Tapio Malinen, tapio.malinentathata.fi, Sundintie 26, FI 06650 Hamari, Finland

 

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Psychotherapy as an Ethical and Spiritual Exercise

Tapio Malinen, M.A.

Tapio Malinen, M.A., Psychologist, Private Practitioner, Teacher in Psychotherapy, Helsinki Psychotherapy Institute, Finland. Address: Sundintie 26, 06650 Hamari, Finland. Email: tapio.malinen@tathata.fi. Telephone: 358-(0)400-595074.

 

 

Abstract

This article describes how precious the practice of psychotherapy can be, and how priviledged we are as therapists in practicing this activity. In this paper psychotherapy is seen as an ethical and spiritual exercise, as an existential enterprice that can change the therapist´s entire experience.
Seen and experiencing our work in this way can change the domestic into exotic, and the job of the therapist can thus be a meeting point for the real, beautiful and good in a unique manner.

The article is also offering the reader small examples of experiental exercises that they can use to increase their connection to spirituality or to help them be more present in their work. Their aim is to function as a guide for therapists who are seeking this type of connection in their dayly work.

Key Terms: psychotherapy as a ethical practice; mindfulness; a spiritual exercise; the unskilled skill of precense; therapist´s well-being.


Psychotherapy as an Ethical and Spiritual Exercise


“The true value of man is defined based on to what extent he is liberated of himself.”
     - Einstein

“Words hide all that is not words.”
     - G.Ågren

A recommendation to the reader! You are recommend to read this article like we can read poetry. When we read poetry, we can be poets. We remain passively allert, letting the words be active, listening to how they echo on every level, how they sound, how they move us, how we are moved by them. We wait attentively, without conclusion, for the poem to find us. In this openness the words can be a catalyst to the real formulation which takes place within the reader.

Introduction

“If I planned to go to a conference, and if I knew forehand what I would be thinking at the end, then I wouldn´t go. It is like that with my work. If I knew where we would be at the end of the session, I don´t think I would do this work. And if I had not changed at all after the session, then my actions probably would not have a very big impact on the people who came to me.” This is what Michael White answered in an interview (White, 2000, p. 138), when he was asked what goals mean to him in psychotherapy.

“Therapy is a spiritual path on which we suddenly realize that we are something full-bodied, as it were something with guts, something that makes you suddenly realize that you are breathing... that your awareness encompasses time and as it is embraced with it, that something is beautiful or absurd, or magnificent, or ridiculous, and every inch of you is moving through space, and knows, and doesn´t know that it knows...” This is how the New Yorker poet and psychotherapist Dvorak Simon described her work in the mid 90s in his article Doing Therapy as a Spiritual Path (Simon, 1995, p. 2).

Both of these comments share a mutual thought: therapy does not just have an impact on our clients but it is action that has its effect also on the therapist. An idea like this is not brand new. The philosophy of classical antiquity was originally directed at an ordinary man, so that he would have the opportunity to become more of a man. Philosophy was considered to be “a spiritual exercise” and the philosopher was not meant to only learn how to speak or debate, but also to live a philosophical life (Hadot, 1995). For example the so called Socratic dialogue was such a spiritual exercise the purpose of which was to help the hearer to examine oneself and to take care of oneself. All spiritual exercises had this basic idea: to make a person to revise their attitude and beliefs, to have a dialogue with oneself. The purpose was not to assume abstract knowledge but the “metamorphosis of personality”. According to Hadot mindfulness was the key to all of these spiritual exercises (Hadot, 1995).

In an even older wisdom tradition, in Buddhist psychology, research, in another words meditation, does not just produce scientific knowledge but also gradually changes the scientist. One of the basic elements of this psychology is “sati”. This concept is in language Pali and it signifies a skill to observe experiences as they present themselves from moment to moment.

There has been much focus in the past 10 years on the professionalization of therapy, that the art of therapy has been overlooked. Given an opportunity for therapists to focus on the experience of therapy itself as a spiritual enterprice seems particularly relevant and valuable in our time of constant demands of outer productivity and effectiveness. This opportunity can also give us the experiense how to maintain our sense of significance and getting on under these demands.

