Obsessive Thinking (3)

Phillipson outlines a behaviour therapy approach to "Pure-O" along these lines: "crazy" thoughts pop into our minds from time to time but some people invest them with such significance that these thoughts are taken to represent action(s). Further, efforts are then made to avoid these thoughts occurring again.

Phillipson's behaviourist approach is based on classical conditioning procedures of "exposure and response prevention" (ERP), of learning to allow the crazy thoughts to occur as much as they want and not trying to run from them but just allow them to be what they are, just random thoughts (that have taken on a meaning far beyond their status). The goal is not to eliminate these thoughts ("spikes") but to practise non-avoidance of the spikes.

One technique mentioned by Phillipson is called the "Spike Hunt" in which the patient/client is instructed to purposely seek out spikes (instead of avoiding them). So a client who has the thought that he may get up in the night and violently assault his wife and child because he has secretly hidden a weapon in the house, is instructed to sleep with a kitchen knife beside his bed!! Phillipson reported that this patient gained 75% relief from this counterintuitive measure.

This particular technique sounds similar to Viktor Frankl's paradoxical intention wherein obsessive patients are asked to do the thing they most fear. Frankl has challenged patients to go to the shop window which they fear to go past because of the thought they have that they will throw a brick through the window. He told them to go there and throw a brick through the window! Of course, it never happens and the spell of the feared thought is broken.

(Frankl's existentialism is quite different from the behaviourism of Phillipson but nevertheless, on this small point of technique they seem agreed even though their rationales are antithetic!)

Obsessive Thinking (2)

Last time mention was made of three types of obsessive-compulsive disorder (OCD) as identified by Steven Phillipson: the common type of OCD which may involve hand-washing because of fear of contamination for example; the second is the "responsibility" type, who fears for the well-being of everyone else he knows and is driven by guilt; and lastly the pure-O type.

To counteract the third "pure-O" type where the person tries to push away the thought by thinking or imaginal means Phillipson proposed three methods that are not very helpful according to him. The first which is saying, Stop! ("thought stopping") or stinging oneself with a rubber band around the wrist, he says, has not been proved to be adequate. The second method is to point out the illogicality of the mental rituals. This approach hasn't proved to be effective either because invariably the sufferer already knows that what he thinks is illogical. Another option is to use analytic interpretations, which assign meaning to the "spike" (the worrying thought) with a view to resolving its power by understanding it. Phillipson believes this approach also to be detrimental because trying to find solutions to the thoughts will only prolong the condition.

Phillipson advises the use of behaviour techniques even questioning whether the addition of cognitive procedures adds anything to the former. We will outline his behavioural rationale and list some of the behaviour techniques he suggests next post.

Obsessive Thinking (1)

When I started counselling I imagined naively that clients would appear with circumscribed complaints that I would then be able to help them with. What I came to realise quickly was that clients will come with fragments of their emotional life, inner acts and outer actions exemplifying different syndromes. For example, obsessive thinking can be a feature of major depression but then it can be part of a borderline personality disorder condition too among other conditions.

Obsessional thinking is a painful, torturing condition and only sufferers can know the full extent of its misery. Sufferer fight against their thoughts but this does not seem to help because they seem too strong for them. Hence, they feel powerless and helpless. At times, they feel like two people with two different sets of thoughts: one sensible and rational, the other destructive and irrational.

They try to divert themselves in various ways by activities or sometimes with self-harming but such deflections work only for so long before the thoughts begin to intrude again. What to do?

Both psychodynamic and behaviour therapy schools offer something for sufferers with the latter probably being more appealing for those who want an "action-based" approach while the former appealing to those wanting to know the "real reason" for their malady. However, David H. Malan who wrote the superb Individual Psychotherapy and the Science of Psychodynamics on brief psychotherapy conceded that sometimes successful dynamic therapy constructs a convincing mechanism for how the obsession got started but fails to cure the patient! That is, one can be given a good reason and it might not help.

Christian psychotherapy should be aware of the spiritual nature of mankind. That is, that clients being made in the image of God, have no existence other than in their relation to God. All their temporal lives are expressions of their spirituality as image of God.

