THEORY OF CAUSE: why do people behave atypically.
This is the fundamental assumption that creates the direction of how we identify problems and look for solutions. Obviously, if we believe that all people who behave atypically have a biological, genetic or disease issue – we will try to look for the biological pathology, use medication and seek a cure. On the other hand, if we believe that atypical behavior is caused by bad parenting, none of this will work and we would be looking elsewhere for evidence. Generally, the causes are viewed as nature [biology] or nature [upbringing] or some combination of the two. Both of these and the combination cause us to look outside the individual person for results. For the nature/nurture remedy, we often have to do things for the subjects ‘own good’ because they are not responsible for their own behavior.
But what if the remedy was within the subject? What if they had the capacity to ‘cure’ themselves with our help and support? This would envision an entirely different approach where choice is really an option – and the subject could choose to remain ‘crazy’ or choose to improve their social competence.
The fundamental assumption: People are the sum total of what they believe leads to an entirely different methodology and technology. This assumption is based entirely on experience AND interpretation of that experience. What did that experience mean? There are a host of theories about how one comes to believe what they believe, how they modify those beliefs and how meaning is established. But it is probably best to start with how people learn – from birth human beings are learning animals. In fact, it is reasonably clear that our genetic makeup is not only influential rather than directive – it is actually modified by what we do. Even our brain is created by our own thinking and is flexible enough to recreate itself to a more satisfactory model.
It is also important to understand that our central nervous system also learns and in doing so, creates an automatic system of thoughts and actions. The autonomic nervous system handles the automatic processes of the body, such as breathing, blinking, digestion, etc. It is interesting to note that the first two examples can be brought under the control of the conscious self at least for short periods of time. How about the third example?
The central nervous system handles the mental automaticity. Anything over-learned can become automatic in the same way that breathing and blinking is automatic. Thus, if you say to yourself a million time, ‘I am stupid”, this thought will appear automatically in self-talk and the individual is about as aware of these thoughts as they are of breathing and blinking. They can be aware, but normally are not. Thus, a lot of what we believe is hidden to us.
THEORY OF CHANGE: obviously change occurs within the individual. This theory is really about how do we intervene in such a manner as to enable the subject to improve those areas of his or her life that is meaningful to them. Does taking medication help the subject improve those areas of his or her life? If so, that is great. However, that has not generally been the client’s experience, except perhaps with bipolar. Even if it helps, there is usually a down side to the side effects, but if you have fully informed the client about the potential for tardive dyskinesia or other effects and they are dying to take the medication – I will support their choice. But can anyone give an example of that actually happening. Yes, I know family members like it, because it often solves the family member’s problem, but does it solve the subject’s problems. And whose problem is it anyway?
If a person is the sum total of his or her beliefs, what impact do the messages have – of medication, hospitalization, chronicity, or incurability? Does this raise the hope of improved quality of life? Is hope important? It is with AIDS patients who are presumably terminal. Why not with people with problems in living? When words like depression, schizophrenia and the like are used to describe ourselves, what is the impact?
Ah but this is all idealism, a theory of change based on thought must have a technology that works. But cognitive behavior management is a scientific system that is based on evidence. Medication has no evidence to support its use – unless the truth criterion is based upon the ‘dead man test’ – meaning the more the subject acts like a dead man the better he is.
Cognitive behavior management is based on the truth criterion of Contextualism – if the intervention meets the purpose for which it was intended – it is successful. So if the purpose of the intervention is to improve one’s quality of life, the expected outcome can be measured that way.
THEORY OF MEANING: Nothing has meaning. Human beings connect to the world through our senses. Multiple sensations accumulate and are ‘learned’ through association [analogy] – e.g., this is like that, and utility – e.g., this is more pleasurable than that. Upon this limited basis, the neonate learns about the world. However these sensations are just an accumulation of ‘sensations’ and have no meaning, meaning requires cognition – a concept of what this thing is, what it does. Is it a good thing or a bad thing? Things that are intensely good or intensely bad provide some very important information and can create beliefs. These beliefs develop into attitudes – ways of looking at the world that predetermine how we will respond to things – which may or may not be conscious.
A neonate operates from a data based, ‘bottom up’ perspective. Each experience is explored for itself and only as one is able to associate an analogy – this is like that and identify those experiences that are more pleasurable and more painful, can the child gradually begin to create his or her own ‘inner logic’ or theory of meaning. At somewhere after age four, the child creates this theory and thereafter his or her experiences are reviewed in perspective of this theory – a ‘top down’ process. The confirmation bias kicks in and we become less and less likely to ‘think outside of the theory’. Yet we do change and those who are most flexible in ‘thinking outside of the theory’ have a greater degree of psychological fitness than those who are rigidly theory driven. And again, we must remember that this theory is habituated and automatic.
