Counselling, to be effective, has to be flexible, multi-modal, and creative
Jim Byrne and Renata Taylor-Byrne
29th November 2020
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There are more than 400 different schools of thought in counselling and psychotherapy. Yet CBT claims to be “the one true therapy”! (By coincidence, there are more than 400 different religions on planet Earth, and each of them claims to be “the one true church”).
Nobody is willing to invest the kinds of money that would be required to scientifically measure the physical/biological correlates of emotional states (because there is no profit to be made from counselling and therapy for big companies!), and thus nobody can currently measure the degree of improvement wrought by any particular school of thought.
Therefore, we must tread carefully in constructing systems of counselling and therapy, and we must see ourselves as creative healers, who do our best, with the systems and tools at our disposal. We must aim to help our clients to the maximum, and avoid causing them any harm!
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Our approach to counselling and therapy is holistic, as indicated below:
The social-emotional-individual
Society shapes families; and families shape their offspring.
One way of graphically depicting these processes would be as follows:
Table 1: A hierarchy of levels of influence (from 1 to 4) on the development of the social-individual (or any child/person)
Level 1: Society and economy: In Table 1, we show society and economy as being dominant – or foundational – in impacting and influencing what goes on in families. (Society is shaped by political forces far more powerful and influential than individual families, or even subordinated social classes!)
There is a lot of evidence that “more equal societies reduce stress, restore sanity, and improve everyone’s well-being”. (Wilkinson and Pickett, 2018)[1]. And there has been a massive increase in social-economic inequality in the UK and the US, and in the English-speaking world more generally, because of the introduction of what has variously been called Globalization or neoliberalism or Selfish Capitalism.
And, according to Oliver James: “… the advent of Selfish Capitalism in English-speaking nations since the 1970s has caused a high increase in the amount of emotional distress (what psychiatrists call mental illnesses), over and above any increasing trend since the 1950s”[2].
And Pickett and Wilkinson (2010) reported that mental illness is much more prevalent in unequal rich societies than elsewhere[3].
Level 2: Our family of origin. There is a lot of research which supports the conclusion that more economically deprived families, on average (there will be exceptions to all such rules), tend to engage in harsher forms of parenting, because of the stresses under which they operate. And harsh childhood experiences (or Adverse Childhood Experiences [ACEs]) result in traumatic scars which need to be processed in therapy in order heal the heart and mind. Harsh childhood experiences can and often do damage the attachment style of the newly developing children of deprived families, leading to insecure attachments throughout their lives. (Of course, ‘privileged families’ also harm their children, often by being excessively cool or cold, or sending young children to boarding schools!) Harsh childhood experiences can also impact the personality adaptations that the child forms to their stressed parents. (Indeed, there is evidence that mothers who are stressed while pregnant with a child, will produce a baby which has higher than average levels of anxiety for the whole of their lives, because their brain is awash with cortisol during their gestation in the womb)[4].
Some of the most important processes that go on inside of families are:
– the formation of attachment styles (secure or insecure); and:
– the development of personality adaptations (to the parents’ ways of being);
– plus social learning about lifestyle self-management;
– plus a life script (or philosophy of life).
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Level 3: The bond between mother and baby. A good-enough mother, who has a benign conscience, and who was raised by a mother who had a secure attachment style, is most likely to pass on that secure attachment style to her own children.
On the other hand, when things go wrong with the mother-child bond, the individual will tend to develop an insecure attachment style, which takes one of two forms. The first is a tendency to withdraw from others, and to avoid intimacy. The second is to cling (but not in a pleasant way) to other people, such as parents, peers, and, later, to love partners.
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Level 4: Lifestyle consequences in adulthood: Children learn to eat from their mothers; and they copy the family’s approach to exercise and sleep. They tend to reproduce, in adulthood, some version, or variation upon, the patterns of attachment; security of employment; and approach to diet, exercise, sleep, relaxation, and stress management/mismanagement; that they observed in their family of origin. Later experiences can modify those approaches to some extent (especially psychotherapeutic experiences), but early formed habits are difficult to break!
The system of counselling, coaching and psychotherapy developed by the E-CENT institute deals with all four levels of the hierarchy shown above; and with the life-history and lifestyle of the client.
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Our most important insights
The most fundamental founding principles of E-CENT counselling theory include the following:
– Because societies shape families, and families shape the individual (or “the socially-shaped-individual”), you cannot fix most emotional problems by giving people drugs, or criticizing their ‘thought processes’ or ‘beliefs’.
– We have to address their family history – especially their attachment style and their personality adaptations; plus childhood traumas (or Adverse Childhood Experiences);
– We have to address their current lifestyle, including: diet, exercise, sleep patterns, tension/relaxation states, and external stressors at home and in work/school/college/life…
– We also need to look at their philosophy of life, including the ways in which they understand and think-feel about their socio-economic status, their social relationships, health, happiness, and so on.
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The shape of E-CENT counselling sessions
In speaking to an individual client, we normally have a particular agenda in mind. That agenda is about life history and lifestyle ‘choices’ of the socialized-individual…
This is how it was sketched out in Chapter 8 of our book entitled Lifestyle Counselling and Coaching for the Whole Person.***
Chapter 8: Counselling individuals using the E-CENT approach
8.1: Quick introduction
There is no standard or invariable structure that can be applied to all E-CENT counselling and therapy sessions. There are several core models that we use to guide our counselling process – and they will be reviewed below – but they tend to occur in various, unpredictable patterns, depending upon the client’s narrative, and various automatic counsellor-judgements.
There are at least twenty standard principles that guide the thinking of the therapist, but not all of these is activated by any particular client, or client-problem: (See Chapter 3). And the order in which they become relevant cannot be anticipated or pre-specified.
Furthermore, the E-CENT counsellor is guided from non-conscious levels of mind, rather than consciously working out how to respond.
So, given these facts, how can I quickly provide you with an overview of a ‘fairly typical’ individual E-CENT counselling session, as a map of the territory to be explored? The most important things to bear in mind are these:
- Right-brain to right-brain, non-verbal, emotive communication is probably the most potent thing that goes on in emotive-cognitive therapy: (Hill, 2015; Siegel, 2016; Rass, 2018; Forgas, 2001).
- We are attachment therapists first; affect regulation therapists second; and only then cognitive-behavioural-informational.
- We aim to build a warm relationship of attentive awareness and acceptance with the client. We aim to become a safe-harbour and a secure base.
- We also practice sensitive attunement to the emotional state of the client.
Beyond that point, here is my ‘quick tutorial’ on how to apply E-CENT counselling in practice, drawn from my impressions of thousands of counselling sessions. If I have to try to summarize ‘the process’, here is my best approximation to what the counsellor is trying to do:
- Build a relationship with the client, while trying to find out what they want and need.
- Get an outline of the client’s story – the ‘confession stage’ (in the Jungian tradition) – about the client’s presenting problem.
- Help them to explore their story, and to refine it, so it becomes more accurate – more complete; or more digested; more known. For example, help them to check if their story has been subjected to any (or many?) deletions, distortions or over-generalizations. Help them to explore their story of origins and their story of relationships (to begin with).
- Help them to see that their stories (including their emotions about events) could be edited (‘re-framed’)[5] so that they are less disturbing, less painful, and more tolerable than they originally seemed[6].
- Teach the client that the quality of the story that they inhabit – or live inside of – is strongly and unavoidably affected by their diet[7], physical exercise regime, sleep pattern, relaxationprocesses, relationship support (adequate or inadequate), physical and socioeconomic environment, and social connections (good and/or bad)[8], etc.; as well as their inner-dialogue (or self-talk; mainly at non-conscious levels of mind).
- Teach the client:
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- To dedicate themselves to reality at all cost![9] (Even though it is hard for a human to know what is ‘real’, because we automatically interpret every event/object on the basis of our prior, cumulative, interpretive, cultural experience.)
- To acceptthe things they cannot change, and only try to change the things they can. (Even though it is actually very difficult to find out what might be controllable!)
