[From Psychoananalytic Energy Psychotherapy. Karnac 2008]
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Ethical aspects of energy psychological work – dangers of idealisation and illusions of knowing.
“In developing right affiliations, we are speaking about establishing appropriate, healthy, outreaching, caring, and mindful relationships. These relationships differ markedly from inappropriate ones that are ruled by arbitrariness, self-righteousness, perfectionism, or self-centeredness.” [Hover-Kramer 2006 p 10] click
Practitioners of energy psychology methods know, from their experience that they usually work well, rapidly, gently, with minimum distress, are non-invasive, and mostly have no adverse side-effects. Clearly they are the treatment of choice in many cases. However, their effectiveness and (for most people) their seemingly innovative nature, present new ethical and professional practice considerations (discussed extensively by Dorothea Hover-Kramer 2006).
These can include the following:
Informed consent, particularly insofar as the methods may not correspond to the client’s prior expectations. This also concerns the nature of the explanations given to the client.
Scope of practice issues – the extent to which use of energy methods legitimately falls within a practitioner’s scope of practice within their designated profession.
Management of the slightly altered, and sometimes disoriented, states of mind entered by clients (and sometimes practitioners) during energy-based work.
Maintenance of an appropriate therapeutic relationship that minimises excessive dependency, transference, idealisation, and other distortions in the client’s view of the therapist. These concerns can be somewhat at odds with some principles and assumptions found in traditional, psychoanalytically-oriented psychotherapy.
Caution regarding the use of intuition, muscle testing, and other forms of non-verbal sources of data.
Of course, all the normal ethical, professional and legal considerations that are relevant in traditional forms of psychotherapy also apply in relation to energy modalities. The stunning effectiveness of energy methods makes the necessity for the highest standards of ethics even more central to our work. Professor Michael Cohen, expert in ethics, law, and medicine, puts this as follows:
“On one level, energy therapies share the same ground as other health and mental health professions in terms of the propensity for boundary violations. Caregiver and client meet in a unique space: one in which the client offers vulnerability and receives wisdom, knowledge, and nurturing. The therapeutic relationship is deep and exhilarating; prior limits, it feels, can be transcended in the healing space of understanding and empathy between therapist and client. This very freedom allows space for abuse for those who are unwary. Humans who have not fully done their own psychological and spiritual work, it seems, can be tempted to turn the grace of a sacred encounter into an unwelcome and profane violation; the safety of therapeutic intimacy into terrifying violation. Whilst energy therapies share this potential danger zone, boundaries are perhaps even more easily penetrated in energy therapies than in psychotherapy, because the work can move quickly through deep emotional layers and, in the experience of many healers and clients, even further, to spiritual layers that may have been previously hidden.” [2006 xv-xvi]
Much of this revolves around the need for the therapist to be cautious, honest, self-aware, observant, continually monitoring results of the work, generating and revising hypotheses in the light of emerging evidence. Whilst it should obviously go without saying that a practitioner should not make misleading claims about his or her work and its effects, the excitement of discovering the potency and astonishing range of application of energy psychology methods can lead some, particularly those new to the field, to make claims that are both simplistic and misleading. Energy psychology methods do not operate by ‘magic’, they do not produce ‘miracles’, in the sense of bypassing work that needs to be done. Instead, they seem to enable the necessary work to be targeted and carried out much more efficiently than purely talk-based methods. Nevertheless, complex problems remain complex, and many layers, strands, and networks of cognitive, emotional, and energetic issues may need to be addressed. The speed of change may be alarming and disorienting to some clients. Such aspects require astute and sensitive, empathic and energetic, observation of the client’s shifting states of mind and body. Appropriate explanation needs to be given, and this will vary from client to client. Some may like extensive and detailed discussion of the nature of the work, the principles and history behind it, and so forth. Others may be happy with a very brief and general explanation, their essential concern being with finding relief from the presenting problem. It can be important to avoid a misleading impression of certainty regarding the mode of action of energy psychology methods. Thus, it may not be appropriate for a practitioner simply to repeat a dogmatic explanation provided by the founder of one of the methods. Instead, it may be best to acknowledge that we are far from fully understanding the mode of action of energy psychology methods, that they are based on observation rather than theory, and that a range of hypotheses have been proposed. Indeed, I would go further, and suggest that the practitioner should aim to avoid dogmatism even in his or her private beliefs. Our most favoured assumptions and beliefs can often turn out to be flawed and in need of revision. So whatever perspective or theory appears most apt and relevant at one point is best viewed as merely a provisional working framework and series of hypotheses. This allows us to retain an essentially scientific stance of enquiry. If we can manage to hold on to this position, of tolerating not knowing (all such ‘knowing’ being illusory), we are less likely to utter misleading claims to clients, colleagues, or the general public. We are also less likely to idealise our own ‘knowing’ and inadvertently foster the client’s idealisation.
