by Evelyn Einhaeuser
What struck me when I read your book ‘Meaning-full Disease’ was that you were talking about the body trying to express something through disease, that disease is not just happening to us, but that it is a somatic metaphor or symbol for our stories, our emotions, feelings, patterns, traumas, social environments, etc. We might know that we fall ill because of “stress”, but we don’t really have a connection or clue why we get a certain illness and what the body is trying to communicate. In ‘Meaning-full disease’ you talk about the psychotherapist making sense to the patient as the first step in healing. Can you talk a little bit about that and how your work as a MindBody therapist looks like?
The first thing is that, in any consultation, I assume that all dimensions of a person are present in the room. Both the person’s physical symptoms and their life experiences, however you categorize those, whether you use the language of mind or of relationships or of life events or of family or of context, are treated as being in the room together. So it becomes a question of me meeting that person and responding from a number of different aspects to their need for relief of suffering.
For a whole person therapist it is crucial to hold this attitude of both together. It means not to say to yourself in a split way, ‘Oh, I take a body approach’, and the mind and emotions get split off, or ‘I take a mind approach’ and the body and its symptoms or disease are not integrated. So the clinician has to be integrated in his or her thinking. If this is not the case the clinician is usually unhelpful.
So as a physician I take an interest in the physical presentation, the diagnosis, but at the same time I am listening for cues, asking questions and considering the other elements. Now, how does that look like? Often I tell them about myself as a ‘whole person’ clinician and that I don’t split body and mind, but that I see mind and body as a part of one whole and that therefore I like to ask questions from a physical as well as a nonphysical perspective. And I ask them what they think about that. Almost always they say ‘That sounds good.’
Then I would be listening very carefully to what they say. Listening is an important part of my practice and I take really seriously the words people use. So when a woman some years ago was talking about her husband’s depression and she had a rash on her face, she said to me that ‘she was keeping up a brave face’. Now most physicians or psychotherapists would probably not even notice the words she used, but I would say that could be significant.
So listening is really important and I will ask them what happened around the time when the symptoms came up. Commonly what people remember leads to that which is significant.
From a holographic perspective, where the part represents the whole, you can expect that the small will lead to the large. So, when a person says something in a certain way, I will join them at that point, that’s a doorway or window, in the sense that there is an opening, where the person has presented themself and I will gently and cautiously explore that with them and be safe enough and loving enough and generous enough for them that they feel that they can stay with me and bring more to their original point.
There is something really important about relationship, openness, the grace of listening, and the belief that the person is indeed whole. These qualities help the conversation to be safe and generous and caring, and you will eventually get to the place where you need to be. And that is a relational thing rather than an expert thing. The expertise is more about relationship than it is about knowing. There is also a deep power in recognition which is mobilized in the knowing that if someone says something it has deep meaning. Or choosing another metaphor, what people present with is the top of an iceberg and as you go down you realize that it is a lot larger than it appears on the surface.
Why is it so difficult for us to connect to what is actually happening with and inside us and why do we need someone else to make sense of our diseases and of us?
I think that is a deeply existential question. Life is fundamentally relational. We are not just clusters of atoms, we are deeply connected. A lot of these hurts and pains and traumas which frequently lie underneath disease manifestation have occurred in relationship. When you think about most of our experiences, the ones that either generously formed us or deeply hurt us are generally all relational. And I am not sure there is anything that is not relational, though that is another question. So that might be one aspect of it.
Also I don’t think it is simple to know what we feel. If I am blazingly angry or intensely fearful or incredibly sad, that is not complicated. But from day to day we exist with a complexity of feelings, which are nuanced and shaded and they exist in a mixture. And with every feeling state or existential state, when you unpack it, there is a lot of feeling in it, much of which is left unrecognized because we can’t manage the intensity or complexity. And if the feelings are very early feelings, pre-language, from the first two years of our lives, they may have never been verbalized or even mentalized and they might have never been mirrored or responded to by the parent. So if there are feelings that have never been responded to, you need an “other” to come in and join with you and respond to you in relationship. So that is one answer why we need another person.
And in my own experience, for example with grief, the one thing that makes such a feeling tolerable is the willingness of other people to accompany us, not to fix it, not to smooth it over, but to be with us in it. So I think some feelings are only tolerable when we are held. That is fundamental to healing and leads us to the question what is healing.
What is healing and what is health in your perception?
We go through life healing ourselves for the most part. If we get wounded or bruised, we heal. So there is something about life that is essentially healing or about healing. Some parts of the treatment or healing process are about removing the impediments to healing, breaking into the patterns or structures that keep one wounded or traumatized.
