“Moving
on”
A look at Psychotherapy and the demands of the client
of the 21st century
It's close to Easter so Good Friday is a great day to have a closer look at this important subject.
It is a new age, a time where one of
the most precious commodities we have is ‘time’, and where also our
expectations are to have ‘things’ instantly.
We live in a
time where we can email or text someone on the other side of the planet, secure
in the knowledge they will receive the message, in most cases, instantly.
Our children are learning differently, and have an amazing ability to speak on
the phone whilst watching TV and sending an email …all at the same time.
Some research
currently being carried out in Canada is showing on scans that there are
specific areas of the brains of children such as the corpus collosum and pre
frontal lobes are changing, perhaps it could be said they are mutating or as I
prefer to say evolving. We now have Digital children; so no wonder they have
issues at school, when they are still being taught with an analogue
methodology.
Business
is done at the speed of thought, transactions made globally at the flick of a
switch. Life is rapid, fast, and that in itself raises its own stresses and
issues.
The
W.H.O… (World Health Organization) has stated that by the year 2020 the primary
global killer on the planet will be ‘stress’. Doctor’s largest outlay in many
clinics is the budgetary cost of prescribing anti-depressants and other ‘happy
pills’ to patients who report that ‘life is getting too much for them’.
Stress however is a ‘dirty’ word and is a real stigma in corporate life and in
many other areas of our life.
Even
the terminology has changed to show this. We no longer have to attend stress
management courses, we now have courses for ‘Performance under pressure’, which
because it does not have the ‘S’ word in it means it must be more positive in
its framing and its outcome.
What
a pleasant reframe? I think not.
Stress
affects us at a deep bio chemical level and can bathe every single
neuro-transmitter we have in our corporeal form with its insidious effects.
Stress depletes our immune system’s ability to cope with disease and can affect
our cardiovascular makeup leading to hypertension, cardio vascular accidents
(strokes), diabetes, and other cardiac related illnesses.
Stress indeed is a silent killer, because we are
expected to cope and not give in to life’s stresses. In life’s rat race we
cannot be seen to be a weak rat.
Corporate
businesses build profit schemes around this, for example Tesco have a “just in
time” policy to reduce wastage and even on the leisure side we have sites like
lastminute.com to help us because we do not have time to plan our lives, just
to react to things which become urgent.
This
is commonly referred to as crisis management.
Out
of necessity we become very adept at “putting out fires”, however it should be
noted that upon closer scrutiny we could be seen to be the ones carrying the
matches too.
Time,
is indeed becoming our scarcest resource. Once it has been used then it has
been used up, no second chances, no retakes, you cannot have the time again.
Bearing this in mind then we must review current therapy models to align
ourselves with this new way of thinking and being.
As
therapists choosing to be successful, we need to embrace every possible tool
and resource we can to enable us to resolve our clients issues as quickly as
possible, and give them back the control they
currently do not have, which in my opinion is the “prime-driver” in their
“dis-ease”, which will manifest itself in the symptomatic behaviour with which
they seek help with from you, their chosen therapist.
A
good example of this symptomatic behavior is addictions. It matters not what
they are addicted to, Cigarettes, cocaine, crisps, chocolate, champagne or
chardonnay or anything else beginning with “C”, the taking of the addictive
substance gives the other “C” which is ‘control’ on a temporary basis of their
anxieties and stresses. It anaesthetizes them and disassociates or distances
them chemically from having to face the reality of the pressures and stress
upon them. This is the primary effect at least. The secondary effects are much
more serious and damaging, including, cancer, coronary artery disease, obesity,
premature dementia and many other serious physiological reactions to things we
should not be casually putting into our body.
If
we are unable to anaesthetize the stress then it can and often will manifest
itself in many ways, at either a deep psychological level or perhaps even at a
physiological level too. Even idiopathic diseases such as asthma, eczema,
psoriasis and other autoimmune conditions are often exacerbated by stress and
anxiety, sometimes to a crippling level.
We
then add to this all of the secondary negative emotions like anger,
frustration, jealousy, shame, embarrassment and guilt and we can be in a real
emotional mess.
Dr.
John Sarno in his book the “Mind Body Prescription” posits the idea that almost
all neck back and shoulder pain is caused by trapped stress and anger or even
rage. Our clients feel “helpless” and in many ways are, which is why they
turn to us the therapist for “help”. We should do this for them as
expeditiously as possible.
Now
I am not saying that this is for “all” clients who seek our help, and indeed
there are some who need to emote over a period of time and may have a number of
issues to be dealt with, and we should treat them accordingly.
