There are many excellent books and articles available that address cognitive approaches to problems in living. Among my own favorites are those written by Martin E.P. Seligman and those by Matthew McKay with a host of other writers, most significantly Patrick Fanning and Martha Davis.
McKay and his friends are particularly helpful in writing self-help or lay focused materials and as such are reasonably free of promotivation. Nonetheless, in self-help books such as Brain Lock by Schwartz, Say Good Night to Insomnia by Jackson, The Feeling Good Handbook by Burns promotivation exists and from my perspective this is not helpful either to the people with problems in living or for the cognitive science of helping.
Promotivation is a word I invented some time ago when I was working with gang kids. I would find myself occasionally at a social gathering when someone would ask what I do. After mumbling something about social work, they would often go on to talk about how interesting that was and want to know with whom I worked with. Up until this point, they were simply making conversation, but if I mentioned ‘gangs’, I immediately became somewhat of a celebrity – often the other person would call someone else over to listen and comment about how dangerous such work was.
It was easy to have promotion of myself as a motivation, leaving the impression that working with gang kids [or later with people with schizophrenia] was dangerous when, in fact, it is not. It took real energy and determination to point out that these kids [and adults] were really quite nice people who nonetheless had severe issues that they needed to address and that I was not in harm’s way. ‘Setting people straight’ was a rather self defeating social strategy as others soon lost interest when they found out that you weren’t James Bond incarnate, facing evil at every turn. Actually, I think most people thought [and probably still think] of me as a ‘kill joy’ who took all of the fun out of it.
But failure to ‘set people straight’ was promoting myself at the liability of the people I served. A substantial part of the stigma of people with problems in living comes from the need of individual workers to promote themselves by indicating how awful their clients are. It also, of course, explained why we were so incompetent that we were unable to help them. This blaming of the clients for our own inadequacies is an epidemic in the human service business.
The term promotivation here is used somewhat differently, but with the same purpose. It is the desire of people who should know better to continue to relate themselves to the ‘medical’ experts in ways that are incoherent to what they are espousing.
They continue to use the terms therapy, treatment and patient ignoring the attributions that these terms have for the people they serve. A necessary part of any plan of intervention is to define and implement a process that is philosophically coherent and based on a sound theoretical base. One major aspect of cognitive behavior management is attribution theory, and we will take a moment to delineate this theory.
Attribution theory developed as an approach to social perception and is concerned with analyzing the cognitive processes that underlie causal explanations. It is a theory of the ways people try to ‘make sense’ of events by explaining them in a causal framework.
When individuals engage in an activity, they may attribute their outcomes to the operation of one or more causal factors. There is a tendency to ascribe responsibility to personal forces (e.g., ability and effort) or to impersonal forces over which the individual has little control (e.g., situation and bad luck).
One personality dimension is the nature of causal attribution is internal-external control of reinforcement (I-E). The I-E variable represents a generalized interpretation of how reinforcement is causally related to one’s own behavior. At one end of the I-E dimension are individuals who believe that reinforcement is contingent upon their behavior (internals), while those at the other extreme believe that reinforcement is independent of their actions and is controlled by luck, chance or powerful others (externals).
It has been suggested that some individuals who obtain external scores on the I-E scales may have developed this expectancy for defensive reasons. By adopting an external orientation, these individuals are able to maintain self-esteem by attributing negative events to forces beyond their control. It is suggested that externals have less need to resort to forgetting and denial as defensive strategies since they can readily account for failures by attributing them to impersonal forces.
If an external orientation does serve as a defensive function then it might be expected that the relationship between I-E and attribution of responsibility would be mediated by the nature of the outcome in an activity. Specifically, externals, following failure, would be more inclined to rationalize this outcome by attributing it to forces beyond their control. In contrast, successful task performance would engender little or no threat and, therefore, differences between internals and externals in assigning responsibility to outside forces would be diluted.
The net result of these findings is that when we have an experience we attribute the causes to external factors an we become ‘victims’ of these circumstances and thus are ‘unable’ to control our destiny. When we attribute the cause of failure, depression, and other problems in living to internal forces, we have placed ourselves in the position of ‘hero’, able to take charge and take control of our lives. The traditional methods of ‘expert’ intervention urge the person to become a ‘victim’, a patient, unable to help himself or herself. As we generate new terminology and disseminate them within the culture, so do we insinuate ourselves into daily relations. As these terminologies are disseminated to the public – through classrooms, popular magazines, television and film dramas, and the like – they become available for understanding ourselves and others.
These terms are, after all, the ‘terms of the experts’, and they become languages of choice for understanding or labeling people (including the self) in daily life. Terms such as depression, paranoia, attention deficit disorder, sociopath, and schizophrenia have become essential entries in the vocabulary of the educated person. And, when the terms are applied in daily life they have substantial effects – in narrowing the explanation to the level of the individual, stigmatizing, and obscuring the contribution of other factors (including the demands of economic life, media images, and traditions of individual evaluation) to the actions in question.
