Description of the Approach

Transpersonal psychotherapy draws upon both psychology and spiritual traditions to create a bold new vision of a psychologically-informed spirituality and a spiritually-based psychology. Perhaps the core assumption of transpersonal psychology is that individuals are essentially spiritual beings rather than simply a self or a psychological ego (Sperry, 2001) . The psychological and spiritual dimensions of human experience are seen as different, though at times overlapping, with the spiritual as foundational (Cortright, 1997) . The core qualities associated with spirituality are considered not only appropriate as a focus in psychotherapy, but as goals of transpersonal psychotherapy:

Spirituality presupposes certain qualities of mind, including compassion, gratitude, awareness of a transcendent dimension, and an appreciation for life which brings meaning and purpose to existence. Whereas spirituality is essentially a subjective experience of the sacred, religion involves subscribing to a set of beliefs or doctrines that are institutionalized. (Vaughan, 1991, p. 105)

Historical and Theoretical Basis of the Approach

The Association for Transpersonal Psychology (ATP) was founded in 1971 by many of the original founders of the Association for Humanistic Psychology, including Abraham Maslow, Anthony Sutich, Miles Vich, Stanislav Grof, Michael Murphy, and James Fadiman. Sutich and Maslow are generally regarded as the midwives for the articulation of the transpersonal view within humanistic psychology (Valle, 1989) . They saw the need for a psychology that was willing to study and explore experiences, particularly spiritual experiences, in which the sense of identity extends beyond the individual or personal ( trans personal) to encompass wider aspects of humankind, the natural world, and the cosmos. Behaviorist theory ("first force"), psychoanalytic theory ("second force"), and humanistic psychology ("third force") lack a systematic place to study spirituality and consciousness.

The emerging transpersonal psychology ("fourth force") is concerned specifically with the empirical, scientific study of, and responsible implementation of, the findings relevant to becoming, individual and species-wide meta-needs, ultimate values, peak experiences, B-values, ecstasy, mystical experiences, awe, being, self-actualization, essence, bliss, wonder, ultimate meaning, transcendence of the self, spirit, oneness…and related concepts, experiences, and activities. (A Sutich, 1969, p. 16)

Such states are notoriously difficult to study, as William James (E. Taylor, 1983) pointed out in Exceptional Human States . James's philosophy of radical empiricism argued that a true science must be based on the study of all human experiences, not just those that can be manipulated in a laboratory. The discipline of transpersonal psychology attempts to scientifically study the reports of transpersonal experiences and behaviors (Krippner, 1990) . Consciousness and spirituality continue to be the keynotes in transpersonal psychology and practice.

However, one can trace back larger historical forces leading to the founding of transpersonal psychology. The Greek Eleusinian Mysteries used an LSD-like ergot in rituals to induce transpersonal states (Wasson, Hofmann, & Ruck, 1978) . (E. Taylor, 1990) attributes the origins of transpersonal psychology to the unique cultural context provided by America , which began as a spiritual democracy that was home to many mystical religious groups (e.g., Quakers, Shakers). The Quakers, for example, maintained that one could be moved by the inner light, thus obviating the need for priests, books, buildings or other parts of religious organizational bureaucracies. Transcendentalism, spiritualism and Swedenborgianism took hold on American soil in the 1800s and can also be seen as predecessors of transpersonal psychology. The Boston School of Psychotherapy which flourished from 1880-1920 was a direct forerunner of transpersonal psychotherapy in its use of diverse religious iconography and practices in therapy, and led to the founding of pastoral counseling and Alcoholics Anonymous. This school was supplanted in mainstream academic and clinical psychology by the Freudian psychoanalytic and behavioral approaches, but the counterculture movement in 1964 provided a return to the focus on inner and communal religious experience. Several transpersonal psychology graduate schools were founded in the 1960's and 1970's, including the Institute of Transpersonal Psychology, Saybrook Graduate School , the California Institute of Asian Studies (now CIIS), JFK University , and Naropa which train students in transpersonally-oriented psychotherapy.

