New Article Outlines Contemplative Psychotherapy Approach to Extreme States

In a new special edition on extreme states, a contemplative psychotherapist maintains that extreme states represent opportunities for transformation and that recovery is always within reach.


In the Journal of Humanistic Psychology’s new special issue, “Humanistic Perspectives on Understanding and Responding to Extreme States,” edited by Dr. Michael Cornwall, Charles Knapp explores theories and treatments for “extreme states psychosis.” Drawing on his own mental health struggles and nearly 30 years of practice at Windhorse Community Services in Boulder, CO, Knapp proposes that extreme states hold the potential for transformation into “a highly individual path of discovering and manifesting… [one’s] own unique, intrinsic sanity.”

“In more than 30 years of knowing people in extreme states, I have not encountered a thought, emotion, or process in others that I do not recognize as part of my own mind,” Knapp writes.

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Knapp’s writing is grounded in the tradition of contemplative psychotherapy, an approach born out of a collaboration between Tibetan Buddhist teacher Chögyam Trungpa Rinpoche and Western psychiatrists and psychologists in the 1970s. One of contemplative psychotherapy’s fundamental principles is that of “brilliant sanity,” which refers to an expansive, clear, and compassionate quality of mind to which all humans have access.

The Naropa Institute (today, Naropa University) was founded by Chögyam Trungpa Rinpoche in 1974 in Boulder, Colorado as a home for the teaching of contemplative psychology and psychotherapy. In 1981, Trungpa Rinpoche went on to develop the Windhorse Project with Dr. Ed Podvoll; the project later evolved into Windhorse Community Services, where Knapp is a senior clinician. Windhorse uses a contemplative psychotherapeutic approach to support those experiencing extreme mental states in a manner that is holistic, home and community-based, and recovery focused.

Knapp addresses two questions in his article: “What are the causes and experiences of extreme state psychosis?” and “How does understanding this inform how we might be helpful?”

Recognizing that the causes of extreme state psychosis are complex, Knapp focuses on two particular reasons — environmental and psychological. Environmental causes include one’s family, community, and the broader zeitgeist (e.g., human degradation of and disconnection from our natural environment).

Environment likewise influences individuals’ paths to recovery upon experiencing extreme states. Although some people’s surrounding communities will “respond with skill and gentleness,” Knapp writes, others’ will react with “aggressive intervention,” which can result in “a spiritual death sentence: a conclusion that the person is fundamentally damaged and always will be.”

Regarding psychological causes of extreme states, Knapp describes the disruption that can occur when “consensus reality” slams into a deeper, more “fundamental level of reality” that is typically not a part of our daily consciousness. He recounts his own experience avoiding this level of reality as a young man through work and “self-medication.”

In discussing how awakening to this level of reality can be shocking and cause one to become untethered from consensus reality, Knapp draws from the Tibetan Buddhist Medicine and Psychiatry, which states that “Realization of the inevitable facts of decay and death, of impermanence in all aspects of life, can be devastating…The psychological basis of insanity is the same basis for enlightenment.”

In response to his second question regarding how one might be helpful to someone in an extreme state, Knapp presents four principles employed by Windhorse’s practitioners:

1.) “People are fundamentally sane and healthy, thus mental confusion exists and functions in a secondary position.”

Clients’ “fundamental sanity” should be recognized and affirmed; such a stance serves to diminish fear and convey respect. Helping clients connect to their previous experiences of health can also help foster a sense of confidence and possibility.

2.) “We are inseparable from our environment.”

Clinicians should strive to create “environments of sanity” for their clients. One of the ways Windhorse practitioners accomplish this is through the practice of Basic Attendance, which involves attuning and bringing oneself fully to relationships with clients. Other concepts include mutual recovery and exchange, which recognize that clinicians are on a journey alongside their clients and that in being radically open to clients’ experiences, clinicians may have uncomfortable experiences in which they “directly experience” their clients’ “minds and physical states.” As exchange is a mutual process, clients are also able to take in the “healthy aspects of the stable minds in the environment.”

3.) “Recovery is the path of discovering and synchronizing with one’s own health and sanity.” 

Knapp emphasizes that this involves starting where clients are and helping them connect with a sense of health through their own senses and supportive relationships. “It is well known that many people in extreme states feel unspeakably lonely — their inner worlds unknown to others and cut off from contact with people who are willing to just be with them,” he writes. “As a therapist, to simply feel another’s pain and predicament without looking away and without trying to change them is often a meeting point where genuine communication can occur.” Knapp’s perspective echoes Dr. Michael Cornwall’s advocacy for approaching those experiencing extreme states from a place of “loving receptivity.”

4.) “No matter how disturbed a mind has become, recovery is possible.” 

