A Basic Outline of Course-based Psychotherapy

I have wondered for years exactly what Course-based therapy actually is. Even after doing a class on Psychotherapy: Purpose, Process and Practice last year I still did not have an overall picture. Instead, I felt like I had a pile of pieces, and I didn’t know how they all fit together, and what that whole looked like, once assembled.

I’ve just finished going through Psychotherapy again, along with the paragraph-by-paragraph commentary I wrote last year. My goal has been to try to assemble that whole picture. Even more specifically than that, I wanted to understand what the therapist did to bring about healing. To put this differently: What factors, when present, brought about healing? I was mostly focusing on factors on the therapist’s side, things over which the therapist had some control.

I came up with four main aspects of Course-based therapy. These do not exhaust what Psychotherapy says about the enterprise of therapy, but they do seem to me to be the main things that the therapist tries to bring to the relationship. With these four aspects, I finally feel that I have a good feel for what this style of therapy actually is. Following the four aspects is another section entitled “Supports for the Four Main Aspects,” and a final one called, “Other Relevant Issues.”

Aspect I. The belief doctor

The main thing the therapist will be doing in her discussion with the patient is working on the patient’s belief system, working to expose it, bring it up for question, and lead the patient toward choosing a different belief system through forgiveness.

The patient’s belief system

The patient’s belief system is that he is a fragile, insecure self which is at the mercy of a powerful, dangerous, attacking world. All of the power seems to lie in the world. The patient seems to have no power to dictate his own responses, his own decisions and his own emotions. What the world tells him about himself, he has to internalize. How the world treats him, he has to feel. The only way he can really exercise his power is to constantly defend himself from the onslaught of the world and to attack in order to get what he wants. The world is not just going to give him what he wants, so he is forced to try to take it. In sum, the only option the world leaves him is to respond to it with defense and attack.

The patient’s “solution”

The patient does not want to question this belief system. He does not want to question the reality of the war he sees going on. What he wants is help in winning it. He wants to acquire new powers, skills, abilities, and strategies to meet the world on its own terms. He wants to form a new, confident self-concept that is equal to the task, that can hold at bay the world’s attacking forces, that doesn’t crumble in the face of the world’s assaults and demands. He wants to become a confident, secure person able to manage his life and skillfully make his way through a treacherous world. He wants to win at the game of life. This is what he is hoping that therapy will do for him.

The flaw of the patient’s “solution”

The problem with the patient’s solution is that it assumes the validity of his beginning belief system, and within that belief system there is no solution. Within that system he will always feel like a vulnerable self at the mercy of a cruel world, a self so vulnerable that no defense will ever be truly sufficient. This strong self that can handle the world, therefore, will really be no more than a cover designed to hide how he really feels. Even if he becomes this capable self that is literally on top of the world, deep down he will still feel like the fragile self he was before. He will still be insecure. He will still live in fear.

The real problem

The patient’s real problem is guilt, which comes from his anger and resentment. His belief system is one big argument for the fact that anger is justified. Its core assumption is that the world is attacking him, pressing on him, badgering him, making demands on him, treating him unfairly, not giving him his due. Given that belief, what else is he going to feel but anger-hidden, maybe, but surely present? And no matter how justified he tells himself this anger is, it will cause him to feel guilty. Because of his anger, he believes that he is an attacking self, an evil self, a sinful self. He believes he is guilty, and this belief says he deserves to suffer. His guilt, in fact, not the world, is the real source of all his suffering. All of his sorrow is an act of weeping for his own lost innocence. That the patient’s real problem is guilt stemming from unforgiveness is very difficult to accept and to uncover. “This is never apparent to the patient, and only rarely so to the therapist” (P-2.II.3:4).

The therapist’s job

The therapist’s job is to help the patient reconsider this belief system. This appears to be the primary work that transpires between patient and therapist—what their talk is geared towards. The therapist helps the patient become aware that he sees himself at the mercy of the world, that he sees the world (its people, situations and events) as cause, and his mind (its emotions, decisions, responses) as effect. The therapist helps the patient question this cause and effect relationship; helps him accept that mind is cause and world is effect. The patient must learn that his mind is what’s in charge. Since it has the freedom to interpret the world however it chooses, the world has no actual power over it. The therapist’s job is to help the patient reclaim this power of the mind and use it to choose a new interpretation of the world.