- To live a moral life (on the basis that “You cannot live The Good Life unless you are willing to live A Good [Moral] Life!”). This involves growing their Good Wolf side (or virtuous side), and shrinking (starving) their Bad Wolf side (or the vicious, evil side of their character). See Appendix H of Byrne (2016).
- To keep their expectations in line with reality. (Even though it is difficult to identify what is actually ‘real’!)
- To understand their emotions, and also how to manage them. (See Chapter 7, above, on human emotion).
- To grow their Adult ego state, and to shrink the inappropriate elements of their Controlling Parent, Critical Parent, and Adapted/Rebellious Child ego states[10].
- To restrain their tendencies towards passivity or aggression, and to mainly try to engage in assertive communication with others.
- To love some significant individual(s) in their lives; and to offer love to one of those significant individuals, as a way to get love: meaning, to establish a couple relationship.
- To take responsibility for their life. Nobody is coming on a white charger (or in shining armour) to rescue them. If it’s to be, it’s up to them!
- To commit themselves to personal and professional development; and, if they are up for it, some form of spiritual development; or community involvement; or political activity.
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8.2: Validity of our models and processes
Most of the models and processes which went into forming the theoretical foundations of E-CENT counselling come from one or more of the ten systems of therapy which were evaluated by Smith and Glass (1977), and found to be not only effective, but fairly equally effective![11] So I do not feel any need to waste resources funding a Randomized Control Trial to ‘prove’ the efficacy of E-CENT. (West and Byrne, 2009[12]). You cannot use research to ‘prove’ anything anyway: according to Karl Popper’s philosophy of science.
The main types of therapy ‘validated’ by Smith and Glass (1977, 1982)[13], and also by later studies[14], and used in E-CENT counselling, are:
# Transactional Analysis;
# some small residue of (moderate) Rational emotive therapy (especially Rational Emotive Imagery);
# Psychodynamic approaches;
# Gestalt therapy;
# Client-centred counselling;
# and Systematic desensitization.
The main exceptions to this rule – that E-CENT has been constructed from validated systems of counselling and therapy (validated by the Common Factors School of research – Smith and Glass [1980]; Wampold and Messer [2001]; and others) – include the use of:
- Elements of Attachment theory(which is perhaps the most researched and validated approach to developmental psychology in use today). See Wallin(2007); and Bowlby (1988)[15].
- Aspects of the most popular approaches to Moral philosophy (including The Golden Rule; Rule utilitarianism; Duty ethics; and Virtue ethics.)[16]
- Moderate aspects of Buddhist philosophy, including elements of the Zen perspective on language; and some of the insights of the Dhammapada.[17] Plus moderate aspects of Stoic philosophy[18].
- The Narrative approach to counselling and therapy, which has become increasingly popular, mainly as a result of the work of White and Epston; and Kenneth Gergen; plus Theodore Sarbin[19].
- And the paradigm shift “…from the primacy of behaviour, cognition, and content to the primacy of emotion, relationship, and context…” promoted by Allan Schore and others, is a new, but highly rated scientific re-evaluation of the nature of the human brain-mind and how it is shaped by social-emotional experience. (Rass, 2018; Siegel, 2016; Hill, 2015; Forgas, 2001).
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8.3: Imaginary ‘typical’ session structure
Most systems of counselling and therapy have a characteristic ‘session structure’ to which trainee counsellors are expected to conform, and this seems to carry on into full professional practice for many systems (including Rational Emotive Behaviour Therapy)[20].
The publishing industry has tended to accentuate this requirement: that a system of therapy must have a beginning, a middle and an end phase, which are distinct and clearly specifiable, with common tasks for each phase. (See in particular the Sage Publications’ ‘Counselling in Action’ series).
However, as stated above, E-CENT counselling does not have a predetermined or predictable session structure. On the other hand, it may be necessary to imagine a ‘typical’ (though not invariable) structure, in order to teach some of the standard models and processes that we commonly use.
Overall, we are guided by our own Holistic SOR Model. Here is a quick introduction to that model:
The human body-brain-mind is affected by all of the factors shown in Row ‘O’, in Table 1, below; but almost all counsellors typically ignore most of those factors:
Table 1: The Holistic SOR Model (Created by Dr Jim Byrne, with inputs from Renata Taylor-Byrne)
This means that “Pure Talk Therapy” – which ignores the body – is going to miss lots of factors that are contributing to the client’s emotional, behavioural and relationship problems. For examples:
– A person who consumes a lot of trans-fats (widely found in junk foods) is likely to have problems managing their anger, regardless of their stated philosophy of life;
– A person whose diet is too high in sugar (and one teaspoonful is more than enough!) is likely to be prone to depression and anxiety problems…
– A person who does not get sufficient high-quality sleep every night is likely to suffer from reduced emotional intelligence and poor impulse control…
And so on.
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We could try to use the Holistic SOR model to explore the kind of work we do with clients in E-CENT counselling. But it might be somewhat easier to explore the models and processes of E-CENT counselling by using the standard Jungian therapy session structure (not because we are Jungian, but just because it is a neat structure for reflection). The Jungian approach has the following four stages: (1) Confession; (2) Elucidation; (3) Education; and (4) Transformation.
If we are to use this approach, then we must begin with the confession stage:
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8.3(a): Confession
The main model that I want to emphasize in the ‘confession’ stage is our own version of the RCFP model, (or the Rapport⇒ Contract⇒ Focus⇒ Process model), which is described below.
By using the concept of ‘confession’ we evoke memories of the Catholic confession box. However, it is important to note that E-CENT has a secular approach to spirituality; and a link to moderate Buddhism and moderate Stoicism, rather than any brand of Christianity.
Confessions we do hear, but we do not begin our counselling and therapy work by asking the client to confess, or even to open up. We actually begin with a very gentle process, based on our Rapport⇒ Contract⇒ Focus⇒ Process model (RCFP) model.
This model determines and structures how we meet and greet our clients, and how we work slowly towards a therapy focus; and thereafter we (spontaneously, intuitively) select additional models to guide the processing (P) of the client’s communications.
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The RCFP model:
R = Rapport. Build rapport[21] (or attentive attunement) with the client as a basis for a strong therapeutic alliance. (This is increasingly seen as our role of providing a ‘secure base’, and a ‘safe harbour’, as defined in Attachment theory. [See Wallin, 2007, and Bowlby, 1988]). It also includes the core conditions of genuineness, empathy and non-possessive love (agape)/ caring[22]).
C = Contract. Find out what the client wants to work on, as a contractual undertaking. But bear in mind that this might be the first of more than one ‘presenting problem’, before the client feels secure enough to reveal the ‘real’ problem. (Sometimes this does seem as if the client has decided to ‘confess’, or ‘own up’ – or to arrive at some new stage of conscious awareness of some previously hidden aspect of their problem).
F = Focus. Focus in on an area of work that will assist in the pursuit of the client’s goals, as implied by the contract (C).
P = Process. Process the client’s communications and concerns about this ‘area of work’ through one (at a time) of the various models available; some of which are discussed below.
(This RCFP model was inspired by a similar model developed by Dr Ed Jacobs, in his system of Impact Therapy)[23].
Some of the unsolicited client testimonials, which I (Jim Byrne) often receive, testify to the importance of our emphasis on building rapport.
Here are two recent examples (in which the clients’ identities and locations have been concealed):
♣ “Hello Jim, I am so grateful to you for all the skillful help you’ve given me over the two years that I’ve been seeing you. You have given me a new kind of life; new ways of relating; and an improved view of myself as a person in the world. Thank you so much.”
P.A.G., Crag Vale, Calderdale. (20+ sessions of face to face counselling for a range of attachment, relationship and self-esteem issues).
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♣ “Dear Jim, I want to express my gratitude for the help you gave me over the past few weeks. I was in a bad way, lost, and not understood elsewhere – but you understood me, believed in me, and helped me to work out a better understanding of my condition. You were right to focus on my diet and lack of physical fitness, rather than the psychiatric emphasis on my ‘brain chemicals’! I am now back on my feet, and back in my university studying. (In fact, I did a resit exam last week, and got a ‘grade A’ pass.) Thank you for your excellent diagnostic and humanitarian skills.”
