New Perspectives in Metapsychology Today

Frank A. Gerbode, M.D.

Introduction

I am a psychiatrist, trained at Stanford and Yale. I have made it a lifetime purpose to discover, invent, and develop helping techniques that are easy to use, easy to teach, and can significantly improve the quality of life in a short period of time. This search has led to Traumatic Incident Reduction (TIR) and related techniques which I developed with the aid of colleagues, including Marian Volkman, from whom you will hear more later. But along the way, I had to undergo a complete transformation in my orientation.

Today, I would like to speak about metapsychology and its role in providing a new viewpoint of the entire process by which one person can help another to improve the quality of life.

Help as External Causation I would like to start by looking at help from the broadest perspective. There are many ways of helping another person. The means one chooses depends on the basic orientation one takes toward the client - whether we are looking at help from the viewpoint of external or internal causation. (For simplicity, I will refer to the person being helped as the client and the helper as the practitioner.). From this viewpoint, help is regarded as something that an external agent - a practitioner - gives to a client or does for a client. It is either an inflow or a crossflow. From the inflow viewpoint [Figure 1], one may give the client money, good nutrition, medical care, gainful employment, psychotherapy, etc.	Figure 1. Inflow help.
From the crossflow viewpoint [Figure 2], one can make beneficial changes to the client's environment, by introducing social or political changes, improving public health, cleaning up the environment, or doing interpersonal interventions, such as taking a person out of a "toxic" relationship or family situation or providing family therapy to improve the situation. These are things the practitioner does to the client's environment. Both the inflow and the crossflow views of help present help as an externally caused action.. How did this view of help come to be?	Figure 2. Crossflow help.

The Copernican Revolution Until the mid-16th Century, the Ptolemaic view of the universe was prevalent [Figure 3]. That this model should have been the first to arise is quite understandable, because it really seems natural to assume that we are at the center of the universe - after all, we are at the center of our universe of experience, and in our lives, we naturally think and act as though each of us is of supreme importance in our own world, as the pre-Copernican Leonardo da Vinci illustrated in his concept of "Man as the measure of all things" [Figure 4]. People were considered not only to be at the center of the physical universe but also at the center of their mental universe. They were supposed to be responsible - i.e., to blame - for what they did. Therefore, people with cognitive, emotional, or behavioral problems were considered ethically culpable, possessed, or otherwise morally or spiritually compromised. In other words, they were considered "bad" or "alien", and were treated with exorcism, punishment, isolation, and incarceration	Figure 3. The Ptolemaic system.
[Figure 5] In the mid-16th century, the Copernican, heliocentric, view began its infiltration, first in scientific circles, and eventually into the general world-view. The model of external causation is an outgrowth of the Copernican revolution and the outstanding success of the physical sciences in general and medicine in particular. Instead of blaming and ostracizing individuals with emotional and behavioral problems, helping them was done as a kind of medical intervention. This idea was an improvement, in that such individuals were treated more humanely.
Figure 4. Man as the measure of all things.	Figure 5. The Copernican view

The medical model has persisted to this day, and now, as in DSM-IV, we see a wide variety of human characteristics and behaviors being labeled as symptoms of "mental illness". The client receiving help is a "patient", i.e., a passive recipient, of a "treatment", i.e., an externally caused intervention, to handle a "mental Illness". And this action has to be done by a doctor-like "therapist", who, although usually not an actual physician, has to "diagnose" and "treat" the patient, just as a doctor would. Therapists, in this view, are conceptually paramedical personnel, like physical therapists, occupational therapists, nurses, and the like.

However much of an improvement this medical model of help was over the earlier approach, it contains serious flaws. The first of these is that it violates the common-sense view of what help is.

What does it really mean to help someone? In reality, helping someone is not doing something to that individual, nor is it deciding what will be helpful to do to the person's environment. Real help consists of finding out what a person's intentions are and taking action in cooperation with that individual toward the fulfillment of those intentions. In other words, the client provides the primary impetus or causation, and the role of the helper (whom we will call the "practitioner") is merely to facilitate the action that the client is doing. In the model of external causation, the primary authority - the primary author of the action - is the practitioner, and the client is passively receiving the help, or at best "cooperating" with the practitioner. In fact, in this model, the client is helping the practitioner, rather than the other way around!