The power of the mind also implies a new view of the self. The patient sees himself as a weak self buffeted by the world, but he must realize that this self is nothing but a mental construct. It is not his real self at all. It is just an image he made up with his mind, which is anything but weak.

The therapist must also help the patient uncover his guilt. The patient is continually singing a song of guilt to himself, the chorus of which says, “God may not enter here [because I am so guilty]” (P-2.VI.1:4). Yet even while he sings it, he doesn’t hear himself singing it. This is because it takes disguised forms. The patient’s song of blame towards the world is actually this very song of guilt, only in disguised form. Since blame causes guilt, while he sings “look what so-and-so did to me,” he is really singing, “I am so guilty that God may not enter me.” The therapist must help him hear this song of guilt he sings to himself. Usually, he will only hear it for brief moments. These moments give him a chance to question the song and “change his tune” (P-2.VI.2:2), something the therapist can’t do for him.

How does he change his tune? He learns to forgive. This forgiveness, however, is not the same as conventional forgiveness. Conventional forgiveness is an unmerited gift bestowed on those who really injured us. This forgiveness, however, is based on the idea that the world didn’t injure us at all. The world seemed to cause us pain, but all along we caused our own pain, through how our minds interpreted the world. The world never hurt us. It never did anything to us. And if that is so, then our resentment toward it has no cause. This realization is forgiveness, a forgiveness that is the inevitable product of seeing the truth. It is not an undeserved gift.

This single choice to forgive is what heals the patient. When he forgives, he lets go of his picture of a fearful, threatening world about to blot him out. He realizes he made that picture up. Thus, his fear is gone. When he forgives, he no longer believes in a weak and vulnerable self. He realizes that his powerful mind made up both his view of the world and his view of himself. Such a mind is hardly weak and vulnerable. Most importantly, when he forgives, he is cleansed of guilt, because its source—his anger—is gone. Now he no longer sees himself as an evil self in anguish over its corrupt nature and awaiting its just punishment at the hands of the world. That self, too, was just a mental construct. Forgiveness, therefore, is his entire healing.

Aspect II. Forgiving the Patient

This form of therapy aims, above all else, to release the patient from guilt. As we saw above, this happens through the patient’s own choice to forgive others. Yet it also happens through the therapist’s forgiveness of the patient.

While the therapist is engaged in the work of challenging the patient’s belief system, she is also engaged in the inner work of challenging her own. She is looking on the patient and seeing his appearance as a sick, maladapted loser, filled with problems and clearly inferior to her. He is not only unsuccessful at life, he is not particularly good when it comes to being in therapy. He resists his own healing, fails to see obvious truths, refuses to make the right choices, and battles with his therapist. All things considered, his secret belief that he is an unredeemable sinner, it is sad to say, appears to have some truth to it.

The therapist has to realize that this is an illusion; in fact, her own illusion. This is a miniature reflection of her belief that the world is attacking her and causing her pain. This is the projection of her own guilt. She sees the patient as guilty and defective due to her attempt to unload her sins onto him. She sees him as vexing her and frustrating her because she sees him as the chosen instrument of the punishment she secretly thinks she deserves. And by seeing him in this unloving way, she reinforces her guilt.

Any lack of love, therefore, in how she sees her patient is her own song of guilt, in disguised form. This, in fact, is where she can get in touch with her song, question it, and change her tune. She does this by overlooking everything worthy of judgment, everything imperfect, in her patient. She sees past his sickness. She sees past his sins, recognizing that they are not real. She sees him as God’s saint, as God’s Own Son, as the bearer of God to her. She sees something in him that is perfectly innocent and pure, despite all of his problems and mistakes.

