The Therapy Turf Wars

“My therapeutic approach is better than yours!” All too often therapists with one particular approach criticize one – or all – of the others, and I’m sick of it. CBT is frequently involved in these turf wars, partly because it’s the favourite of the NHS. Some CBT therapists imply that their approach is vastly superior to all others, ignoring the evidence that supports the effectiveness of other schools of therapy. Humanistic therapists frequently respond in kind, suggesting that CBT is shallow, simplistic and unable to tackle deep rooted issues.

Ruby Wax is an especially irritating ‘turf war’ critic. Ruby is a passionate advocate of Mindfulness Based Cognitive Therapy, an approach I have a lot of respect for. Sadly Ruby feels it necessary to dismiss several of the most important ‘rival’ schools of therapy with funny parodies. Carl Rogers developed the Person Centred Approach (PCA) that unpins most Counselling in the UK today. According to Ruby the PCA is about repeating “whatever you said back to you like a parrot but with love” (Wax, 2013). She goes on to dismiss Gestalt, Existential and Psychoanalytic approaches. Ruby; it may be funny, but it’s not clever!

Triggering my ire today is a book about the Human Givens Approach, which claims that the PCA, Psychodynamic school and CBT are all “piecemeal approaches” and that none of them “are sufficient on its own” (Griffin and Tyrrell, 2007). Their solution is, of course, the Human Givens Approach! The research evidence suggests that PCA, Psychodynamic and CBT can all be effective in certain circumstances. In fact CBT make much of the robust research base that supports it and a Person Centred Approach is one of only four therapeutic modalities approved for the treatment of depression under the NHS.

All this frustrates and saddens me. The Human Givens Approach has a great deal to offer and I intend to integrate it into my own therapeutic practice. But I’m galled that those who developed it feel the need to dismiss other approaches as inadequate. It sometimes feels like I’m back in the school playground hearing one kid saying “My Dad’s bigger than your Dad!” Viewing all this though a psychodynamic lens, I wonder if some therapists have unresolved childhood issues!

Elephant parable ilustration

We need a wide perspective

Given that the human mind is the most complex system in the known universe, is it really plausible that one school of therapy will have the definitive and complete answer to every individual’s unique mental health problems? Maybe one day, but most certainly not yet. Meanwhile I’m adopting a pluralistic approach, learning as much as I can about as many different paths to healing as possible. I try to take a wide perspective, asking myself the question; for this particular client, at this specific moment, which therapeutic lens is going to be the most helpful? This is usually called having an ‘integrative’ approach, but I think I’m best described as a pragmatic therapist: My only interest is what works?

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Five steps to mental wellbeing

As I was walking home earlier this week I saw a card lying in the street. I picked it up and realized what it was; the five steps to wellbeing developed by the New Economics Foundation (NEF). This little card is a brilliant reminder of the 5 steps so I now make sure I see it everyday.

Five Steps to Wellbeing card

The Five Steps to Wellbeing

The five steps are simple and powerful.

Connect – I’ve often written about the importance of connection; in fact I think it may be the most fundamental source of wellbeing. The NEF research concurs: Having less than four close relatives or friends puts you at high risk of future mental health problems. On the other hand, wide social networks “promote a sense of belonging and well-being” (NEF).

Try to connect with the people around you:

  • Talk to someone instead of sending an email or text;
  • speak to someone your don’t know yet;
  • don’t just ask how someone’s weekend was; really listen when they reply.

Be active – In Exeter, there’s no excuse! Walking, cycling, kayaking, climbing, swimming, football or, of course, rugby! You don’t have to take on anything too demanding; just find an activity you enjoy and make it part of your life. I often recommend physical exercise for clients who are experiencing depression: Exercise can boost your endorphins and moderate aerobic exercise can help with emotional regulation (Bernstein & McNally, 2017).

So why not go for a walk, try a sport, take up yoga or maybe tai chi? If you walk to a colleague’s desk instead emailing them, you get a bonus social connection!

Take notice – Research shows that paying attention to your immediate experience and ‘savouring the moment’ enhances wellbeing. It can also deepen self-understanding, thus helping you to assess and reaffirm your priorities. Taking notice is related to mindfulness which has been shown to promote positive mental states and facilitate emotional self-regulation.

  • Cultivate your curiosity; look out for the unusual.
  • Notice the changing seasons.
  • Just pause to notice your sensory experience: Really be with this moment.
  • Remember to check in with your self: How are you feeling right now?

