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AHP PERSPECTIVE June/July 2002 Table of Contents

Spiritual Inquiry in Psychotherapy and the Effect of Managed Care — Katherine Kainz

The central aim of spiritual inquiry is the transforma- ion of the knower. In his work “Contemporary Epistemology and the Study of Mysticism,” Donald Rothberg explains that there is contemporary interest in “spiritual universals,” or an interest in interreligious dialog in an increasingly global context (in R. Forman, ed., The Problems of Pure Consciousness: Mysticism and Philosophy, New York, Oxford University Press, 1990). Also, traditional and secular forms of spirituality are seen as possible solutions to contemporary cultural problems, on individual, social, and ecological levels. Rothberg believes there is a “practical urgency” to interpret human spiritual traditions in the postmodern situation to contribute to the resolution of contemporary cultural problems. He believes, from a psychological perspective, the approach identified as transpersonal psychology (con-cern with extraordinary experiences and the transformation of con-sciousness) is especially promising.

In Eye to Eye: The Quest for a New Paradigm, Ken Wilber argues for “a ‘transcendental paradigm,’ meaning an overall knowledge quest that would include not only the ‘hard ware’ of physical sciences but also the ‘soft ware’ of philosophy and psychology and the ‘transcendental ware’ of mystical-spiritual religion” (Garden City, NJ: Anchor-Doubleday, 1983). In answering the question of whether or not higher philosophical truths can be adequately validated, the author proposes three modes of attaining knowledge—each appro-priate to a particular type of knowl-edge quest. He calls these modes: the eye of flesh, eye of reason, and the eye of contemplation.

The eye of flesh is employed in the study of subjects capable of detection by the five human senses. This is an empirical mode perceiving the external world of space, time, and objects. The eye of reason, or mind, is a rational mode and is a subtle realm participating in a world of ideas, images, logic, and concepts. This includes, but transcends, the sensory field. The eye of contemplation is a transcen-dental mode. It transcends the mental realm and results from “the contemplation of the Immutable, of the Self which is Reality, Consciousness, and Bliss.” Wilber goes on to explain that all humans possess each eye; each eye has its own objects of knowledge (sensory, mental, and transcen-dental); a higher eye cannot be reduced to nor explained in terms of a lower eye; and each eye is valid and useful in its own field, but commits a fallacy when it attempts to fully grasp, by itself, higher or lower realms. The author calls this fallacy a “category error.”

Thus, a new and transcendental paradigm would draw freely from and be an integration of empir-icism, rationalism, and transcen-dentalism. One major hazard to be overcome, however, is the tendency toward category error, or the attempt of one eye to seize the role of the other two. “Sensation, reason, and contemplation disclose their own truths in their own realms, and anytime one eye tries to see for another eye, blurred vision results.”

Wilber illustrates this point through religions such as Buddhism and Christianity that contained transverbal insights into ultimate reality. Before it was understood that it is useful to differentiate between the eyes of flesh, reason, and contemplation, the revelations of these religions were confused with logic and empirical fact. The philosophers came in and destroyed the rational side of religion, and science came in and destroyed the empirical side . . . Western spirituality all but went blind. It did not fall back on its eye of contemplation—but merely fell apart and spent its time in futile argument with philosophers and scientists.

The rise of science, and the scientific method, involved using the eye of the flesh to look at the realm of the flesh—such as used by Galileo in proving the fact that all objects fall at the same rate of acceleration. Here, flesh is not confused with reason and contemplation. This approach benefits not only science but also religion. Religion can free itself from its pseudoscientific rubbish.

Regarding the place of psychology in the three eyes, Wilber states: Psychology is considered an empirical science only if it offers measurable patterns, which is why behaviorism is an empirical science and psychoanalysis is not. (Notice I did not say that behaviorism is therefore valid and psychoanalysis is not; they are two sets of data gathered through two different eyes, both of which are valid; one of which is empirical, and one of which is mental-phenomenological.)

Thus, if psychology is viewed in this way, then it is committing a category error if it tries to be religious. Contemplative and spiritual truths cannot be deduced (the conclusion follows with certainty from the premise) by philosophers and psychologists. “Reason cannot grasp the essence of absolute reality, and when it tries, it generates only dualistic incompatibilities.” Or put another way, “The eye of reason is trying to see into heaven.”

Wilber goes on to offer a framework for evaluating knowledge. All valid knowledge—in whatever realm—must consist of these basic components:

1. An instrumental strand. This is a set of instructions, such as, “If you want to know this, do this.”

2. An illuminative strand. This is seeing by the particular eye of knowledge evoked by the instrumental strand.

3. A communal strand. This is actual sharing of the illuminative seeing with others who are using the same eye. If the shared vision is agreed upon by others, this constitutes proof of true seeing.

Wilber believes that we are seeing a new type of scientist emerge today, one who has already mastered one or more empirical and phenomenological sciences, and who now has or is mastering a contemplative science. The practitioners of transpersonal psychology are considered to be in this domain. This is an example of Wilber’s concept of a transcendental paradigm which integrates the eye of flesh, the eye of reason, and the eye of contemplation. The higher forms leave their footprints in the lower, but these imprints cannot be grasped by the lower realms nor reduced to them. This does justice to the full spectrum of human possibilities and proclaims the new and truly higher sciences.

