Inadequacy and Low Self-esteem Feelings

Case Study 2

In this example, Russ Hoover (RH) shows how to disengage the alarm while not allowing the use of defence mechanisms such as minimisation, denial and rationalisation which avoid the impact and seriousness of the original complaint for the client.

Betty, late 50s, had worked in a restaurant for about 3 months and had suddenly been confronted with a 16-year-old male doing the same work as she was. He had made the job look so easy, joked about how simple the job really was and made all the difficult parts of the job look very easy.

However, Betty found the job required a great deal of concentration and didn't find it easy at all. But his care-free attitude to the job had shaken her confidence and brought on deep feelings of inadequacy and low self-esteem.

She's been stewing about the whole matter and we pick the transcript up with RH asking her:

RH: And I notice that you haven't been able to shake off this feeling we've talked about?
Betty (B): No. I haven't been able to get it out of my mind. I guess I knew I wasn't doing very well at my job and this situation brought it home to me.
RH: And do you know why you are thinking about it so much?
B: Well, no.
RH: It's because of the psychological alarm. Have you ever heard of that?
B: Yes. I read the book. (She is referring to a copy of the present book which RH had recommended she read.)
RH: So something in this whole incident alerted you to something bad that could endanger you. A good warning system tells us about potential danger because if it waited until we knew it was a danger it might be too late. [That is, the alarm precedes the knowledge of the potential danger.] If you knew you could do what this young man could do then the alarm would have been turned off. But in this case, it was something bad about you that alarmed you; so what did your attention focus on?
B: That I wasn't able to do the things he was doing and that kept my attention.
RH: Precisely. Just as a reminder, you can never be alarmed over any potential you might know to be good/okay; good potentials have no warning system and in fact, de-activate alarms. You probably sense that feeling inferior is not something good or you wouldn't be talking to me now.
B: I just hate it.
RH: If feeling inferior were okay we'd be trying to get you feel that way more often. So if we try to get rid of that low self-esteem, under what conditions will we be trying to get rid of it?
B: (pauses) Under what conditions? I don't know what you mean. [And we might not either! Maybe better if he had said, 'Under what circumstances . . . . etc.]
RH: Well we wouldn't be trying to get you over the sense of inadequacy under conditions that don't make you feel that way would we? We'll only be trying to get you over the feeling under conditions that make you feel inferior, not anything else?
B: Yeah. That's makes sense.
RH: It might even help to list all the conditions [situations] that don't produce any sense of inadequacy such as when you are doing well or better than others or when inadequacy doesn't matter that much. None of those conditions produce bad feelings do they?
B: No.
RH then formulates a treatment goal as: 'our goal is to [control] your sense of inadequacy only [in] conditions that create that sense of inadequacy' (p. 89). She is happy with that. And he gets her to spell out that the conditions in focus are like those that she encountered in the restaurant the other day.

He then explains that it's not good to try to reduce feelings of inadequacy when the feelings are justifiable. [By the way, it's notable in this therapy that a large amount of repetition is used to make sure the therapy goal and the means towards reaching the goal are not lost to sight.]

She accepts the clarified therapy goal but is doubtful about how they are going to fulfill it.

The words underlined in the subsequent dialogue are what he calls 'antagonists' (see earlier posts) because they antagonise or act against the mood inducing a reduction in its intensity.

RH: What if you declared, silently to yourself, it's not reasonable or understandable for me to be performing okay? It makes perfect sense I perform a second-rate job in this circumstance. How would you feel then?
B: (hesitating) It wouldn't bother me anymore.
RH: Why wouldn't it bother you anymore? Do you know?
B: No, not really.
RH: How much can you get bothered about something you know to be perfectly reasonable?
B: I don't think you can.
RH: And what if the thing you know to be reasonable [feeling inferior] is something very bad, something you hate about yourself?
B: But it's reasonable?
RH: Yes. Absolutely reasonable though you loathe it.
B: Well, I don't think you'd bother about it so much.
RH: Right but remember it can't be really acceptable to you because then you couldn't have got bothered about it in the first place. All you'd be doing is shifting your values and making something you now believe is bad into something neutral or okay. But remember now: what did we do before to ANTAGONISE the bothered feeling you felt when you realised your actions were not up to scratch?
B: Well, seeing it's unreasonable.
RH: Yes, it's very unreasonable for me to be bright and witty and to have a lot to say. Now how would you use that with reference to what happened to you in the restaurant?
B: That it's unreasonable to be doing things as well as he is.
RH: And how would you then feel?
B: Not so bothered.
RH: Right. You wouldn't feel so bothered unless that wasn't the real issue. 

