10CTI: The Hunger Illusion

See the original article @ Psychology Today

Cool Intervention #6: The Hunger Illusion

10CTI: Growls from your unconscious

Published on January 30, 2010 by Ryan Howes, Ph.D. in In Therapy

No, this intervention isn't (necessarily) about food. Tucked away in the pages of a George Weinberg book lies one of the most powerful and elegant techniques ever. And it's safe to use at home, no therapist required.

Dr. Weinberg is known for many things. The Manhattan psychologist has authored a dozen books on topics as varied as statistics, Shakespeare and fear of commitment. He coined the term "homophobia" in his 1972 book Society and the Healthy Homosexual. And he's also the guy who wrote The Heart of Psychotherapy which ranks among the best books in the trade and introduced me to one of the Ten Coolest Therapy Interventions.

Many people come to therapy to figure out why they do what they do. This could range from why they binge drink to why they seek unavailable partners to why they talk with their hands. They're engaging in some behavior that feels automatic and has a mysterious origin, and want to know why. Freud would say they have unconscious motivations that are blocked from awareness. Such motivations may leak out in dreams, slips of the tongue, hypnosis or free association. These standard tools of psychoanalysis are fine, but they take time: you may have to wait for an insightful dream or slip, and it can take a while for clients to get comfortable with hypnosis or free association.

Enter the Hunger Illusion. According to the text: The person stopping any habitual behavior becomes subject to an illusion, which becomes pronounced as the impulse mounts to resume the habit. I call it the Hunger Illusion.

The process is simple: 1) identify the moment you tend to act automatically, 2) don't, and 3) see what thoughts and feelings come up. He gives an example in his book of a big, tall man who tends to wave his hands around frantically when he is trying to make a point. When he resists the urge for a moment and talks about the thoughts and feelings that arise, he describes feeling small and afraid he won't be heard. He's huge and Dr. Weinberg is listening intently, so this is clearly irrational. This leads back to a memory of him as a small child with older siblings who wouldn't listen unless he made a fuss physically. He is unconsciously playing out a behavior that was necessary in childhood, but is no longer needed. Making the link to his early belief helps him understand and control the behavior.

The applications are innumerable. Feel the urge to walk away, crack a joke, grab the donut (there's the food tieback), have a drink, sigh deeply, view porn, spend irresponsibly or approach the wrong mate? Stop the automatic response and see what thoughts and feelings arise. Tie it back to an earlier memory. You may discover the hidden meaning for the behavior, which gives you power to control it.

I recently tracked down Dr. Weinberg and had one of the best phone calls in recent memory. Here's an excerpt from our conversation:

When would you use the Hunger Illusion?
Usually they bring up the subject of something they either can't do or can't not do: what happens to you if you don't drink? If you have an alcohol problem and you go back to your buddies and tell them, "I'm not gonna go into the tavern," you might think, "well, they'll think I'm not a man, I'm not tough." So maybe you drink partly to feel virile, like one of the guys. You may not have known that until you literally don't go and say, "no, I don't drink anymore." It helps you learn about yourself.

 In your experience, how have you seen the Hunger Illusion help clients?
Well, they learn what they're really afraid of and then they can look for other places where they have the same fear, and if you can attack a thing from many sides, pick up a blanket from many sides, you can really deal with a problem better than if you pick it up from one. If you're afraid of asking for things from men then maybe the first thing you have to do is return a broken iPod to a clerk and then ultimately you'll be asking to run the company, you know, down the line.

As far as the interventions you've known and used, what would you say makes the Hunger Illusion a cool intervention?
What makes it cool is that it's easy to do, it's available, it doesn't require deep analytic theory, you don't have to be a Freudian or subscribe to Mahler's Rapprochement theory. It's cool because it's waiting for us. It gives unique information, it doesn't fall into any theoretical stereotype and I think that makes things cool when they don't follow the lines of some one true light, someone's one religion. It's available to all of us. Yourself, as a therapist too, which makes it cool. You don't have to pay top dollar to use it, you can try it in your own life. Anyone can verify that it teaches us things.

Sure. I could see therapists from almost any modality using it.
Yeah, anyone, and these schools of therapy keep multiplying. There's got to be something wrong if we have 700 theories of how people change.

What's next for you?
My new book is Lies Your Therapist Told You which will be out next year.

Uh oh, you're gonna kick me out of a job here.
No, but I think we can do a better job if we don't lie. We need more interventions like this instead of saying: "well it's obvious that you had an attachment to your father that you have to discover, and come here for the next 12 years to discover it." We're dealing with people as they come along, not stereotypes. That's one of the reasons why therapy is losing ground. Talk therapy was a booming new idea at one point, and now half the things people went to talk therapy for they're taking a pill for instead, and I think they underestimate the power of really investigating yourself.

