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18 April 1996

Therapists without Borders

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Comments to Stan Grof, Program Coordinator of the International Transpersonal Association conference in Manaus (Brazil, 16-21 May 1996), reply by Ken James, and further comments. The first parts of this document appeared in UniS (The UniS Institute), April 1996

Comments

Following my earlier e-mail to you on this topic, I have received encouraging support from some therapists as a result of copies sent to them. I am therefore sending you a new version of the "open letter" below, together with a response by a psychoanalyst, and my reply to it.

Having received your excellent conference programme for the International Transpersonal Association conference in Manaus (Brazil, 16-21 May 1996, with the theme: Technologies of the Sacred), I am writing to express a concern.

These are difficult times for many. We are constantly exposed to presentations of the sufferings of those in Bosnia and Rwanda, for example. There are many other such places, often less well publicized.

Whilst we hear much about the activities of "Doctors without Borders" in repairing the physical bodies of those damaged by such crises, we hear nothing about "Therapists without Borders". And yet in Rwanda, hundreds of thousands of children are acknowledged as having been severely traumatized by the sight of their parents having been massacred before their eyes. In the face of such slaughter, and the stresses to which they were subjected in caring for them, members of Doctors without Borders have required various forms of therapy.

It is therefore with some astonishment and sadness that I peruse the programme of your conference. There is not a mention of this dimension of the challenge faced by humanity. There are of course no "Therapists without Borders" and there is no call to create such a group to respond to those who suffer in such crises.

The question is why not? Presumably it is because therapists have defined their activity such that it only operates in settings in which therapists can control the environment and the processes which occur in it. Also the financial situation is much clearer. But physicians have been able to overcome such barriers in creating their group -- despite considerable professional resistance.

Is there not a strong case for therapists to debate the merits of creating an equivalent body. How might it operate? What might it strive to accomplish? Who might support it?

Clearly a central challenge is what can therapists accomplish in an open, rather than a closed, environment -- and an essentially chaotic one. Rather than focus on a lengthy process, the question is what can be minimally done with many people to make a difference to their lives. Many in refugee camps call for such aid.

My sense is that unless "Technologies of the Sacred" can extend to the making whole of impoverished people in acute distress, then their proponents leave themselves open to the accusation of a strange form of "self"-ishness and "self"-indulgence.

I understand the view that only by transforming oneself can one transform the world. But it is possible that by endeavouring to transform the world, as represented by the conditions of those who have survived massacre, this may even trigger a degree of personal transformation. It is not an either/or situation, but rather a both/and challenge.

I wish you the best with your event. Brazil is an exciting and beautiful country. Perhaps participants will spare a thought for those in the favelas and in conditions of bonded labour. How can transpersonal disciplines facilitate their transformation?

Comment by Ken James

It seems that Anthony is pointing to a particularly poignant example of material overload. The healing professionals who participate in Doctors without Borders open themselves up to material events which are difficult to connect with the media stream in order to derive meaning. Often these professionals are witnesses to "periods of reciprocal destruction" which are so deeply unconscious that it is virtually impossible to derive meaning from these circumstances.

Anthony calls for the consideration of Therapists without Borders to care for those who suffer and survive the inhuman yet all too common events that we read about every day in our newspapers and magazines. He asks, quite rightly, why such an organization has not been formed as yet. He wonders whether it is the psychotherapists overconcern with issues of "frame": a controlled environment, sterile and separate from daily life, in which to perform their "therapy". Many therapists feel that such a frame should be adhered to regardless of the needs of the individuals whom they serve, and for this reason the idea of Therapists without Borders is almost an oxymoron.

As a Jungian psychoanalyst, I must plead guilty to concerns about frame. But I fear that the most serious impediment to developing a team of Therapists without Borders is the artificial and defensive border between the patient and the doctor created by many therapists in a misguided and formatory attempt to avoid dealing with their own woundedness and unconsciousness. This is an area where the Work and Jungian psychology overlap: we are all asleep, all unconscious, and the most we can hope for is someone just a little ahead of us who will care enough to turn around and give us a hand up the long ladder of transformation. In the absence of such an individual, we are trapped and must create artificial boundaries to convince ourselves that we are really not as mechanical as we know, in a deeper part of our being, that we really are.

The most essential and valid qualification for being a psychotherapist is that one can openly acknowledge one's own suffering, woundedness, and unconsciousness. A good therapist can readily express his or her own bouts of meaningless, periods when the media stream seemed like a cruel fantasy that could not be touched at any cost. From this place of meaninglessness, of material overload which unites all humanity, the therapist acknowledges the experience of meaning which breaks through not from the therapists own efforts, but as the result of being visited, as it were, by breakthrough experiences that carry with them the certainty that somewhere, outside of our prison of mechanicalness and unconsciousness, there lies a realm of meaning that we can enter into. The important part of this healing is the willingness to be influenced by the media stream in spite of the material overload. Viewed from the perspective of the Work, the situation is perhaps best described by Maurice Nicoll in a recently published transcript of his informal work talks and teachings (Informal Work Talks and Teachings, 1940-1950. Quacks Books, 1995). Nicoll writes:

"To realize that you have not got something and that you need it, this is real asking. This is asking from passive force and everything that starts from passive Do grows and increases. But to think you already know what you want, to think you can manage yourself is, as it were, starting from active Do."