H.H.G., Bradford. (Six sessions of face to face counselling for unusual physical sensations and panic about personal identity difficulties).
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Questioning strategies:
From the beginning of the counsellor’s relationship with each client, and especially as rapport is achieved, there is a need for effective, systematic questioning. Effective, systematic questioning has a number of features:
In the opening encounters with a new client, I normally offer an invitation to speak, rather than a tightly focused question. I am trying to establish a relationship, tentatively, carefully. I want to hear the client’s story, in their own words, and in their usual way of conversing.
I then explain that I want to arrive at a contract which will involve me in working on the client’s key issues. Of course, I also know that they may begin with a ‘presenting problem’ which is not their main concern. I may have to wait some time before they feel safe enough to present the real issue.
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In the confession stage, we are still mainly dealing with the client’s presenting problem, which may not go deep enough in terms of understanding what is really causing the client’s main difficulties in life.
When thwarted goals seems to be a significant part of the problem, I might use the WDEP model. From Dr William Glasser’s ‘Reality therapy’, this model asks:
W = What do you Want?
D = What are you Doing to get what you want?
E = How well is this going (the Evaluation stage)? And:
P = Let’s re-Plan, or produce an explicit Plan linked to what you Want.
Out of this questioning process normally come some fragments of story, which may or may not fit well together, and with which we work to make sense of the client’s overall life narrative.
If there is a tension between what the client wants and what they are doing, we are immediately into the elucidation stage; helping the client to change either what they want, or what they are doing, so they both line up.
If there is no tension between what the client wants and what they are doing, I often switch to the Egan Model
The Egan model: This is a more detailed exploration of the client’s goals and resources for making progress. In its simplest form it includes asking the client the following three questions:
- Where are you now (in your inner and outer life)? Or what is the problem with which you are stuck?
- Where are you trying to get to? Or what would need to change for the problem to be resolved?
- What (new or revised) action could you take to get from 1 to 2? Or how could you begin to build a bridge towards your goal?
This process often gives us a ‘focus area’ to begin to work upon. It also often reveals blind spots that they client has, which we can clarify; and we can often help them to identify resources for solving their problem, about which they were unaware.
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However, we should note that, in E-CENT counselling, we are not just interested in the so-called ‘thinking’ side of the client; or the so-called ‘feeling’ side of the client. We are also interested in these questions:
How well do you sleep? How many hours per night do you sleep?
Do you get up in time to have a slow and gentle start to the day, or do you begin late, with tight time deadlines, which push up your stress level?
What do you have for breakfast, and is it the healthiest option possible? (It is never a good idea to skip breakfast!)
How well do you manage your time and your stress, in your daily working life?
How good are your relationships with your significant others? At home and in work?
How much physical exercise do you do, and how many days per week do you do it?
How much water do you drink during the day?
What do you eat for lunch?
What snacks do you have mid-morning and mid-afternoon?
How much alcohol do you drink?
Do you consume any of these toxic foods: sugar; alcohol; caffeine; gluten; trans-fats (or hydrogenated fat, in junk foods); and highly-processed foods (with added sugar, salt, trans-fats, colours, flavours, and other denatured components)?
Tell me about your childhood? Was it broadly happy? Or not? Are you secure or insecure in your relationships?
What is the problem that brought you here today? And how does it relate to the questions I have asked above?
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During the confession stage, some clients have admitted to serious wrong-doing, such as being unfaithful to their partner, or stealing family assets. At this point I switch from confession to education, and begin to teach the importance of pursuing a virtuous life, and avoiding vice, because of the inevitable outcome of ‘bad karma’[24]. We tend to reap what we sow, and we cannot have a happy life if we live in an unprincipled manner. (Of course, I also teach the importance of morality for the sake of being a moral agent – a good person; which is a social requirement). And I teach that immorality also tends to undermine our sense of self-esteem.
Furthermore, I also teach the Golden Rule[25] – which requires us to treat other individuals at least as well as we would want them to treat us, if our roles were reversed – and I often recommend reading of the Dhammapada (which outlines basic Buddhist teachings)[26].
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8.3(b): Elucidation
There are a number of models that I use for the purpose of elucidating the client’s concerns, dilemmas, goals, etc.
Chief among them is our own holistic version of the Stimulusà Organismà Response (or Holistic-SOR) model.
The original SOR model (created by the neo-behaviourists) suggested that, when an animal (or human) notices a stimulus (S), it outputs a response (R), because of the way the organism (O) processes the stimulus.
Figure 8.1: The classic S>O>R model:
That original SOR model of neo-behaviourism was dumped by Dr Albert Ellis, the creator of Rational Emotive Behaviour Therapy (REBT), and replaced by the simple ABC model, in which the client is assumed to be always and only upset because of their ‘irrational beliefs’. (And Freud’s ‘ABCs’ were no better, in that he implied that when something happens [let’s call it an ‘A’, or activating event], the client responds with their own phantasy [let’s call it a ‘B’, or belief], which upsets them [at point C – consequence]: though Freud did not use that ‘ABC’ lettering system)
Aaron Tim Beck (despite being a medical doctor, and theoretically aware of the importance of the human body) also adopted this simple ABC model. (Beck 1976).
So one of the main contributions of E-CENT counselling has been ‘adding back the body’ to the client; and accepting that the client’s body-mind-environment-whole is implicated in all of their emotional and behavioural states.
In the process we developed a more holistic version of the Stimulus⇒Organism⇒Response model. (See Figure 8.2 below)
In the simple, classical SOR model, an incoming stimulus (S) – (which is a sensed experience) – impacts upon the nervous system of the organism (O) – (or person, in our case) – causing a reactive response (R) to be outputted (or generated), to cope with the stimulus (or incoming experience).
In the early stages of our explorations, after looking at Freud and Ellis – on the ABC model and the Experience-Phantasy-Neurosis model – we turned our attention to the Parent-Adult-Child (PAC) model of TA, plus this simple, classic SOR model.
But then we began to ask ourselves what factors are most likely to affect the capacity for a human organism to be able to handle difficult incoming stimuli, or activating events. We came up with an extensive list, which includes:
Diet: (meaning balanced, healthy, or otherwise). (Does the individual/ organism have enough blood-glucose to be able to process the incoming stimulus, physically and mentally?)
Exercise: (meaning regular physical exercise designed to reduce stress, versus a sedentary lifestyle)[27]
Self-talk, scripts, frames and schemas: (Including conscious and/or non-conscious stories and narratives/ thinking-feeling states/ self-signalling/ attitudinizing / framing, etc. Plus other culturally shaped beliefs and attitudes, expectations, prophesies, etc. Plus non-narrativized experiences stored in the form of schemas and frames, etc.)
Relaxation: (or release from muscle tension and anxiety, versus tension and anxiety);
Family history: (including attachment styles [secure or insecure]; childhood trauma; and personality adaptations, etc.);
Emotional needs: (including deficits and/or satisfactions);
Character and temperament: (as in Myers-Briggs or Keirsey-Bates)[28];
Environmental stressors: (including home environment, work situation, economic circumstances, and so on);
Sleep pattern; and the balance between work, rest and play.
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By keeping our focus on the fact that the client is a complex, socialized body-brain-mind; steeped in storied- (or narrativized-) experiences (plus non-storied experiences) of concrete experiences in a concrete world; and living in a complex relationship to an external social environment – which is often hostile and unsupportive, resulting in stress-induced over-arousal of the entire body-brain-mind – we never fall into the trap of foolishly asking the client: “What do you think you are telling yourself in order to cause your own problem?”
And we do not foolishly tell the client that the thoughts which (in reality, very often) follow on from their emotional experiences are causing those emotional experiences!
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We focus on the client’s story and the client’s physical existence, both with roughly equal, but variable, emphasis. Sometimes the story needs most attention, and sometimes the state of the body-brain-mind, in terms of diet, exercise, etc., is more important.
Traditional medical doctors were guilty of separating the body from the mind, and trying to treat the body as a ‘faulty machine’ – which was in line with Newtonian mechanics of the nineteenth century, which lasted well into the twentieth century and beyond.