The benefit for this type of spiritual exploration has been pointed out lately through a growing body of research that demonstrates how the cultivation of “sati” significantly encances the well-being of health care professionals (Sapiro & Carlson, 2009; Didonna, 2009; Hick, 2009; Germer & Siegel & Fulton, 2005; Brown & Ryan, 2003; Bien, 2006; Mace, 2008). We are starting to acknowledge that mindfulness and spirutual issues are a valuable part not just of the lives of our clients, but also for ourselves as therapists (Walsh, 2009; Carlson & Erickson, 2002).

What does a therapist practice in therapy?

The words “practice” or “exercise” are used to denote a special meaning in this article. When psychotherapy is understood and experienced as a spiritual exercise through which the therapist’s way of looking at the world and experiencing it changes, it is not just about external action. Psychotherapy is seen and experienced rather as creating a mental state in which we practice humanity. We are not working for some goal that awaits us somewhere out there. We practice because practicing itself is life as fullness, something we want to do for the sake of it itself (Kabat-Zin, 1999). Every encounter with a client becomes a part of the therapist’s own learning process. Psychotherapy becomes the practicing of existence, and the internal experience that is brought to life like this will at best change the basic tone of our minds and the entire basic tune of our existence. Our work can thus be a meeting point for the real, beautiful and good in a unique manner.

This does not mean that we as therapists could not set goals for ourselves and aim at achieving them. It is more about acknowledging therapy as a process and also living through this process as mindfully as possible. It is good to remember that without plans our work can easily become scattered and ineffective. However, practicing as a way to change the quality of our experience and deepen our understanding always takes place in the present; it is being in the present. Thus planning is not goal oriented. We can easily get stuck on goals and forget that the goal and the process that takes us to the goal are parts of the same reality – just like “good” and “bad” are parts of the same reality or heads and tales the different sides of the same coin (Loori, 1194). Once we realize this, our attachment to the goal fades off and we acknowledge the present. At that time every step is living and it can be experienced as fullness.

Nowadays goals are underlined to such extent that traveling often loses its meaning. Without the “pollution” of purpose, practicing psychotherapy can in the best case deepen into action which changes our entire existence. Through this we will become increasingly aware of the moment in which we are living and of the qualities of experience and possibilities connected to this moment. Hence our work becomes practicing mindfulness. At the same time the whole idea of practicing will disappear and a gradual transition towards a mindful life begins. In another words, when we do things mindfully, our skill will eventually turn into a non-skillful skill. Such practice is also closely connected to the ideas of knowledge and learning that support our work, the ethics of our actions and to the proaspect of who or what is the therapist’s “self” (Malinen & Thomas, 2009).

Shu-Ha-Ri

The traditional understanding of knowledge is based on the idea that there is a reality existing independently from us and of which we can acquire objective knowledge through so called scientific research methods. In this dualistic setting another person is an object which we can objectively explore. Knowledge is then something that exists independently outside us, and it can be transferred as a block from the expert therapist’s head into the client’s. This so called modern understanding of knowledge and the power practices involved with it are still dominant in the Western therapy culture.

According to the postmodern understanding of knowledge reality is created within social relations. Knowledge is existence constructed within historical and social relations. The increase of knowledge signifies the emergence of new power relations and courses of action (Järvilehto, 1997). One cannot transport knowledge, because no-one can transport existence onto another person. As Harlene Anderson states: “Therapy cannot be taught, but one can learn it.” Learning therapy is not an action in which knowledge is passed on, mould, worked on and transferred in paragraph-like teaching packages, but instead it is co-operation between the teacher and the student, partnership with conversations, that adds to both parties’ performance. There is always an existential aspect to learning based on wisdom, and for example practicing the skill of psychotherapy is seen as existential and changing the therapist’s entire experience. In the Eastern tradition a skill and the other parts of life are not separated. Hence for example teaching is never just about technical preparation, but rather about guiding the student deeper into the different existential experiences brought on by the rehearsing.

Timo Klemola has described in his book The Philosophy of Skill – The Skill of the Philosopher the three stages of learning as understood in the Japanese tradition (Klemola, 2004). If a teacher is a master of skill, she is more than a technical example, she is an example through her entire personality. The first level of learning is “shu”. This concept can be translated as “protect”, “defend”, “comply with”. This means that the student complies with given instructions while repeating the basic interventions of the school. In addition to that she learns the ethical virtues of psychotherapy: respect, appreciative curiosity and the attitude of not-knowing. This first level of knowledge usually lasts from three to five years.