[What RH is doing at this point is to make sure that he is addressing the correct part of the situation that is causing her the upset.]

RH: For example, the real issue might be not your in adequate performance but the fact that others might look down on you as a consequence. So they're thinking you're incompetent. How would you deal with that if it were the actual issue?

B: I don't know.
RH: You'd use the same strategy. You could ask, is it logical for people to look favourably on me and think me competent?
B: Well, no; not all the time.
RH: So then, if you didn't think you were doing too well then it doesn't seem to follow that they would either. And knowing that, how do you feel?
B: At the moment I don't feel upset.
RH: So, it's beginning to reduce feeling bothered under the conditions where the bother is usually created. Later we'll come back to that again and make sure it's second nature for you. But right now, we going to look at something else you said: the feeling of inferiority which can't be okay or all right or you wouldn't be upset by it. Our treatment goal is to reduce the upset to something that's not okay anyway. 'But how do people feel when they see something shamefully unacceptable about themselves at a time that it in some way matters to them?' (p. 92).
B: They feel bad and down on themselves.
RH: 'Right, unless they did what you did before which retracts [antagonises] the mood that corresponds with that condition' (p.92). For example, what if you knew if wasn't fitting or sane for me to feel okay about myself all the time; that it's quite sane for me to feel bad when I do.

He has her repeat the words in the example and challenges her about the truth of them. She affirms their truth but when he asks for a basis she replies that we can't feel good about ourselves all the time because it's hard to do. His rejoinder is that because we are flawed [affected by the Fall] and recognise our shortcomings then we're bound to feel bad which is completely proper.

And paradoxically, accepting our feeling bad as being completely proper allows the badness feeling to slip away. Trying to get rid of it only stirs it up and increases it.

The Vehicles

In this closing part of the main body of the book--he has detailed appendices as well--he draws a sharp distinction between vehicles and their loads and applies that distinction to the psychotherapeutic situation.

He warns of the danger of confusing such things as humour, analogy, persuasion, rapport and question and answer with psychotherapy. For the former are simply means of conversation and not treatment. The former simply deliver the treatment but are not that treatment themselves.

Particularly he attacks strongly the idea that humour is 'the best medicine' as applicable to the more serious job of psychotherapy which he has outlined in his book.

In my final two posts on this book, I will examine first an appendix entitled, Therapeutic Pretensions. In the final post, on a section Non-Therapeutic Dialogs (sic). The latter is important because it contrasts his views sharply with cognitive therapy.  

Part Three: In the Trenches

The third part of Hoover's Non Cognitive Psychotherapy is 'a review of therapeutic transcripts' (p. 85). (Yes we are now getting into the 'practical' stuff.) He speaks about these transcripts as being 'raw, unedited sessions' but obviously I will have to edit them to save space and time.

The sessions he details in order are:

1. Inadequacy and low self-esteem (pp. 85-97)

2. Panic disorder (pp. 98-110)

3. Compulsive acting-out (pp. 110-117)

4. Compulsive drug-use with relapse the issue (pp. 117-135)

5. Mounting anxiety (pp. 135-146)

6. Increasing assertiveness at therapeutic closing (pp. 146-153)

7. Hostility and depression (pp. 153-158)

{Note: If any readers would particularly like to see this site focus on one of these scripts please contact me at ir 1946 AT gmaildotcom replacing AT with @ and closing up all spaces in my address.}

I want to take up the 'Mounting Anxiety (pp. 135-146)' transcript because we have introduced it in an earlier post (The RULE). It was the case involving an 11-year-old, so-called 'schizophrenic' girl who was very frightened by spirits after the death of her uncle.

You will remember that case followed The RULE in that the therapist did not try to dissuade her that she was wrong about her belief in spirits and what they could do to her.

The author Russ Hoover (RH) starts at a crucial point when he says:

RH: Could it ever be possible for you to be among these spirits lurking around and not be afraid?
Deb: Well, yes if you knew they weren't going to do bad things to you!
RH: And if you didn't know that for sure?
D: I'd be scared.
RH: But would it be possible to know that they might do something to you and not be scared?
D: No.
RH: But what if we made that our goal: not to be scared when we don't know whether they will do something to us or not.
D: (pausing) Yeah, but then I'm scared.
RH: Of course, some people might tell us that they got over being scared by noting that there aren't such things as spirits, but is that something you really know?
D: No. There are spirits. I've seen them. I don't care what anyone says.
RH: And we could say that if there are spirits, and especially if they might do something to us in some way, it would be a bit strange if we weren't bothered. But, what if we made that our therapeutic goal: of not being scared knowing all the while they might do something to us. What do you think about that?
D: Yes, but I just don't see how you could do that.

