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 

The Alarm

Russell Hoover defines what he calls THE ALARM as,

a more or less programmable involuntary action that occurs subsequent to adversity either threatened or real' (p. 39).

The Alarm is a warning sensation that alerts a person to the presence of potential or actual danger or threat of harm.

Note that Hoover's sequence ending in psychological (psychic) upset begins with The Adversity which sets off The Alarm. The intensity of the Alarm is roughly proportional to the perceived nature of the adversity.

Most cognitive-based therapies, on the other hand, begin with (what has been called) an 'Activating Event' which leads to 'automatic' (partly illogical or irrational) thoughts in the one being affected by the event. These thoughts are hypothesised to be what disturb us, not the event (or in Hoover's model The Adversity).

Until the advent of the 'cognitive revolution' in psychology--1950s to 1970s--it was commonplace to believe that adversities did directly create or lead to a corresponding mood. With this 'revolution' adversity shifted from being in the objective sphere to being a subjective experience.

I believe a superior view is to regard the process as having both 'objective' and 'subjective' sides to it. For example, humans tend to develop phobias regarding heights but not regarding tables and chairs. However, some have little fear or anxiety of heights whereas a limited number might have fears of tables and chairs (because of past history). Hence, both 'poles' of experience (object-inner response) are relevant.

Hoover believes that The Alarm, 'a central feature of any working psyche' (p. 39), has been ignored in many contemporary therapies.

He summarises the main characteristics of 'the psychological alarm' (p. 43) as:

• 'It is triggered by threat' (p. 43) focussing the threatened person's attention on the adversity. That is, it's purposeful.
• It acts according to prior experience; those with more adversity-punctuated histories tend to get 'more active alarms' (p. 43).
• It signals not only the adversity but the mood to follow the 'threat elements'.
• It is cued by potential threat as by 'events certainly forthcoming or already underway'.
• 'Its action is involuntary once the threat or injustice is perceived'.
• Its intensity is always linked to event's significance for the perceiver (although other factors such as the one's physiological state also play a part).
• Its action continues until the threat cuing it is perceived to be ended.

One thing I do appreciate about Hoover's work is the humanity of it. He underlines the fact that most of the troublesome emotions that people bring to counselling are understandable within the context of their lives and are feelings we have usually experienced ourselves. That sets the counsellor free from preconceptions about what the client should or should not be feeling or thinking. We can more readily empathise with the client because we have trodden this path of anxiety and distress ourselves.

And for me it is heartless to tell a recently sacked worker that he has to change his thinking about his situation because it is his thinking that is making him depressed. Nonsense! That is too simplistic and sets him up to be blamed. 'It's not the fact that you've been sacked that has made you this way, it's your own fault that you are feeling this way.' This merciless approach takes no account of what has happened to him and is stoicism writ large.

Rather, his negative thinking is a reflection of his depressed state brought on by the impact of losing his job which he has assessed quite rightly as a major loss in status and security.

Cognitive theory treats humans as if they are separate from life events and only joined to them by their cock-eyed interpretations. But one's job--to take the previous example--had a meaning before it was taken away and its loss will certainly impact a person swiftly after the initial shock wears off.

Next time, THE EMOTIONS.

Part One, The Mechanics of Mood: The Adversity

Under the heading of 'The Mechanics of Mood' Hoover addresses 6 sub-parts*:

The Adversity

The Alarm

The Emotions

The Compulsions [a]

The Defenses (sic) [a]

The Psychotherapies

THE ADVERSITY

Hoover's general point in this sub-part is that emotional irritation is caused by some adversity, some event that matters to us. 

We may read this as a trivial statement, a truism. But in the world of therapy it is rejected by the major cognitive-based therapies. These therapies argue that events do not cause human emotions but that human interpretation of events causes emotional reactions. 

Contrariwise, non-cognitive psychotherapeutic theory states that moods arise when something we meet is unacceptable or not okay for us. 

These adversities occur when things, events, or states we value are 'lost, damaged, upset . . .  foiled' (p. 31) or are threatened; adversities occur in actions outside our control and acts we ourselves commit both deliberately or inadvertently. Hoover challenges the reader to upset himself by something that he accepts as perfectly all right.

     Degree of Irritation

Although the adversity is the sole cause of the upset in the individual, the degree of the annoyance and irritation is dependent on both the severity of the adversity but also on the person's tolerance as well.

And tolerance level is related to both the number and nature of adversities already being endured and to one's physiological state. However, Hoover quickly asserts that one's tolerance is not the cause of emotional unrest (as Albert Ellis had asserted).

To summarise: the intensity of an irritation arises from how much the event matters, its significance; and the level of one's tolerance. The latter is understood as 'the number and size of the adversities one already faces' (p. 35); and 'one's physiological state' (p. 35). (One's physiological state could be affected by medication, alcohol and drugs, by hormonal levels, and by certain disorders such as diabetes.)

Therapy usually concerns those moods that arise out of contexts where 'enduring values' and particular 'inalterable consequences' (p. 38) occur. Therefore, quick fixes are not common because of this robust context.

Some Comments
Although Hoover calls his system 'non-cognitive' he is obviously not using that word in the sense that cognition (thinking, imagining and willing) are not involved in emotional upset. It is clear from his model that cognition is involved when we consider the words 'matter to us' about adversities. To know that something matters to us we have to judge it as such and this calls for cognition.

Second, I wonder if he could improve his model by adding to it what I call psychic preparedness (Martin Seligman): the human ability to learn reactions to certain threats, losses, poison foods, etc. almost instantaneously. This preparedness to learn emotional reactions and moods incidentally makes changing these reactions very difficult; but the preparedness dynamic is oriented to survival.

Next Time: The Alarm

*Confusing at least for me is, that in the book's table of contents, all the sub-parts are given as above as if they are all of equal weight. However, in the text they are all fully capitalised except for those above with [a] after them.