This is what she is practicing inside herself while she is discussing her patient’s belief system. The following passage speaks of this internal practice: “The process that takes place in this relationship is actually one in which the therapist in his heart tells the patient that all his sins have been forgiven him, along with his own” (P-2.VII.3:1). “In his heart” implies both “silently” and “with genuine sincerity.” Another passage speaks in different terms about the moment when forgiveness occurs: “It is in the instant that the therapist forgets to judge the patient that healing occurs” (P-3.II.6:1). The implication here is that the therapist’s judgment of the patient is a chronic, habitual thing which, even though it probably goes unnoticed, is constantly blocking healing. The moment when this chronic judgment is not maintained, healing occurs.

Both of the above passages say that healing comes from the occurrence of forgiveness inside the therapist. The therapist will of course express this forgiveness in many different ways on the outside. It is very doubtful that she will say, “Guess what? I just forgave you.” But if the forgiveness inside is genuine, whatever she says will be a way of communicating this message: “Awake and be glad, for all your sins have been forgiven you.” (P-3.II.4:10). The patient will probably experience this as feeling totally accepted and loved. This experience of being loved by his therapist, despite all his defects, is central to whatever healing he receives. His therapist’s love is how he is helped to “forgive himself for all the trespasses with which he would condemn himself without a cause” (P-2.V.7:6).

The therapist’s forgiveness is so powerful that it doesn’t even necessarily need to be communicated visibly. It will transfer directly, mind-to-mind. In fact, the therapist’s patients will not always be people who meet her and come to her office. Sometimes they will be sent to her mentally from afar, by the Holy Spirit. In this case her job is to send them the healing power of her forgiveness, join with their minds across the distance, and trust that healing has occurred.

Even though the therapist’s forgiveness must occur privately, inside of her, it also has an active, external dimension. For the active process of therapy will uncover a great deal of ugliness inside the patient’s belief system. It will uncover a thought system filled with anger and rage, and floating atop a sea of guilt. It will reveal selfish, aggressive impulses beyond what is considered socially acceptable. The ideal is for this dark, shame-producing material to meet with the unconditional forgiveness of the therapist.

In this sense, the therapist functions as a kind of confessor. Hopefully, the patient will in time want to bring to her his deepest, darkest secrets, all of the things that have led him to condemn himself. Her job, in the face of this material, is to offer her pure and undivided forgiveness, and through this offering help the patient truly accept that he did in fact “condemn himself without a cause” (P-2.V.7:6).

Aspect III. The Holy Relationship

A primary healing agent is the therapeutic relationship itself. The patient’s unhealed self-concept is a result of his antagonistic relationship with the world, and this relationship with the world is primarily contained in his conflict-ridden relationships with the people in his life. The therapeutic relationship is meant to be a more beneficent, healing relationship that shifts his perception of all relationships, and of himself in the process.

Therapist and patient are meant to enter into a holy relationship, a relationship in which real joining takes place. They have a joint project they are undertaking. The patient has asked for help and the therapist is trying to give that help. For their relationship to really come together, they have to unite in this joint project. They have to be working toward the same outcome, the same goal. The key to real joining is for therapist and patient to genuinely share a common goal.

Yet they typically begin therapy with divided goals. The patient wants to keep his belief system and self-concept completely intact and simply acquire ways to succeed in his perceived struggle with the world. The therapist generally wants to change the patient’s sick identity into a healthy one. Both of them will need to let go of these goals and unite in the true goal of therapy: to help the patient undo his faulty self-concept and uncover his already innocent and pristine identity.

Psychotherapy suggests that the patient and therapist will need to go through a process of slowly reconciling their divided goals, for these alone stand in the way of successful therapy. To the extent that the two of them can get past this division and unite in the same goal, they invite God into the relationship, even if they don’t believe in Him. Once He enters, He will direct the healing process and complete what they began. Because of His Presence, their limitations will in the end count as nothing.

It will be up to them, however, how much they draw upon the vast potential represented by God’s Presence in their relationship. Ideally, they will unite more and more over time (and they will need the time to do this). They will share their common goal so fully that they will eventually transcend all belief in separate interests. All of the differences that lie between them will slowly vanish from their sight. To achieve this ideal requires a very advanced therapist (a term which is synonymous with an advanced teacher of God) who can facilitate such a holy joining.