I think we have reached this point when Deb was mentioned in the earlier post but it's been repeated here to put all readers in the picture once again.
 

RH: Sure. In the usual sense that would never happen because that's not the way it works. When we see something scary we naturally feel scared.
       But, if you knew the way fear works when we see something scary you're better able to undo it. See, people don't understand how fear works or at least, I've seen few that do. [More on this cardinal point below.]
D: When I say they might do something to me I think sometimes they might make me like they are.
RH: Oh (pause). I see. And would that be okay or a so-what event?
D: Well no. (She looks annoyed.)
RH: The silly rabbit asks a silly question. Right. That wouldn't be something that is okay. But, I'm going to ask you another silly question just to see if you understand what is going on. What about the fear you have when you realise you're scared, is that okay?
D: No, that's even worse.
RH: Interesting that you can see that so clearly. Right. That wouldn't be okay either. But how do we know it's not okay?
D: (pauses) Because it upsets me.
RH: Very good. Not many people know what you've just said. but there's another reason that let's us know it's not okay. Anything that is okay, really okay, isn't that something we try to get more of?
D: Well, yeah, if it was okay.
RH: Sure we'd want more of something okay. So is the fear you have an okay or un-okay thing?
D: (looking exasperated) No, it's not okay.
RH: And you could say, you couldn't ever be upset about something you know to be okay anyway---so that too tells us why it's not okay.

I'm going to save my typing fingers by giving away his secret that he shares with Deb after more discussion. What he gets to is that humans tend to try to get rid of painful things which works on most things other than fear and depression. 

But trying to get rid of fear and depression does NOT work. All it does is provide more 'fuel' for our fear and depression. Fear's food is our secondary fear of the fear itself (fear of spirits in Deb's case). '[B]eing scared is like a monster that feeds off our attempts to get over it' (p. 138).

Trying to get away from it only makes it cling all the more.

How do we weaken it? RH says, we can't just tell the anxiety to stop because it's normal to be scared about scary things--that's the way things are and they're like that for a good reason. 

So he leads her to suggest that she might try telling herself to be scared. 

Why does he do this? Because he believes that being scared is much harder 'if you try to feel that way' (p. 141) and furthermore, being fearful will increase when we try not to feel scared.

To add to this suggestion, he recommends that she has to tell herself 'in [a] manner that's more convincing' (p. 141). 

She then says that she could say to herself, 'darn it, be scared!' 

He agrees with her about that but proposes that she tell herself that '[D]arn it. It absolutely makes no sense whatsoever for me to be unafraid; it is perfectly and completely reasonable for me to be scared. After all, who feels okay when spirits are skulking around, and worse might do something to us? (p. 141 with small alterations in expression).

He gets her to repeat, 'It doesn't make sense for me to feel okay'. 'It's ridiculous for me to feel good'. He challenges her about her willingness to accept this understanding, 'deep down inside [yourself]'.

However, he warns her about our in-born tendency to try to evade the painful. That's a given and usually works; but not with with anxiety, depression etc.

The uniqueness and simplicity of RH's view is that he believes his outline of how anxiety works is the way it works in reality. His tactic is not just a way to reduce anxiety but also an instruction in the way our emotional-psychical structure functions in response to adversity in the world. And remember he defined adversity as those things in the presence of which we feel not-okay. 

What he is trying to do then is to get her to accept that her scaredness is sensible and needs affirmation. By affirming it, the fear will not be fed and become a greater fear.

In closing this fascinating example, it is obvious that RH's therapeutic process is a series of tactical 'nudges' informed by his 'antagonistics' and 'constants' of earlier posts.

Next time, I will choose another example that I at least find interesting but I am very open to suggestions from any reading this.

Summaries and Case Study

 A Backtrack

Just to backtrack a little so that we can catch our breath!

Hoover is concerned about the overreaction of the alarm response to adversity in clients but at the same time does not advocate a method that seeks to shut off the alarm altogether because that would imply that the alarm is a 'bad' thing when it is rather the case that its expression is working overtime.

Just to give an example: imagine an alarm on a building site which goes off all the night disturbing the local neighbours. We are not allowed to modify the alarm system but we can inform the owner about the neighbourhood context of the alarm system.

