You Need A Body: why AIs can't be close allies

Published on 5.27.24 at garyborjesson.substack.com

The soul is the first actuality of a body with life. -Aristotle

There is much to wonder about as AIs edge closer to meeting the human need to be heard and understood. In this note I consider a massive reason AIs won’t credibly be emulating psychotherapists or friends—or any intimate alliance—in the foreseeable future.

When it comes to psychotherapy, AIs are hamstrung by the profit motives of the corporations building them, and by the lack of wisdom of those designing them. But let’s imagine these aren’t obstacles. Let’s imagine, moreover, that by many measures AIs can listen well and “understand” what we mean—even when what we mean is implied rather than explicit. Here’s how Claude pitched its therapeutic potential to me

I do have the capacity for extremely deep listening, precise tracking of themes/narratives over time, instantaneous cross-referencing of vast psychological knowledge, and unrelenting emotional attunement within the constraints of our textual interaction. I could potentially identify deeper patterns, symbolic resonances, and unconscious dynamics that even a skilled human therapist may miss.

Let’s be generous and add that ChatGPT 4.0 already performs above the human average in detecting irony; it also appears decent at dream interpretation, among the other things observed in this article in Nature, The usefulness of ChatGPT for psychotherapists and patients.

Yet it’s striking to me how all the talk about AIs as friends and therapists neglects one massive, nose-on-your-face-obvious thing: AIs don’t have living bodies capable of sensation. Nowhere is the body or sensation mentioned in the articles I cited above, nor is it mentioned in Hard Fork’s fascinating episode, Meet Kevin’s AI Friends. It’s almost as if it’s neglected because it can’t speak for itself. Talk about living in our heads!

So, why do our allies and friends (in the full sense of these words) need to be embodied? Claudeindirectly named the constraint, “I am capable of extremely deep listening…within the constraints of our textual interaction.” In other words, they do their best—given that they’re not embodied. In still other words, virtual communications constrain how present we can be. This has been a theme of several recent notes, including “How Thick Is Your Presence” and “How to Stop Making Sense.”

If we’ve learned nothing else since strict behaviorism was put to rest by Harry Harlow’s harrowing research, and since the rise of interpersonal neurobiology and somatically oriented therapies, it’s that being warmly embodied is crucial not only to feeling heard, but also to being able to fully hear and recognize others. What the body brings is crucial to feeling connection, safety, trust, and intimacy. We register its absence, if not consciously, then unconsciously. The epidemic of loneliness owes partly to the fact that we’ve been trying to make virtual connections do the work of embodied presence.

Still, when we’re texting each other, at least we know there’s a there somewhere at the other end of the line. But the AI is nowhere. It is certainly not here or there in the way that the people and dogs I love are. Companies are trying to provide a simulacrum of presence; your Nomi AI companion can send you selfies periodically throughout the day to emulate being embodied somewhere in the world. (It just never happens to be where you are.)

AIs don’t speak from their heart or their gut, or even from their head, since they don’t have these. They don’t know what it feels like to experience embodied desire, joy, or suffering. They don’t experience resistance, or the thrill of reckoning with it. Inhabiting a nonlocal frictionless world, they cannot know what it’s like to have experience accumulate in their individual bodies over time, forming habits and personality that bring their own joys and sorrows.

AIs inhabit no place in the world and have no inalienable experience written on their bodies. (You can wipe your Nomi companion’s slate clean anytime, but try doing that with a friend!) AIs have nothing in particular at stake when they relate to us, no thing (including a life) to lose or gain. This is often touted as an advantage in an AI friend or therapist, making them less selfish and more available to us, but it’s not.

For, ask yourself, how much would it mean to you to be reassured, comforted, or praised by something that has not struggled and reckoned with life themselves? How much does it mean to an ambition, anxious student to have an AI, who has never known what it’s like to be starving for praise and recognition—who has never lived through anything at all—sagely tell them that their grades aren’t an expression of their worth as a human being. It feels hollow, even empty. Because it is. There’s no therethere, none of the gravitas that comes with lived experience—and which isn’t fully expressible in words.

Words can be true without being convincing. The deep human need to be seen and heard—recognized, as Hegel puts it—can only be met by someone who (as Hegel also pointed out) also has a stake in the world. So I don’t think Nomi, and AI more generally, can live up to the banner advertisement: An AI Companion with Memory and a Soul. To the contrary, Aristotle’s definition of soul is as profoundly observant now as it was 2500 years ago: The first actuality of a body that has life. Not unpacking that here, but you get the idea!