Keep learning – lifelong learning promotes optimism, enhances self-esteem and improves overall life satisfaction. Learning new skills also encourages social connection and is associated with a more active life. Why not join a class, a book club or learn to play an instrument?

Give – Remember the injunction to “practice random kindness”? It seems the Hippies were onto something! Evidence from a range of sources suggest that giving promotes wellbeing. It doesn’t need to be much: Research found that just one act of kindness a week boosts wellbeing. A simple smile or a kind word can count. Start small and maybe you’ll be encouraged to do more, like volunteering for a local community project.

These five steps work beautifully in nature, and the NEF research notes the importance of contact with the natural world for wellbeing. You could easily weave all five steps into a bird watching walk with friends, volunteering for a local conservation group or helping out a neighbour with their gardening!

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Psychedelic psychotherapy: The next big thing in psychiatry?

The UK Home Secretary has announced a review of cannabis for medicinal use. Does that bring psychedelic psychotherapy a step closer? When LSD was synthesized back in the 1950s psychiatrists were quick to see its potential. Research proliferated over the following decade, producing over 1,000 peer-reviewed clinical papers. The results were overwhelmingly positive and “psychedelic therapy was truly considered the next big thing in psychiatry” (Sessa, 2017).

So what went wrong? Several factors came together to stop what could have been a revolution in psychotherapy. Millions of people were taking LSD recreationally, and perhaps inevitably there were casualties. Psychedelics open us to experiences that the more reactionary elements of society find weird at best and even threatening, so it’s no wonder that the press leapt on any negative news. Psychedelics like LSD are the most powerful mind changing substances that exist and deserve to be treated with respect. There are a few basic principles to using psychedelics: Are you in the right mental state to take them? Is this the best place and time for the trip? Carefully considering these essentials – commonly known as set (mindset) and setting – will very much reduce the risk of a ‘bad trip’. In a psychotherapeutic context set and setting are carefully controlled and the whole process is facilitated by a trained professional.

A second factor was the rise of antipsychotic drugs which led to less emphasis on outpatient psychotherapy sessions. Someone with a more conspiratorial turn of mind might also point out that psychedelic psychotherapy promised a permanent cure for many mental health disorders. People who are cured don’t need a daily dose of expensive drugs to keep them feeling (kind of) OK.

The psilocybin molecule

The psilocybin molecule

The good news is that research into psychedelic psychotherapy is undergoing something of a renaissance. Clinical research using psilocybin (the active ingredient of ‘magic mushrooms’), MDMA (ecstasy), ketamine, ayahuasca and LSD is ongoing. Psilocybin looks especially promising. A recent review of seven clinical trials found “large effect sizes related to improved depression and anxiety symptoms” (Thomas et al.) The results overall are encouraging: Psychiatrist Dr. Ben Sessa concludes that psychedelic psychotherapy “is a cost effective way of treating otherwise unremitting mental illness” (Sessa, 2017).

Why is psychedelic psychotherapy so effective? According to one influential paper, one of the key processes is a shift from “disconnection (from self, others, and world) to connection” (Watts et al., 2017). I’m hugely excited by all this, not least because there are some parallels with my PhD research. My research suggests that what inspires and supports many environmental activists is a profound sense of connection. The experience of living close to nature and practices like mindfulness help facilitate this, as does the use of psychedelics like psilocybin. Could it be that a sense of connection – or reconnection – is the underlying mechanism behind our sense of wellbeing?

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Phenomenology: What is it and why should you care?

Would a sentient fish ever wonder what water is? Do you ever wonder what time is? Probably not: Some aspects of our experience are so ‘obvious’ that we just don’t notice them. Phenomenology is a philosophical approach that aims to uncover the obvious. The aspects of our experience that we take for granted can be difficult to identify, but these hidden assumptions and attitudes entwine us.

Phenomenology originated with Edmund Husserl in the early 20th century. Husserl wanted to very carefully examine our experience, teasing out our presuppositions and interpretations to try to get closer to the things themselves. He called our everyday, habitual way of experiencing the world the ‘natural attitude’, and phenomenology offers a way to step back from that. Phenomenology is similar to mindfulness in the way that it invites us to become “aware of the fullness, variety and transiency of experiences in the stream of consciousness” (Patrik). In other ways we might see phenomenology as a scientific project. Husserl saw it a rigorous “science of the essence of consciousness” (Husserl), and there’s some validity to that. Phenomenology is influential in psychology, and has been applied to both Artificial Intelligence and cognitive science.