In fact, one of his 'antagonists' is to let clients know that reacting to adversity is 'proper'. Only insensitive people show or feel no reaction when adversities occur. On this same basis, Hoover is also opposed to psychotropic medications (e.g., antidepressants) because like cognitive therapy they seek to close down valid reactions to various events. (This comment by Hoover is inaccurate IMO because the use of medication does not typically close down such reactions but moderates the intensity and duration of the reactions; nor is it true that cognitive therapy seeks to prevent all emotional reactions to adversities.)

Hoover understands 'the constants' (last post) as 'ancillary principles', to be added to the antagonists (=actual world knowledge that opposes or counteracts the overreaction of the alarm response) being used. (See post on antagonists.) The constants are listed below.

Summary of Constants ('Ancillary principles')

• According to Hoover's system, 'okay', 'all right' and 'acceptable' are synonyms; whereas the phrases, 'so what', 'who cares a darn', and 'big deal' imply neutrality and 'can also be used interchangeably' (p. 77).

• 'The antagonist . . . coupled [with] some wrong or bad condition does not' make that 'wrongness into something acceptable or neutral because 'wrongness' cannot be at the same time good or 'ho-hum'.

• Proper and not-okay can be the same thing but okay and not-okay cannot be. Only a change in perspective could make the latter so.

• 'All right' is a circumstance one regularly seeks, promotes and welcomes more often.

• 'Something . . . "all right" is inherently all right and not made all right because of some beneficial by-product' (p. 78).

• 'The antagonist not specifically targeted at the precise wrongness of an adversity, works much less effectively when it works at all . . . ' (p. 78).

• Facing adversity, or potential adversity and being 'unbothered' is bizarre and leads the psychical system 'to act in a way for which it is not inherently designed' (p. 78).

Case Study

We note how Russ Hoover (RH) uses some of these general principles with a client (B) presumably after B has told RH something of why B has come to see him. (I've shortened this so some of the dialogue will appear abrupt but may not be so in the original.)

RH: So when we are threatened it is usual to experience an answering mood. What would be the nature of that mood, pleasant or unpleasant?
B: Obviously it would be unpleasant.
RH: Yes! Now why do you think we were designed to feel pain when threatened?
B: I don't know. It doesn't seem to make sense though that I'd feel good.
RH: Right again. Could it be that it tells us something very persuasively?
B: It probably does but I don't know what it is.
RH: Could it be that it tell us urgently that something is wrong?
B: Could be. I can buy that.
RH: If we removed that discontent when something might go wrong: what's the risk we run?
B: You might not think something not all right and think it's okay.
RH: You've hit the nail squarely on the head. Humans when unpained about something universally think all is well. But if it is not okay isn't there something hazardous about that?
B: Yes because you might not know the danger and do something wrong.
RH: Yep. You might just forget about it. So we want to devise a system that won't insert that mistaken assumption: to think a harmful thing is okay but to be unbothered.
B: Yeah, but I don't see how you can do that.
RH: If nothing else, we could also say that the psychical system is not constructed to operate this way. 
(Adapted from pp. 78-79.)

Given the absence of emotional discomfort in the presence of something not-okay when that disorderedness leads the client to be affected negatively, resistance to therapy can be expected to occur. (To repeat, Hoover believes it creates the wrong impression to imply that when emotional discomfort is absent in the presence of a real adversity that that's a healthy state; to instruct a client otherwise is to breed potential distrust in the client!)

RH: What's the purpose then of a painful mood?
B: It tells us something is wrong.
RH: So if we remove that pain that goes with something bad, what risk are we taking?
B: Well, you might then start thinking, 'it's okay' (when really it's not).
RH: That's right. In reality, it's not okay. The painful mood when reduced begins to help us conclude wrong conclusions. In your case, was it okay that you were sexually abused over and over?
B: No way.
RH: No. Stupid question. But if we lessen the painful mood and you get the idea we're saying, 'it's okay', how might you react?
B: That what you're saying is not correct.
RH: Yeah, you might begin to lose confidence in the procedure which could help you. You might begin to suspect the process. 
Hence, whenever you get the idea that the sexual abuse was 'okay' that's the time to go back and discuss the matter with me. We are not working with something that was okay. We're never saying, 'It's okay'; but on the contrary, it's not always fit for things to be positive. 
(Adapted from pp. 80-81.)

Concluding Good Treatment Points

Good treatment is:

first, SELDOM about telling clients what to do/what not to do or imposing one's will upon the client.

second, more frequently about telling clients HOW TO DO SOMETHING within the framework of some treatment goal.

third, informing clients WHAT HAS TO HAPPEN before this or that occurs and/or an explanation of HOW it would be implemented (p. 81).