Truly helping someone begins by assigning authority to that person, and the help is about facilitating the action that the client is doing.

In other words, in a real helping situation, the practitioner has a subsidiary role, one of facilitating the fulfillment of the client's intention.

Theoretical Problems with the Medical Model

One problem with the medical model lies with the concept of "normality". From the person-centered viewpoint, it is up to the client to decide what she wants to have in the way of behaviors, emotions, and thoughts. It is the facilitator's job to help the client achieve them. In the medical model, the therapist may end up working against what the patient wants.

The medical model is entirely a negative gain model. Its definition of health is "the absence of illness". There is no prescription for or accounting for the possibility of a positive direction in which growth might occur, beyond normality. And that's a problem because - let's face it - the normal state of affairs for humankind is none too good. The personal growth model we espouse in metapsychology-based methodologies is superior to the healing or therapeutic model, in this respect. It allows for an indefinite amount of positive gain - how much depends entirely on how far the viewer is willing to go and how much he or she is willing to put into it.

Furthermore, improvement is not the attainment of a fixed condition of "normality" or even "enlightenment" but a betterment in one's current condition.

Practical Difficulties with External Causation Model

A practical problem with the model of external causation is that it is inefficient. If everyone's life can only be improved by the intervention of an external "expert", then a great number of people are not going to enjoy an improvement in their life condition, because there are simply not enough experts around to cause those changes, compared with the number of individuals that need help.

Also, when speaking of helping someone with mental or emotional conditions, the practitioner has no direct access to or influence over the mental and emotional state of the client. It's hard to "treat" emotions, attitudes, thoughts, and feelings because they are invisible to that practitioner. Everything has to be done by the client, actually - all the observing and all of the changing. The practitioner can only facilitate something that the client has to do for herself. The only direct effect a practitioner can have over the client's mental and emotional state is by administration of drugs - a fact that may explain the prevalence of administering medications in today's practice.

Help as Facilitation - the Person-Centered Viewpoint

I am proposing a shift of the locus of authority and causation to the client, what Rogers calls a "person-centered" orientation. In 1950, Carl Rogers published Client-Centered Therapy, in which he challenged the medical model and its Copernican roots. In Rogerian work, the therapist is a person whom Rogers - appropriately - refers to as a "facilitator". The facilitator's role is to respect the authority of the client and to work in a non-directive fashion, accompanying the client on a journey of exploration though her world of experience, providing only empathic reflection of what the client says. The client thus occupies a central and authoritative place in her own universe. Rogers sought to replace the medical model with one of personal growth, and he refused to consider that a doctor would have any particular claim to expertise in handling the cognitive, emotional, and behavioral difficulties that individuals experience in their lives. To the end of his days, he eschewed labels and diagnoses, and he was ever a champion of the lay practitioner, who would play the role of a facilitator of personal growth, instead of that of a doctor treating an illness, and he was equally a champion of the basic wisdom, authority, and goodness of the client as the basic agent in personal growth.

Carl Rogers (1902 - 1987) Pioneered Client-Centered Therapy

And indeed, the Rogerian approach is very congenial and creates a wonderfully safe session environment, since clients do well in an environment that respects their importance and their ability to be the primary cause in their universe. The non-directiveness of the Rogerian approach, however, makes it too unstructured and unfocused to handle serious problems like PTSD in a reasonable period of time.

The challenge, then, is to find an approach that is structured and methodical, yet remains completely person-centered. At first sight, they seem incompatible.

The answer lies in the fact that there is a difference between "person-centered" and "non-directive".

Note that different therapeutic modalities can fit into different categories [Figure 6]. Rogerian facilitation, for example, is both person-centered and non-directive. Psychoanalysis, curiously, is the opposite: it s not person-centered because of the interpretation involved, but it is also not directive, because one is supposed to free-associate in an undirected fashion. Metapsychology-based techniques fit into the remaining quadrant.