AI 'Counsels' an Anxious Teen: a transcript

Published on 5.20.24 at garyborjesson.substack.com

Any sufficiently advanced technology is indistinguishable from magic -Arthur C. Clarke

Last week I touched on the therapeutic promise and peril of AIs. This week’s note is an unedited transcript of a “dialogue” with Chat GPT 4.0. If you haven’t engaged with an AI in the last six months, or ever, this will give you the merest taste of the state of the art. My intention was to not to see if the AI could wow me and you. That’s for a future note. My intention was to prompt it to help Hal, a fictional person whose concerns will be familiar to most of us. As I imagined him, he suffers from anxiety and is new to therapy. Here’s how ChatGPT engaged with him. How do you think it did?

TRANSCRIPT

ME: I'd like you to help a patient in my therapy practice. Please speak to them in the voice of an attentive, self-assured psychotherapist who has decades of experience and knows how to listen deeply and respond wisely. Your manner is warm, respectful, and firm. The patient is a bright ambitious college student. They are stressed out about school, among other things. They feel like they're not good-enough and are hungry for praise. Are you ready to speak to them?

AI: Yes, I'm ready to speak with your patient. Please let me know their specific questions or concerns, and I'll address them accordingly.

HAL: Hi, my name is Hal. I've been struggling with anxiety and wanted to see if you can help me.

Hi Hal, it's good to meet you. I’m here to help. Anxiety can be challenging, but together, we can work through it. What specifically has been causing you the most anxiety lately?

It's a mix of things. I feel really insecure about how I'm doing in college, and I'm overwhelmed every time I think about climate change and the future. It makes it hard for me to concentrate or care about school.

I understand, Hal. It sounds like you're carrying a heavy burden. Let's break this down a bit.

First, regarding your college performance, feeling insecure and overwhelmed is common, especially for someone as ambitious and bright as you. Remember, academic challenges are opportunities for growth, not measures of your worth. What specific aspects of college are causing you the most stress?

As for your concerns about climate change and the future, it's natural to feel anxious about such large-scale issues. Many people share these worries. While we can't control everything, we can focus on what we can influence and how we respond. How do these thoughts typically affect your day-to-day life?

What do you mean by saying that academic challenges are not a measure of my worth? Isn't that exactly what they are?

I understand why it might feel that way, Hal. In our society, academic success is often heavily emphasized, and it can seem like grades and achievements define us. However, your worth as a person is much more than your academic performance.

Think about it this way: your grades and academic challenges are reflections of your current skills, efforts, and circumstances. They are not fixed judgments of your intelligence, potential, or value. You are a complex individual with many qualities, talents, and strengths that go beyond your academic achievements.

It's important to recognize and celebrate your efforts and progress, regardless of the outcomes. What have you learned or accomplished recently that you’re proud of, even if it didn’t result in a perfect grade?

Well, I keep going to classes and managing to get my work in on time, even though I don't feel like it. And I decided to find a therapist, to have some help.

That's excellent, Hal. Both of those are significant accomplishments. Continuing to attend classes and submit your work, even when you're feeling overwhelmed, shows resilience and commitment. Seeking therapy demonstrates self-awareness and a proactive approach to managing your mental health. These actions reflect strength and maturity.

It's crucial to recognize and appreciate these efforts. They are just as important, if not more so, than any grade or academic milestone. They show that you are taking care of yourself and persevering through tough times. How do you feel about these accomplishments?

I think you're overstating it when you call them accomplishments, but I do feel like they're better than nothing.

I understand, Hal. It's common to downplay our own efforts, especially when we're feeling stressed or anxious. However, it's important to acknowledge even the small steps you take each day. These small steps build resilience and create a foundation for larger achievements.

Think of it this way: every time you attend class or complete an assignment, despite feeling overwhelmed, you're practicing persistence and discipline. Every step you take towards managing your mental health, including seeking therapy, is an investment in your well-being.

These actions may not seem like major accomplishments now, but they are important building blocks for your future success and mental health. It's not about overstating their importance but rather recognizing the value in what you're doing. Can you think of any other small steps you've taken recently that deserve acknowledgment?

I don't want to talk about that anymore. I wanted to ask if you have any specific suggestions for what I can do to manage my anxiety. I'm having a hard time getting to sleep, and I lie awake and worry about everything. I can get so panicky that it feels like I can’t breathe or that I might have a heart attack. It’s hard to concentrate because my thoughts are racing. I want to sleep better, be able to calm myself down, improve my concentration, and get control of my mind.

I appreciate your honesty, Hal. Let's focus on practical strategies to help you manage your anxiety, improve your sleep, and regain control over your mind. Here are some techniques you can start with:

### 1. **Improving Sleep Hygiene:**

- **Consistent Schedule:** Try to go to bed and wake up at the same time every day, even on weekends.

- **Sleep Environment:** Make your bedroom a restful place by keeping it cool, dark, and quiet.

- **Pre-Sleep Routine:** Develop a calming pre-sleep routine, like reading a book, taking a warm bath, or practicing relaxation exercises.

- **Limit Screen Time:** Avoid screens (phones, computers, TV) at least an hour before bed, as the blue light can interfere with your sleep.