'A psyche unable to be negative is one disabled' (p. 82).

We have now completed Part Two. 

Next time we will begin PART THREE entitled,  

In the Trenches

This Part is subtitled, A review of therapeutic transcripts and promises to reveal how his principles are worked out in practice. Sigh! 

Creep, Signature, Antagonist, and Constants

The four parts of this post's title are terms unique to Non Cognitive Psychotherapy (NCP) espoused by Russ Hoover and require some hard work to understand what he means!

THE CREEP

'The creep' is the tendency in psychotherapy to move away from proper therapy towards 'treatment corruption' (p. 68). Examples of the latter diversion/distraction techniques and/or not adhering to the 'primal rule' (as given in last post).

The creep, therefore, has to be managed and its temptation has to be resisted. Not to resist means that the therapist ends up badgering the client to give up their irrational thinking and adopt the thoughts/values of the therapist. However, generally speaking, therapists are not 'value specialists' (yet cognitive methods imply that therapy is chiefly about getting the client to accept new values).

Hence, 'tracking "the creep"' (p. 69) is understood as a vital part of NCT being 'an integral part of many tactics employed' (p. 69). Hoover says that what is crucial is that of 'locking [client] perspective in place so that mood antagonistics' (p. 69) affect the client's mood alone.

[[Consulting the Glossary I find that 'antagonist' is defined as the 'active therapeutic ingredient used in NCP that when correctly employed blocks or inhibits emotional irritation while holding constant all relevant observations [attitudes, views, values] typically creating that mood' (p. 207). He has borrowed the antagonist idea from neurobiology where antagonists 'bind to a receptor [and block] its activation' and has applied this notion of antagonistic action to psychotherapeutic tactics.]]

Hoover concludes this section asserting that the question should not be how the client feels so much as the question of how well the treatment has preserved the original client perspective as mood reduction is occurring (slightly rephrased, p. 69).

THE SIGNATURE

A signature inter alia is 'any unique, distinguishing aspect, feature, or mark' according to an internet reference here. Hoover leaves the reader to figure out what the 'thing' is that he is examining to determine its unique or distinguishing feature. As he begins this section examining adversity, I can only assume that it is the distinguishing feature of ADVERSITY that he is seeking.

He says that adversity is associated with 'emotional irritation' (p. 69) and the presence of the latter doubles as a 'workable definition of adversity' (p. 69). I take it that he is trying to pin down more precisely just what is the distinguishing feature of adversity since adversity is so important in his whole conception of therapy.

THE ANTAGONIST

It would be well to rehearse what Hoover has said as I've outlined it in the paragraph above using the [[square]] brackets because I've found this area of the topic a struggle to comprehend what is being said.

He opens this antagonist subject thus: '[a]t NCP's inception in 1989, a certain order was recognized to all things and from which any incident or condition is made to occur' (p. 71). He also says in the same opening paragraph that 'this order' he is speaking about 'contains within it a response to the oft-repeated symptomatic question of "why?"' (p. 71).

This section seems to be an outline of a 'metaphysical' position which he summarises in seven theses (pp: 71-72):

1. 'The universe is made to function in a certain fashion and in that sense can never be out of order'. Of course from a person's perspective, car tires do get annoying punctures at times and we do think that universe is out of whack when all sorts of bad things happen but 'the procedures by which [the universe] operates . . . cannot be broken'.

This assumption is a curious one for us living in a secular age. It seems to have been taken out of a Christian view of things leaning towards the Calvinistic wing of Christianity. Of course, it can be said that the present order of things is 'out of order' because of the introduction of Eden's apostasy; however, in other ways, law and order are decided features of the universe we inhabit.

2. 'When the forces responsible for an event come to pass, it is absolutely [proper] . . . for that event to occur, in that it would be impossible for it to be otherwise . . . . [For] to be otherwise would set the universe out of order, and the universe cannot be out of order'.

3. On the other hand, if 'the conditions responsible for an event fail to occur, it would be utterly unsuitable and improper [unnatural, abnormal, illogical] for that event to occur'. My words in square brackets in this sentence indicate the flavour of 'unsuitable and improper' although in a later note he rejects the terms 'natural' and 'normal' because of the dangers of 'creep' which involves the use of invalid defence mechanisms.

4. 'In that every event is made to happen, the best evidence that [an] event has been made to happen is [the existence of] that event itself.' In other words, he seems to be saying that the existence of an event means that the event has been caused.