Transpersonal psychotherapy evolved concurrently with transpersonal psychology. Sutich (1973) wrote an article on this topic shortly after the founding of the ATP in which he described it "as therapy directly or indirectly concerned with the recognition, acceptance, and realization of ultimate states. As such, it is not new; rather it is perhaps the oldest of all the therapeutic approaches" (p. 10). The focus on “ultimate states” in the early days of transpersonal psychology has expanded over the past 30 years to address the whole person, not just their transpersonal experiences. Initially it was important to bring attention to these areas which had been pathologized and ignored in other models of psychology. More recently in transpersonal psychology, attention has shifted to examining the way the spiritual is expressed in everyday life. A similar shift occurred in transpersonal psychotherapy which now addresses the whole person, including ordinary consciousness, suffering, pain, abuse, mental disorders including psychosis, and relationship conflicts. As Vaughan (1993) expressed this shift, “Transpersonal psychotherapy is a healing endeavor that aims at the integration of physical, emotional, mental, and spiritual aspects of well-being. Its goals include the classic ones of normal healthy functioning” (p. 160) .

Main Theoretical Constructs

Jung was an important precursor to transpersonal psychology. He personally translated his term uberpersonlich as transpersonal, but most translations use the term collective unconscious. He explored the psychological value of many spiritual traditions, writing the introductions to the first translations of the I Ching and Tibetan Book of the Dead . Assagioli (2000) developed a theory of Psychosynthesis that drew upon spiritual teachings. He introduced the concept of the soul into psychological theory, along with distinguishing between “higher” and “lower” levels of the unconscious, a point that has continued to be elaborated in the transpersonal field.

Grof's theoretical approach is perhaps the most comprehensive in that it incorporates, and provides explicit accounts of a wide range and diversity of transpersonal experiences. The origins of Grof's theory lie in his extensive investigations of the therapeutic potential of LSD and later of holotropic breathwork. Grof found that the types of extraordinary experiences reported were remarkably similar and included sensory alterations, emotional reliving of past events and traumas, death and rebirth episodes, as well as a variety of psychic, archetypal and mystical experiences . Grof defines the transpersonal:

To understand the transpersonal realm we must begin thinking of consciousness in an entirely new way … as something that exists outside and independent of us, something that in its essence is not bound by matter … Transpersonal consciousness is infinite, rather than finite, stretching beyond the limits of time and space. (S. Grof, 1993)

Wilber is another leading transpersonal theoretician who developed a comprehensive model of consciousness, spirituality, psychology and therapy that is popular among transpersonal psychologists along with a following in diverse academic and professional fields. He posits evolutionary changes in consciousness, beginning with the mystical participation in nature experienced by the earliest humans, through a series of "eras" involving magical, mythical, and mental-egoic consciousness, to our present-day capacity for existential authenticity and transpersonal identity. All psychological and spiritual systems contain partial and complementary truths, and different psychotherapies address specific levels. Whereas most psychotherapies are directed toward the lower levels of the spectrum, transpersonal approaches focus on the upper levels of the consciousness spectrum (Wilber, 2000) . Wilber's (2000) Integral Psychology model provides a spiritual framework for psychotherapy that addresses diverse spiritual experiences, developmental levels, and issues. He has proposed which types of spiritual practices should be employed or avoided at each stage, and which types of psychopathology are related to specific developmental stages.

Relationship Between Psychology and Spirituality

While the roots of transpersonal thinking and practices are quite ancient, transpersonal psychology has adapted ideas and practices from many different religions, cultures, and epochs to a Western modern and postmodern psychological language as well as to practical applications in therapy. Transpersonal psychology rigorously inquires into the multiplicity of spiritual techniques, disciplines, and methods to distill their essence and commonalities (Walsh, 1999) . Transpersonal psychology has been greatly influenced by Huxley's (1944/1990) Perennial Philosophy which posits universal themes shared by all religions.

By incorporating a spiritual dimension, transpersonal psychology stands in marked contrast to earlier schools. Transpersonal psychology considers spirituality in its own right, distinct from Freud's reduction of religion as wishful illusions, Ellis' irrational thinking or Skinner's manifest disregard.