Further, when these terms are used to construct the self, they suggest that one should seek professional treatment. In this sense, the development and dissemination of the terminology by the profession acts to create a population of people who will seek professional help. And, as more professionals are required – as they have been in increasing numbers over the century – so is there pressure to increase the vocabulary. Gergan has called this a ‘cycle of progressive infirmity’ [Gergen, Hoffman & Anderson].
Cognitive approaches are supposed to place the person with problems in living totally in control. The individual may choose to attribute anything they wish to external forces, but, the helper will not support such intrigue. Or at least, they should not. Distinction needs to be drawn between attributions about a) the source of the problems in living, and b) the attributions about the source of the resolution, as these are perceived by the person in crisis.
An attributional dilemma – an uncertainty about the cause to which an event is attributable – is faced when the person in crisis attempts to identify the source of crisis arousal: to what should the feelings of crisis be attributed? A second attributional dilemma is faced later when the person attempts to attribute the resolution of the crisis: to what should the relief from crisis disturbance be attributed?
The intervention should provide the individual with the kind of information that will help answer both of these attributional questions in ways that minimize the emotional disturbance and maximize the internalization of constructive changes made in resolving the crisis.
Why then, do these authors, who clearly understand the cognitive aspects of thought driving behavior, not understand the attributional aspects that can diminish their own effort. Or do they understand, but feel that their ‘professional status’ is more important than the people they serve?
Probably the most profound concern is the notorious meme of ‘chemical imbalance’. The human body is the most profound mechanism ever encountered. It invariably works to self-correct problems that occur. It is highly unlikely that the body would increase serotonin [I believe this is the drug of choice these days] without responding to something. And what the brain is responding to is probably its own thoughts. Which is why we have no basis for any pathology.
Let me give an example from Brain Lock by Jeffery M. Schwartz:
For the first time ever for any psychiatric condition or any psychotherapy technique, we have scientific evidence that cognitive-behavioral therapy alone actually causes chemical changes in the brains of people with OCD. We have demonstrated that by changing your behavior, you can free yourself from Brain Lock, change your brain chemistry, and get relief from OCD’s terrible symptoms.
Several issues of coherence abide in this short paragraph.
- Schwartz refers to a psychiatric condition. This of course means that a psychiatrist has the condition. Does he perhaps mean a psychological condition? Perhaps since he is an M.D., he has a promotivation to mention psychiatrist every chance he gets!
- Schwartz mentions psychotherapy technique. But cognitive interventions are social learning theory and psychotherapy is a long dismissed dynamic theory. These are of two different orders and not connected in any way. [See the Outcome Problem in Psychotherapy: What we Have learned? – Eysenck 1994.]
- Schwartz uses the term cognitive behavioral therapy. Now therapy is a reasonably good word that has been misused for so long that it now stand for a medical intervention and should be avoided when using a learning intervention.
- Schwartz boldly exclaims ‘eureka’ we have discovered that brain chemistry is controlled by thought. Of course we already knew this through transcendental meditation and biofeedback, but perhaps Schwartz was unaware. However, he should have picked up the anomalies in what he was saying. If thought is capable of changing brain chemistry, is it not possible that the presence of the serotonin is an effect of OCD and not a cause?
I don’t mean to pick on Schwartz, he is, after all no different than many other writers, and his four-step system is rather good. But, he, like many other cognitive advocates does not seem to understand attribution theory or expectancy theory, or ignores this understanding. He seeds the environment with memes of his own expertise [See – I am a medical doctor, and although I do not think coherently, I can read brain scans and spout irrelevant medical terms.] Sorry, I could not resist.
But who among the powerful will be the first to break out of this promotivational role and stand up for the people they serve? I recognize that these authors have a lot more to lose than I do. Many have medical credentials and the APA has been known to attack those credentials when the owner of them disagrees.
Mundus vult decipi: the world wants to be deceived. The truth is too complex and frightening; the taste for the truth is an acquired taste that few people acquire.
Not all deceptions are palatable. Untruths are too easy to come by, too quickly exploded, too cheap and ephemeral to give lasting comfort. Mundus vult decipi; but there is a hierarchy of deceptions.
On a higher level we find fictions that men eagerly believe, regardless of the evidence, because they gratify some wish.
Near the top of the ladder we encounter curious mixtures of untruth and truth that exert a lasting fascination on the intellectual community.
What cannot, on the face of it, be wholly true, although it is plain that there is some truth in it, evokes more discussion and dispute, divergent exegesis and attempts at emendations than what has been stated very carefully, without exaggeration or onesidedness.
Mundus vult decipi: The world winks at dishonesty. The world does not call it dishonesty.
Once a few respected men have fortified a brazen claim with their prestige, it becomes a cliché that gets repeated endlessly as if it were self-evident. Any protest is regarded as a heresy that shows how those who utter it do not belong: arguments are not met on their merits; instead one rehearses a few illustrious names and possible deigns to contrast them with some horrible examples.