Category: psychological models

Models of Madness

Posted in Addiction, mental health system, psychiatry, psychological models, psychology, psychotherapyLeave a comment

In prior posts I’ve written about the pros and cons of the medical model (psychiatry) as the predominant model for the treatment of mental illness, and about what I call “the model muddle.” Models are ways of organizing and framing ideas in a way that serves as a guide. A good model is like a good map: it helps you to get where you want to go. The map is not the territory, but merely a helpful representation. No model is perfect and complete, or demonstrably superior to all other models, in all situations. Each one has its flaws and limitations.

Psychiatry is the medical model’s methodology for treating mental illnesses – primarily with medications. In a nutshell, the model starts with the identification of symptoms, which leads to an appropriate diagnosis, which in turn leads to an appropriate treatment.  The medical model is very good at what it’s good at, such as mending broken bones, doing surgery, and treating many physical ailments. But psychiatry is built more on theory than on scientific evidence.

One limitation of the medical model is that it’s mainly focused on what you do after you have symptoms, not so much on wellness and prevention. A distinct limitation of the medical model as regards mental disorders is that, unlike most common physical disorders, there are no identifiable biological markers to distinguish (for instance) what we call “schizophrenia” from “schizoaffective disorder” or “bipolar, manic.” Psychodiagnosis is not rocket science, because mental illness isn’t measurable in the way that many physical illnesses are (i.e. medical science can distinguish between asthma and pneumonia). At best it’s educated guesses, and many people with an extensive history of psychiatric treatment have been diagnosed with – and treated for – a variety of diagnoses.

Critics of psychiatry have argued that mental illness is a social construct and not a medical condition, and that psychiatry is a process of coercive social control. The negative side effects of some psychotropic medications and mood stabilizers outweigh the benefits for many patients. The term iatrogenic effects refers to treatments that do harm. Unfortunately, contemporary psychiatry is wedded to the pharmaceutical industry. That having been said, psychopharmacology has its place in the treatment of what we call mental illnesses. I believe that in some instances there’s no effective substitute for the right dose of the right medication at the right time. But I also believe that other interventions can mitigate the need for primary reliance on drugs as the default treatment for psychopathologies.

The biopsychosocial model takes into account such factors as physical health, heredity, stress, social stigma, social support system, mental habits, chemical dependency,  economic status, nutrition, and homelessness. We need to embrace a more holistic treatment model for what we call mental illness, and to provide a range of services that gives people who’ve been labeled as mentally ill more autonomy and more options for resolving problems related to their mental health. Unfortunately, the national mental health system is severely underfunded, and many people in need of help are underserved. This is a national disgrace.

The recovery model is an alternative to the medical model. A lot of mental health professionals initially scoffed at the idea of people “in recovery” from chronic psychiatric disorders. Recovery made sense as a helpful model for “recovering” substance abusers, but did it apply to the mentally ill? Many mental health professionals have come to recognize the merits of the recovery model, and there are now recovery centers/programs in some cities, that aren’t run on the medical model. Such programs don’t necessarily preclude psychiatric interventions, but also offer educational resources to empower patients, professional and peer support, and access to community resources, to reduce the stressors that exacerbate symptoms of mental illness.. The concept of recovery from mental illness doesn’t mean full and permanent remission of symptoms, but suggests that psychiatric treatment isn’t the only route to symptom remission and control of one’s life. To find out more about the recovery movement and alternatives to traditional psychiatric treatment, check out madinamerica.com.

Existentialism and psychotherapy

Posted in comparative religion, philosophy, psychological models, psychology, psychotherapy, religionLeave a comment

Although I studied a variety of therapies in my preparation for a career as a psychotherapist, I never identified exclusively with one approach – gestalt, client-centered, behavioral, psychodynamic – as a descriptor of my style of therapy. I was an eclectic practitioner, but have always considered my therapeutic orientation to be existential.

I respect that there are therapists whose work has a religious foundation, but mine was a secular practice. I validated faith in God and prayer as best I could, with clients who found meaning in their religious beliefs; but if clients asked me to pray with them, I declined. Although I was raised as a Christian, and most of my values are rooted in the Judeo-Christian ethic, I’m an agnostic of the kind that’s very comfortable with saying “I don’t know” when asked about specific religious beliefs. I think that it’s just as arrogant for an atheist to assert sure knowledge that there is no God as it is for a religious person to assert that I’m in error for not believing what they believe. Define God, then we can talk.

I don’t believe that I have the authority to definitively answer questions about religion and am tolerant of  those who claim to “know” that their beliefs are true, as long as they do no harm as a result of religious beliefs. Of course, there’s considerable room for debate about what constitutes harm. (I personally consider any form of indoctrination to be harmful.)  I consider myself an existentialist because existentialism directly addresses morality and personal responsibility, without the excess baggage of sin and redemption and pleasing God. I’ll briefly summarize some of the basic principles of existentialism, as I understand them.

