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Deconstructive Contemplation -- A Contemporary Psycho-spiritual Discipline

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© Peter Fenner, Ph.D

I would like to thank Prof. Barry Reed for suggestions which have improved the accessibility of this paper.

1. Introduction
2. Prerequisites
3. Fixation
4. Deconstruction
5. Disclosing the Self-Referentiality of Beliefs
6. Obvious And Transparent Beliefs
7. The Juxtaposition Of Opposite Beliefs
8. Creating A Clear Disclosive Space
9. Guiding Observations
10. Awareness And Action
11. Somatic Sensitivity
12. Facilitation
13. A Course Format
14. Deconstructing A Course
15. No Best Practice
16. Deconstructing The Notions Of Engagement And Disengagement
17. Deconstructing The Phenomenon Of Fixation
18. Deconstructing Deconstructive Contemplation
19. References

 

Introduction

Deconstructive contemplation is a contemporary expression of the liberating, analytical insight contained in the Perfect Wisdom (Prajnaparamita), Middle Way (Madhyamaka), Contemplative (Zen), and Complete Fulfillment (Dzogchen) traditions of Buddhism. It is a practical discipline for the disclosure of beliefs that structure our experience of reality, as these beliefs are manifesting. It makes apparent the transparent assumptions and embedded beliefs that shape our thoughts, feelings, and perceptions. In the process of revealing our belief systems, deconstructive contemplation discloses the fixations that freeze and solidify our experience of ourselves, and the world by interpreting the world and ourselves through dualistic categories. By solidifying our thinking, these fixations support serious and inflexible opinions about how things are. They lock us into habitual ways of living life and interpreting the world, and reduce our repertoire of healthy and sensitive emotional responses.

The principal assumption of deconstructive contemplation is that reality is created through our beliefs (prajnapti-sat). This assumption allows us to see the constructed nature of our experience. This is an assumption which is itself deconstructed within this work - leaving "reality-as-it-is". So in the final analysis deconstructive contemplation is a "non-event". As the Perfect Wisdom (Prajnaparamita) tradition of Buddhism says, it is a radical teaching that is openly presented as a non-teaching. However, for as long as we figure that there is something we need to do, deconstructive contemplation fits the bill, for some at least, as a sophisticated tool for recovering that which we can neither gain nor lose.

The use of the term "contemplation", in the term "deconstructive contemplation", points to the fact that the practice of deconstruction occurs most fluidly and naturally within a psychological space that is free from urgent or intense emotional reactions. This work supports, and is supported by, a mellow and psychologically mature personality structure that isn't heavily fixated or opinionated. Contemplation in this context does not refer to a practice, such as formal meditation, which is segmented out from the rest of our everyday activities. Thus, deconstructive contemplation cannot be compared with a methodology such as Theravada-based insight meditation (vipashyana).

 

Prerequisites

The minimum prerequisites for this type of work are a spiritually mature, attuned intelligence and the absence of intense and overpowering emotions. By and large, this perspective can't be cultivated when people are in an emotional crisis. In such circumstances, people are often locked into the validity of their experience to such an extent that they can't begin to activate the critical intellect required to dismantle their interpretation of their situation. Also, if people are urgently trying to relieve intense emotions they are usually seeking explicit suggestions and methodologies, both of which are lacking in this work. For such people, this work would be frustrating and pointless. Also, if people are experiencing intense emotional pain, the need to urgently escape their suffering can propel an ungrounded participation in this work. They could use this work to "dis-connect" from their pain, instead of disclosing its constructed nature.

This work also requires an open mind and critical intellect. In particular, people need to be able to track their thinking in a gentle yet precise way over an extended period of time in order to appreciate the underlying beliefs that mold their lives. The type of intelligence required is quite distinct from that which is used in developing elaborate theories, or trying to prove the validity of some particular interpretation of spirituality. This work is inaccessible to people who are only looking to defend their own ideas. 

 

Fixation

Fixation occurs every time we take a rigid and inflexible position about any aspect of our experience. When we are fixated, we invest mental, emotional, and physical energy in defending or rejecting a particular interpretation of reality. All forms of fixation can be traced to a core assessment that something is missing in our lives. What is missing can be anything from a nice cup of tea through to enlightenment. We feel that "This isn't it" - where IT represents our particular version of how things should be. We are sure that something is happening that shouldn't be happening, or that something that should be happening, isn't. Either view is a fixation which throws us into emotional confusion as we struggle to gain whatever IT is. We fear not getting IT, and having got it, we fear losing it. And by all counts IT will probably be derived from our concept of a state of enlightenment, i.e., a state of limitless possibilities and unending happiness.

The base-line assessment that "something is missing" is cyclically displaced by the feeling that "This is it". For a time we validate that things are turning out as we would wish. We figure that we are getting it, or have got it - this is how things should be. We might even convince ourselves that we have arrived at the long sought after goal of our spiritual endeavors. However, the belief that we have got it sets up the possibility of losing it, as we reconstruct that we don't have enough of it, and that we could use more of it. We also question if this really is IT and even if it is, whether we now want it.

The core assessments that "this is it" and "this isn't it" spawn innumerable secondary fixations. In terms of our personal and spiritual development we spend a huge amount of time and energy constructing the interpretations that we are making progress or that we are standing still. As these constructions shift and change we spend yet more time trying to work out whether we are stuck or mobile. We oscillate between trying harder and giving up. We determine that we do or don't need help, or find ourselves unable to decide whether to seek help or go it alone. Sometimes we are clear and committed and at other times we are confused and vague, struggling to determine whether our experiences are meaningful or meaningless, real or unreal.

These experiences are palpably real when we are in the middle of them because they are supported by complex "stories" that validate our core assessment. For example, if we assess that we aren't making progress in our spiritual pursuits we listen to a battery of "supporting evidence". We judge that we should be calmer, more aware, or less reliant on foundational methodologies. We draw on the claims of others - who are making progress - and conclude that there is insufficient payoff for our sincere effort. These fixations lock us into habitual and conditioned ways of living life and interpreting the world. They throw us between the extremes of elation and depression, excitement and resignation.

These fixations emerge in an attempt to produce a fixed and solid experience of ourselves and of the world. Two opposite viewpoints or beliefs emerge in dependence on each other - coexisting, separating and finally dis-connecting. When they have dis-connected the two beliefs appear to be independent of each other. Our attachment to one as valid and the other as invalid produces a fixation.

Our fixation with a particular personality structure (pudgala) emerges in the same way. Firstly we develop the distinction "self", or me, by contrasting this with what we are not. This provides a platform for developing a specific identity. Through time we build up a set of beliefs about ourselves. If we identify with being sincere we simultaneously dis-connect and dis-identify with being insincere. If we think of ourselves as unreliable we dis-identify with being reliable. We acquire all our beliefs about who we are in this way. We then spend the rest of our lives defending, avoiding, or trying to change our identity.

 

Deconstruction

Deconstructive contemplation is a gentle procedure for neatly dissolving fixations by revealing that our everyday and professionally-informed interpretations of reality are self-referencing mechanisms for deceptively validating the core fixations that "This is it" and "This isn't it." By disclosing the beliefs that internally validate our fixations, these fixations lose their capacity to control our experience. By revealing their core structure in real-time, we discover that our fixations are arbitrary and that they don't refer to a solid, objective reality. Ultimately we discover that our fixations aren't fixations. We see that a fixation is merely a concept that is superimposed on the flux of our experience. In this way deconstructive contemplation discloses the open and fluid texture of reality (shunyata).

As a procedure for disclosing fixations, deconstructive contemplation is loosely based on the Middle Way (Madhyamaka) tradition of Buddhism. In its traditional Indian and Tibetan settings Middle Way deconstruction systematically demolishes fixed beliefs through rigorous logical investigation. The Tibetan instructional manuals on deconstructive contemplation outline a variety of methods which are tailored to different types of fixed beliefs (drshti). These methods are employed in a rather mechanical way during formal sessions of meditation. A meditator will fabricate a particular fixation, perhaps by recalling a past situation in which the fixation was active. The belief that supports this fixation is then processed using strict logical procedures designed to progressively dismantle the fixed belief through disclosing internal contradictions (prasanga).

Contemporary deconstructive contemplation differs from traditional Middle Way methods in two important ways. Firstly, it operates in a way that transcends the need for formal periods of meditation. In fact, contemporary deconstructive contemplation systematically deconstructs the activity of meditation, whenever meditative activity becomes a self-justifying method for blindly conditioning beliefs in our personal worth and spiritual progress. In this regard deconstructive contemplation is closer to the original Perfect Wisdom (Prajnaparamita) tradition. A second difference is that deconstructive contemplation focusses on dismantling fixations as and when they arise rather than artificially reactivating pre-existing fixations in the context of meditation. These differences make deconstructive contemplation much more organic and fluid when compared to traditional, stylized methods for meditating on egolessness (nairatmya). Rather than being driven by hard-nosed logical analysis, the deconstruction of fixations occurs naturally, as a consequence of the creation of a clear, disclosive space.

Disclosing the Self -Referentiality Of Beliefs 

In general terms, deconstructive contemplation moves gently through two or three different phases. In a practical context these phases are only discernible to a skilled observer as each one blends fluidly into the next.

Deconstruction begins by disclosing the "stories" that internally validate our beliefs at any point in time. The stories within which our beliefs are embedded are uncovered as self-referencing systems of meaning that render our assessments true and factual to us. These stories contain an internal logic in just the same way that the interpretation we are developing here has its own localized coherence. These self-referencing stories gain their plausibility from various forms of "evidence". Typically they draw on memories, causal explanations, and authoritative sources, such as friends, mentors and psycho-spiritual literature. For example, if we are locked inside a belief that we need to engage in a certain spiritual practice (such as meditation), this belief will be linked to judgements that it has helped us in the past, anecdotal support from a network of practitioners, reference to a "lineage" of transmission, and declarative claims in texts that advocate our chosen methodology.

Deconstructive contemplation uncovers these explanations and allows us to see that the validity of our core assessments depends on the interpretation (or story) within which they are embedded. We see that under a different interpretation the core assessment would be false or indeterminant. For example, the belief that we need to engage in a spiritual practice is rendered invalid when held in conjunction with a belief that spiritual activity merely conditions, and perpetuates a sense of incompleteness.

The process of disclosing the local or contextual validity of our beliefs doesn't involve heavy intellectual analysis of how we think and feel. Instead, it is a function of creating a clear disclosive space that allows personal and social discources to be naturally revealed. When delivering this work in a course format, facilitators work with participants to disclose what is already there through simple exercises, group discussions and one-on-one conversations. This pro-active disclosure of core fixations distinguishes this work from other processes such as the Therav›da-based insight meditation (vipashyana) that is widely taught in North America and Europe.

In this phase of the work, people begin to recognize that any opinion or viewpoint that they are inclined to defend or reject signifies a fixation. They become sensitive to the energy modulations that are triggered when their interpretations of the spiritual endeavor are supported, or challenged, by their present experience. They become gently aware of the feelings of comfort and confidence that arise when they judge that they are on-track, and the feelings of frustration, threat and disappointment that occur when they think that something is wrong or "shouldn't be happening." People begin to appreciate that these feelings and emotions are indicators of obvious and subtle forms of fixation. This awareness produces a natural adjustment so that people no longer feel compelled to vigorously defend their beliefs. People see that their beliefs are the product of prior experiences or conditions, and they are therefore content to let their beliefs and opinions arise as thought forms that don't need to be cultivated or suppressed. No special instruction or directive is needed to produce a less defensive or less confrontational relationship with our own and others' beliefs. A more mellow and spacious mood emerges as a natural consequence of seeing the interdependent relationships within our beliefs, and between our beliefs and feelings.

Throughout this process we focus on disclosing and deconstructing fixations as they manifest. This is what distinguishes the practical from the theoretical application of deconstructive contemplation. Thus, whilst some transpersonal patterns of fixation may be deconstructed in a group setting the focus is always on locating and dismantling live fixations.