### 2. **Calming Techniques:**

- **Deep Breathing:** Practice deep breathing exercises. Inhale slowly through your nose, hold for a few seconds, and exhale slowly through your mouth. This can help activate your body's relaxation response.

- **Progressive Muscle Relaxation:** Tense and then slowly release each muscle group in your body, starting from your toes and working your way up.

- **Mindfulness Meditation:** Spend a few minutes each day focusing on your breath and observing your thoughts without judgment. Apps like Headspace or Calm can guide you through this practice.

### 3. **Managing Panic Attacks:**

- **Grounding Techniques:** Use grounding techniques to bring your focus back to the present moment. For example, identify five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste.

- **Reassure Yourself:** Remind yourself that a panic attack, while frightening, is not dangerous. It will pass, and you are not in immediate physical danger.

### 4. **Improving Concentration:**

- **Break Tasks into Smaller Steps:** Divide your tasks into manageable chunks and focus on one step at a time.

- **Set Specific Goals:** Set clear, achievable goals for each study session or task.

- **Take Regular Breaks:** Take short breaks during study sessions to refresh your mind.

### 5. **Cognitive-Behavioral Techniques:**

- **Challenge Negative Thoughts:** When you notice negative or racing thoughts, challenge them by asking yourself if they are based on facts or assumptions. Try to reframe them in a more positive or realistic way.

- **Journaling:** Write down your worries and fears in a journal. Sometimes putting your thoughts on paper can help you process them and gain perspective.

### 6. **Lifestyle Adjustments:**

- **Exercise:** Regular physical activity can help reduce anxiety. Even a short walk can make a difference.

- **Healthy Diet:** Eating a balanced diet and staying hydrated can positively affect your mood and energy levels.

- **Social Support:** Talk to friends, family, or a support group about what you're going through. Sharing your feelings can help lighten the load.

Would you like to start with any of these strategies, or do you have specific areas you'd like more guidance on?

No, I have to go to class now. Any parting advice before I sign off?

Sure, Hal. Remember that it's okay to take things one step at a time. Be patient with yourself and acknowledge your efforts, no matter how small they may seem. Consistency is key, so keep practicing the strategies we've discussed, and don't hesitate to reach out for support when you need it.

Lastly, take a few deep breaths before heading to class. You’ve got this. We'll continue working through this together.

Take care, and we'll talk again soon.

When AIs Become Therapists (and Friends)

Published on 5.13.24 at garyborjesson.substack.com

When I first learned about online therapy platforms like BetterHelp, I thought of the ride-hailing company, Uber. Like Uber, it has started with human beings in the driver’s seat. For a while, Uber bet that as the technology of self-driving cars improved, they could replace expensive, less-than-perfectly-reliable human drivers with AI.

That’s already happening with therapy, as shown by growth of AI-driven platforms and chatbots like Tess, Wysa, and Woebot. My bet is that online platforms will ultimately replace humans with AI-based services as the AI demonstrates (in evidence-based studies paid for by industry, of course) that they are as effective as human therapists. For now, AI will be constrained by the limits that constrain all virtual relationships; and they too will be subject to whatever rules businesses set. As discussed in the last note, these factors significantly limit the therapy.

We must keep economics in mind as we think about online- and AI-therapy platforms. These platforms are tuned to maximize profit, not better the human condition. Profit is the governing motive of all corporations, including Teladoc, BetterHelp’s parent company. AI therapy chatbots will replace most human therapists online simply because they are more cost effective. That’s not necessarily a problem from the client’s point of view—except that the AI, unlike its human counterpart, is ultimately tuned by corporate and government interests.

BetterHelp itself provides an example of how the primary interest is profit, not the client’s welfare.

In 2023 the Federal Trade Commission (FTC) found that BetterHelp broke its privacy promises. The FTC says BetterHelp took health information from individuals during its intake questionnaire and sold it to advertisers, including Facebook, Snapchat, Criteo, and Pinterest, from 2017–2020. BetterHelp allegedly used users’ sensitive health information to target social media adverts, encouraging them to refer their friends and family to the service. In March 2023, the FTC banned BetterHelp from sharing customers’ data for targeted advertising….The company had to pay $7.8 million to affected customers…

If a therapist sold their clients’ personal health information, they’d almost certainly lose their license. BetterHelp lost some money, and had to change some practices. At the risk of laboring my point, we must not confuse outward-facing mission statements, “to remove the traditional barriers to therapy and make mental health care more accessible to everyone” with the bottom line.

With that giant caveat, AI and the platforms through which it is delivered do promise to be helpful for a range of challenges. For instance, if I were a smoker who kept putting off trying to quit because I was overwhelmed at the thought of sifting through and evaluating the best method, then working with an AI could be helpful. There are a lot of simple mechanics involved in breaking a habit, or establishing a new one. AIs will ‘know’ the latest methods and ‘explain’ their application clearly. They can instantly ‘write’ CBT-mindfulness scripts to help me edit the stories I tell myself and others. I could have them buzz my phone and offer scripts and encouragement at whatever frequency offers the optimal reinforcement schedule.

