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!

The Psychotherapies

THE PSYCHOTHERAPIES

It's at this point that our author, Hoover, makes the claim that all psychotherapies--apart from the one he is going to advocate--work on the principle of minimising our consciousness of the (perceived) threat we are facing. And they minimise our threat awareness by using the defences outlined in the last post such as denial, blame shifting, minimising its impact, busyness and/or any combination thereof.

Hoover illustrates what he means in the following examples:

1. Denial and Diversions
For example, John has got into serious financial debt and is obsessing about his woes to the point where it is affecting his work and health. In therapy he is told to forget about what he has done--would any counsellor do this I wonder (?)--and get his thinking onto something positive. He is told to realise that he has not done anything that all humans haven't at one time or other done. So John does not change his ways at all but gets angry about the system that has got him into debt; the therapist feels good that John is no longer beating himself up.

2. Minimisation and Value Shifting Deceptions
The next example Hoover gives is a marriage difficulty where Mary wants to stay in what is an unsatisfying relationship. The counsellor believes it would be best to leave the husband. She uses a technique of challenging the wife with the question, 'Just how bad would it be to leave him?'. Hoover says that the therapist is using an anti-'awfulsing' technique with the client. Eventually the wife is persuaded to leave the marriage.

3. Rationalisation and Intellectualisation
'Leon' who has been anxiety and unable to sleep for over three weeks seeks help from a health professional. In the ensuring counselling it emerges that Leon has taken advantage of some friends in business just to get his monthly quota. The professional invites Leon to rethink the situation in this way: 1) you didn't do anything wrong because you were only doing your job; 2) your friends must have been contributing to their being cheated because it takes 'two to tango' in such situations; 3) realise that you actually did your friends a favour: they might not to be so gullible in the future. Leon is told, 'Look on the brighter side'.

4. Suppression
Gerald has been washing his hands too much and the behaviour is increasing. He confides to his therapist that he hates the thought of 'germs'. The therapist teaches him the technique of 'thought stopping': where every time he thinks about 'germs' he instantly says to himself STOP in a forceful way. After he practises this technique for 2 weeks Leon is happy to report that his hand-washing frequency has been halved.

Hoover does not comment on these four examples other than implying that each is non-therapeutic because each appeals to the better use of a defence rather than addressing the ADVERSITY itself.

A CONCLUSION TO PART ONE: The Mechanics of Mood
Hoover leaves us with some questions that he regards as crucial to understanding his therapy such as:

(1) what is the difference between causation and tolerance in emotional unrest?

(2) what is an obsession or the mechanism by which a compulsion gets its existing force?

(3) can you explain those forces that can make an emotional reaction seem out of proportion and out of thin air?

(4) why did develop a system [as a result of the Fall--my gloss] that would leave us suffering at the occurrence of some adversity or adverse potential that has relevance for us?

 His final word in the chapter is

'.......did you know?

the psychological alarm is the 

Rosetta Stone* (the key)

to the human mind' (p. 55).

*The Rosetta Stone was discovered in AD1799 and enabled the translation of Egyptian hieroglyphics which had not been possible up to that time.

Next time we begin: PART TWO, Mood Antagonistics . . . . and the primal rule 

Compulsions and Defenses (sic)

The next two sub-parts of the first major part (The Mechanics of Mood) of Hoover's Non Cognitive Psychotherapy (NCP) are first,

The Compulsions*

The author defines a compulsion as 'the automatic attempt to prevent . . . pain or dissatisfaction, or to preempt that discomfort when it's actually occurring' (p. 48). Compulsions typically try to prevent or reduce the discomfort of pain either being felt or likely to be felt. Compulsions are more than ordinary habits.

To understand compulsions (such as repeated hand-washing for example) they must first be accepted as rational attempts to mitigate pain. However, that said, compulsions are 'unwholesome' by definition just as long as it is also accepted that 'to avert or preempt pain . . . is not a clinical issue' (p. 48) in itself. That is, it is normal to want to avoid pain if possible.

When compulsions are primarily expressed at the intellectual-verbal level they are known as defences; when primarily expressed as an action they become what is called 'acting out'. These protective devices are used for the immediate affect of 'relieving discomfort' (p. 48) and tend to be learned from imitation and observation.

Sometimes adversities do not suggest any method of relieving unease leading to the sufferer getting fixated on methods of getting respite. this situation will often lead to an obsession where intrusive thoughts or ideas predominate. Hoover gives an example of a man's fiancee who throws him over for another man. The abandoned man begins to suffer from depression and anxiety but strives to win back his former fiancee by pleading with her to reconsider. His efforts fail dismally. This result leads him to ruminate tirelessly and painfully on his betrayal; he continually obsesses over ways to woo her back.