10CTI: Voice Dialogue

See the original article @ Psychology Today

Cool Intervention #7: Voice Dialogue

10CTI: Group therapy with one client

 

Published on January 28, 2010 by Ryan Howes, Ph.D. in In Therapy

Ever feel a battle raging inside you? The part that wants to achieve versus the lazy bum? The good guy versus the rebel? The loner versus the attention-seeker? Or maybe your critic, inner child, ideal self and saboteur get together to play poker once in a while. Voice Dialogue may be the technique for you. The Ten Coolest Therapy Interventions series explores this elaborate method.

Voice Dialogue is the main intervention used in a modality called the Psychology of the Selves developed by psychologists Hal and Sidra Stone, who had such diverse influences as Jung, Skinner, Kazantzakis and Hermann Hesse (read their full bio here). Their theory suggests that various parts of self coexist within each of us and determine our thoughts, behaviors and relationships with others. According to their website:

Each of us "contains multitudes". We are made up of many selves, identifying with some and rejecting others. This over-identification with some selves and the loss of wholeness that comes from the rejection of others, can create imbalances and blind spots. This work is about embracing all the selves. This dance of the selves is an amazing process and we see the dynamics of the world around us shift as our internal world changes.

Rather than making choices based on a given criteria (the most rational, what feels right, what other people want, etc.), Voice Dialogue encourages a discussion between the parts of self at odds with one another. The understanding and expression of these selves helps us increase our self-awareness and even function better within a relationship. Although it does turn a couple into a group rather quickly.

I'm honored to host Hal and Sidra Stone (and their assorted selves) who help explain this cool and complex intervention:

1. When would a clinician use Voice Dialogue?
When there is a sense that the client has a feeling that he or she has different selves or parts.  For example, let us say that John goes to a party that he doesn't really feel like going to.  Once there he has a few drinks and soon he is the life of the party.  In the middle of the night when he awakens he is a bit depressed. In his session he may say something like:  "I don't understand how I get into these things.  I really didn't feeling like going and again it is as if something just takes over and there I am again doing something I don't really feel like doing."  In a situation like this Voice Dialogue could be a very effective intervention.

2. What does is look like?
The therapist might say: "It really does sound like there are two very different ways of being or value systems that are operating in you.  There is you the party person, the more extraverted self who generally needs some alcohol or drug to get him going.  On the other side is a more introverted part of you trying to come out and be heard but he seems to have less authority than the other one.  How would you feel about my talking to these two feelings or ways of being in the world to see if this might help clarify some of the conflict that you are describing?"
The therapist starts always with the self that is the more primary, that leads his life in the world.  For this the client actually moves over physically to a different position and the conversation or interview begins.  When finished John would go back to the center for a discussion of the work so far.  In this, or the next session, the therapist might have a conversation with the less developed, often totally disowned self.

3. How does it help the client?
It helps the client in three ways.  First he gets to hear in a very objective way what these different "voices" or selves have to say, what they want and need, how they developed -- the family forces that shaped them. Just knowing that the voices are real can be a total revelation.  A woman might say that she can't stand looking in the mirror in the morning. To discover that she has a voice in her, the Inner Critic, that embodies all of her self criticism can initiate a major shift in her life.
Secondly, the therapist helps to develop a new place between the opposites, a place that can help the client hold the introversion with one hand and the extraversion with the other.  It is a new "center" of personality that we call the Aware Ego.  It is this Aware Ego Process that can learn to embrace the vast system of opposites that live within each of us.
The third advantage is that from this Aware Ego Process the client is in a better position to make conscious choices.  A conscious choice is one that honors both sides of the conflict no matter which choice is actually made.

4. In your opinion what makes Voice Dialogue a cool intervention?
First of all it is way of working that is fun and alive and brings in all kinds of different thoughts, feelings and emotions.  It is impossible as a therapist to be bored or tired doing this work.  It the therapist gets tired or bored it is because he or she has fallen into a pattern of being overly responsible or overly mental or some primary self that limits possibilities of enjoying the work.
Secondly there is the constant excitement of new discovery.  Discovering and separating from a primary self is like waking up from a dream and discovering whole new worlds of possibility.
Thirdly, what you judge in the world are generally expressions of selves in you that have been shut down or rejected over time.  What a ride it is and how relationships do change as you begin to learn how to catch hold of these judgments.
Fourthly, how different it is to learn how to allow your own vulnerability to live in the world of relationship.  So many people look for more meaning in their lives. Learning how to use vulnerability in a conscious way is really the royal highway to a more deeply felt and experienced life.