A deep union of this sort profoundly changes the self-concept of both individuals. It proves to them that they are not the separate, vulnerable, guilty selves that they thought they were. It undoes their current self-concept and proves that their real identity actually includes the other person.

This joining between two people is God’s plan for salvation. Such a joining is not the perfect oneness of Heaven, but it is the earthly reflection of heavenly oneness. And therefore it is the way to remember that oneness.

Aspect IV: The example

The therapist’s goal is to lead the patient out of his current belief system and into sanity. To do this effectively, the therapist must be a living demonstration of sanity, at least to some degree. She ought to be at least slightly less insane than the patient.

The patient is deeply afraid of really changing his belief system. He is profoundly threatened by the prospect of moving into real sanity. He believes that the loss of his self-concept means the loss of identity—means death. Therefore, he will see the therapist as trying to take away that thing he treasures above all: his self-concept. As a result, he will resist the therapist’s efforts and even attack the therapist.

The therapist’s role is to respond to these attacks with defenselessness. This demonstrates to the patient another way of being, a way of being that is so secure that it doesn’t need to defend itself. As a result, this way of being seems attractive. It seems safe. The patient starts to think that giving up his defensive, fearful state for the alternative which the therapist represents may not be so scary after all. It may actually be a move toward safety, toward the cessation of fear.

To approach this from another angle: The therapist can show the patient the inevitable suffering caused by his current way of thinking, but this doesn’t help unless she can also help him accept the alternative. How does she do this? She presents an example of one who has moved into this alternative and lives there happily. She stands forth as someone who, at least to some extent, has let in the light, embodies the light, and is no longer trapped in the same fearful patterns. This kind of example, the Course tells us, “can speak with power greater than a thousand tongues” (T-27.II.5:5).

This doesn’t mean that her words are useless in communicating her message, but these words will have little power unless they are backed up by her life. As the Course says, “Words can speak of this and teach it too, if we exemplify the words in us” (W-WI.14.2:5).

Overall, the therapist is trying to coax the patient into a new way of thinking, one of which he is extremely wary. How can she really ask him to leave behind the familiar and step into the new unless she herself has done so? How will he be convinced that this way can work for him unless he sees that it has worked for her? The therapist, therefore, must above all be dedicated to her own journey to sanity. She cannot lead her patients there if she hasn’t made the journey herself.

Supports for the four main aspects

Not playing god

Perhaps the primary caution for the therapist in Psychotherapy is that she not play god. Playing god takes two main forms. The first form is that she sees herself in charge of the process, responsible for figuring out what the patient needs, and responsible for whether or not healing occurs. This leads to guilt, since it is a role that is simply too big for her to possibly shoulder. The solution is for her to realize that she is just an instrument for the Holy Spirit. The second form of this error is that she sees herself as being superior to the patient, higher up on the great chain of being. This demeans her patient, agrees with his sick self-concept, and blocks joining, for only equals can join. The solution to this is realizing, in spite of all appearances, that the patient is her equal. Both forms of the error come together in the notion of the therapist as judge, a judge who knows all and who looks down upon the patient from a great height.

Being a follower of the Holy Spirit

The therapist ideally should be a follower of the Holy Spirit. She is there to be an active instrument through which the Holy Spirit can do the therapy He wants to do with the patient. The Holy Spirit is the true Healer, but He needs someone to work through. It is not the therapist’s place to decide what her patients need, or even who her patients should be. She is just supposed to get her script from the Director and read her lines. If she decides what her patients need, she will decide they need her to make sacrifices for them. Being an instrument of the Holy Spirit is a delicate paradox. On the one hand, her job is to realize that of herself she can do nothing, and so to lean on Him. But on the other hand, her job is to realize that He is in her, and that therefore she has all power, that all the gifts of God are in her hands to give. Many therapists do not believe that the Holy Spirit is there to shepherd the healing process, but as long as the goal is healing, He will be there, directing the process as much as He is allowed to.

