How-Not-To-Do-Therapy According To Hoover

Non-Therapeutic Dialogues

These examples describe what Hoover calls 'non-therapeutic dialogues' even though these patterns are quite common in cognitive-type psychotherapy.

The dialogues illustrate very well one of Hoover's central contentions that just because someone is bothered or distressed about an event, it doesn't prove the person is being irrational, illogical or stupid. 

In fact, it rather might prove that they're normal.

First Vignette: mother's loss of child access

In the first vignette, a 29-year-old mother, Anne, has lost custody of her children and now only sees them for limited times.
Anne: I couldn't have believed how painful it would be living without my kids. At first I was just angry with Jim [husband] but now I just miss them so much.
Counsellor [CR]: But you have them every second weekend. Isn't that better than nothing?
Anne: It's just not the same.
CR: I don't get it. Sounds like you're saying that you are prepared to be without them every second weekend. 
Anne: In a way.
CR: But if you loved them you'd want to be with them at least part of the time.
Anne: I do love them but when they leave it is heart-wrenching and I wonder whether it's all worth it.
CR: You need to know it's worth it. You need to tell yourself that being without them is just tough. Too bad but it's not really awful.
Anne: But it's rough on them too.
CR: You don't know that for sure. They may look sad when they leave but how do you know that they're not having a good time five minutes later?
Anne: But they don't sleep well when they are at night. I'm sure of that, and they always sleep well when they are with me.
CR: Boy, your thinking's really out of kilter. Your really giving yourself a hard time.

You get the point I'm sure. None of us would like to be 'counselled' using this 'struggle' method perfected by the communist Chinese during Mao Tse Tung's era! The dialogue has become an argument with the counsellor trying to convince the client that the counsellor is correct and that the client is wrong and should change her thinking. It assumes that the client is wrong until s/he starts agreeing with the counsellor's analysis. 

But what if we accepted that what the client is feeling and saying is realistic given what she is going through?

Second Vignette: client adultery

A further example leads into another discussion of the function of feelings of self-esteem.

A male, Sid, comes to counselling who has been cheating on his wife and is feeling guilty about it. He believes he has let his family down and others who look to him with respect. So the Professional Counsellor [Cpro] leads off with:

Cpro: But why put yourself down? Why can't you still like yourself?
Sid: I cheated on all the principles I believe in.
Cpro: So that's why you're irrationally hating yourself as much as you do.
Sid: I wouldn't say I hate myself exactly but I certainly feel bad about what I've done.
Cpro: But you couldn't be feeling guilty unless you were irrationally saying to yourself how worthless you are. Are you saying you like yourself for what you've done?
Sid: No, I don't like myself for what I've done.
Cpro: I would say, 'hate yourself' and 'putting yourself down'. Now is that wise?
Sid: Probably not.
Cpro: Suppose it was me who had done the cheating. Would you be hating me?
Sid: No.
Cpro: So. You've got a double standard and that's part of the irrationality. In addition, as long as you keep hating yourself you remain dependent.
Sid: What do you mean?
Cpro: If you don't like yourself then you can't believe in yourself and you get dependent on others such as the dependency you have on your wife caring for you.
Sid: Dependency on my wife. I don't think I have a dependency on my her. I just want to be fair and save my marriage if I can.
Cpro: What you are saying is true to a point but you also are to some degree dependent on her.

This example epitomises the modern obsession with trying to ensure that the client feels good about himself even though he has done something wrong.

The feelings of guilt that Sid above is experiencing should not be treated as a noisy inconvenience but as promoting self-examination and an openness to correction. (Sometimes clients come suffering from false guilt but not always as in the above case.)

It is not the function of psychologists to rid people of genuine guilt or low self-esteem when sometimes these feelings will give the sufferer valuable information about their actions. 

Trying to encourage unlimited positive self-regard in order to escape depression, anxiety, guilt feelings, low self-esteem feelings etc. is trying to aim for an existence that is unattainable in this life by robbing people of their feelingful lives.

Of course, I doubt that Hoover has those abused clients in mind who have been almost destroyed emotionally by noxious comments made by neurotic parents or others over long periods of time. Moreover, a proportion of clients also exists who will find it hard to be helped by psychotherapy at all.

But of those amenable to psychotherapy some of what he advocates would surely benefit many.

Therapeutic Pretensions

or ... don't tell me you didn't know that!

The New Standard Non Cognitive Psychotherapy (2001) by Russell Hoover lists 10 Pretenses (not an exhaustive list) associated with cognitive-style psychotherapies (particularly of the Albert Ellis therapy type).

These pretenses could be equally labelled errors!

(I've adapted the following from Hoover's list on pp 168-169.)

Taken from FreePhotos Site

Pretense 1
You like the rest of humanity not only have the major tendency to think irrationally but irritation is a sure sign you are not thinking rationally.

