‘Moving on’

July 6, 2012

A look at psychotherapy and the demand of the 21st century

Business is done at the speed of thought, transactions made globally at the flick of a switch. Life is rapid, fast, and that in itself raises its own stresses and issues. The W.H.O (World Health Organisation) has stated that by the year 2020 the primary global killer on the planet will be ‘stress’. Doctor’s largest outlay in many clinics is the budgetary cost of prescribing anti depressants and other ‘happy pills’ to patients who report that ‘life is getting too much for them’. Stress however is a ‘dirty’ word and is a real stigma in corporate life and in many other areas of our lives. Even the terminology has changed to show this. We no longer have to attend stress management courses, we now have courses for ‘Performance under pressure’, which because it does not have the ‘S’ word in it means it must be more positive in it’s framing and it’s outcome. A pleasant reframe? I think not.

Stress affects us at a deep bio chemical level and can bathe every single neuro transmitter we have in our corporeal form with its insidious effects. Stress depletes our immune systems ability to cope with disease and can affect our cardiovascular makeup leading to hypertension, cardio vascular accidents (strokes), diabetes, and other cardiac related illnesses. Stress indeed is a silent killer, because we are expected to cope and not give in to life’s stresses. In lifes rat race we cannot be seen to be a weak rat. Corporate businesses build profit schemes around this, for example Tesco have a “just in time” policy to reduce wastage and even on the leisure side we have sites like lastminute.com to help us because we do not have time to plan our lives, just to react to things which become urgent. This is commonly referred to as crisis management. Out of necessity we become very adept at “putting out fires”, however it should be noted that upon closer scrutiny we could be seen to be the ones carrying the matches too. Time, is indeed becoming our scarcest resource. Once it has been used, it has been used up, no second chances, no retakes, you cannot have the time again. Bearing this in mind then we must review current therapy models to align ourselves with this new way of thinking and being. As therapists choosing to be successful, we need to embrace every possible tool and resource we can to enable us to resolve our clients issues as quickly as possible, and give them back the control they currently do not have, which in my opinion is the “prime-driver” in their “dis-ease”, which will manifest itself in the symptomatic behaviour with which they seek help with from you, their chosen therapist. A good example of this symptomatic behaviour is addictions. It matters not what they are addicted to, cigarettes, cocaine, crisps, chocolate, champagne or chardonnay or anything else beginning with “C”, the taking of the addictive substance gives the other “C” which is ‘control’ on a temporary basis of their anxieties and stresses. It anaesthetises them and disassociates or distances them chemically from having to face the reality of the pressures and stresses upon them. This is the primary effect at least. The secondary effects are much more serious and damaging, including cancer, coronary artery disease, obesity, premature dementia and many other serious physiological reactions to things we should not be casually putting into our body.

If we are unable to anaesthetise the stress then it can and often will manifest itself in many ways, at either a deep psychological level or perhaps even at a physiological level too. Even idiopathic diseases such as asthma, eczema, psoriasis and other autoimmune conditions are often exacerbated by stress and anxiety, sometimes to a crippling level. We then add to this all of the secondary negative emotions like anger, frustration, jealousy, shame, embarrassment and guilt and we can be in a real emotional mess. Dr John Sarno in his book the “Mind Body Prescription” posits the idea that almost all neck, back and shoulder pain is caused by trapped stress and anger or even rage. Our clients feel “helpless” and in many ways are, which is why they turn to us, the therapist, for “help”. We should do this for them as expeditiously as possible.  Now I am not saying that this is for “all” clients who seek our help and indeed there are some who need to emote over a period of time and may have a number of issues to be dealt with and we should treat them accordingly. I have even had in Harley Street some clients who have as near as damn it ‘instructed’ me not to fix them too quickly because they have a story to tell and see that, (in their mind at least), as an important and integral part of the therapeutic healing process. Conversely, I get the ‘City’ boys who know of my reputation for rapid work and they ask if I can “sort them out in their lunch time” as they see no value in keeping something that can be collapsed rapidly. I fix them fast and they are back at work stress free and earning again. For this rapid service they are happy to pay a premium rate.
Being able to adapt to both ends of the time ”“ need spectrum for the client is a very useful ability upon which to call. Options and flexibility of operation is the key. In fact the law of requisite variety states “he or she who has the most flexibility to function will win out in all situations”. A kind of 21st century survival of the fittest, if you will.