However, a transpersonal therapist is not merely accepting of spirituality, but actively helps clients achieve or strengthen their spirituality. All transpersonal therapists address spirituality in therapy; some even fill the role of spiritual guide for their clients ( Vaughan , 1991). Other transpersonal therapists see the therapist–client relationship as “two fellow spiritual sojourners becoming intuitive to inner promptings and intimately involved in spiritual quests” (Lines, 2002, p. 109) . Kornfield (1993) has discussed how the boundaries between the two provinces are not at all clear and, in practice, there is significant overlap.

However, Vaughan (1993) points out that while psychotherapy supports spiritual work, it is not the same. Two principal differences are:

• Therapists let the clients lead and determine the content of the sessions.

• Teachers provide the content to be learned or the practice to be followed by their students. In keeping with standard therapeutic tradition, most transpersonal therapists would not teach a client a specific spiritual philosophy.

When transpersonal therapists incorporate spiritual practices such as meditation in psychotherapy, they point the client to the original practice for continued exploration outside of therapy, and use the therapy to explore the psychological meaning and value to the client of their spiritual experiences, beliefs and practices (Hutton, 1994) . However, non transpersonal therapists may use spiritual practices such as meditation based solely on their clear health benefits without adopting a transpersonal perspective (Benson, 1975) .

Spiritual Context

Context refers to the attitude and orientation of the therapy, its basic assumptions and attitude toward suffering, healing, and human potential. Vaughan (1979) maintains that holding a transpersonal context for therapy is what defines a transpersonal approach, rather than specific techniques. Transpersonal therapists utilize techniques from psychodynamic, behavioral, family and other therapies as well as from spiritual disciplines (Hutton,1994) Similarly, for Boorstein (2000) ,

Foremost is the spiritual context within which I hold all of my patients. I have no doubt that this helps me stay in a caring mode--especially with difficult patients. To convey to a patient that you see him or her as being a piece of the Divine is incredibly powerful to begin to counter a life-long view of worthlessness. It can only be done when appropriate for the given patient, and it will not be effective if the therapist does not actually believe it in his/her mind and experience it in his/her heart. (p. 413)

The context is not always explicitly articulated to the client, as exemplified in the case of Bryan presented later in this chapter.

Spirituality and Psychopathology

Some people attempt to avoid dealing with their emotional and behavioral problems by turning to spiritual practices instead. Wellwood (2000) calls this "spiritual bypassing.” Several kinds of spiritual bypass have been identified: fear of intimacy leading to monastic lifestyle, joining a cult to deal with a fragile ego, accessing nonordinary states of consciousness to avoid feelings of depression, "surrendering" to a higher power to avoid confronting one's problems. Some people engaged in spiritual practice suffer from psychological wounds including self-hatred, aggression, narcissistic egocentricity, and depression, for which a course of egoic-level psychotherapy could support and further their movement toward spiritual development.

Mindfulness Practices

Transpersonal psychotherapy has adapted and incorporated mindfulness practices beginning with meditation in the early 1970s. Benson (1975) established the value of meditation for treating medical diseases such as high blood pressure in the 1960s. The importance and application of meditation in mental health was first discussed in talks by Ram Dass (Dass, 1970) that were published in the Journal of Transpersonal Psychology along with several other articles on meditation in psychotherapy (Goleman, 1971; Van Nuys, 1971) . Ram Dass had been a co-investigator in LSD studies with Timothy Leary, then traveled to India in 1967 and met a spiritual teacher. Despite a recent stroke, he continues to influence transpersonal psychology, sharing his explorations with a variety of spiritual practices, including yoga, chanting, and Sufism from his wheelchair. Alan Watts contributed to the meditation/psychotherapy dialogue in articles in the Journal of Transpersonal Psychology and several popular books (Watts, 1957, 1974) .