First, existentialism asserts that there’s no universal Meaning “out there” that all right-thinking people can apprehend – as opposed to religions, which assert that there is, i.e. “God’s plan.” To existentialists, concepts like Sin and Redemption and Divine Intercession are constructs based on religious doctrine. They don’t exist in any objective sense. Meaning only exists in the eye of the beholder. Life is absurd, as illustrated by Albert Camus in “The Myth of Sisyphus.”  Sisyphus continues to push the boulder up the hill, despite knowing that it will just roll back down. He persists, despite the absurdity of his efforts, because the act has meaning for him.

Because there are no absolute rules, or Divine rewards or punishments in an afterlife, we are each free to do whatever we want. But the other side of the coin of freedom is responsibility. We’re absolutely responsible for whatever we choose to do, and can choose to behave morally even if we don’t believe in Heaven and Hell. We can choose to live in good faith with others, because of our moral responsibility for all of our actions. Although we can find joy and meaning in authentic relationships, we’re all essentially alone in our lives. (A song sung by Country singer Bill Monroe expresses this as well as anything I’ve read on the subject; “You’ve got to walk that lonesome valley,/ You’ve got to walk it by yourself,/ ‘Cause nobody else can walk it for you./ You’ve got to walk it by yourself.”) We each have to deal with Angst (anxiety) and dread that comes from the knowledge that we will someday cease to exist. Existentialists don’t rely on the comfort of religious promises of eternal life for the faithful, to come to terms with our mortality.

To say that there’s no objective Meaning to existence “out there” isn’t to say that meaning is unimportant. As an existentialist I’m free (like Sisyphus) to find, or create, my own meaning. One of the best-known existential therapists, Viktor Frankl, named his school of psychotherapy logotherapy – from the Greek “logos”: meaning, or reason. (I’ve written about Frankl in previous posts. I’ve recommended his book, Man’s Search for Meaning, to more clients over the years than any other book.) Although I didn’t practice logotherapy, per se, I’ve worked with many therapy clients to help them find or create meaning in their lives. It can be a life-or-death matter with people who are suicidal.

I initially saw existentialism as grim and forbidding: if there’s no extrinsic Meaning to existence, then all we can do is to sweat along with Sisyphus, acting as if there was meaning to our lives. But now I see the richness of choice, where I once saw austerity. Existentialism gave me a philosophical context for the I-Thou encounters of psychotherapy. We all have a need for our lives to mean something; but we needn’t rely on “God’s plan,” as taught by this or that religion, or on promises of eternal life, to find meaning in our lives.

If you want to learn more about existentialism and the colorful characters (Jean-Paul Sartre, Simone de Beauvoir, as well as Camus, Heidegger and Merleau-Ponty) who formulated its principles, I recommend Sarah Bakewell’s highly-readable At the Existentialist Café: Freedom, Being and Apricot Cocktails. I’d never have guessed that phenomenologist Maurice Merleau-Ponty was good at dancing the Jitterbug.

The Peace Corps experience

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Have you ever considered serving in the Peace Corps? Even before we got married in 1990, both Maria and I had, and we’d both lived abroad (Maria in Korea and me in Austria and Germany). Within weeks after our wedding we applied to serve as Peace Corps Volunteers (PCVs). At that time only one-in-three applicants was selected to serve. Would-be PCVs don’t typically choose where they’ll serve, although fluency in the language spoken is a given host country can be a determining factor. The more open you are to serving wherever your skill set is needed, the better your chances of selection. We were approved for service after a lengthy application process, and were selected by Jamaica. We had two weeks to decide if we’d accept Jamaica’s invitation, but it didn’t take us an hour after reading about our assignment to call Peace Corps headquarters in D.C. and accept. We put all of our belongings in storage, and sold our cars around the time we got our plane tickets in the mail.

The Peace Corps is an independent government agency, not a branch of the State Department. It currently has volunteers in over sixty developing countries around the world. PCVs aren’t sent to these countries to advance or influence American foreign policy, but rather to share their skills with host country nationals, in the service of sustainable development. Each volunteer serves within one of six sectors: education, health, agriculture, community economic development, youth in development, or environment. The host country, not the Peace Corps, decides how many volunteers in each sector they need, and where they will serve. Most PCVs serve for two years, after training.

In order to qualify for Peace Corps service, you have to be at least eighteen and in good general health. Most volunteers have at least a bachelor’s degree, but exceptions are made for people with experience in certain areas, including construction, business and forestry. To be accepted, you have to pass a physical (which the Peace Corps pays for) and establish that you’re not fleeing indebtedness or legal charges. People who’ve served in intelligence agencies like the CIA need not apply. You have to have a skill set (and in some cases, appropriate certification or licensure) that people in host countries need to support development projects. The largest sectors are education and health.

