Part 4: The bridge of relationality
The Fall of 2024 began and we stepped into our final clinical practicum. Three days a week in practicum, and two days a week in class and seminar. The seminar is a Friday class that we attend every week until the end of the program. Thursday is a full class day, and that topic and professor shifts every six weeks. These classes have an emphasis on studying the DSM (Diagnostic and Statistical Manual of Mental Disorders), writing case reports, and learning and practicing more models of practice. It is our seminar class that has the capstone project as the final piece to conclude our program, and our first paper was on the topic of discussing the foundational theories we currently align with and how we envision them informing our practice. This was an important piece of work I composed and that I revisit in many ways as I substantiate myself within the clinical environment.
Bridging Theory to Praxis
Critical clinical practice requires more than being grounded in anti-oppressive theory; the transition from intention to embodying is also essential (Brown & MacDonald, 2020). The purpose of this paper is to bridge that gap, within my current area of specialization of psychedelic assisted therapy, through the lens provided by regulation theory, critical theory and the foundational influence of relationality common in Indigenous worldviews.
Relationality
I begin this journey by offering context as to what relationality means in both western social work and within the commonly shared epistemological and ontological Indigenous worldviews. In the western context, practicing relationally is central to social work’s values and requires the ability to recognize and work within the interrelated facets of “the individual’s immediate social context and wider social structural issues” (Winter, 2019, p. 158). Within an Indigenous conception of relationality, Wilson (2019) invites us to expand our understanding, saying, “[r]ather than viewing ourselves as being in relationship with other people or things, we are the relationships that we hold and are a part of” (p. 80).
At first glance these two approaches to relationships may appear to be the same or at least similar, however, the culture in which a concept comes from is what shapes both how a brain in that culture learns as well as how that brain decodes information (Siegel, 2023, p. 27). Western culture prioritizes a top-down approach that begins with the mental construction that we are individuals and separate, whereas an Indigenous perspective begins with a ground-up or outside-in approach as a collectivistic culture, and this leads “one to construct a perception of the whole with a wide focus of attention” (Siegel, 2023, p. 27).
Prior to colonization, our Indigenous brothers and sisters from around the world shared sentiments of one-ness with nature, spirit, source, and everything that there is (Okun, 2023; Siegel, 2023; Wilson, 2019). A one-ness that was described by Black Elk, a medicine man of the Oglala Lakota people, with the poetic description: “The center of the universe is everywhere. Everywhere. That means we’re intimately related” (Neihardt, 1932, referenced by Siegel, 2023, p. 40). The myth of the solo-self may be one of the most catastrophic echoes from our shared experiences of the “colonial shattering of identity…a wound inscribed at the heart of an identity no longer coinciding with itself" (Drichel, 2013, p. 40). Lakota scholar Tiokasin Ghosthorse (2021) highlights the English language as perpetuating this sense of separation and isolation, as a noun-based objectification that is inherently dominating, riddled with phrases, cultural narratives and expectations that seek to possess and contain. We cannot liberate ourselves or wake ourselves up with the same language that put us asleep or boxed us in (Ghosthorse, 2021).
To grasp the difference between being in relationship with something or someone and inhabiting the whole or being the relationship that we are a part of, Siegel (2023) suggests we must awaken from the illusion of the solo-self and “its noun-like self-reinforcing isolation, and rejoice in our revelation of the reality of a self that is broader than any one individual as we integrate our identity and broaden our belonging into the wider world of our life on Earth” (p. 30).
This reminds me to pause and to bring mindful attention to the music beneath the words and non-verbal cues I choose, as I am interested in perpetuating connectivity and collaboration while deconstructing isolation and dis-ease. I want to invite others into this ground-up and outside-in approach to relationality as a way to re-center our hearts in the relational space we inhabit and co-create as individual AND collective beings (without over-emphasizing one over the other). It is this understanding of relationality that I choose to embody, practice and invite others into as I am informed by regulation theory and critical theory in my ongoing practice (aka praxis).