You can gain a sense of this by speculating right now about the beliefs that account for what you are presently doing. Very likely, the act of reading this paper discloses a belief that there may be some benefit or gain in studying the (as yet ill-specified or unknown) discipline of deconstructive contemplation. Reading this paper can disclose the active presence of a belief that something is missing at a personal and/or professional level, and that you can recover, or discover, what is missing by reading or listening to what others might have to say. This belief, in turn, discloses a belief that you can become more competent, skilled or insightful in managing your own and others' lives. This in turn points to the belief that insight or competence is "something", and that you can learn it or acquire it. At the very least you are engaged with this paper through a need for stimulation or entertainment.

Were we to unpack these beliefs and see how they only hold up within a complex, personally-customized story about how we should be able to do things we can't, we would begin to deconstruct the belief that something is missing. We would discover, for example, that our needs are based on assessments about what we should have, but don't have. And to the extent that the story within which these assessments are embedded is convincing - to the degree to which we really believe our interpretation - we will experience the desire to aquire that which we don't have.

In a course context we do not need to unravel these "stories" in a laborious way. Rather, we present generic versions of these stories in group meetings. In essence these stories are simple because they disclose the most basic structures of the psycho-spiritual enterprise. We explain, for example, how we can invalidate our experience by constructing an interpretation that we shouldn't be experiencing whatever is happening. Participants share how they may have been constructing such an interpretation. If someone has been seduced by a tantalizing description of "bliss and enlightenment" they may share the impact of this expectation on what they are presently experiencing. If people begin to really like what is happening, or experience supposed "breakthroughs", we use this as an opportunity to disclose how we validate our experience through reference to a story about what should be happening to us. The structures that are disclosed reflect the fixations that manifest at any particular time. Participants reflect on their personalized versions of the generic constructs in the periods between group meetings. Participants aren't instructed to do this. It is a natural outcome of the intentionality and energy that is created and focussed during group dialogs.

 

Obvious and Transparent Beliefs

 In the initial stages of this work the extent of deconstruction that occurs matches people's willingness to share the beliefs they access at an obvious and familiar level. They become aware of beliefs that have been cultivated through their own unique exposure to culture and education. In Buddhism these are called acquired (parikalpita) beliefs. Given the psycho-spiritual nature of this work, people tune in to their own personal discourses about psychological and spiritual development. They speak as though they "know" where they are, and where they would like to be. They also tend to have reasonably firm ideas about how to get there. Within a course structure people quickly appreciate how their beliefs derive from traditions, teachers, books, etc. They also appreciate that there are alternative and equally authoritative discourses, some of which directly contradict their own. Through sharing in a psychological space that neither supports nor rejects any particular belief system, people begin to see through their beliefs in the sense that they no longer need to defend or reject what they are thinking. People become present to their thoughts in a simple and uncomplicated way.

Behind our acquired belief systems are structures that shape our experience of ourselves and of the world at a more foundational level. These structures show up in the basic constancies and recurrent patterns in our lives. They shape the very landscape of our experience. Generally we don't observe these structures because they function in a more obvious way. In Buddhism these transparent structures are called innate (sahaja) beliefs. In contrast to parikalpita beliefs, we are born into these deeper structures. In fact birth is one of them. The closeness and familiarity of these structures makes them invisible. Also our capacity to observe them tends to be displaced by the density and urgency of our thinking, and the complexity of our interpersonal activities. However, once people can appreciate their acquired beliefs (parikalpita) without needing to apologize for them or take them seriously, they automatically begin to observe their more transparent belief structures.

The first structures to emerge often reflect people's need to know what is happening. They begin to see how they construct the phenomenon of progressing towards a goal. The course becomes a microcosmic expression of people's need to be able to track their progress towards some privately designed goal. People experience moods of expectation and frustration that can accompany the "path of waiting". They experience how the "path of waiting" is built on the belief that "IT isn't happening now" and see how this motivates them to discover what they need to do to make IT happen. Participants experience how waiting is displaced by "arriving", i.e., getting IT, and how arriving is displaced in turn by more waiting, as people reconstruct that they have lost IT.

People see how they cycle between experiences of success and failure as they judge their progress, or lack of progress, against a quite complex set of assessments about what they have done, whether their past training is a help or hindrance, what there is to "get", whether they are getting it, if there is anything to get at all, who is to judge success and failure - themselves, a facilitator, other participants, etc. The disclosure of these structures is not specifically intellectual. People experience these structures together with the moods and emotions that accompany them. They experience the feelings of frustration and disappointment that are fused with the assessment that they have failed. And they get high on the feelings of excitement and elation that accompany judgements of success. These feelings are experienced as they are in other situations. However, rather than simply enjoying or enduring these feelings, people see how they are conditioned by the stories they weave about what should and shouldn't be happening to them.

Other transparent structures that this work reveals include the construction of authorities, or sources of knowledge in the form of people and traditions, and the creation of dependency relationships with authorities. By revealing the personal and societal discourses that support these structures, people begin to operate outside an identity of needing or giving help. In a relatively short space of time people are accessing the deeper flows of conceptuality that reveal their sense of uniqueness and separation from the world.

As people progressively disclose and deconstruct their deeper beliefs, they encounter their identity at a more basic or existential level. They experience the sense of just wanting to hang onto something familiar, or wanting to escape the experience of being who they are. They also discover the beliefs that produce the transpersonal features of our experience such as time, motion, location, and distance.

 

The Juxtaposition of Opposite Beliefs

Our usual pattern is to cycle between conflicting fixations. We oscillate between feeling separate and connected, clear and confused, fulfilled and lacking. We need help at one point and then don't need it some time later. We get locked into perservering, striving to determine the "right" perspective, which then gives way to giving up. However, when we see that these are responses to the conflicting constructions that "this isn't it" and "this is it", the oscillations flatten out and we move into a space where these constructs lose their capacity to describe an objective or subjective reality. For example, when we see ourselves move through a number of cycles of waiting and arriving with no apparent change in terms of real movement towards a solid goal, we see how our concepts and beliefs create the phenomenon of progress against a highly fluid and vaporous concept of what it is that we ultimately want.

We see how we can interpret our experience differently, even without changing our thinking, feelings, or physical circumstances. For example, instead of believing that we are stuck and just aren't getting IT, we can just as legitimately construct that we are free and mobile. This insight releases our attachment to a limiting interpretation of our circumstances. Having seen how we can simultaneously construct the two experiences of constriction and freedom, we realize that there is no such thing as being really bound or really free.

Two opposing perceptions are juxtaposed over the same moment of illumination. For example, if we are participating in a course, we simultaneously experience the possibilities that we are participating and not participating. We see that whether we are participating or not is purely a matter of what we think we are doing at any point in time. The space itself neither confirms, nor denies, either belief. There is nothing within the course that we can refer to in order to determine if we are participating, or not participating. The capacity for two opposite interpretations to equally describe where we are, renders such assessments meaningless. The juxtaposition of these perceptions deconstructs the beliefs that we are either "doing it" or not "doing it". This same type of insight occurs around "getting it" and "not getting it", making and not making progress, needing and not needing help, being confused and being clear. In terms of their identity people experience how a sense of separateness intimately connects us with the world, and how a sense of connection confirms our uniqueness. Furthermore, to the extent that this work is construed as a vehicle for gaining spiritual insight or liberation, we see that there is no difference between reality and illusion, wisdom and ignorance, bondage and liberation. At this point the need to make such distinctions simply doesn't compute.

As an example of the transitions that occur: when people first share what they think is happening during a course, they might give an interpretation based on a comparison with other work they have done. At a later point they might begin to struggle with not being able to readily make sense of what is happening. They begin to question whether they know what is happening. At this point they reach a deeper level of belief. They may begin to connect with the belief that they need to understand their experience. This point can evolve further to a place in which they don't know whether or not they know what is happening. Participants can arrive at a point where the assessments "I know" and "I don't know what is happening" can equally apply.

As the interdependence and groundlessness of people's fixed beliefs is revealed, fixations begin to dissolve naturally. This produces pockets of clarity and openness. The energy for constructing bondage and release is liberated into a state that is free from bias and limitation. As this work evolves, the process of releasing fixations becomes more natural and effortless. The heaviness and density of people's conflicting emotions thin out, producing greater spaciousness and ease. Through this process people can experience a delightful space that is free from reactive emotions and habitual interpretations. They transcend any preoccupation with getting it or losing it. And in saying this, I acknowledge that you might think this is an experience worth gaining, or avoiding!!

 

Creating a Clear Disclosure Space

In general there are two ways to stimulate the observation of fixation. One way is to impose a rigorous level of structure and constancy over one's physical activity. This way fixation breaks out in an attempt by the ego to affirm its own uniqueness and independence against a background of discipline that is imposed from outside. Zen Buddhism tends to choose this way for stimulating and working with ego fixation. An alternative way to observe fixations is to remove structure and meaning so that there is no reason for doing or not doing what we are doing, nor any way of determining whether we are on–or off–track, in terms of our spiritual aspirations. In this situation we search for grounding and reference where there isn't any, by creating our own systems of meaning, in order to have a purpose and to track our performance and progress. This allows us to observe habitual patterns of fixation.

We have found the later method particularly effective for disclosing both obvious and subtle forms of spiritual and psychological fixation. Thus, our work occurs in a space that is created by the progressive removal of specific and generic structures and assumptions. The removal of such structures and assumptions allows people to see how their experience is constructed. For example, there are no practices or conversations in this work which specifically allow people to conclude that the course has, or hasn't, a purpose. The creation of such a space gives people a unique opportunity to see how they need to construct meaning, purpose, and outcomes. It brings their constructions into high profile because the "space" doesn't collude with these constructions. People discover what they, and they alone, make out of the space. Also, because the space neither validates, nor invalidates people's constructions, it isn't skewed towards any particular personality profile. For example, it isn't biased towards encouraging conceptualization and suppressing emotions, or vice versa. The environment allows participants to experience the structure and behavior of their personality without distortion. Consequently, everything that is created during the course is an accurate reflection of what occurs away from the course. The belief that "something is missing or wrong" emerges in the same way as it does in other situations in life.

The creation of the space is very much a function of the facilitators' capacity to not condition the space with their own beliefs about what should and shouldn't be happening. In fact, the evolution (and effectiveness) of this work is driven by the progressive disclosure and removal of assumptions and expectations that facilitators have unwittingly imported into the space. Facilitators also need to progressively dismantle any imputation of direction, meaning, or lack of meaning that has been inferred from the light structure and content that initially defines the working space.

 

Guiding Observations

Whilst the structure of deconstructive conversations is loosely modelled after Middle Way "unfindability" analyses, the ambience for undertaking this work is inspired by the Complete Fulfillment (Tib. Dzogchen) and Complete Seal (Skt. Mahamudra) traditions of Buddhism. These traditions advocate a transcendental balancing of our thinking, feeling, and acting, in preparation for the liberating insight that deconstructs the differences between application and non-application, bondage and liberation, etc. The integration of these extreme orientations is achieved through a natural correction that occurs by observing their manifestation.

The great fourteenth century Tibetan master Longchenpa summarizes the most important Complete Fulfillment principles when he writes:

If there (are views and opinions) to be negated and established, and (experiences) to be rejected and accepted, then in the process of doing this you get caught in a web of dualistic fixations (based on) hope and fear. Because we have gone astray and haven't reached our desired destination, the point is to cultivate the non-rejection and nonacceptance of whatever arises.

At a cognitive level one progressively filters out any tendency to validate or invalidate one's own and others' beliefs systems. Similarly, one checks and corrects the tendency to view one's experience as expanded or contracted, sublime or mundane. At an emotional level one learns to operate in a way that filters out the extremes of depression and excitement. In summary, one acts to progressively remove all cognitive and emotional bias from one's experience. While these directives are given prominence in the Complete Fulfillment tradition, a related set of parameters occurs in the original teachings of Buddhism which recommends that we avoid being driven by the eight worldly aspirations; namely, loss and gain, pain and pleasure, fame and disrepute, praise and denigration.