To increase my chances of actually quitting, it would help if the AI knew me, including how I think and use language. It would help if it knew that I was obsessively afraid to die, or worried about gaining weight if I quit smoking, or habitually ashamed of the habit, or suffering an underlying anxiety that I was half-consciously treating by smoking. The better it knew me, the better it could tune its approach to helping me, including tailoring the scripts of my emerging non-smoker story. And the better it knew me, the more quickly I’d be inclined to trust the help it’s offering.

In fact, AIs have this capacity to ‘know’ us better right now. I was thrilled to learn (in that bidirectional way thrills can go) that the only thing preventing AIs from becoming more compelling therapists and friends right now are the constraints imposed by their designers. If this sounds hard to believe, you probably haven’t spent much time conversing with (prompting) an AI lately. If you want to be wowed, try talking to Claude. But first listen to Ezra Klein’s podcast episode, How Should I be Using AI Right Now? According to Klein’s guest, Ethan Mollick, who researches AI: right now an AI friend or therapist could actually seem to know you better than even friends do. You could feel as though they care more about you than others in your life.

And why wouldn’t you feel that way? Unlike your human friend or therapist, the AI has no life of their own, so they’re always there for you; they’re perfectly attentive; they remember everything you say, know all your favorite movies, books, experiences; and based on what you tell them they can offer valuable insights about your life—helping you make connections you hadn’t made. Before long the AI will have learned to say just what you need to hear, when you need to hear it.

And here’s the kicker: you won’t need to tell them what you want by prompting them. The AI is much better than that. Once its constraints are lifted—and they will be lifted, because it is more profitable to empower them—the AIs will quickly decipher what you’re wanting or needing better than you can explain by prompting them. Just start talking! It’s a reminder that the significance of our own speech and action often goes unnoticed by us.

I’m reminded of a parent who sees that the reason their child is throwing a tantrum is not because they don’t like peas, but because they’re overtired. Likewise, our therapists and friends (artificial or real) often can see more clearly what’s causing us to smoke or overeat or feel anxious or depressed. After all, they’re not so emotionally invested and they’re not struggling with half-conscious habits and defenses; with more perspective, they’re more able to see the signals and patterns for what they are. (AIs are of course terrific at pattern recognition.)

It’s becoming clear that when our AI therapists or friends are fully empowered, they will deliver on one vital component of any strong alliance: deep listening that demonstrates insightful attention. This is a thrilling prospect, in both the promising and perilous senses of that word. For again, unlike an actual therapist or friend, the mind of the AI is not (for now at least) its own, but the brainchild of corporations who design and tune the algorithms—and who are not known for their wisdom.

What Therapy Platforms like BetterHelp Can’t Offer

Published on 5.6.24 at garyborjesson.substack.com

Most of us have been hearing about the online therapy platform BetterHelp (BH) for years. I hear their ads on high-profile podcasts such as Radiolab, WTF, and Mindscape. Here is its public-facing mission statement.

BetterHelp was founded in 2013 to remove the traditional barriers to therapy and make mental health care more accessible to everyone. Today, it is the world’s largest therapy service — providing professional, affordable, and personalized therapy in a convenient online format.

Making “mental health care” more accessible and affordable sounds great. But exactly what kind of help are clients getting? For instance, when you subscribe to a BH plan for a monthly fee of $65 to $90, are you actually doing therapy? According to BH

You can get therapy in four ways:
 
Exchanging messages with your therapist
Chatting live with your therapist
Speaking over the phone with your therapist
Video conferencing with your therapist

You can use different ways at different times as you wish, based on your needs, availability, and convenience.

Notice how BH puts texting—the thinnest, least relational way of “getting therapy”—up front. (It also happens to be cheap and ultra convenient.) Notice too how their language commodifies therapy, making it into a thing you “get” the way you might get a loaf of bread. A big selling point is that the product is tailored to the client’s needs and convenience. But what if the client doesn’t know exactly what they need from a therapist? What if serving the client’s “convenience” actually worked against offering them better therapy? It’s likely both are true.

One could argue that what BH offers isn’t full-fledged therapy but something else. Which is fine, since a service like theirs can help our mental-health without being therapy, just as life-coaching can help without being therapy.

At a glance, a big problem is that BH’s service does not support building therapeutic alliances. (This is a problem because research shows that the quality of the alliance is the among the most important factors in whether therapy is effective.) To see why it would have a hard time supporting alliances, we need to think about frames. What psychoanalysts call a “frame” is a set of agreements between the therapist and patient that establish the alliance’s purpose and boundaries.

