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!