Self is not a solid, never changing thing. An analogy: Euripides indicated that you could never step into the same river twice. What he meant was that the water that is in the place you stepped before is not the water you step into now. The river water is every changing. Yet there is a consistency about rivers; after all, we draw maps. If you watch the water, you note patterns of similarity of flow around rocks and other surfaces. Chaos theory would indicate that the obstacles were ‘attractors’ and despite the fact that each water molecule is unique and arrive randomly, they over time will create some very identifiable patterns.
Human attitudes are very like a river. Every cell in the body changes within seven years – so if you are eight years old, you are an entirely new person. Similar things happen with thoughts. Over time an individual will learn more and accommodate or adapt to this new learning. However, once formed, the attitudes are attractors – even with new learning we tend to recreate patterns of thought and behavior. That person who had difficulty relating to the opposite sex at eight will probably have similar problems at eighty.
These repetitions identified by chaos theory will continue, unless of course we change the course of the river through natural disaster [earthquake] or by building a dam. In the same way in our analogy, the individual may have a traumatic, life-changing event, or they can build a new belief system. The changing of beliefs over time changes the structure of the brain just as what we are thinking at the moment changes the chemistry of the brain. And just thinking new, less distressing thoughts can change the problems in living.
So the process of change is built upon behavioral, social and neural network learning theory. It seems that we have arrived at a very different place than the nature/nurture and need to control controversy. It is not the environment per se that affects our behavior; it is the interpretation of the experiences with the environment that have causal effect. The interpretation is built upon the ‘inner logic’ and if we can re-experience and re-interpret the experience we can change our beliefs and the cognitively structured emotions that go with those beliefs – ergo, freeing ourselves to act differently.
This also does not imply that the genetic heritage is irrelevant. But genes do not cause behavior, they trend towards behavior and the trend can be averted. Based on our biological value of survival, we have a inherent trend towards violence for protection of self, yet many people are pacifists. Genes are not the final answer.
METHODOLOLGY: The question then becomes, how do we enable a subject to re-experience and reinterpret events? Two initial pathways come to mind: the right-brain logical re-examination of our beliefs and the intuitive re-imagining of our experience and the re-interpretation of the meaning. One downside of the logical pathway is that it demands a psychological mirror that will hold us to the facts and nothing but the facts. The person playing the psychological mirror role may, in fact, be more aggressive and instead of helping the individual work things out, provide a new set of thoughts. This is not necessarily bad – both Beck and Ellis to some extent dispute [project their own belief systems] the meaning of concepts. Obviously, in the wrong hands, this can lead to difficulties. This is why we emphasize the aspect of enabling the client to speak for him or herself. In this process, we use a scientific or detective method AND have a public process, including a helper who will enable us to avoid our confirmation bias, but also support our own processes of working through our thoughts. The formal method generally used is to become AWARE of our automatic self-talk, ATTEND to our self-talk, ANALYZE our beliefs and identify what is distressing to us, seek ALTERNATIVE ways of thinking about our experience and then ADAPT through habituation. Sometimes the adaptation phase itself can be used through repetitive affirmations. This process is built upon the creation of new neural networks through habitual repetition of the thoughts. Since language is the media for logical thought, it is an important component in the left-brain helping process.
The intuitive right brain approach is built upon the fact that the brain does not discerne a difference between perception and imagination. One can visualize a phobic image and the same neural patterns are stimulated as when we actually perceive the phobic object. This fact allows us to re-experience traumatic incidents and re-interpret the meaning of the experience. This can sometimes be done in a manner that almost instantaneously changes the thought and emotion allowing the person to move on. The intuitive pathway is less well known, but extremely powerful. Since children do not become right-brain dominant until after four years of age, and since trauma is both more likely and more powerful in infancy, the development of beliefs that cannot even be expressed are virtually impossible to address without the intuitive pathway.
In reality both of these pathways are usually involved in helping clients improve their thinking patterns. One could ask, for example, whether mindfulness and acceptance are left or right brained. Mindfulness is an awareness of the processes going on in the mind in a real time aspect. Acceptance is a process of awareness without response. [I am having thoughts about anger and this is accepted and ignored – not acted upon.] This is not all a logical process.
The opportunity to enhance our quality of life through a process of thinking about thinking is here now – you have ears, but do not hear.