In our own work we have enriched the above principles by offering a more comprehensive account of the biases that inhibit the dismantling of our fixations. When we describe these biases we do so in a relatively casual and common-sense way, using language that accords with our everyday way of thinking and talking about them. This helps to transform theoretical and attractive-sounding suggestions into instruments for the direct and real-time disclosure of cognitive biases and emotional fixations. By describing the personalized discourses and feelings that accompany generic fixations, we can easily track their structure and manifestation as they occur. The following list summarizes the type of cognitive, emotional, and behavioral biases that are incrementally articulated in establishing the personal and social atmosphere that invites people to inquire into the reality of their "breakdowns" and "breakthroughs". In the context of this work people are invited to observe in real-time how they are:

• drawing attention to themselves, or diverting attention from themselves.
• exposing themselves to, or shielding themselves from, fears and
perceived threats.
• helping or hindering their own and other's process.
• making things easy, or difficult, by "cruising" or "busting their guts".
• trying to please, or aggravate people.
• clamming up, or speaking out.
• letting it all out (i.e., being an open book) or cultivating an aura of
mystery around themselves.
• holding back, or pushing forward.
• trying to contract, or expand, their field of influence.
• pushing on, or giving up.
• trying to intensify, or dilute their experience.
• dramatizing or trivializing a breakdown or breakthrough.
• attempting to prolong, or shorten, what they are experiencing.
• resisting, or giving into, an experience.
• validating or invalidating their own and other's beliefs.
• attacking and defending beliefs, or acquiescing to others' opinions.
• agreeing or disagreeing with what others are saying or doing.
• expressing interest, or disinterest, in other peoples' thoughts and
conversations.
• approving or disapproving of how they and others are being.

These and other biases manifest uniquely for each individual. For example, what constitutes speaking up for one person may represent relative silence for another.

In this work, facilitators offer their observations on how these biases are manifesting. Whilst facilitators are rigorous in providing feedback to participants, they do this in a way that is neither heavy handed nor intrusive. Facilitators also function as role models, as they personally implement these principles.

 

Awareness and Action

 People also observe how they can engage in this work half-heartedly or make hard work of the process. Furthermore, to the extent that we distinguish actions from awareness, people can interpret this activity as either the mere observation of biases or their elimination from their experience. These biases reflect a passive and active approach to spiritual work, respectively. By observing such tendencies, and acting in terms of these observations, they move into a space where they are neither compensating for a bias nor resisting the impulse to make a correction. In this way balance is applied to the relationship between observing and correcting these biases. The result is that people neither actively intervene to change their thinking and behavior, nor remain merely inert observers of their biases.

An awareness of these biases produces a serene and alert atmosphere that is conducive to the more rigorously deconstructive dimensions of this work. The gentle observation of biases slows down people's thinking and introduces a smooth pace into their physical activities. Their personalities become integrated and harmonized and they achieve a sense of emotional balance and physical well-being.

At an interpersonal level an awareness of these biases produces a delightful atmosphere in which there is a harmonious balance between privacy and sharing. People neither intrude into other's space nor convey the message that they don't want others to come near. People neither operate in an insensitive manner nor feel the need to tread warily People are respectful without being obsequious.

 

Somatic Sensitivity

 Facilitators also sensitize people to the somatic effects of fixation. People learn to use their bodies as instruments for detecting the presence of cognitive, emotional, and behavioral biases. They become sensitive to the bodily sensations that signal they are operating from a reactive space. They begin to feel how they are physically drawn into some situations and repelled by others. As this awareness grows, feelings of attraction no longer magnetically grip their body, and feelings of aversion no longer repel. An uncalculated correction occurs, such that they are no longer compelled to move into attractive situations, nor to avoid distasteful ones.

People give relatively less energy to their strategic intellect and begin to operate more from a feeling dimension. At any point in time, the spatial location of their body represents a point of emotional equilibrium in that it precludes the triggering of intense desire or aversion in response to the environment. Similarly, the movement of their body is defined by a path wherein they are neither giving into nor resisting their desires. They move into a highly responsive feeling state which is empty of coarse feelings. People's capacity to experience their own and others' energy increases as specific feelings dissolve into a heightened state of sensitivity.

 

Facilitation

 The facilitation of this work brings forth its own expression of these principles. Firstly, we neither encourage nor discourage people's participation in this work. Were we to encourage people's participation we would contribute to stimulating expectations that would then need to be deconstructed once they were involved in this work. In fact, if people can't wait to participate in this work we tend to cool right off in communicating it to them. But, nor do we discourage people's interest and involvement because in the absence of this, or related work, people just continue to live out their painful constructions.

Once people are engaged in this work, we neither positively nor negatively reinforce their own assessments about making, or failing to make progress. We listen to any assessment people may share with us, but we do not buy the assessment as a description of an unconstructed reality. This involves listening in a way that neither validates nor invalidates people's interpretation of their present situation. One needs to be able to listen closely and attentively to people's constructions without this triggering any feeling in participants that one is accepting or rejecting, what they are saying. Of course, one's capacity to listen from a space that is neither earnest nor dismissive depends on being able to see through one's own constructions.

Furthermore, in this work, facilitators neither make themselves excessively
available nor unavailable to participants. They neither encourage people to
communicate with them, nor put them off. Facilitators don't collude with participants' needs to dissipate the rigor of this work by encouraging trivial conversations. But, nor do they force participants to sit with their painful constructions, building them up in their minds to the point where they lose the clarity and peace that is necessary to see through their constructions. Consequently, the timing of conversations ensures that they are consistently deconstructive in nature.

A skillful balance between accessibility and inaccessibility ensures that participants neither contrive to put themselves on the level as facilitators, nor project "guru-type" identities onto them. Facilitators support this space by neither putting themselves up, nor putting themselves down. They aim at neither accepting nor rejecting the identities that participants project onto them. Ideally, they are neither interested in gaining people's approval nor avoiding their wrath.

In summary, we could say that facilitators do not try to make things easy or difficult for participants. By neither helping (making things easy) nor hindering (making things difficult), they free participants from the compulsion to seek or resist help. The space this produces cultivates a balance between dependence and independence.

 

A Course Format

 This work is currently offered in courses that range from one to six days. The course format exists because many people believe that the opportunities for spiritual growth and development are enhanced by setting aside specific time and intensively engaging in activities that differ from those we perform during our ordinary working and family lives. This is the reason why workshops, intensives, and retreats are popular structures for transformational work.

A "course", by its very nature, also speaks to our need to be able to "progress" towards whatever it is that we are seeking. By virtue of having a beginning, a middle, and an end, a course initially supports our need to track our progress towards completion - be this construed as achieving a rarefied spiritual goal, or getting in touch with our present experience. The feedback that is provided in a typical course also allows us to distinguish our location in terms of being closer to, or further away from, the result that we seek. Generally, courses also offer the promise of achievement, and provide the incentive of positive feedback and reinforcement as we progress towards, and finally celebrate, achieving a mutually agreed upon goal. A course structure also expresses and supports the belief that there is something specific that we should be doing. It allows us to believe that there is a "correct' or 'best" thing to be doing.

These "expected" features of the course format mirror the structure of spiritual paths leading towards a goal of freedom or liberation. As such, a course can easily function as a microcosmic expression of the psycho-spiritual endeavor. The course format is thus a logical interface for this work because it can be used to stimulate an expression of the very beliefs that define people's psycho-spiritual activities.

 

Deconstructing A Course

 Whilst the expected and generic features of courses do attract people to this work, our own course systematically deconstructs the concept of a "course" by disclosing the beliefs that validate this structure as a vehicle for the delivery of this work. When people project that the course is a suitable event for realizing their goals and aspirations we disclose the beliefs that fuel this projection. We begin the disclosure of these beliefs prior to people's participation in a course (as we are doing now), and during the course itself.

For example, if someone asks whether the course will help them, we point out that the course is not designed to help them. However, it will allow them to see how they construct and deconstruct the identity of "needing help". If they think that this sounds like a very valuable insight to acquire we point out how they are constructing a desirable outcome, possibly in order to validate their participation. If, as can sometimes happen, people flip to an opposite fixation and figure that the course is pointless if it can't help them, we simply point out that the level of disclosure we bring forth rarely occurs outside of this course. Still, we do not condition a belief that participation in a course is necessary for engaging in this type of work.

During the course itself we strike a balance between too much and too little structure. We generally reject a complete absence of structure because this can stimulate a level of anxiety that reduces people's capacity to neatly disclose their fixations. On the other hand, the imposition of a heavy and rigid structure simply feeds into people's belief that they need to be doing something definite and concrete in order to achieve a desirable outcome. Thus, at least initially, we produce a gentle misalignment between the course and people's expectations. Too much misalignment makes people too uncomfortable and too much alignment makes them feel so comfortable that there is no stimulus for exploring belief systems. You could say that the level of structure in the course is continuously assessed and adjusted so that people are neither comfortable nor uncomfortable.

If people are seeking more structure, the structure naturally retracts. Less is provided for people to work with (i.e., hang onto). If participants are drifting off or getting totally lost in the absence of structure, some structure re-emerges. In this way the course automatically acts to correct people's fixation with structure. As the ninth century Chinese master Linji says about Zen: "If you try to grasp Zen in movement, it goes into stillness. If you try to grasp Zen in stillness, it goes into movement... The Zen master, who does not depend on anything, makes deliberate use of both movement and stillness."

If and when processes or exercises are introduced in this work, we explain how their introduction is a reflection of people's need to engage in definable processes in order to take them to a place that is more preferable than where they feel they are. In other words, we point out how people begin to look for a method when they want to displace the belief that "something is missing". This serves to ameliorate people's need to do an exercise. However, if they then think there is no need to do the exercises that are offered, we observe that they must be thinking that "not doing" is the best thing to be doing. In this way people's participation or lack of participation in specific exercises, constantly reveals their strategies for "getting IT", or "keeping IT", if they think that they have already got it.

The experiences of progress and lack of progress are deconstructed in part by the absence of specific signposts against which people can assess either movement or its absence. The notion of a beginning, middle, and end
dissolves because there is no structure within this work that corresponds to "getting it" or "not getting it." The experience of progress and lack of progress are also deconstructed through an absence of positive and negative feedback. When participants attempt to co-create success or failure, i.e., enrol a facilitator in an interpretation of their participation, facilitators will give simple feedback that they are seeking approval (i.e., confirmation) or disapproval (i.e., non-confirmation) of their experience.

Facilitators simply act as mirrors to disclose people's beliefs without accepting or rejecting what they say. If participants assess that they are making progress we might ask "Progress towards what?" If they respond by saying, "Becoming more aware," we might say "Why are you trying to become more aware?" If they say, "Isn't that what this work is about," we might respond by saying "What have we said that gives you that idea?" In this way they learn to see how they construct both a goal and a method for achieving their goal. If participants construct that they "aren't getting it" - that they are failing the course, we might ask: "What is it that you think you could, or should, be getting?" If they say, "Well I'm not feeling blissful," we might respond, "Is that what you think the course is about," in a way that will let them see that this is their own construction of the space.

The deconstruction of progress and lack of progress also means that there is no such thing as "finishing the course". There simply isn't any benchmark against which people can assess their level of completion, or lack of completion. Toward the end of the course participants are invited to consider what could constitute, or signal the end of the course. It becomes clear that "saying goodbye", "getting into one's car", "leaving the venue", "arriving home, etc. are simply the next things that they will be experiencing. Further, because there is no issue around having completed it, there is no concern about losing it either. If people begin to anticipate losing it, we reactivate the space by asking them WHAT it is that they think they have acquired, that they could lose.

 

No Best Practices

 When people construct a purpose for their participation in any program or process, they necessarily assess their participation against a set of alternatives for realizing their goals. They begin searching for the best thing to be doing. Within a course setting people can spend a considerable amount of time speculating about the most useful or fruitful activity to engage in. They will become preoccupied with assessing the relative value of what they are presently doing against other possibilities. People can swing back and forth between the extremes of thinking that they are completely on-track (i.e., that they are clearly doing the best thing possible) and thinking that they are totally off-track and wasting their time.

