Transpersonal Perspectives on Community Mental Health

Adam Neal (00:05): Welcome Dr. Suzanne Adams to the pathways to heart podcast. It's so great to have you with us and thank you again for agreeing to spend this time with me. Suzanne Adams (00:16): Thank you, Adam. Thanks for having me. It's really honestly, an honor. Adam Neal (00:21): Wonderful. Yeah, so to get started you've spent about 15 years as a mental health professional and a clinical psychologist. And you actually graduated from the Institute of Transpersonal Psychology now, Sophia in 2012. So I was wondering if there are any shifts that you've noticed in the way that the clients you have disclosed or describe or deal with transpersonal issues or experiences Suzanne Adams (00:53): Now I think this is a really interesting question and I kind of have two ways of answering it. One is, I don't think so. <Laugh> I think partly why I'm saying that is because I think most of the changes that I may or may not have experienced over the years in terms of how clients talk about transpersonal experiences, more stems from how I orient myself to the work. And part of what came up for me as I was thinking about this question was, when I was in graduate school and doing my practicum, or even immediately doing my post doc or those first few years of my career, I was so immersed in the transpersonal world. And what was ITP or is now Sophia that it's almost like you look for those things more heavily than when you're not really immersed in that kind of a world. Suzanne Adams (01:51): So I'm not sure that it really changes how clients speak to me or disclose to me those experiences. But I do notice that by way of how I orient myself to the work, how I describe myself, especially on my website or in initial meetings with clients or in consultations, I'm very explicit about being a spiritually oriented existential transpersonal psychologist. And really what that means is for me, like a holistic approach to psychology, where we talk about spirituality and experiences that people might have had. And I do feel like it draws a certain clientele into the practice, especially in private practice. And in community mental health, frankly, I think that's kind of a whole other topic of conversation because I think the way spirituality is talked about in community mental health is different in a lot of ways and can be pathologized in a lot of ways. And so I think my answer to that question sort of stems from other answers that other questions that you've asked me later on in <laugh> the interview. Adam Neal (03:03): Sure, sure. So, yeah, being even a bit anticipatory as to all the things that might come up during this. And so one thing that came to mind for me as you were talking is just about your stance as a transpersonal practitioner and kind of opening up those possibilities for clients to potentially describe or disclose things that have happened to them. And the pathologizing part that you were starting to speak to it does kind of go into what I was going to ask you next, which was about community mental health settings and how you find that you or colleagues of your approach, different kinds of transpersonal issues, whether they're religious or spiritual, the DSM, the most recent version, the DSM five adding the spiritual religious category of experience to that. So are there ways that people have been honoring those, those possibilities of spiritual religious issue within those structures of assessment diagnosis, treatment planning, that are so much a part of community mental health services? Suzanne Adams (04:22): Yeah, it's such a complex question. I think that there's a fair amount of difference between private practice clients and community mental health clients in terms of more often in their religious or spiritual orientations and, in my experience. And so therefore the kinds of spiritual issues or, or symptoms quote unquote that might arise take on a different tone, a different category. So in community mental health specifically I have found over the years, clients are more readily able or willing to discuss transpersonal experiences or spirituality. It often comes up when we talk about resources or strength-based aspects of their life. So if we're talking about documentation and how that relates, if we're doing an assessment or a treatment plan, part of what we're asking is what resources do you have to draw upon that support you during this time? Suzanne Adams (05:34): And spirituality or religion is often a big one, especially in community mental health. And then in terms of symptoms, I think we kind of ride the fine line between what is a spiritual experience and what's psychosis, and how we can differentiate between the two, if there's even a need to differentiate between the two. So for me, part of what's come up over the years is about holding space for the possibility that what might be traditionally seen as psychosis in a community mental health client might be real and certainly is real to that person. And so the focal point isn't necessarily the reality quote, unquote of the experience or the phenomenon, but whether or not it's distressing to that person. And does it impede their functioning or is it in fact a strength that they can talk to their past ancestors or that they believe they have a deep intimate relationship with a goddess or a God, or that they've had, you know, a spiritual emergence of some kind? Suzanne Adams (06:44): I think often too, in community mental health, sometimes these spiritual experiences are protective mechanisms, right? Like I've often come across clients with delusions of grandeur or erotomania and now sure, again, it's possible that these narratives are real more that their symbolic of something else, right. That there's a kernel of truth related to those stories that