Hameroff, it is the presence of intact microtubules; and for Marshall, it is the existence of tiny gaps between vibrating proteins. Lane points out that the evolution of such specific systems is less likely than the evolution of a system whose only requirement for generating consciousness is a generally increasing complexity, as described by the biological account. He writes:


"...from a quantum broadcasting point of view, the machinery required to sustain consciousness must have evolved without compromising the computing function of the nervous system. Cells as highly specialized as neurons, which have evolved to a high degree of complexity even in organisms with little recognizable consciousness, cannot have much remaining flexibility to support the evolution of a new infrastructure for consciousness."


Because of this, Cairns-Smith has argued that neurons are bad candidates for ever being used to explain human consciousness, and that we should instead be looking to the less specialised glial cells of the brain, such as oligodendrocytes in the white matter or astrocytes in their support network throughout the brain. 


Yet examining certain neurodegenerative conditions, even this hypothesis seems doubtful. In Multiple Sclerosis (MS), we see an attack on these very same oligodendrocytes- but no loss of consciousness. In Alzheimer's disease, we see early correlations between symptoms and neurofibrillary tangles in the neocortical association areas of the temporal lobe, such tangles being "but the ghosts of microtubules"- but again, no loss of self-awareness, with even advanced sufferers continuing to speak in first person and to respond to changes in their conversations and their environment.


In acute ischaemic stroke, however, there may be tentative evidence for some of Cairns-Smith's ideas. This kind of stroke sometimes brings about widespread depolarisation of astrocytes. A 1995 study of 24 patients who showed dramatic recovery from their stroke during a thrombolysis trial by Grotta & Bratina found that "most patients seemed peculiarly unaware or blasé about their deficit and improvement", perhaps implying that a sluggish recovery of the astrocyte network led to a sluggish recovery of their self-aware consciousness.


While Lane's article is certainly informative, but my major critique would be his working definition of 'consciousness', even if it is a somewhat orthodox one. He writes:


"For consciousness... I mean awareness or sentience, both of our own self and of our relationship to the world around us."


Yet this strikes me as a rather reductive definition. We tend to think of something that is not 'conscious' as being 'unconscious'. Yet there are many altered states of consciousness where one might not satisfy Lane's working definition above, but still be far more 'conscious' than 'unconscious'. Altered states of consciousness may be reached in many ways, whether through certain types of meditation, through use of illicit drugs or through experiential therapies such as Holotropic Breathwork. In these altered states, one may experience a loss of identity and individuality, often coupled with a sense of oneness and unity with the universe. One might also 'hallucinate' in such a way that an outsider would say you were 'seeing things that weren't there' when, in actual fact, a proper understanding of the experience would acknowledge the deep psychological meaning and healing potential of the visions. Crucially, these experiences, in which one ostensibly loses awareness of one's self and one's physical surroundings, are often experienced as being far more real than ordinary wakeful consciousness. The person going through them is not in a dream and could not be said in any sense of the word to be 'unconscious'. Therefore, while much of what Lane says in his article is fascinating and illuminating, a proper study of human consciousness cannot be undertaken while the background definition of the subject excludes states where one is quite clearly conscious in some sense of the term. 


So, what of the question that started off this blog post? Despite his definitional deficit, Nick Lane provides an evidential background to the theory of the Quantum mind and shows it to be lacking. In this context, while the truth and mechanisms of this particular theory have yet to be established, there seems to be little we can take from it into the therapeutic situation.


References:

Lane, N., 2000. "Medical constraints on the quantum mind", Journal of the Royal Society of Medicine, 93:571-575

Stoicism, 'Logos' and the reform of Cognitive Behavioural Therapy

Posted by a.marlow on December 4, 2012 at 1:40 PM Comments comments (0)

An interesting article appeared in the Guardian today that I'd like to discuss here in this blog.


It starts with a discussion of the ancient Roman system of philosophy called stoicism and one of its central ideas, that of the λογος (pronounced 'logos'). Λογος can be translated into english as either word, discourse, reason, activity, or principle, although none of these words truly reflects its full meaning. Writing about λογος, the early Stoic philosopher Cleanthes wrote:


"...For thus you [Zeus] have joined all things, the good with the bad, into one,

so that the eternal Word of all came to be one.