Some personal qualities that make for a good PCV are good people skills, self-confidence, autonomy, flexibility, and persistence in the face of obstacles. Peace Corps service is always an adventure, and sometimes an uphill struggle. As I wrote in my book, Two Years in Kingston Town: A Peace Corps Memoir, Peace Corps service can be likened to climbing a mountain; you wind up knowing more about yourself than about the mountain.

In most host countries, accepted applicants have to have three months of in-country training, including language lessons, before they’re sworn-in as PCVs and start their assignments. But since English is Jamaica’s official language, Maria and I only had six weeks of in-country training before we were sworn in (the same oath as when I joined the Army) and started working. Two things stand out from our training as development workers in Jamaica. The Peace Corps Country Director said something to the effect of, “If you think of Peace Corps service as ‘giving up’ two years of your life, Jamaica doesn’t need you that badly. You’re here to live in Jamaica for two years, and to learn as well as to teach.” A Swedish guest lecturer with years of experience in international development work said something like this: “For at least the first six months, keep your mouth shut, and your ears and mind open. Nobody needs to hear you telling them the right way to do things. You need to establish trust and credibility before you start offering advice.”

Maria taught psychiatric nursing, but had to get licensed as a Jamaican nurse before she could join the faculty at the School of Nursing. When we applied, having no idea where we’d serve, I thought I’d end up teaching English somewhere, as I have a B.A. in English. I never dreamed that I’d serve as a psychologist. But the University Hospital of the West Indies had just opened a detox/rehab ward for Jamaican addicts, and my skill set was just what they needed. So I served as the ward psychologist, and helped to develop a relapse prevention model for the ward.

As a PCV you don’t get paid a salary, but you get a living allowance that allows you to get by on the local economy. Every month you serve, a modest amount of money ($200 when we served) is set aside for your readjustment allowance, after you complete your service. Not all PCVs fulfill their two-year obligation. Some volunteers leave behind a lasting accomplishment,  however small, in terms of sustainable development in their sector; others don’t. But I still think that the Peace Corps gives more “bang for the buck” in terms of winning friends for the U.S. in developing countries than aid agencies like U.S.A.I.D., because Peace Corps service is all about developing helping relationships within host country agencies and Non-government Organizations (NGOs).

PCVs are citizen “goodwill ambassadors,” because they work at ground level with host country counterparts. After I was robbed on a bus in downtown Kingston, I heard a fellow commuter sympathetically refer to me as “jost a workin’ mahn” because – although white – I rode the bus to work, just like them. It was one of the best compliments I received while working in Jamaica.

Maria and I didn’t serve simply out of altruism or idealism. Peace Corps service was an opportunity for cultural enrichment and personal growth. We got to know the beautiful island of Jamaica, it’s people and culture. Not all PCVs leave behind an identifiable accomplishment in terms of sustainable development in their host countries; but Maria helped Jamaican nursing students to view mentally ill people as human beings first, and not as “mental patients.” I recently learned that the relapse prevention model I introduced on the detox/rehab ward is still being used at the University Hospital of the West Indies. Maria and I still echo what’s been called the “Peace Corps mantra”: we got more than we gave.

 

Psychiatry: pro and con

Posted in mental health system, psychiatry, psychological models, psychology, psychotherapyLeave a comment

I write this as someone who had a career as a psychologist in the mental health system, working within the scientific/medical model of psychiatric treatment. So, I’m not writing to reject psychiatry outright, but to examine its efficacy. I’ve written about the value and limitations of models in previous posts, and about what I call the “model muddle.” Models are just maps, helpful only to the degree that they’re accurate. No one model is demonstrably superior to all other models, in all situations. Every model has its limitations.

First, I’d like to distinguish between psychology, psychiatry and psychoanalysis. Psychology is the study of human behavior, and provides the basic theoretical structure for psychotherapy. Sigmund Freud came up with the concept of “the talking cure,” the notion that dialogue with a caring professional could help to resolve symptoms and treat psychopathology. Psychiatry is a branch of medical science, based on the concept that the accurate assessment of symptoms of mental illness can lead to an accurate diagnosis, which will result in an appropriate treatment. Psychiatrists are medical doctors who specialize in the treatment of mental illness. Freud was a psychiatrist, and psychiatrists who are trained in the system of Freudian psychotherapy are called psychoanalysts.

While I believe that psychiatric (medical model) treatment has helped a lot of people with debilitating metal and emotional symptoms, like any model, it has its limitations. Since the 1960s, the efficacy of psychiatric treatment has been questioned – with good reason. A primary critic was psychiatrist Thomas Szasz, who wrote The Myth of Mental Illness. Another psychiatric rebel was R.D. Laing, and yet another psychiatrist, David Cooper, coined the term “antipsychiatry.” Critics of psychiatry argue that mental illness/madness is a social construct and not a medical condition, and that psychiatry is a process of coercive social control. This core of criticism has led to the current antipsychiatry (alt. recovery) movement.