can give us information about this client's life and give us this historical context about who this person is or who this person was before they ended up in a community clinic or a shelter sitting in front of us. So, and then I think in terms of like documentation, I think there's a, what I call like a sacred separateness between how I hold the truth of a client and their transpersonal or spiritual experiences. And then how maybe if I do write about that in an assessment or a treatment plan. Suzanne Adams (07:57): And so, yeah, I think it's about kind of hard to explain, but I think it's about who our audience is and then kind of holding the space and this fine line. And I think leaning a lot on what I was naming earlier about, about someone's level of distress or someone's level of functioning around it. And in private practice, I think I've noticed when clients talk about spiritual experiences and specifically if it was like an emergence or a spiritual emergency that simply giving clients that kind of framework and being able to document it in a similar way that I might in community mental health. I think it has been a good approach and normalizing a lot of those experiences, no matter what the population of people, can be incredibly useful. And I think the other thing that I'll say here is mindfulness has become such a big part of the therapeutic world in the last few decades. Suzanne Adams (09:10): And specifically I think in California, in the Bay Area, in the last decade or so that mindfulness is kind of the catchall word for spirituality when it comes to therapeutic work. And so it becomes something that's in like most treatment plans that I write, or most progress notes that I write. So we're going to do a mindfulness practice, really, we're going to meditate. And really, we're going to try to kind of get in touch with our spiritual selves because there's something strength- based about connecting to that part of my psyche or connecting to the universe in that way. I'll let you talk. Adam Neal (09:50): Yeah, well, such beautiful points that you've brought up in terms of not only how to, how to support the integration of the transpersonal within community mental health settings, and even within the private practice setting, but also to, and I loved your phrase sacred separateness that, in being an informed a trans personally informed practitioner, that we are able to provide certain frameworks and to normalize things like spiritual emergency like other kinds of experiences that people have had that they might not feel comfortable sharing with a practitioner or provider who is not as, as informed about these things. And maybe that there are ways in which those providers are unwittingly taking that out of the realm of possibility and those clients would decide not to disclose certain things. And I appreciate you mentioning that kind of distinguishing distress from potential strength or, or benefit. Mm-Hmm, <affirmative> because, if someone has a particular you know, belief that is serving them in a beneficial way, then why pathologize, why decide that it can't be serving them and that it's important to somehow reality test it away or something like that. Suzanne Adams (11:18): Right. Adam Neal (11:19): So thank you for those insights. It's so important. Suzanne Adams (11:24): Mm-Hmm, <affirmative>, Adam Neal (11:25): I wanted to talk a little bit about of the specialized research that you've done relating to the LGBTQ plus community and whether there are any particular transpersonal issues or experiences that you found seem to be more prevalent among this population, or that have come up in ways in working with these individuals Suzanne Adams (11:52): Mm-Hmm <affirmative>, I, I think this question is so fun and can send us down many, many rabbit holes, like I was saying earlier. I think what comes up for me the most is the transcendent nature of queerness in general, right? That even the word or the category of queer using that obviously as an umbrella term for orientation and gender it, I think it denotes something that is beyond definition and is beyond a boundary it's kind of inherently transpersonal, right? It's beyond the personal, it's something else. And so I think inherently, as we can see from other cultures and societies, I think a really easy reference point would be in Native American culture, like two spirit people, for example, being really revered in those communities as spiritually transcendent. And so, I think for some people, there is a spiritual nature to identity and the fluidity sometimes that can come as a result of identity. Suzanne Adams (13:09): And even in so far as sexual practices or sex acts or relationship or love styles, when we talk about the prevalence of open relationships, polyamory, BDSM, within the queer community and there's the spiritual research and phenomenological experiences that can come from those kinds of modes of being those kinds of sexual or relational behaviors. I think it should also be noted that what is spiritual or transpersonal especially for someone who identifies as LGBT in whatever way, might also be a point of trauma. Right? I've seen many clients over the course of my career who have been ostracized from family or ostracized from spiritual or religious communities because of that identity. So I think it's a both-and situation and something that perhaps should be viewed through a trauma-informed lens. Other things that pop up in my mind are, of course, my dissertation is about transpersonal sexual experiences among identified people both in gender and in sexual orientation. Suzanne Adams (14:29): And so that's come up with clients and in practice over the years. And the other piece that popped up for me as I was thinking about this question is, particularly earlier on in my career in mental health, I