Buddhism has had a large influence on transpersonal therapy because Buddhist mindfulness practices involve training in the qualities of attention and presence required to do effective therapy. In addition, meditation trains self-observation skills, which can also be beneficial to the therapist: “Becoming aware of one's primary interrupting factors can be diagnostically and therapuetically significant because one can clearly see unhealthy, habitual mental processes” (Deatherage, 1996, p. 209) . Buddhism also includes techniques for addressing anger, anxiety, forgiveness, and other psychotherapeutic issues. It can help patients go beyond merely recognizing their problems to healing them by complementing therapy and leading to new dimensions of wisdom and wholeness (Epstein, 1998) . Meditation has expanded as a psychotherapeutic modality into a whole field of mindfulness practices used in the treatment of both somatic and psychological problems (Kabit-Zinn, 1990) .

Other Asian spiritual practices have also influenced transpersonal psychology. Aikido is a Japanese spiritually oriented martial art that emphasizes working with a partner, not fighting against an opponent as in competitive tournaments. The essence of the practice is the blending of movement and breathing which physically creates harmony in a conflict situation.

Aikido has influenced the practice of transpersonal psychotherapy through the graduate program at the Institute of Transpersonal Psychology (ITP) founded in 1975 by Robert Frager. Frager, who studied Aikido with its creator, Master Ueshiba, has taught Aikido four times a week as part of a required mind-body healing course at ITP. Charles Tart (1992) incorporated concepts from Aikido in his influential theoretical work in transpersonal psychology. Aikido as an adjunct to therapy has been described in individual psychotherapy (Fagianelli, 1995) , adolescent treatment (Heckler, 1985) and family therapy (Saposnek, 1980) .

Yoga (Scotton & Hiatt, 1996) , Sufism (Deikman, 1996) , qigong (Mayer, 1999) , and many other Asian practices have been adapted as modalities for transpersonal psychotherapy (see Boorstein (1996) for case examples).

Nonordinary States of Consciousness in Transpersonal Psychotherapy

William James first explored how nonordinary states of consciousness can be induced and the value that they have for providing access to special knowledge that cannot be gained through ordinary consciousness. Many schools of psychology "adhere to an unnecessarily restricted view of the psyche [and refuse to] work therapuetically with spiritual experience and experiences of nonordinary reality" (Scotton, 1996, p. 3) . In transpersonal psychotherapy, induction of nonordinary states of consciousness has a respected place. Transpersonal psychotherapists have explored the healing potential of many states of consciousness, including those associated with meditation, bodywork, movement, dreamwork, guided imagery, prayer, drumming, chanting, sweat lodges, fasting, shamanic journeying, and psychedelic drugs (Cortright, 1997) . Anthropologist Michael Harner (1990) and Native American psychologist Leslie Gray (2002) have developed shamanic counseling approaches based on shamanic practices that induce nonordinary states (particularly drumming).

New techniques to induce nonordinary states have also been developed such as holotropic breathwork, an experiential procedure developed by Stanislav and Christina Grof involving several hour sessions of music, energy work, and hyperventilation to simulate psychedelic drug experience (K. Taylor, 2003) .

Therapist's Skills and Attributes Necessary for Effectively Utilizing the Approach

Scotton (1985) and Wittine (1989) have both posited requirements essential for those practicing transpersonal psychotherapy. These include

• Openness to the transpersonal dimension, including the belief that contact with the transpersonal realm may be transformative and healing.

• The ability to assess the presence and value of transpersonal experiences that occur in spiritual practices, dreams, visions, synchronous events or interactions with a spiritual teacher.

• Knowledge of a variety of spiritual paths.

• Ability to facilitate spiritual and nonordinary state experiences, both inside and outside of therapy, to promote transformation and healing.

• Active pursuit of his/her own spiritual development.

• Grounding in other psychotherapy approaches and psychological theory.

The transpersonal therapist's own consciousness and presence “provide the guiding light for the therapeutic journey” (Cortright, 1997, p. 238) . Therefore, transpersonal therapists are expected to continue to work on their own development and develop qualities of attention, clarity, compassion, and nonattachment. They should also have firsthand experience of transpersonal states in order to work effectively with those who seek guidance in dealing with them. Firsthand experience is often interpreted to mean having a discipline that provides grounding in spirituality (Walsh & Vaughan, 1996) .