A primary criticism of psychiatry is that psycho-diagnosis isn’t rocket science. It’s imprecise relative to the diagnostic precision for most common physical medical conditions, and can be selective and subjective in its diagnostic criteria. Unlike with physical medical conditions that can be diagnosed by tests and procedures that reveal “markers” of a specific condition (i.e. pneumonia vs. tuberculosis), there are no such markers that distinguish schizophrenia from schizoaffective disorder or bipolar disorder. I’ve known many people with chronic mental and emotional disorders who have gotten a wide range of psychiatric diagnoses, over years of treatment. Ideally in the medical model, an accurate diagnosis results in appropriate and effective treatment. This is less often the case in psychiatry, because there’s more “educated guesswork” involved.

Proponents of the antipsychiatry movement contend that psychiatric treatment is all too often more damaging than helpful to patients. Extreme treatments such as prefrontal lobotomies haven’t proven to be effective; and the negative side effects of some psychotropic medications and mood stabilizers seem to outweigh the benefits for some patients. The term “iatrogenic effects” refers to treatments that do harm.

Another valid criticism of psychiatry is that it’s over-reliant on pharmaceuticals, and that the psychiatric profession has had incestuous ties to Big Pharma. I believe that, as a culture, we’re too dependent on medications as a panacea for health problems related to bad lifestyle choices. Drug company ads suggest that we can eat whatever we want and take pills to control any gastro-intestinal symptoms that result from a poor diet.

Having said that, psychopharmacology has its place in the treatment of what we call mental illnesses. I believe that in some instances there’s no effective substitute for the right dose of the right medication at the right time. But I also believe that other interventions can mitigate the need to rely primarily on drugs as the default treatment for psychopathologies.

The concept of recovery from mental illness doesn’t necessarily mean full and permanent remission of symptoms, but suggests that psychiatric treatment isn’t the only route to symptom control or remission. There are recovery centers in cities around the country that offer alternatives to traditional psychiatric treatment, recognizing that community and peer support can be important components of treatment. Such programs don’t preclude psychiatric interventions, but don’t rely on them as the default mode.

Factors such as physical health, stress, social stigma, chemical dependency, poverty, homelessness and nutrition can all play a role in mental health and mental illness. We need to embrace a more holistic treatment model for what we call mental illness, and to provide a range of services that give people who have been labeled as mentally ill more autonomy and more options for resolving their problems.

You can find out more about the antipsychiatry movement, the recovery model, and alternatives to traditional psychiatric treatment at <madinamerica.com>.

 

 

The meaning of dreams

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We spend roughly one third of our lives unconscious, and when we’re asleep we’re unaware of our immediate surroundings. But sometimes during sleep, we’re aware of ourselves in a realm of illusions. We remain ourselves in our dreams; but the people, animals, places and things we encounter may transform.  A dream has a sequence of events but, unlike a story, it has no contrived plot. So, why do we dream, and what is the meaning of our dreaming? It depends on who you ask.

Dreams are regarded as sacred and/or prophetic in some cultures, and the interpretation of dreams is an ancient and widespread practice. In many cultures the interpretations have been made by priests, priestesses or shamans, proceeding from the assumption that dreams mean something in our waking lives. Many modern sleep scientists would disagree, believing that dream content is the result of random neural  firings, connected to memory retrieval. One theory about why we dream is that it’s the way the brain sorts and edits new memories for later retrieval.

The history of modern dream analysis in Western culture starts with the 1899 publication of Sigmund Freud’s The Interpretation of Dreams, in which he called dreaming “the royal road to the unconscious.” Along with free association, dream analysis was a component of Freudian psychoanalysis, used as a key for the unlocking of repressed thoughts and feelings. Freudian dream analysis has to do with themes such as wish fulfillment, unconscious desires, and anxiety related to conflicts in the dreamer’s life.

Carl Jung is perhaps best known for his concept of the collective unconscious. Jungian dream analysis is similar to Freud’s, in that it delves beneath the surface content of the dream as described by the dreamer (latent content), to explore the unconscious, symbolic meanings (manifest content). Jung’s system differed from Freud’s, in that Jungian therapists related the dream’s symbolic content to universal mythic themes in the collective unconscious, and archetypes such as The Mother, The King and The Hero.