Regulation Theory
Regulation theory has emerged from the influential work of several infant research and child development psychotherapists, chiefly Bowlby and Ainsworth’s Attachment Theory, and further enhanced with neuroscientific research that explores the discerning qualities between right and left brain hemisphere modes of processing and functioning (Schore & Schore, 2014, p. 181). Regulation theory contributes to the field of interpersonal neurobiology with its assertion that “the emotional environment provided by the primary caregiver shapes, for better or worse, the experience-dependent maturation” of the right-brain hemisphere (Schore & Schore, 2014, p. 180). Developing right-brain qualities equates to more interconnectivity in this side of the brain, which results in a more collaborative brain system in multiple ways:
Improving mental and emotional flexibility,
Enhancing ability to efficiently and effectively self and co-regulate nervous system(s), and,
Develop capacity for understanding, including and communicating feelings (Schore & Schore, 2014, p. 190).
Specifically, regulation theory seeks to utilize the therapeutic relationship to repair and update developmental gaps and ruptures in the client that were perpetuated by the lack of right-brain to right-brain attunement during key stages of early life (Schore & Schore, 2014). This type of relationship looks like an adult who models what it is to listen and validate, ensuring the other (the child) feels heard and worthy/loved. Our sense of belonging is first accessed in this primary relationship, as our caregiver helps us make sense of what we feel with mirroring and co-regulation. If we haven't had enough of it, we might not trust or feel validated in knowing our inherent and internally driven sense of belonging. We learn who we are in relationship with others.
In therapy, it is the right-brain to right-brain attunement between practitioner and client that is the cornerstone of Regulation Theory (Schore & Schore, 2014). In this relationship with an attuned other, we access a shared space and experience of connection where we co-create with a ‘self-state sharing’, learn how to express nuanced aspects of our experience, feel seen and heard, and respond to the cues and signals of another (Schore & Schore, 2014, p. 186). Our identity or sense of self is constructed first in our primary relationship as a child, and these same neuronal frameworks are re-purposed in our relationships as an adult. Where there is a stored relational rupture in someone’s psyche, there may be reoccurring struggles related to an unhealthy relationship dynamic. There is possibility of updating and healing by way of an attuned therapeutic (or generally, loving) relationship engaging in the relational process (Schore & Schore, 2014).
Critical Theory
An integral piece that I will continue to be informed by is Critical theory and its evolving, multifaceted scope (Rowe et al., 2015, p. 301). In social work, critical theory is explicitly political as it strives to transform society by empowering individuals while revealing power structures that are unjust (Rowe et al., 2015). Empowerment and self-care without the understanding of the immense impact of larger systems, i.e.., cultural, societal, tribal, global, historical, and the collective zeitgeist, is short-sighted and perpetuates harm. Rooted in sociology and philosophy, critical social work indicates that our self-perception is an emergent quality derived from cultural narratives that we internalized (Brown & MacDonald, 2020, p. 29). We must step back and consider these cultural narratives to truly empower the individuals of a collective existence.
To understand critical theory I find it helpful to reflect on how it has supported revolutionary resistance through postmodernism, feminism, narrative therapy, queer theory, and decolonizing approaches (Brown & MacDonald, 2020). These approaches invite us to challenge various notions, such as that there is an absolute truth and we can organize reality into dualistic categories (Brown & MacDonald, 2020, p. 28). It also helps us to recognize how the idea of truth is a form of power, and how social constructions, narratives and essentialist categories tend to reinforce imbalances of power (Brown & MacDonald, 2020, p. 28). These problems are often amplified by the way in which oppressive dominant narratives tend to be internalized (Brown & MacDonald, 2020, p. 28). These ideas align with regulation theory and the Indigenous worldview of relationality as the development of the right-brain hemisphere is well-suited for handling complexity as an inclusive, non-linear mode of processing that creates space for ‘both/and’ (McGilchrist, 2019). The right-brain hemisphere defaults to presence and inhibits certainty by recognizing the multitude of possibilities and perspectives alive in each moment, knowing there is always more to discover and explore (McGilchrist, 2019). This humility and curiosity inherent in the right hemisphere curate's resonant relationships that allow space for differences and encourages uniqueness. Additionally, right-brain to right-brain attunement is a form of connecting and communicating that tends to include what is felt and expressed beneath words, making it a proficient access point for the non-verbal and pre-verbal storage of internalized oppression and trauma (Schore & Schore, 2014).