I
have even had in Harley Street some clients who have as near as damn it
‘instructed’ me not to fix them too quickly because they have a story to tell
and see that, (in their mind at least) as an important and integral part of the
therapeutic healing process.
Conversely,
I get the ‘City’ boys who know of my reputation for rapid work, and they ask if
I can “sort them out in their lunch time” as they see no value in keeping
something that can be collapsed rapidly. I fix them fast and they are
back at work stress free and earning again. For this rapid service they
are happy to pay a premium rate.
Being
able to adapt to both ends of the time – need
spectrum for the client is a very useful ability upon which to call.
Options
and flexibility of operation is the key. In fact the law of requisite variety
states:
“he or she who has the most flexibility to
function will win out in all situations”.
A kind of 21st century survival of
the fittest, if you will.
So how is this achieved for the client?
There
are in these current times a wealth of therapeutic interventions available to a
therapist to train in, from Analytical Psychotherapy, Hypnosis in all of its
forms, NLP Neuro Linguistic Programming, EMDR Eye Movement Desensitisation and
Reprocessing, CBT Cognitive Behavioural Therapies and the more esoteric Energy
Psychologies such as EFT Emotional Freedom Technique or TFT Thought Field
Therapy.
So
which is best?
Well
the answer is simple the technique that is best is the one which is best for
the client and provides a desired outcome to overcome a perturbing issue.
Another strategy I employ to allow me to often pre-select the modality, in
which I am going to work, is to ask the client to send me a detailed synopsis
of their current state, along with a history of negative issues and incidents they
have experienced. I also ask for details of any medications or drugs they use
or have used (both prescribed and non prescribed) as this gives me a chance to
research any contra-indications that taking these medications may have.
This
process in itself I feel is an integral part of the healing process and many
clients have never actually written down the issues and report the process
itself was quite cathartic.
In
many cases I also find it negates the need for the client to need to emote in
the session and I do not have to get covered in ‘emotional vomit’ as a friend
and colleague once graphically referred to it. I also find it useful at the end
of a successful session to give the client back the document, and ask them to
read what they wrote down. On most occasions they re-read it and often report
it is like reading about ‘someone else’ and they no longer have any emotional
attachment to the ‘story’.
This
for me as a therapist is a great indicator that we have made significant
progress. On occasion they will pick up on a specific part of the text and
report that this particular aspect still perturbs them. This is good to know,
as we can then often work on that specific issue quite quickly, using, once
again the most optimum modality for that specific issue. Then, once treated, I
will ask them to again re-read the document (sometimes in whole, or sometimes
in part) and they often report that they can no longer attach any emotional
negativity to it.
Clients
often report feeling ‘lighter’ or may look confused when they can no longer
access the negative emotions that in the past have accompanied the cognitive
memory of the disturbing issue.
Many
will enter into what is referred to as the “Apex” state.
This
is the state where the client can no longer access the negative emotional
states they came to see you with, which you have “fixed” but that cannot accept
that the issue can be or has been resolved so quickly. The logical left-brain
aspect will try to find some other explanation for the ‘cure’ rather than
putting it down to your treatment.
Apex
clients will often make statements like:
“Well I cannot think of it right now”. (Remind them they could
a few minutes ago) or
“It is not something I can give a SUD
(Subjective Unit of Distress 1-10 scale) to. Or
“You are just distracting me” or
“This is too simple, it cannot have worked so
easily” or
“Well I feel fine now but I know it will come
back later” or
“I have had this phobia all of my life, you
cannot get rid of it in minutes”
There
are many other variables to this but these are the most common ones I encounter
in my work with my clients.
Let
us take the last one as an example: I use the bag metaphor and say, “so if the
phobia was a bag you have carried most of your life, tell me…how long did it
take you to pick the bag up?” The answer is obvious to me, and to them,
it took only a moment to pick it up. You then ask “so how long should it take
to drop it and leave it behind you?” Again the answer is obvious, but the “yes
buts” come, all the same.
Like
all problems there is a simple solution. My personal preferred solution to the
apex problem is to say to the client “Okay then, shall I put you back how you
were before you came here?”
The
common reaction is for the client to say “No” usually accompanied by a
definitive and vigorous shake of the head. I then point out that there are only
really two answers to that question, one is to react as they did by saying “No”
and the other is to say “well I feel exactly the same”.
This
is an access to the non-conscious response, and when this is pointed out, the
logic circuits tend to kick in and the acceptance that the problem or issue is
gone or looks or feels different is accepted. Sometimes this is done
reluctantly and sometimes with a “Wow”.
On
occasion you do get the odd client who will challenge you when you offer to put
them back how they were, and they will respond by saying “Yeah, go on them put
me back”. I then simply have to point out how can I put them back to something
if it had not gone or had not been changed. Again the logic circuits kick in
and they accept that they truly cannot access the disturbing emotion in the
same way, if at all.