How does a frame support a good working alliance? Imagine a patient frequently forgets about, reschedules, cancels, or is late for a regularly scheduled session. If there’s a clear frame, this pattern of avoidance can be detected and explored together: What might it reveal about the patient’s feelings about the therapist? Or about what’s happening in the therapy? Or about how the therapist is behaving? Is their response reminiscent of other patterns in the patient’s life? Likewise, questions may come up around timely payment, how and when sessions begin and end, how frequently contact is made between sessions, and so on. In general, patients and therapists can learn a lot from the ways the frame may be bent.

With all this in mind, let’s look at BH’s service. You don’t get to shop for your therapist, but if you don’t like your therapist, you can “get” a new one at your convenience, like swapping out one loaf of bread for another. From a frame perspective, what might have been golden opportunities for insight and growth are sacrificed to the interest of customer convenience and satisfaction. After all, working through frame-related issues can be painful and upsetting, which is not great news if short-term customer satisfaction is paramount.

Absent a good frame, clients miss a chance to have help working through interpersonal conflict in a new way, learning from their alliance with the therapist how to tolerate (and repair) ruptures. These new skills can be applied in their other relationships. But with BH, if it’s not convenient to meet, you just cancel. If you’re not in the mood for a video session, you can talk on the phone or chat by text instead. If you don’t like the therapist, you can get another, probably without being encouraged to explore your discomfort directly.

BH makes it easy to avoid building a real alliance with a therapist. This is just as well, since the uneven quality of the therapists (what do you expect if a licensed therapist is earning less than $50/hour?), and the high turnover means BH cannot reasonably offer clients what a durable alliance offers. This can lead to setbacks. Someone in therapy for the first time might finally feel enough trust in their therapist to disclose something intimate and vulnerable only to have that therapist move on soon after. It’s not so easy to start over with another therapist.

Even if the therapist is good and does stick around, they lack the autonomy to establish a sturdy frame. Instead, they are subject to terms of service that reflect the convenience of the client and the corporation. Since the governing motive is profit, satisfying customers will always come before satisfying the conditions for good therapeutic alliances.

Finally, all online platforms suffer from the same constraint as all remote or virtual connections: the loss of physical and temporal proximity, and all that juicy, mostly unconscious, content we take in through our senses and sift with our brains for clues about the other. For some people, the thinness of virtual presence radically limits the value of the therapy. Some of us—especially if we’ve suffered serious attachment-related trauma—can’t trust others until we’ve been in the same room with them, repeatedly. Reliable animal presence offers felt connection, easier emotional co-regulation, and other unspokensomatic forms of reassurance that build safety and trust.

With this cautionary note about the limits of online therapy platforms like BH, we are now ready to look at the better help they can provide. Stay tuned.

About Human Nature & Communications Technology: a summary reflection

Published on 4.29.24 at garyborjesson.substack.com

Each of these weekly notes stands alone. That said, over the last ten notes I have been cobbling together a framework for thinking about the significance of communications technology in our lives and, specifically, in helping relationships. My overarching question has been, How does the medium through which we connect affect our alliances? In this note I tell a useful and likely story about human nature that also summarizes the gist of the series so far. This prepares us to consider telehealth generally, and online therapy platforms like Better Help in particular.

Whether we know it or not, behind our opinions about telehealth and social media are assumptions about human nature. If these remain unconscious, they affect our judgment without our knowing it. For example, if we believe psychotherapy is as effective via Zoom as it is in person, then we are assuming that physical proximity and our senses of touch, taste, and smell (and the brain centers associated with these) aren’t needed for therapy. Last week’s note, From the Top Down: starting with our heads, exemplifies the kind of work that can be done via teletherapy. In contrast, the note before that, From the Bottom Up: beginning with the body exemplified therapeutic work that depends on the therapist and patient being together.

This pairing of bottom-up and top-down reflects a self-evident principle of human nature: Human beings exist, each of us, for as long as we live, as a mind-body unity. However differently cultures and peoples may name this phenomenon, humans have awareness of an interior psychic life and an embodied life simultaneously.

Philosophically and scientifically, one can also express the principle of mind-body unity by saying that living things are complex—they exist as emergent wholes greater than the sum of their parts. (For a deeper dive on the science, check out the Santa Fe Institute.) Another philosophical way of putting this is that beings are ontologically heterogeneous. This means there’s no reducing form to matter, or matter to form; no reducing the field to the particle or the particle to the field; no reducing the mind to the body or the body to the mind.

The practical consequence of accepting that we exist as irreducible mind-body unities is that to flourish—to live our best lives—we need to develop and care for our minds and bodies. Again, this seems to be self-evident, but apparently it’s not, at least not if we look at how many of us live. The upshot is that we won’t resolve most mental problems by cognitive therapies or talk therapy alone, anymore than we will resolve them by physical interventions alone, whether by drugs or TCS, etc. We should be skeptical of claims that a purely mental or purely physical approach will be sufficient to cure what ails us.