Research, Relevance and Reservations in Psychedelic Assisted Therapy
Psychedelics target dendritic growth and cause metaplasticity in foundational aspects of identity and social relationality that are predominantly wired during critical periods in early development (Nardou et al., 2023). This supports the importance of therapeutic assistance during psychedelic experiences as that relationship acts as a guide and becomes an increasingly important model for re-learning perspectives and emotional engagement with self, spirit, others and the world in a way that increases wellbeing. The right-brain to right-brain attunement featured in regulation theory becomes even more prolific in the use of psychedelics as the possibility for increased efficacy in learning self and co-regulation is amplified as recent research has highlighted psychedelic medicine as a means to reopen critical social learning windows (Nardou et al., 2023).
Some areas for careful attention in this field include the possibility of continuing to perpetuate the neoliberal agenda by way of cultural appropriation, and the medicalization and privatization of psychedelics (Celidwen et al., 2023; Devenot, 2023). Indigenous Nations are not routinely recognized nor are they profiting from this industry that is primarily privatized or operating illegally “underground” (Celidwen et al., 2023). While there are steps to follow - outlined by Indigenous populations - regarding the respectful and reciprocal process to engage with medicines in a ceremonial and spiritual way (Celidwen et al., 2023), I am also guided by critical theory and relationality to explore ways that I can steer clear of individualizing mental distress and continue to question and challenge the systemic oppression and structures of power that are invested in maintaining the solo-self (Gearin & Devenot, 2021; Siegel, 2023). In order to engage in therapy through a decolonizing lens, Mullan (2023) makes it clear that we are not to focus just on childhood trauma and neurodevelopment, there must also be the inclusion of a present day cultural and historical generational trauma lens (p. 365).
The term psychedelic was coined by English psychiatrist Humphrey Osmond, and could be interpreted as perpetuating an anthropocentric perspective with its meaning of “mind manifesting” (Christie, 2024). However, through the lens of relationality and the examples we have within many Indigenous cultures that have used non-ordinary states of consciousness for ceremonial and medicinal purposes, “mind manifesting” can be understood as eliciting notions of connecting with the mystical, and re-balancing ones connection and relationality with spirit, land, life, and others (Christie, 2024). Psychedelic medicines are often described as ‘non-specific amplifiers’ (Christie, 2024; Wolfson & Hartelius, 2022) which have the similar qualitative experience of expansion from the solo-self to the space of intraconnection or oneness. However, experiences of oneness could amplify authoritarianism, narcissism and hierarchical and harmful power imbalances if that is the foundational cultural narrative and internalized structure we leave unquestioned (Devenot, 2023). In other words, ‘the medicine’ is not the medicine without the inclusion of right-brain to right-brain therapeutic attunement within the Indigenous worldview of relationality and critical theory as our guides.
Alignment and Potential Disparity with my Values and Experiences
I was raised in a religious household and community until I was 16 years old. I recognize now that the process of leaving that belief system presented me with the opportunity to deconstruct a cultural reality. This required the hard neural work to release what I internalized and develop a new worldview based on a new personal narrative that manifested through my relationships. The bouts of existential paralysis I experienced, in hindsight, were essential as I flailed in the loss of the illusory ground on which I once thought I stood. With the support of bodymind holistic frameworks and psychedelic ceremonial experiences, in group and one on one with an attuned facilitator, I found my own spiritual and healing path.