So how is this achieved for the client?

There are in these current times a wealth of therapeutic interventions available to a therapist to train in, from Analytical Psychotherapy, Hypnosis in all of its forms, NLP(Neuro Linguistic Programming), EMDR (Eye Movement Desensitisation and Reprocessing), CBT (Cognitive Behavioural Therapies) and the more esoteric Energy Psychologies such as EFT (Emotional Freedom Technique) or TFT (Thought Field Therapy). So which is best? Well the answer is simple, the technique that is best is the one which is best for the client and provides a desired outcome to overcome a perturbing issue.

Another strategy I employ to allow me to often pre-select the modality in which I am going to work, is to ask the client to send me a detailed synopsis of their current state, along with a history of negative issues and incidents they have experienced. I also ask for details of any medications or drugs they use or have used (both prescribed and non prescribed) as this gives me a chance to research any contra-indications that taking these medications may have. This process in itself I feel is an integral part of the healing process and many clients have never actually written down the issues and the report process itself was quite cathartic. In many cases I also find it negates the need for the client to need to emote in the session and I do not have to get covered in ‘emotional vomit’ as a friend and colleague once graphically referred to it. I also find it useful at the end of a successful session to give the client back the document, and ask them to read what they wrote down. On most occasions they re-read it and often report it is like reading about ‘someone else’ and they no longer have any emotional attachment to the ‘story’. This for me as a therapist is a great indicator that we have made significant progress. On occasion they will pick up on a specific part of the text and report that this particular aspect still perturbs them. This is good to know, as we can then often work on that specific issue quite quickly, using, once again, the most optimum modality for that specific issue. Then, once treated, I will ask them to again re read the document (sometimes in whole, or sometimes in part) and they often report that they can no longer attach any emotional negativity to it.

Clients often report feeling ‘lighter’ or may look confused when they can no longer access the negative emotions that in the past have accompanied the cognitive memory of the disturbing issue.
Many will enter into what is referred to as the “Apex” state. This is the state where the client can no longer access the negative emotional states they came to see you with, which you have “fixed” but that they cannot accept that the issue can be or has been resolved so quickly. The logical left-brain aspect will try to find some other explanation for the ‘cure’ rather than putting it down to your treatment.

Apex clients will often make statements like:

“Well I cannot think of it right now”. (Remind them they could a few minutes ago) or
“It is not something I can give a SUD (Subjective Unit of Distress 1-10 scale) to. Or
“You are just distracting me” or
“This is too simple, it cannot have worked so easily” or
“Well I feel fine now but I know it will come back later” or
“I have had this phobia all of my life, you cannot get rid of it in minutes”

There are many other variables to this but these are the most common ones I encounter in my work with my clients.
Let us take the last one as an example: I use the bag metaphor and say, “so if the phobia was a bag you have carried most of your life, tell me…how long did it take you to pick the bag up?”  The answer is obvious to me, and to them, it took only a moment to pick it up. You then ask “so how long should it take to drop it and leave it behind you?” Again the answer is obvious, but the “yes buts” come all the same.

Like all problems there is a simple solution. My personal preferred solution to the apex problem is to say to the client “Okay then, shall I put you back how you were before you came here?”

The common reaction is for the client to say “No” usually accompanied by a definitive and vigorous shake of the head. I then point out that there are only really two answers to that question, one is to react as they did by saying “No” and the other is to say “well I feel exactly the same”. This is an access to the non-conscious response, and when this is pointed out, the logic circuits tend to kick in and the acceptance that the problem or issue is gone or looks or feels different is accepted. Sometimes this is done reluctantly and sometimes with a “Wow”.
On occasion you do get the odd client who will challenge you when you offer to put them back how they were, and they will respond by saying “Yeah, go on them put me back”. I then simply have to point out how can I put them back to something if it had not gone or had not been changed. Again the logic circuits kick in and they accept that they truly cannot access the disturbing emotion in the same way, if at all.