was working a lot with men in San Francisco and specifically gay identified men in San Francisco. And in most of those cases, we would speak about their use of substances and specifically like crystal methamphetamine and its impact on their sense of oneness with their partners, especially during sex. And they would often describe this as a spiritual experience as a transpersonal sexual experience, for example, despite or because of the substance use. And so that became something that was really interesting to work with is we have something that might be problematic in terms of like a substance abuse issue. But then we have something that is beautiful and transcendent and connective in multiple ways. And so, that became an interesting point of this therapeutic work. Those were most of the things that popped up in my mind as I was contemplating this question. Adam Neal (15:53): Yeah. And there's so much to be said as far as the way in which substance use has informed a lot of different areas within transpersonal psychology. I'm thinking about the use of psychedelics and other substances. Yeah. As ways of maybe experiencing something transpersonal, transcendent, mystical mm-hmm <affirmative>. And to your point about trauma, there is certainly that connection between being, having been traumatized because of one's identity because of one's sexuality and a minority status, and maybe needing, or feeling like those substances provide a way to surrender or not to feel as restricted. In order to experience those kinds of intimate connections to people. So there's something really fascinating there that I think what you were mentioning about that connection and how within different sexual minority communities that maybe that there is that need to address trauma and how there might be ways to get at transpersonal experience through, through other means that might be other <laugh> that might be among other populations. Suzanne Adams (17:25): Yeah. Part of part of what pops up for me in response to, to what you just shared to Adam is this recognition that I think, like most people, we often seek some form of escapism and whether that's food or television or sex or drugs or whatever it is, or even healthier ones like walking in nature or meditating, all of these kinds of things that substances provide us with a quick access to that escapism. And that escapism is often transcendent in and of itself, kind of no matter how we get there. And so again, I think we're kind of riding that line of like pathology or functionality and recognizing that like you said, it is a vehicle that we can use to access higher levels of our consciousness or deeper experiences of connection with other people or some kind of universal force. And to your point, how can we access that perhaps without something that could be so harmful? Adam Neal (18:32): Yeah. And there's even this intimate parallel that I feel like is coming up and what you're saying about society's readiness to accept the transpersonal in relation to society's progress in accepting individuals of different sexual identities, orientations, practices, even just the word, you know, a word like transpersonal, like that indicates this kind of going beyond or expanding. Yeah. That connects to a word like transgender, which could also be seen as moving beyond gender mm-hmm <affirmative> depending on someone's way of perceiving it. Absolutely. So thank you. Yeah. For, yeah. bringing all that up. And so I wanted to get a little bit into your work as a, a clinical supervisor somebody who has the opportunity to support others, other clinicians and providers in their work, and any ways that you feel like you've been able to support, let's say associate therapists, pre-licensed providers in navigating transpersonal experiences that come up during supervision, whether it's their own or those of clients that they're seeing. Suzanne Adams (19:57): Yeah, absolutely. Similar to my work with clients, I do the same spiel about myself and about my orientation when I'm beginning clinical supervision with a supervisee and specifically identify myself as a transpersonal existential spiritual oriented therapist and spiritual oriented supervisor specifically. And so I think often, like we were saying earlier that introduction provides this open space in terms of disclosure and dialogue, additionally depending on the circumstance and depending on the relationship with the supervisee or what's being presented, I will disclose my own personal experiences my own, you know, sexual transpersonal experiences, my own kind of more psychic, medium experiences that I've had over the years. And it's been interesting to note that specifically I have one supervisee right now who also went to a transpersonally oriented school. So we share this orientation with the work and share this with each other. Suzanne Adams (21:12): And speaking with her specifically around this sort of phenomenological experience, I've noticed over the years, and I've spoken about in my own therapy, is this kind of sense of like “psychicness” that can arise. And I use that word for lack of a better one with clients where, as an example, and I know Adam, I think you and I have talked about this separately, but when I'm working with a client often it feels like I'm not necessarily thinking a whole lot. Right? My cognitive activity doesn't necessarily feel like it's online. It feels almost like I'm getting information from somewhere else. And I'm a very somatic oriented person. So obviously some of that is bodily. But there's also sometimes information that feels just like it drops in. And like it drops in from perhaps a collective consciousness or the shared energetic or shared psychic space that I have with a client or I have with a supervisee. Suzanne Adams (22:13): And so sometimes I'll share an