5. And on the other, 'the best evidence [that an event] has not been made to happen is its failure to occur' (p. 72).

6. The fact that an event could occur 'is insufficient to legitimize its occurrence since the conditions that make it happen still may never take place' (p. 72).

7. '[W]hen something is [as] yet uncertain it is improper for it to be certain at that particular time'.

+ He adds in a note that his conception laid out in these seven point above is not meant to exclude random or serendipitous events but doesn't develop the point at length.

When we scan this set of frameworks, what is he trying to say?

At very least, he is arguing for a world in which things occur lawfully. Notice his use of the word 'proper/improper' or 'suitable/unsuitable' which I've drawn attention to above in 3.

However, though I have set these theses out fully, it seems to me at least that the next section, The Constants, is much more helpful for therapists as a set of guiding 'precepts' when doing this form of therapy.

The Constants (Precepts)

Hoover understood it seems that the theses above needed some 'other allied precepts' to make NCP work effectively and framed those below known as Constants.

The first of these principles is that when we are upset (depressed, anxious, or angry) something is not 'okay' in our environment and to try to imagine it is 'okay' is to distort the nature of what is happening. This precept is aimed at all forms of cognitive and behaviour therapy that attempt to reduce clients' anger, anxiety and depression in the face of genuine adversity by confronting their 'irrational thoughts' or by seeking to change their behaviour. As Hoover has said previously, people react in these ways because adversities actual or potential 'matter to them'.

His second precept is that 'anyone confronted with the same circumstance or threat potential as the client, would be upset as well, unless it was over something they could not or had not sensed or something that for what ever reason did not matter to them' (p. 73-74). This latter [result] happens because all humans don't share the same values or experiences; therefore, a threat for one person may not be a threat for another. A flat tire for the average motorist is an annoyance at least but could easily be experienced as a blessing by those who remedy such problems.

His point being that clients will often understand their psychical reactions to events as evidence of their particular weaknesses rather than understanding that most people faced with their situation will feel as they do. This misconception is more likely given a greater intensity of clients' circumstantial reaction.

Moreover, not to experience pain in the presence of adversity he describes as 'quirky', 'aberrant' and even dysfunctional.

Hence,

irritation is not the product of a mind unable to contend, but a mind contending with something (p. 74).

If I could inject a clarification at this juncture: Hoover is suggesting that when a client is angry about a cheating spouse's betrayal for example, that reaction is understandable and should not be tamped down by getting the client to 'think' things like, because 'I am reacting this way, I am thinking irrationally' (Rational Emotive Behavior Therapy). To do that, is to suggest that marital sexual betrayal is no big deal for the sinned-against partner. Clearly for many clients in my experience, it is a big deal and from Hoover's point of view trying to argue them out of that mind-set is 'stoic indoctrination' and lacks any respect or compassion for clients' plights.

He uses a helpful image of an adversity being represented by a lock and by a particular antagonistic being represented by the key to the lock.

He concludes this part of his exposition by announcing two features related to the degree of relief likely to be experienced by the application of the antagonist to the adversity:

a) the 'greater the amount of irritation the greater the degree of relief imposed by the antagonist' (p. 75).

b) the amount of relief is greatly affected by the frequency of application or better by the level of conviction in which it is presented. So clients are encouraged to fully decide for themselves what in particular about an adversity was proper.

He illustrates this principle with the following: a male client (J) comes to Hoover (H) saying that his past counsellors were accusing him of fighting attempts to get better (pp 75-76). I've shortened and also quoted directly slabs of this interchange that were difficult to summarise.

H: They were wrong about that of course.
J: Well of course. I've been working hard.
H: What might happen do you think if you acknowledged that 'it was not proper' for them to think you're getting better but rather that it's proper to think something's wrong instead: chiefly, that you're not getting better! How might you feel then?
J: . . . Maybe I'd feel better.
H: 'Yeah, it's hard to be upset about something you know is proper'. [Important point here. One of his guiding principles as detailed in earlier posts.]
J: 'I don't know about that'.
H: 'What do you mean?'
J: 'Well, I hear it all the time; a person knowing something is proper and still being upset. It's like someone telling you to forget it and go on, and you're still being madder than hell about. It just p----s me off more'.
H:You are wise and have a sensible mind to see that. You might still be upset unless you recognise more specifically what is proper. It's proper for them to think something wrong about you, something untrue. Let me ask you: is it always proper for people to know the truth about you?
J: Well, no.
H: I want you to see that if you merely say that it's proper for them not to know the truth about you you might not sense any relief. You might even think it's fine to be mad with them. So you want to apply it to what is specifically wrong.
J: But they should know better.
H: Then again, is it always proper for people to know what they should?
J: Probably not.