This Word, however, evil mortals flee, poor wretches;

though they are desirous of good things for their possession,

they neither see nor listen to God's universal Law..."


Λογος is also found at the heart of Christianity. In one of the most famous passages of the Bible, from the beginning of John's gospel, it is proclaimed that: "[i]n the beginning was the Word, and the Word was God, and the Word was with God". Christians take this to mean that Jesus Christ is 'the Word' and often leave it at that, but one would reach a fuller understanding of the passage if one understood the meaning of 'the Word', or 'λογος', in the context of stoic philosophy, from which the author of John's gospel undoubtedly took inspiration.


Explaining the concept of λογος in the practical stoic life, Mark Vernon in his article for the Guardian writes that:


"The ancient stoic training was an attempt to orient the whole of life to the logos. Chrysippus, the third head of the school and one of the most brilliant philosophers of the ancient world, used the metaphor of a cylinder rolling down a hill. Life is like that. There is nothing you can do to change it. What you can do is learn "to go with the flow", as opposed to resisting the bumps and shocks.


But why should you go with the flow, one of his young disciples might have asked? Because the flow can be trusted, Chrysippus would have replied. It is the action of the logos. It is mysterious, yes; often painful, yes. But ultimately benign. And if life were not providential, you are right: it would be more noble to resist it all the way."


In this way, belief in the λογος is a belief that the universe is ordered in a rational way according to a unifying rational principle, and that one can be sure that everything one enjoys or endures is for the good of the whole, even if it is not good for the self, and should therefore not be resisted. This idea makes sense when one takes into account the statement of another ancient philosopher, Heraclitus, that:


"Listening not to me but to the logos it is wise to agree that all things are one."


If, underneath it all, 'all things are one', then each of our individualities would have to be seen as nothing more than separatist illusions, mere parts of a greater whole; and if we believe that temporary harm to our individual selves is ultimately for the good of the whole of which we are merely a part, then we will be much more able to endure the inevitable challenges that life throws in our path.


What does any of this have to do with Cognitive Behavioural Therapy (CBT), though? As a matter of fact, the ancient school of stoicism is often said to bear many similarities to modern cognitive approaches to mental health. And yet, if  CBT has taken on many aspects of stoic thought, it has left out consideration for the λογος. Mark Vernon warns us:


"the stoic notion of flow was a kind of devotion, an offering of yourself. Cultivating the right inner attitude was absolutely crucial to the good life stoicism promised. Practise stoicism for self-serving reasons, as instrumentally driven therapies and self-help might encourage, and you risk alienating yourself further...


...Longitudinal testing of CBT appears to be suggesting the benefits are short-lived. I wonder whether Chrysippus might help explain why: does CBT unwittingly encourage the delusion of living out of your own strength, he might ask?"


It is this difference that could be crucial. If CBT does encourage its clients to live out of their own strength, then when that strength inevitably fails them, they will lose the faith they gained in themselves and go back to square one. If, however, consideration of the λογος were included in CBT, then such setbacks would be taken on the chin and accepted as being, in some as yet inconceivable way, a good, whether that be for oneself or for others, and could therefore be endured much more effectively without returning to the symptoms for which the patient sought CBT in the first place.

The New Physics: Quantum Skills for the 21st Century Therapist

Posted by a.marlow on December 2, 2012 at 3:20 PM Comments comments (0)

I was trawling through the internet on a lazy Sunday afternoon, as you do, when I came across and interesting article from 2010 called "Spirituality, Mental Health and the New Physics" (reference below). Intigued, I read it, and what follows is a summary of the ideas contained therein.


The premise of the article is that, with the new understanding of physics engendered by quantum theory and chaos theory should come a new understanding of psychology and, thus, new approaches to psychotherapy- or, at least, a rethinking of old approaches.