Sigmund Freud, as a trained neurologist and MD, came out of that tradition and began the process of moving towards some kind of appreciation of the mind.
However, many generations of counsellors and psychotherapists have gone too far in this direction, and forgot all about the body.
Some modern medical doctors are beginning to realize their original error.
Here’s how Dr Ron Anderson, Chairman of the Board of the Texas Department of Health, describes his aim for all the doctors he influences:
“I try to have people understand wholeness if I can, because if you don’t understand the mind/body connection, you start off on the wrong premise.
You also have to understand the person within their family and community because this is where people live”.[29]
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Using the Holistic SOR model
Figure 8.2 below shows how we present the holistic SOR model for our clients.
Figure 8.2: The E-CENT holistic SOR model
As indicated in Figure 8.2, E-CENT theory takes a holistic view of the client as a social-body-mind, with a habit-based character and temperament, living in a particular social and physical environment, with stressors and supports.
The client has a personal history which is unique to them; plus some social shaping that extends to their family, and some to their community; some to their nation/ race/ gender, etc.
This illustration should be read as follows: Column 1 – ‘S’ = (or equals) a stimulus, which, when experienced by an O = Organism (in our case a human), may activate or interact with any of the factors listed in column 2; and this will produce an R = Response, as shown in column 3.
To be more precise: The holistic SOR model states that a client (a person) responds at point ‘R’, to a (negative or positive) stimulus at point ‘S’, on the basis of the current state of their social-body-mind.
How well rested are they?
How high or low is their blood-sugar level (which is related to diet)?
How well connected are they to significant others (which is a measure of social support)?
How much conflict do they have at home or at work?
What other pressures are bearing down upon them (e.g. from their socio-economic circumstances; physical health; home/ housing; work/ income; security/ insecurity; etc.)
And how emotionally intelligent are they? (Emotional intelligence is, of course, learned, and can be re-learned!)
Within the Holistic-SOR model (in Figure 8.2 above), in the middle column, what we are aiming to do is to construct a balance sheet (in our heads) of the pressures bearing down on the client (person), and the coping resources that they have for dealing with those pressures.
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So this is a historical-social-stress model. It is not a purely ‘cognitive distortion’ model; nor a purely ‘biological/ sexual urges’ model; nor a purely ‘prizing and listening’ model.
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The exploration process
Once we have established rapport, and worked on a contract and a specific focus, we move on to the detailed work of processing the client’s communications about their concerns.
Process = The process of E-CENT counselling can have formal and informal aspects; including: discussion and questions; or the use of questionnaires to explore possibilities. And/or the use of a range of models and techniques and strategies, as described and explored throughout this chapter.
And the process tends to vary considerably from one client to another, as each client is unique. Although there is no one right way to begin, one fairly typical or common approach could be to:
- Explain the H-S-O-R model, and then:
- Explore the details of the client’s Diet, Exercise, Sleep patterns, Self-talk, Relaxation/Meditation (as first priorities) – if appropriate.
- Then, explore the client’s relationships (current and historic), as the next priority – if appropriate. (Of course, for some clients, the order of items 2 and 3 would be reversed).
This elucidation sometimes involves the use of explicit questionnaires, but more commonly we stick to informal questioning about:
Diet and vitamin supplementation; Exercise routine and frequency; Sleep quality and duration; and Relaxation and/or meditation practice.
Also: What’s going on at home, and/or in work? What has changed recently?
And, if called for, what went on in the family of origin.
And so on.
Other instruments
The emotional needs assessment questionnaire (adapted from the Human Givens approach): This allows the client to identify any unmet needs which may be affecting their equilibrium, and thus causing emotional disturbance. (See Appendix B of Byrne 2016).
A brief Depression inventory (from Dr David Burns’ handbook[30]): This is sometimes used to check the intensity of a client’s depression; and sometimes to check on progress over time.
A brief Anxiety inventory (from Dr David Burns’ handbook): Like the depression inventory, this is sometimes used to check the intensity of a client’s anxiety; and sometimes to check on progress in reducing anxiety over time.
Other models: We also use some other models, to help the client to understand their marriage, or to help them to understand stress, or the handling of panic, etc. For examples, we teach eighteen principles of happy relationships – some of which come from Professor John Gottman’s books[31].
We teach twenty-one principles of stress management, from a broad range of sources[32].
And we use our own desensitization process to help clients to reduce their traumatic stress and panic symptoms. (See Appendix C of Byrne 2016).
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Questioning strategies
Various questioning strategies have been adopted, adapted or evolved within E-CENT; and these are particularly important at the elucidation stage:
As we move into the Focus stage (of the RCFP model), we begin to ask a range of open and closed questions; and as we enter the Process stage, we begin using funnelling questions – going deeper and deeper into the client’s problem.
If we get stuck, and no longer understand the shape of the client’s presenting issue, we may have to use one of the following questioning techniques:
(a) The 5W’s & 1H model: In this approach, the counsellor asks: Who…? What…? When…? Where…? Why…? And, finally, How…? (Or some relevant sub-set of those questions, in whatever order makes most sense).
(But be careful. Questions can trigger anxiety in the client!)
(b) The Five Why’s model: This model is a form of drilling down into the problem: Why did it happen? Why did you respond the way you did? Why did you not try X instead? Why…? (And I will explain later how we modify these questions to substitute ‘For what reason…?’ – instead of the word ‘Why?’ And we do that to avoid making the client anxious).
(c) Other approaches: Of course, the WDEP model (which we mentioned above) is also primarily a questioning model. And we also use the simple Egan Model of the Skilled Helper:
- Where are you now?
- Where are you trying to get to?
- How could you build a bridge from 1 to 2?
- Reflection and insight: (The counsellors watches out for blindspots and unutilized resources or sources of strength, and discusses them with the client).
Dangers of questioning!
This is a good point to mention our reservation about excessive questioning, or the intensive or insensitive use of questioning, especially when the client is particularly stressed.
The main problem here is that the client may become anxious and even feel that they are being ‘interrogated’ or ‘treated as the villain of the piece’.
If the client has an avoidant attachment style, they are highly likely to become stressed if questioned about their feelings: (Hill, 2015, pages 208-209).
And many clients become upset if they are questioned about their actions or behaviours. CBT/REBT therapists are completely unaware of the disturbances they may cause by misguided questioning strategies.
In particular, we need to be aware of the insights of Joines and Stewart (2002), on personality adaptations. These authors clarify that each of our clients will have a particular adaptation to their parents.
This theory asserts that:
(1) Some people respond to life by thinking; some by feeling; and some by acting unthinkingly.
(2) Some people have their behaviour “walled off”, unavailable for inspection or consideration; while some will have their thinking walled off; and some their feelings. And:
(3) The challenge for therapy is to identify the element of their mental processing – thinking, feeling or behaviour – which the client leads with; and which needs to be integrated with that element.
The most helpful aspect of this book is that it allows us to see and understand that some clients will lead with their thinking, and thus be happy to engage in encounters where we ask questions which cause them to think.
Some clients will have their thinking “walled off”, so that they lead with behaviour or feelings, and cannot think without digging holes for themselves. So we would be doing such clients a disservice by questioning them about their thinking.
And, some clients will have their behaviour “walled off”, and they will be ultra-sensitive about having their behaviour challenged or questioned, so we should not use questioning of behaviour with them.
So, in practice, we do not use the Five Why’s, as such, but rather the gentler, ‘For what reason?’ times 5. “For what reason did you go there?” “For what reason did you respond the way you did”? Etc.
(We might use this approach with the first four personality adaptations:
[1] the Enthusiastic-Overreactors, who lead with their feelings, and need to integrate their thinking with their feelings;
[2] the Responsible-Workaholics, who lead with their thinking and need to have their feelings integrated with their thinking;
[3] the Brilliant-Skeptics, who lead with their thinking, and need to integrate their feelings with their thinking; and:
[4] the Creative-Daydreamers, who lead with behaviour, and need to integrate their thinking with their behaviour.