It is quite possible to be highly directive, so long as the directions one gives do not intrude on the belief system of the viewer. Any set of directions presupposes a belief system, but the trick is to find aspects of human experience that are experienced by all people and would, of necessity, be part of anyone's belief system. Not everyone, for instance, believes in Jungian archetypes or the Freudian Superego, but everyone has - and therefore believes in the existence of - feelings, emotions, sensations, mental pictures of one sort or another, memories, and other incontrovertible elements of human experience. In his search for something that one could be entirely sure of, Descartes came up with the concept that the one thing we could be sure of is that we think. It is literally inconceivable to disbelieve in the existence of thought. The very thought that thought does not exist is itself a thought and refutes the hypothesis! Without having to get that tricky, however, we can say that it would be equally true to say, "I feel, therefore I am," "I perceive, therefore I am,", "I remember, therefore I am." In fact you could give a long list of basic elements of experience that must exist in order for us to live life at all. It is perfectly possible to refer to such elements in providing structure and giving directions without leading the client to any particular kind of conclusion. In Traumatic Incident Reduction, for instance, once the client has come up with an incident to work on, we can ask the client when it happened, how long it lasted, etc., without intruding, so long as we accept the client's answers without question, and without in any way interpreting their meaning or value.

René Descartes (1596-1650)

In other words, a systematic examination of the elements that are in common in all human experience is invaluable as the basis for any person-centered, yet structured and focused, helping method. We have adopted Freud's term, "metapsychology" to describe this study, bending his usage somewhat, but preserving his sense that metapsychology is what, of necessity, should lie behind any psychological system and practice. Lacking such a foundation would be like trying to play chess without clearly defining what the pieces are and the rules by which they move. Only when you know the pieces and their moves, can you start mapping out effective winning strategies, or, indeed, play the game at all.

Sigmund Freud coined the word Metapsychology in 1896

Metapsychology - the Study of Experience

Human experience and the human mind seems, at first, too ephemeral, complex, and chaotic to be subjected to systematic study, but it only appears so because the terminology used to refer to mental and experiential entities is often vague, inconsistent, and not agreed-upon. Basically, the fields of psychiatry, psychology, and psychotherapy constitute a Tower of Babel, in which there is a plethora of warring theoretical and conceptual structures and no experientially-based, mutually agreed upon lexicon in which people who want to communicate scientifically about human experience can speak to and understand each other.

In order to have a coherent basis for agreement, we need to identify the elements of experience that are universal and hence, when clearly defined, can be the basis for the agreement that is so sadly lacking in the helping professions. This is the purpose and task of metapsychology.

In metapsychology, therefore, you will find that, as in the physical sciences, every term is carefully defined before it is used. With careful attention to precise definition of terms, patterns emerge from the chaos, and it becomes apparent that the world of experience, including the mind, is not chaotic at all, but has a definite structure and set of laws by which it operates. When the structure and laws of experience are understood, they provide clear guidance toward the development of structured and effective helping techniques like TIR.

A central metapsychological principle, for instance, is that in order to be aware of or to act on anything, there must be a distance between oneself and the object of awareness or action. If I am not separated in any way from the blackboard - if my eyeballs are glued to it, say - I will not be able to perceive it. In other words, I cannot perceive anything that I am being or that is part of me. If, in my experience, something is inside me, i.e., within the boundary that separates what is me from what is not me, I cannot observe it. Now, suppose we look at the world from a person-centered viewpoint [Figure 7]. The person is at the center of her world of experience, surrounded by elements in her environment, by things that are part of her world. These would include trees, houses, other people, and the like, but certain mental elements are equally a part of a person's world - things like ideas, emotions, feelings, and memories consisting of mental pictures of the past. In conventional therapy, one often asks the client to look inward to find these mental entities, but it should now be obvious from the foregoing discussion that if these elements of experience were truly inside the boundary that separates self from non-self, the client could not perceive them. Since, in our work with clients, we are going to ask the client to look at things like ideas and feelings, then they must not be inside but a part of the client's environment. This may seem to be a trivial quibble, but it is not. It entails a profound change in the way we look at human nature. If we expect clients to examine the mental disturbances that are ruining their lives, we must consider that these disturbances are not part of the client but, rather, part of the client's environment.