After this the student enters the second level of knowledge. It is called “ha”. In English that means “tear”, “break”, “come undone”, “destroy”. These concepts refer to the therapist breaking free from the first level. What is learned is reorganized, elements that are unfitting to the person in question are abandoned and one’s own limits and possibilities are acknowledged. At this point learning new things does not mean adding something, but quite the opposite: letting go of something, which for its part requires courage, realization and internal certainty. Once one understands the theory and is ready to apply the principle, it is the time to separate oneself of those, so one can live and carry on discussion again normally. At this point it is not so much about “what to do” than about “how to be”.

The final and the highest level of skill in this three-staged process is “ri”. It is about liberation, separation, a preparation of kind. This does not however signify the end of studying, but mental independence of other teachers. Now the therapist is only dependent of her own continuous rehearsal and research. She is usually at this point an experienced senior member with a working experience of 25-35 years after becoming a therapist, and aged 60-70 (Lehtovaara, 2003). At this stage the techniques of therapy are increasingly created through the person’s own personality, are less mechanical and their limits are understood better than before.

The road is built of the steps we take

Dvorak Simon considers solution focused psychotherapy techniques spiritual practices which help the therapist to absorb the values, attitudes and courses of action needed in therapy work (Simon, 1996). She presents an anecdote about this, one that has become very significant to me during my career. In it Jay Haley, a central character in the development of strategic family therapy, lives in a Japanese family. Every afternoon as the father of the family comes home the daughters bow at him respectfully. As Haley asks, what is it in their father that evokes such respect, one of the teenage daughters answers: “In our Dad? There’s nothing to respect in him! But if someday we met a person we could respect, we’d already know how to bow!”

Dvorak says that struggle is unnecessary in talking about change. She thinks that therapists can relax and sit back, since our clients are essentially ok, and they have an unlimited amount of alternative stories. We can peacefully rest in the miracle which is created when we are together with our clients in what is as it is, and when we let the infinite possibilities of life become real as we move from the known towards what is possible to know and feel. As we “bow” for example in a solution focused way we practice respect, thankfulness, openness, awareness of the consequences of our actions and compassion all the time. The spiritual growth which takes place after hundreds and hundreds of “bows” signifies the therapist’s gradual clarification of values, responsibility of oneself and of others and nature, sensitizing one’s concept of beauty and decrease of negative ways of thinking and acting. As therapists we do incredibly privileged work: we can practice all the time – no more and no less than – the full execution of our humanity!

Psychotherapy as an ethical practice

In order to function ethically in our work, we have to be aware of those factors which underline our actions. This calls for constant awareness, mindfulness which we cannot achieve without practicing. It is clear, for example, that if we cannot be aware our emotions, we can easily commit hasty deeds. In the next paragraph I examine Buddhist ethics as an example of an ethic which is based on practicing the body and the mind. At the same time I will aim at showing that ethics is not a matter to be taken too lightly!

Instead of ordinary morality and the ethic codes related to that, Buddhist ethics highlights the practice of the mind in a manner which makes us more aware of the processes which are crossing in it: feelings, thoughts, desires and motives, which are all factors defining our actions (Segall, 2003). Exactly like human vision without equipment is an insufficient tool to examine the moon, planets and stars, Buddhism considers an unpracticed mind to be an unreliable tool while researching mental objects, processes and the nature of consciousness.

In academic philosophy studying the so called ethic of content usually means contemplating on ethical theories. The goal of such courses is not to teach how to live a “good life”, but what is meant by the concept of “good life”. Buddhist ethics is not only chasing conceptual thinking, but “the special practicing and researching of an open heart” in that inter subjective space which in an open dialogue is built between the therapist and the client (Swim et al., 2001). This so called process ethics is based on practicing the mind and solving existential, fundamental questions in an experience based manner. Questions like this are, for example (1) What is the meaning of practicing as the modifier of the quality of experience and of deepened understanding? (2) What is the place of a human being in the world, in the entity of being? (3) What is the nature of “the self” or the ego? (4) What is the place of compassion in being with fellow men? (Klemola, 2004).