As a byproduct of many years of practicing and benefiting from the Internal Family Systems (IFS) model, I have developed a personal affinity for the concept of a Higher Self (Schwartz & Sweezy, 2020). Within the IFS model, we guide client’s to access qualities innate to their Higher Self (such as compassion, curiosity, confidence, perspective, playfulness, etc.) as we curate and model healthy relationality with the goal of supporting the client to repair internal relationships between their Higher Self and their many parts (Schwartz & Sweezy, 2020). Fatimah Finney (2024) suggests that rather than trying to operate as our Higher Self, consider that we are the dynamic relational space where Self and parts are learning to work together. For many of us, this is a process where Self is learning how to be the leader of our internal system and our parts are learning how to let go of control and fear and open up to allowing this leadership. It is through our parts that we feel more Self, and as we are in relationship with them they learn that they can soften and step back as Self energy leads more fully (Finney, 2024). This same complex dynamic relational field resides within each one of us, and is the same relational space we inhabit in our external relationships.
Critical theory surmises there is no core essential self, rather, our sense of self or identity is both limited and expansive based on dominant narratives (Brown & MacDonald, 2020, p. 25). While IFS appears initially to be in direct conflict with critical theory, as Higher Self is akin in many ways to an essential core self, I question whether this conflict is irreparable. Perhaps the specific meaning, the worldview it comes from, and how one wields this belief is what matters most. I have found that IFS’s inclusion of this shared energetic state within humanity to be a helpful paradigm as it aligns with Buddhism’s concept of the Bodhisattva and ancient Indian culture’s yogic philosophy regarding Brahman and Atman (Schwartz & Sweezy, 2020). These, and many other contemplative and ancient wisdom teachings express humanity’s birth from a one-ness that remains within us as we are the reflection and embodiment of this innate source energy having our individual experiences; a both/and experience. I am further guided by critical theory, as I am mindful to not push this belief on others and I remain open and curious as a humble human who does not hold the key to absolute truth, rather, experience has shown me the benefit of this belief while I also remain open to nuance, to adapt, as I gather new data and am changed by the relationships I am a part of.
Traditionally, critical theory has been categorized as an anthropocentric model (Rowe et al., 2015, p. 301). However, by including the Indigenous notion of relationality, and the “centerless center”, we are invited to shift away from notions of domination or hierarchy, and into a heterarchical system that includes nature, sentient and non-sentient beings (Siegel, 2023). For me, this reflects what’s possible on the grand scale for all who are stuck or lost in part because of the cultural and societal structures that impose duality, separation, individualism, and domination into our sense of self. I re-learned to approach life from a bottom-up perspective, and have experienced healing by way of viewing the bodymind as one, which includes the differentiation of parts yet also holds space for mystery and uncertainty as the whole is greater the sum of its parts. This has led me to continually experience a sense of awe as I witness the intelligence that arises in myself and others when I lead from a right-brain mode of processing and invite others into that space with me. Additionally, this aligns with my personal value of self-care and accountability for my energy and capacity. Right-brain attunement is not only a skill to practice, it requires a certain level of nervous system regulation and self-awareness that is more difficult to access when exhausted or caught up in stressful events in life (Schore & Schore, 2014).
Conclusion
With regulation theory, critical theory and an Indigenous worldview of relationality, I feel more equipped to promote socially just outcomes through my social work practice. I feel myself land in the relational field where transformation is possible, as the micro reflects the macro, and vice versa (Wilson, 2019). In a resonant relationship of right-brain to right-brain, with the addition of psychedelics when appropriate, the relationship becomes the catalyst to repair ruptures from ancestral and present-day trauma, as well as harmful cultural narratives that are foundationally imprinted during specific developmental windows of learning (Schore & Schore, 2014). Teaching self-regulation and modeling co-regulation is essential, yet not enough. I recognize that larger systems of power and oppression enact a threat response in individuals and communities, much of which is internalized and reinforced as our cultural constructions become the lenses we see through. Critical theory in my foundation as a clinical social worker ensures that I am continually addressing and challenging colonial systems that perpetuate the myth of the solo-self (and all that goes along with that), while regulation theory and the Indigenous worldview of relationality ensures I am accountable to recognize that who I am is my relationships with self, others, land, and spirit. It is in the relationships that I co-create moment by moment where the possibility for change, growth and healing takes place.
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