Pretense 2
Your emotional upset (hostility, depression, or worry) is the produce of attitudes you hold; attitudes that are stupid, disturbed, negative and sick (p. 168).

Pretense 3
Upset is a sign of mental weakness; calmness of mental strength. Corollary: 'those who best exemplify emotional maturity are free of tension and anxiety' (p. 168).

Pretense 4
Acting in the way that is not in your best interests is stupid.

Pretense 5
Being upset has no value and is 'destructive to your overall well being' (p. 169).
   
Pretense 6
You have an inherent capacity to over-react . . . and unhealthy minds do so more readily than others (p. 169).

Pretense 7
You are not bothered by events as such but by the distorted way you view them. So coping becomes a way of re-defining everything as 'so what', 'okay' or transforming it into something that makes you feel better.

Pretense 8
In reality, no absolutes exist anywhere so 'absolutist' thinking is dysfunctional and the main reason for people's emotional suffering.

Pretense 9
The universe has no will of its own and therefore demands nothing of us. Those who think in demanding imperatives such as 'should, must, ought, got to' are thinking in irrational ways. Hence, 'imperative thinking is impaired thinking' (p. 169). 

Pretense 10
'Being down on yourself, or feeling self-pity are hideous disturbances that create psychological weakness and a sure sign of ones [sic] lower emotional IQ' (p. 169).         
   
Hoover demolishes these Pretenses carefully which I won't take time to do. 

But what I will do is to outline his 'restatement' of these views which Hoover describes as being in a 'plausible fashion' (p. 185). He does not directly argue against each one but restates his own position alongside them.

Plausible Restatements

1. Emotional upset is unlikely to result from negative thinking etc. Rather it results from hardships and adversities.
2. Hoover argues earlier in the chapter that irrationality is hard to define 'on a scientific basis' (p. 186). Hence, one person's 'irrationality' can be another's wisdom.
3. Calmness in the presence of adversity may leave other's thinking about whether the calm one cares or not. So it's not a sign of emotional toughness in itself.
4. Acting outside one's best interests (co-dependency) is not necessarily disturbance but can be because other choices are not known or other choices are worse than the one selected one.
5. Being upset or irritated is a sign that something needs attention. It's unwise/maladaptive to get rid of a sign that cues us to take some action; it's like disconnecting the oil warning light because it keeps coming on!
6. An empty pejorative use of language about the intensity of one's reactions to life events.
7. However, one's view of things is not arbitrary but based on knowledge of possible eventualities.
8. It's simple nonsense to say no absolutes exist. The proposition itself is an absolute! Moreover, to say no absolutes exist serves to degrade 'ones [sic] psychic operations in mental therapeutics' (p. 186).
9. Any thing unalterable is an imperative whether we like it or not. It must be so. [I think Hoover has erred in this area because Albert Ellis would say that certain things must be accepted the way they are because of natural evolution. But, Ellis would also say that humans would be advised not--note the concealed should--assume that they are bound to follow their own internal 'shoulds, oughts, have tos, etc'.]
10. Hoover believes that being self-critical allows one to develop a more realistic self-image. The accompanying mood may aid one in this endeavour.

Unrealistic Thinking

He finishes this Therapeutic Pretensions appendix (I would call it this but he doesn't) with an interesting discussion on having unrealistic thoughts. This is quite important for therapy as I will show.

Hoover's discussion is about REALITY. What do we mean when we say that something is REAL? It may be said that when something occurs or has occurred it's real. But is that the only meaning of real?

Probably not, he says. In fact, the real can be extended into the sphere of the 'maybe' or the 'possible'. (Of course, clients like all persons talk a lot about maybes and possibilities.) Knowing what could happen is very much part of reality for us.

Hence, we can now ask, is it possible to think an 'unreal' thought, an 'unrealistic' thought? Can the reader think such a thought? The usual response to this challenge is to say, "Well I can. I can think of a 'cow jumping over the moon', from the nursery rhyme." Admittedly, this event has a very small chance of occurring.

Now clients visit therapists with all their supposedly unrealistic thoughts and imaginings--that's the clients I'm talking about--but what Hoover is now saying is that almost all of these unrealistic thinking is possible even if highly unlikely.

He doesn't want to conclude definitively that humans can't think unrealistically but he is not 'totally convinced such a thesis is gospel' (p. 188). However, it's hard to be unrealistic, 'it's a very difficult task' (p. 188).   

Why I find this important from a therapeutic point of view is that so often we try to get the client/counsellee to adopt our more reasonable and rational views.  We therapists have the more realistic viewpoints so they should be willing to bend to our wills. In many cases, they won't accept them anyway (even though that is not the point).

If we started with the notion just presented we might gain valuable rapport with clients who would see us less as struggling to change their minds.