The ‘apex’ originates from Koestler’s ‘Ghost in the Machine” work, and defines the brain working at its apex state where it will always try to find a rationale or reasoning behind something which seems implausible or impossible despite whatever evidence they have to the contrary.
The expectation of many clients does appear to be that therapy can be a long and drawn out process, and the whole concept that an issue can be resolved very quickly is indeed an alien concept to many.

Another advantage to working with such rapidity is that it minimises the potential for transference to occur. The standard or common ‘therapeutic alliance’ when working with rapid techniques, is very short term, and is often not even relevant in certain cases. A metaphor I use is as follows; it is like taking your broken car to a mechanic. The mechanic could ask you about every journey you have made in the car, and tell you why the way you have driven it or maintained it may have caused the problem, he can even over time, educate you into all the fine and precise details of why the car is not working. Then once you have fully understood why it is not functioning as you would hope it to he hands you back the keys. Not fixed but you understand why it is broken and that understanding should make you feel better about it. So there you are pushing the car home, but at least now you know why you are pushing it home.

Or the mechanic can just fix the problem. Drive or push? What would you choose?

Now, another consideration when doing rapid change work with clients is that the speed of change, if not dealt with correctly, may create its own problem. When Richard Bandler the co-creator of NLP Neuro Linguistic Programming does rapid change work, he poses the following question to the client.
“So now the problem that you thought you had, you no longer think is there what do you think you will do with all the time you used to waste on thinking about a problem that is no longer there?” This is a typical ‘Bandleresque’ type of confusion patter, working with the non-conscious directly by bypassing the conscious or cognitive reasoning process. It is however a serious consideration to bear in mind. Quite often with a client their issue can become deeply intertwined with their identity and in more severe cases become their identity, so if you are taking away the issue you could also be taking away their identity. Gives a whole new meaning to the phrase identity theft doesn’t it?
I feel it is imperative for the therapist to enable the client to be able to deal with this issue. I call it avoid a ‘void’, the void in question being the space created when the problem is no longer there. What will the space be filled with now?
Well there are a variety of options but one is a strategy I like to train my clients in called eating a P.I.E or Positive Imagery Exercise. It goes like this…

Raise the right hand up and to the right of you so you are looking up at it…. Look into your palm and create a compelling image of what you want to be like assuming that nothing can fail.
Then double the intensity of the picture and brighten it. Then double it again and again…when it looks amazing and only then take a deep breath in and as you exhale pull the image into your chest and absorb it through your heart then as you breathe in intensify the image and as you exhale drive the feeling through your body into every cell muscle nerve fibre and tissue until you are saturated with the good feeling.

Then repeat with another good image.

Do this as often as you like……………after all who can ever have enough good feelings?

It is a very simple but elegant exercise, which enables the client to quickly develop a positive visual to kinesthetic link, and like the work done to remove the issue it is a rapid technique in both it’s application and its effectiveness.
It is because it is easy to do, and takes such little time, and has such a strong kinesthetic effect, that the client will do it. They feel the results quickly and want more of the good feelings it creates. It is a no-brainer technique.

So ‘in a nutshell’ as Viktor Frankl used to like to put things, you take away the problem with rapid techniques and you give the client a new strategy to employ to give them good feelings as opposed to the bad feeling they initially came to you with.

I suppose the final consideration must be given to the therapist. If the therapist relies upon repeat sessions with a client to generate an income (we all have bills to pay) and what I am proposing is in many cases we treat in a single session, then surely this is a business suicide?

I personally have not found this to be the case. I believe in modern times when speed is of the essence and becoming our conditioning to expect things to be done ‘quickly’, a slow change therapy solution will not resonate with many. I believe if a client has the choice of having something resolved quickly for a premium or slowly for less perceived cost then they will often choose the former.

It is also simple math… One session at £300 or ten sessions at £90

Smarter clients work this out anyway and all you have to do is remind them of the economy of both the monetary value but I think equally as important the time value too. The money you can make more of, the time you cannot.

Here’s to a good time for rapid therapeutic interventions.

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