My role in that process as a whole person clinician is to bring in information that needs to be in the field to allow re-balancing or repair. I had a female client for example who had genital pain and inflammation for 15 years. What had happened was that she had had a very abusive relationship when she was in her twenties, which made her feel very inadequate. When she broke out of the relationship she made a vow that she would never have another relationship. The pain she suffered from began in the next two weeks. She kept this vow for 15 years, and then someone came across her path and she fell in love. But she still had these symptoms, which prevented the new relationship. So we explored the vow and the sense of inadequacy over 12 sessions and her symptoms entirely disappeared. What we were doing was exploring her feelings, we were reframing the original hurtful experience, and we were allowing and encouraging her to put that vow aside.
So we were balancing her life. I don’t do it; we do it together, in my willingness to be with her and her willingness to work at it and to explore it.
Is the healing in the owning or acknowledging of a feeling or in resolving it or in the substitution of negative feelings with positive ones? Or is a generalization not possible?
The notion of reducing healing to one thing is not possible because it implies excluding other things. So I would say healing was in this case coming into the possibility of a new relationship, the confrontation of her experience from the past and getting past that, the recognition of her anger, the love of the man that she had met, the context and environment of permission to see that mind and body and her life experiences have been connected, as well as my capacity to stay with her. So you see you can’t reduce all that to one thing. It IS not one thing.
Often clinicians and healers want to instrumentalize the process so that it can be commodified and taken by other people and I just don’t think it is like that. In surgery you cut a leg off, and everyone can learn how to cut a leg off, but I think the kind of processes we talk of are deeply relational, complex and rely on intimate interaction and the emergence of a resolution, defying simplistic reduction.
But that is one of the fundamental problems of healthcare nowadays, isn’t it? Whether you are a psychotherapist or a physician, clinicians are trying to segment the person and try to find a box whereas this is maybe not possible because of the complexity of individuality and the different symptoms everyone brings together.
I think you are right. The moment you try to generalize, you move away from the person to the authority of the expert. And whilst there is some of that and you can never abandon that element, what we are shifting to is a person-centered or a highly unique idiosyncratic mishmash of factors and influences that have led to the emergence of this disorder of that person. So I am very against some of the popular versions of symbolic disease and somatic metaphors where sore throat means this and sore nose means that. What these simplistic ideas tend to do is shift the power to the expert and remove the power of the relational, exploratory, emergent elements and answers that come from the patient and the clinician working together.
But don’t you think it also expresses a sort of helplessness on the clinician’s side? Also if a clinician has to open up to a patient or client on that level, he might feel discomfort in the meeting. This discomfort is very well described by your colleague Paul Hemmingson in your book “Transforming clinical practice using the MindBody Approach”. He describes that he is feeling the feelings of his client in his own body and states that holding that discomfort is sometimes hard to bear. So this openness and taking on also asks a lot from the therapist and it might be not doable for everyone.
Absolutely! I think this is one of the reasons why many clinicians won’t go there. If you are willing to enter authentic and intimate relationship with another you get changed yourself, and the reality is you do need to change yourself and grow and transform. That is a part of what relationship is. So if disease is in some measure a representation of distortion in relationship, then that applies not only to the patient, but also applies to the clinician. So fundamentally the clinical relationship is always two persons meeting. That is made manageable by the fact that it is a confidential and private situation but it might not be manageable for a lot of clinicians because it is too scary, it is too frightening and they feel too incompetent. Some of it of course is institutional training. If you are not taught that it is alright for a patient to cry, or to be moved to tears yourself as a clinician, or to feel vulnerable because you don’t know where to go with the consultation and you don’t know that you can actually say that and think aloud in a collaborative way around that, if you don’t know any of these things and you have not been held by your education system through that not knowing and seen that it has a wonderful gift to it, then of course you are not going to do it. I think it does require us to privilege not knowing, in recognizing the expertise in the holding of oneself in the not knowing.
And holding oneself in experiencing the discomfort and feelings and turmoil of an “other”. Because I imagine that is also difficult?
That is right. There are certain situations, although I am experienced, in which I find myself uncomfortable. What I have learnt of course is if I can access what my discomfort is, I can turn it into something useful for us as a clinician-patient dyad if you like. My discomfort is actually the signaling within myself of what is actually happening in this space. Some of it is of course about who am I in this space with this “other”. But to turn that discomfort into an expertise or into a gift or into a range of possibilities is actually part of the art of this kind of story-oriented therapy.
You mentioned education earlier. Can you talk a little bit about the Mindbody postgraduate program that you helped install at Auckland University? How does this program look like and what is it that people learn there? And what process do clinicians go through before they become mindbody therapists?