Listening

The therapist is meant to listen deeply to the patient, so that she can adapt her overall approach to each individual patient. Through this listening, she will let the patient, in effect, formulate his own ways to reach the true goal of therapy (a goal which is already set, and not up to the patient). The therapist is meant to listen so deeply to the patient that she hears the Holy Spirit in him, and it is He Who tells her what exact treatment fits this person’s individual needs and temperament.

The holiness of helping

The therapist will be constantly tempted to believe that her efforts to help her patient are sacrifices that only deplete her, unless she receives appropriate compensation and rest. Instead, she must keep before her the thought of the holiness of helping another. While there are people who are suffering, “they can and must be helped” (P-2.V.3:5), and the therapist must give her all in the attempt to do so. To hear another’s call for help and try to answer him is the holiest thing one can do in this world. It is “the formula for salvation” (P-2.III.3:5). It is not a sacrifice, but the only road through which the therapist will find her own salvation. Only through her judgment of another can she get in touch with her own guilt. Only by forgiving another will she find forgiveness. Only by joining with another will she discover her true Self. She must, therefore, see the patient as the bringer of her salvation, as a saint sent from God to awaken her. If she refuses to let her patient into her heart—either because of her judgments or because he cannot pay—she shuts the door on her savior. But if she endeavors to meet his need as if it were her own, she will find that her need is met. Thus she will realize that she and the patient are one. And this is how she becomes liberated from her ego.

Empathy

The therapist must walk a very fine line in her empathy toward the patient. On the one hand, she must be deeply concerned about the patient’s state of mind, want his healing, care about how he feels, and understand why he feels that way. On the other hand, she must see that his feelings and state of mind are not who he really is, see that he is already healed, and realize that his pain is ultimately not understandable, because it makes no sense and is not necessary. She must, in other words, be the bridge who, in her own mind, spans the gulf between insanity and sanity, allowing the patient to cross over and be healed. She must share his doubts, fears and pain in the sense of seeing them through his eyes, yet not in the sense of joining in them. To join in his suffering would reinforce his sense of weakness and vulnerability, and would mean joining in blame of those who supposedly caused his pain. Her focus must be on empathizing not with his weakness and suffering, but with the strength in him, the Christ in him, and turning to the Holy Spirit for how this “true empathy” can most helpfully be expressed through her.

Other relevant issues

Psychotherapy and religion

This style of therapy does not require belief in God and other spiritual realities on the part of either the patient or the therapist. Its goal is to relieve the mind of guilt through forgiveness. To demand that the patient believe in God would be unfair, but he does need to hold the goal of separating the truth from his own illusions. It is also not necessary for therapists to believe in God. All that is required is for them to teach forgiveness. By extending forgiveness, “They can succeed where many who believe they have found God will fail” (P-2.II.7:6). Even if patient and therapist don’t believe in God, they have approached and served God in the process. For it is forgiveness, rather than belief in God, that removes the blocks to the awareness of God. And it is joining with another person that invites God in. In fact, true religion and true psychotherapy share the same goals and even the same outer forms in the world. True religion is not the formal religion of traditional churches, but a holy relationship between a spiritual teacher and his pupil, which is designed to remove the blocks to the awareness of God’s Presence. This also is true psychotherapy. At their highest the two disciplines meet. The relationship between an advanced spiritual teacher and his pupil is indistinguishable from the relationship between an advanced therapist and her patient.

Relationship to conventional psychotherapy

Jesus (in the Course, Psychotherapy, and personal guidance to Helen and Bill) is both critical of conventional psychotherapy and affirming. His criticisms are that it:

• probably trains its practitioners to be judges (in the sense of knowing how to diagnose and select treatment, and in the sense of mentally standing above their “defective” patients), rather than followers of the Holy Spirit who see their patients as their holy equals.
• can offer a pseudo-forgiveness by telling the patient that his destructive thoughts are OK because they don’t affect anyone (so long as they are not acted out).
• can help the patient take charge of his life and develop ego-strength in a superficial way that amounts to mere symptom relief, that simply reinforces the notion that the patient really is under attack by the world. This is one of Psychotherapy’s major critiques of conventional therapy.
• can be preoccupied with unearthing and analyzing the ego in the assumption that the patient is his ego. Yet the patient’s identification with his ego is his core sickness and the source of all his guilt.
• can involve long (and expensive) analysis and endless tiring discussions that are not necessary (because healing is just the single shift away from guilt) and can even have the result of merely helping the patient be more tolerant of his ego (when the real goal is to get rid of it).
• can (in the case of psychiatry) reinforce the basic error that the problem and the solution lie in the body and its chemistry.
• can realize that the mind is the source of sickness and healing, but then believe that the separated mind can heal itself. The truth is that the separated mind is by definition sick, due to its separateness, and therefore needs divine help (i.e., the Holy Spirit) from beyond that separated framework.