The second sub-part of this post are,

The Defenses** (sic)

Adverse emotions like anxiety, anger and depression--remembering that I have already said that (IMO) Hoover wrongly fails to distinguish between emotions and moods--are moods and emotions from which we all seek to escape.

These avoidances 'disconnect all or part of one's awareness of the adversity [from] which the painful emotion is produced' (p. 50). We may deny it will or did happen; shift the blame ('It was them not me!'); minimise its impact ('It's okay.', or 'I can handle this.' ; distract oneself by busyness; or a combination of any of these.

Although we might succeed in controlling our mood we are none the less reducing our effectiveness in being able to audit likely impact of the adversity. Hoover says by way of illustration: it's as if we have turned off our home's smoke-detector alarm and boast that the smoke-detector never annoys us!

Various factors contribute to which defences any one person will choose related to one's history and experience, personality predispositions, level of threat posed, or the physical condition of the person concerned. Hoover instances a man suddenly faced with the news from a doctor that he has prostate cancer who yet shows no emotional reaction; in Hoover's opinion the man must be considered to be using a defence of some sort.

Next time: The Psychotherapies

*This sub-part (and the next one dealt with in this post) appears as in the heading but it is not evident to me why it is not in upper-case as have been the preceding sub-parts. (Compulsions don't appear to be a sub-sub-part of THE EMOTIONS, which we dealt with last time. So I'm confused.)

**I've spelled this according to U.S. usage because that's what is used in the publication. In Australia of course, we follow the British tradition of spelling and would spell this word 'defences'.

The Emotions

When something we value is threatened a corresponding mood is triggered by an Alarm* warning us of the threat to whatever it is that we value.

Two occasions of threat readily spring to my mind: one with a large, growling dog and another with a slithering snake which both led me to stand paralysed in fear with heart beating. Both animals came from nowhere and were unexpected; my reaction was understandable and if I took the time to explain more fully the circumstances all readers would make sense of my fear (because we all share a common humanity if not always common fears).

We all understand that, generally speaking, humans' welfare are threatened by aggressive dogs with which they are unfamiliar and by rapidly-moving snakes in the wild.

Hoover, author of Non Cognitive Psychotherapy, says that the mood or emotion following the Adversity* is not 'arbitrary or chaotic' (p. 44) but the ensuing mood depended on various conditions:

• type of threat (internal or external). My dog and snake examples above were both external but an internal example would be if one suddenly begins to feel panicky and nothing seems to be causing it.
• recognition/understanding of adversity. For example, a small child may not understand the danger of the hot stove whereas a normal adult would.
• origin of the adversity; who is/are responsible for it?
• its temporal status: is it impending, happening now, or concluded?
• nature of its possible impact; is the damage resolvable/repairable or not?

'Adverse emotions' are categorised by the author as 'anxiety, depression, guilt and anger' (NCP 2001: 45).

[I would argue against his calling these 'emotions' and with the seeming implication that emotions and moods can be equated. I think these states are moods except for 'anger' which can be associated with irritability which is better classified as a mood. However, moods and emotions are usually distinguishable by noting that the latter are intense and short-lived while moods are less intense but experienced for a longer time. (See Paul Ekman on this topic.) Moods can become disorders such as depressive disorder or major depressive disorder as can anxiety.]

Hoover notes that anxiety relates to 'impending' adversities while depression to some already incurred damage to one's health, status or well-being. (This observation explains why anxiety and depression so often occur together.)

Losing one's job is a pertinent example of an adversity that given it is recognised as a threat will result in anxiety over future employment and depression over the losses in social stature, work itself, friendships, etc. If the job was lost through one's own fault then guilt and shame might also be involved as opposed to being retrenched by a company who is downsizing where one might feel hostile and resentful.

The Action of Past Events

Hoover finishes this subsection with the well-known observation that, 

When an adversity of the past is linked to some current hardship or threat, that past event can stay emotionally active and bothersome--even enhancing reactions to that current hardship to which it is connected (via the psychological alarm)--without absolute confirmation that any link exists (p. 46).

Sexual abuse of children provides the classical example of this principle: 'past events do not remain functionally active without due cause' (p. 47). A young girl or boy abused sexually will probably experience sexual problems within their marriages at a later stage if not before because such abuse unaddressed remains functionally active. This upsetting of later sexual experience will occur whether the person concerned recognises the link or not. The same interference with normal adolescent and adult life can occur with other types of child abnormal experiences including severe emotional and physical deprivation and neglect, as well as physical and emotional abuse.

* These words are technical terms within Hoover's presentation.

Next time: The Compulsions