Self-Reflection and Awareness in Social Work

concrete suggestions. These include: how to set up and arrange an “ideal” playroom; how to choose appropriate toys for children of varying ages and developmental stages; how to deal with the inevitable mess; and how to explain the nuts-and-bolts, as well as the nuances and benefits, of CCPT to children, teachers, and parents. They also provide a user-friendly Axlinian checklist for maintaining a non-directive attitude. For the purposes of documentation, which becomes more and more critical in this age of managed care, the authors discuss case conceptualization with regard to emergent and recurrent themes in play, and how to document themes and client progress in a logical fashion for case notes. Toward the end of the book, the reader finds a helpful discussion of real-life extensions of CCPT that the authors have encountered in practice. Several controversial issues facing all therapists are unflinchingly examined, including the use and misuse of touch in therapeutic relationships. Attention is also given to the common occurrence of children’s use of curse words in therapy; cheating at games; and physical aggression toward the therapist, or to objects in the room.

Personally, I did struggle with some of the terminology used. For instance, the authors’ frequent description of CCPT as an “intervention” felt jarring. I cannot help but read intervention as an invasive act, no matter how gently conducted. After all, one generally only intervenes in situations where something – or someone – is going awry. I also felt uneasy with the suggestion of “supplemental” or additional treatments for “severe cases” as from a classical client-centered perspective, the core conditions outlined by Rogers are not only necessary, but sufficient, regardless of presenting complaint or situation. I prefer to view directive treatments, in general, as entirely separate entities; rather than in any sense complementary or enhancing to the core conditions. However, this may be an indication of my own propensity to split linguistic hairs. Certainly the authors have achieved their own stated aim, and I would expect future editions to evolve from this solid theoretical and practical base. I would be comfortable sharing this book as a training tool. I extend my appreciation to the authors for an overall successful synthesis of their own experience, combined with the collective and evolving wisdom of their own teachers and students, amounting to a truly seminal volume.

Amanda R. E. Aller Lowe Integrative Counseling, Psychological Services, Naperville, USA

Email: [email protected] © 2013, Amanda R. E. Aller Lowe

http://dx.doi.org/10.1080/14779757.2012.753396

Therapeutic presence: a mindful approach to effective therapy, by Shari M. Geller and Leslie S. Greenberg, Washington, DC: American Psychological Association, 2012, 304 pp., (hardback) ISBN 978-1-4338-1060-2 £50.47

I do not know of any other book at this time presenting an equally convincing and informed case for the promotion of being rather than doing in the art of therapy. The authors define therapeutic presence as “the state of having one’s whole self in the encounter with a client by being completely in the moment of a multiplicity of levels – physically, emotionally, cognitively, and spiritually” (p. 7). Presence involves “being in contact with one’s integrated and healthy self, while being open and receptive to what is poignant in the moment and immersed in it” (p. 7).

Person-Centered & Experiential Psychotherapies 177

The book’s refrain, variously articulated over 300 pages, is twofold: (a) given the subtle attunement (pp. 70–71) and interoception (p. 260) it engenders, therapeutic presence is beneficial to the client and to the therapeutic relationship; (b) it is also good for the therapist: being at heart a way to cultivate care of the self, it decreases stress and burnout, heightens vitality and decreases anxiety (p. 9).

The book is expediently divided into four sections: (1) Theoretical and Empirical Basis of the Model; (2) The Model of Therapeutic Presence; (3) Additional Perspectives on Therapeutic Presence; (4) The Cultivation of Therapeutic Presence. With part four also including useful exercises and practices, this book is a welcome addition to the library of any person-centered trainer and practitioner.

Grounded in their broadly humanistic ethos, yet generously reaching out to all orientations, Geller and Greenberg recognize how, for over a century, diverse and even contrasting perspectives have championed the essential notion of therapeutic presence. From Freud’s “evenly suspended attention,” which underlined “receptivity” and “impar- tial non-judgemental … attention” (p. 18) and Rogers’ own formulation of presence (p. 27), to Daniel Stern’s emphasis on the “moment of meeting” (p. 20), to Gestalt and the dialogical approach exploring presence emerging “in the between” (p. 21), the question of how to be with a client has indeed been at the center of the therapeutic endeavor.

And yet, in spite of the trans-theoretical nominal endorsement of presence, the book’s argument in favour of presence feels more urgent than ever. In fact, given the technologiza- tion of therapy we are witnessing today (alongside the mishandling of its purpose – towards becoming the policing and normalisation of individuals) the book’s claims take on a counter-cultural significance. This is not because the authors, in their contagiously optimistic tone, seemed to have noticed how technical, prescriptive and bluntly unsympa- thetic to the subtle nuances of presence mainstream therapy has become in recent years. “It is true that certain therapeutic approaches are more technical than relational in their approach” (p. 8) they write. “However, more recently these therapies have also identified that the development of a therapeutic relationship … is important and helpful in facilitating the use of cognitive-behavioral techniques” (p. 8). This is certainly auspicious and (broadly speak- ing) true. Yet the “mindfulness” model, a dominant brand name in mental health settings discussed at some length in the book, has itself drawn from the arguably reductive para- meters of cognitivism and behaviorism alongside a reified, i.e. non-contextual reading of the Buddha’s teachings.