While in grad school, I attended a leaderless gestalt dream interpretation group. Both theory and method were different from Freudian and Jungian dream analysis. The constant focus in gestalt therapy is staying in the here-and-now of your direct experience; and in the dream group you first related all that you remembered of your dream, in the present tense: “I’m walking on barren ground, in the middle of nowhere. I see a house in the distance and I’m walking toward it. As I get closer, I see that the house is deserted and falling apart. The wood creaks beneath me as I walk up the steps to the porch. The wood is rotten and I’m afraid I’ll fall through the floor, but I have to go inside. . . .” After the whole dream had been related in this manner, the dreamer would then take on the role of objects from the dream: “I’m a house in the middle of nowhere. I look good from the distance, but I’m actually falling apart. Nobody would want to live in me. . . .” After the dreamer finished, a group member might ask what it feels like to be this house, and the group would discuss possible meanings, before going on to the next dream object.

Things that happen to us  in our dreams often mirror circumstances that arouse our anxieties in our waking lives. Fear, anxiety, helplessness, frustration, and shame (e.g. naked-in-public dreams) are frequent emotional states experienced in dreams. Most of us have gone to school, and I expect that we’ve all had school dreams. I’ve done some stage acting, and I imagine that every stage actor has had some variation of a recurring dream theme from my acting days:  I’m onstage, the curtain is about to open on a full house, and I can’t remember what play I’m cast in, let alone my first line of dialogue. I’ve had very few nightmares as an adult, but a frequent theme in the dreams I remember is frustration, e.g. I need to get somewhere from where I am in a foreign city, but I’ve misplaced my luggage (or my car key) and can’t leave until I recover it. And then I can’t find my car, and the streets and buildings keep changing. It’s such a relief to wake up and realize that I’m right where I need to be, with no immediate problem to solve.

I’ve had some dreams that were so vivid, I’ve had to convince myself that they weren’t real. Researching the subject, I’ve come to believe that they were hypnogogic hallucinations, which occur in the twilight state between consciousness and unconsciousness, before falling asleep. Similar hallucinations that occur in the twilight state between sleep and wakefulness are called hypnopompic hallucinations.

Another unconventional dream state is lucid dreaming, where the dreamer becomes aware of being in a dream, and can control its content. I’ve had a few lucid dreams and have heard many claims that it’s a learnable skill. Some proficient lucid dreamers say that they can fly in dreams, overcome any adversary, and have sex with anyone they want. If you want to learn more about lucid dreaming, I highly recommend Richard Linklater’s 2001 animated film, “Waking Life.”

Dreams are but one of the mysteries of consciousness, and I believe that what they “mean” is ultimately subjective. Ancient shamanic tradition has it that Dreamtime is a real world parallel to our own, and that those who can “journey” in Dreamtime can heal people and work magic in the waking world. Whatever clues or signals dreams may hold in regard to our waking lives, their interpretation is culture-bound, and there are no authoritative answers to our questions about this mysterious, otherworldly phenomenon.

Esalen and the human potential movement

Posted in behavior modification, Humanistic Psychology, philosophy, psychological models, psychology, psychotherapy1 Comment

In previous posts I’ve written about humanistic psychology, which has been called the Third Force in modern psychology, after Freudian psychodynamic psychology and Behaviorism. The founders – including Abraham Maslow, Carl Rogers, Fritz Perls, and Rollo May – seeing that psychology was primarily focused on psychopathology, wanted it to also focus on psychological health and personal growth. Esalen Institute, an isolated  retreat on the Pacific coast near Big Sur, California, is considered by many to be the birthplace of humanistic psychology. I’ve wanted to visit Esalen, a retreat center for growth and learning, since my graduate education in a humanistic psychology program. I’ve just returned home from a writing retreat at Esalen, and it felt like a weekend on holy ground.

Esalen Institute was founded by Michael Murphy and Richard Price in 1963. The land on which Esalen is located was owned  by Michael’s family for generations, and the two of them had a vision of a center for holistic learning. The place is called Esalen because for thousands of years the area was the home of the indigenous Esselen people. Accordingly, Esalen is considered sacred land, and is treated with reverence by residents and visitors. It’s isolated, far from any town, and doesn’t have cell phone service or television. There are hot springs down by the rocky shore, and everyone knows that clothing is optional at the baths. When I soaked, naked, in a pool, looking out at the Pacific sunset, I had the sense of participating in an ancient cleansing ritual.

Humanistic psychology has also been called the human potential movement. The only required course in my psychology Masters program was “Human Growth and Potential” – known by the students as “Gro and Po.” Although most of my coursework involved psychotherapy and psychological testing, I could understand why Gro and Po was required. Psychology had to be about more than psychopathology and the remediation of symptoms. Indeed, our equivalent of an “Abnormal Psychology” course was “Unconventional Modes of Experience,” lest there be any stigma regarding “abnormal.”

While psychanalytic theory and Behaviorism were dogmatic and monolithic, humanistic psychology was more like a tree, with many roots and branches. It was holistic in its orientation to the study of human behavior, focusing on mind and body as a unity, and exploring the factors that enhance creativity and enable self-actualization. It was holistic in studying both Eastern and Western philosophies and practices, recognizing the benefits of things such as yoga and Buddhist meditation, long before they became popular. Existentialism and phenomenology also influenced the human potential movement.

