WilliamPRyan.com| Heart Centered Psychotherapy |Therapist Guide


I love my patients. It may be a kind of heresy in the current climate of behavioral objectives and short-term outcomes required by managed care to say that the love of the therapist for the patient is one of the most important aspects of psychotherapeutic work. Yet that is indeed what I am saying. Love is not measurable. Love is not concrete, rational or linear. Yet our patients experience it in ways that are palpable. In psychological research, whenever patients are asked to evaluate what was most helpful to them in producing a successful outcome in therapy, invariably they say, “My therapist really cared about me as a person.”

My psychotherapeutic approach is not unique or revolutionary. I am not saying that all patients need is love, or that we should ignore justifiable concerns about boundary issues. What I am advocating is a shift in the figure-ground. Most of the therapists I know are compassionate and caring people. When we entered this field, we had a heartfelt desire to help people with their problems and suffering. Our training pushed that into the background and emphasized theory, technique and professional distance. I am suggesting that it is time to bring compassionate caring into the foreground. It is not that techniques and theories should go into the background, but rather that a synthesis needs to occur. Patients benefit not only from our minds, but also from our hearts. When we work in a heart-centered way, we feel freer to be both professionals and loving human beings. I do not consider this a revolution, but rather an evolution.

At the age of sixty-nine, after thirty-five years of private practice, I am an elder in the field of psychotherapy. Five years ago, I was diagnosed with a very aggressive cancer. After the surgeon removed my spleen, a fist-sized organ, he said that it weighed eight pounds and looked like a deflated basketball. As a survivor, I do not know when or if the cancer will return. Yet I am very acutely aware that my allotted time is limited. Each day I ponder the question, What do I want to do with my time? One persistent response is that I want to leave a legacy to the therapists who come after me. I want to pass on what I have learned about effective psychotherapy that they may not hear from other teachers or read in other books.

Most specifically, I want to advocate that therapists develop a more heart-centered approach to our work. From my perspective, the love of the therapist for the patient is a core ingredient in the healing process of psychotherapy. I am not talking about romantic love or sexual love or sentimentality. I am referring to the wide spectrum of love: kindness, compassion, encouragement, warmth, non-judgment, emotional feeding, hugs, gentle challenge and celebration of growth. Over the many years of my practice I have come to understand that techniques, theories and professionalism are all important, but insufficient for deeply effective therapy.

When I look back at my own training in traditional psychoanalysis and ask the question “How often was the idea of compassion or loving-kindness toward your patients mentioned?” or when I ask therapists trained in other theories of psychotherapy, “How often were you encouraged to love your clients?” the response is the same, “Rarely, if at all.” What a profound dilemma that creates. Our natural inclination to be a caring human being is not even acknowledged as an important aspect of being a psychotherapist. How are we supposed to interpret that absence? Does it mean that compassion and other acts of love are unnecessary or, even worse, unprofessional or harmful? Early in this book I describe my struggles with this dilemma and how my work evolved into a more heart-centered approach.

What does it mean to have a more heart-centered approach? First of all, I am not implying that other ways of working are cold-hearted or that other therapists are uncaring. A heart-centered approach simply calls for a greater awareness that the therapist’s love is a cardinal aspect of effective therapy. It means the therapist is more openly expressive of non-sexual, non-romantic, non-sentimental forms of love. This is especially true in offering consoling touch when appropriate, in working through what I call love blocks and in being a sanctuary for our patients. Second, there are certain therapeutic issues that cannot be resolved at the level of consciousness at which they exist. Cognitive, behavioral and analytic methods will be minimally effective. They are areas in which another aspect of consciousness – the realm of the heart – of both therapist and patient needs to be actively engaged. These issues include the patient’s need to forgive themselves, most major life decisions and those emotional territories that are too overwhelming for the small heart of ordinary consciousness.

Each chapter in this book focuses, from a heart-centered perspective, on a particular aspect of psychotherapeutic work that I feel has been insufficiently addressed in training and supervision or has not been addressed at all. For example, at some point in therapy, every patient has something for which they need to forgive themselves. Perhaps they hurt someone they loved, or they have failed to do something needed. Perhaps they harbor an expectation of themselves that they are unable to fulfill. Generally we were not trained as clinicians in how to help people forgive themselves. It is as if the issue of forgiveness is considered to be in the realm of spirituality or religion and not an aspect of psychotherapeutic work. In the rare instance that self-forgiveness is mentioned as a therapeutic goal, no one talks about techniques. Most therapists develop some areas of special interest and expertise that emerge from our own histories. In my own life, overwhelmed with guilt after initiating a divorce, I was lost and despairing. From this experience, I have evolved a perspective and techniques to help patients to forgive themselves. In this book, the chapter on Self-forgiveness begins with that personal journey.

One of the most important goals of a heart-centered approach to therapy, perhaps the most important, is to increase people’s ability to give and receive love. My particular focus has been on the oftentimes pervasive, usually unconscious, psychological blocks that we all have to being receptive to love in the many forms that it is available to us. Almost twenty years ago, I co-authored a well received book entitled Love Blocks, Breaking the Patterns That Undermine Relationships. In Working From the Heart, I am revisiting that topic from the perspective of a more heart-centered approach, honed by years of additional practice. How often we have difficulty in easily receiving compliments, being comfortable with physical affection, accepting help when it is offered or asking for help from people we know would assist us. It is difficult for many of us to accept and honor the myriad ways in which people show love that do not fit with the ways we want this love expressed. Why do we block opportunities for love in our lives?

How can we lessen or remove these barriers? The answers to these questions are the focus of the Love Blocks chapter.