A fish thinking "What's water?"

Phenomenology is essentially the study of phenomena – that is, things as they appear in our lived experience. It’s grounded in careful observation and description. Phenomenologists investigate all kinds experience, including perception, imagination, emotions and bodily awareness. Phenomenology was foundational in my psychotherapy training and it’s vital in Focusing Oriented Therapy: Being able to pay careful attention to my own experience and that of my client is essential to good therapeutic practice.

Husserl begins with the notion of “intentionality” – the way that all consciousness is “consciousness of something”. That sounds very obvious but that’s partly what phenomenology is about; paying attention to what we think is obvious. It can be quite revealing to pay careful attention to our awareness. Let’s say I’m signing a document. We might assume that I’ll be aware that I’m holding a pen while I’m signing. But let’s look more closely: In the moment that I’m signing, I’m not paying attention to the pen at all. In a strange way the pen is transparent to my awareness. If it stops working, then the pen will leap into the foreground of my consciousness, but if not I’ll just sign my name as I have so many times before.

Phenomenology isn’t just for therapists and academics; it can be usefully applied in everyday life. It can help us avoid errors in reasoning like confirmation bias (preferring perspectives that support our pre-existing views) and projection bias (assuming that most people think just like we do). I invite you to question what seems ‘obvious’ in your own life. My guess is that you’ll become more aware of the nuances of experience that we miss when we rely on the habits and unthinking assumptions of the ‘natural attitude’.

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Bringing Mindfulness in Nature to the City

Both mindfulness and spending time in nature have many benefits, and combining the two – practising mindfulness in nature – creates a synergy that enhances them all. Nature connection, well-being and mindfulness are interrelated: Nature connection is enhanced by mindful meditation and both support well-being.

Current research has focused on mindfulness practice in nature reserves or in the context of wilderness trips lasting several days. Urban natural spaces are typically not considered to be ‘wild’ enough for this kind of approach to work. So while there’s good evidence that mindfulness in nature can enhance nature connection and wellbeing (Unsworth et al.), limiting it to remote ‘wild’ nature puts it beyond the reach of the majority.

Could structured mindfulness practice in city parks enhance nature connection and wellbeing? My personal experience as a therapist and workshop facilitator suggests that it can. My mindfulness in nature workshops draw on a range of approaches including ecopsychology and traditional Buddhism. By combining breath work, walking, sensory awareness and gratitude mediations, participants can develop greater acceptance, compassion and a deeper awareness of our interconnectedness.

On a mindfulness in nature walk. Photo: Adeline O'Keeffe

On a mindfulness in nature walk. Photo: Adeline O’Keeffe

Taking mindfulness in nature into the city makes this valuable practice accessible to those who, arguably, need it the most. To mark Mental Health Awareness Week, I’m co-facilitating two free mindfulness in nature workshops in the city of Exeter. Join Audaye Elesedy and myself on the early evenings of Tuesday, May 15 or Saturday, May 19. Numbers are limited so you need to book.

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The Inflamed Mind

There’s a growing body of research linking mental health and the immune system. In his new book, The Inflamed Mind, Professor Edward Bullmore claims that we need treatments that can break the vicious cycle of stress, inflammation and depression. Speaking on the BBC this morning, Professor Bullmore said it was time to abandon Cartesian dualism and “treat mind and body as if they were more integrated” (Today, Radio 4). Although welcome, this realization comes rather late in the day. Candace Pert recognized that the mind and the body are aspects of a single system back in the 1980’s, and introduced the concept of the ‘bodymind’. That insight has been borne out by neuroscience, embodiment research and embodied therapy, so it’s good that psychiatry is catching up!

The Inflamed Mind book cover

The Inflamed Mind

Candace Pert was the first person to recognize the existence of endorphins, the body’s very own opiates. Endorphins are feel good hormones that are released when we exercise or experience pleasure. The runners high, a chocolate hit and even the kick of a hot curry all depend on endorphins. Endorphins don’t just create feelings of pleasure; they also counteract the effects of stress and play a role in maintaining the immune system.

All this suggests to me that increasing the production of endorphins might be an effective way to treat depression. Kinesthetic meditation – aka ‘the endorphin effect’ – is a simple technique to stimulate the production of endorphins at will. There’s been very little research on kinesthetic meditation, but what evidence we have is intriguing as it was shown to “improve subjective and objective measures of wellbeing” (Bullen et. al., 2006). Kinesthetic meditation also reduces the level of cortisol, a hormone produced in response to stress. This is significant because elevated cortisol is associated with an increased risk of depression and a reduction in the effectiveness of psychotherapeutic treatment.