From the beginning of the movement, Esalen has been its Mecca. Fritz Perls did a five year residency in the late sixties, leading gestalt therapy seminars. Other eminent persons who influenced the development of humanistic psychology and had Esalen residencies were Gregory Bateson, Joseph Campbell, Ida Rolf, Virginia Satir, Rollo May, and Alan Watts. Today people go there to study massage and body work, wellness and alternative medicine, psychotherapy, meditation, and a variety of other subjects. I went there to work on being a better writer, and came home with my spiritual batteries re-charged.

A lot of what was new and esoteric back in the sixties and seventies has gone mainstream. Among the extra-curricular classes available to students in the psychology graduate program at West Georgia College (now the University of West Georgia) were massage, hatha yoga, zen meditation, clowning, tai kwan do, and vegetarian cooking. The program was allied with the Philosophy Department, and there were opportunities to study existentialism and phenomenology. In my therapy courses, I learned about psychoanalytic theory, behavior modification, client-centered therapy, gestalt therapy, transactional analysis, sex therapy, and trance work. Once I was a working psychotherapist, my therapeutic orientation was existential, and I was very eclectic in terms of therapeutic style and techniques. I consider myself very fortunate to have attended the West Georgia College psychology Masters program.

Contemporary concepts like emotional intelligence and positive psychology couldn’t have emerged from Freudian psychodynamic theory or Behaviorism. The humanistic psychology movement created a new paradigm for human growth and potential as a legitimate area of study within the science of psychology. I think that the regard for Freud’s contribution to psychology and psychotherapy will diminish over time, relative to the contributions of humanistic pioneers like Abraham Maslow, Carl Rogers, Fritz Perls, and Milton Erickson.

The concept of emotional intelligence suggests that there are other kinds of intelligence than cognitive intelligence. Accurate empathy and compassion are important factors in human relating, and are deserving of scientific study by students of human behavior. I had initial objections to the whole notion of positive psychology, thinking, “psychology is neither positive nor negative.” But then I came to realize that it’s an outgrowth of the impulses that inspired humanistic psychology. The study of psychological wellness and peak performance, of thriving, of human creativity and the process of self-actualizing, is a legitimate pursuit within the field. Psychodynamic theory and Behaviorism will always have their place in psychology, but they need to be viewed in the context of the psychology of growth and human transformation.

Ericksonian hypnotherapy

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Dr. Milton Erickson was one of the giants of psychotherapy, as evidenced by the fact that the largest convocation  of psychotherapists in the world, the Evolution of Psychotherapy conferences (held every four years), are organized by the Milton Erickson Foundation. He has been called the father of modern hypnosis. He not only developed a powerful alternative to traditional hypnosis, but introduced a new model of solution-focused brief psychotherapy.

I explained traditional hypnosis in a previous post. Ericksonian hypnotherapy was something new. Whereas traditional hypnotic inductions are characterized by commands and direct suggestions, implying that the therapist wields some kind of power over the “subject,” Ericksonian inductions use indirect suggestion, metaphors, and storytelling to induce trance states, circumventing client resistance to complying with the imperative voice. (You should, you will, etc.) Trance-inducing suggestions like “Your eyelids are getting very heavy and you want to close your eyes” were replaced by indirect suggestions such as “As you relax, you may find that you want to close your eyes.” Instead of hypnotic prescriptions for a person in trance, an Ericksonian hypnotherapist might say such things as “… and as you practice self-hypnosis, you may find that it’s easier for you to ________ .” Erickson also developed non-verbal methods for inducing trances.

Erickson’s life story is remarkable. Long story short, he was stricken with polio at age 17. Told that he would never walk, he taught himself to walk again. Told that he was too disabled to work, he went to medical school  and became a psychiatrist, and later a psychologist. He trained himself to be acutely aware of changes in peoples’ posture, respiration, vocalizations, skin tone (blanching or flushing) and pupillary dilation. He learned to “read people” and their immediate responses to his therapeutic interventions, adjusting his techniques to the unique individual and situation.

Erickson recognized that trances occur naturally every day in all of our lives. (There are many kinds of trance states, including confusion, daydreaming, rumination and jealousy.) He learned to induce them in non-traditional ways and to utilize the power of the subconscious mind to focus on solutions to the presenting problem that brought the person to therapy. He could induce a trance with a handshake or a story. Sometimes he used a confusion technique, framing his words with a deliberate complexity that caused confusion. This put the listener off-guard and receptive to suggestions aimed at the subconscious. The immediate results of some of his interventions would appear miraculous to someone unaware of the techniques being employed.

