Holmes The Spirit of Psychotherapy

1. Auflage 2024
ISBN: 978-1-913494-81-0
Verlag: Karnac Books
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 288 Seiten

In The Spirit of Psychotherapy, Holmes considers whether the principles which underpin religion this can be applied to the largely secular world of psychotherapy. Having a belief system is generally associated with good physical and mental health, and the prime focus of psychotherapy theory and practice is intrapersonal and interpersonal, but these are nested in an often-unexamined supra-personal context, sociological, ecological and spiritual. Structured around a qualitative study based on in-depth interviews with people from a wide range of faith backgrounds, Holmes presents the role belief and spirituality play in everyday lives. From these interviews the author identifies core themes such as attachment and hope; frameworks of meaning and rhythm and ritual. Individual chapters are devoted to detailed descriptions of subjects' accounts of these, while drawing parallels and implications for psychotherapy.

Jeremy Holmes MD was for 35 years a consultant Psychiatrist and Medical Psychotherapist at University College London and North Devon and chaired the psychotherapy faculty of the Royal College of Psychiatrists from 1998 to 2002. He co-founded the psychoanalytic psychotherapy programme at the University of Exeter, where he is Visiting Professor. His many publications include John Bowlby and Attachment Theory, Introduction to Psychoanalysis and Attachment in Therapeutic Practice.

Autoren/Hrsg.