Illusions of knowing do indeed cause all manner of problems. They can lead us to overlook evidence that is incongruent with our assumptions, or ignore client’s expressions of doubt or concern, or fail to modify and develop our understanding in the light of evidence; they can also lead to a grandiose identification with the power of energy methods. In the case of the ‘cynics’ who are certain of their own beliefs, that exclude the possibility that energy psychology methods can work, the illusion of knowing prevents them being open to new and valuable information that is potentially of benefit to their clients.
Transference, idealisation, denigration and disillusion.
The realm of transference, and its associated distortions in the perception of the therapeutic relationship, deserves particular consideration. Here I will state some observations and conclusions that seem to me obvious but are at odds with pervasive assumptions within the psychoanalytically derived forms of psychotherapy. In that field, it has somehow come about that ‘transference’ is viewed as the most crucial focus of psychotherapy – but transference seems to be a source of some of the most terrible twistings and malign transformations of the relationship between client and therapist.
The practice of conventional psychotherapy is difficult. It requires a discipline of relationship with the client, such that professional boundaries are maintained whilst being maximally open emotionally to his or her communications of need, desire, hope and fear. Into this receptive vessel of the therapeutic frame comes the potentially explosive force of the transference – containing the thwarted desires and needs of childhood, combined at times with trauma and potential despair. In the case of clients who have experienced extensive and severe childhood trauma or neglect, this transference can be profoundly difficult to manage. The ‘logic’ of the transference is that the therapist will at some point potentially be perceived as being as bad as the original abuser, this alternating or coexisting with an image of the self as overwhelmingly bad. Such perceptions will create enormous anxiety in both client and therapist – and both may be motivated to ward these off. A common reaction is for the client to try ever harder to show that he or she is not bad, abusive, exploitative, uncaring etc., and also to demonstrate that the client is not utterly bad, by endeavouring to express love by accommodating the client’s expressed ‘needs’ for special gratifications or reassurances that extend the normal boundaries of the frame. With such situations the two possible outcomes of these pressures tend to be either that the client breaks off the therapy, or some kind of serious violation of the usual boundaries takes place. Although these are the more difficult instances of the impact of transference, they are essentially just stronger expressions of the normal features of work that is focussed in the relationship between therapist and client.
Boundary violations in psychotherapy tend to be regarded as expressions of inadequate discipline, awareness, training, or ethical standards in the therapist. Of course such factors may be components of the situation, but I think the problem that is revealed in these more extreme circumstances of boundary derailment is one inherent in psychotherapy generally, whenever there is an implicit assumption, on the part of either therapist or client, that the relationship itself is to be healing or reparative. Freud did not view the therapeutic relationship in this way. His method was that of free-association as a means of revealing repressed childhood memories, desires, phantasies, and fears, which he aimed to bring into the light of consciousness in order that the ego might deal with these in a more reality-based way. He found that often the patient would repeat, rather than remember, childhood constellations in relation to the analyst – and that this was the patient’s way of remembering. This transference relationship was to be viewed not as real but ‘as if’, a form of memory that contained information about the patient’s childhood developmental past. Although this strategy of making use of the transference as memory can work reasonably well in relation to a small spectrum of relatively well-functioning patients, for many people it is unfeasible. In such cases there is simply too much childhood trauma and unmet needs that become downloaded into the relationship with the therapist – and these cannot easily be contained within the boundaries of the therapy. Too much is expected of the therapeutic relationship, leading to rage and disillusionment in the patient and, at times, burn-out in the therapist. Excessive focus on the here-and-now and interaction between client and therapist is often seen as necessary in response to this onslaught of childhood trauma and need, and yet this attention to the relationship may only serve to stimulate the client’s endeavours to seek gratification and nurturance from the therapist.
One of the many advantages of the energy psychology methods is that they redirect the therapeutic focus back to the internal dysfunctional information within the client’s own mind-body-energy system. It is this dysfunctional information, encoded in the client’s energy field, that has brought him or her to seek help – rather than because the client has a problem in relation to the therapist. The therapist becomes a facilitator of change in the informational energy field of the client, rather than a receptacle of transferred desires, needs, and images from infancy. As a result, there is less strain on the therapeutic relationship. The energy psychology perspective on transference is succinctly stated by Dorothea Hover-Kramer (2006): “Transference happens when the client personalises the professional relationship with the therapist which diminishes the effectiveness of the therapeutic relationship.” [p 43] She adds that “The more disorganised, disempowered, and lacking in internal resources clients are, the more susceptible they will be to transferences.” [p 43]. I believe this is actually startlingly close to Freud’s original view of transference as ‘resistance’, a truthful perspective that has become lost in some contemporary approaches. Minimising the intrusion of preoccupations with the therapist enhances the speed and effectiveness of the therapy, in my experience.
