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Psychotherapy with a soul

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VOL: 97, ISSUE: 49, PAGE NO: 34

Jenny Droughton, MSc, RMN, Dip Psychosocial Management of Psychosis, is a freelance writer

Psychosynthesis is a little-known psychotherapy that may offer positive outcomes for certain mental health problems. It is an eclectic form of treatment that draws on aspects of psychoanalytical, existential and humanistic psychotherapies as well as some Eastern and Western philosophies.

Psychosynthesis is a little-known psychotherapy that may offer positive outcomes for certain mental health problems. It is an eclectic form of treatment that draws on aspects of psychoanalytical, existential and humanistic psychotherapies as well as some Eastern and Western philosophies.

As its name implies, psychosynthesis refers to a psychotherapeutic framework that recognises and seeks to integrate, or 'synthesise', the psychological, emotional, physical and social dimensions of human experience. While these dimensions are common to mainstream psychotherapies, psychosynthesis has an additional dimension as its central emphasis: spirituality and the experience of individuals and groups (Whitmore, 1991).

In psychosynthesis, the term 'spiritual' is not used simply to denote religious affiliation and practice. It is used in its broadest sense to encompass the 'transpersonal', dealing with both the existential-humanistic and psychospiritual aspects of people and their problems (Tuyn, 1988). The approach focuses on the interactions between the different parts of the client's self and personality, aiming to reconcile these diverse elements into something new. Therefore the goal is to enable the client to synthesise an integrated, balanced and complete self that recognises and values all its component parts. The rationale is that this integration will lead to the resolution of the emotional distress.

Historical background
Psychosynthesis was developed by an Italian psychiatrist, Roberto Assagioli (1888-1974). Originally an acolyte of Freudian psychoanalysis and later of Jungian psychotherapy, he became disillusioned with the emphasis on the past in psychoanalysis. He felt that it would be more beneficial to focus on a person's future potential rather than dwelling on past traumatic experiences.

Assagioli believed that if the vast human potential could be harnessed it would result in psychological and spiritual healing and positive change. He also argued that repression of this 'higher potential' would lead to disturbances every bit as incapacitating as repression of childhood trauma (Assagioli, 1990).

This fundamental difference in emphasis distinguishes psychosynthesis from psychoanalysis. While psychoanalysis aims to alleviate emotional disorders by dismantling the client's psyche and personality into their key components, psychosynthesis seeks to do so by synthesising or integrating previously divergent influences on the self or psyche.

In addition to its psychoanalytical roots psychosynthesis can also be categorised as part of the 'human potential movement'. While many mental health nurses may not have heard of psychosynthesis, they will have encountered the work of Abraham Maslow (1968), a key proponent of this movement. Maslow's ideas on the hierarchy of needs and self-actualisation still form the basis of much mental health nursing theory. Like Maslow, Assagioli argued that we all have an intrinsic drive to meet higher goals over and above our most basic physical needs. When this is frustrated or denied, psychological distress is an inevitable result.

How it works
The process of psychosynthesis includes some interventions drawn from or common to therapies other than psychoanalysis including, for example, Gestalt therapy (Ferrucci, 1990). Proponents consider this eclecticism vital in creating a process that matches each client's unique needs for psychospiritual integration and restoration. The journey and the final destination are important, rather than the mode of travel or the specific triggers to positive change and improved mental health.

Therapy starts with a comprehensive initial assessment that aims to identify the client's main problems and exclude serious mental disorders, as these would affect the extent to which the approach could be applied. After this, up to four phases of therapy can be undertaken, depending on the client's needs and current mental health.

The first phase provides an opportunity for clients to focus on and learn about their own personality. Using supportive counselling and similar techniques, they are encouraged to develop awareness of their personality and the factors influencing its development.

According to Assagioli (1990), the next two phases must only be attempted with people who have relatively minor mental health problems and no serious personality or psychotic disorders.

In the second phase the client learns about his or her 'major identifications'. Identifications are the roles, habits, personality traits and even possessions that are intrinsically linked with a person's identity. The ones that often cause emotional or psychological difficulties include career and relationships. These identifications are not in themselves bad or unhealthy. What is problematic is a tendency to over-identify with them. When people do so, they lock themselves into certain restricted images not only of who they are but of who and what they may become (Ferrucci, 1990). In other words, they inadvertently condemn themselves to cycles of helplessness and hopelessness.

Psychosynthesists argue that when people do this they reinforce the static quality in their language, for instance, by saying and thinking 'I am depressed'. Instead, psychosynthesists encourage people to recognise that feeling depressed is just one of their qualities and that they can choose to learn more about it and possibly get some control over it instead of being driven by it (Assagioli, 1990).