LIGHT AND SHADOW F. Vaughan and B. Wittine show how intensive psychotherapy can be used for spiritual inquiry (“Psychotherapy as spiritual inquiry,” ReVision, 17, Fall 1994, 42-48). They explain how psychotherapy can be “a process of inquiry that employs an essentially ‘phenomenological’ method involving a search to reveal the basic truths of one’s experience.” In some forms of psychotherapy, such as transpersonal and existential, inquiry is used not only to address personal concerns, but to explore deeper spiritual questions, potentially leading to direct experience of spiritual realms. Inquiry in psychotherapy can bring lost and disowned aspects of the psyche into awareness so they can be examined, cultivated, and integrated. These questions, for example, might be explored:

• Where am I now in my life? What meaning does this period have in the context of my life as a whole?
• What is trying to emerge from within me at this time? What potential is trying to unfold?
• Which self-images, object- images, and beliefs of the past must I relinquish at this time to support what is emerging from within me?

The therapist guides the client through this inquiry and assists in becoming aware of aspects of him or herself that have been hidden or neglected. The authors state that, with a skilled therapist, the client may “make new discoveries in energetically charged flashes of direct knowing . . . far more than simply mental insights. They are keenly experienced with one’s whole being.” They go on to confirm that, like most forms of psychotherapy, spiritual inquiry in psychotherapy requires a good relationship with the therapist. Also, the therapist should be committed to his or her own spiritual growth, and have first-hand experience of spiritual realms.

Therapists concerned with spiritual inquiry should ask their clients in which directions do they want to grow—exploring both the heights and depths of conscious-ness—and not only what emotional healing do they want to do. “Just as traditional forms of spiritual practice often ignore the shadow while striving for the light, many psychotherapists risk making the opposite error of ignoring the light while exploring the shadow.” Vaughan and Wittine articulate the goals of spiritual inquiry in psycho-therapy as: decreased agitation, becoming more peaceful and more comfortable with oneself, more tolerant of others, and better able to enjoy the simple pleasures of everyday life.

THE POLITICS OF KNOWLEDGE Knowledge can be regarded as a core cultural value. What constitutes knowledge then can depend on what culture creators and people in leadership roles say it is. This brings me to the issue of managed care—which is shaping the delivery of psychotherapy services today. Managed care has severely restricted the practice of professional psychology. It is a system of cost containment imposed by insurance companies. It demands empirically validated, short term, and systematic treatments with measurable goals. In 1995, The American Psychological Association (APA) formed the APA Task Force on Promotion and Dissemination of Psychological Procedures in an effort to promote empirically supported treatments (J. Perez, “Clients deserve empirically supported treatments, not romanticism,” American Psycholo-gist, 54(3), 1990, 206-206). Some feel as Perez does that managed care has forced the field of psychology to become more accountable for what is practiced and that the APA’s efforts to promote empirically validated treatments is a step in the right direction.

Others believe therapies that might involve spiritual inquiry are threatened with disenfranchisement by the restrictive guidelines of managed care (A. Bohart, M. O’Hara, and L. Leitner, Empirically violated treatments: Disenfranchise-ment of humanistic and other psychotherapies, Psychotherapy Research, 8(2) 1998, 141–157; M. O’Hara, Emancipatory therapeutic practice in a turbulent transmodel era: A work of retrieval, Journal of Humanistic Psychology, Summer 37(3), 1997, 7–33; and K. Schneider, Clients deserve relationships, not merely “treatments,” American Psychologist, 54(3), 1999, 206–207).

I deal with managed care guidelines and health insurance companies every day in my own work as a clinical psychologist in a medical clinic. I can safely say that the therapy techniques that do not follow the medical model, and therapists who are not on a preferred provider list, have little chance of getting authorized by third party payers. There is a great proclivity toward cognitive-behavioral therapies. Recently, the following headline appeared in my local newspaper, “Counseling Center to Close.” The Rochester Area Pastoral Counseling Center, which offered spiritually based counseling services, will close after 17 years of service. The director and full-time pastoral counselor stated, “It is difficult for the financial survival of services like ours, which operate out of the Managed Care and Preferred Provider networks” (Counseling center to close, The Post Bulletin, May 29, 1999, p. 9c).

If the hope that we will ever be able to sort out truth from politics in the definition and practice of knowledge is an illusion, it may be that those opposed to the medical model of diagnosis and cognitive-behavioral therapy will have to leave the system and set up shop elsewhere. When strict criteria of medical necessity are applied, a great many equally important, but less catastrophic, quality-of-life concerns will have to be provided for outside the health care system. As people become more aware, these days, that there is a deep and important inner life, they may simply go on their quest for spiritual satisfaction without the benefit of third party payments. Times, therefore, may actually be promising for some spiritually oriented therapists who can carve out their own practice niche.

So, while managed care appears to have dictated the current political definition of knowledge in psycho-therapy, and spiritual inquiry in psychotherapy may be outside of this definition, this may not be a bad thing. Just as there are different eyes to see truth and knowledge, so may there be different eyes with which to see psychotherapy. Perhaps the cognitive-behavioral therapies are validated through the eyes of flesh and reason and transpersonal therapy through the eye of contemplation. Although this perspective of different but equally valid ways of knowing may be too much for the managed care industry to philosophically and financially grasp, there may still be room for all three perspectives of therapies in the larger scope of the human service profession.

I thank Jurgen Kremer for his assist-ance in the preparation of this article. The views expressed are those of the author and do not necessarily reflect the views of Olmsted Medical Center.

KATHERINE KAINZ, Ph.D., has practiced psychotherapy for 26 years and is currently staff psychologist at Olmsted Medical Center in Rochester, MN, where she provides individual and group psychotherapy to physician-referred clients. She received her Ph.D. in Psychology from Saybrook Graduate School. Her research interest is physician-psychologist collaboration.

AHP PERSPECTIVE June/July 2002 Table of Contents

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