Transpersonal psychotherapists must also be able to address the unique ethical issues associated with nonordinary states, such as ecstatic blissful states associated with mystical experiences and detachment associated with meditative states. “Adequate training to induce nonordinary sates of consciousness requires many personal therapeutic experiences as the client in nonordinary consciousness” (K. Taylor, 1995, p. 49) . Since clients in nonordinary states may also be more suggestible and vulnerable, transference, and countertransference issues can be heightened. The informed consent form should include comprehensive information about the kinds of experiences that may occur, agreements about touch, duration of sessions, availability of the therapist in case of distress, and therapeutic procedures, in addition to fees, confidentiality and the other informed consent requirements.

Strengths and Limitations of the Approach

Strengths:

Transpersonal psychotherapy provides a basis of theory and practice which allows for cross-cultural communication and for genuine dialogue with traditional healers, such as shamans and Native American medicine healers. Edwards (1995) , a South African professor of psychology, has noted that,

Transpersonal psychology has a number of features of its research and practice that make it particularly relevant to the South African context. It is a multistate discipline, which recognizes the importance of a variety of states of consciousness. Many counseling models adopt a unistate perspective…This position has made meaningful contact between African Traditional Healers almost impossible. Transpersonal psychology, with a perspective which is much less Eurocentric than many other approaches in psychology, provides a basis of theory and practice which allow for genuine dialogue with African Traditional Healers.

Limitations:

Transpersonal psychology has not achieved theoretical agreement among practitioners, such as cognitive-behaviorists and psychoanalysts largely have. There are certain commonalities to the major transpersonal theories of Abraham Maslow, C.G. Jung, Roberto Assagioli, Stanislav Grof, and Ken Wilber. All view transpersonal experiences as ones that go beyond both egoic and existential identity. All concur on the importance of spiritual experience. There is also basic agreement about what constitute basic spiritual qualities: compassionate, loving, wise, receptive, intuitive, spontaneous, creative, inspired, peaceful, awake, and connected ( Vaughan , 1991).

But “Where the theories fail to agree is in their conceptual understanding of the transpersonal self, and in their developmental psychology or explanations of how transpersonal identity may be achieved” (Daniels, 2002, p. 5) . The result is that transpersonal psychology has at times been splintered by contentious internal debates about the validity of competing theories. In addition, this lack of generally agreed upon theory has provided an opportunity for critics of the field to question its validity. When transpersonal psychologists petitioned the American Psychological Association for the formation of a formal transpersonal psychology division in 1990, the proposal was denied due to some concerns about the “unscientific” nature of transpersonal psychology. The second proposal, submitted shortly afterwards, was also denied, this time due in part to criticism from prominent humanistic psychologists like Rollo May who disparaged transpersonal psychology for trying to “leap across” the dark side of human nature, focusing on transcendent states and ignoring suffering, guilt, and jealousy. Albert Ellis attacked transpersonal psychology for an irrational belief in divine beings, a tendency toward dogmatism, and opposition to science. However, May and Ellis seem to have focused on New Age popularizations of transpersonal approaches, “a common confusion between transpersonal psychologists and ‘transpersonalists'” (Chinen, 1996, p. 13) . Currently there is no division within APA focused on transpersonal psychology, although the Division 32 (Humanistic Psychology) does include transpersonal psychologists on its board and and transpersonal presentations in its programs at APA Annual Meetings.

Indications and Contraindications for the Use of Transpersonal Psychotherapy

Because transpersonal psychotherapeutic approaches pay attention to and accept the importance of nonordinary states, they have been successfully used in the treatment of spiritual crises and psychotic disorders (both acute and chronic) (Lukoff, 1996) . Psychotic states of consciousness hold a special place in transpersonal theory. In Wilber's (1980) spectrum model of consciousness, psychosis is neither prepersonal (infantile and regressive) nor transpersonal (transcendent and Absolute), but is depersonal --an admixture of both higher and lower elements. Wilber (1980) writes: "[Psychosis] carries with it cascading fragments of higher structures that have ruinously disintegrated" (p. 64). Thus, he continues, psychotic persons "often channel profound spiritual insights" (p. 108). However transpersonal psychologists do not view psychosis as a higher state, but as one that is problematic for both the individual and society. Some individuals have been able to benefit from such experiences, but the potential for a tragic outcomes and lifelong impairment suggests that alternative paths to such breakthroughs through therapy and spiritual practices are safer and more reliable.