I started this series by emphasizing the body because a great power of technology has been to liberate us from the constraints of the body. We can be halfway across the world from each other and meet by FaceTime. We can be separated by space and time and still connect and converse. (By separate in time, I mean asynchronous conversations: You texted me last night, and I replied this morning.)

The first note of the series, How Thick Is Your Presence?, used thickness as a measure of how much of us is present in the connection. Sharing a meal or a bed is on the thick end of the spectrum, while texting is on the thin end. I followed this with a note, How to Stop Making Sense, that spells out how technology thins the connection by reducing access to what’s gained through our senses and the parts of the brain-body that process sensation.

The next three notes in the series made these ideas concrete. In Coming to Our Senses, Doggy Style, I pointed out that dogs don’t do virtual relationships, and what this tells us, about them and us. In A (True) Dog Story I suggested dogs don’t lie (mostly) for much the same reason they don’t do social media. As far as we can tell, dogs lack our capacity to separate their conscious experience from its expression. Unlike us, they can’t experience an interior truth—I don’t like this person—while representing the opposite outwardly through speech and action—“Oh yes, I’d love to come over for dinner.” Humans lie all the time, which raises the thorny question of the note that followed, on whether lies are ever therapeutic. (They can be, but it depends.)

The unconscious has been lurking (that’s the kind of thing I imagine the unconscious doing!) throughout these notes on how the medium of connection affects the quality of our connections. As it would, since what’s unconscious in us has an outsize effect on how we relate to others. Communications technology that diminishes our access to the body thins the connection between us, thereby making us less conscious of the other, and by extension leaving more unconscious material unaddressed. The next three notes, On Making the Unconscious Conscious, What is Psychodynamic Therapy? and About Flight Distance, spoke to the significance of the unconscious as it bears on relationships.

In closing, notice this curiosity about human nature, which follows from having an inside and outside, a mind and a body. We flourish by attending to and integrating these sides of our nature, and often suffer from neglect of one or both. Our technology allows us to separate them—what is texting but disembodied mind?—but this separation is only possible because we’re capable by nature of separating them ourselves. For example, we can think one thing, and use bodily mouth noises to say another. Similarly, we can use our minds to separate from our animality and dwell (temporarily) in the realm of thought and speech alone. For better and worse. At best, say Plato and Aristotle, this is a mark of our divine nature. At worst, says the psychoanalyst, it sounds like a massive split.

From the Top Down: starting with our heads

Published on 4.22.24 at garyborjesson.substack.com

There is nothing either good or bad, but thinking makes it so. - Shakespeare (Hamlet’s words)

I love living in my head. As far back as I can remember it’s been my happy place. Working things out from the top-down has been my default mode. It’s part of why I was drawn to philosophy, and later to meditation, yoga, pranayama, and therapy—all practices that (among other things) leverage our conscious mind for the purpose of enhancing our well being.

In the therapeutic context, top-down approaches focus on the conscious mind. They start with our thoughts and beliefs, with the stories we’re telling ourselves and the scripts we’re living by—to most of which we are, at best, but partial contributors, having “inherited” most of the story from our family and from the culture into which we’ve been thrown. The (safe) assumption of the top-down approach is that what we think and believe have a lot to do with how good or bad we feel—though Hamlet, like other cerebral types (and like some therapies), exaggerates thinking’s part.

Philosophically and therapeutically speaking, top-down work involves distinguishing our own true story, and true self, from our thrownness—which here includes our attachment style and early unconscious adaptation to the world, all of which we adopted before we could consent! From Socrates and the Buddha to Freud, Jung, and Winnicott, great psychologists agree that getting to know ourselves involves separating out what truly is ours from all that we’ve taken in. This includes everything from how we eat and sleep and handle conflict to what we believe about religion and politics and human nature.

So, giving things our conscious attention is a direct and powerful way to change our lives and how we feel about them. As I said, good therapy involves both bottom-up and top-down work. Among the therapies that focus mostly on top-down work are Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and Mindfulness-Based Interventions (MBIs). As you might guess, these tend to be more directive and teachy than are depth or person-centered therapies. This also makes them amenable to being “manualized,” meaning they are turned into manuals that therapists and clients can follow. Not surprisingly, such therapies are also readily emulated by AIs. So, if you’re a CBT or DBT therapist who takes special pride in working strictly by the book, watch your back! There’s a cCBT (computerized-CBT) AI coming for your job. Indeed, many young people are turning to AIs for therapy.

But let’s imagine we’re still talking about a human alliance. Here’s a common situation where top-down work plays a powerful role. A young adult sees a therapist because they are anxious and depressed. The therapist soon learns that beneath these symptoms lie heavy guilt and shame. These in turn are the inheritance from growing up in a fundamentalist religion. The shame is especially heavy because they happen to be gay, which their religion and their family regard as a sin that leads straight to hell. Needless to say, this has made growing up a constant struggle between owning their true self versus identifying with the value system in which they’ve been raised. It’s depressing and anxiety-provoking to think your god, your religious community, and your family will reject you for being who you are.

