Psychotherapy is Never Non-directive
Reflections on inter-subjectivity, inner healer intelligence, influencing and music in the context of psychedelic therapy
Please note that this article is divided into five parts, which are published sequentially and are ideally read in chronological order:
Part 1
Psychotherapy is never non-directive | Reflections on inter-subjectivity
Part 2
Music is always directive | Reflections on the therapeutic function of music
Part 3
Psychedelic therapy is highly directive | Reflections on the use of music in psychedelic therapy
Part 4
The use of music is not necessary | Reflections on the use of silence
Part 5 (PENDING PUBLICATION)
Healing often requires direction | Reflections on Inner Healer Intelligence
Prelude
When air stops moving
Is it still wind?
In this article I will explore the notion of psychedelic therapy as “non-directive”. Frequently used, this term is almost irreversibly linked to psychedelic therapy. As if they are two sides of the same coin.
Thus I expect to surprise some readers when I state psychedelic therapy to not be non-directive. Or when I say that psychedelic therapy, in the form by which it is most commonly practised today, might arguably be one of the most directive forms of therapy one can imagine.
Some of you may be on the (de)fence about these opening remarks. Perhaps tempted to highlight the more recent usage of the term "inner-directive." While this term acknowledges the existence of a guiding and directive force, the assumption that this direction arises solely from within is, as I will argue, rooted in similar oversights.
Do not misread me. For good reasons, non-directive intentions became central to many psychotherapies. I recognise how this has significantly revolutionised care in absolutely necessary, much-needed ways.
In this article I will argue three main points:
First, the term "non-directive" is fundamentally misapplied in the context of psychedelic therapy.
Second, framing the therapy as non-directive can restrict the development of an accurate, holistic understanding of its mechanisms.
Lastly, this perspective can hinder both the effectiveness and the safety of the therapy.
These points will be explored from one core premise: therapists inevitably will influence the patient's experience. And that any influence given, directs the awareness of the patient in one way, away from others.
Whether actively or passively, consciously or unconsciously, explicitly or implicitly, there will always be an influence. Sometimes it’s subtle, through non-verbal cues confined to the intersubjective relational field. Other times, it’s more forceful, such as when music is played or explicit suggestions are formulated.
Recognizing and integrating this directive layer in psychedelic therapy might be crucial. Only then can therapists take fuller responsibility over the many ways they influence the patient’s experience. And only with full responsibility taken, these influences can be harnessed more effectively, safely, and ethically.
Part 1 | Psychotherapy is never non-directive
Reflections on inter-subjectivity
One of psychotherapy’s master teachers and the first to articulate the idea of a non-directive approach, is Carl Rogers. Rogers argued that patients have all resources needed for transformation within themselves. The primary prerequisite for this healing process is a relational climate characterised by empathy and “unconditional positive regard”. This climate will then offer care-seekers an (often rare) opportunity to be authentic.
This authenticity in turn is thought to ignite an innate and subconscious intelligence, an endogenous process, that at its very essence always strives towards wholeness. Away from entropy, towards syntropy.
What is often practised in the broader field of psychotherapy, is what one might call a cartoon-version of Rogers’ deep and nuanced insights. Therapists trained in non-directive approaches might strive for example to refrain entirely from reflections, suggestions or interpretations. They may focus instead and primarily on reflecting back to the client what they are perceiving. They might share subtle encouragements to further explore what comes up spontaneously.
It’s essential for care-providers to keep their own agendas and motivations in check. I fully agree with this intention. Yet, I simultaneously believe it is a logical fallacy to work on the assumption that one is able to not be providing direction of any kind. And that there is something essentially wrong with providing direction as a therapist in the first place.
There will per definition be never such a thing as being a neutral person in the room. The very presence in that same room (i.e. by the therapist), will always influence the subjective experience of the other person (i.e. of the client).
The entire fabric itself of this "intersubjective" field is built out of the mutual influences between therapist and client. These may express itself via body language, facial expressions, gestures, tone of voice and other ways. No matter how subtle, at the very minimal basis already, the relational nature of the therapy session will always exert influences on the client’s experience.
It is worth pointing out that Rogers himself used the term “non-directive” less and less the more his writings progressed. Being “person-centred” or “client-centred” is different from being non-directive. These terms became central to his method as it evolved.
In fact, sharing empathy is providing a direction. Helping your client "tune into a potent creative tendency" provides direction. Encouraging them to "surrender to the experience," to "trust," or to "be carried by the music," and reassuring them that they are safe—these are all ways in which direction is given. Psychotherapy sessions can impossibly be fully non-directive.
It will be more truthful to acknowledge one’s influences, and more responsible to take ownership over one’s influences. Instead of trying to accomplish the impossible (being non-directive), therapists can instead consider the different ways and degrees by which they are directive. Directions might be given with gestures, sounds, words or with music. They might range from the implicit or the barely noticeable towards explicit encouragements, guided meditations, elaborate suggestions or sonic rollercoasters.
With this shift in perspective, therapists can stop viewing themselves merely as an empathic companion on the journey. Instead, they can start viewing themselves as a gifter of experiences.
Interesting reflection to start the series, and I fully agree, but the article is missing some nuance present in the person-centred approach that I find both useful and important (especially when talking about non-directiveness): person-centred therapists or counsellors avoid being content-directive (e.g. choosing a topic for the session, or having their hypothesis of what something may mean and trying to convey that to the client) for a bunch of reasons, but are process-directive all the time (e.g. focusing on a specific feeling, asking for permission to introduce an emotional expression technique) and openly acknowledge that. I don't think there is anything inherently wrong with a very content-directive therapy (such as classic second-wave CBT). Still, I do see a lot of value in a way of working that's not content-directive, especially in the field of psychedelic research, and especially when conducting psychedelic integration.
Excited for this substack