Therapy in which the goal is to reach ones potential for self-actualization is known as

Self-Actualization

Self-actualization is defined as “the desire to become more and more of what one is, to become everything that one is capable of being” (p. 22).54 This is the highest human need. Once all needs that are lower in the hierarchy have been met, this need has to be met (failure of which leads to a sense of meaninglessness, and could even lead to suicide). Maslow identified some of the characteristics of self-actualized individuals as including the following:

A sense of adventure and novelty: Self-actualized individuals are not afraid to try new things, new ways of doing things, and new ideas, or to reconsider old ideas in a new way. They are energized by novelty.

Confidence: Self-actualized individuals are comfortable with themselves, and they do not rely too much on approval by other people.

Non-prejudicial: Self-actualized individuals are open minded and accepting of others from a variety of backgrounds. They are comfortable with ideas and viewpoints that are different from theirs.

Empathic: Self-actualized individuals empathize with humanity in general.

Above polarities: Self-actualized individuals are neither good nor bad, neither introvert nor extrovert, and so on. They transcend polarities.

Creativity and Health

Both creativity and self-actualization are indicative of psychological health. As is the case with most signs of health, however, it is not easy to determine which comes first. It is possible that self-actualization allows the individual to be creative, or that the creative tendency supports self-actualization. It is also possible that both are results of a third variable. This third variable might be the capacity for effective coping, adaptability, or intrapersonal intelligence. Recall here that Rogers said, in the quotation earlier, that self-actualization and creativity both reflect an underlying motivational force.

It does appear that some creative persons are not self-actualized. Some are certainly not healthy. In fact, creativity can be downright destructive. The dark side may be seen in creative but destructive discoveries and inventions, such as thermonuclear weapons, and in the not uncommon self-destructive behaviors of creative persons. This self-destruction may take the form of suicide or alcoholism.

3.3 Motive for Self-Actualization

Goldstein coined the term self-actualization (Goldstein, 1939; Modell, 1993), which refers to the idea that people have an inner drive to develop their full potential. The process of development is thus considered to be an important motive for goal-oriented behavior. The implication is not that every person must strive for an objective goal such as a career, but rather that all persons should develop according to their own potential—potential that might be directed toward creativity, spiritual enlightenment, pursuit of knowledge, or the desire to contribute to society (Goldstein, 1939). Self-actualization is related to the concept of self-determination, both built on the assumption that an individual's greatest need is to realize her or his own maximum potential.

One approach systematizing the idea of need for self-actualization was proposed by Maslow (1943). He developed the widely used concept of a hierarchy of needs, a pyramid model aimed toward explaining the order of needs that humans try to satisfy. In Maslow's model, the needs are organized in a sequential manner, such that the lower level of needs—hunger, for example—must be satisfied to enable striving for the next higher motive. His pyramid consists of five levels, with the lowest level addressing basic physiological needs such as water, food, and sleep that are required for human survival. The second level contains the need for security. Only when people feel secure in personal, financial, and health domains they can approach the next level—a level that consists of psychological needs, such as friendship or a feeling of belonging. Humans have a need to belong, to feel connected to friends and family, or to a partner. The fourth level details the need to feel respected, proposing that when people are accepted and valued by others they are capable of attaining the final level, self-actualization. However, while Goldstein understood self-actualization as an inner force that drives people to achieve their maximum performance, Maslow interpreted self-actualization more moderately as a tendency for people to become actualized in what they are capable of becoming (Gleitman et al., 2004).

Although prominent, the pyramid by Maslow is often criticized for not depicting, precisely, how people are motivated in real life. For instance, in some societies people suffer from hunger or are exposed to life-threatening situations on a regular basis. The first two levels of Maslow's pyramid would clearly not be met. However, those same people form strong social bonds, thus fulfilling the need for bonding which is a higher order need. Obviously, the hierarchical nature of Maslow's theory does not account for this behavior (Neher, 1991). Nevertheless, the hierarchy of needs continues to be influential in research in psychology and economics. One reason is that it proposes a model that is applicable for various approaches to motivation, and that systematizes different motives into subgroups—of which some are innate and others can only be satisfied in coordination with other people (Trigg, 2004).