Whilst helping to counter some of the excesses and imbalances in contemporary psychoanalytic approaches, there are, on the other hand, other dangers for the therapist’s attitude and state of mind inherent in energy psychology. The most obvious of these is that of mania and illusions of omnipotence. Most people who encounter the rapid and profound shifts brought about by energy psychology methods, unless striving to ward off a full awareness of the implications, are likely to become filled with enthusiasm, eager to tell and demonstrate the phenomena to all who will listen (and many who will not). Along with this enthusiasm there can be impatience with those who refuse to believe the paradigms-challenging accounts. It can be easy to slip into thinking that one can heal anything using these methods – and indeed it is true that most physical and psychological problems can be helped to some degree using TFT, for example, since there appears always to be a corresponding encoding in the energy system which, when tapped, makes some contribution to the alleviation of illness or distress. Idealisation of self, the method, and the originator are common results of identification with these powers of healing. As a counter to these, it is good to remind oneself that we are mere technicians of the energy system. We know what to do to bring about a certain result in some, but not all, cases. This does not mean we are anywhere near a real understanding of the phenomena – nor that we can help everyone with these methods.
Idealisation of the originator of a method can stifle innovation since any deviation from the founder’s own style or protocol may be viewed as heresy or betrayal, provoking denouncement or even ‘ex-communication’. The condemnation of deviance is not necessarily carried out by the founder, but may be the function of those who strive to receive the founder’s blessing. In place of genuine scientific and rational assessments of the value of innovative ideas, there is a judgement based on ‘herd’ thinking and concern for status within the group. Such dynamics are found within psychoanalytic, clinical psychological, and other professional and scientific groups, as well as within the energy psychology fields.
The flip side of idealisation is disillusionment and denigration. Sometimes those who have been the most enthusiastic proponents of energy psychological methods become ardent opponents – denouncing a once idealised founder and the methods themselves as fraudulent. The rigid idealisation is replaced by an equally rigid and restricted denigration. Neither position allows for the truth of the imperfection of the methods, our understanding of their nature, and the personal qualities of the founders. It is sobering and helpful to remind ourselves that whatever methods and understanding we have evolved at any one point will inevitably be viewed as primitive by future generations. All we can do is our imperfect human best.
Communicating with colleagues – the use of bridging concepts
Obviously it is necessary, for both scientific and professional reasons, to integrate the findings of energy psychology into the rest of our knowledge and theories of how the material and human world is. On the one hand, it is important not to minimise what is new and surprising in energy psychology, when compared to traditional approaches – but, on the other hand, we need to make use of bridging concepts that help us and our colleagues in other fields make links to more familiar domains. Moreover, we need to do so in such a way as to facilitate our own critical examination of energy psychology methods and theoretical frameworks. EFT is an interesting example here. If we look at any of its individual components – such as taking a history, identifying crucial formative experiences, linking adult and childhood traumas, finding recurrent core conflictual themes, identifying automatic negative thoughts and limiting beliefs, reframing and cognitively restructuring the client’s relationship with the problem, using body-based forms of desensitisation, use of in vivo desensitisation, testing the results, and so forth – these can all be found in other well-established therapeutic methods, including those found in the UK guidelines from the National Institute for Clinical Excellence (NICE). Nevertheless, there seems to be something in the overall gestalt of EFT that goes well beyond the sum of its constituent parts. TFT, by contrast, in its attention to details of the energy system as originally revealed in Applied Kinesiology, seems to present phenomena that are less easily conceptualised within other frameworks. I feel it is important to allow these epistemological and conceptual tensions to remain open, not rushing to premature conclusions or pseudo understandings. At one pole is the danger of simplistic formulations of energy psychology methods that have a superficial and seductive appeal – whilst at the other pole is the dismissal of reports of energy psychology effects because they do not fit conventional paradigms. Neither position facilitates true enquiry and the furtherance of knowledge.
Perhaps the best we can say to our colleagues in neighbouring fields is that many of us, having worked for years with other, psychoanalytic or cognitive, methods, find that energy psychology appears to offer results that are more rapid, deep, and gentle than we or our clients have hitherto experienced. We have struggled with our own perplexity and scepticism, including the natural and almost ubiquitous tendency to reject whatever violates our fundamental assumptions, and we find ourselves embracing this developing field of therapeutic enquiry with persisting enthusiasm and astonishment.