As you saw from the book “Transforming clinical practice with the mindbody approach” it is a multidisciplinary course. So you have doctors and therapists and occupational therapists, natural therapists and body therapists and others taking this course. That forces an ethos of creativity in which people are forced to realize or discover that there are powerful cross-disciplinary generic elements in addition to their own specific disciplinary elements. It is also true that whole person work requires different up-skilling for different disciplines. So for instance a body therapist discovers that he needs to listen more, a psychotherapist has to learn how to be a good host to the body in the room without taking medical responsibility for it, a doctor has to learn how to listen rather than fix and so on. Some of it is about each discipline discovering in what way they have shut down elements of access to the whole of the patient and the client.
One of the reasons why we started this program is that I had done many workshops around the world and realized that many people get enthusiastic after a two day workshop and then they go back to their workplace and find that they can’t actually summon up the resources to be a whole person oriented clinician in their normal context. There are two reasons for this. One is that unless you have a very strong sense of the wholeness or connectedness of the other, you can’t do this work. Because you are always implicitly or unconsciously or subconsciously saying ‘is it the mind or is it the body’, you will be moving like a puppet from one side to the other at the mercy of the dualism or the split. In our experience it really takes four to five months before the clinicians really start to sit comfortably with a non-split view. So the first thing is developing and absorbing a whole person concept that is unshakeable in the face of the patient’s worry and the potential criticism of one’s colleagues.
The second thing is that it is one thing to have an adequate conceptual framework, but it is another thing to know what to do in the hurly-burly or mayhem of a clinic that is running as usual. So a lot of the course is about going through role-plays, skills training, how to listen, what to listen for, how to introduce yourself, how to open things up, how to hold things in such a way so that in the next session it is still all there and hasn’t vanished. All that kind of stuff gets talked through and worked through role-plays from different disciplinary perspectives. A lot of the role-play is around learning to listen and to listen properly. Instead of looking for more and more information and keeping on the surface the students (who are all experienced clinicians) learn to go deeper with the little bit of information they already have. So the second thing is gradually developing skills in how to operate in your own disciplinary perspective.
In terms of the course itself, it is a block course. So we have 8 block courses over 2 years and those block courses are two and half days each. The students are seeing the teachers every two months essentially each academic year and are in contact with the teachers by online, byemail and telephone and by assignments. They come from all over New Zealand. We normally have 12 to 16 postgraduate students at any time.
When you are talking about students owning that concept I am thinking that they also have to go on a journey to find out how fragmented they themselves are because if you own that concept of perceiving another in a whole dimension then automatically you will have to see how fragmented you yourself are. In that context I liked the language concept you were presenting in ‘Meaning-full disease’ that unconsciously we all talk of “I have a body” rather than” I am that body” which points to our own disconnectedness. We often see the body as dead matter; something that only is a vehicle for our self. I could imagine that your students face that a lot in their individual processes?
You are absolutely right. Whilst all of the students that come in have a longing to be more holistic or integrative and so on, they spin their wheels a lot in the first few months and some of it is about facing their own resistances. Some people find it so challenging that they leave, as they decide they can’t cope with the change that is needed. We are not forcing change but it is forced by the whole notion of wholeness and the reality that all of us come to reality with a partial view and some compartmentalization. And it is our job as teachers to be caring and compassionate around that and I tell them “look, this is really hard this first year because you are spinning your wheels the whole time but I can pretty much guarantee you that by the end of the two years your confidence and competence will be hugely different.’ And it actually always is. It takes time to re-do some of these templates and motives that we’ve been entrenched with and didn’t even know we were entrenched with except that we were uncomfortable with what we were doing and the limitations of what we were doing.
Can the mindbody approach really be applied in all medical fields? I think if you have a private practice you have lots of time and can create the environment you want but how about time frames in hospitals and a reality of healthcare that doesn’t seem to allow much time?
From a more extreme perspective it is unethical not to take the time to listen to a patient. From the perspective of whole person care it is wrong not to make the time for that person who is seeking help. The implication that you need lots of time is also both true and not true. You see, if you are a physiotherapist and you have the person on the table and you are doing some sort of manual therapy of the spine and you gently say to the patient: “When did this come on?” And the patient is feeling safe and says: “Last September”, and you say: “What was happening then?” And the patient starts to cry and says: “Sorry I didn’t mean to cry”, and the physiotherapist says: “It is alright to cry, it sounds as if this was really important. And maybe it is connected with the pain in your back.” And the patient says: “You really think so?” And the therapist says: “I think it could be. Maybe we can think about that a little bit.” Now how much time has that taken? You see it is more about an attitude rather than time, resources or a sophisticatedmethodology. It is more about connecting. And what better moment have you got to listen to a patient? I think everyone and especially doctors say of course “I don’t have the time” and underneath my breath I am saying ”You haven’t got the attitude”. I have GP friends who do struggle with making the time and partly that is the system, but they do gradually learn to pick up bits and pieces from every short interview and stitch it together, whereas a psychotherapist has 50 minutes. The GP has to learn a different skill of putting the fragments together over time. There are different ways to do it in each discipline, but I just don’t think it is valid to say I haven’t got the time to do that which is essential. I know you can train students to encourage people to open up in simple ways.