See Joines and Stewart, 2002. Pages 42-47).
However, we do not use questioning, which causes thinking to start up, with those clients who have their thinking “walled off”. (These are the Playful-Resisters and the Charming-Manipulators. See Joines and Stewart, 2002, pages 47-49).
In the ‘bad old days’, when children were asked ‘Why?’ at home or in school, this was often a signal that they were ‘in trouble’ and that they should ‘button their lip’ to avoid being punished.
When we ask (of the clients who do not have their thinking walled off): “For what reason…?” we are clearly focusing on causality (or causation) and/or motivation, and not blame!
(“I would be interested to know the reason that… [you did X]”, is an even better formulation.)
However, overall, in E-CENT counselling (with clients whose thinking is not walled off), we try to stick to the five functions of questioning that are outlined in G.I. Nierenberg’s (1987)[33] book on negotiation skills.
Those five functions of questions, are as follows:
Q1. To cause the client to focus upon a particular point (event, or object);
Q2. To cause their thinking to start up;
Q3. To ask them for some information;
Q4. To pass some information to them (rhetorically); and:
Q5. To cause their thinking to come to a conclusion.
Nierenberg also argues that you can arrange those five questions in a grid, like this:
Figure 8.3 Gerard Nierenberg’s question grid
Using this grid, you can see that a question can be in two parts. For example, in Figure 8.3, I have illustrated a combination of Q1 + Q3. Q1 Should/could/can aim to cause the clients attention to focus on a specific event/experience, and Q3 should/could/can ask them for some information about that specific event/experience.
Here is an illustrative example:
“(Q1) With regard to (event X), (2) for what reason did you experience it as (an insult, [for example])?”
The great beauty of this system is that it gets rid of the “Socratic smart-arse” aspect of questioning the client, which is prevalent in rational therapy (REBT).
The problems with classic Socratic Questioning (as used in REBT/CBT) include:
- That the client may interpret the therapist as ‘picking a fight’ with them; making them wrong; or putting them down;
- That the client may become anxious when asked particular kinds of right/ wrong questions (perhaps because of re-stimulation of one or more of the many humiliating experiences of being a child in classrooms in school and being subjected to interrogations, the aim of which was to find a reason to punish the client when they were a child).
- That the client may – (as suggested by the research studies of Asch, Milgram and Zimbardo)[34] – simply go along with the therapist’s inferences, as a form of obedience or conformity to authority.
- That the client may have their thinking “walled off”, is described in our discussion of Personality Adaptations, a la Joines and Stewart 2002, above. Asking them questions will not help, since they cannot think well or clearly enough to benefit from this approach.
- That the client may have their behaviour “walled off”. The first three Personality Adaptations looked at above – the Enthusiastic-Over-reactor, the Responsible-Workaholic and the Brilliant-Skeptic – have their behaviour “walled off”, such that, any questions about their behaviour will tend to make them feel bad (not-OK), such as shamed or humiliated!
- That the therapist never gets to know the client, because s/he (the therapist) is always tilting at the windmills of ‘innate irrational beliefs’ – or ‘negative automatic thoughts’ – and not paying attention to the actual story the client is telling them. Or the actual wiring of the client’s personality – such as walled off thinking – is never noticed, and thus the possibilities of effective therapy are seriously compromised!
And so on.
The point is not to avoid questions completely (as some Rogerian, person-centred counsellors do), but to use questions skilfully, sparingly, and appropriately. And to be particularly aware of the client’s personality adaptations, and to try to avoid using questions with those people who cannot benefit from them!
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>>> Continue adding images from here >>>
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8.3(c): Education
Education of the client is a key aspect of our work. We teach the client that they are socialized-body-minds, interacting with social and physical environments, and not just ‘floating heads’.
We teach them (or try to help them to learn – to be more accurate) that everything they put into their body – and some of the things they fail to put into their body – will have some (positive or negative) effect on their mind.
And we try to clarify that, everything they do with their mind or mental processes – like ‘thinking’ (which is really perfinking!), feeling, ruminating, worrying, planning dire outcomes, et cetera – will have some effect on their body – which will in turn rebound on their mind (because the so-called body and mind are really a unified, integrated, body-mind).
We try to get them to see that it is most sensible to work at taking care of their body-brain-mind as a holistic activity. And also to work at managing their relationship to their social and physical environment.
But we also try to educate our clients like a good enough mother of a young child tries to educate: by modelling certain attitudes and behaviours; by providing gentle and kind developmental feedback; and by showing care and concern for the feelings of the client.
General teaching points, including diet and exercise
We teach our clients that they are storytelling animals, which live in a sea of stories – but not disembodied stories. Rather, they live in a sea of stories about experiences – their own story, their family’s stories, their community’s scripts and legends, and their nation’s narrative; as well as the stories of their religion/ race/ creed/ gender/ sexual-orientation. But we also help them to see that they must pay attention to their own physical existence; their own social existence, including their key relationships.
Our stories live in our bodies; and the stories we can generate about our present and our future depend upon the state of health of our bodies.
We teach some basic principles of diet and physical exercise; sleep hygiene; meditation and relaxation; and we recommend that clients follow up on this introductory educational input with more extensive study of these fields of self-care, perhaps with the support of a nutritionist or dietician; a sports coach; a meditation teacher or relaxation class or audio program; or with a holistic healthcare practitioner.
We teach assertive communication strategies, in order to improve relationships and social connection, which are essential to good physical/ emotional health. We also teach dedication to reality at all cost; and the importance of accepting the things we cannot change.
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We sometimes make general or explicit recommendations to our clients regarding the kinds of changes to make to their diet[35] and/or physical exercise[36] practices. (And we sometimes refer them to see a nutritional therapist, or a sports coach at a local gym).
We also recommend particular relaxation programs (normally audio CD, or DVD based programs by Glenn Harrold or Paul McKenna); and teach them simple approaches to meditation[37].
And we have explored, and teach, particular (non-drug-based) approaches to sleep promotion; and where to get more holistic professional help for sleep problems.
If we begin to suspect that character or temperament may be part of the client’s problem, we suggest a self-analysis using the Keirsey-Bates approach[38]. And we discuss their results with them.
When insecure attachment style seems to be a part of the client’s problem, we might recommend that they assess their own attachment style at a particular website.[39] We use those (attachment style) results to adjust our approach to the client, and to expand our understanding of their life story. And we follow Wallin’s (2007) approach to being a secure base for the client. Being a good-enough re-parenting figure.
To help clients change their self-talk (or how they frame their problems) we use the Nine Windows Model.
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The Nine Windows Model(s): We have already outlined this model in Chapter 6 …. We created the Six Windows Model (which has now become the Nine Windows model) mainly from some of the more moderate insights of Buddhism and Stoicism. Initially there was only one model of the Six Windows, though we recognized that there were likely to be at least 66 different ways of looking at any problem, and possibly even 666. (See Figure 6.1(b) above).
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Our aim in developing the Windows model was this: We wanted to develop a way of introducing the client to several different ways to re-frame their problem, which would hopefully break up their automatic, (non-conscious), mono-focal (or single focus) way of viewing their problem.
This theoretically involves them in integrating new ideas ‘in their left brain’ with old emotions ‘in their right brain’. (Hill, 2015).
In other words, we wanted to help them to re-story their approach to the presenting problem; to create a new narrative about it. This has worked well in practice. An example was shown in Chapter 6, above.
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Applying the Nine Windows Model
This is how we apply the model:
- We ask the client to rate a particular presenting problem, on a scale of 1 to 10, where 10 is as bad as it could possibly be. (These are called ‘subjective units of disturbance’ – or SUDs, for short).
- We then ask them to view their ‘presenting problem’ through Window No. 1, and to decide if the problem shows up as less bad (reduced SUDs) when viewed in this way. (Typical question for Window No. 1: “Since some things are within your control, and some things are beyond your control, are you willing to accept those things which are beyond your control [today], and to only try to change the things that seem to be controllable [today]?)
- We repeat step 2 with each of the six different window frames, each of which has a particular perspective (or framing statement) written around it. (The typical question obviously varies from window to window, and reflects the slogan written around each particular window).