Holmes, Jeremy

Leseproben

CHAPTER 2 Starting points: summary of the book’s main arguments
The notion of spirituality is by its nature an abstraction, a sublimation, a distillation of everyday experience. Likewise, this chapter attempts to explicate the book’s essence. It arises out of a juxtaposition of two frameworks, one contemporary, one firmly embedded in the psychoanalytic canon. The first is the ‘free energy principle’ developed by the mathematician-psychiatrist Karl Friston and his colleagues (Friston, 2010; Friston et al., 2018; Seth, 2022) and which has been applied to the processes of psychotherapy, among others, by Cahart-Harris and Friston (2019), Solms (2021), and Holmes (2020). The second is the Winnicottian concept of ‘transitional space’, which I shall argue is the locus for higher levels of shared/relational free energy minimising. As with our new patient laying out their story, I ask readers temporarily to suspend disbelief—and belief—and to accept the rough contours of my argument, in the hope that later chapters will make things clearer and more convincing. Or—yet perish the thought—another option, for those determinedly allergic to neuroscience, is to skip, and move briskly on to the next chapter. My starting point is the contention that, in the Global North at least, psychotherapy occupies a specific and necessary psychological and social role in an age of formal religious decline and pervasive ‘disenchantment’. Psychotherapy and counselling are custodians of the inner life in ways previously occupied by religion. The consulting room parallels a church as a place of safety in an uncertain and trauma-stalked world. I’m suggesting that the ethos of psychotherapy is one of secular spirituality, the essence of which is connectedness, interpersonally with our fellow humans, but also with the living and non-living entities whose existence we share. This concurrence of psychotherapy and spirituality arises at a fundamental biological level from the fact that we live in a world of radical uncertainty. Our knowledge of ourselves, of others, and of what is to come is inescapably constrained. We are limited by the veil of ignorance drawn by the narrow range of our senses, by the fact that the brain is only statistically rather directly connected with the surrounding ‘world’, by time’s unidirectional arrow, and by the tendency towards entropy/disorder, which the second law of thermodynamics tells us is, where ‘we’—our selves, our species, our planet, and our universe—are in the short and long runs heading. Friston and free energy
Current neuroscience (e.g. Seth, 2022) holds that, like all living creatures, we negotiate this uncertainty by making Bayesian predictions, based on prior experience and current sensory information about the likely state of the world and imagined consequences of our actions. This Bayesianism is embedded in the wider context of the need to stave off entropy—for a while at least. In order to survive and thrive, an organism must minimise the disruptive forces with which it is beset. Life depends on order and the maintenance of boundaries, the very antithesis of entropic chaos. As quantum physicist Erwin Schrödinger (1944), asking himself ‘What is life?’, succinctly put it, life is ‘negentropy’. And for motile organisms, that is, the animal kingdom, this is where brains—their own and those of their conspecifics—come in. Brains integrate and regulate incoming information about the state of the world and the inner state of the organism itself. They do this, as best they can, by minimising free energy (Friston, 2010, 2018). Energy here refers to informational energy: order is high in energy, disorder low. A fuzzy TV screen tells us ‘nothing’ and thus is high in entropy. A low entropy crisp picture represents free energy channelled and minimised, giving us needed information, from the triviality of football scores to a heart-stopping Middle-Eastern death toll. The idea of free energy minimisation (FEM), like heliocentrism, is counter-intuitive. As Wittgenstein said, why would one not think the sun went round the earth. Similarly, pace Isherwood (1939), it is surprising to think that we are not cameras, reproducing a pristine vision of ‘the world’ derived from the senses and registered or represented in the cerebral cortex. In reality, we see not with our eyes, but our minds; our versions of the world around us are more akin to testable illusions than pixelated reproductions (Hoffman, 2019). Based on prior experience, we have built up pre-existing pictures of ‘our’ world and its affordances (Gibson, 1986), that is, those features which ‘matter’ to us, for survival, security, pleasure, reproduction, etc. We—our brains—continuously compare and correlate our working models of the world, ‘top-down’, with incoming information, as derived ‘bottom-up’ from our senses. Where there is correspondence, the incoming sensory information/energy is ‘bound’ and can be taken for granted. Attention is alerted by and focuses on discrepancies/anomalies, which in turn trigger minor or major readjustments of our preformed models of ‘reality’. The reason that Leonardo’s Mona Lisa continues to excite admiration and wonder half a millennium after it was painted rests with the enigmatic, and so attention-grabbing ‘smile’—is it invitation, modest rejection, denoting satisfaction or concealed misery? To repeat, incoming ‘free energy’, generated bottom-up by the senses, is chaotic and ‘unbound’. Brains, top-down, ‘bind’ and so minimise free energy with their preformed models of what they predict, Bayes-wise, the world is likely to be like. This occurs hierarchically from level to level within the brain, from sense organs ‘upwards’ to the higher reaches of consciousness. At each stage residual discrepancies between incoming sensory information and preformed models are passed upwards for further minimisation. Unbound free energy eventually (although we’re talking milliseconds here) is passed to the prefrontal cortex with its capacity for conscious thinking, and, crucially from a psychotherapeutic perspective, for thinking about thinking, adding another potentially health-giving top-down layer to the hierarchy. This goes on continuously and dynamically in a loop which includes sensation, FEM, and action, stimulating further sensation, as the world changes in consequence of action, and so on. Thus once a ‘situation’ is appraised—which may happen entirely below consciousness at a purely physiological level—action (including speech, which is a form of action) follows, consciously directed or otherwise. From the brain’s point of view, free energy arises out of the discrepancy between its models of the world and the incoming information provided by the senses. The upper limit of free energy is ‘surprisal’, which equates, once again, to chaos and entropy. The principle of homeostasis, on which our survival depends, insists that free energy/surprisal is required to be minimised by all means possible. Under the aegis of the free energy principle, we adaptively align ourselves and our top-down models with the state of play of the world—inner and outer—as we perceive it. This alignment is achieved in three main ways. We act so as to enhance the precision of perceptions, for example looking yet more closely at La Giaconda; second, on the basis of this generating modified models that correspond with the world-as-it-appears. Here surprisal is embraced and used to stimulate creative adaptation. A third strategy, seen often in psychopathology, is to move into and create environments where the contours of reality are constrained in ways that correspond with our pre-existing models. Thus do we create the very ‘world’ which we expect. In a psychotherapy setting this forms the basis of transference and projective identification. As suggested, permeating this model of brain function is the notion of Bayesian inference. With no direct access to the world, external and internal, other than that provided by our limited and often erroneous senses, we speculate about its present and future states. These informed guesses or predictions will be guided by a combination of past experience and current input and modified accordingly by our actions. We’ve yet to see the sun rise in the west and so it’s a safe bet that it won’t tomorrow, and so we can direct our strictly limited attention and energy elsewhere, although of course for a newborn on the first day of their life, this would not be so. Let’s return to the hierarchical nature of bottom-up/top-down surprise minimisation. As information ascends the minimisation ladder, so specificity increases: round object/mouth-and-eyes/human/male/mid-fifties/in contextually known dwelling—can be no one else but my brother. At each step along the way surplus uncertainty is passed up to the next level where the relevant repertoire of top-down models is deployed until a statistical best fit is found. It is only at this point that consciousness supervenes...