The two case studies in this chapter concern patients who had psychotic episodes and were able to integrate their experiences through transperonal approaches. While long-term follow-up studies documenting the effectiveness of transpersonal approaches and which kinds of patients are more likely to benefit from them have not been conducted, case studies such as the ones included here have included long-term follow-ups with successful outcomes. Some criteria have been proposed to make differential diagnoses between serious psychotic disorders which may require hospitalization and medication, and spiritual emergencies (Lukoff, 1985) . Even with mental disorders, acknowledging the powerful and often positive transpersonal experiences that occur in psychosis is often helpful to develop a therapeutic alliance necessary for ensuring medication compliance (Jamison, Gerner, Hammen, & Padesky, 1980) .

Transpersonal approaches have also been used in addiction disorders, which have been viewed as a misguided “spiritual thirst” for connection with a higher power (C. Grof, 1993; Miller, 1990) . The nonordinary states involved in many drug addictions have been addressed through the use of transpersonal interventions to induce alternative nonordinary states (Peteet, 1993) .

Transpersonal psychotherapy has also been applied to death and grief by incorporating the insights from spiritual traditions which address these issues (See Journal of Transpersonal Psychology articles (Garfield, 1975; Leslie, 1976; Lieff, 1982; Richards, Grof, Goodman, & Kurland, 1972; Waldman, 1990) . This is another area that has been heavily influenced by Buddhism, including books such as the Tibetan Book of Living and Dying (Rinpoche, 1994) .

Cultural and Gender Considerations and Issues

Some religious and spiritual beliefs and practices include values and images that are patriarchal (Campbell, 1972) which, if adopted in their original form, can be repressive toward women. However, the transpersonal perspective is generally very accepting of feminine values and feminine religious iconography (e.g., the article in Journal of Transpersonal Psychology entitled The Feminine Principle in Tibetan Vajrayana Buddhism: Reflection of a Buddhist Feminist) (Asante, 1984) . ATP conferences have included many presentations on feminine spirituality by Jean Bolen, June Singer, and others.

Studies have consistently shown that patients would very much like their health care professionals to talk with them about spiritual needs related to their health problems, and only a small percentage (5-10%) of US population is not comfortable with explicit religious or spiritual concepts, language, and practices (Koenig, McCullough, & Larson, 2001) . Thus transpersonal therapists, by explicitly acknowledging the importance of spirituality, are more aligned with the majority of the population who want to have sensitive and informed discussions about spirituality with their healthcare providers.

Expected Future Developments and Directions

Many of the major political conflicts in the world are drawn along religious lines. Transpersonal Psychology can contribute to interreligious dialog in an increasingly global context that could aid in the resolution of contemporary conflicts (Rothberg, 1990) .

In the future, transpersonal clinical approaches will greatly expand and evolve, often without using transpersonal psychology constructs. Forgiveness practices based upon diverse world religions are becoming widely utilized to address group conflicts and in individual psychotherapy (Luskin, 2001) . Another example is the positive psychology movement spearheaded by Martin Seligman, Ph.D., former president of the American Psychological Association. In a study, he reported that one of the major statistical buffers against depression is serious religious commitment (Sethi & Seligman, 1993) , and he has declared that spirituality and religion have a major role to play in addressing the epidemic of depression sweeping across the U.S. and other countries (Seligman, 2001) . Another example is mindfulness interventions, originally the province of transpersonal psychology, but now widely incorporated in the burgeoning field of complementary and alternative medicine. Spiritual healing and shamanism, also foci in transpersonal psychotherapy, are being investigated as spiritual interventions in complementary and alternative medicine (http://nccam.nih.gov).

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