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.

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.