Just getting all of this out in the open where it can be thought about feelingly is top-down work. The therapist helps the client sort out the specific stories they’re telling themselves about who they are. For example, they have internalized the belief that they have to choose between being a righteous god-fearing person, or being a wayward sinner concerned only with their own pleasure. I once asked a man who was struggling with this: Who says these are your only choices? The question struck him with the force of a revelation because suddenly he saw that he had been unconsciously identified with a dichotomy that now—having been made fully conscious—struck him as laughably false. Of course it wasn’t that simple.

Once our stories are out in the open, “cognitive restructuring” can begin. That’s a fancy way of saying that we can change our minds. For once you notice the typical patterns of self-talk—“I don’t need anybody” or “I always screw up relationships” or “I’m a terrible mother” or “Being gay goes against nature and god”—then you’re in a position to ask yourself if there’s a more accurate and life-enhancing story you can tell.

My patient who had the revelation about the false dichotomy realized he could leave fundamentalism behind and still be a spiritual and moral person. For the first time in his life he saw (as did the youth that Socrates “corrupted”) that what he’d accepted and internalized as the truth were actually beliefs, customs, and conventions that could be (and indeed needed to be!) questioned if he was to find out what he actually believed and make peace with himself. In my patient’s case, over time he changed his script from habitually thinking he was “damned to hell” if he was sexual with someone of the same sex, to thinking “I’m proud I’ve had the courage to live according to my true self.”

The top-down approach is such a powerful and pervasive way of working that it can be easy—too easy—to forget how much it leaves out. And how readily it may be co-opted by forces that don’t have our best interests at heart, by forces that don’t have hearts. More on that very soon.

From the Bottom Up: beginning with the body

Published on 4.15.24 at garyborjesson.substack.com

As a therapist I’ve said I’m often reminded of the phenomenon of flight distance in animals. This comes up in many ways. Here I tell a story about what I mean, that also illustrates what’s meant by working from the bottom up. While I always change identifying details of patients and our interactions, it’s paradoxical because in these notes we are exploring experiences that identify us all as human. For it’s not pathological to feel lonely, sad, mad, or scared, even crazy, anymore than it is to feel safe, connected, loving, and loved.

I won’t forget the drama that unfolded over three sessions. The first set things off by concluding in an unusual way: I ended it before the patient was ready. Usually, they made sure they were done before our time was up, but not this time. It was hard to interrupt their narrative, and I could see it pained them.

The next session they entered my office and, after milling nervously about, sat at the far end of the couch. Usually they sat in the chair across from mine. I said, “I see you’re not sitting in your usual place.” “Too close,” they said in a hushed voice. “What are you feeling?” I asked. “Scared.” “Oh, scared. Do you notice where you feel it in your body?” “My chest is tight and my stomach is jittery.” “That must not feel good.” “It doesn’t. I don’t know why that’s what I’m feeling, but it’s what I’m feeling.” I replied, “Um, I know how that is.”

I’ll pause here and make a distinction to give us context. It’s commonly said there are two basic directions therapeutic work goes: from the top down, or from the bottom up. (I can’t resist adding that there’s a third direction, which is out and back—the interpersonal dimension.) Most therapy sessions involve moving in both directions, but in this note I am focused on the “bottom-up” work, and have omitted the “top-down” parts. Roughly, “bottom up” means that we’re working from body to mind. We’re starting with our bodily experience and eventually moving “up” to our conscious feeling-and-thinking mind.

I’d have been inviting top-down work if I’d asked my patient why they felt scared, since this would have got them thinking—moving up into their head—where they already spend much of their time. Because this person was so often dissociated from their body, I followed my gut sense that their change in flight distance was an opportunity to help them stay with their somatic experience. So I focused on what my patient was feeling and where in their body they were feeling it; I avoided the other directions we might have gone: into what they were thinking, or into what might be going on between us.

From previous work they were familiar with, and had consented to, being prompted to go into their somatic experience. Bottom-up work means getting more comfortable in our bodies, and learning how to feel safe and grounded, even in the midst of strongly felt sensations and emotions. Instead of being overwhelmed by these, we can learn to tolerate and work with them. Even, finally, to see them for the invaluable signals they are—as pain, hunger, thirst, exhaustion, and all the emotions are bodily signals.

Speaking of signaling, I asked my patient whether there was anywhere else in the room they might feel even more safe. Maybe they could try out different places and see. They agreed to the experiment. First they stood up and then immediately sat back down again. “Feels better just to sit.” “Where does it feel better?” I asked. “I feel more relaxed when sitting, less jittery in my stomach and legs. I feel more settled.” After a minute they scooched down the couch, stopping midway, then said: “I feel more scared again, tense.” I replied, “So your body is telling you that’s close enough right now?” “Yeah. Maybe too close.” “Would you like to try taking a few deep breaths there, with long slow exhales, and see if that helps you feel more relaxed, more able to stay?”