I will attempt to translate Nicoll's ideas into our present area of concern. If we are to be healed, if the artificial borders erected by therapists and others are to be erased, we must ask for what we need from the position of one who is lost, who suffers as much as those with whom one works. This is asking from "passive Do", and it can stimulate magnetic center and draw to oneself just those experiences which are needed to provide mutuality of healing and a mutual awakening to one's true being.

The transformation which can be experienced by connecting with the media stream and finding meaning in the brutal materiality of war and its aftermath is not a function of time, but rather of the openness of the therapist to find meaning in what appears to be meaninglessness. This meaning may lead one beyond the particularities of the experiences themselves, into the realm that Jung called the collective unconscious. We act out the archetypes we are unconscious of, in sleep. By awakening and unflinchingly witnessing the havoc wreaked by the action of unacknowledged archetypes of destruction and imagined vengeance, the "therapist" and the "patient" are both transformed. We must take seriously Anthony Judge's statement, "It is possible that by endeavouring to transform the world, as represented by the conditions of those who have survived massacre, this may even trigger a degree of personal transformation." The call to make meaning through a unification of matter and media will result in transformation of the outer circumstances and our inner being. Indeed, responding to such a call can destroy the carefully constructed boundaries we set up between inner and outer worlds.

It seems that UniS Institute's next phase, "going beyond duality", fits in very nicely with the issues raised by Anthony Judge in his letter. By transforming material overload through connection with the media stream, we break down the dualities that we set up between pleasure and pain, form and formlessness, silence and sound, stillness and movement. What matters is how awake we are to the present moment, and in that moment of awakening, we transcend duality and enter, even if only for a moment, into a realm that goes beyond this schizoid defensive splitting. Perhaps the Work injunction to consider externally always and internally never is really speaking to this point as well. The "external" only seems external because we refuse to see through the artificiality of the border between the other and oneself. Once we give up this border, many other similar "borders" must follow. Perhaps then we will be able to respond as Anthony would have us, by creating a situation of mutuality that provides therapy without borders, facilitated by therapists who understand the folly of believing in borders when there is human suffering to be overcome.

Please respond as you are moved to do.

Sacrificing humans to professional frames: Response by Anthony Judge

I much appreciate the extensive comments of Ken James with regard to the theme "Therapists without Borders". It is especially helpful that he has focused the discussion on the importance of frame to any conventional approach to therapy. As he notes, many therapists feel that such a controlled therapeutic environment, sterile and separate from daily life, should be adhered to regardless of the needs of individuals whom they serve. It is also helpful that he has taken up the related implications of "without Borders" in the sense of without boundaries or frames.

In exploring further the appropriateness frame, it is again useful to compare psychotherapists with the physicians and nurses of "Doctors without Borders". In refugee camps and similar situations physicians are also faced with a challenge of frame. In their case this can be usefully understood in relation to hygiene. They need a hygienic environment in which they can control the treatment given to the patient. There are of course a number of degrees of hygiene. They cannot hope to operate in the conditions of the best surgeries in modern hospitals. In many cases they have to accept much less. In the worst cases they have to accept that they cannot provide more than token hygiene before engaging in what may amount to major surgery. They are faced with a tragic choice involving real risks to life. If they do not act, the patient may have no chance of survival, and if they do, the patient may die as a result of their intervention.

Their situation is quite similar to military field hospitals in war zones where the tragic system of triage may have to be used for lack of appropriate resources -- beds may have to be freed up for higher priority cases. Then there are the situations where medical personnel with appropriate skills are not available, notably in frontline situations. People's lives may then depend on crude application of first aid in response to major physical damage. Hygiene of even the most limited kind may be a luxury.

The question in all these situations is whether it would be appropriate, for those with even limited skills, to stand back and claim that they consider it inappropriate to act -- given the inadequate level of hygiene. Physicians, and those supplying first aid, have come to recognize that in such circumstances compromises are necessary. They adapt their techniques accordingly.

In the case of psychotherapists, it seems that hygienic frames are considered essential to the ability to provide any assistance whatsoever. They do not see it as their role to work in situations where such conditions cannot be provided. No compromise is considered possible. They do not seem to have any understanding of what might constitute the equivalent of "first aid" -- nor any recognition of how it may have to be provided by people without the appropriate qualifications who have not undergone many years of training.

This perception is however not totally correct. Following major accidents and terrorist bombings in Northern countries, "help lines" and related facilities are provided to provide counselling for those experiencing personal distress. If these initiatives are taken by psychotherapists, it is possible that this is seen as leading into a longer period of "within frame" therapy. But, independently of such incidents, help lines are also available for people experiencing other forms of distress, including those contemplating suicide. So some form of first aid therapy is possible without the formalities of frame.

