Foundations of Psychotherapy

The psychotherapy I offer is based in developmental psychology/attachment theory and research. It incorporates the practices and philosophies of mindfulness-based, cognitive and existential psychotherapies and interventions. This means that I view what you bring to therapy in the broad lens of your life historically, from your birth onward into your adult life stages, to the present moment. I see you as a person who has many tasks—learning about yourself and environment and trying, as we all do, to feel competent, safe, have good enough relationships and create a meaningful life. I am interested in helping you understand the issues you bring to therapy in the context of your lifelong emotional, intellectual, social, occupational development and your life current circumstances, interests, relationships and work. I am also very interested in your sense of purpose and your aspirations and the choices you make in the present, today.

It is true that we are born with biological temperaments and dispositions, physical characteristics and family histories of various kinds that we do not choose. Nonetheless, we can choose and change our views about ourselves, other people, the world, our current circumstances and we can effect a future that suits us better than the past that we reflect on. Indeed, there is much about us that is not solid or absolute but is created and shaped by circumstances and experiences and ongoing choices we make. Psychotherapy at its best can offer you corrective experiences, ones that to some extent relive and readjust your relationship with your interpretations and feelings and actions around your experiences, past and present and future, and help you make choices and author your life. And through this process you really can change the ways you think and feel and behave.

Part of the method we use in psychotherapy to make changes is to accept that, from birth and throughout our lifespan, we are always naturally in need of relationships with ourselves and other people. This process of relating to ourselves and others, and their attuning to and understanding us, and how we understand ourselves, is how identity is constructed— a sense of “me”.

Finding meaningful and healthful attachments to people, and becoming a “me and you”, is psychological, social and biologically based and is just something that you—and everyone else– must do. How you do it and how you make your experiences, knowing what you think and feel and want and need, become important things to consider when you want better self-other relationships. You do not have to be confused and tied down in anxiety and depression. Fortunately, it is possible to look at all of this and understand it. You can look at how you are trying to connect with yourself and other people, and the sense your life makes overall, and you can begin to see the choices and detours you make. And you can wisely choose them and find a better way to live and relate.

But let’s get specific and nail things down a bit. All the words and ideas aside, you may rightfully ask, “How did things become the way they are in my life, and why therapy now?” Let’s go back for a minute. Sit back. Think about your life, you in particular. Early in your development you “took in” influences, other people and experiences of yourself in relation to them. Picture all of that. See what you find in your memory. Notice anything? Okay, just consider that those events and people remain active internally in your thoughts, beliefs, emotions and behaviors, right now! Yes, even many years after the events happened and people and circumstances have gone. Gone and changed, yes, but the ideas you have about them took shape in your thoughts and they do live on inside you even if you don’t see them as historic, even if you do not really know they are there. They continue in all of us, and they color how we see the world. but we do not think about it this way. Usually, the “inside me” parts seem like “out there” experiences. But “Out there” is to a considerable degree, not entirely, what you think and feel inside of you, and it comes from  your personal history, including the story lines that became your foundation and ongoing narrative over many, many years. Again, you can understand most of this and change much of it.

With this methodology, I specialize in treating persons who are concerned with relationship adjustments in all life stages, from young adulthood through mature adulthood. Additionally, I am able to help persons who have mental illness, chronic depression, generalized anxiety, and people who have been diagnosed with borderline personality disorder. I am trained in DBT, Dialectical Behavior Therapy, as developed by Marsha Linehan Ph.D. at the University of Washington. And I have been in clinical practice for seventeen years. Indeed, most of my practice serves adults who experience symptoms of anxiety and/or depression and find themselves in years-long patterns of mood, relationship and life situations that do not suit them. Generally, I am available to assist anyone who is reevaluating his or her life’s purposes and wishing to establish greater personal meaning.

What’s it like, specifically, in mindfulness-based, existential psychotherapy?