Abstract

Peak experiences are moments of self-actualization, which may include mystical and transcendent elements. Many cultures have incorporated psilocybin into religious rituals because of its ability to induce these experiences. Research has established that peak experiences facilitated by psilocybin may have long-lasting effects, although set and setting are important determinants of both the content and the emotional tone of individual drug experiences. Experimental research has demonstrated that psilocybin can induce peak experiences in controlled environments and these effects persist over the long term. The mechanisms through which psilocybin facilitates peak experiences involve blockage of 5-HT2A receptor sites, decoherence of cortical oscillations, and disruptions to ordinary functioning of the default-mode network.

Being Love

For the person moving toward the self-actualization of her/his values, they increasingly become other-oriented. Such a mental stance allows the listener to love the other for who they are. It strips the judgmental attitude of being holier than thou. An example of this type of love is exhibited in the classic novel, play, and movie Les Misérables. The downtrodden Valjean had stolen candlesticks and other artifacts from a cathedral. When the bishop discovered Valjean, instead of punishing him, the bishop offered Valjean kindness and food. This simple act of acceptance transformed Valjean’s life. This was the turning point of the novel, play, and movie. This simple act transformed Valjean’s life.

People of all walks of life have this opportunity daily. It is not the giving of an empty handout, as Cattell so bluntly forewarned against about helping people on welfare. Rather, it is a daily venture of truly listening to what the other person needs at that time. When a therapist truly can hear her/his clients, they know what the client needs. Sometimes, frequently, it is passionate words which release an unnecessary sense of guilt. Sometimes, the person needs a two-by-four across the head, as only a best friend could get away with. The expression of being love varies, it is not simply a passive sympathetic gesture.

Creative Intention

In 1999, Conti and Amabile proposed that creativity is motivated by psychic conflict or self-actualization. Psychic conflict is prevalent in individuals suffering from mental disturbances such as bipolar disorder or affective illness. Creative expression is effective in channeling anxiety induced by psychic conflict in some individuals. Self-actualization, alternatively, is evident in individuals pursuing important problems, often of a humanistic nature. In both cases, the primary drive is to overcome limitations. Whereas psychic conflict diminishes a premature, perhaps conventional, sense of psychological closure (and satisfaction) thereby fostering new avenues of thought, self-actualization sensitizes individuals to existing boundary conditions inspiring attainment of individuals’ full potential.

In 2007, Horan addressed both factors by describing creativity as the “manifestation of the intention to transcend the limitations of information” (Roy Horan, 2007: 182). It would seem that simply having an intention (motivation) to solve a problem creatively does not preclude creative output. Intention must be supported by a prepared mind, genetics, personality, education, family, zeitgeist, etc. The proclivity, however, to display creative intention involves some, if not all, of all these factors. Combs and Holland noted increased reports of synchronicity induced by psychic conflict (boundary conditions) and self-actualizing practices like meditation. The relationship between intention, synchronicity, serendipity, and other meaningful coincidences has not been adequately investigated.

Serendipity is divided into two types according to the existence, or absence, of conscious intention. What is less obvious in this taxonomy is that intentions can be conscious and/or unconscious. Sometimes these intention levels may conflict. For example, parapraxes occur when unconscious intent surfaces unexpectedly during situations where conscious intent is otherwise oriented.