There is also the traditional role of the priest on the front line and in refugee camps. Here too there is an effort to respond to the non-physical condition of the patient. In the terms of the ITA conference, is this not a dimension of "technologies of the sacred"? But, as with the psychotherapist, a priest may well require from the patient a form of "submission to authority" before being able to act. The question is what skills are required to evoke a mutual relationship that can provide a basis for therapy? Therapy professionals seem to expect that submission to authority to be set up in advance of any dialogue -- possibly by reputation, certificates on the wall of the waiting room, or priestly garb. Who are the people that can evoke mutuality of relationship under frontline conditions? How are such skills acquired?

In the case of massacre and the like in distant countries, it would seem that psychotherapists are willing to allow human psyches to be sacrificed to the preservation of their sacred frames. One wonders to what extent such frames should not also be understood as "comfort zones", as much for the therapist as for the patient.

Ken James distinguishes between the ordered environment within frames and the chaos of the "media stream" of war and its aftermath in which the therapist may be challenged to find "meaning in what is "meaningless". As a Jungian he relates this challenge to dealing directly with the collective unconscious. For a therapist he sees this as a challenge of openness.

Accepting such difficulties, the challenge might be "reframed" through the question: what kind of skills can be usefully deployed in response to psychic trauma in chaotic situations -- and what kind of person is capable of acting effectively in this way? Maybe it is not the skills of the psychotherapist?

At the simplest level it may be someone capable of responding affectively and with compassion -- as on help lines for which fully trained psychotherapists may be unavailable. Or maybe someone who can "animate" a group of people in depressed situations -- like a singer, a musician or a comedian? Such roles can be seen in a very superficial light -- and may indeed be performed with little skill where more skilled performers are lacking. In this respect, there seem to have been more people from the performing arts communities acting to "raise morale" in Sarajevo than there were from the therapeutic community. Is this to be understood as "first aid"? Such roles could also be seen in a more profound light, building on the understanding of various forms of art therapy (sounds, colours, drama, etc) as pioneered by Marsilio Ficino centuries ago.

From such a perspective, there may be a case for designing "therapeutic shows", crossing language and cultural barriers, that can be set up and run at low cost in refugee camps. Anything would be better than the current absence of therapeutic support or concern.

In the absence of sufficient numbers of concerned "therapists", is it too cynical to imagine that laser lights can be played on walls, or on smoke, for example, using insights from visual and colour therapy. Thought could also be given to appropriate music -- and what about homegrown DJs for refugee camps? It is tragic that satellites are used to capture pictures of the dramatic conditions of remote refugee camps, although such technology is not used to convey back anything, from the cultural and therapeutic riches of the world, that might respond to the despair that characterizes such places. Any such collective response may lack the personal touch, but this could be separately addressed. How is it, for example, that the therapeutic role of "visitors", so well developed in hospitals, has not been adapted to such situations?

Faced with the abdication of modern therapists in the face of such challenges, one wonders how traditional healers would choose to work in such chaotic situations. Does a witchdoctor or shaman also rely so heavily on a frame? Or does he or she effectively set up a kind of "show" in which there are both active and passive participants? Is this not an example of evoking mutuality of relationship?

But then there would be the question as to who would be prepared or able to legitimate the presence of traditional healers in such chaotic settings. Governmental authorities also have their frames which have to be preserved by human sacrifice and suffering. It would seem that in therapeutic terms we are about at the level of the Crimean War, in which more people died of non-combat ills than from those incurred in combat. Is the therapeutic community waiting for its Florence Nightingale to respond to such tragedies?

Sacrifice to frame may also be seen more generally. A related area is the frame reliance of consultants offering reconciliation skills to communities torn by conflict. Again, such skills can only be brought to bear once opposing groups "agree" to go along with the consultant's process -- a kind of contractual prerequisite, even though the parties are at each other's throats . As with therapists, if they do not subscribe in this way they are considered to be beyond the scope and responsibility of the consultant -- and are best "left to fight it out amongst themselves" (as was done in Bosnia for many months). For such consultants, this preliminary agreement is an essential prerequisite for effective reconciliation.

In both the therapeutic and reconciliation situations, it becomes clear that time is being used to absolve those with relevant skills of any responsibility for those sacrificed daily to frame. The message is: "if you in your suffering do not meet conditions that my profession considers appropriate, then I cannot be held in any way responsible for your fate". For the therapist, there is "not enough time" to engage in any effective therapeutic process, so any suffering incurred in consequence can only be deplored. For conflict resolution, "until such time" as the parties conform to the recommended process, any suffering that they cause each other can only be their own responsibility.

Given the dimension of crises, whether now or to come, it may be time to stop treating time as an infinite resource. It may be time to find ways of acting effectively in the present moment -- with whatever resources are to hand. Maybe it is sacred frames which should be sacrificed to human lives and not the reverse. And, through this new sacrifice, new approaches may become apparent.

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