Uncovering our Client’s History of Sanity

October 16, 2018 Journal

The first open-air cremation I ever attended was of a psychiatrist and Buddhist teacher Ed Podvoll, or Llama Mingyur. It was the winter of 2003 at the Rocky Mountain Shambhala Center. There was a light snow on the ground, chants and prayers in the air and ashes in the sky. It was a pretty powerful experience and in some ways it was my initiation on the path that I’ve been on ever since.

This was during my first dathun, or 30 day meditation retreat in the Tibetan Buddhist tradition, near Red Feather Lakes, Colorado in the Rocky Mountains. At that point I had already been meditating for several years but was just getting into the deeper teachings and practices and diving headlong into the psychological unfolding, work and blossoming that is this path.

Dr. Ed Podvall was a Buddhist teacher, respectfully known as Llama Mingyur. He was also the founder of Naropa University’s Contemplatively Psychotherapy Department and program. He was a psychiatrist, author and the founder of what is now Windhorse Integrative Mental Health. His book, “Recovering Sanity: A Compassionate Approach to Understanding and Treating Psychosis” is a wonderful discussion and map of the interplay of the therapeutic and mindfulness practices in supporting those with psychosis.

I did not know all of this as I sat with some of his students (my close friends), his family, and friends as a light snow fell all of us and oil was poured on his body to keep the fire going. But as the chants and prayers of gratitude were offered up I was struck by the contract of the burning body in front of me and the joy, sadness and kindness in the eyes and on the faces of those around me.

I would soon discover a paper of his, “The History of Sanity in Contemporary Psychotherapy”, that along with my mentor’s view and teachings would influence me, inform my worldview and chart my course for both my personal and professional path.  

In being invited to do a presentation on this topic recently, I was given the opportunity to revisit this paper in depth. In short, Dr. Podvoll highlights that, “A patient in therapy has two kinds of psychological history: a history of sanity as well as a history of illness. In order for a healthy development to begin within the therapeutic relationship, it is necessary that both patient and therapist shift their allegiance toward the history of sanity.”

We all know our clients histories of pain, pathology, diagnosis, medications, etc. And we absolutely must utilize this information in treatment formulation and after care planning. But equally essential is for us to notice, foster, support, remind, and empower our clients to relate to their own history of sanity, truth, strengths, and wakefulness. By focusing on these things we often see a natural, and sometimes more effective, symptom reduction than we see by focusing on the presenting problems directly.

When orient toward our client’s wellness, wisdom, strengths and sanity, we are helping our clients to reverse the negativity bias and to develop capacity to have a positivity bias. This can allow for our clients, in times of psychosis, depression, etc., to swim from, what Dr. Podvoll refers to as one “island of sanity” to another. This can foster the further development of perspective and capacity to understand that there are times and places where they can come up for air. That hope is not lost and that they can bring more of these islands of sanity together in order to build a safe space where recovery and stability are possible. Where hope and trust can begin to be the currency of exchange.

The more often we can help our clients and families see and identify their strengths, their movement toward what’s good, meaningful and positive, the more holes we are able to poke in a solid-seeming, self-defeating narrative.

But, in order to do any of this, we must start with ourselves. We must double down on recognizing our strengths, notice our own wisdom and function them as much as possible. Like our clients, it is helpful for us to address our weaknesses, and our neuroses. But, keeping our eyes on our own history of sanity and wellness might do more for us than keeping our neurosis a priori.

It is helpful for us and for our relationships with our clients to walk this parallel path with our clients. This way what we are pointing out to and in our clients is an authentic and a well traversed path for us, and on it we are sure footed. Dr. Podvoll founded the Contemplatively Psychotherapy program at Naropa University. In 1974, this was a dynamic and fruitful convergence of Eastern Religious and spiritual view and practice with Western psychotherapeutic education and techniques. A main focus in contemplative psychotherapy is the impact of a meditating therapist on the client-patient relationship and the client’s healing and unfolding. Whether the clinician is teaching meditation directly, is utilizing some of the skills cultivated through meditation in practice, or simply holding one’s seat as someone who is a seasoned practitioner, the impact of a clinician who also has a mindfulness practice can be profound in the lives of their clients.

The second open-air cremation I was a part of was even more profound and impactful. It was of my mentor and friend. The one who set me on my current path and to whom I owe much of my work and vision. Like Dr. Podvoll, he too was a student, practitioner and teacher of Buddhism and contemplative psychotherapy. The space he held for others allowed them to feel safe and comfortable, and fostered change both with words and without them. This is the path I was fortunate to have stumbled upon, or lead to, in my own attempts to alleviate my suffering. And this is the one I tread daily, working to notice my own sanity and wisdom so that I might help others see their own.