The
‘apex’ originates from Koestler’s ‘Ghost in the
machine” work, and defines the brain working at its apex state where it
will always try to find a rationale or reasoning behind something which seems
implausible or impossible despite whatever evidence they have to the contrary.
The
expectation of many clients does appear to be that therapy can be a long and
drawn out process, and the whole concept that an issue can be resolved very
quickly is indeed an alien concept to many.
Another
advantage to working with such rapidity is that it minimizes the potential for
transference to occur. The standard or common ‘therapeutic alliance’ when
working with rapid techniques, is very short term, and is often not even
relevant in certain cases.
A
metaphor I use is as follows; it is like taking your broken car to a mechanic.
The mechanic could ask you about every journey you have made in the car, and
tell you why the way you have driven it or maintained it may have caused the
problem, he can even over time educate you into all the fine and precise
details of why the car is not working.
Then
once you have fully understood why it is not functioning as you would hope it
to he hands you back the keys. Not fixed but you understand why it is broken
and that understanding should make you feel better about it. So
there you are pushing the car home, but at least now you know why you are
pushing it home.
Or
the mechanic can just fix the problem. Drive or push? What
would you choose?
Now,
another consideration when doing rapid change work with clients is that the
speed of change, if not dealt with correctly, may create its own problem. When
Richard Bandler the co-creator of NLP Neuro Linguistic Programming does rapid
change work, he poses the following question to the client.
“So now the problem that you thought you had,
you no longer think is there what do you think, you will do with all the time
you used to waste on thinking about a problem that is no longer there?”
This
is a typical Bandler’esque type of confusion patter, working with the
non-conscious directly by bypassing the conscious or cognitive reasoning
process. It is however a serious consideration to bear in mind. Quite often
with a client their issue can become deeply intertwined with their identity and
in more severe cases become their identity, so if you are taking away the issue
you could also be taking away their identity. Gives a whole new meaning to the
phrase identity theft doesn’t it?
I
feel it is imperative for the therapist to enable the client to be able to deal
with this issue. I call it avoid a ‘void’, the void in question being the space
created when the problem is no longer there.
What
will the space be filled with now?
Well
there are a variety of options but one is a strategy I like to train my clients
in called eating a P.I.E or Positive Imagery Exercise. It goes like this…
Raise the right hand up and to the right of you
so you are looking up at it…. Look into your palm and create a compelling image
of what you want to be like assuming that nothing can fail.
Then double the intensity of the picture and
brighten it. Then double it again and again…when it looks amazing and only then
take a deep breath in and as you exhale pull the image into your chest and
absorb it through your heart then as you breathe in intensify the image and as
you exhale drive the feeling through your body into every cell muscle nerve
fibre and tissue until you are saturated with the good feeling.
Then repeat with another good image.
Do this as often as you like……………after all who
can ever have enough good feelings?
It
is a very simple but elegant exercise, which enables the client to quickly
develop a positive visual to kinesthetic link, and like the work done to remove
the issue it is a rapid technique in both is application and its effectiveness.
It
is because it is easy to do, and takes such little time, and has such a strong
kinesthetic effect, that the client will do it. They feel the results quickly
and want more of the good feelings it creates. It is a no-brainer technique.
So
in a ‘nutshell’ as Viktor Frankl used to like to put things, you take away the
problem with rapid techniques and you give the client a new strategy to employ
to give them good feelings as opposed to the bad feeling they initially came to
you with.
I
suppose the final consideration must be given to the therapist. If the
therapist relies upon repeat sessions with a client to generate an income (we all have bills to
pay) and what I am proposing is in many cases we treat in a single session,
then surely this is a business suicide?
I
personally have not found this to be the case. I believe in modern times when
speed is of the essence and becoming our conditioning to expect things to be
done ‘quickly’, a slow change therapy solution will not resonate with many. I
believe if a client has the choice of having something resolved quickly for a
premium or slowly for less perceived cost then they will often choose the
former.
It
is also simple math… One session at £300 or ten sessions at £90
Smarter
clients work this out anyway and all you have to do is remind them of the
economy of both the monetary value but I think equally as important the time
value too. The money you can make more of, the time you cannot.
Here’s to a good time for rapid therapeutic
interventions.
Happy Easter everybody!
Kevin Laye TFT DX RCT
Therapist, Trainer and Author
Don't forget "The Discovery day" on the 27th April in London UK, where I will present together with 4 other Master trainers, click here for details.
And if you are on the other side of the world, from the 22nd July "The Visit" in Sydney, Australia
click here for more details.