image that pops up in my mind with a client or a supervisee or a phrase. And more often than not, I would say nine and a half times out of 10. They're like, I was just thinking about that. Or that's like a perfect analogy or metaphor. That's the exact word that this feels like. And again, it's not something that comes from my brain. It feels like it's something that comes from a higher source of information or possibly just this kind of collective space. And recognizing that that's a tool I think I utilize and lean on in clinical supervision too that not only am I having to get a sense of the person who's physically in front of me, but I'm also having to get a sense of someone who maybe I've never met before, right. Suzanne Adams (23:03): Of my supervisees client. And so, then there's this wider collective consciousness, I think that exists. And some things that can get picked up on in that sort of shared cognitive shared transpersonal realm. The other piece that pops up in my mind is around the use of nature in clinical supervision. Obviously I think because of the COVID pandemic, we've had to get kind of creative in terms of how we provide supervision to people. And more often than not, it's been virtual. So you're staring at a computer screen all day long and doing that. And I work with other psychologists who also do like walk and talk supervision, and obviously we're conscious of confidentiality, but I've been utilizing walk and talk supervision, or like ecotherapy, or eco supervision a little bit more with my supervises. Because one, it creates the separateness from the virtual space and the screen. But two, I do really feel like nature provides this openness for our consciousness that we might feel really limited by when we're sitting in the same office and we're staring at the same screen and we're just hitting the end session, start session button over and over again, rather than walking in the woods and hearing the birds. And I do think it provides for a, a wider consciousness for the work when we give ourselves the container and a more diverse container to do so. Adam Neal (24:50): Yeah. And the idea of being able to share experience and to share it in ways with clients and with supervisees that accounts for other ways of knowing, I think that was what I was kind of gleaning from what you were saying that first of all, to be, to be transparent in ways about our own experiences, as a way to validate, to normalize that it happens for us and that it's okay to let the intellectual side go offline here and there so that we can have space for the other ways of knowing. Its so important. And I think so missing from a lot of the work with providers who feel so much pressure to be very intellectual and, and focused on, you know, substantiating every moment in all of these intellectual ways. <Laugh> Suzanne Adams (25:52): Yeah. I appreciate that a lot. I, especially that phrase, other ways of knowing and part of what came up for me as I was thinking about this question and in response to what you just shared too Adam is I think often, especially as a clinical supervisor, working with younger clinicians, folks who are earlier in their experience of being a therapist ,that I think there's often this anxiety or nervousness around doing the right thing or using the right intervention or the right modality in this kind of heavy pressure that we can put on ourselves as though there is a quote unquote like right way of doing it. And perhaps I guess part of what I'm offering is the option to sort of dial down that pressure and dial down this idea that you should lean so heavily on a specific intervention or modality or orientation, and perhaps let something else work through you, let some other way of knowing come through and whether that's somatically or psychically or spiritually or, or otherwise, I think it's just important to remember that we're multifaceted tools in the room. Suzanne Adams (27:08): We don't necessarily always have to lean so heavily on in evidence-based practice as it were. Adam Neal (27:15): Sure, Yeah. And we're always talking about this notion of attunement, and empathic attunement and what, what becomes such a part of that is that willingness to really let someone else have that impact on us and to be sharing that impact and that there are those ways of knowing that feel psychic, telepathic mm-hmm <affirmative>, or just deeply connected that can be accessed because we're truly joining with someone and even allowing ourselves to be in nature, as you said. And to, to not feel the necessity of containment in very traditional ways. <Laugh>, Suzanne Adams (28:05): Mm-Hmm, Adam Neal (28:06): Yeah, Suzanne Adams (28:07): Absolutely. Adam Neal (28:10): Well over the past few years there have been very in terms of talking about containment and ways of being with others <laugh> there have been a lot of efforts nationally in the us to improve diversity, equity, inclusion, accessibility among different organizations and institutions. And there's been a lot more visibility around this, a lot more work around this. So I'm wondering, having worked with people of all different cultural backgrounds, and as a transpersonal provider, if you think there are any particular lessons that could be learned through the use of a transpersonal approach that would support notions of diversity that might elude those who don't have the same kind of informed backgrounds. Suzanne Adams (29:13): Yeah. Such an interesting multifaceted question. When I think about DEI policies or procedures and in particular, I think the way that shows up in individual people or in communities of people and I'll also use because I’m also LGBT identified that I'll use the LGBT community as an example. It's often said that we, as members of the community are able to identify in all of these kind