- The process is simple: The client is asked to consider how – taking each of these six perspectives into account – their problem shows up differently, each time, for them. They are not obliged to reach a definitive answer (or specific SUDs rating) at the end of each window. We are happy to wait to the end of the process, to see what the overall effect might be.
- The ultimate question is this: “Does your ‘presenting problem’ seem any better when viewed through any or all of the new (window) perspectives?” (Other questions could be: “And, on a scale of 1 to 10, how bad does your problem now seem? Has your ‘subjective units of disturbance’ [SUDs] rating declined as a result of considering these six new perspectives?”)
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The first three windows (or framings; or perspectives) are as follows:
Window 1: In life, there are certain things I can control, and certain things are beyond my control. I have to restrict myself to only trying to change the things that seem reasonably controllable.
Window No.2: Life is difficult for all human beings at least some of the time, and often much of the time, (so why must it not be difficult for me right now?)
Window 3: Life can be significantly less difficult, provided I pick and choose modestly, realistically, and reasonably. (We cannot give up picking and choosing outcomes completely; but we can moderate our choices and expectations!)
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Testimonial about the Windows Model: Here is an example of the kind of feedback we receive from our clients about the usefulness of the Nine Windows Model:
“Thank you, Jim. I use your … Windows Model every time I’m emotionally disturbed; … and the specific applications you developed for dealing with depression, anger, and stress are very helpful. … I normally rely upon my … religious beliefs to get me through my life … but the … Windows philosophy made the difference recently.”
P.J.L., Argentina. (Three sessions of email counselling for a variety of emotional problems).
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Once the client is familiar with the Nine Windows Model, it might sometimes be helpful (in face to face counselling) to prompt them to use it, by applying the EFR model, which follows next:
Using the EFR model
In 2010, the EFR model was at the core of E-CENT, alongside the Six Windows Model. But this has now changed, and this model has been somewhat downgraded.
The EFR model is structured like this:
E = Event. What happened in the client’s life, about which they are disturbed.
F = Framing. How did the client frame this experience? (They normally will not know this, as it is mainly non-conscious. And the way they frame it varies from situation to situation, depending upon the current state of their body-mind. But they can often infer what their attitude towards the Activating Event, or Life challenge, seems most likely to have been, especially after they have been using the Nine Windows model for a while).
R = Response. How did the client respond to their Framing (F) of the Event (E)? What emotion did they feel? How did they act? Is this response something they want to change?
Today, in 2018, we have completely given up on the simple ABC model. We have also downgraded the EFR model (to a lower priority; or a later stage in counselling) – and, as mentioned above, instead we now mainly emphasize our own holistic version of the SOR model: which involves exploring the total state of the client’s body-mind, and not just their verbal-framings, or beliefs or attitudes.
Whenever we do use the EFR model, the next element after the ‘R’ is this:
Narrative inquiry
NI = Narrative inquiry: This step normally involves questions to the client (assuming their personality adaptation does not make questioning them counterproductive or iatrogenic). For examples:
What seems likely to be going on ‘in the basement’ of your (the client’s) mind to produce the kind of feelings and behaviours that are a problematic Response for you?
What do you think the story could be that produced this ‘R’ response to this particular ‘E’ (or activating Event or Experience)?
What is the narrative that is implied by this reaction? How helpful, logical or reasonable is this implicit narrative (or frame)?
We need to find out (if possible):
(1) What could the client change in their implicit narrative, which would make it more positive?
(2) How could they reframe this experience to produce a better outcome for themselves?
Very often, all of this remains hidden; and it is only by using the Nine Windows Model to help the client to rethink and reframe their situation that we can produce any real, lasting change for and with the client.
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Teaching the client about human disturbance
In Chapter 7, we outlined our approach to understanding the core of human emotional and behavioural disturbances.
Stress is often part of the client’s problem – meaning too much pressure in their life, relative to their coping resources. So we help them to work on reducing those stressors which they can reduce, and building up those coping resources which they can increase.[40]
One area of education involves helping the client to learn how to ‘reframe’ their identified problems.
As we have already seen, we have a strategy to get the client to rethink how they frame the problem, beginning with some conscious re-framing, which will become non-conscious with practice. And that strategy involves teaching them the Nine Windows Model, which we have already reviewed, above.
We also teach the client just how automatic and instantaneous their emotional reactions tend to be.
One of the ways we do this is by teaching them the APET model, from the Human Givens approach (Griffin and Tyrrell, 2004, 2008).
The APET model:
Because the ABC model (of REBT) tends to emphasize ‘beliefs’ – assuming that the disturbed emotions experienced by the client (at point C in the ABC model) are caused by linguistic beliefs (at point B) we had to reject this model. Furthermore, REBT theory talks about clients ‘choosing’ to upset themselves, whereas in E-CENT theory we see the client as a largely non-conscious and automatic organism, responding emotionally to environmental cues. Therefore, it may often be more realistic to use the APET model, from the Human Givens school of thought, as a corrective. This model illustrates just how automatic human disturbances tend to be. The key elements of the APET model are as follows:
A = An Activating event (as before): Something frustrating, challenging, frightening or saddening in some way, happens to the client.
P = Pattern matching. Our ‘organism as a whole’ recognizes this activating event, and ‘matches it’ to an appropriate response. Our brain-mind recognizes any particular event or object because it can be assimilated to (or fitted into) an existing ‘schema’ (or recognizable pattern, or frame) in long-term memory. (Pattern matching can also be thought of as habit-based perceiving-feeling-thinking [or perfinking] in which the incoming stimulus is apprehended,/identified and responded to all in one automatic grasp of the body-brain-mind).
E = Emotion. Our organism as a whole then ‘outputs’ a standard, habitual, emotional response to this stimulus (from ‘A’ above), in a fraction of a second, which is much too fast for any thoughts to occur.
T = Thoughts. Thinking follows on from consciously registering the fact that the emotional response has already occurred.
Whereas the ABC model tends to focus attention on the B (or belief system of the client), and what the client can do to change their beliefs/ attitudes about the A (or Activating stimulus), the APET model often focuses attention on the possibilities of changing the A, or activating stimulus. Or coming up with a new E (or emotional response) which is more self-helping than the old emotional response.
This can be done by asking: What would be a solution to the problem posed by the Activating event (A)? What could you do – or do differently – to achieve that solution?
However, because the ‘A’ often cannot be changed – e.g. in the case of redundancy from employment, for example – the APET model also can draw attention to the need to change the client’s inappropriate patterns of automatic responses to particular stimuli. This can be done by the therapist telling relevant ‘educational stories’, using metaphors, or using appropriate humorous images.
More importantly, we can get the client to use the Nine Windows Model to come up with new ways of framing their noxious stimuli (or unpleasant activating events). According to E-CENT theory, this tends to (eventually, after several repetitions) produce non-conscious insights, and revised evaluations, which tend to modify the client’s (or users) current pattern-matching options which are stimulated by a particular Activating stimulus (A). (Or, to put it differently: the client learns to perfink more self-supportingly about particular, noxious activating events!)
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Fragments of disconnected story
We might also want to use the Jigsaw-story model at point P in the RCFP model. (Point P involves processing the client’s communications about their Contract/ Focus issue).
The Jigsaw-story model is a kind of notional mental-matrix in which we accumulate bits and pieces of the client’s story or stories, over time.
Figure 8.4: The Jigsaw-story model
Part of the challenge here is to try to make the various bits and pieces cohere. You might ask yourself: What is the overall storyline? How well do the transitions work? How healthy are the foundational stories: of origins and relationships. Are there any gaps, blind spots, or contradictions?
(This is similar to case formulation in cognitive therapy, except that the CBT therapist seems to mainly focus on the client’s thoughts and behaviours, which are assumed to drive their feelings. In E-CENT, we focus on the client’s stories about their lived experiences. We assume that the external environment has a very powerful effect upon the client’s body brain mind. We assume that they client is doing the best they can with what they have to make sense of their lived experience. And our aim is to help them to ‘straighten out’ their stories, so they are consistent, reasonably accurate, hopeful and self-helping. This is similar to the emphasis on the coherence of the story in Affect Regulation Theory and Interpersonal Neurobiology [IPNB]).