Next time: a more detailed summarisation of his methodology up to now and more illustrative examples. The next post will see the end of PART TWO. In PART THREE he deals with a review of therapeutic transcripts which cover a range of psychological problems.

The Rule

THE RULE

The first principle of NCP (Hoover calls the therapist 'a technician' -oops!) is to:

• seek to understand the client's point-of-view fully AND make every effort to ensure 'it is not altered' (p. 62).

Although this procedure seems counter-intuitive to normal therapy practice it's in accord with what Russ Hoover has argued to this point. Psychotherapy is not about fixing up what's inside people's heads for them; it's first about 'holding all relevant environmental and intrapsychic features constant as treatment systematically ensues' (p. 62).

When the above is not done, therapists are moving into the realm of desensitisation and defence mechanisms, just schooling clients in 'crafty sorts of minimisation and denial' (p. 62).

Interestingly (and I applaud him for this) he accepts that sometimes, in emergency situations, psychotherapy has to be put to one side because a person's life may be in danger.

Hoover gives an illustrative example: Judy has separated from her husband. The husband is very distressed that she has left. He is ringing her regularly, crying over the phone and saying he will do anything to get her back. She has come to psychotherapy to try to cope with the situation.

From my examination of the dialogue which I can't obviously reproduce in this post, his responses to the client initially could be described as paraphrasing. This stage enables him to fully understand what situation she is in. But next he also goes to an empathic level: where the emotional and cognitive elements implicit in the client's words are made explicit by the therapist. The latter is no mean ability and calls for either natural talent and/or tutored experience.

The gist of the first part of the session with Judy is that she keeps saying that she doesn't understand why she is having this tortured reaction (of guilt?) about his ringing her up crying and distressed. The therapist points out that his suffering matters to her--it's an adversity, already defined as something that matters to the client--otherwise she wouldn't be concerned about it. (We only get concerned or upset about things that matter to us. We cannot distress ourselves about things that don't matter to us unless we are actors and have vivid imaginations which enable us to go into a make-believe 'world'.)

Although the NCPst may think her husband is a 'loser' from earlier reports from Judy the therapist does not initiate any effort to get her to leave him. To do so would be to break the basic rule above and in any case, NCP is not interested in meddling in people's lives.

NCP resists any procedure that involves convincing clients that they are irrational to be upset and to change the presumed thoughts they have that are upsetting. Hoover says insightfully,

[I]s Judy really being irrational or rationally recognizing something the likes of which quite logically activates her alarm? . . . Is it not within the realm of feasibility that George really cares about her and that maybe she still cares about him? And one could ask, moreover, is it not at least conceivable she is to some degree the cause of his suffering (p. 65)?

The therapist's main focus is the adversity-alarm-emotional/mood reaction complex and his knowledge that people cannot get alarmed by what is completely okay with them. To blind oneself to this fact is to encourage the client to use defence mechanisms that in the long-term will not benefit the client. Defence mechanisms defectively reduce people's sensitivity to their environments.

His second illustrative case under the Rule heading involves an 11-year old girl, Deb, diagnosed as 'schizophrenic' who is afraid to be alone after attending the funeral of her uncle. The plot thickens when we realise that Deb believes that spirits are in her bedroom. The spirits she says can follow her anywhere but trouble her mainly at night.

Therapist identifies her scaredness and then says tellingly, 'I can [understand what you are saying]. But could it ever be possible for you to be among these spirits; to know they might be lurking about, and not be afraid?' (p.66).

She says well she would be okay if she knew they weren't going to do anything to her.

He says but if you didn't know that for sure, what then? 'Well I'd be scared she says'. She is quite sure that she can't live with the uncertainty about what they might/might not do to her without being scared.

Then he proposes not being scared coupled with this state of uncertainty as their therapeutic goal.

He makes sure that the denial and suppression paths are not used. He doesn't want to convince her that no spirits are in her room because he believes it is 'not therapeutic' to destroy her belief even if it's mistaken. (The RULE at work.) Moreover, he tells her that if there are spirits sneaking about it would be strange not to be a little bothered.

'But what if [---to restate the point--what if] we designated . . . our therapeutic goal, the queer thing of not being scared knowing all the while they might do something to us?' (p. 67).