of diverse, unique, special individualized kind of ways, and that's beautiful and unique and having ownership over our identity. And there's also something that becomes kind of self-segregating as a result. Right? I'm this. And so I'm not that. And so therefore we can't really relate to each other. And I think there's, there is the, a little bit of that slippery slope, and I'm not saying that that's the case across the board or for every single person or community of people. But I do think that that can be a side effect. And so I want to kind of hold that space and then pick up something else and I will merge them together. The other thing I want to pick up is oftentimes when I've spoken with people about my career in community mental health, but then also having a private practice people often ask what the difference is Adam Neal (30:46): Mm-Hmm <affirmative>. Suzanne Adams (30:47): And my response is that there really isn't one. That ultimately, I think it's as simple as recognizing the commonalities that we all have as human beings. And I think inherently that is a transpersonal approach that it's beyond identity and ego and segregation and all of these things; it is about oneness in a lot of ways. And I think at the core, despite socioeconomic disparities, specific to community mental health and private practice, that we are all the same, we want to be seen and heard for who we are. We're all trying to figure out who we are and how to be seen and heard for who we are. We're all seeking sameness and uniqueness simultaneously. We all want safety and security, adventure, and mystery. We want to belong and we want to be loved. And I don't think that that changes just because of how we identify ourselves or what policy and procedure we're trying to follow that ultimately, as a transpersonal psychologist in the room with clients, I think that is the ultimate truth. Adam Neal (32:13): Beautifully put. Yes. And it makes complete sense. I think in this cultural moment of identity becoming almost commoditized that yeah, people are so encouraged <laugh> to identify a certain way that, and I loved your term self-segregating that people are almost being encouraged to almost overly identify in a certain way to kind of overcompensate almost. Suzanne Adams (32:45): Yeah Adam Neal (32:47): Yeah. It just makes me wonder about ways that as transpersonal providers, we can kind of hold both or hold all that someone, a client might be coming from a place of feeling that need to self-segregate based on what they've gone through or continuing to go through. And also honoring that we can be supportive in those transcendent ways as well. Mm-Hmm <affirmative> so, yeah, I'm just curious as we kind of are bringing our time together to a close. Anything that comes up around that, a client who for example says this is my identity and I feel very unable to move forward or feel very oppressed as a result and how we can hold that? Or there ways that we hold that? Suzanne Adams (33:56): I've certainly worked with clients who have expressed that and felt that way specifically the couple of clients that pop up in my mind are trans-identified people and were in the process were just post affirmation experiences. And largely what came up around oppression were systems of oppression, specifically the two that pop up for these particular cases that I'm thinking about were religion to name one that we have already spoken about. And the isolating that resulted from that religious experience and feeling like she could not find her community or her faith because she had been ostracized. But she still believed. And so that being a really challenging thing to navigate in a new quote unquote, like new body Suzanne Adams (35:00): Mm-Hmm <affirmative>. The other system that pops up of oppression is just the medical system of oppression, especially when we're talking about trans folks and going through the affirmation process where the idea that insurance will only cover your quote unquote transition. If you've seen a provider for a year and they diagnose you with a specific code and they write you a letter of support that as though there is not a trust in someone's own personal experience or self-assessment, that it requires a mental health or medical professional to validate someone's identity, is a really incredibly difficult thing to navigate. And so I think as a transpersonal psychologist, being able to hold space for those systems of oppression, but then to allow for like, yes, you need a letter from me, but do I care about the diagnosis that I'm giving you? Suzanne Adams (36:04): Do? I think, do I rely so heavily on that? Is that something I ascribe to? No. And so we're just kind of playing this game and our work is going to be about something deeper and more important. That's about community and belonging and strength and knowing yourself and figuring out how you want to move in the world now. So I think there's a way in which as a provider, we do have to kind of work in some of these systems of oppression as we talked about insurance and documentation earlier, but that we can also hold space for our individual clients that's beyond that. And that's far more compassionate. I hope that answers your question. Adam Neal (36:48): Okay. Absolutely. Absolutely. Yeah. Well, I want to thank you so much again for your time and your insight. It's been such a pleasure getting to have this time with you. Thanks again for joining us. Suzanne Adams (37:04): Thank you, Adam. I so appreciate the invitation to be here and to reconnect with my old school and yeah. If anybody has questions, I strongly encourage you to reach out. I'm sure Adam will share contact information. And I just so appreciate the time to kind of reconnect with this material and this framework and this mindset. Thank you, Adam. Appreciate you.