In psychotherapy, for the first time, aware of your lifetime developmental history, significant events and relationships, your unique strengths and dispositions and personality, an hour at a time you will pay attention to the stream of your thoughts, the qualities of emotion and the behaviors that are linked with your thinking, emotion and mood. You will become a keen observer of yourself from the inside out, skilled enough to “decenter” from your usual stream of thoughts and images and emotions and begin to watch them. Watching, naming, you will begin to know yourself as an observer and differentiate yourself from the habits of your thinking and feeling and acting. With this mindful attention, you will understand that certain experiences that were at one time direct and unfolding are now just mental representations and not solid facts. You will begin to realize that you are not your thoughts, your feelings, and that what you think and feel are quite important, and that you have choices about some of this experience.

We will help you go from automatically acting on the command of those mental representations, to a new mode of being aware and knowing what you are feeling and thinking, and choosing to be in current, direct contact with yourself, people and events in the “here and now”, working with how you interact with your internal states and your relationships with other people, and choosing how to be. This can become a highly creative process and you can develop an intelligence that you may not have used very much. This is where discussing courage and purpose, freedom and choices, and personal faith and can support you to realize a life based much more on what you desire and create. Based on your abilities, wishes, ambitions, your defined sense of purpose and meaning, you can begin to authentically live your life.

What are “mindfulness-based” contemplative psychotherapy practices not just from psychology but from the area of Buddhism, and where do they come from? Also, how does an existential focus in therapy figure into Buddhist-influenced mindfulness practices in therapy?

If you like to read about psychotherapy, which is certainly not necessary to do therapy, I am happy to share that the mindfulness-based/existential therapy I practice is influenced by the works of Marsha Linehan, Pat Sable, John Bowlby, Donald Winnicott, Arya Nagarjuna, Soren Kierkegaard, Paul Tillich and Rollo May. These writers and thinkers have much to say and offer on the topics of emotion regulation/attachment, human development, faith, courage and choices. Further, you might be interested to know that the mindfulness-based/contemplative movement in psychology includes very well regarded contemporary scholars, researchers and psychotherapists such as Jack Kornfield, John Kabat-Zinn, Mark Epstein, and Daniel Siegel. You may want to look at these authors and review their work.

Central to mindfulness practices and “Buddhist psychotherapy” as some have called it, which need not involve Buddhism per-se, is the understanding that we can use mind to understand brain behavior, and that our moods, views, perspectives and behaviors come about for many reasons (causes and conditions) and they arise and fall away continuously and are not permanent or absolute, and they are not solid facts about us, our lives, or who we are. Rather, when we are mindful and investigate the appearances of people and things, we can see that every moment is a continuous (and mostly unnoticed) stream of thoughts, feelings and behaviors that arise and fall away. This is ancient wisdom that was well understood by the contemplative people who developed the foundations of Buddhist methods of inquiry into the nature of suffering and the paths to wisdom and happiness. Much like modern psychology, careful observation and critical analysis are essential methods and objectives in the mindful, meditative and psychotherapeutic processes.

Buddhist psychotherapy ventures comfortably into territory of ontological exploration. Academic psychology is not concerned with the investigation that philosophers describe as ontology, the study of being, and to some degree phenomenology, the study of how we know things.

Where psychotherapy stops short of philosophical inquiry, is in its benevolent pragmatism, which is to study and ameliorate symptoms of mental illness. There is nothing wrong with a practical, problem-solving and behavior modifying approach. However, to change symptoms and behavior, we might also become interested in the states of mind and experience through a deep exploration of mood, anxiety and, to some degree, to ask, what is the self or “I” that experiences these states of mind? But we do not need to find some kind of ultimate answer to this question. Instead, in mindfulness-based therapy, using a Buddhist method of inquiry, looking at “who and what is this ‘I’?”, and what is this anxiety and depression really?, we can just ask the questions, experience the thoughts and feelings, notice the perceptions, and make this process of observing and inquiring and noticing our practice. In this practice, by definition, our relationship with our experiences, our being, becomes more than an inquiry. It becomes a different way to live. We can see into depths we used to be ignorant of, no matter how intelligent we are, and we can make important choices. As we become choice-making actors, we can live in a generative, creative way.