When two people forget about themselves, they will see each other

We work and live mainly in an ego-centered experience: we think, plan, reminisce, and imagine all the time. Our minds are full of different thoughts, feelings, recollections, representations. As the client speaks, the therapist assesses, categorizes and plans. When we practice mindfulness we can – if we so wish – be aware of our inner speech, representations, and exist in the present moment as it is, without distorting our perceptions with our own theories or presuppositions. This means that we are not only quiet outward, but that for a while our inner dialogue, our way of talking to ourselves all the time has calmed down. Practicing silence develops clarity, the ability to receive and concentrate, in another words the qualities effective psychotherapy always requires. This is not easy, but just like any other skill it can be trained. Silencing our minds is also a political action: at this moment we need less greed, anger and ignorance, instead of more 5-year-plans or expansive profit thinking.

Anatta, egolesness, is one of the most central concepts of Buddhist psychology, and one that a meditating person can directly experience after meditating for a bit longer. According to it “self” is not an internal entity, but a process which is constantly formed by the changing sensations, thoughts, feelings, perceptions and mental events (Fulton, 2008). It is about a process in which the experience of the place of the “self” is gradually changing. When “self” is forgotten in practicing therapy, we do not ourselves guide our actions, but it is done by the situation or the practicing itself. At that point there is no difference between the doer and the doing, and the deed is characterized by flexibility, security and influence. If we understand self as a mere concept or image, not as an independent entity which has to be protected and satisfied at any cost, things will not shock us as much.

The idea that we need a strong ego in order to succeed in our work and lives is due to the way we confuse attachment for ourselves, for our own image and the strength of mind, determination, which is imperative in realizing deep efforts (Richmond, 1999). It is not worth it to prove oneself to the extent of causing damage to oneself! The effort to always present self in a positive light creates fear. Instead, surrendering to a cause makes one bold enough to free oneself of anxiety.

Within presence, in the current moment our work does not unravel from the therapist’s ego, but from the relationship between the world and a person. When we as therapists experience ourselves more and more as parts of the stream in our inner lives, the stream in which the world and life express themselves through us, it is possible to see things the way they are and not like we would want or imagine them to be. When ego centrism decreases, the conflict between subject and object is surpassed: something more profound and more real than the everyday consciousness gets the possibility to emerge.

There are two mind sets in human action which have to be in balance in order for us to feel harmony, inner strength, joy and devotion. They are the sets of doing and being. We do not often take note of the mind set of being and its perfection in amidst all the doing (Holmberg, 2004). A busy lifestyle is always throwing us with centrifugal force away from the state of equanimity within ourselves. In a performance oriented society the mind set of doing becomes easily too dominating at the expense of the mind set of being. The therapist’s and our clients’ internal well being depends, however, on our ability to balance our need to do and our inner capacity to be.

The unskilled skill of presence

The greatest battle in life is not against aging or time, it is against becoming bored, against the routines, the illusion of isolation and an unlived life. These wither our existence: there is no more joy in the everyday life, nor excitement, joy of working or happiness. Our life becomes a grey path,
spiritually withering place of performing necessities and routines. When a therapist experiences her work as a spiritual practice in which perceptions, feelings and thoughts become recognized and then let go into the space of our consciousness, our spiritual longing to experience the present moment strongly and freshly is satisfied. Mindfulness dismantles and removes alienation and the separation between a human and the world. When we in therapy practice the full execution of our humanity we can in our work stand before reality from moment to moment feeling amazement! What does this mean from the standpoint of the therapeutic process, the therapeutic system and relationship?

When practicing mindfulness the therapist’s power position is effective but we are not in the center of the process. The client will learn to recognize that a person is not the same thing as her thoughts or feelings; she is more than just her conception, image or story about herself. In addition to the members from the client’s club of life(1), also issues experienced as sacred can be invited into the therapeutic system. Thus it is possible to build new stories which are richer and more meaningful than before. The greater a space we are able to identify ourselves with and also let this identification go the freer we are.