In E-CENT counselling, the Jigsaw-story model is utilized at various points, when the counsellor spots a discrepancy between stories; or senses that a new revelation may make a lot of sense of an earlier mystery.
This is part of the detective-investigator role of the counsellor. And we often need to use systematic questioning, (when appropriate) as described earlier in this chapter, to resolve a jumbled jigsaw arrangement of stories.
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The Parent-Adult-Child model
When the problem involves interpersonal conflict, we often turn to the Parent-Adult-Child (PAC) model of Transactional Analysis (TA).
Figure 8.5: The PAC Model of TA (as adapted by us in E-CENT)
This model is used to teach clients how they move around between ego states (or ways of being – or distinct styles of thinking-feeling-acting); how those ego states can be managed; and how to grow the Adult ego state, and keep the Adult ego state in the Executive position in the personality.
The Adult ego state is the highest expression of our integration of thinking-feeling-acting which is guided by what Freud called the Reality Principle. Thus, our perfinking capacity is a measure of the balance between the Parent, Adult and Child states of being (or ego states).
The Adult ego state can be characterized as a compromise between:
- The Controlling and Nurturing aspects of the Parent ego state, on the one hand; and:
- The Rebellious and Conforming aspects of the Child ego state, on the other.[41]
We internalize models of Controlling and Nurturing ego states – or ‘states of the ego’, ‘ways of being’, or ‘sub-personalities’ – from our parents and parent substitutes. And our Rebellious and Conforming child ego states are memories of how we actually responded to our parents and/or parent substitutes during our childhood.
When a client shows up as being ‘too high’ on Bad Adapted Child – that is to say, they are too conformist; too adapted to their inner our outer Bad Controlling Parent forces – we set out to teach them to become ‘higher’ on Good Rebellious Child. Good Rebellious Child ego state is all about striving for socially-responsible Autonomy from Bad (inner our outer) Parental Control.
On the other hand, when a client shows as being ‘too high’ on Bad Rebellious Child – that is to say, too resistant to Good (inner or outer) Parental Control – we set out to teach them to become more socially responsible; more morally reasonable; more adapted to reasonable social rules.
And a good deal of our work involves trying to persuade clients to reduce their Controlling Parent ego state, in their relationships with others; and to grow their Adult ego state, which is guided by the reality principle – or reliable data about how the world works!
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The OK Corral (from TA):
This model – which is illustrated below – helps the client to understand that the only healthy life-position to operate from is this:
“I’m OK and so are you (all)”
– assuming we are both (or all) committed to acting as moral and socially-responsible individuals.
Figure 8.6: The OK Corral
It also helps the client to understand if they are operating from negative attitudes towards themselves or others. In TA, these could be classified as conscious or non-conscious not-OK life-positions (about self or others).
A ‘not-OK’ life position could include, any of the following attitudes:
(1) “I’m not OK because I cannot get a partner; (or I cannot get a job; or I cannot make a success of my career; or I cannot get along with others”; etc.) Or:
(2) “You’re not OK because you’re too rich (or too poor); (or because you frustrate me; or threaten my self-concept; or because you challenge me in ways that make me feel uncomfortable”; etc.) Or:
(3) “The world is not OK, because it does not give me what I want, when I want it; (or because it is too difficult; too boring; too painful; too uncertain or scary”; etc.)
We are committed to teaching our clients to reverse their not-OK life positions, by teaching them that they are OK, exactly the way they are, so long as they are striving to be good, moral citizens of their communities. (Byrne, 2010b)
We encourage them to forgive the imperfections of the people in their lives, so long as those individuals are not acting in an illegal or significantly immoral way towards our client.
When other people are treating our client badly, we teach our client to try to change what is not working for them – or to escape from the oppressive situation – and then to try to accept what they cannot change.
But we do not encourage them to stay in intolerable situations in order to grow their capacity to tolerate anything that life throws at them (which is a weakness of Albert Ellis’s system, and other forms of extreme Stoicism).
We help the client to see that they are OK (so long as they are committed to acting in a moral fashion).
When the client is excessively passive in the face of pressures from other people, or from life forces, we teach them to fight back – to the degree that this seems reasonable and safe! We teach them to adopt this non-verbal attitude: “Don’t F— With Me!”; and we teach that lesson using a Gestalt-like Boundary Exercise of our own invention.
We also teach them that, no matter how inefficient or ineffective they might happen to be; or how poor their general judgements often prove to be – this just proves that they are imperfect humans. They can still accept themselves with all these imperfections, so long as they can honestly say they are trying to live a good, moral life[42].
And we teach them to keep their expectations of life in line with reality; to only try to change those things that seem likely to be changeable by them; and to take responsibility for steering the boat of their life through the choppy seas of frustration and challenge.
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8.3(d): Transformation
Transformation of the client’s fundamental way of being in the world is slow work. Most clients do not stick around long enough for this phase to become very much of a reality. They mostly leave when they have had sufficient education to be able to resolve their burning issues and questions, and to resolve their most painful problems. And that’s okay with us!
However, a small minority of clients, with major developmental needs, do stay on for quite long periods of time – between one and five years, to work on deepening their therapeutic change processes.
Six main therapy-deepening processes
The long-term work that is required for personal transformation involves at least:
(1) deepening the therapeutic relationship;
(2) facing up to painful insights and memories (after suitable preparation and at an appropriate time!);
(3) more honest and exhaustive confession of personal insights of the client’s own contribution to their disturbance (though we do not blame the client for the non-conscious, habit-based functioning!);
(4) repeated use of the jigsaw-story model;
(5) some writing therapy work by the client, to clarify their stories further; and:
(6) some, if not all, of the following processes:
Use of the Gestalt Chair-work model:
We use this model to help clients to explore incomplete relationships (e.g. with mother or father, etc.), by allowing the client to have previously unexplored conversations with the absent other.
This could be designed to help the client to heal psychological splits, or to become more fully self-expressed. (Source: Scott Kellogg[43])
The client sits in one chair, and imagines another person sitting in the opposite chair. They then have a previously uncompleted conversation with this significant other. Sometimes more than two chairs are used, if the client is badly fragmented in terms of ego states or sub-personalities.
And the E-CENT counsellor may often encourage the client to have dialogues between their Parent and Child ego states, to resolve old family conflicts.
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Gradual desensitization:
We have evolved a four-stage gradual desensitization hierarchy, for problems of panic and trauma, with three processes at each stage in the hierarchy of ascending degrees of intensity.
It takes one session to complete each level in the hierarchy.
The three processes that we use are: (1) Full-body relaxation suggestions[44]; (2) Rational Emotive Imagery[45]; and: (3) Havening[46]. (See Appendix C of Byrne, 2016). We also teach diaphragmatic breathing. And we have recently added emotive recall with interceptive processing and breathing and/or physical movement.
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Cutting the Ties that Bind:
This is a process which was developed by Phyllis Krystal[47], and adapted by us for use in a secular form, (though we sometimes use a spiritual form, for those people who like that approach). It is a kind of (often badly belated) puberty rite – or rite of passage into fully functioning adulthood. In the exercise, the client spends fourteen days visualizing a process of cutting the invisible ties between themselves and one significant other person (most often mother or father), who has had (and often is still having) a negative influence upon them (even – sometimes – if the parent has already died!)
After that 14-day visualization process is complete, the client attends the counsellor’s office. The E-CENT counsellor then facilitates a process of:
(1) Complete physical relaxation;
(2) A ritual (visualization of) cutting the ties to the person in question;
(3) Mutual forgiveness (of client and significant other) for past transgressions; and:
(4) A release from past influences of the ‘divorced’ (or ‘cut away’) person (who is often a parent figure).
Clients report great relief as a result of this exercise, which often changes significant aspects of their interpersonal way of relating in the world today.