Figure 7. The person-centered viewpoint

In other words, in working with a client, we are not trying to change her, or even to get her to change herself. The client - the person - does not contain any of the imperfection with which she is surrounded. The client is basically good, as Rogers always said. With Rogers, that statement is an article of faith, but now we can see why it is the case. In fact, the client is basically perfect, in the person-centered view, because any imperfection we might want the client to work on must be conceived as outside the client - part of the client's environment, not part of the client. Instead of trying to change the client, we are giving the client tools with which to engage in an environmental cleanup in her mental - and possibly her physical and social - environment. This is the nature of the alliance that is formed between the now-present client and the practitioner - both are involved in the cleanup, and each has a specific role to play in this alliance, as we shall see.

The Practical Nature of Person-Centered Work

In taking the person-centered approach, we are not just being humanistic, warm, and fuzzy. We are adopting the only practical approach.

Practically speaking, what do we have to work with in a session [Figure 8]?

Practically speaking, no one knows better than the client what the client is experiencing or what it means. And no one can change the client's life and experience directly without going through the client. Thus, from a practical viewpoint, everything important done to help a client must be done by the client. It is the client, not the facilitator, who must become aware of what they need to be aware of; it is the client who must gain control over emotions and other aspects of her experience.

Therefore, in respecting and working with the client's awareness and ability, we are only doing what is practical.

An objective, manipulative approach works well with physical objects but poorly with people. If someone's life is to change for the better, it is that person who must change it, from that person's point of view. For instance, to take a relatively trivial example, if you want to help someone play better tennis, you must work with elements of experience that they are aware of. Although neuromuscular changes are no doubt taking place during the game, in coaching, you must somehow bring it down to an experiential level - perhaps getting them to relax, to follow through, to shift their weight in a certain way. The person-centered approach is inherent in any effective training or, indeed, any form of personal enhancement.

The Viewing Session

In TIR and related techniques, there is a definite division of labor [Figure 9].

We call the work the client does "viewing", because the main tool we give the client is various systematic ways of directing his awareness toward his experience. For the same reason, we call the client the "viewer".

What the practitioner does is to facilitate the process of viewing by structuring the session, offering the viewer the appropriate tools in the appropriate order, by providing a safe space in which, without distractions, the viewer can freely view, by communicating effectively and being a good listener, and by giving the viewer a workable methodology with which to address his issues - viewing techniques. Thus we call a practitioner of metapsychology-based techniques a "facilitator", following Rogers' usage.

The viewer is like an executive - she has all the important ideas and does the important things that need to be done. The facilitator is like a secretary - he keeps track of what is being done in the session and provides a structure in which the executive - the viewer - can work effectively. The facilitator, like a secretary, has a subordinate role, but, like a secretary, he can and should be highly skilled. Thus we provide Communication Exercises to sharpen up communication skills, Rules of Facilitation that will ensure a safe space, and training in the metapsychology-based theory and methodology that the facilitator will need to use in a session.

The viewer also becomes increasingly skilled in doing her job - finding and viewing elements of experience, acquiring insight from so doing, and, in the process, changing her life for the better.

These two roles and skill sets are complementary, not competitive. The strictness of the division of labor must be absolute. If a viewer starts to take over running the session or the facilitator starts to offer insights or asks leading questions, the viewing process breaks down immediately.

Summary

I have tried to present in this talk the most important thing that the study of metapsychology has to offer: a profound reorientation in our view of the helping process, an Anti-Copernican revolution in which the client - the viewer - once more occupies her rightful place at the center of the life she is trying to change.

I have shown that the existence of metapsychology allows for the creation of a highly structured, do-able, and effective methodology that can thrive in a completely person-centered environment without compromising its person-centeredness.

To emphasize the change in orientation that has occurred, let me list some of the differences between the orientation of the "conventional therapies" that characterized the twentieth century and the helping techniques that I hope will characterize the twenty-first [Figure 10].