The authors make an important and often forgotten distinction between presence and mindfulness: the former is a way of being; the latter (now pervasive thanks to the way in which mindfulness it is currently apprehended), a set of techniques. It is true that, unlike mindfulness, “therapeutic presence does not necessarily involve teaching clients to be mindful”, focusing instead “on the therapist being mindful” (p. 13). This crucial distinction between presence and mindfulness, so perceptively made, could have been developed further. This is not a book on mindfulness, but since a whole chapter is devoted to it, I would have appreciated a more detailed analysis. Instead, the book relies on a current, reductive understanding of “Buddhist mindfulness,” passively accepted as a given, with the authors displaying at times a submissive ethos with regard to, respectively, an arguably reductive and nowadays obligatory alliance to neurobiology, and a presentation of mindfulness almost entirely decontextualized from the complex array of social, ritual and religious components into which it is embedded.

As a Zen practitioner of 30 years, I did not know (nor, frankly, cared to know) that my central nervous system’s circuits and the parasympathetic nervous system are activated and

178 Book reviews

working harmoniously together (p. 166), nor that my regular practice of zazen (sitting meditation) helps me achieve a satisfactory level of neuronal integration (p. 168). MRI scans of Buddhist monks and nuns are all the rage now – weirdly reminiscent, if in reverse, of Phrenology, that pseudo-science which in Victorian times claimed to determine a person’s moral fiber and acumen by the shape of his skull. This is not to suggest that neurobiology or neuroscience are pseudo-sciences, but to emphasize how seeking the validation of an essentially unquantifiable experience via quantifiable means, is an effort which produces mixed results and in the process bolsters the view that the mind is reducible to the brain. I am intrigued by the argument of measurable reduction in physical arousal brought about by yoga and mindfulness practices (p. 166). This is undoubtedly therapeutic, yet might confirm the current western handling of meditative practices for the appeasement of troublesome, intense vitality and passion – in short, the creation of a veritable technology manufacturing a reliable and evidence-based opium of the middle-classes. At heart, the teachings of the Buddha are not a set of techniques for “stress-reduction” but, with their emphasis on remembering impermanence, the certainty of death and the uncertainty of the time of its occurrence, “stress-inducing”. Their existential edge challenges complacency rather than offering soothing consolation.

Which brings me to a crucial point: in their discussion of mindfulness, the authors overlook its most important element: mindfulness is mindfulness of impermanence. For the Buddha there is no such reified, capitalized notion of “Mindfulness” as such but always mindfulness of, mindfulness-in-context. The context here is the transient, fundamentally unsatisfactory nature of life. Mindfulness is first and foremost mindfulness of imperma- nence. Understanding this engenders a way of being in the world; it does not emphasize proficiency in a set of techniques or mere control of troublesome emotions and states of mind.

Instead of the Buddhist context in which mindfulness developed, what the reader finds repeatedly emphasized in the book is the mystique of the present moment. But being present and attentive is the very basic requirement for any practice, of any profession, any work or craft. There is nothing special or particularly “Buddhist” or mystical about being present and attentive. It is just that a whole industry has been created with this central tenet of “being present.” In the Zen tradition this is known as selling water by the river.

The quarrel here is not with the authors, but rather with their surprisingly supine acceptance of the dominant interpretation of Buddhist ideas, variously presented as useful in regulating emotions and as surrogacy affect regulation (p. 189), a set of skills (p. 188) and often quoting an unreferenced “Buddha” who has recently and speedily become (in contemporary psychology literature) as ubiquitous, as Americanized and as watered- down as that other ‘prophet’ of the ‘inner world’, the Sufi poet Rumi.

Do not get me wrong. This is a wonderful book on therapeutic presence. I found the argument in favor of the latter nothing less than formidable. Two chapters in particular, chapters 11 and 12, respectively discussing experiential approaches and presenting a set of very useful exercises, are reason enough to want to buy this book and learn a great deal from it. The argument in Part 1 presents a powerful case for presence as a trans- theoretical methodology, and I have personally found several insights and exercises invaluable for my own work. I also found welcome references to teachers and practi- tioners whose work continues to be relevant, inspiring and profound: I am thinking of pivotal figures in the world of contemporary spirituality such as Bernie Glassman, Ram Das, and my wonderful friend and teacher of urban shamanism and dance Gabrielle Roth, who sadly died recently. Co-author Leslie Greenberg movingly and convincingly writes of drumming, dancing and rhythm work as additional ways towards greater integration

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and the developing of presence. In their laudable aspiration to reach out to everyone the authors perhaps stretched the scope of the book to the point of diluting its powerful central message.

Manu Bazzano University of Roehampton, London, UK

E-mail: [email protected] © 2013, Manu Bazzano

http://dx.doi.org/10.1080/14779757.2013.804653

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