A well-told story can put listeners in a trance. Erickson was a master storyteller, as well as a master at crafting strategic metaphors that were aimed at the subconscious mind, pointing toward solutions. His verbal presentations – whether in conversation or telling a story – were often layered, talking about one thing on the surface, but using metaphors designed to become embedded at the subconscious level. Sometimes he’d prescribe specific activities related to the metaphors he employed, to amplify the embedding.

An example of this is a case history I remember reading, about a client who was an alcoholic. Erickson first asked questions until he felt he had a good understanding of the client’s life situation and his history of problem drinking. Then he gave a rambling discourse about cacti. “There are many varieties of cacti, but they all have one thing in common. They hardly ever need rain, because they have an amazing capacity to retain all the moisture they need. It’s like they’re never thirsty.” Having planted a strategic metaphor about thirst and resiliency, he then directed his client to take a hike on a specific nearby hiking trail (Erickson lived in Phoenix) the next day and study all of the different kinds of cacti. As I recall the case history, the client got and stayed sober after this strategic intervention. There are many such documented stories of Erickson’s successful brief therapies.

In his later life Erickson suffered from post-polio syndrome and lived with daily, severe pain, which he controlled using self-hypnosis. He knew first-hand how to harness the amazing powers of the subconscious mind, and taught many others how to do this. He frequently taught his clients self-hypnosis, for pain control as well a for anxiety and other psychopathologies. He was the founding president of the American Society for Clinical Hypnosis, and had a major influence on brief therapy, strategic therapy, family systems therapy, and Neuro-Linguistic Programming (NLP).

Albert Ellis

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In my post “The Gloria Sessions” I wrote about a three-part video series titled “Three Approaches to Psychotherapy”  in which a brave young single mother named Gloria had brief therapy sessions with three of the twentieth century’s giants of psychotherapy. The three therapists were Dr. Carl Rogers (client centered therapy), Dr. Fritz Perls (gestalt therapy), and Dr. Albert Ellis (rational therapy). Little did I know  when I saw the series in grad school that I would actually meet two of these luminaries. I’ve already described my encounter with Carl Rogers. I’ll conclude this post with an account of my brief exchange with Albert Ellis.

Ellis is best known as the creator of Rational Emotive Behavior Therapy (REBT), and is widely considered one of the most influential psychotherapists since Freud. I first came across his work as a teenager, when I read his 1958 book Sex Without Guilt, which made the case that guilt about responsible sexual behavior is irrational. This was my first introduction to rational thinking, which made a lot of sense to me. However, parts of the book were (in retrospect) just his claptrap notions, like his theory of homosexuality – which was still considered a mental illness back then. He corrected his errors in later editions of the book.

Ellis was a foundational pioneer of what is now known as cognitive behavioral therapy (CBT), and I consider his A New Guide to Rational Living to be his single most important book. (He wrote or co-authored more than eighty books and many academic papers.) When I watched him in “Three Approaches to Psychotherapy,” I didn’t like his therapeutic style. He was the opposite of sensitive, gentle, avuncular Carl Rogers; he was a fast-talking, abrasive New Yorker, who seemed impatient in his dealings with Gloria. But I couldn’t argue with his logic, and Gloria seemed to get something from the session.

Although behavioral therapies weren’t popular in my humanistic Masters program, I started learning and practicing rational thinking in the eighties, and began teaching it in my clinical practice. Being a rational thinker has spared me a lot of unnecessary pain, and I’ve been known to say that if I had a Gospel to preach as a therapist, it was the Gospel of Rational Thinking. REBT focuses on the rational analysis of irrational and self-defeating beliefs and behaviors. Ellis continued to write and lecture and do therapy until shortly before his death in 2007, at the age of 93. He has been charitably described as having a “provocative personality.” I was in the audience for several of his presentations at Evolution of Psychotherapy conferences over the years, and witnessed his provocative style first-hand.

For one thing, his presentations were laced with profanity, and his response to any objections about his language was usually  along the lines of “F _ _ _ you!” If you didn’t like the words he chose, that was your problem. He was still the abrasive stereotypical New Yorker I’d first seen on videotape in grad school; but I’d come to appreciate his personality and his delivery, as well as his contributions to psychotherapy. He made the point in his public speaking that it’s what you say that  matters, not so much how you say it. In his own way he echoed Fritz Perls’ idea, “I am not in this world to live up to your expectations and you are not in this world to live up to mine.”

At an Evolution of Psychotherapy conference I happened to find myself on the same elevator as Dr. Ellis and his small entourage. Seizing on the opportunity, I asked him, “Dr. Ellis, didn’t you write a book titled Sex Without Guilt?” “Yes I did. Did you read it?”  “Yes I did.” “Did it help you?” “I’ve read several of your books and I think I’m a better man for it.” Dr. Ellis grinned at me and said, “I’ll bet you’re a sexier  man for having read Sex Without Guilt, too!”