The strategy to facilitate the required learning is disidentification. This involves practising and building recognition and understanding that their self is separate from the roles and emotions they experience. Various techniques can aid disidentification. Their aim is to nurture what Assagioli called the 'vigilant self' and to start to control and redirect the energy from over-identification.

The third phase involves clients achieving realisation or recognition of their unique 'true self'. It represents 'the discovery or creation of the self as the unifying centre of experience' (Assagioli, 1990). Many of us will not reach or complete this stage as it is an immense undertaking. The process of inner growth can occur without therapy, shaped by our experiences of life, but this route is usually very slow. Psychosynthesis advocates that the process can be accelerated by deliberate conscious action and the use of appropriate active techniques, including guided imagery, meditation and relaxation.

The fourth phase involves clients forming or reconstructing their personality around the unifying, healthy centre of the true self they discovered or created in the previous stage. Now they consolidate the insights and learning gained during the earlier phases of therapy. This involves channelling the psychological energy released through the disintegration of over-identifications into constructive intellectual, imaginative, social and physical activities.

It also requires enhancing aspects of their personality and cognitive functioning, such as memory and imagination, which may be too underdeveloped to support the goals they now want to attain. Key techniques include exercises to train their will and creative affirmation.

What it claims to do
The holistic outlook of psychosynthesis endeavours to address the neglected dimension of spirituality and integrate it with biological, psychological and social aspects. It offers a framework for personality and spiritual development, particularly for people experiencing emotional problems, such as mild to moderate anxiety or depression. It is a form of self-help that nurtures personal and emotional growth by offering innovative strategies for holistic self-development (Mathers, 1994). The approach also has applications in teamwork, organisational development, education, youth work and international relations.

Risks and contraindications
Psychosynthesis involves the exploration of unconscious drives, emotions and defence mechanisms. Like conventional psychoanalysis, it can trigger an uncontrolled release of energies which may overwhelm both the client and the therapist. Assagioli (1990) documented various potential dangers and drawbacks, together with strategies to prevent them. The importance of adequate therapist training, competence and supervision cannot be over-emphasised in ensuring clients' safety.

As the third phase of psychosynthesis involves examining the personality through disidentification, it may pose risks for people experiencing florid psychotic symptoms, such as hallucinations and delusions, affective symptoms, such as mania or severe depression, or those with a personality disorder. In this respect it is similar to most conventional psychotherapies, which suspend in-depth therapy in favour of supportive interventions during such times. However, Assagioli's (1990) clinical work with people with psychosis provides a case illustration of the process and outcomes for therapy with people with schizophrenia.

For such vulnerable clients, he recommended only the first and last stages of therapy: the first is non-threatening and necessary to gain information and build rapport while the final stage promotes the reintegration and reidentification of the self. The logic is that people experiencing psychosis are in the midst of an unplanned, chaotic process of disidentification, so the third stage is not only potentially dangerous but also redundant. What the person needs from the therapist is support and care to help them make sense and reintegrate what seem to be alien and discordant aspects of their emotions, experiences and thoughts.

Implications for nursing
Most models of nursing claim to offer a holistic approach, which incorporates or at least refers to the spiritual dimension. Yet in practice this aspect is often poorly understood by clinicians so they largely ignore it. Some care plans do include a brief note on whether the person participates in a formal religion, mistakenly considering that doing so comprehensively covers this important area.

However, as Tuyn (1988) points out, even in mental health nursing most psychological theories and frameworks used 'offer little or no recognition of the spiritual dimension of human experience, and virtually no guidance on how to incorporate this dimension into treatment strategies'. Psychosynthesis offers an alternative perspective that emphasises spiritual and existential issues rather than skirting round them.

Limitations
No data exists to confirm the average length of therapy required for some resolution of the client's emotional distress. It is also not known how cost-effective psychosynthesis is, for example, in treating minor mental health problems, such as anxiety and depression, compared with established, clinically proven interventions, such as cognitive behavioural therapy.

Like psychoanalysis, proponents of psychosynthesis advocate the lengthy, usually expensive, training of therapists. Training is available only in a limited number of places in the UK. However, a range of courses, from short introductory to diploma programmes, are available and make therapists eligible for British Association of Counselling accreditation. Trainee psychosynthesis therapists are expected to undergo personal therapy, incurring further expense. These factors limit both the availability and dissemination of psychosynthesis in publicly funded services.

Strengths
Many key psychosynthesis texts display an infectious passion for human potential and the capacity for positive growth and change. This does not guarantee 'good' therapy, but it can revalidate the values and optimism that led many of us into nursing and enable us to reflect on and consolidate our personal and professional satisfaction.

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