When a person is able to accept their experience in the present moment, without reacting to it automatically, without rejecting it or clinging to it, she is in a living contact to each moment. When a therapist is able in a relaxed, uncategorized and uncritical manner to face things as they are instead of mechanical reacting, she is building a space between people for the richness of present moment (Rasinkangas, 2007). When we maintain our attention in the present moment, we can be sure about one thing: no matter what we focus on in this moment, it will change, and give us a chance to practice the skill of acceptance regarding whatever emerges in the next moment. Tapio Koski, who has examined the philosophy of running, makes an essential question for this point: “How to practice in mindful and persistent way, but at the same time without trying anything special?” (Koski, 2005, p. 212)

_ _ _
(1) The metaphor of club of life comes from Michael White. It evokes the image of person´s life and identity as an association or a club. The membership of this club is made up of the significant figures of a person´s history, as well as the identities of the person´s present circumstances, whose voices are influential with regard to how the person constructs his or her identity. (White, 2008)

Conclusions

As a therapist I am like my reader and my clients. We are connected to each other by the basic features of the conditional existence: suffering, the impermanence of everything and the fact that nothing has a permanent, innate nature. Not even the therapist’s professional self. Things and events are “empty” in that they do not possess any immutable essense, instrinsic reality, or absolute “being” that affords independently. The self is a process that arises when conditions support it and vanishes when conditions do not (Fulton, 2008). This recognition of the fundamentally dependent nature of reality – called “dependent origination” in Buddhism - lies at the very heart of the Buddhist understanding of the world and the nature of our human existence. No phenomenon exist with an independent or intrinsic identity: things and events in the world come into being only as a result of the interaction of causes and conditions. When selves are empty, arising in response to immediate experience, we are all intimately connected and “each can only inter-be with all the others” (Nhat Hanh, 2001, p. 55). The therapy meets the family, but is created by the family; the family meets the therapist, but is created by the therapist. The therapiast creates himself or herself creating the client, and the client creates himself or herself creating the therapist. As people we are also likely to aspire to similar goals: balance of the mind, peace and happiness (Rosenbaum & Dyckman,1996).

Practicing psychotherapy can be seen and experienced as an opportunity to make every word and moment count: the encounter with a client becomes a spiritual encounter for the therapist. By maintaining mindfulness, avoiding ensnarement in transient states of desire and aversion that might divert the therapeutic endeavor and by employing compassionate speech, therapist is not just

learning in terms of becoming a better therapist, but in terms of becoming more fully human. Capabilities cultivated my mindfulness to notice the details of our behavior moment to moment is a way of developing clarity about what is happening. This awareness can itself be profoundly transformative. According to Olendzki (Olendzki, 2003) Buddhist emphasis on ethics in behavior is not a prescription for right behavior as opposed to wrong behavior, but rather an intivation to notice the details and the nuaces of one´s own behavior. Thus the wholesome skills gained through mindful awareness of experience naturally flow into the skillful execution of behavior. In the ethical exercise of doing therapy, it turns out, that well-being itself is a skill that can be learned.

The most essential in psychotherapy are not the terms and concepts one uses to talk, but the thought-provoking space which is co-created between people. Sometimes it is like a soft, peaceful windless wind that brings you to a stop and revitalizes you. It also reminds us of the fact that our work can at its best be inner touching, in which the person touching and the person being touched are in the end revealed as the inseparable parts of the same mystery.


Appendix A: Deep Breathing
Extend yourself a little bit. Inhale, count to three and experience the inhaling. Hold your breath for three seconds. Exhale, count to three and feel how the next inhale deepens and your exhaling slows down. Note how the inhaling makes you peaceful and exhaling brings softness. During the next inhale you can smile a bit internally and while exhaling experience how your body becomes softer and softer. While you inhale this moment is all there is. While you exhale this miraculous moment is all there is. Do this exercise at least two time a day.

Appendix B: Recalling
Bring yourself back to this moment by either redoing the earlier breathing exercise or by some other manner appropriate to you. Then recall a moment or moments when you have felt clearly being in the present – experienced strongly your life force and acknowledged what happens within you and around you. Do not strain it, just let images flow freely into your mind. Where have you been at that moment, what has happened around you? What in your experience caused this feeling of highlighted presence? What could you do before meeting your client and during the meeting to arouse and maintain full awareness and presence?

Appendix C: We-dentity
Feel your breathing again for a while. Then return to your mind a client with whom you are working with at the moment. This person is a human creature who suffers, who has hopes and dreams. She has also tried to be happy and maybe only partly succeeded in it. She has contacted you hoping that you will be able to lessen her suffering. Think about how reading this article could change your way of being with her. Hold on to this person in your mind for a while and think how reading this article can connect you through your client into your dayly life? Do not worry if you do not immediately recognize this connection.

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