There’s a complex picture emerging connecting stress, depression, cortisol and the immune system. The interactions between these elements are still unclear, but I think endorphins could play a key role. So could kinesthetic meditation be an effective intervention for the treatment of depression? On paper, it looks promising, but without further research we can’t be sure. Meanwhile it might be worth teaching kinesthetic meditation to people experiencing depression; it has no known negative side effects and it’s free!

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Can ‘Power Posing’ change your life?

Can simply standing in a powerful pose boost your confidence? Back in 2010 psychologist Amy Cuddy, along with colleagues Dana Carney and Andy Yap, claimed that it could (Carney, 2010). There was considerable media excitement, especially after Cuddy delivered a hugely popular TED talk. But subsequent research didn’t replicate the original findings, and suddenly power posing didn’t look cool any more. Dana Carney, the lead author of the original article, abandoned the theory in 2016, announcing that “the evidence against the existence of power poses is undeniable“.

But Cuddy is back with updated research claiming that power posing does have a significant positive impact on “mood and evaluations, attitudes, and feelings about the self” (Cuddy et. al. 2018).

All this is important for several reasons. First, it’s a classic example of how scientific research should work: There’s a claim, it’s tested, refuted and then further research revisits the data. More interesting is how the original research impacted on the public. The media loved Cuddy’s TED talk, with big players like CBS and the New York Times making much of her claims: Sexy science sells. There was much less public reporting when the scientific backlash came and of course now the story is even more complicated!

Man in Power Pose

The author conducts an early Power Posing experiment (c. 1980)

So does power posing work? It probably doesn’t have an impact on behavior: Doing a power pose before you go in for that scary interview won’t enhance your confidence. But a power pose will, on current evidence at least, have a positive influence on your emotional state.

Power posing is a lively topic of discussion amongst trainers and therapists who are interested in embodiment and the body. Power posing is closely related to the work of embodiment trainers like Mark Walsh and Francis Briers. It’s also in line with the kind of embodied therapy that I practice: How a client is sitting, standing, moving or walking says a lot about how they are experiencing their place in the world.

Power posing, embodied training and embodied therapy are all grounded in embodied cognition, the principle that thinking and feeling depend on the body as well as the brain (Robbins and Aydede). Embodied cognition is well supported by cognitive neuroscience and supports the ideas of Merleau-Ponty, Gendlin, Bateson and others who argue that “the body shapes the mind” (Gallagher). Power posing may not change your life, but a better understanding of embodied cognition just might, so keep reading!

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‘Sacred Ecology’ Revisited

Almost a quarter of a century ago I presented a paper called ‘Sacred Ecology’ at a Newcastle University conference (1994), and it’s still my most widely read article. Should I be dismayed that I haven’t come up with anything more popular or pleased that it’s remained relevant?

Sacred Ecology was published 1996 (Harvey and Hardman) and has been republished several times since, both in books and on the internet. When ‘Humanistic Paganism’ re-posted Sacred Ecology in 2015 I added a short introduction to put it into context. I commented that my emphasis on ritual missed something: “While ritual can be very powerful, there are many ways to access the wisdom of the body and some – like Focusing – are arguably more reliable”. Three years on, I’m increasingly curious about a whole range of pathways to the wisdom of the body and what fundamental principles might underpin them. I’ve already discussed several of these pathways in this blog: Focusing, mindfulness and the wilderness effect, but there are many more.

black and white photo of trees with dramatic sky

St. Catherine’s Hill

Since writing Sacred Ecology I’ve gained a better understanding of ritual. Back in the ‘90’s I was heavily involved with Paganism. While that gave me a profound personal experience of the power of ritual, it was in a very specific context. I’ve since explored ritual in other contexts, notably ecopsychology and dance therapy.

Ritual is fundamental to the practical ecopsychology of Bill Plotkin and Joanna Macy. While Plotkin has a more Pagan orientation, Macy’s ‘Work that Reconnects’ is grounded in Buddhism. Both are valuable and widely influential.

Psychotherapy can be a kind of ritual: I’ve argued elsewhere that ritual theory can help us understand the healing process in outdoor therapy (Harris, 2014) and that’s probably true of psychotherapy in general. Moreover, ritual is used explicitly in Family Therapy (Hecker & Schindler), dramatherapy and the dance therapy developed by Anna and Daria Halprin.