Of course, given the minimalist nature of this work, people can also construct that it has no purpose, but this doesn't relieve them of the search for a "best practice" either. The idea of "no purpose" can be understood in two different ways depending on whether people are validating or invalidating this work. If people are within a mind-set that validates this work they can conclude that the purpose of the course is that it has no purpose. This leads them to experiment with how best to "get" that it has no intrinsic purpose. For example, should they try to be natural and unconcerned about striving for a goal? Should they try to become more aware of their feelings? Should they try to be evenly aware of everything? Should they deconstruct the discourse of "having a purpose"? Should they deconstruct the discourse of "not having a purpose"? Should they try to do nothing? Or, should they not try to do nothing?

People can also conclude that the course is pointless, by virtue of having decided that it won't produce the results they are seeking. In other words, they invalidate the course as a vehicle for realizing their goals. However, having negated the course (i.e., made it the worst, or at least a negative thing to be doing), they are simply looking for the "best thing to do", outside the course setting. So, whether people construct that this work is useful or useless, they are still caught in the idea that there is a "best thing to be doing".

An awareness of these limiting discourses arises as a natural consequence of the very minimal and flexible structure of the course, and from the fact that facilitators neither validate nor invalidate any particular activity. From time to time, we might also invite participants to inquire into the question of "What is the best thing to be doing?" For example, if someone is engrossed in the idea that there is a best thing to be doing, we might invite them to change whatever it is that they are doing so that it is fully aligned with their idea of the "best thing to be doing", and then observe what happens. Typically there will be a short-term experience of being on-track which is gradually displaced by the belief that there is now something better for them to be doing. After observing this repeating pattern, they will be primed to more rigorously inquire into the very notion of a "best activity".

They will readily appreciate that the best thing to be doing is either the activity they are presently engaged in, or something else. We then unpack both alternatives. If the best thing to be doing differs from what we are doing we cannot do it, because it is displaced by what we are presently doing. Alternatively, if the "best thing" to be doing refers to a future activity, then the "best thing to be doing" is simply thinking about an alternative and better thing to do some time later on. Thus, the idea of a "best practice" is constituted as a speculative discourse about what may be a useful thing to do in the future. In fact, there are times when people's present practice mainly consists of wondering about what better thing they could be doing. If people think they should be doing this better (and alternative) activity right now, they come to appreciate that they are simply constructing that they should be doing something that they aren't!

At this point people can be tempted to conclude that the best activity must be the one they are doing, since this is the only thing they can be doing. This implies, once again, that they could be doing a less useful or less constructive action which they can't be doing if they are doing what they are doing. Given that they can't be doing anything else, they see that it doesn't make sense to call it best or worst.

So, the best thing to be doing is never something that people can be doing now, unless it consists of either thinking that one should be doing what one isn't, or speculating about what one could or will do in the future.

 

Deconstructing the Notions Of Engagement And Disengagement 

Deconstructing the idea of a "best practice" naturally leads to dismantling the distinction between engaging, and not engaging in this work. This particular dimension of deconstructive contemplation is aligned with the dissolution of the division between meditation and non-meditation that occurs in the Complete Fulfillment (Dzogchen) and Complete Seal (Mahamudra) traditions. On the one hand, these traditions reject the heavy handedness of forced meditation, and on the other, they reject the extreme (and now somewhat popular) interpretation of spirituality which suggests that there is nothing to do, other than what we are doing. The texts of these traditions distinguish a state that is neither static (gnas) nor dynamic ('phro), and which isn't conditioned by either the peace of deep meditative equipoise, or the turbulence of everyday activities. For example, Longchenpa declares that there is no real activity of meditating (sgom) as distinct from not meditating. And the powerful Indian practitioner, Shavari, says that the "perfect meditation is to remain inseparable from the state of non-meditation."

Deconstructive contemplation duplicates the dissolution of the distinction between "doing" and "not doing". However, rather than point to a way of being that transcends the fixations of practicing or not practicing, deconstructive contemplation critically dismantles the distinction.

The very minimal assumptions of this work, and the fact that all structure is revealed as a reflection of people's need to be doing something, allows us to ask participants what they are doing, and why they are doing it. We might, for example, ask people, "What is it that you think you are doing that is consistent with the assumptions of the course?" Their response will disclose their particular "take" on what constitutes participating. They might say that they are "simply being aware of whatever they experience." To which we might respond, "Give me an example of not being aware of what you are experiencing?" People see the tautological nature of their claim. They see that the claim to be aware of what they are experiencing is always true and doesn't distinguish their experience within a course. Through dialogues like this, people discover that there is no definable behavior, emotion, or thought that confirms or disconfirms their participation.

Alternatively, we might invite people to see if they can "not participate" for a period of time. If they subsequently report that they disengaged from this work we might ask them how they did this. If they respond by saying, "Well, I just turned off. I let my awareness and vigilance lapse, and I got distracted in meaningless conversation with another participant", we might ask, "Were you aware that you were distracted?" If they say, "No," we might reply by asking, "Then how do you know you were distracted? How can you say you were disengaged from the work?" If they reply, "Yes," [they were] aware of becoming distracted," we might ask them how they could become aware of becoming unaware. In terms of their participation in the course they see that their capacity to observe that they aren't participating shows that they are actively engaged in the course. In this way participants discover that irrespective of what they tell themselves, there is no such thing as being engaged with, or disengaged from, this work. There is no such thing as being inside, or outside the course.

Another way we deconstruct the distinction between "doing" and "not doing" is to invite people to observe the discourses that transform "doing" into "not doing" and vise versa. What typically happens in a course setting is that certain activities, for example, group dialogs, conversations with facilitators and following specific instructions, are viewed as "doing it", while other activities, such as eating, sleeping, taking time out, etc., are viewed as "not doing it". We invite people to observe in real-time what is occuring that has them assess that they are now engaged, or disengaged, in this work. We focus on the windows, of five to ten minute's duration, during which these changes usually occur.

People become aware of the construction of importance and significance that precedes a group dialog, or individual session with a facilitator. They experience the construction of "getting ready" and the accompanying mood of expectation. They also track any dissipation of intentionality that often occurs immediately after a group meeting, and then observe the partial recovery of focussed energy that occurs when they begin to personally explore the generic discourses disclosed in the group meeting. The on-going observation of these modulations in thought, mood and atmospherics, deconstructs the assessments that people are engaged, or disengaged in this work. These observations introduce a sense of flow and continuity, such that people's involvement is no longer segmented into periods of "doing it" and "not doing it". People arrive a point where they really can't determine whether they are participating or not.

 

Deconstructing The Phenomenon Of Fixation

As we explained earlier, the observation and correction of fixations that is introduced as a preliminary phase in this work, only makes sense in the presence of a belief that we need to be doing, or not doing something, in order to achieve an on-going experience of clarity and contentment. While it might seem that this preliminary phase merely conditions the belief that we should be "doing, or not doing something"; in practice it deconstructs the phenomenon of fixation. The observation of pairs of extreme fixation deconditions the belief that things are right or wrong.

The exercise of observing fixation evolves beyond itself into a way of being and living that transcends the need to strategically employ any psychological or spiritual device to change or maintain one's present experience. This exercise transcends itself because as the belief that "something is missing" is gently deconstructed, this naturally attenuates the need to implement any exercise at all. As people refine this practice, there is less and less to hang onto. The need to employ some procedure dissolves in precise harmony with the effectiveness of its implementation. As such, this practice dismantles itself.

Engagement with the exercise of observing fixation opens out in such a way that they embrace everything that we can possibly think, feel, and do. They gently and imperceptibly take us to a point where there is nothing that we can do that is inconsistent with them. The practice is fully realized when people discover that there is no practice, or - what amounts to the same thing - that there has never been a time when they weren't fulfilling this practice. In the very midst of engaging with this preliminary exercise people discover that they aren't doing anything different from what they would otherwise have been doing. They experience the impossibility of practicing a method, as opposed to not practicing it. At this point ceasing a practice becomes indistinguishable from continuing with it.

Previously, practice consisted of a discipline that one could do, as opposed to not do - whereas now they experience that there is no such thing as practice, since there is no thought, feeling or behavior that is to be accepted or rejected. There is no special thing to do, or perform, that is different from what we are already doing. The guidelines simply describe what we are already and always doing. From this point of view we could just as validly say that everything is our practice, or that there is no such thing.

For example, people experience the impossibility of resisting, or giving into a desire; as distinct from being present to the thoughts and feelings that are manifesting at any point in time. Giving into, or resisting, one's desires, are experienced as assessments we make about what we should and shouldn't be doing. People see that there is no such thing as "giving into or resisting a desire". In the context of neither giving into nor resisting their desires, people see that the language of desire and aversion doesn't direct their behavior. They find themselves being in a way wherein they are neither giving into, nor resisting their desires.

People similarly experience the impossibility of holding onto their pleasures, or letting go of painful experiences. They are already neither letting go of, nor hanging onto, their experience. There is nothing else they could be doing. The notion of letting go of, or hanging onto an experience is simply a thought that accompanies an experience. They discover that they are already doing what they are trying to do in correcting fixation. They have accomplished the purpose of the guidelines without even needing to think about them.

Likewise, people experience the impossibility of dramatizing or trivializing their experience, since this assumes that there is something different that they could be experiencing. The suggestion is that we are making up something that isn't there, or ignoring something that is there. However, this discourse trades on the assumption that we can be experiencing something when we aren't, and that we can not be experiencing something when we are. It implies that there is something behind, or within, our experience that we are distorting. People experience the impossibility of distorting what they are experiencing. They are simply experiencing what they are experiencing. People similarly recognize that their experience isn't real or illusory for this distinction implies that we can have two conflicting experiences at the same time.

This new development comes as a result of seeing that the typography of fixation is a linguistic creation. People see that there is no characteristic that distinguishes an experience as "fixated", beyond a declaration that it is so. A thought, emotion or attitude that represents a fixation from one perspective, can also be experienced as a natural process that expresses the harmony and interdependence of our thoughts, feelings, and actions from another perspective. It is simply a matter of our interpretation. Similarly, there is no characteristic that can tell us that one action is emotionally neutral, whereas another is reactive. We reach a point where everything, or nothing, can be seen as a fixation. Outside of the standards we set internally, there is no reference system at all with which to make the distinction that some thoughts, feelings, and actions are fixated, while others aren't.

People similarly discover that there is no such thing as practice. There is only a description of an exercise, such as we have given. The notion of a practice is merely a conversation that is laid over the flux of our experience. "Practice" is a construction that we have "chosen" to do something "personally worthwhile". The standards that we set for assessing whether we are engaging well, poorly or not at all, are standards that only exist within the "discourse of practice" itself. They don't correspond to an objective, experiential reality. The whole thing is an elaborate (often externally corroborated) construction.

At this point people see through the construction of needing to become enlightened. They are no longer hell bent on urgently and radically transforming themselves. They are considerably less strategic and much more gentle in their engagement with what they are experiencing. As a result they are present, in an open and inviting way, to an ongoing flow of fresh sensations, emotions and ideas. The heavy judgements we have about what we should and shouldn't be feeling, dissolve; leaving us with a smooth, spacious and even-minded experience of being-in-the-world.

People realize that there is nothing they could do to enhance or destroy this experience. The experience cannot be cultivated because it isn't modified by any change in our thoughts, feelings, or behavior. Similarly, it is impossible to turn it off. Metaphorically, we can't go to sleep even if we'd like to. The experience is so acute and spacious that nothing is unobserved. Any attempt to fall unconscious fails because we can't help but see what we are doing. We watch ourselves trying to turn off or become unconscious by distracting ourselves in some trivial or meaningless activity, but our insight into the intrinsic meaninglessness of this and every activity renders it incapable of damaging or diverting our awareness. We are unable to trick or deceive ourselves any longer.

The space we are describing mustn't be confused with giving up a practice. It doesn't arise as a consequence of being loose or slack in observing fixations. What we are describing is totally different from ceasing to practice as a deliberate decision, or as a reaction to the challenge and possible discomfort of becoming aware of our thoughts, feelings and actions. Stopping presupposes that we could have continued. The act of stopping (or continuing) achieves nothing because we are still caught up in our fears and hopes about what could, or would, have happened if we had continued (or stopped). Whether we believe we need or don't need to practice, we are still trapped by the belief that practice refers to a real and objective activity. We are still inside the conflicting belief structure that we can or can't change our experience by continuing or discontinuing our practice. Of course, this space does not preclude the exercise of discipline, except here it isn't designed to consolidate or displace what we are experiencing.