10CTI: Paradoxial Interventions

See the original article @ Psychology Today

Cool Intervention #8: Paradoxical Interventions

10CTI: Don't think about a paradox

 

Published on January 23, 2010 by Ryan Howes, Ph.D. in In Therapy

You know, this contribution to the Ten Coolest Therapy Interventions isn't very interesting. I wouldn't waste your time reading about the fascinating and controversial world of paradoxical interventions or the interview with one of psychology's living legends: Cloe Madanes. Kindly move along to the next blog. Okay, read if you must, but definitely don't send it to a friend. Or leave a comment.

Paradoxical interventions involve prescribing the very symptom the client wants to resolve. It's a complex concept often equated with reverse psychology. For example: the client fears failure, so the therapist asks the client to fail at something. A man has problems with procrastination, so the therapist asks him to schedule one hour a day to procrastinate. Your four year-old resists brushing her teeth so she's told she isn't allowed, and may end up doing it out of spite. Or a woman who can't initiate sex with her husband is advised not to initiate for a month. Don't think about a purple elephant. It's asking for something in order to achieve the opposite result.

The underlying principle is that we engage in behaviors for a reason, which is typically to meet a need (rebellion, attention, a cry for help, etc). In prescribing the symptom the therapist helps the client understand this need and determine how much control (if any) they have over the symptom. By choosing to manifest the symptom, they may recognize they can create it, and therefore have the power to stop or change it.
You can see how this might get a bit dicey. If the symptoms could cause harm to the client or anyone else, nudging the client toward it would pose an ethical problem. In fact, much has been written to establish guidelines for paradoxical interventions. Only clinicians well-trained in the technique should consider using it.

It's a privilege to interview Cloe Madanes, a pioneer in the field of family therapy and a prolific writer, speaker and fellow PT blogger. She wrote the book on Strategic Family Therapy, a modality that looks at the balance of power within the family and the hidden function of symptoms. Her work continues to grow and evolve - she's recently joined forces with Anthony Robbins to find solutions to interpersonal conflict, violence prevention and creating a civil community (watch them work together at www.madanesfilms.com).
On to her interview:

1. When would a clinician use a paradoxical intervention?
A clinician would use a paradoxical intervention when there is a clear symptom or presenting problem that the patient believes is an involuntary behavior, such as depression, fears, pain, even seizures.

2. What does it look like?
The therapist asks the patient to deliberately have the symptom at the therapist's office and/or outside the office.  Family members may be asked to encourage, advise or reward the behavior.  The idea is that, if a symptom is involuntary, having it voluntarily means the behavior can be controlled and is no longer a symptom.  If the person can have it voluntarily, this means he/she can also not have it voluntarily.  A variation is to ask the patient to pretend to have the symptom.  When a person is pretending to have a symptom, they are not having the real symptom.  Secondary gain or positive reinforcement can be arranged for the pretend behavior, so that it replaces the involuntary behavior.  The involuntary behavior is no longer needed in order to obtain the secondary gain.

3. How does it help the client?
It helps the client to be in control of his/her behavior and experiences.  It's based on humor because the intent is for the patient to laugh at the idea of bringing on an unpleasant symptom voluntarily and humor is always therapeutic.

4. In your opinion, what makes paradoxical interventions cool?
Paradoxical interventions are cool because they are painless and funny.

10CTI: The Empty Chair

see the original article @ Psychology Today

Cool Intervention #9: The Empty Chair

10CTI: Therapy with furniture

Published on January 20, 2010 by Ryan Howes, Ph.D. in In Therapy

The Ten Coolest Therapy Interventions series continues with a technique widely recognized among gestalt therapists, their clients and furniture aficionados everywhere. Gestalt therapy expert Dan Bloom shares his thoughts on this powerful procedure.

The term gestalt refers to a whole that is greater than the sum of its parts. Gestalt therapy, formulated by Fritz Perls (1893-1970) is based on the idea of a whole being as connected with their environment, loved ones and memories. Therapy works toward creating full awareness of the here and now, both within the client and between client and therapist. The empty chair is one of many interactive techniques used to help engage the client's feelings, thoughts and behaviors.

The ol' empty chair has had quite a tongue-lashing over the years. Clients have given a piece of their mind to innumerable spouses, bosses, best friends and dead relatives thanks to this simple tool. But the chair is none the worse for wear, and millions of people have a greater understanding of feelings and communication as a result. This definitely qualifies it as a Top Ten finalist.