What we do, think and say defines our view of self and other people and the world. Our concepts of past, present and future come from the process of mind. We “hold” the world in our thoughts like an internal map. The streams of mental chatter and images and emotions that come from our internal schema take up our attention without our knowing that they take our attention, and they influence our behaviors. And a lot of what we assume about ourselves and other people and things and events during our days, Buddhist teachings remind us– seem like they are “out there”, not in our own heads, not of our making, as if what we see, feel and think is one big observation of what goes on in the world. But it’s both–it’s in our minds and in the world out there. This is the understanding of the Middle Way. So, through mindful examination of this internal chatter, and paying attention to our thoughts and focusing on our senses, and “watching” what is inside and outside, we can begin to see that a lot of our views and behaviors are actually just so many projections of mind, and a lot of what goes on around us can just be left alone, or acted upon, and that we have choices–many more than we thought. Causes and conditions exist, and our constructions of reality are indeed like recipes for making meaning. You could say that through our eyes, ears and sense of touch and smell, and through thinking—labeling, putting words on, and acting in the world, we take in what is around us and then represent these data to ourselves as facts, but since it’s really mostly our thinking, labeling, imputing meaning to things that in themselves do not have inherent meaning, we can make the meaning and create some very important changes after all, in the best way. We can add and change things a bit.

When we begin to pay attention one-mindfully to our internal mental processes of observing and describing, we engineer our lives to fit better with the conditions around us as well as within us. We can address the human, existential anxiety that arises and understand it as a gift to wake up and accept birth and death and the task or project of becoming, authoring ourselves and choosing, if we want to, to create happiness. This is our active role, where we are not stuck in interminable therapy or merely equipped with a lot of intellectual insights. Indeed, we can influence and create some of those conditions around us. We can also become the cause of the quality of our lives. Simply put, we begin to decide how we are going to use our minds and become wiser and happier by paying attention, deconstructing and constructing meaning and taking action wisely and joyfully being both ourselves and part of the conditions around us. We are “the world”, so this process is like making friends with the world inside and outside and having a lot more freedom, happiness and meaning in life.

In summary, mindfulness-based therapy helps you learn to stand still and observe and become aware of life as a dynamic flux of contingencies. It’s a way to accept the way things really are, not just how they appear. You can find that life, living, being yourself, are all pretty flexible, and not just what you thought. You’re not stuck, really. Nothing is really solid at all; rather, you and everything around you are fluid and built on still other things, including who you think you are, and all of it changes all of the time, and it always did! And that is partly because everything comes from many other things, and the names you give things, yourself, events, come from you and not from the things themselves. You can see deeply into how events become what they appear to be and what they really are and you can have a great influence on yourself and your life which are, after all, multiple events and cause and effect. Becoming aware, you can stop going just on appearances and stop your habitual chain of unconscious reactions and storytelling about “how it is” or “how it has to be”. You can understand your life in terms of its root causes conditions instead of looking just at symptoms, problems and “issues”, and you can embrace painful emotions and use your troubles and symptoms as guideposts to cultivate wisdom and change. You can begin to create a great life, moment by moment, breath by breath. Wisely, you can begin to construct much of your experience of self, other and the world and become happier and fulfilled in the deepest and most intrinsic ways.

The existential part of this therapy concerns the—let’s call it—“project” of creating a meaningful life, realizing that what your life means to you is an ongoing project based on what you choose. I suggest that no particular meaning or purpose for living comes automatically with your birth, but certainly your life provides you with ongoing choices, and between birth and death you can (and perhaps you must) choose to live and understand anxiety and depression as useful calls to attend to your personal project of existing and being and becoming,  and to direct yourself by your skills, talents, insights, imagination and desires and circumstances.