 

Deconstructing Deconstructive Contemplation

Finally, we deconstruct the process of deconstructive contemplation because people can latch on to this as a new method for fixing, managing, or transforming their lives. Through participating in this work people can easily think they are engaged in a very unique process. They can't really compare the experience with anything else they have done. Very often they have never engaged in this type of thinking before, nor clearly seen how bondage and freedom are constructed. So they conclude that this work is special, profound, or esoteric. In other words, they construct deconstruction as a distinctive event. For example, people may think that they have actually deconstructed various psychological and spiritual discourses. They may think that their capacity to deconstruct psycho-spiritual discourses depends on a special tool called "deconstructive contemplation". In this way, contemplative deconstruction becomes a new form of practice. You might also be led to conclude that there is something in this discipline by virtue of having read twenty odd pages about it!

When this occurs, we ask participants what this "deconstructive contemplation" is, that they think has been occuring. They might answer that it is a refined process for uncovering and dismantling transparent beliefs that have structured and limited their lives. If this begins to occur, we disclose how a phenomenon called "deconstruction" can be constructed, just as we have done in this paper. In general terms, deconstruction is constructed on the assumption that within a fixed time-frame, certain belief structures have been disclosed that otherwise wouldn't have been disclosed. It is invoked as an explanation for how the disclosure was accomplished. But to say that "what was disclosed", wouldn't have been disclosed, were it not for the presence of deconstructive activity, is to claim the impossible, since it assumes that something different from what happened, could have happened. But, there never can be any evidence to demonstrate that what did happen, needn't have happened.

Similarly, to say that "what was disclosed", wouldn't have been disclosed in the absence of a clear disclosive space, is to construct that a disclosive space can be created. A disclosive space is the field within which all things manifest, persist, and decay, exactly as they do. Ultimately, it is indistinguishable from the experiential field. It is the occurence of that which occurs in it. We can't create this disclosive space since this is tantamount to creating the universe. As such, a course cannot create a disclosive space. A course occurs as an event within the disclosive space that precedes and follows it. (Just as reading this paper is continuous with what precedes and follows it.) Further, to the extent that there is never a time when there is no disclosive space (time being an occurence within it), it is a vacuous concept. In fact, the disclosive space that is disclosed doesn't exist.

In the absence of a disclosive space we cannot claim that a course creates privileged conditions for seeing through limiting beliefs. What transpires during a course in terms of conversations, feelings and private thoughts, is simply what transpires. In terms of reading this paper you have thought the thoughts you have had, and felt the feelings of interest, excitement, confusion, annoyance, etc. that accompanied them. If people are inclined to make this event into something special, then that is what occurs, and that is what is disclosed in this disclosive space. If people then slide into an opposite interpretation, and judge that this event has been trivial, or that there is no such thing as deconstruction, the slide is disclosed as yet another construction of what is occuring. If people are stuck in this intellectualization we may point out that without this work they would not be observing what they are now observing. In this way people see that deconstructive contemplation is neither something nor nothing.

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Transactional Analysis (TA)

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What is Transactional Analysis

Transactional Analysis (TA) is a personality and psychotherapy for personal growth. It has wide applications in Clinical Psychology, organizations and education also.

Dr.Eric Berne, the originator of TA, considers a transaction as the unit of social intercourse. A transaction consists of a transactional stimulus (TS) and a transactional response (TR). TS is the behavior (verbal or nonverbal) produced by one person in acknowledgement of the presence of others when two or more people encounter each other. TR is the response to TS by another person.

Ego States

In his encounters with his clients, Dr. Berne understood that there exist three distinct states in all people. People change from one state to another in the course of their transactions. This change can be easily noticed by the manners, appearances, words, gestures, and tones.

The three distinct states called the ego states are the Parent ego state, the Adult ego state, and the Child ego state. The Parent ego state is produced by the play-back of recordings in the brain of unquestioned or imposed external events perceived by the person before his social birth i.e., before the age of 5 years. This ego state consists of NO's, DON’T's, HOW -TO's and the facial expressions, tone of voice, manners etc. of the person's parents. In other words, this ego state consists of the "taught - concepts" of life.

The Child ego state is the response the little person produced to what he saw, heard, felt and understood. Most of these are feelings because the child has not developed verbal responses at that time. In other words, this ego state may be considered the collection of "felt-concepts" of life.    The Parent ego state begins with the biological birth of the individual and extends up to and age of five years. The Child ego state also starts with the physical birth and continues to develop until the social birth (around the age of five). The Adult ego state develops after both the Parent and the Child ego states have began to develop. This state begins to develop from about ten months of age. The function of this state is to update both Parent data and Child data by continuous examination of these data with respect to actual reality. Thus only those taught concepts and felt-concepts applicable and appropriate to the present are accepted. Thus the Adult state is said to be the "thought-concepts" of life.

Fig -1 PAC System

 

 Berne opines that the recordings in the brain that causes the ego states cannot be erased at all, but "we can choose to turn these recordings off".

Berne represents the ego states as circles and represents TS and TR by arrows drawn from the respective ego state of the first person to that of the second person.

 

Types of Transactions

Berne identifies two types of transactions:

1. Complementary Transactions

Complementary transactions Examples of Complementary Transactions Parent-Parent, Adult-Adult, Child-Child, Child-Parent, Parent-Child, Child-Adult, Adult-Child, Adult-Parent, Parent-Adult First Rule of Communication We have the first rule of communication in TA : "When TS and TR on the P-A-C diagram make parallel lines, the transaction can go on indefinitely."

Fig 2. Parent-Parent Transaction (Complementary Transaction)

2. Crossed Transactions

Examples of Crossed Transactions Adult-Adult and Parent-Child; Adult-Adult and Child-Parent; Parent-Child and Parent-Child; Child-Parent and Child-Parent Second Rule of Communication Here we have the second rule of communication in TA: "When TS and TR in the P-A-C diagram cross each other, communication stops."

Fig.3 Parent-Child and Child-Parent (Crossed Transaction)

 

Duplex Transaction

There can be implied communications along with the primary communications. Eg., "Where did you hide the can-opener?" Here the main stimulus is Adult-Adult. But the word hide has an implied stimulus elicited from the Parent of the communicator to the Child of the receiver. This type of communication is called duplex transaction. The duplex transaction (the implied TS or TR) in the transactional diagram is represented by broken arrows.

Fig.4 Adult-Adult with Parent-Child and Child-Parent (Duplex Transaction)

 

Personality and Psychopathology According to P-A-C system

There are two ways in which people differ according to TA. This is either due to contamination or exclusion.

In contamination, the P-A-C system overlaps. For example, when Parent and Adult overlap, we have a Parent contaminated Adult. This results in Prejudice. When Adult and Child overlap, we have a Child contaminated Adult. This condition causes delusion.

Fig.5 Contaminated Adult (Prejudice and Delusion)

 

In exclusion, the communication from one of the P, A, or C is cut off. For example, when Child is cut off, the person cannot play at all and is very rigid and serious, causing neurotic behavior. When the Parent is cut off, the person does not have any conscience at all. If his Adult is also contaminated with Child, the person will be psychopathic.

Fig.6. PAC system with Child cut-off

 

According to this system, psychosis results when the Adult is completely blocked from Parent and Child. This is called decommissioned Adult. If the blocking out of Adult is periodic, the result is Manic-Depressive personality.

Fig.7. The Decommissioned Adult ( Psychosis)

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Last Updated: 08 August 2022

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MANAGEMENT OF ALCOHOL DEPENDENCE:

A COMMUNITY BASED MULTI -MODEL APPROACH

L. Sam S. Manickam

 

•   Introduction
•   De addiction Centres
•   Counseling Centres
•   Treatment Models
•   The Vellore Model
•   Bodhi Experience
•   Extension to the Community
•   Social Support Person and the Community based Model
•   References

Introduction

Alcohol and drug abuse has been showing an increasing trend in India. However, there is very little systematic data on the extent of use and abuse of alcohol. National Sample Survey data is the only available data source for a countrywide analysis on consumption of alcohol. The NSS third round (1987-1988) provides details of number of households consuming alcohol beverages per thousand households state wise (Sarvekshana, 1991). These data are based on the response of the households to the question whether the household consumed alcoholic beverages on the month of survey. The data do not provide details on the quantity of consumption. But it gives an idea of the percentages of households consuming alcohol beverages. It appears from the NSS data that only four in rural areas and one in six or seven in urban area are given to drinking.

In Kerala, a comprehensive health survey was conducted in rural villages in 1987(Kannan, et. al.1991). It showed that among male population above the age of 15, 10.1 % were using alcohol less than 10 days in a month and 8%were abusing alcohol more than 10 days in a month. Together it constitutes 18.1% of the total male population.

Only 104 women, ie.0.5 % is in the habit of using alcohol. Though the number of women addicted to alcohol is very low in rural areas, in cities, there is an increase in number of women who seek psychiatric help (Selvaraj, et. al., 1997). None below the age of 15 reported using alcohol. Mattoo and Basu (1997) also observed that the first drink of the dependent persons is above 19 years.

Considered against the popular impression of widespread and growing practice of drinking, the above survey figures appear to be underestimated. The number of people who would admit to consuming alcohol is usually low, for various reasons. Hence the magnitude of the problem is much more than what is projected.

 

De-addiction Centers

Considering this fact, the Ministry of Health and Family Welfare, Government of India, sanctioned de addiction centers in different parts of the country in 1988 (Manickam, 1994). The number of centers in 1988 was 18 and in 1998, there are 121 centers. In Kerala in 1988, there was only one centre and in 1998, there are 20 centers. Each centre has bed strength of 15 with additional facility for another three for relapse persons.

The total number of bed strength available at each centre for a year would depend on the number of days of stay of each person at the centre. Generally, each patient stays at a centre for 18 days. The approximate number of people being de addicted would be 255 in a year at one centre. Through all the centers, the number of people de addicted would be 308557. The facilities available at these centers are for a population of more than 90,00 Million, of which around 18 million are using or abusing alcohol. This figure does not include the drug addicts.

Apart from the de addiction centers referred above, both private and government mental health centers do help those who abuse substances. However, the number of centers and the effective bed strength of these places are difficult to gather due to the following reasons:

1. The centers mainly treat people with mental disorders. Hence, the number of people who undergo treatment for substance abuse may vary.
2. At present there is no system of collecting data of those who seeks treatment for alcohol related problems at the district or state level.

The figures show the extent and intensity of the need and the availability of services.

 

Counseling Centers

These centers are exclusively for the people who abuse the substances. The number of counseling centers in 1988 in the country was 15. In 1998, there are 217 centers in the whole country. In Kerala, in 1988 there was only one centre and in 1998 there are 19 centers.

Each Counseling Centre has 2 psychologists and 2 social workers. Some of the centers are given a vehicle for community extension work. The counselors have to visit the families of those who are de addicted, visit the dropouts and relapsed persons. In addition, they visit the community to motivate people who are addicted to seek treatment, and they organize prevention programmes in the community.

 

 

Treatment Models

Each centre has developed treatment packages for themselves.

TTK Model, Chennai, South India (Cherian, 1986)

TTK hospital Chennai, (Madras) had done pioneering work in de addiction in the country. This is a private centre, started as six bedded centre and now has facilities for about 45 patients.

TTK Hospital offers a comprehensive in-patient treatment programme. It also includes the involvement of the family of the addict. The treatment programme includes detoxification, intensive psychological therapy, and follow-up. Detoxification is for a period of 7 to 10 days. After detoxification, the patient undergoes an intensive 3-5 week, in-patient therapeutic programme at the hospital. Apart from individual counseling, the treatment package includes lectures, group and family therapy, dietary counseling, relaxation techniques and recreation.

This centre has also developed a day care centre for alcoholics (Cherian, 1986). In addition it started camps for the detoxification and care of persons with alcohol dependence in the sub-urban villages of Tamil Nadu. (Murthy, 1992).

