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.