Knapp prefaces his description of this final principle with a response to the question, “Recovery from what?” The “what,” he writes, is “drowning” — circumstances in which clients have reached a point of not being able to “maintain life in consensus reality,” and have become so disconnected from the “body and senses” that they are no longer able to be in “reciprocal relationships and community.” Knapp emphasizes, however, that a healthy life comes in many forms: “Swimming’ does not mean becoming somebody else’s version of normal.”

Knapp closes with lyrics from a song by the Zen Buddhist monk and famed singer-songwriter Leonard Cohen:

Ring the bells that still can ring

Forget your perfect offering

There’s a crack in everything

That’s how the light gets in

Finally, he writes, “This “crack” refers to gaps in our minds as well as in our familiar life…For better or worse, extreme states are a gap… for those of us who are in positions of being helpful, confidence in these gaps potential to catalyze highly individual paths of sanity should never be forgotten.”



Knapp, C. (2018). That’s How the Light Gets In. Journal of Humanistic Psychology, 0022167818761998. (Link)

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Rebecca Troeger
MIA Research News Team: Rebecca Troeger is a doctoral student in the Counseling Psychology program at the University of Massachusetts Boston and has a Master’s degree in Psychology. Her work explores how Western psychology can move towards valuing other cultures' knowledge more deeply. She is also interested in the impact of social support and community life on mental health and anti-racism interventions.


  1. The problem with psychosis is that this is something beyond apollonian ego FIXATIONS of control, rationalism, unity, which means – we are happy because FOR US mental suffering, death – the rest of the psyche does not exist, we are healthy, (what means also that we are blind, but we refuse to admit that). And when someone is out of touch with Hades reality he is called sane. Because Hades reality is the oponent of Apollonian traits, you must be psychologically raped like Persephone to ADMIT THAT THIS PSYCHOLOGICAL REALITY IS TRUE, AND IF YOU ARE NOT – YOU WON’T SEE IT, YOU WILL REFUSE TO ADMIT ITS EXISTENCE. You will see the persons in depression or psychosis as if they were stupid, weak, impaired AS IF THEIR MENTAL STATE WAS SOME KIND OF BIOLOGICAL ILLNESS. That is apollonic blindness and arrogance.

    Apollonian will see you as impaired, because for them, Hades (psychological) traits are THE MOST ALIEN and his world is the danger for their simple convenient psychological reality which give a meaning only to their material world (money, carrier, easy growing up model). The reality of Apollo is easy – the flesh, the external material world, and the reality of Hades is harsh, INNER (growing down), invisible, this is pure psychological world, not the natural or material world. And Apollonians hate the treasures of Hades reality, because they have their MATERIAL ——power money, pathological lack of empathy and pure psychological world means a tragedy for their PSYCHOPATIC MATERIALISTIC REALITY.

    I try to explain it from phenomenological, mythical point of view, most of people are in the simplest/ the least psychological archetypes, moreover they do not know what is psyche, they think that psyche is only their easy point of view, that the apollonian ego is the psychological ruler, but it is not . Zeus or Hades are the psychological rulers OF PSYCHOLOGICAL REALITY and the main trait of Hades reality is death, (not in biological meaning). And our culture refuse to admit that, because it is extremely shallow, and the state reality is APOLLONIAN and for APOLLONIAN GROWING UP MODEL – easy, material economic reality (or spiritual), not the deep, psychological one.

    PSYCHOLOGICAL People are brutally removed from community of normal (apollonians) who refuse to admit that psychosis is psychological necessity, and not the mental health disturbance and the mental health means – the psyche is the enemy it means nothing for us, it is only some kind of of functional disturbance. Mental health is apollonian ego fundamentalism.
    Diagnosis without acceptance of the psychological reality are just empty dehumanizing nominalism.

    We are living in society completely divided from their psychological roots. Psychiatry it is egoic communism without place for psychological man, and people represents mental health policy do not represent psyche, but its destruction. AND THE LACK OF MEANING. As if the Ku klux klan represent the interests of black people using the book with white people shooting to them, on the cover.



    Without exchanging the base of today psychological reality, from the shallow psychopatic Apollonian fundamentalism to main (all archetypes) Zeus/Hades reality, nothing will change.

    Psyche is something that is completely removed from the state territory as to preserve the illusion of its materialistic reality which is consider as THE ONLY HUMAN REALITY.
    And psyche is not something which is seen as valuable for materialistic shallow culture. For me, the victims of psychiatry are the pioneers and the only heroes of today world.

    To change the psychological world, the history must do that what Copernicus have done. Stop the Apollo and move the Hades/psyche. Now, the primitive apollonian reality of the state is not refined enough for psychological man, for Hades, we leave in materialistic dull reality. Capitalism, communism, nazism have one in common —–hatred for the psyche. Chronos will eat them too.

    I recommend everyone the Hillman’s Re -visioning psychology.

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