NIMHANS, Bangalore.

This centre has developed two models.

 

1. Behavioral Model ( Prasadarao &Mishra,1994 )
2. The behavioral model is based on learning theories, which states that all behavior is learned one. Addictive behavior is a learned one and hence it can be unlearned. The behavioral model envisages multidimensional therapeutic programming at the physical, psychological and social levels. The treatment programme concentrates on the antecedent cues and maintaining factors. Behavioral procedures used in the broad spectrum treatment programmes include relaxation, aversion therapies, covert sensitization, self-control training, social skills and assertiveness training and contingency management.
3. Behavioral counseling to significant others is also an essential part of the package. This ensures modification of reinforcement pattern to provide adequate positive reinforcement contingent upon the individuals sober behavior.
4. Medical Model (Murthy & Janakiramaiah, 1996 )

The medical model essentially involves admitting patients to the de addiction centre, and detoxification. Counseling is also an important component of the treatment programme.

NIMHANS also collaborates with voluntary agencies in the community. With the agencies' co-operation, they initiated once a week service to the community. A team of mental health professionals visits the villages for education, counseling and community level care, and action. The target population was mainly those with early features of dependence.

Camp Approach (Murthy, 1992)

In the North Indian states of Rajasthan, at Jodhpur, a community-oriented approach was initiated about 15 years ago. The programme is primarily for opium dependent people, since there is a widespread use of opium by a large proportion of population. The camp lasts for 10 days. About 20 to 30 individuals who are motivated to give up opium are kept in a local school or local building and detoxified initially in a group setting. Group discussion, inspirational talks, and final oath taking to give up the drug use follow this. This programme is cost effective since local resources are used and volunteers are mobilized for conducting the camp.

 

The Vellore Model (Manickam & Kuruvilla, 1990)

This model is based on a multi modal approach. This is essentially a hospital-based model. This model has the following components.

Initial Assessment:

The initial assessment focuses on evaluating the psychiatric status of the patient.

Assessment of motivation

Admission to the mental health centre with spouse or significant relative.

Detailed physical examination and investigations.

Treatment of concomitant physical illness, if there are any significant findings.

If the physical status is satisfactory and if the patient and the family are well motivated, the person gets admitted. The person has to stay for a period of 35 to 45 days.

Detoxification

Most patients do show significant withdrawal symptoms on cessation of alcohol at the time of admission. In such cases, appropriate medications are given to control the withdrawal features. Depending on the duration of drinking and the period of abstinence, the medications are tapered off over a period time, which are usually ten to fifteen days. Once the withdrawal symptoms are controlled, the patient and relatives have a tendency to leave the treatment programme. Therefore, at this stage the patient and relative have to understand that detoxification is not ‘the’ treatment of alcoholism and all that detoxification does is to prepare the person to begin the recovery process.

The different modalities of the package include the following therapies

Individual psychotherapy. Each patient gets around ten sessions of individual psychotherapy.

Family Therapy is provided depending on the need of each individual client.

Group therapy

Though group therapy is an effective method in counseling and providing support to the alcohol dependent persons, it could not be provided to all those who were admitted. In the thirty-five bedded psychiatric set- up, the number of patients who are admitted for the dependence problem is often below five. However, if sufficient number of patients are available, the group functions by including those who are outpatients and who are in the process of recovery. Though group therapy is of great help to the recovering persons, in Vellore situation, it did not work, since most of the patients come from different parts of the country, quite far away from the centre.

Behavioral Strategies

1. Relaxation training:
   According to learning theories, alcohol pharmacologically reduces conditioned anxiety .In order to get quick and temporary relief of anxiety, many persons use alcohol. Kinney and Leaton (1979) have observed that a recovering alcoholic is likely to face a high level of anxiety. It can be of temporary nature, the initial discomfort with his non-drinking life or a more chronic one, if he is an anxious person. In order to alleviate this anxiety, relaxation training is taught. Once the person learns to relax by self, he or she is asked to practice it everyday. On mastery of relaxation technique, it becomes easier for the person to achieve the relaxation response, which can be called at will. Rather than resorting to alcohol, the same response can help to deal with situations, which provoke anxiety in day to day living.
2. Aversion Therapy:
   Another behavioral explanation given to alcoholism is that it is a conditioned response associated with a pleasant experience. Therefore, using counter conditioning, alcohol is associated to an aversive event or shock. Different types of aversion therapy including chemical aversion are tried out in different treatment centres (Chakravarthy et. al., 1990). In Vellore setting, the patient has to sip the alcohol. When alcohol is in the mouth, the patient gets battery- operated mild electric shock of 9 volts. The patient spits out, when the aversive stimulus is above his threshold and simultaneously the electric shock is stopped. Using patient’s choice of drink, the patient gets about six to eight shocks in each session. This procedure continues for 21 to 28 sessions, depending on individual patient.
3. Cue Control:
   A careful behavioral analysis of the person’s pattern of drinking helps to identify the cues, which lead one to drink alcohol. Helping the person to break the habitual pattern eases stress and helps achieve the objective of avoiding the drink. Alternatively, in the presence of cues, the person is trained to generate and perform alternate activity to avoid these cues. Identification of all such cues and handling them result in bringing about significant changes in the daily style of living (Prasadarao &Mishra, 1992).
4. Covert Sensitization:
   The therapist encourages the patient to imagine a typical drinking situation. As he imagines, the therapist verbally describes to the patient an unpleasant scene, like the patient having nausea and vomiting. The pairing of the unpleasant scene with the imagery of his drinking behavior creates unpleasantness to the latter. The patient learns to use the same procedure to handle the cues, which stimulates a drink.

Occupational Therapy

During the stay in the hospital, the patient and spouse or relative attends the occupational therapy department. In the initial day of recovery, the alcoholic needs his environment to be simplified. In occupational therapy, the patients choose a simple yet creative work, and the occupational therapist supervises the activities. Sometimes a group of alcohol dependent persons takes up a common project, which ensures the participation of all the members. The members attain the ability for accepting each other member and get an opportunity to interact with others. It also helps in developing social skills, decision making, and implementation of assigned tasks and opportunity for recreation.

Drug Therapy

Disulfiram (Esperol) is administered at the end phase of the stay in the hospital. After careful review of the physical status and the liver functions, discussion focuses on initiating disulfiram therapy. After signing the written consent form for administration of the drug by the patient and spouse/relative, an initial dose of tablet Disulfiram 500mg per day is administered for two days. If there is no adverse reaction with the initial dose, it is reduced to 250 mg. per day and is maintained for a period of one to two years.

Follow-up care

The patients with their spouses/relatives are asked to come for follow up counseling once in a week initially. Depending on the maintaining factors of sobriety, the interval of visit to the centre is increased. If the patient is coming from far off places, information about social support networks around their place of stay are given and they come for review after 1 or 2 months, depending on the distance.

At Vellore, the follow up rate was very poor. The reasons are,

1. The patients and relatives expect an abrupt and radical cure.
2. The patients have less knowledge about alcohol dependence and the process of recovery.
3. The patients come from far off places.

However, the model developed at Vellore was instrumental in formulating the treatment package for the de addiction centres in Kerala.

 

Bodhi Experience.

Bodhi De addiction Centre was started in 1988, by the voluntary agency, Abhaya in Kerala. This is a 15-bedded de addiction centre, funded by the Ministry of Welfare, Government of India.

Intake Counseling: During intake, the focus of assessment is on the motivation of the patient to give up drinking. Arrangements for detailed physical examination by a physician ensure attention to patient’s immediate physical problem. Moreover, laboratory investigations aid this process. Admission to the centre is confirmed only if,

•  

1. The patient is free from any major physical illness, which requires immediate attention. 
2. Free from overt psychiatric disorder. 
3. Motivated to stay as inpatient for the stipulated period of 19 days. 
4. The patient’s spouse or if unmarried, a significant relative visits the centre and consents to stay with the patient throughout the inpatient treatment period and
5.  Abide by the rules and regulations of the centre during the stay.

 

The Setting.

A batch of fifteen patients with their spouse or relative is admitted at a time. The inpatient stay is for a total of 19 days. The patient and the spouse are to stay in the centre until the completion of the inpatient treatment programme. However, the patient is not permitted to go out of the campus during the treatment programme. The patient and spouse/relative are given the choice to accept the treatment offered. Conforming to the whole package is the first learning experience of every patient. However, they are free to leave the treatment at any moment.

Family Context as the Base.

Involvement of the family in the inpatient treatment of various psychiatric disorders have very good impact on the course and outcome of the illness (Varghese, 1988). In the Indian setting, the therapy can be envisaged only in the context of family, in most situations. Bhatti (1982) observed that alcohol dependent persons’ family needs treatment as much as the person who is addicted to alcohol does. Surprisingly, in many cases we experience resistance to family therapy either from the patient of from other members of the family.

The patient and the spouse living together though for a short span of time, creates a sustained environmental context for learning and change. The situation in addition provides opportunity for resolving the interpersonal conflicts through community nurturing, empathic understanding and control of personal behavior. The atmosphere thus generated within the centre encourages self-disclosure.

The mini community formed within the centre though lasts only for a short period provides encouragement support and reward for desirable behavior. The family-like community often gives shelter to each individual and at the same time helps to confront personal behavior which could hurt the spouse or any other member staying within the community.

Distancing themselves from the routine of alcohol abuse in an environment free of external cues helps them to reflect in a different perspective.

Treatment Package

The treatment package involves detoxification, individual counseling to patient and spouse, marital counseling, group therapy, and disulfiram therapy. If there is need, the patients undergo family therapy also.

On admission, the patients are given drugs to take care of the withdrawal features. Usually it takes about a week’s time for the patients to get over the withdrawal features. However some of them take more time and they are given the drugs to get over those.

Individual counseling

Each patient gets around ten sessions of individual counseling. Initial session aims at finding out the problem areas of the person. Though the patients discuss various family related problems, some of them are rationalizations, to continue their addictive behavior.

Structuring of the therapy depends on the assessed problem areas of each person. The problem areas assessed are, physical, psychiatry, personality, personal, marital, sexual, family, social, occupational, economical and spiritual.

Most of the patients do not know that addictive behavior is a disorder (Rao et. al., 1988). Many are unaware of the health hazards that are caused by prolonged intake of alcohol. The patients’ knowledge, if not adequate, imparting information on the above topics is important.

Some patients report that their drinking is related to a chronic physical problem they have, which they never thought of revealing it to their physicians. In such cases they are prepared for a consultation.

Past history of affective disorders if found to be associated with drinking, the information on early signs and symptoms helps the person to consult psychiatrist or mental health professional at the early stage. Co morbid disorders like, schizophrenia, paranoid disorders or delusional disorders and other major psychiatric disorders may surface on withdrawal of alcohol. Kannappan and Cherian (1989) observed that the dependent persons have elevated extraversion and neuroticism traits. Other minor disorders like anxiety disorders, phobic disorders, psychosomatic disorders and other disorders if found are referred for further psychological help.

Identifying the concomitant personality disorder helps to refer the person for further psychological help or aid in setting the counseling limits.

Though the individual counseling is not psychoanalytically oriented one, defense mechanisms shown by the patients are carefully dealt with. Denial of their own addictive status and physical health extends to other problems existing in life. The family bonds in our cultural setting are strong. Therefore, the relatives both in the immediate and distant circles are involved in decision making process of the individuals' life. The usual tendency of the patient’s relatives is to force him to face all the facts immediately. The relatives do not realize how painful it is for the alcoholic to look at his own drinking behavior and its consequences. The therapist or counselor deals with this conflict of the patient carefully without provoking undue anxiety in the patient.

In the personal area, the common problems experienced are guilt, self-blame, inadequacy to control one’s own emotions, passive dependency or excessive independence and not having the sense of ‘real time’.

It is desirable to mitigate the degree of both guilt and self-blame. However, it is also necessary to avoid the other extreme, rejection of social values and blaming others.

The therapist helps the person to recognize his emotions and to deal with them appropriately. He needs to learn or relearn that feelings need not be repressed altogether or widely acted out. Recognition and acceptance of the emotions can help develop a healthier reaction.