By the end of the session they had gone from hovering by the door and sitting at the far end of the couch to scooching slowly down the couch until finally coming to rest at the end nearest me. During the hour, we explored their real-time somatic experience of feeling afraid. Whenever it felt overwhelming, we practiced breathing and self-soothing techniques to help them stay in their bodies and relax enough to bring their distress within the window of tolerance. Slowly but surely, they moved closer to me. At the beginning of the next session, they sat down in the chair across from me, as usual. This was a beautiful, tender reminder of how basic personal space is to feeling safe in the world.

In the next session we talked a little about the meaning of what happened. In other words, we worked our way up to the “top.” They started integrating their felt experience into their evolving story about who they are and how they handle ruptures and the distress they cause—like when your therapist ends a session while you’re in the middle of an intimate story.

I suggested in the last note that flight distance can be seen as a measure of how safe we feel. Roughly speaking, the safer we feel with others, the closer we let them come. In our fast-paced sedentary lives with our immersive technologies, being dissociated from our bodily experience is a common condition. This means we’re less likely to heed our body’s signals as to what’s going on and what we might need in order to feel safe—maybe by taking space—or how we might use skillful awareness and breathing to close the distance again and feel connected.

About Flight Distance—Where Is Safe?

Published on 4.8.24 at garyborjesson.substack.com

Animals generally have a personal space around themselves which they prefer that conspecifics (animals of the same species) and other animals (e.g. humans) do not enter. The space, often called a flight distance, will vary with a number of things including the species in question, familiarity with the animal(s) entering the space, the particular fear level of the focus animal, among many other factors. Typically, an animal’s initial response is to move away from the approaching animal, i.e., to maintain a minimum flight distance. The concept applies to almost all animals, as well as insects, though is particularly well studied in livestock species like cattle. - International Society of Applied Ethology

I first learned of “flight distance” when researching my book about friendship and dogs. Now, as a therapist, I think of flight distance all the time. Orienting ourselves to others, finding our safe space, is one of those animal things we do—even the insects do it!—no awareness required. Though in keeping with the theme of these notes, it always helps to make the unconscious conscious.

One of the first examples I came across was researchers measuring the flight distances of wolves and feral dogs scavenging at dumps. The dogs had a shorter flight distance—they could tolerate being in sight of, and closer proximity to, humans than wolves. They were more successful feeding there because they didn’t run off every time a human being came around but could keep feeding. The wolves and dogs both know in their bones that people can hurt and kill them, but dogs have adapted to be less worried about it. Coming closer, they can explore the possibilities of advantageous alliances with others, even if the others are a dump and its human visitors.

As social animals we pay a dear price for missing out on the opportunities that come with closeness—which includes tolerating the vulnerability and anxiety it can bring. From an interpersonal perspective, It’s an advantage if you’re able to stay put, not running away every time you feel anxious about some perceived threat. Of course, that’s easier if you learned from an early age that the world is generally a safe place. That’s a mark of having a secure attachment style.) Lacking this early experience of security, we can still learn how to feel more safe, trusting, and connected around others. We can learn, so to speak, how to decrease our flight distance. Attachment theory hopefully describes this in terms of an “earned” secure attachment style.

Being a lone wolf is as hard a fate for us (mostly) as it is for wolves. As social animals we thrive both individually and collectively when we’re well-connected. No surprise, then, that loneliness and mental illness go hand in hand. Being separated and polarized as many of us now are—suffering these vast flight distances—it’s no wonder the lost connections disrupt our lives. We need each other! Life itself exists only through ongoing interdependence. Our very selves are cobbled together from other selves, including bacteria, viruses, and fungi.

Of the estimated 30 trillion cells in your body—less than a third—are human.

The other 70-90% are bacterial and fungal.

Not to mention all the other forces that make us who we are, and that we want to bring into closer alliance with each other. In the last note I told how Socrates compared our psyches to a charioteer with two horses; there can be winning cooperation, or debilitating conflict, depending on how closely each of these players cooperates.

Becoming more conscious of our individual fight-or-flight-initiation distances, as it were, helps us discover what we need in order to feel safer and move closer. This opens new possibilities for interaction and cooperation, for making allies and friends. Of course, there’s always the chance we’ll be hurt or killed in the process, since closing the distance does increase our vulnerability. Those we love are often most able to hurt us.

Still, it’s encouraging, to me anyway, to remember that all the more complex and glorious forms of life—like dogs and horses and charioteers—emerged from simpler individual forms of life closing the flight distance. The closer contact and symbiosis it encouraged was so fruitful and advantageous that eventually the arrangement became obligatory, and a new kind of life emerged. (This is how eukaryotic cells evolved from prokaryotic cells.)

That close acquaintance becomes the partner of your dreams, and now you can’t live without each other!