I don’t know about that, but I do know that Ellis’ influence made me a better therapist. He enhanced my ability to reach some clients, helping them to understand that they didn’t need to feel guilty about being a sexual person, with sexual feelings and needs.

The role/goal model

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There are many models of human behavior in the field of psychology, among them the psychoanalytic, behavioral, gestalt, and dialectical models. Most have their utility, but none of them is “the best,” or explains everything. A model is just a description or a map and, as I quoted in a prior post, “the map is not the territory.” I haven’t written about what follows in any formal or comprehensive way yet, but I’ve come up with the bare bones of my own model. I think it’s original, and helpful in explaining certain unconventional or extreme behaviors – as well as many common ones. I call it the role/goal model. It has to do with motivation and it’s rooted in social psychology.

We all play multiple roles in our lives, some of the more conventional being spouse, parent, employee (or boss), host, and caregiver. Other roles have to do with one’s profession or skill set, and yet others are unconventional and highly specialized. Behaviors appropriate to one role in a person’s life – for instance sexual expression within a marriage – are inappropriate in other roles. If a drill sergeant behaved at home like he did at work, it would be domestic abuse.

Many behaviors are motivated by the desire to feel good about ourselves for fulfilling the expectations of a given role, whether that role is father, wife, breadwinner, merchant, healer, or evangelist. You may not feel like getting up when the alarm goes off at six, but in service to your role as family provider, you get up on time and prepare to go to work, day after day. The goal of such persistent behavior is the feeling of satisfaction you get from providing for your family’s material needs. You know that if you don’t get up and go to work most workdays, you won’t get a check on payday. You’ll fail to meet the goal of the breadwinner role, your family will suffer, and you’ll feel terrible about yourself.

Many times in my life I’ve heard people say things like, “He did that for no reason!” In fact, people don’t do things without a reason, and a more accurate statement would be “He did that for reasons I don’t understand.” We might have a hard time grasping what would motivate a person to torture animals, or purposefully start a forest fire, or shoot schoolchildren, or coax cult followers to drink a fatal dose of poison. I think this model helps to make such behaviors comprehensible.

The role/goal model explains conventional or extreme behaviors by identifying the role that a person perceived herself to be in at the time of the behavior, and the goal of that role-appropriate behavior.  For instance, a mother who has never acted-out violently in her life might inflict severe bodily harm on a stranger, if he was threatening her children with violence. Some roles, like mother, are conferred by circumstance; other roles are self-conferred and may be secret, or unrecognized by others. Self-conferred roles include Rescuer/Hero, Tragic Hero, Devil, Martyr, Outlaw/Rebel, Victim, Player, and “Secret Agent.” Identifying the role and the goal explains almost any behavior that isn’t due to psychotic mental processes.

By Secret Agent I don’t mean a literal spy {although “spy” is an example of a rare and highly specialized role), but someone who acts in secret, or has a perceived “secret identity.” I think that role descriptor helps to explain many aberrant behaviors, such as serial arson or serial rape. Examples: “They think I’m a Nobody, but I burn down forests.” “Women trust me because they think I’m a nice guy.” People like this get off on not only the feeling of power they experience when they commit their crimes, but on their daily feelings, when they think “Nobody knows who I really am” or “She doesn’t know that I want to rape her.”

A less extreme example is the role/goal analysis of an obnoxious, Bible-thumping street preacher who thinks he’s preaching on the street because God wants him to. What motivates him to persistently shout at strangers who don’t want to listen to him? The role/goal model posits that he’s in the evangelical role, and what could be more important than saving souls? The behavior is motivated by the attendant feeling, not the sure knowledge that souls will be saved. People in such a self-appointed role believe that their objective (i.e. saving souls from damnation) is what’s driving their behavior, when in fact their role-appropriate, goal-directed behavior is motivated by the feeling that they’re doing the most important work of all, God’s work.

The goal of the Hero is to be admired for his achievement or strength. The goal of the Tragic Hero is to get sympathy and to justify his helplessness in the face of insurmountable odds. The goal of the Victim is to gain something by being pitied. The goal of the Martyr is to be admired for her sacrifice. The goal of the Player is to get over on people. The goal of the Rebel/Outlaw is to get away with breaking the rules. The goal of the Devil is to raise Hell. The goal of the Rescuer is to feel powerful and to take credit for someone else’s survival or success. None of these roles exists objectively, but in subjective perception and the attainment of consequent, predictable emotional states. The feeling state is often the  goal of the behavior, although it will be rationalized as role-appropriate and goal-directed.

Emotional expression is modulated by both role and goal. An emotion is suppressed if it’s seen as inappropriate to the role or unhelpful in reaching the goal, i.e. never let them see you sweat if you’re in the Hero role. The emotion is exaggerated for effect if it’s seen as role-congruent and/or helpful in reaching a goal, i.e. the Boss’s display of anger, or the Victim’s tears.