The return of the person in clinical training

The psychological humanities approach

Psychology has always had a difficult object of study. The mind is not simply there before us in the way a tissue sample might be. The mind itself is also always the medium through which anything becomes available to us at all. To study it, we depend on the very capacities we are trying to understand. We perceive, remember, anticipate, interpret, desire. We inhabit languages and histories that shape what can appear meaningful in the first place.

And yet psychology has nevertheless learned a great deal by making aspects of this ongoing activity available for systematic study. Take, as an example, a psychological construct like emotion regulation. We can define it, develop scales that reliably measure it, test its associations with other variables, examine its neural correlates, and design interventions intended to improve it. This is all very useful and improves our interventions and, sometimes, our understanding of the mind as well. 

However, in order to understand, as a psychotherapist, how emotion regulation comes into play in a person’s daily life, we need tools for returning this construct we’ve created to lived, conscious, moment-to-moment experience.

Someone opens an email that begins, “Do you have a few minutes to talk?” Their stomach drops. They read it again. The meeting begins to take place in their imagination. They picture the sender’s face, feel the pang of an old embarrassment, then find themselves rehearsing an explanation for something they have not yet been accused of doing. They close the email.

Then, maybe, something changes. 

A moment of trust with that person returns, perhaps a conversation where they expected criticism and received understanding. They let themselves remember it. They notice that they have been holding their breath, exhale, take a sip of water. Their heartbeat is less insistent in their ears. They look around. The room seems a little different.

What are we naming, in this unfolding experience, when we speak of emotion regulation?

The construct is still useful here and can help us notice certain patterns. But the trouble comes when we forget the act of abstraction through which the construct became visible and begin treating it as though it were simply an object sitting somewhere inside the person.

Perhaps I can put it this simply: In psychological science, we abstract from experience and learn something useful. In the psychological humanities, we develop the ability to return what we have learned to experience—to the lived, embodied, relational, cinematic flow from which the abstraction was drawn. We then ask: Does the concept allow us to perceive more? What does it obscure? 

This second move is necessary for those who wish to do clinical work. Psychotherapy depends on this return to experience. It is one reason the psychological humanities have a central place in our program. Through our collaboration with the Lynch School’s Department of Formative Education, students will study philosophy, literature, history, anthropology, and theology alongside psychological science.

I can understand the question: What does any of this have to do with becoming a therapist? There are a number of answers, but the one I keep returning to has to do with attention—with whether sustained engagement with these disciplines changes what we are able to notice when we return from our abstractions to the person sitting across from us.

This is closer, I think, to what Mark Freeman has in mind when he argues that human reality is not exhausted by the terms psychology has developed for making it available. Persons live through stories, metaphors, bodily habits, moral traditions, rituals, political arrangements—and these are themselves psychological realities. Literature, philosophy, anthropology, history, and theology can therefore become modes of psychological inquiry because they disclose dimensions of persons that our disciplinary forms of attention may leave difficult to see.

So in courses like Psyche, Soul, Person; The Human Drama: Ritual, Play, Performance; Madness: Literature and First-Person Accounts; and Identity and Difference, we are trying to do something more than broaden students’ intellectual horizons (though hopefully that happens too). We are trying to work on the habits of attention they will eventually bring into the consulting room.

Can a first-person account of madness make something visible that a diagnostic description left out? Can a novel teach us to stay with an ambiguity we would otherwise resolve too quickly? Can anthropology help us understand the significance of a gesture, a ritual, a silence? Can philosophy expose an image of the person already operating within our clinical judgment?

I don’t know that reading books guarantees any of this. One can quote famous philosophers and novelists at length and still panic when a patient goes silent. The difficulty is sustaining attention when we become unsettled ourselves. This is where I think the second commitment of the program—sustained training in therapies of depth, insight and relationship—begins to fold back into the first.

Therapies of depth, insight, and relationship

Maybe a patient begins talking about something hopeless and your voice gets a little brighter. You ask a question about coping. Nothing obviously strange happens. The session continues.

Then someone in supervision—someone who has heard you talk about patients for a few years, who knows the rhythms of your voice—hears the shift. Or they notice something in your process note. Up to a certain point, you had been writing down the patient’s particular language: small images, odd turns of phrase. Then, at the difficult moment, the person disappears into clinical language. “Processed grief.” They’re able to ask, “Okay—what happened there?”

Together, you create space to wonder about this and consider what happened for you and the client in that moment. Maybe it was useful to talk about coping; maybe it also helped move the patient, and you, away from something difficult to bear. 

The point is that someone noticed. Something that had passed silently through the session has been returned to attention. This is a thing we need other people for.

Students need people around them who know them well enough to notice what changes when they become frightened, ashamed, eager to please, desperate to help. They also need enough trust that a defensive movement or a bad intervention does not become the final account of who they are as therapists.

That kind of trust will have to be built. We can write “supportive learning environment” in every handbook and still create a culture in which everyone becomes very skilled at looking reflective while hiding what they are actually afraid to bring into the room. The ability to slow down and notice the moments we most want to brush over and speed through will come from reading together, students bringing in work that didn't go especially well, disagreeing about what happened, discovering someone has misunderstood you, and coming back the next week.

Faculty have to submit themselves to this process too. If we ask students to examine how their wishes and defenses enter perception, then we have to remain open to the possibility that our understanding of them—or of the program itself—has become too settled. What are we failing to notice? What are students learning to keep out of view because they think we do not want to see it?

Here we return to the question with which I began. What do we need other people for?

Perhaps one answer lies in the peculiar difficulty of encountering another subject: someone we can affect and who, inconveniently, has an experience of us that we cannot entirely control. Another person exceeds our understanding of them. They can surprise us, resist our account of them, tell us that we have misunderstood. If we are able to hear this, the encounter may require something of us in return.

A chatbot may help someone put words to an experience. It may offer an interpretation that opens something genuinely new. Perhaps the absence of another vulnerable human being even makes some disclosures easier (no one there to disappoint, burden, anger, frighten).

But no other subject has entered the encounter. There is no one whose understanding must change in response to what has been said. No one who must discover whether they can remain present when confronted by anger, withdrawal, disappointment, or need.

Psychotherapy places these questions inside a relationship. Can I be angry with you and discover that you remain? Can I tell you that you failed to understand me without having to reassure you immediately afterward? Can what I tell you require you to reconsider yourself and return to me differently?

This, I think, is one place where we begin to see what a human therapist may be for.

The psychological humanities and depth-oriented psychotherapy meet around the problem of encountering another person without confusing our understanding of them with the person themselves. The psychological humanities help us notice what exceeds our categories and return our abstractions to experience. Depth-oriented psychotherapy asks us to practice this while another person is actually there—speaking back, surprising us, disturbing an account we had begun to trust.

The program will have to submit itself to the same test. Our first students will arrive with ways of seeing that we do not have, intellectual traditions we did not build into the curriculum, experiences that reveal where our descriptions have become too settled. They will also encounter gaps between the program we imagined on paper and the one they experience.

Can we remain attentive there? Can their experience alter our understanding of what we have built? I hope so. It seems an appropriate test for a program organized around returning the person to view.