Poincaré, Pauling, and others have attested to unconscious processing during creative incubation. In 1985, Oakley and Eames cited neuropsychological studies of unconscious information processing being reflected in behavior. In 1998, Baars indicated that the unconscious mind's capacity for processing information exceeds the conscious mind. Volition is an important element in both conscious and unconscious processes. In 1925, William James described volition as “nothing but attention” (William James, 1983: 424). Posner (1994) stated that attention appears at all levels of information processing including consciously directed, sustained attention. In 2001, John Taylor indicated that subconscious goal-directed attention is woven into perspectivalness, the sense of having a point of view. Therefore attention (intention) is, at all levels, a form of choice.

In 1987, Yaniv and Meyer proposed that unsuccessful attempts at problem solving activates memory traces relevant to a solution, but when attention is engaged elsewhere the activation process sensitizes the individual to chance encounters with external stimuli that are further integrated into trace information. This mechanism reflects the common experience of ‘keeping a problem on the backburner’ (incubation) while unconsciously seeking appropriate solution stimuli. If incubation is sustained, the chance of relevant stimuli appearing increases. This may also account for how apparently random external stimuli found in serendipitous events react with unconscious attentional processes to induce insight. For example, if sustained, perhaps lifelong, unconscious intentions like discovering the nature of reality, its underlying physical principles, or developing innovative products exists simultaneously with specific intentions like testing a radio-telescope antennae (e.g., cosmic background radiation leads to the Big Bang theory), deducing why the moon remains in orbit (e.g., falling apple leads to the universal theory of gravitation), or testing a magnetron for radar sets (e.g., melted candy bar leads to invention of the microwave oven), those unconscious intentions could conceivably direct an individual's awareness, and curiosity, toward the investigation of unusual phenomena.

The more poignant question, perhaps, is: Can unconscious intentions influence the seemingly random events involved in serendipitous discovery? In The Intention Experiment, Lynne McTaggart reviewed a considerable amount of serious research on parapsychological phenomena. She noted that intention can have a nonlocal/nonrandom influence on biological systems and random event generators (REGs – electronic devices driven by quantum fluctuations). The effect sizes, over many studies and trials, were significant though generally quite small. Effects also tended to decline over time.

In 2007, von Lucadou and others provided empirical evidence that: (a) the decline in effect size is balanced by an acausal displacement toward noncomparable variables; that is, other apparently unintended phenomena are affected by the original intention; (b) the process does not involve any known form of signal transfer; and (c) individuals with innovative behavior, though less motivated than other subjects to participate in a REG experiment, demonstrated an increase in nonrandom effects. Results imply that creatives may naturally induce meaningful coincidences.

Empirical confirmation of this phenomenon may be feasible via nontraditional experimental designs. Though the exact mechanisms of these intentional influences are presently unknown, and often contested, unconscious processing is suspected. The larger effects in most of these studies are attributed to mindfulness and the ability to ‘let go,’ or surrender, conscious intention to a greater, universal sense of self. Creative individuals often describe this process as consciously ‘letting go’ of unresolved problems in order to solve them unconsciously. In 2009, Horan posited that the process of surrender is part of a neuropsychological phenomenon he terms creative contemplation, a practice with ancient roots in some meditative traditions. Creative contemplation extends the sense of self by temporarily dissolving the self-other dichotomy. Creative contemplation doesn't limit new associations to weak or nonexistent neural connections within the brain; it expands its associational influence into external reality ‘as if’ there were no difference between self (brain) and other (world). Horan suggested that this transcendent-integrative connection is attentional (intentional) in nature and exists in higher creativity and certain meditative states.

Chaos models could account for an intention's apparently discontinuous, acausal influence on the physical world if it operated (consciously and/or unconsciously) as a strange attractor, a fractal entity which evolves over time and incorporates self-world information into new emergent patterns. A fractal structure could potentially give serendipity (and synchronicity) an appearance of discontinuity or acausality. Intention, as an attractor, would be subjected to natural evolutionary processes both within and outside the brain. It must compete with other intentions, and noise, thereby making the overall self-world connection effect quite small. Though serendipity and synchronicity have noticeably small effect sizes, they could conceivably be magnified over time through persistent creative effort.