A person who has strong dependency needs may resolve his conflicts by resorting to alcohol. Making the person realize this, may help him to find alternate source of meeting his dependency needs. Alternatively, it may be because of his stubborn independence that he resorts to it. In such cases, the person has to realize that every one in the society is interdependent.

.

Social problems are related to the individual’s place of living, how the society perceives the individual and how the person perceives the society. Some of them are related to the person’s faulty perceptions while some others are real. The caste structure and the interpersonal relationship based on the caste structure are sometimes stressful for the person and the family. The conflicts related to this problem, the person acts out under the influence of alcohol.

Problems in occupational area are related to incompetence, sidelining, not getting the promotions for government employees. For the seasonal workers like the fishermen have no alternate work or the middlemen exploit them and it is difficult for them to cope with the situation.

Sexual problems if identified are referred to counselors who are competent to care. Since long dependence of alcohol can produce sexual disorders, the clients are taken up for the therapy, only after a period of three or four months of abstinence.

Economic problems are either due to their own drinking behavior or those could have been caused otherwise. Upsets in business, loans and debts incurred, as a result of poor planning or extravagant spending of money requires attention.

Some of the problems do overlap. Dowry related problems, leads to marital and family problems. Or, money lent by the woman’s family spent unwisely by the man’s family leads to unrest in both the families.

The spiritual dimension

The spiritual dimension of the clients requires attention. This aspect assumes more importance if the person’s conflicts are related to the spiritual dimension (Manickam, 1992). During the stay at the centre the clients get the opportunity to take part in prayer meetings. Clients of different faith participate in the prayer meeting.

During individual counseling, discussion centres on participation in religious activities like attending the worship and prayer meetings with family members. Adopting this has helped many clients to achieve change in life style more effectively. People from Hindu faith, some of them begin attending the place of worship. Similarly, people from Islamic faith, begin their daily prayers and attend the worship. Christians, some of them restart attending Sunday worship and start taking part in various church related activities. Clients who were atheists have started attending religious programmes.

However, during individual counseling if the clients’ problems are found to be predominantly in the spiritual area, that the counselor cannot help out, they are referred to religious counselors or authorities of one’s own faith.

Group therapy

The Groups

The patient group meets for twelve, 75 to 90 minute sessions. In two of these group sessions spouses /relatives are included (orientation group and disulfiram therapy group)

A therapist and co-therapist, preferably of the opposite sex conduct each group. The seating arrangement is circular, the therapist, and the co-therapist occupying opposite seats; this placement of the therapists facilitates group communication.

Orientation Group

The orientation group meets in the first week of stay, i.e. during the period of detoxification. In this session, emphasis is on regulations to be followed in the hospital, which were explained to them at the time of intake. Need for co-operating with staff at the centre and keeping the time schedule are pre- requisites for successful completion of the treatment programme. Briefing about the different modes of treatment in the package ensures the support of every one staying at the centre.

From the second week of stay, patients and their spouses are to take up handicraft of their choice, preferably a joint activity involving both the patient and the spouse. Engaging in some useful activity provides the opportunity to utilize the daytime effectively and facilitates communication between the patient and the spouse. (Manickam & Kuruvilla, 1990).

Disulfiram Therapy group

Disulfiram therapy group meets in the third week of stay and the psychiatrist or the physician conducts the group along with a co-therapist. Explaining the actions of the drug, precautions required, and the procedure to be followed in case of alcohol intake or allergic reaction helps both the patient and spouse in case of emergency. Patients who had earlier undergone disulfiram therapy are helpful while discussing the limitations of the drug.

 

Therapeutic Groups

Twelve major topics or areas are covered over the ten sessions. These areas were identified based on the experience at Vellore and the discussions held with experienced therapists in treating substance abuse (Manickam, et. al., 1994).

Patients’ group is divided into two subgroups of 6-9 members, after the first therapeutic group. The groups are divided based on age, education, occupation, and ability in communication to attain more homogeneity. The weaker group sometimes functions for a longer time, if it does not meet the objectives of each session.

Session One: Sharing and structuring

This session aims at introducing individual members to the group. Each participant briefly narrates the history of one’s drinking behavior and the circumstances, which led him or her to seek treatment at the centre. They describe the periods of abstinence, if any, and the situations which led to relapse.

The therapists encourage the members of the group to raise questions for clarification, in order to facilitate group interaction. Reassurance by the therapists about confidentiality provides a role model for the participants. Since the patients are living with their spouses, misplaced comments and jokes about any person’s verbal and/or non-verbal behavior are likely to threaten the harmony in the centre. Ensuring confidentiality reduces the chances of occurrence of this problem. They are encouraged to be more open and to give a "true picture " of their problems. Option not to disclose matters, which the participants feel highly personal, reduces the stress. Information that such matters can be discussed with personal counselor gives relief to many. The session gives opportunity for every one to realize that each one’s problem is not too different from that of the other. Hence, no one feels ridicule or rejection, which he or she usually experiences at his or her home or in the community.

Session Two: Disease/Illness Concept of Alcoholism

The session starts with the question whether alcohol dependence is an illness. Some patients hold a moralistic view and extreme guilt about their inability to control their drinking behavior. On the other hand, there are many who deny their dependence on alcohol even though they would have described their withdrawal features, psychological dependence, inability to control their drink, craving for increased tolerance and impairment in social functioning. Focusing on their own symptoms helps to educate the group about the disease concept of alcoholism. Without direct confrontation by the therapists, most of the members realize their own responsibility in taking the first drink.

Session Three: Treatment

Alcohol dependent persons are unaware of the kind of therapies offered to them (Rao, et al., 1988). Hence, this session aims at imparting information about the different components of the treatment package. The process of detoxification, counseling, group therapy, counseling the spouse and marital counseling are explained. In majority of the situations, educated members who are familiar with these processes facilitate imparting the information.

The role of the client and that of the counselor are clearly spelt out. Many patients come to the centre with the hope that there is "magical cure" for their problem drinking, which could be achieved through the administration of "some injection" which ‘wipes out the thought of alcohol". The task of changing their belief systems is made easier by drawing their attention to the experiences of members who had taken treatment earlier and who had history of periods of abstinence. Though there are claims by different researches that controlled drinking could be one of the treatment objectives, reports from different centres in our country favor life long sobriety as the goal of treatment (Cherian, 1986, Manickam &Kuruvilla, 1990). And to achieve this objective, change in life style is required. During the stay in the hospital, they need to plan about changes, which are realistic and can be implemented when they get back to their community. Expecting a dramatic cure, some of them express the feeling, "Now that we have decided to give up, you do your best to keep us sober."

Clinging to such ideas makes the person resistant to discuss about making changes in life style. The realization that the treatment does not help them as they think it would, may lead to feelings of frustration, hostility and rejection. The group atmosphere is very helpful in resolving such reactions. The therapists’ support to help them find the possible ways of changes in life style eases out the situation.

Session Four: Physical Aspects

Generally, it is assumed that the alcohol dependant person is aware of the effects of alcohol on physical health. Though many of them know that it affects the health adversely, they tend to rationalize their drinking based on several misconcepts they hold. This rationalization may take the form of "increases work efficiency by releasing extra energy," "is medicinal" "many Ayurvedic and allopathic medicinal tonics contain it" and other similar views. These views may be held even by patients who had undergone multiple hospital admissions for alcohol related problems. Specific information on health, when given by physician is likely to remove misconcepts about the abuse of alcohol (Tulkin, et al., 1989). Moreover, physicians’ description regarding abstinence from all mind-altering chemicals is found persuasive. Therefore, physician at the centre attends this session and explains the effects of alcohol on various systems of the body, with the help of visual aids.

Session Five: The Family

Evaluating the cultural and sociological aspects of the family systems in India, Bhatti (1982) demonstrated that dependence and group affiliation are the hallmarks of Indian family system. Therefore, strengthening the dependency and improving the relations are the two main components of this session. Many patients are either ignorant or incapable of taking up the family responsibility. Participation in discussing the role in the family in performing the prescribed duties, nurturing healthy communication within the family, maintaining harmony and cohesiveness of the family help individuals to be aware of these issues. Most of them either discusses their issues in the group or take it up during individual counseling. Inability to provide parental model to children which leads to behavior disorders and scholastic backwardness are issues brought to the fore by the group members. Becoming aware of the adjustment problems of children which are related to the their drinking helps some to modify their behavior (Kodandaram,1995).

Feed back on their disclosure, helps them realize the effects of drinking on one’s spouse. Many are unaware that excessive drinking leads to psychological problems and psychosomatic disorders in the spouses (Haritha, 1990). When the patients neglect their role in the family, usually the spouse takes it up. The idea of taking up family responsibility on achieving sobriety can be threatening to some. The group sometimes helps individual participants to resolve the conflicts. Otherwise, during personal counseling the clients takes it up.

Many patients tend to focus on the economic aspects. The therapists intervene to avoid the discussion on economic issues, since other issues of the family system could be sidelined. However, care is taken not to induce guilt in them. The patients often discuss the ways to bring about changes in life style, to compensate for what they missed.

Session Six: Work and Rationalization

Many patients deny the impairment in work. Research studies indicated that the occupational adjustment is unsatisfactory in terms of productivity, punctuality, and quality of work and attendance. (Senthilnathan, et. al., 1984). Discussion and confrontation between members of the group help each one to realize the "real" state of affairs, which at times is threatening to the individual. The tendency to present a clean picture disappears when members present their own work record filled with disciplinary actions on them. Manual laborers reveal their own state of not being offered work due to their drinking.

As elicited by Rao et al, (1988), patients tend to use "presentable reasons" for continuing their drinking behavior. The discussion unravels the defense mechanism of rationalization. The skill to discriminate a " genuine" and "real" problem from a defending reason is imparted. This process helps the patients to focus on their craving for alcohol and to take up the genuine problems during individual counseling.

Session Seven: Cues

Explaining the principle of cue and response in the group is not difficult. To make the group more clear about the concepts, the members themselves come up with very good examples. Once the concepts are clear to all the members, each one is encouraged to identify one’s own cue. At times, the group does a careful behavioral analysis of each participant. Following this, the group members propose alternate behaviors to tackle the cues.

Majority of the clients report that associating with friends who abuse alcohol is a cue (Manickam, 1989). The group members learn the skills to avoid their associates who are likely to invite and persuade them for a drink. Similarly, other cues related to time, place and person are discussed.

Session Eight: Leisure Time

The sober life provides extra time, which they were spending with the bottles. Encouraging the clients to make a careful planning of day to day activities reduces the availability of extra time. Each member assisted by the group identifies one’s own leisure time, in accordance with the social and cultural background. It may require reviving one’s hobbies or interests that were nourished during pre-morbid period. Engaging in alternate behaviors help reduce the strength of responses to cues. Positive reinforcement to the suggestion of involving the family members in leisure time activities helps the group members to plan similar activities.

Session Nine: Life long Sobriety.

The goal of attaining life long sobriety is viewed as a burden by many patients. It is more so among younger patients. It is considered as a burden since they anticipate a number of problems in making changes in life style. Self-reinforcing of one’s own non-drinking behavior is one of the tips Some of the other strategies suggested by the clients include setting up short-term goals, planning for being sober each day and involving in other alternate activities.

Session Ten: Follow Up and Relapse

Follow up of alcohol dependent person is difficult in Indian situation (Mahadevappa, et. al., 1987). Hence, the group discusses its need. Many patients feel that it is to check on their alcohol status. They are to continue to visit the centre for a minimum period of one year. Follow-up is part of the treatment process and the suggestion is to come with their spouse or relative.

Since many of the clients do not view counseling as a treatment modality, the importance of follow up counseling requires discussion. The fact that sober life cannot be equated to problem free life makes the clients more realistic. The clients learn that they can discuss the difficulties, which they face as they start leading a drug free life with the personal counselor.

Each patient has to align with a social support person and it is usually discussed during individual counseling sessions. Discussing in the group is helpful for those who do not know the concept and its importance and to the highly independent who is reluctant to accept help from others.

The possibility of relapse and knowledge of early signs of relapse help them plan their schedule realistically.