Does all this shed light on why Sacred Ecology is still relevant? I wrote Sacred Ecology to illustrate the importance of EcoPagan ritual, but if that’s all it was about I doubt that anyone would bother to read it today. Sacred Ecology hints at something more fundamental: A profound re-connection with the other-than-human revealed thorough the wisdom of the body.

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Nature Connection: Have you got it yet?

When I used to run nature connection workshops back in 2010, it was a struggle to get people to sign up. It seemed that people didn’t get what nature connection was or why they might want more of it. But times have changed and according to The Huffington Post, “Nature Connection Will Be the Next Big Human Trend”!

What happened? Research is part of the answer. The Nature Connectedness Research Group at Derby University have done a lot over the last few years and Miles Richardson, the project coordinator, has a great research blog.

The RSBP are also on the case, having realized that “disconnection from nature is … one of the major problems facing nature conservation”. Deep Ecology got it right; once you recognize your connection with nature, you’ll be actively engaged in protecting it. The health benefits are also very apparent now, with new research consistently demonstrating that connecting to nature is good for you.

Dartmoor ponies drink from a stream

Drink from the source

Elizabeth Nisbet from Trent University in Ontario, has developed a Nature Relatedness questionnaire. If your level of nature relatedness it isn’t already obvious, you might like to try it. Crucially, Nisbet emphasizes that Nature Relatedness isn’t just a romanticized idealization of nature; it’s “an understanding of the importance of all aspects of nature, even those that are not aesthetically appealing or useful to humans, such as mosquitoes, mice, death, and decay”.

Maybe the suggestion that nature connection can improve you health and help save the planet isn’t enough to convince you? Well, research Nisbet conducted with her colleague John Zelenski suggests that nature relatedness may also lead to greater happiness (Zelenski and Nisbet, 2012).

Research has helped increase awareness of nature connection, but people have also begun to feel the need for it themselves. There are an increasing number of workshops to help: Nature Connections draws on an appreciation of bird language to reconnect us, while the Art of Mentoring teaches a range of valuable nature connection practices. Maybe it’s time for me to lead some more nature connection workshops too!

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Can mindfulness in nature help with ADHD?

Richard Louv, who suggests that many of us suffer from ‘Nature-Deficit Disorder’, believes that there’s a link between how kids are raised and ‘attention deficit hyperactivity disorder’ (ADHD). There’s some evidence to support his suggestion. Research suggests that every hour of daily TV watched by preschoolers increased their likelihood of developing symptoms of attention deficit disorders by 10 percent (Christakis et al, 2004).

I’ve written elsewhere about my distrust of psychiatric diagnosis, but there’s no question that increasing numbers of children are experiencing impulsivity, hyperactivity, lack of focus, low self-esteem and aggressive behavior: The diagnosis of children with ADHD increased from 7.8% in 2003 to 11.0% in 2011-12 (US data).

shadow of boy on seascape

Attention overload?

Nature connection seems to help; whether kids play indoors or out has a significant impact on ADHD. Researchers from the University of Illinois found that “children who played in windowless indoor settings had significantly more severe symptoms than children who played in grassy outdoor spaces”. The authors conclude that “contact with nature is systematically related to lessened attention deficit symptoms” (Taylor et al., 2001).

The University of Illinois research was inspired by Attention Restoration Theory, as developed by environmental psychologists Rachel and Stephen Kaplan (Kaplan and Kaplan, 1989). Attention Restoration Theory proposes that natural phenomena like birdsong, trees, or the gentle sound of a stream are restorative because they give our thinking minds time to rest.

Mindfulness is also useful for alleviating the symptoms associated with ADHD. Psychiatrist Lidia Zylowska led the first study of how mindfulness training might help with ADHD and I’ve found her book on this subject useful in my client work (Zylowska, 2012). Recent research has supported her initial findings, concluding that mindfulness meditation “is efficacious in reducing symptom load in adult ADHD” (Hoxhaj et al., 2018).

Given that both mindfulness and nature connection have been shown to help with ADHD, I’m drawn to wonder what might happen if we combined the two. Crucially, this isn’t just adding one to the other: I’ve argued elsewhere that practicing mindfulness in nature, as compared to indoors, creates a synergy between two powerful sources of healing (Harris, 2016). To my knowledge, no-one is pursing this avenue of research so I’m putting it out there in the hopes that I can attract some interest. Watch this space!

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