Another interpretation of intention's potential effect on space–time events was suggested by the work of David Bohm. In 1980, he posited the implicate order, a deep universal structure in constant flux from which space–time, quantum, and classical events emerge like vortices in a stream (the explicate order) and wherein no sustainable distinction between thought and matter exists. Bohm's implicate order parallels Jung's collective unconscious consisting of subtle archetypes, or psychic behavior patterns, embedded in the universal mind as themes or images which are mirrored in external reality via physical processes in the brain. Archetypes, like intentions, carry psychophysiological energy and may trigger, or be triggered by, synchronistic events. They provide the alphabet of metaphor and comprise the symbolic relationships found in dreams, myths, legends, cultural icons, and much serendipitous discovery.

Bohm's theory did not receive much acceptance in the physics community. His ideas did highlight the fact that physicists get different statistical results each time an atom is measured, suggesting some additional process is at work. Walker, using information theory, proposed that human will capacity, estimated at 60 000 bits per second, acts not only directly on the physical body but nonlocally on external physical reality. He calculated that will's influence is small within the brain due to a low signal-to-noise ratio which disallows most individuals from distinguishing will from other thought processes in the brain. Consequently, individuals don't experience a complete efficacy of will.

In 2004, Stapp proposed a mechanism for the mind's ability to alter physical reality called the Quantum Zeno Effect, a confirmed physical effect demonstrating the influence of high-frequency repetitive attentional states on the physical state of an atom. Stapp's theory divides mind and matter according to John von Neumann's quantum interpretation in which the choice of question physically affects the system being addressed.

The main contention with a quantum interpretation of a serendipity effect is decoherence, nature's tendency toward closure. In the complex, thermal/chemical fluctuating environment of the brain, quantum coherence is so fleeting and extremely localized that any potential effect in the brain (much less externally) is canceled. What is overlooked in decoherence theory is that thermal/chemical fluctuations themselves are indeterminate quantum processes. Rosenblum and Kuttner also remind us that decoherence is the probability of what one might expect, or find, not what actually exists in physical reality. Consciousness becomes unavoidable.

In 2009, Ryser posited that even if individuals could intentionally manipulate the indeterminacy of their brains and bodies, the indeterminacy of external reality is influenced solely by the universal mind. This concept corresponds with both historical accounts of paradigm-shifting creativity arising from the universal mind of God and modern research on the power of intentional surrender to influence physical reality. If unconscious intention can influence incubation and illumination as well as apparently random occurrences of meaningful external events, then the presence or absence of conscious intention may not be the distinguishing factor in serendipity, or in its relation to synchronicity. What may uniquely identify serendipity is the creation of new meaning by operator-induced insight and sagacity.

Childlike Tendencies, Playfulness, Daydreaming, and Paracosms

Creative persons may have a tendency toward playfulness. This may be a reflection of their spontaneity and self-actualization. Whatever its origin, it no doubt helps them to find divergent and original ideas. In fact, recommendations for enhancing creativity often include a suggestion about “being more playful,” and many businesses have recently attempted to bring playfulness into the workplace (e.g., Berg 1995; Starbuck & Webster 1991; Tang & Baumeister 1984Berg, 1995Starbuck and Webster, 1991Tang and Baumeister, 1984). March (1987) really brought this point home with a technology of foolishness.

Defining Play

It is surprisingly difficult to define play (see Dansky 1999; Lieberman 1977; Piaget 1962Dansky, 1999Lieberman, 1977Piaget, 1962). Mark Twain’s (1876/1999) definition, from his novel Tom Sawyer, is as good as any: “Work is what a body is obliged to do, and play is what a body is not obliged to do” (pp. 25–26). This ties play to intrinsic motivation, which suggests yet another connection between creativity and playfulness (Figure 9.3).

