18 April 1996
Therapists without Borders
- / -
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
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
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
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
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
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
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
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
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
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
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.