The article pits old-school Newtonian physics, based on the idea that the universe can be conceived of as a 'Great Machine' with fixed, predictable rules of behaviour, against the new insights of Quantum Mechanics, which might imply that the universe should rather be conceived of as a 'Great Mind', where randomness and chance rules the day and where the more mystical and maligned ideas of Jung, Janet, James, Assagioli and the modern school of Transpersonal Psychology would come to prevail over the accepted orthodoxies of Freudianism and behaviourism. The author of the article, one Charlotte Shelton, uses these ideas to suggest seven 'Quantum Skills' that therapists should use and clients should develop to further their mental health goals.


The first "Quantum Skill" is "Quantum seeing", based on the insights gained from Quantum Mechanics about just how much our own perceptions and intentions shape the world around us. Based on this idea, the skill of 'quantum seeing' would acknowledge that a bad situation is only bad because of our own intentions and perceptions that shape our experience of that situation, and that our first task should be to change those perceptions in order to have a much more pleasant experience of life.


The second skill is "Quantum thinking", based on the insight that, at least at a subatomic level, our reality is much more governed by randomness and chance than it is governed by fixed, binary laws. Despite this, most adults tend to think in a fixed and binary manner, one that limits their creativity and blocks certain nuanced possibilities from emerging in their lives. Challenging this way of thinking, especially by encouraging right-hemisphere thinking, is the route to a more creative life, suggests Shelton.


The thid skill is "Quantum feeling". This builds on the ideas of 'quantum seeing', but focuses on one's feelings and, especially, the relationship one has with one's own heart. Research by the Institute of HeartMath has shown that the heart exerts a strong electromagnetic influence on one's thoughts and emotions; specifically, that when one is experiencing a negative emotion, the heart's electromagnetic waves become less coherent, while a positive emotion makes them more coherent. It is therefore healthier to feel better in oneself. This point, really, reinforces the ideas developed in 'quantum seeing'.


The fourth skill is "Quantum knowing". A growing number of physicists are speculating that there is a single unified quantum field containing Bose-Einstein condensates from which the entire material universe emerges, and Shelton suggests that this field might itself be conscious, or at least the source of human consciousness (as one hypothesis suggests that Bose-Einstein condensates are the prerequisites to the neurological structure in the human brain that underpin consciousness, and if this hypothesis is proven true, then this "will lend support to thehypothesis that the quantum field itself is conscious"). If this is true, it might indicate that the human mind can tap into this quantum field, postulated to be the source of consciousness, as a source of intuitive knowledge; and, on this basis, fostering an attitude of mindfulness and intuitiveness will lead to better decision-making. 


The fifth skill is "Quantum acting". As particles have been shown by quantum theory to maintain an instantaneous connection despite being separated by impossible distances, an awareness of this interconnectivity of the universe will foster an attitude whereby someone acts not just for their own atomistic self, but rather for the whole- whether that whole be their whole self, their whole community, or the whole planet.


The sixth skill is "Quantum trusting". At the subatomic level, Bohm has suggested an 'invisible ordering principle' as a means by which the larger quantum field could influence the behaviour of individual subatomic particles, and at the more macroscopic level of chaos theory, computer simulations have shown a 'strange attractor' that seems to set limits on otherwise random structures, that brings order and structure out of randomness and chaos. Quantum trusting, then, is an acknowledgement of the ever-changing nature of life and the way in which order can arise even when one feels completely in disorder.


The seventh skill is "Quantum being". At the subatomic level, the individual particle is a mere abstraction; each particle exists only in relation to the other, and can merge to become one larger, more whole system. Applying this by analogy to the human level, "[q]uantum Being is the ability to be in healthy relationships –relationships based on unconditional love. This skill requires clients to owntheir feelings rather than project them onto others".


Personally, I am not sure whether each of these 'skills' deserves the label 'quantum', and nor am I sure that one can necessarily abstract from the behaviour of subatomic particles to the level of human relationships and mental health. Nevertheless, some of these ideas are interesting, and the relationship between the insights of quantum theory and human consciousness and mental health remains a fascinating and groundbreaking area of research. I hope some of these ideas will be useful to you in your therapetic practice or personal growth, and if you want to read Shelton's original article, you can find it at the reference below.


References:

Shelton, C., 2010. “Spirituality, Mental Healthand the New Physics”, InternationalJournal of Applied Psychoanalytic Studies, 7:161-171.