We know that gentle touch is one of the most ordinary acts of human kindness toward someone who is suffering. Yet, whether or not to touch patients is one of the most controversial questions in the practice of psychotherapy. Some therapists resolve this dilemma by making a therapeutic rule – Thou shalt not touch. From a heart-centered perspective, however, that dictum deprives patients of one of the most healing expressions of love and compassion for someone in pain – non-sexual, non-romantic, consoling touch. In the Touch chapter I encourage therapists to slog through the conflicts about touch in order to discern in what situations and for what patients gentle touch is the right therapeutic action.

From my perspective, in general our male patients need a heart-centered approach more than the women do. In the Men chapter I discuss three aspects of a more heart-centered therapeutic mode that are particularly effective with my male patients: educating them about the language of the heart; using self-disclosure to model having a deeper connection to their inner emotional landscape; employing traditional male metaphors such as the warrior, the provider and the toolbox as a bridge to their emotional lives.

At some point in their therapy most of our patients will be faced with some major decision that will change the direction of their life. The typical therapeutic approach to life crises in the current atmosphere of managed care is to emphasize a solution-focused perspective. From my experience, however, because the larger human dilemmas cannot be resolved at the level of consciousness at which they exist, that approach is rarely helpful. My heart-centered approach focuses on viewing the conflicting ideas and emotions the patient expresses as emanating from diverse parts of the personality. The role of therapist is to help the patient to develop compassion for all these parts, increase their tolerance for the tension among these often opposing inner voices, and get the various parts of the personality to work together for the good of the whole person. Following this model, I have developed a technique I call The Council, in which, the Higher Self of the patient takes on the role of an inner “wise elder” who holds the questions, What is in my best interest to resolve this issue? How can I honor all the parts of myself and create a synthesis of their ideas?

During the process of therapy most patients become aware that they have internalized a feeling or perspective that really does not belong to them. “It” doesn’t fit who they are now or connect to the actual circumstances of their current life. I call these pervasive intrapsychic intruders implants – thoughts, feelings or world-views that have been implanted in the personality by family (sometimes for many generations), class, ethnic group, religion or by the overall culture. Some examples of implants I’ve observed in my practice are: an anxiety about money that does not fit the patient’s actual financial situation; a pervasive judgmental or critical attitude toward others; a fearfulness or sadness that does not seem to have roots in the patient’s personal history; a general mistrust of others. In the Uprooting the Implants chapter, using metaphor and imagery, I teach patients to let go of these implants so that they may release what does not belong in their inner landscape.

Our small hearts, the emotional hearts of ordinary human consciousness, are profoundly limited in their ability to hold all that we need to hold in our roles as psychotherapists. We are exposed on a daily basis to a potentially numbing amount of suffering. We need to navigate the sometimes turbulent waters of transference and counter-transference. We experience our own periodic fluctuations in energy and mood that make it difficult to be fully present. We are asked to be compassionate and loving toward patients we don’t like. In the Small Heart, Big Heart chapter I describe ways of engaging an aspect of our Higher Self, our big heart, so that we can be a loving presence in all of these situations.

Because so many of our patients come from families or other relationships that were physically or psychologically unsafe, it is essential that we find ways to convey to them that we are offering ourselves to be a place of safety and refuge – a sanctuary. The core question for us to ask ourselves is, How do I communicate to my patients verbally and non-verbally the message that they are entering a safe haven in which they will be received with warmth, kindness and dignity? The Sanctuary chapter presents ways of answering that query both within the therapeutic relationship and in the atmosphere of our office space. Since some of the therapeutic work occurs between sessions it is also important to help our patients develop other ways of finding sanctuary in their everyday lives. Some examples that I discuss include: taking solitary walks in nature, creating a sacred space at home and doing regular journal writing.

A central issue that we all struggle with as therapists is taking care of ourselves. How can we sustain an optimal level of open-hearted presence when we are exposed to so much suffering? How do we do that hour after hour, day after day, for years and not become exhausted, overwhelmed, emotionally distant, resentful or numb? The draining nature of our work requires that we find reliable ways to recharge our physical and psychological batteries. We are very good at taking care of others, yet many of us are not good at taking care of ourselves. Why is that? The chapter on Recharging explores that question and describes ways of restoring ourselves both outside the therapeutic space and during sessions.

Our culture generally does not honor the role of elder. My thirty-five years of practice and my experience with cancer have propelled me to reflect at length upon the issues that I raise in Working From the Heart. As an elder in my field, I offer this writing as my legacy to the next generations of psychotherapists. I am profoundly grateful to those who have contributed to my formation as a therapist, upon whose shoulders I stand. I am also grateful that my heart-centered way of being a therapist is uniquely mine, evolving over time, a full expression of who I am. It is my hope that these essays will encourage other therapists to find their own unique synthesis of open-heartedness and professionalism, informed by theory and technique, that truly expresses who they are.

I have intentionally written this book in an informal, non-academic style. It is not intended to be used as a textbook, therefore there are no footnotes or references. Instead, the image that has carried me through the writing of this book is of me and you, the readers, gathered around the woodstove in the living room of my home in the country on a chilly evening. We are a group of psychotherapists coming together from a wide spectrum of theories and perspectives about our healing work, with a range of years of experience. I am sharing my ideas gleaned from all the years of my practice. Let’s have a conversation.

All rights reserved. No portion of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means, electronic, mechanical, photocopying, recording or otherwise without the prior written permission of the publisher. (Working from the Heart, by William P. Ryan, published by RLPG Books, appears by permission of the author and publisher).