Play apparently is frowned upon in certain cultures and circles, at least if it is an adult who is playful. Adams (1974) listed it as a cultural block, his thinking being that in the United States, if an adult has a problem, they should be serious about solving it. He criticizes that view since it may preclude original thinking. Fortunately there is evidence that adults can be playful. Gardner (1993a), for example, found the creators in his detailed study to be childlike, and this implies a kind of playfulness. Then again, he was studying high-level “Big C” creativity.

The childlike tendencies of some creative people lead them in a useful direction. Consider in this regard the paracosms and worldplay of certain creative adults (Root-Bernstein and Root-Bernstein 2006). Worldplay may involve a kind of fantasy life and daydreaming, which could be manifested in the construction of futuristic or other imaginary worlds and imaginary companions. Apparently worldplay occurs in a moderate proportion of certain creative groups, across domains, and is sometimes connected to actual professional endeavors (Root-Bernstein & Root-Bernstein 2006).

10.13.8 Future Directions

Compared to most people living in more individualistic, liberal, Western societies, Arabs are more dependent on their families, their personalities are less individuated, and they do not welcome autonomy or self-actualization. Therefore, an individual's repression is maintained by external factors rather than intrapsychic constructs such as an ego or superego. Implementing psychodynamic or other nondirective therapies, which are designed to deal with intrapsychic processes and to motivate the patient towards self-actualization, may result in serious problems. First, they miss the main source of repression, which is external rather than internal; and second, they activate repressed emotions that may not be allowed to be expressed in the Arabic society, such as sexual drives or aggression towards family members. Therefore, “successful” treatment that makes the unconscious conscious converts the intrapsychic conflict into a conflict between the client and his or her family, and may leave the client with an untreated wound (Dwairy, 1997a; Dwairy & Van Sickle, 1996).

To avoid these problems, therapists are encouraged to be flexible, tailoring the therapy to the client, rather than fitting the client into their favorite treatment approach. Therapists need to be able to alter their personal therapeutic style, and be open and willing to learn new approaches to treatment (Budman et al., 1992). An understanding of the client's cultural identity and family relationships is essential evaluative information in directing the therapist's choice and trajectory of treatment. For Westernized Arabs, such as some of the more educated peoples of major urban areas, a therapist may consider insight-oriented therapies, whereas for traditional Arabs, behavioral, directive, goaloriented, and short-term therapies are recommended. With traditional clients, psychotherapy may include counseling and academic and career assistance (West, 1987). The client's ego strength is another important factor to evaluate. Before implementing any type of insight therapy that may evoke culturally forbidden needs and emotions, the therapist should be reasonably sure that the client is strong enough to participate meaningfully in the conflicts that will emerge between the client and family.

Because Arab patients have many misunderstandings about psychotherapy, West (1987) suggested that issues of trust, the therapist–patient relationship, and status differentials need to be discussed openly in the early stages of therapy. Orientation to psychotherapeutic processes prior to commencing treatment may facilitate the effectiveness of the treatment, as well (Dwairy & Van Sickle, 1996). After careful consideration of the above factors, a therapist may begin treatment in a directive mode and later shift gradually to a nondirective and insight-oriented made (Gorkin et al., 1985).

When a traditional Arab client is not individuated from his/her family, parental authority is never to be challenged or criticized (West, 1987). Joining the authority of the family and gaining its trust is crucial at the beginning, especially when the client is a woman (Dwairy & Van Sickle, 1996; Racy, 1980). Without the collaboration of the family, therapy may well be sabotaged. A supportive personal approach that acknowledges cultural norms may enhance the trust.

Egalitarian family therapy that focuses on encouraging the direct expression of feeling is frustrating, if not impossible, with traditional families. Such therapy may threaten the authoritatian structure of the Arab family, and terminate treatment. Promotion of separation from the family is considered disrespectful (Budman et al., 1992).