I'm honored to host Dan Bloom, JD, LCSW, a New York gestalt psychotherapist and president of the Association for the Advancement of Gestalt Therapy, an international community. He writes, provides supervision and trains therapists in New York and internationally. He kindly shares his thoughts on the empty chair:

1. When would a clinician use the empty chair technique?
The empty chair technique is characteristic of some styles of gestalt therapy. It is often effective at facilitating clients' integration of different aspects or "disowned parts" of their personality in order to further psychotherapeutic insight. It is one of a variety of interventions that help people move from talking about something towards the fullness of immediate, present experience - sensation, affect, cognition, movement. The less people are "in touch," or "verbalizing," or abstractly thinking, the more likely therapists are to use this as an expressive technique. It is not used for clients whose emotionality is already dramatic and who may be already subject to emotional "flooding."

2. What does it look like?
As first popularized by Fritz Perls, one of the founders of gestalt therapy, an empty chair faced the client. The client imagined someone (or himself, herself, or parts of him or herself) in it, and spoke, gestured, or otherwise communicated to the "empty chair," which was now not so empty. The client then sat in the chair, continuing the conversation, this time reversing roles. Variations of the "empty chair" developed over the decades in order to fit the clinical needs of the situation - and as gestalt therapy evolved. The client might participate in this technique without the "prop" of an actual empty chair. Importantly, the technique today always includes attention to the relational dynamic between the client and the psychotherapist.

3. How does it help the client?
This technique often brings clients into present or immediate experiences. Abstractions or verbalizations become enlivened moments. Clients may be able to experience different aspects of their own conflicts in a new manner through empty-chair dialogue. Gestalt therapy is more than a collection of techniques, despite the notoriety of the empty chair. This technique is one of the many interventions within gestalt therapy, all with the common purpose of facilitating discovery and psychotherapeutic insight.

4. In your opinion, what makes the empty chair a cool intervention?
Any intervention that challenges the passivity of the clinician and turns psychotherapy into a creative collaboration is a cool technique. Further, if the empty chair is a new approach to the clients, it offers a new perspective on the therapy process.

10CTI: The Miracle Question

See the original article @ Psychology Today

Cool Intervention #10: The Miracle Question

Published on January 18, 2010 by Ryan Howes, Ph.D. in In Therapy

The Ten Coolest Therapy Interventions series kicks off with supernatural power. Many clients come to therapy looking for a miracle. Here's a technique built on miracles. I'm honored to speak with Dr. Linda Metcalf, expert on the Miracle Question and Solution Focused Therapy.
The therapeutic intervention is a critical element in most forms of psychotherapy. In this series I survey ten diverse techniques that are, in my opinion, cool. For more information on the series take a look at the introduction.

Solution Focused Therapy (aka Brief Therapy) emerged in the 1980's as an branch of the systems therapies. A married therapist couple from Milwaukee, Steve de Shazer and Insoo Kim Berg are credited with the name and basic practice of SFT. The theory focuses not on the past, but on what the client wants to achieve today. By making conscious all the ways the client is creating their ideal future and encouraging forward progress, clinicians point clients toward their goals rather than the problems that drove them to therapy.

The Miracle Question fits perfectly with this model. Imagining an ideal future and connecting it to the present immediately actualizes the work. Clients are challenged to look past their obstacles and hopelessness and focus on the possibilities.

It's cool because it's a relatively simple intervention that can have a powerful impact. Just take a look at the question (response #2). You're probably crafting your response already. It's creative, bold, healing, a bit mysterious and definitely has a cool name. The Top Ten designation is well deserved.

Don't just listen to me, hear it from an expert. Linda Metcalf, Ph.D. is founder of the Solution Focused Institute of Fort Worth, Texas and author of ten books including The Miracle Question: Answer It and Change Your Life. Beyond writing and therapy, she speaks internationally to schools, agencies and universities. She was kind enough to share her wisdom with us today.

1. When would a clinician use the Miracle Question?
The Miracle Question is a goal setting question that is useful when a client simply does not know what a preferred future would look like. It can be used with individuals to set the course for therapy, with couples, to clarify what each person needs from each other and with families, who too often see one person as the culprit. By using the Miracle Question and asking each person what a better life would look like, the system sees perhaps for the first time, what others need from each other.


2. What does it look like?
"Suppose tonight, while you slept, a miracle occurred. When you awake tomorrow, what would be some of the things you would notice that would tell you life had suddenly gotten better?"
The therapist stays with the question even if the client describes an "impossible" solution, such as a deceased person being alive, and acknowledges that wish and then asks "how would that make a difference in your life?"  Then as the client describes that he/she might feel as if they have their companion back, again, the therapist asks "how would that make a difference?"  With that, the client may say, "I would have someone to confide in and support me."  From there, the therapist would ask the client to think of others in the client's life who could begin to be a confidant in a very small manner.