People have inner lives and outer lives. Therefore, claims that humans are just their external behaviour are false. On the other hand, humans are not just made up of a temporal inner and outer life either. Human acts of many kinds emerge out of the supratemporal heart of mankind as thinking-imagining-willing acts. These dimensions are the inward act-life of people and from these acts come external actions.

Having said this is not to say that so-called "behavioural" techniques cannot validly be used by Christians to alleviate pain. Of course they can, as long as we don't allow their use to convince us that our clients are just emitters of behaviours that are elicited by chains of reinforcers.

One of the most sophisticated behavioural presentations I've read on the Internet anyway is that of Steven Phillipson who identified three types of obsessive-compulsive disorder: 1) a "contamination" type leading to repeated cleansing or anxiety leading to checking locks and appliances; 2) a responsibility type leading to a over-worrying about other people; and 3) a "pure-O" type in which the obsession revolves around fear-provoking thoughts (he calls them "spikes"). The person attempts in a mental way to push away the thought, avoid the repetition of the thought (or spike) or tries to solve the question or undo the threat that the thought-spike presents.

Importantly, clients will generally present with aspects of all three types but one will usually predominate. Next time, a closer look at the third type above.

The Trouble with Counselling Theories

When I first started counselling nearly 20 years ago, I was so anxious to find a "correct" theory that would somehow cover each case I encountered. Now I concentrate on clients and develop a theory or even use "mini-theories" with each person.

I wouldn't say that trainees shouldn't learn about the various theories -- indeed I taught the rudiments of such theories to undergraduates at a tertiary college for more than a decade (http://www.myauz/ianr)! However, the danger with theories is that we may too easily force the experience of the client into our web of concepts, falsifying what is being said to us.

Moreover, for Christian practitioners, the secular theories have been shaped by non-christian "basic driving forces" (Dooyeweerd) that severely limit their wholesale acceptance by Christian practice. (As Christians though, we should be equally aware of where our own thought and practice is compromised by unchristian driving forces such as the dualistic motive of nature-grace.)

None of this should be interpreted as saying that theory, hypotheses, concepts and explanatory frameworks are unnecessary. But, the adoption of one set of concepts to cover all clients' difficulties is altogether too limiting.

Finding Purpose in Your Pain?

I recently read Purpose in Your Pain by V. Gilbert Beers. He tells the story of how his family lost a 26 y. o. son in a car accident and vividly recounts the aftermath faith-wise, emotionally, physically and so on. Superb writing and an excellent read on the subject.

Of course, nothing can prepare one for events like these. Presently, in our state of Victoria, we are experiencing a terrific bushfire outbreak that has taken some 180 lives and still counting plus 4 hundreds hospitalised, the worst disaster of this type to afflict our country.

Beers' book stuck me on two counts: first, his explanation of why a son or daughter's loss hurts so much is described in terms of it being an attack on the structure of the family's and each member's identity. We grieve not only the loss of that person but because that person was part of how we were defined or constituted in this temporal life, we have to grieve and repair the loss of a part of our corporate being, which we can never find again in this existence. We lose the person but we also lose our selves because the relationship with that person was part of our selves.

However, we must also remember that our identities are supratemporal not just temporal. We are souls not just temporal bodies with the full meaning of the body being concentrated in the soul and the temporal meaning of the soul being expressed in the body. Nevertheless, the nondual relation between the soul and body means that when the body suffers, so too does the supratemporal soul.

Moreover, Beers spoke later of the wounded healer, a concept well-known through Henri Nouwen's writings. We are able to comfort others perhaps only to the degree that we also know suffering and minister to others out of 'the school of suffering' we have gone through. Beers argued that suffering can become redemptive in the lives of others. A wise woman has said that 'the value of suffering does not lie in the pain of it . . . . but what the sufferer makes of it' (Mary Craig) or we could add, what we are made in rightly using our suffering.

Don't know whether this suggestion means that I can find a purpose in my suffering. In any case, the 'purpose' only becomes apparent when I look back at a later time and see how that experience of suffering becomes to be used for the good of others. That good may be seemingly simple: having suffering I can go and sit with someone who is suffering and not be conflicted by thoughts of not knowing what to say. Often the suffering person needs someone who can sit with her in her pain and not try to problem-solve for some loss than is not amenable to problem-solving.