Individual counseling to spouse

Initial sessions focus on helping them to ventilate their feelings. Providing an atmosphere of trust and confidentiality help them to open up alcohol related problems of their spouses and their own problems. Information provided by them aids in formulating the problem areas of the index patient.

On assessing the problem areas of the dependent person, those areas, which require the spouse’s involvement, gets priority in the initial sessions.

Discussion on role reversal, helping the dependent person to take up responsibility in a gradual manner etc, when discussed individually reduces the stress. Similarly, the coping behavior adapted by the spouses on many instances require modification( Chandrasekharan & Chitraleka, 1998)

The unresolved issues of the family and that of the spouse get attention during follow-up period.

Marital and Family Therapy

While working with the family, maladaptive behaviors can be identified as it occurs and support is provided for changing them in the desired direction.

One of the major objectives is to help the family regain a healthy and harmonious relationship among its members. This requires a change in the style of functioning related to interpersonal relationships (Neeliyara et. al.,1989).

This causes stress to the therapists too. The hierarchy within the family varies according to the culture, region, caste, and religion. Unless the therapists are aware of the norms of the family culture of the client, an effective intervention is not possible.

In some cases, it would require the role reversal of the spouses. The patient who is expected to function in the role of the head of the family spends most of his time with the bottle. The neglected responsibility then falls on the spouse. The therapist has to carefully guide the persons concerned to relearn their roles gradually without upsetting the homeostasis of the family unit. Some families require to learn effective problem solving skills, while some other have to learn to accept each person as an individual in one’s own right.

While communicating within the family, many tend to guess the other person’s intentions and motives and they behave as though the guesses are accurate. This leads to confusion and misunderstanding. The therapists in such occasion’s point out the above immediately and try to stop the "mind reading games."

The Spouses Group

. The spouses group meets for four sessions. The first session is meant for sharing. Most of the spouses have the feeling that it is their fate, and their experience is unique. Each one’s self-disclosure of torture and battering and the agony they had undergone leads to a therapeutic atmosphere which is supportive and strengthening.

The second session focuses on illness, which is taken in similar lines to the one taken for the patients. The spouses group reacts differently to the awareness that it is an illness. Most of them find it hard to accept it, which is also shared by the community. Addiction is most often perceived as a purposeful behavior of acting out and/or neglect targeted to the wife and children or the family.

The third session on treatment often disappoints the members. The symptom of craving or the desire for alcohol, the members feel should be wiped through some magic formula

Majority of them is aware of the need for changes in life style of the dependent persons but not in them. The close family members, who act against the wish of the spouses, sometimes complicate this. In such situations, the women experience a conflict. On occasions when the women were battered or send out of the house, her family is the one, which stood with her. Therefore, if she takes a decision, which is against the wish of the family members who had supported her earlier, they may not come forward to help her again.

The fourth session centres around follow up and relapse. Spouses have a better understanding regarding follow up. Like the patients, they also hold t he attitude that it is just for monitoring their drinking behavior that they are asked to continue follow up. Importance of individual counseling to patient and spouse in helping them maintain their life style changes many women are able to understand. Majority of the spouses shows willingness for follow up and they take initiative in encouraging their spouses for follow up.

Relapse as part of the recovery process is also discussed. It becomes easier when the group has members whose spouse had abstained earlier. Otherwise, it is hard to discuss about the phenomenon of relapse with spouses.

In majority of the situations, the spouse takes effort to see that their husbands are free of alcohol. It is mostly due to the social and cultural compulsions. If the husband is the only breadwinner of the family, it is the economic situation of the family that the spouse is worried about. Many women and their families perceive the life separated from husband to be unsafe. Some of them feel that it is better to say that her husband is living with her even though he is totally dependent on alcohol than to say that she got separated. This concern is more among women who have daughters of marriageable age.

Another interesting observation is that marriage is seen as ‘treatment for dependence". The person who has become dependent on alcohol, the parents, and relatives feel can be freed from alcohol by getting the person married. In most situations, neither the girl nor her family has any information on the drinking status of the individual. Or, the family members of the man do inform that he is a social drinker and justifies drinking saying that it is more common these days. The woman realizes the trap only after marriage and then it is too late for her to react. During the initial days of marriage most of them do not inform their parents thinking not to burden their parents. The parents have already spent borrowed money or their life time earnings for the marriage or ‘getting the daughters married’. In addition, to tell that their choice was not the right one leads to conflict in the woman. Some of them feel hostile to their own parents for getting them such a person. Some of them are worried how their parents and relatives would react and behave to their husbands if they tell them about their husbands’ behavior. There are instances where the woman’s relatives and family members have physically assaulted her husband for his drink- related behavior.

Some of these issues require involvement of the family too, and is taken up during follow up counseling.

 

Extension to the Community

In one of the studies, (Manickam, 1996b) it was observed that patients who have social support offered in the community have better out come when compared to those who did not have. It was observed that a voluntary worker in the community, motivated the people in the neighborhood community to provide social support network. The social support net work thus formed mobilized the recovered alcoholics to meet together regularly at a common place every evening. The recovered persons were provided with recreational facilities and fostered better interpersonal relationship in a drug free environment. Each recovered alcoholic person and their family was contacted regularly and was encouraged to keep the follow up with the de addiction centre. The network, in some instances raised money for meeting the personal expenses of patients during their stay at the de addiction centre. The group could motivate other addicts to seek treatment too.

Taking lead from this experience, a training programme for community volunteers in preventing alcoholism and drug addiction was initiated (Manickam, 1997a). Twenty three community volunteers attended the programme from the administrative district of Thiruvananthapuram. The objectives of the programme were

1. To impart knowledge and skill to identify alcohol and drug dependent person in their community
2. To motivate the person to seek de addiction treatment
3. To motivate their family members to seek treatment at the de addiction centre
4. To provide social support to the person and family after the in patient treatment at the de addiction centre, and
5. To organize prevention programmes in the community

The programme was a week’s residential one and 21volunteers from the community participated.

The training module was as follows:

Day 1

1. Self Introduction
2. Participants’ Perception of the problem
3. Pre- testing
4. Scope of the training / programme goals
5. Extent of the problem in the community
6. Group Work: Alcoholism as I understand

Day II

7. Illness concept of Alcoholism
8. Illness concept of substance abuse/drug abuse
9. Psychological factors
10. Role of voluntary agencies
11. Group work: Identifying alcohol dependent person and Drug dependent person

Day III

12. Medical and Psychiatric Aspects
13. Social implications
14. Drug abuse among the youth
15. Effects on Family
16. Panel discussion: The State scene(Panel included police, legal and public health officials)

Day IV

17. Treatment of alcohol dependence
18. Objectives of counseling
19. Objectives of family counseling
20. Importance of follow up
21. Social support and social support person
22. How to provide social support/lay counseling
23. Role of police
24. Group Work:

• i. How to motivate an alcohol dependent person to consider treatment

2. How to motivate the family to seek treatment

Day V

Treatment of drug dependence

25. Rehabilitation of drug dependent person
26. Problems in the treatment of alcoholism and drug addiction
27. Prohibition and prevention
28. Social activation and prevention(role of songs, folk dances, folk drama, street play and public demonstrations)

Day VI

29. Role of the community volunteers /participants in the treatment programme and prevention
30. Initiating self help group
31. Field visit to the self help group
32. Evaluation of the field visit
33. Group work: Exposure to video tape on alcoholism and dug addition and discussion

Day VII

34. Educational programme for prevention of alcoholism and drug addiction
35. Post- testing
36. Evaluation of the programme
37. Group work: Charting out future programmes in the community.

Effect of Training

After the training some of the participants showed active interest in preventive work and the role expected of them. Five of the trained workers together organized about 24 preventive programmes in the following two years. The programmes were organized at the pre-schools of Church of South India. The target group was the families of the children attending the Pre School whom belong to the low socio-economic level. The counselors from the de addiction centre conducted the programmes. After the talk on dependence and prevention, the spouses and children of alcohol dependent persons meet for the group-counseling sessions. In the groups, the members get the opportunity to ventilate their feelings. Discussion centres on the strategies to motivate the index clients to seek treatment at any of the de addiction centres.

Two of the trained volunteers later organized a camp treatment in the community. Another set of volunteers from a particular geographical area, Panchayat, where the camp was organized were identified and trained using a shorter module. The objectives of the training programme were to identify alcohol dependent person in the community and to motivate them for treatment. In addition, the training clarified their role in the preparation and implementation phase of the camp treatment. Their role in providing continued support of the dependent persons during follow up also formed part of the training.

The trained volunteers were instrumental in organizing the camp. The Salvation Army hospital at that Panchayat gave permission to conduct the camp at their hospital premises. The volunteers assisted the professionals of the de addiction centre during intake counseling and during the camp. The camp was of a shorter duration, for 15 days. During the first week, the patients underwent detoxification and counseling could be started by the fifth day since many patients did not have severe withdrawal features. The same group-counseling package mentioned earlier was offered to the clients. Two counselors from the centre conducted the individual counseling and led the two groups. Of the fifteen patients, two of them relapsed after 6 months, one of them died after a year, and the remaining twelve are maintaining sobriety even after 6 years.

The camp approach evoked much response from the community and there was demand to run the programme in the same geographical area and in the neighboring Panchayat. Unfortunately, the programme had to be discontinued due to several reasons.

 

Social Support Person and the Community based Model

The learning from the experiences of the social support persons in the community, what we call as the parasahayi or the community volunteer or the lay counselor can be the pivotal point in the community based alcohol management (Manickam,1999).

Whether it is a community based camp approach, or a centre based de addiction in patient programme or mental health centre based treatment for alcohol dependence, the community volunteers have a role to play.

Trained community volunteers or lay counselor or the parasahayi can

1. Identify the dependent person in the community,
2. Motivate the person for treatment
3. Motivate and prepare the family for seeking treatment
4. Liaison with the treatment centre
5. Encourage the person and spouse or relative to continue follow up
6. Provide immediate psychological support or help in times of need. This may be in terms of helping to get over the cues, help engage in leisure time activities or to provide and
7. Develop a social support network for the person to maintain changed life style.

In case of relapse, the social support person can repeat the cycle, by motivating the person for treatment again if required or by encouraging the link with the centre.

The human resource for this type of service is available in the community. Nevertheless, effort to mobilize and train them requires commitment. Sometimes recovered persons may be very efficient in this helper role. Others who have interest and motivation to work for the welfare of dependent persons and who possess non-judgmental attitude can be trained to help the people in the community(Manickam,1988).

In Indian situation, studies show that there is more number of people who abuse alcohol in the rural villages than the urban places. Even in the rural villages, the people affected are more in the low economic strata. It is expensive for them to seek treatment at the sophisticated mental health centres. Even the cost involved during the treatment period, many people in the low economic strata find it difficult to raise the amount.

Moreover, it has been observed that the existing number of mental health professionals are not able to cater to the needs of the community (Varghese, 1979). Therefore, there have been a number of initiatives taken at different parts of the country to train lay counselors (Manickam &Kapur, 1985;Manickam,1993; Manickam,1996a). Our research has shown that trained lay counselors do have helper qualities, and can be effectively utilized to help specific problems(Manickam,1990; Manickam,1997b). If the potential people are identified and trained, they can be of great help in combating the problem of drug and alcohol abuse.

In preventing the problem, there has been many efforts taken at different states (Rao &Parthasarathy, 1997; Kuttappan, 1998). The human resources available in the community have to be used to achieve the objective of a drug free world.

Alcohol dependence, which has multiple factorial causation and unpredictable course and outcome, requires a multi model approach in treatment. Programmes that are community based is better suited for the developing countries.

 

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 OBSESSIVE COMPULSIVE DISORDER

 CATHARSIS

 DEPRESSION

 DENTAL PHOBIA

 CURRENT TRENDS IN THE PRACTICE OF COUNSELING

 MANAGEMENT OF ALCOHOL DEPENDENCE

 TRANSACTIONAL ANALYSIS

 DECONSTRUCTIVE CONTEMPLATION

 STRESS AND RELAXATION

 IRRITABLE BOWEL SYNDROME (IBS)