On the other hand, the Course has more positive things to say:

• “The essential goal of therapy is the same as that of knowledge [meaning, heavenly knowledge]. No one can survive independently as long as he is willing to see himself through the eyes of others” (T-3.VIII.11:1-2).
• Psychotherapy is founded on the essential truth that sickness is of the mind. Thus, people who enter psychotherapy have already acknowledged the importance of the mind, which is a real step toward healing.
• It doesn’t matter what school of thought the therapist comes from. If he is able to truly join in a common goal with his patient, he will succeed.

Psychotherapy can be seen to set forth a new approach to psychotherapy (and that is how I’ve spoken of it here). Yet that is not quite how this supplement sees itself. Rather, it appears to see itself as identifying what is truly therapeutic within any form of therapy. No matter what method of therapy you are doing, what is healing is: helping the patient forgive the world (rather than helping him manage the world more effectively), relieving his guilt through your forgiveness, joining with him in a shared purpose, setting an example of genuine sanity, responding with defenselessness to his attacks, etc. Strictly speaking, these are not the special techniques of a new form of therapy, but the healing agents within all forms of therapy.

The mental health of the therapist

Psychotherapy considers the health of the therapist to be crucial, but expects that most therapists are anything but paragons of mental health. It speaks of the uncaring, lying therapist who is in it for himself; the therapist who may be more healing when he leaves the office; the therapist who was taught to be a judge, not a healer; the therapist who may never once forget to judge the patient, and the therapists whose whole goal is “merely to collect bodies to worship at their shrine” (P-3.II.9:8). It says that, in terms of inner development, “most professional therapists are still at the very start of the beginning stage of the first journey” (P-3.II.8:5). It says that the world’s therapists are rendered useless by their demand for money in order to give healing, since this makes the gift of healing not a true gift, and therefore not truly healing.

Yet Psychotherapy also offers many reassuring qualifiers to this gloomy picture. It says that when the lying, uncaring therapist chose to be a healer, a seed was planted inside that will eventually germinate when “a patient will touch his heart, and the therapist will silently ask him for help” (P-3.II.3:6). It says that the therapist is not asked to be perfect, for “Whatever stage he is in, there are patients who need him just that way” (P-2.I.4:5). It says that God will use any opening that is offered Him for healing, however small. Just for the therapist to dedicate himself to being a healer, just for patient and therapist to get together in the same room, means that some opening has been provided, and God will use that for healing.

Progress

No therapist-patient relationship will be ideal, because this world is inherently imperfect. “Ideal” and “world” are mutually exclusive terms. Yet still progress can be counted on. The patient has asked for help, and God has provided him with the therapist that best suits his need. In the same way, God has given the therapist the patient she needs for her own salvation. Just for the two to get together means that they have applied the formula for salvation: “One asks for help; another hears and tries to answer in the form of help” (P-2.III.3:4). Progress must come from this. It may look like retrogression, but that, even at its worst, is only temporary. Some progress will come from every single session. The relationship of therapist and patient may end without it looking like any good came from it. But there was good, as much as they could accept, and that will be saved for both until they can fully accept it.

Therapy as holy encounter

There are two beautiful quotes that speak of what the therapeutic session can become: P-2.I.4:1 and P-2.VII.8:1-4. The sense one gets from these passages is that, in the ideal therapy session, two people lose sight of their conventional identities, forget all the mundane details of daily life, forget the painful, insane world outside the room, and enter into a timeless moment of expansive peace and union.

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Or you may be interested in delving deeper into A Course in Miracles.