Therapists should learn about the culture (values, norms, prohibitions, taboos, etc.) from the client, without imposing his or her own values on the client. Therapists may enlist parts of the Arabic culture to accomplish therapeutic changes (Dwairy, 1998; Dwairy & Van Sickle, 1996). West (1987) suggested cooperating with folk healers to broaden therapists” repertoire of treatment modalities that have been proven effective in Arab societies.

The therapist should find a way to help the client within the limitations and specifications of the client's culture. Their culture should be considered an immutable, but important, piece of the therapeutic process. Racy (1980) suggested that the therapist avoid both of two extremes: the temptation to be so respectful of tradition that one becomes paralyzed, and the tendency to become a social reformer. A combination of warmth, authority, diplomacy, and verbal facility can go far toward establishing an effective alliance.

Based on the sociocultural background of Arabs, characterized by the somatization of psychosocial distresses, and person–family interdependence, the flexible implementation of a biopsychosocial approach to treatment, involving the client's family, may be promising for the majority of Arab clients (Dwairy, 1997c).

Humanistic approaches

Humanisitic approaches to personality emphasise our potential for growth and development, and see people as naturally striving to be creative and happy. Many proponents of humanist approaches suggest that there is a tendency towards ‘self-actualisation’ where the individual is able to satisfy the needs of the self-concept, and therefore be well adjusted. Two of the major theorists in this area are Abraham Maslow (Maslow 1968) and Carl Rogers (Rogers 1951). Maslow emphasized a hierarchy of needs which must be satisfied in order to reach ‘self actualization’. Lower level needs, such as basic drives for food and sex, must be satisfied before higher levels of personal development can be obtained. Rogers believed that we all innately seek to develop in the direction of maturity and positive change. A key concept in Rogerian theory is that we all have a perception of the kind of person we would like to be, referred to as the ideal self. Congruence between the individual's view of their ideal self and the person's view of their real self leads to fulfillment and contentment, whist incongruence between the ideal and real self leads to anxiety and denial.

Both the psychoanalytic and the humanistic approaches to personality have received relatively little empirical support. In contrast more experimental study has been focused on nomothetic theories of personality.

Adult learning theories

The entire educational spectrum, from premedical through continuing professional development, is all about learning. But how do adults learn? Are there ways to enhance learning? To make learning more efficient?

There are multiple theories in several broad categories that attempt to explain how adults learn:

Instrumental learning theories including the behaviorist and cognitive learning theories that focus on individual experience.

Humanistic theories focusing on self-actualization and individual development.

Transformative learning theory in which critical reflection is used to challenge beliefs and assumptions.

Social learning theories that emphasize communities of practice shaping the learners development.

Motivational models that recognize intrinsic motivation sustained by autonomy, competence, and a sense of belonging or relatedness.

Reflective models that propose that reflection leads to action and change [9].

Is there a practical relevance to “real world” medical education of these theories? Rather than focusing on a specific theory, combining the salient features will serve as useful guides for medical educators.

Although medical students matriculate with an extensive array of experiences and backgrounds, a key to success is providing them a way to organize the information they will be learning. Hence, the importance of a mental model or scaffold to serve as a guide as they attempt to organize and comprehend the volume of complex material they will encounter. Students will need to overtly connect new information to previously learned concepts and knowledge and then be encouraged to consider additional potential connections and relationships. This reflection can be facilitated through discussions, demonstrations, seminars and even informal conversations. Then the learner should be helped to reflect on the strengths and weaknesses of their understanding through assessments that can be formal or informal.

These steps are obvious but may not always be followed in working with medical students and residents. In addition, learning theories provide perspectives on motivation, the context in which learning occurs, and a host of other factors. It is important, however, to remember that scientists involved in education research are interested in developing theories that may or may not translate directly into practical applications. Medical educators should be informed of progress in the development of learning theories but need to consider the context, sophistication of the learners they are working with, and the desired outcomes when considering the applicability of a theory to their educational situation.