[From Bill Powers (2008.08.05.1636 MDT)]
Dick Robertson,2008.08.05.1137CDT --
Of course i wouldn't put all the statements in the "not like" pile. I just meant that a lot of them that have the client seeing the therapist as telling him what to do, or what he feels, or the like, would only be characteristic of directive therapists, who are in a small minority as far as i can see.
You would know better than I do. I was under the impression that Cognitive Behavior Therapy (for example) was an expanding field, and from reading Aaron Beck's "Cognitive Therapy and the Emotional Disorders" I get a picture of a very non-MOL approach ("directive" may not be the word to use, since MOL is pretty directive in some respects). Here are some excerpts from the book, the first being a transcript of how a therapist deals with a client who is afraid of giving a bad presentation of something in public (ellipses indicating omitted text are in the original):
"Patient: That's right. It does feel as though my whole future is at stake.
Therapist: Now somewhere along the line, your thinking got fouled up ... and you tend to regard any failure as though it's the end of the world ... What you have to do is get your failures labeled correctly -- as failure to reach a goal, not as a disaster. You have to start to challenge your wrong premises." (p. 251)
Under the heading of "Treatment of Depression," Beck discusses his techniques as a therapist. They include
"Scheduling Activities with the Patient. Since the patient sees himself as ineffective, it is important for him to be active in order to observe himself as potentially more effective. An activity schedule, in itself, helps the patient structure his day. Because depressed patients often resist attempts to get them to be 'busy', it is essential to use a variety of incentives, such as the notion that being more active may relieve his unpleasant feelings to some degree." (p. 271)
"Mastery and Pleasure Therapy (M & P Therapy). The essence of this kind of therapy is to have the patient keep a running account of his activities and to mark down "M" for each mastery experience and "P" for each pleasure experience." (p. 272)
"Homework Assignments. ... the patient is generally expected to carry out certain activities that will counteract his depressive symptoms." (p.273).
I doubt that this was a passive expectation. "Told" might be a better word than "expected."
The main theme seems to be that psychological problems are caused by faulty logic, unsupported beliefs, and scientifically incorrect thinking about evidence, and that simply by demonstrating that fears are logically groundless, depression is an exaggeration of disappointments, and other problems in general result from an incorrect assessment of self or situation, the patient can be forced to admit that there is no actual problem. Since patients often feel better after therapy (eventually), these techniques are considered validated.
Beck did in fact find other approaches that he also used, one being founded on his discovery of "automatic thoughts." He came across them when, as a psychoanalyst, he asked patients if, during free association exercises, any thoughts had been in the patient's mind that had not been mentioned to the therapist. There were lots of them. By asking about these automatic (background) thoughts, he discovered, along with his patients, important areas of thought that would otherwise have been passed over. That, in my opinion, is probably one of the reasons his patients got better when they did get better. I'm sure there were other aspects of the therapy that also encouraged going up a level or two, and Beck does mention that among the things that come up for discussion are conflicts. Examining conflicts is another thing that I think accounts for improvements.
Most of the other techniques Beck discusses, however, I would consider irrelevant to or even detrimental to therapy. I'm sure Beck would be devastated if he learned what I think.
Anyway, some of the items in my list, written as if from the patient's point of view, represent my take on how it would feel to experience cognitive behavior therapy -- items like "012: In the session, I was told or shown that my unpleasant thoughts are incorrect." That would end up scoring quite unlike MOL.
In the American Academy of Psychotherapists, of which I've been a member forever, I haven't observed anyone telling a client what they were thinking, or should do. Most therapists have been influenced by Carl Rogers, in this respect, even if they differ from him in terms of their theories. And even Freud, if you read him as extensively as I have (without being a follower, remember) you will find him saying that he only offered an interpretation
I wonder how representative of psychotherapists in the US or the world your sample was. I tried psychoanalysis for a few months back in my mid 20s and found the therapist to be very disdainful of my silly beliefs and generally overbearing and snotty (at $90/hr). I discovered it wasn't just me, a few months after I quit, when the newspaper carried a story about a disgruntled patient who had just shot and killed this poor guy (Schlageter was the therapist's name, and that was 50 years ago so I don't think I'm offending anyone alive).
Also, it's been my experience that when psychotherapists get together, they like to tell stories about their patients and then reveal what was REALLY going on that explained their behavior. There is a lot of prestige involved in being regarded as a person of penetrating and subtle insight -- someone who, as Shelley Brierley put it in her suggested item, knows the patients better than they know themselves. And don't forget the armies of clinical psychologists, counsellors, and social workers who you probably never saw at those academic meetings. I'm sure they dole out advice and analysis by the shovelful.
Amd don't forget psychiatry.
The main reason for which therapists have difficulties in learning MOL, in my experience, is that they have to stop doing so many things they had been taking for granted as the therapist's duty. It's much easier for someone who has never been a therapist. A lot of the things they have to unlearn are reflected in my list.
My view of the entire interaction we call 'therapy' involves things that don't always look like conflicts. Sometimes a little reframing helps get past the paralysis that has been preventing the realization of conflict, and sometimes a confrontation might hold up a mirror to endless positive-feedback spirals to nowhere.
If I were coaching you in MOL I would probably act very suspicious of those statements.
And one last point. I strongly subscribe to the idea that MOL would probably end up being rather hollow if practiced by someone who wasn't fully familiar with PCT.
I think there's pretty general agreement on that among MOL practitioners. The very concept of a level of perception, and the relationship between levels of control, makes sense only under PCT.
I said to him one day (after wondering whether he might use the imagination arrow to perceive what he might be blocking in his formal goal) "What if you HAD your biblio finished? What would it be like then?" He slapped himself on the side of the head and said, "Oh, you know, I've told my whole family that when I have my Ph. D. I will quit this hippy life (this was in the 70s) and settle down to a conventional practice, but you know what? I love this hippie life." The next week he came in and said, "Well, I finished my biblio. It occurred to me that I can be a Ph. D. and live any life I want to.
I remember that story; it was probably one of your contributions to my education. Asking what would happen if the wanted thing actually took place is a good way to get the person to look at the higher-level goal (I doubt that this guy wanted a PhD just because he likes the feeling of parchment). Also typical of MOL-like results of therapy is the fact that he actually achieved the reorganization between sessions. I've seen it happen and heard about it often. Whatever is causing the changes, it's not the therapist.
Best,
Bill P.