3. How does it help the client?
It catapults the client from a problem saturated context into a visionary context where he/she has a moment of freedom, to step out of the problem story and into a story where they are more problem free. But, more importantly, it helps the therapist to know exactly what the client wants from therapy...and this is what makes Solution Focused Therapy so efficient and brief.

4. In your opinion, what makes the Miracle Question a cool intervention?
It helps the therapist see where the client wants to go. Too often, therapists assume that a client needs to grieve, leave their spouse, quit their job, after the client describes why he/she has come to therapy. The Miracle Question helps the client and therapist to address exactly what the client wants, not what the therapist thinks is best.

10CTI: Intro

This is the first article by Ryan Howes on 10 Therapy Interventions. For the next 10 days I will be posting the 1 of the 10 intervention articles he wrote about.

See the original article @ Psychology Today 

The Ten Coolest Therapy Interventions: Introduction

Published on January 17, 2010 by Ryan Howes, Ph.D. in In Therapy

***This series is for entertainment and basic educational purposes only. My mission for this blog has always been to demystify elements of therapy so it becomes more accessible to the general public. Reading these blurbs is no substitute for the dozens to thousands of hours of training it takes to effectively and ethically apply them. If you're a therapist and find an intervention interesting, please get adequate training before attempting. If you're not a therapist, please seek out a clinician with sufficient training in that specialty. Unless otherwise specified, do not try this at home!

 

Clients talk, therapists listen. That's just the beginning. Most clinicians have a few tricks up their sensitive, rational and insightful sleeves.
I hereby launch another big series, this one honoring a vital component of psychotherapy: the therapeutic intervention. I chose the ten coolest then interviewed the leading experts for each one.
The first thing most psych graduate students learn is how to listen. They study Carl Rogers and others who poured the foundation of the therapeutic relationship with the concept of respectful, empathic and reflective listening. While this is helpful, some clients want more than listening. They want a powerful experience, a deep insight or some tool that provides answers. Many psychological theories address problems on this more tangible and profound level.

Techniques are hailed as vehicles of epiphany by believers and panned as corny gimmicks by cynics. They add dimension and texture to the work, stretching therapy beyond a friendly ear toward a dynamic, transformative process. They're the practical application of psychological theory that creates a turning point for many seeking answers.

For some, techniques are what make therapy meaningful. Others just want to talk and be heard so techniques/interventions get in the way. Which brings me to an important point: this is all incredibly subjective. Some clients work best in a technique-free environment, others thrive in therapy heavy on gizmos. And some gizmos work better for some people than others. Like many elements of therapy, it's a matter of a good fit rather than the One True Best Way to do things.

Rather than give a cursory review of all contemporary psychotherapy techniques, I thought a list of the Ten Coolest would be more interesting. Absurd, given what I just said about subjectivity, but interesting. Now to define cool in this context. In order to qualify as a cool intervention, each must have the following:

• Creativity: innovation beyond convention to find a solution
• Boldness: strong conviction the technique has profound results
• Compassion: directed at healing pain or dysfunction
• Mystery: mechanism for change is not always obvious
• A Cool Name: I'm not sure why, but this tends to be true

Let's also note what I'm not talking about: effectiveness outcomes. I don't want to get into that here. I'll let the bean counters and hall monitors from EBT make their own boring top ten. These interventions have worked powerfully for some people some of the time; I'll leave their validity at that. I'm a therapist and I don't even use most of them, I just think they're cool.

I selected the list then put on my investigative reporter hat to find experts who could tell us more about each one. If you're a therapist, professor, client or a grad student you'll probably be able to guess a few selections, but I doubt you'll guess all ten. My hope is this list will help broaden your idea of psychotherapy. And show how cool it really can be.

***This series is for entertainment and basic educational purposes only. My mission for this blog has always been to demystify elements of therapy so it becomes more accessible to the general public. Reading these blurbs is no substitute for the dozens to thousands of hours of training it takes to effectively and ethically apply them. If you're a therapist and find an intervention interesting, please get adequate training before attempting. If you're not a therapist, please seek out a clinician with sufficient training in that specialty. Unless otherwise specified, do not try this at home!

Here are the Ten Coolest Therapy Inventions (10CTI) (These will link to the article once posted on my blog)
10. The Miracle Question
9. The Empty Chair
8. Paradoxical Interventions
7. Voice Dialogue
6. The Hunger Illusion
5. Head-On Collision
4. Sandplay
3. Primal Therapy
2. Virtual Reality
1. Transference Interpretation