Why are some medical colleagues resisting the concept of a mindbody approach?
They are resisting for all sorts of reasons. You get more open people outside the hospital system. Inside the hospital system it is very hierarchical, careers are dependent on those that are above you, much more than they are outside the hospital, so there is a fear of breaking ranks with the norms of the hospital system. And then some of the older people who have put so much of their career into the biomedical model that it is kind of too late for them to change and there might be some sort of loss of face in changing. Some of it is related to personality, and there are some curious things. For example, I have noticed that the more apparently healthy the clinician, the less likely they are to do this kind of work. They have got themselves in some kind of equilibrium, which they value and enjoy. They are in a social system that is rewarding them them for a certain set of behaviors. Now why would they change? Then you have another set of people who are uncomfortable and things are not really satisfying, or feel dead or materialistic or sterile and they are a bit more open. And then you have got the traumatized and shut off kinds of clinicians who couldn’t bear to do it because it would require too much change or too much intolerable examination of their own structure. But it is the social framework that is the most governing element. Until there is a sizeable increase in pressure and demand from the public and the politicians lots of clinicians will remain with the current biomedical model and won’t move beyond it until it is approved by the mainstream. I think it is a mix of Western physic-materialism, market forces, entrenched reductive evidence-based approaches, a denial of the warm, fuzzy, emotional and meaningful side of life, and certainly a distancing from spiritual elements. But having said all that there is a hunger out there for something more. It is a tiresome split and a big mountain to climb from my perspective.
What was your intention in writing “Transforming clinical practice using the MindBody approach”?
I wanted a resource out there showing that whole person practice was not something confined to medicine or psychotherapy but that it is something that can be picked up by people in any discipline. It is a generic set of values and it is a possibility for anybody. I felt if I kept on writing about my own experience, people would say, well, he’s special or exceptional because he is combining medicine and psychotherapy and the rest of us are not going to do that , so it can be dismissed in that way. And it is true, most people are not going to be trained in multiple disciplines, but what we found is that, everyone, in whatever discipline they are trained, can expand their view and their attitudes and their practice in a way that accommodates the person coming through their specialized door and still being treated as a whole person.
I liked that “Transforming clinical practice using the MindBody approach” doesn’t just show different disciplines but also different ways of perceiving a client or patient. One therapist might listen to the language used by the client very closely and another has a more refined sensibility of feeling another person’s body.
That is the great thing, isn’t it? Because in the end, what it does is disrupt the idea that this is a simplistic methodology that can be adopted and applied as an instrument. It emphasizes the potential of every person in a relationship with a client to discover what is needed using their particular resources.
The last thing I would like to talk to you about is the spiritual dimension. How would you describe that aspect for your practice?
I was brought up in an evangelical Christian ethos, so spirituality of a certain kind was at the center of my upbringing and has remained a focus for me all my life, though I have certainly changed and moved and got a wider view of a lot of things. I think that the world or life or the universe is fundamentally in-spirited.
I have moved to a more immanent kind of spirituality, that sense of spirit in the center of my own being. I feel connected deeply within my being to Spirit or God however one might want to articulate that. But I am less interested in theory and abstraction these days.
Because I am a practitioner and because a lot of my insight and work has developed in and out of encounter with solid, real people, my spirituality is incarnate or bodied. My life is amultidimensional experience, richly described as bodied, as mentalized, as emotional, as in-spirited. And they are all active at the same time. So in the clinic room I don’t need to drag the spirit there, the spirit is already there. It is an incarnational thing.
So what does it mean for the spirit to be incarnated in the clinic? It is for me to be authentic, to be loving, to be generous, to care, to be compassionate, to explore the relationship, to allow things to emerge, etc. This is for me being spiritual with a person. For me spirituality that isn’t incarnated is an abstraction. Fundamentals of faith, hope and love, things that are usually not talked about in medicine at all, the powerful sense that we all are connected, that is for me embodied spirituality. And we come back to concepts like spirituality and healing. I think as a journalist as you talk to many people I am sure you are finding that the most creative way is to look at each person’s model or story or healing function and ask what is important in this. So each one is contributing a different thing to the whole. None of us has a total grip on the whole, it is actually and practically impossible because the whole is much larger than us, we are just a part of it. There is a natural tendency in humans to have a theory of everything. It is known as arrogance (laughs).
(Laughs) I also think it is not just arrogance but behind it is also a hope that things and concepts like health and healing can be simplified.
Yes, and nevertheless it is a fallacy to think we can know everything. What we can do though is we can become broader and deeper and more open and things can happen within that. Just including the physical symptoms and the ‘story’ together is a powerful way to see such things happen.
THANK YOU VERY MUCH!