Her response is fully understandable: 'Yeah, but I don't see how you could do that' (p. 67).

I hope you are eager to know how the therapist deals with Deb! I was. We all have to be a patient because although Hoover does take up the case again. It's in PART THREE, page 132! This PART gives many practical examples of how NCP works.

Part Two: Mood Antagonistics . . . Psychotherapy Definition

This second major part of Non Cognitive Psychotherapy by Russ Hoover, is entitled Mood Antagonistics. What does he mean by this coined word (I think) 'Antagonistics'? As a starter I am guessing his term means such external 'subject matter' (see below) which work against any particularly hard-to-endure mood we are experiencing.

I am hoping though that it will become more apparent what he means by this term and others he uses when we get to the end of this second part.

PART TWO has six sub-parts, viz.:

1. The Definition

2. The RULE*

3. The CREEP

4. The SIGNATURE

5. The ANTAGONIST

6. The Constants

The Definition

In this sub-part he distinguishes between counselling and psychotherapy, a distinction  seldom used today (where the two are taken to be virtually equivalent). However, he says they are 'distinct activities' (p. 59).

For Non Cognitive Psychotherapy (NCP), counselling is understood as telling people what to do: stop drinking, be more assertive, don't be so codependent. Or, counselling may consist of recommending 'actions to secure these goals' (p. 60). So in order to overcome non-assertive behaviour encouragement is given to the client to use '"direct statements rather than questions"' (p. 60).

Psychotherapy, on the other hand, is a subclass of therapy. And therapy, he says, involves 'methods whereby some usually alien something is introduced to amend, regulate, or rectify a harmful biological state while all other relevant conditions remain unchanged' (p. 60, bolding in original).

It's clear that he has medical therapy (healing) in mind. So he uses for an example how antibiotics are introduced into the biotic system of the body to rid it of infection with all other conditions being kept the same. Although doctors may advise rest this aids the focus of their treatment (antibiotic medication) rather than being another treatment in itself.

Hoover extrapolates from medical therapy to argue that psychotherapy is the application of outside (i.e., 'alien') subject matter 'into the mix of psychological features associated with adversity' (p. 60).

This external 'subject matter' does not aim to:

alter or deny pre-existing conditions, such as: goals, values, loyalties, or even the extent of the adversity itself; the latter being more correctly reserved for problem solving, the former for missionary work (p. 60).

What he has said in this quote is quite important for understanding his psychotherapy. Most therapies in various ways do assist clients to re-assess their goals, values, loyalties and attitudes. He is saying that these approaches are not psychotherapeutic but efforts to change people's beliefs or worldviews and hence, they have a 'missionary' intent; that is, their practitioners are seeking converts to their beliefs and practices. I don't know whether he has his tongue in his cheek saying this but it's a provocative statement.

I don't think that this judgement is correct in all cases though the rational emotive behaviour therapy (REBT) practised by Albert Ellis would fall under this criticism. And then, so would Rogerian counselling because of its radical commitment to the free, autonomous individuality of the client. However, it's never possible to provide therapy without the espousal of some commitment to the way things ultimately are. Nevertheless, it might be possible to do that without infringing the rights of clients to continue to hold their own beliefs in what is ultimate.

Psychotherapy, according to Hoover, does not seek to modify anything intrapsychic such as one's attitudes or ideals. Nor does psychotherapy proper seek to change the way clients regard some threat or danger.

What NCP aims to do is to 'disengage the typical alarm features of adversity while one [the client presumably] remains cognizant (sic) of even its absolute worst potential' (p. 61).

Here is my earlier post on the way the alarm operates with the onset of some adversity (if readers need a refresher of how the alarm and the adversity are associated). So NCP is not interested in seeking to use methods of distraction or efforts calculated to change a client's perspective. If that is so, why does Hoover believe that NCP is a psychotherapy? He gives eight reasons all of which I will not canvass at this point.

He believes that NCP satisfies the general features of a therapy. Second, NCP faces up to the fact that some circumstances leading to mood disturbance cannot be changed such as deaths of loved ones. Third, psychotherapy is less intrusive and time-consuming. Lastly, it places power with the client rather than the professional.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

In case readers are wondering, I do have a number of reservations about this form of non cognitive psychotherapy but am committed to finishing the book with some understanding at least about the strengths and weaknesses of Hoover's ideas and where I stand in relation to them.

*The chapter headings have been capitalised as they appear in the chapter and not as they appear in the Table of Contents. I've given up trying to crack the code regarding the way the author capitalises his chapter headings!