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Meditation:
Regular daily meditation, for ten or more minutes, is a great way to relax the whole body-brain-mind; and to practice detachment from material grasping or unrealistic desiring. We teach – (to those clients who show an interest) – a form of secular, Zen meditation, as described on our web page[48].
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Attachment system work:
This work is most often based on the attachment styles questionnaire. This questionnaire helps the client to learn whether they have a secure or insecure attachment style (to their original carers, and/or to their current partner). It also distinguishes between two types of insecure attachment, and I teach how differences in insecure attachment style play havoc with some relational patterns. This is where the first partner is ‘anxious-ambivalent’, and clings to the other partner. But if the other partner is ‘avoidant’, they will feel trapped by the clinging process, and withdraw, which makes the first (clinging) partner feel dreadfully abandoned.
The E-CENT re-attachment process involves the counsellor in providing a ‘secure base’ and ‘safe harbour’ for the client, so they can learn to feel securely attached to the counsellor; and this ‘earned security’ can then be transferred into their relationship with their partner, and also into the wider world.[49]
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Exploring personality:
- The Keirsey Temperament Sorter:
This can help some individuals more than others, especially those who have had a lot of negative programming from parents which has badly affected their self-concept. Knowing their temperament style can help the individual to understand their potential to grow into a very different person from their parental scripting. It can also help individuals in relationships to become much more tolerant of individual differences within that relationship; and it helps individuals to understand their career options.[50]
- Personality Adaptations
We may also, as indicated earlier, use ideas from Personality Adaptations by Joines and Stewart (2002). This latter book can be particularly helpful in deciding whether to focus upon the client’s thinking, feelings or behaviours, as dictated by their personality adaptation. And one of us (Jim) now routinely asks clients to complete the Joines Personality Adaptations Questionnaire before our first meeting.
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Additional processes:
We sometimes encourage our clients to take up physical exercises programs; to manage their diet and nutrition better; to take more care over their sleep patterns; to keep a reflective journal, and bring it to counselling sessions as subject matter for discussion; to write emails for analysis between counselling sessions; and many other processes.
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8.4 Summing up
In this text we have mainly tried to describe (in briefest outline) the nature of an individual counselling session, so that we could illustrate the range of E-CENT theories, models and processes which are available for use.
In order to facilitate that outline, we used the standard Jungian session structure, of: Confession; Elucidation; Education and Transformation. This does not mean that we are Jungian, or that we have this structure explicitly in mind when seeing our clients. And it may be that there has never been a single E-CENT counselling session that has corresponded closely to the structure outline above!
In the process of developing this chapter, we clarified the status and role of some of the most important models used in E-CENT counselling; including:
- The holistic SOR model, which helps us to focus upon the fact that the client is a socialized-body-brain-mind in an environment (especially their social environment), and that there are many factors that go into shaping the client’s emotional and behavioural experiences apart from their beliefs and thoughts. (This model is supported by effective, systematic questioning strategies [where appropriate] – which are quite unlike so-called ‘Socratic Questioning’ – as well as the teaching of mind-body health promotion strategies).
- The Nine Windows Model, which allows us to educate the client regarding various alternative ways of viewing their current problems – which allows them to reframe their experience and to generate reduced levels of emotional arousal, and better forms of behavioural response. (And this is supported by various other models; including: the EFR (Event > Framing > Response) model; the Human Givens (APET) model. Plus the Parent-Adult-Child (PAC) model – and also the OK corral model – both of which are borrowed from Transactional Analysis [TA]).
- The Jigsaw-story model, which helps us to keep track of the stories told to us by our clients, so we can spot tensions, contradictions, gaps, and so on; which we can use to help the client to revise and update their stories, and to get a better life from living within a more accurate set of narratives of their life.
- And a broad range of other models which can be used to support the work done in paragraphs 1-3 above.
And all of this work is done in the context of aiming to provide the client with a secure base; to re-parent them; to help them to grow their Adult ego state; and to improve their ability to regulate their own affects, or emotions, within a more reasonable range than they could when they first arrived to see us.
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Endnotes
[1] Wilkinson, R. and Pickett, K. (2018). The Inner Level: How more equal societies reduce stress, restore sanity, and improve everyone’s well-being. London: Allen Lane.
[2] James. O. (2008). The Selfish Capitalist: Origins of Affluenza. London: Vermillion. Page 3.
[3] Pickett, K.E. and Wilkinson, R.G. (2010). ‘Inequality: An unacknowledged source of mental illness and distress’. British Journal of Psychiatry 2010; 197: Pages 426-428.
[4] Gerhardt, S. (2010) Why Love Matters: How affection shapes a baby’s brain. London: Routledge.
[5] See Chapter 3 – ‘Shaping our narratives’ – in Wilson, T.D. (2011) Redirect: The Surprising New Science of Psychological Change. London: Allen Lane/Penguin.
[6] See Appendix G of Byrne (2016).
[7] See this blog post: Your Emotions Are What You Eat: How Your Diet Can Reduce Anxiety, by Matthew C. Nisbet, Available here: http://bigthink.com/age-of-engagement/your-emotions-are-what-you-eat-how-your-diet-can-reduce-anxiety
[8] Siegel, D.J. (2015) The Developing Mind: How relationships and the brain interact to shape who we are. London: The Guilford Press.
[9] Peck, M.S. (1998) The Road Less Travelled: A New Psychology of Love, Traditional Values and Spiritual Growth. New York: Touchstone.
[10] See our web page – ‘What is Transactional Analysis (TA)?’ – here: https://abc-counselling.org/transactional-analysis/
[11] See my page on ‘REBT and Research’, Available here: web.archive.org/web/*/http://abc-counselling.com/id113.html
[12] West, W., and Byrne, J., (2009) ‘Some ethical concerns about counselling research’: Counselling Psychology Quarterly, 22(3) 309-318.
[13] Smith, M.L. and Glass, G.V. (1977) Meta-analysis of psychotherapy outcomes studies. American Psychologists, 32, 752-760.
Smith, M., Glass, G. and Miller, T. (1980) The Benefits of Psychotherapy. Baltimore, Maryland: The Johns Hopkins University Press.
[14] Wampold, B.E. (2001) The Great Psychotherapy Debate: Model, methods, and findings. Mahwah, NJ: Lawrence Erlbaum.
Wampold, B.E., Ahn, H., and Coleman, H.K.L. (2001) Medical model as metaphor: Old habits die hard. Journal of Counselling Psychology, 48, 268-273.
[15] Bowlby, J. (1988/2005) A Secure Base. London: Routledge Classics.
[16] Beauchamp, T.L. and Childress, J.F. (1994) Principles of Biomedical Ethics. Fourth edition. New York. Oxford University Press. And:
Bond, T. (2000) Standards and Ethics for Counselling in Action. Second edition. London: Sage.
[17] Watts, A. (1962/1990) The Way of Zen. London: Arkana/Penguin. And:
The Dhammapada (1973/2015) Taken from Juan Mascaró’s translation and edition, first published in 1973. London: Penguin Books (Little Black Classics No.80)
[18] Epictetus (1991) The Enchiridion. New York: Prometheus Books. And:
Aurelius, M. (1946/1992) Meditations. Trans. A.S.L. Farquharson. London: Everyman’s Library.
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[19] Wilson (2011); and:
Sarbin, T. R. (1989). Emotions as narrative emplotments. In M. J. Packer & R. B. Addison (eds.) Entering the circle: Hermeneutic investigations in psychology (pp. 185-201). Albany, NY: State University of New York Press. And:
Sarbin, T. R. (2001). Embodiment and the narrative structure of emotional life. Narrative Inquiry, 11, 217-225.
Gergen, K. (1985) The social constructionist movement in modern psychology. American Psychologist, 40: 266-275. And:
Gergen, K. J. (1994). Toward Transformation in Social Knowledge. London: Sage Publications. And:
Gergen, K. (2004) When relationships generate realities: therapeutic communication reconsidered. Unpublished manuscripts. Available online: http://www.swarthmore.edu/Soc.Sci/kgergen1/printer-friendly.phtml?id-manu6. Downloaded: 8th December 2004. And:
Gergen, K.J. and Gergen, M.M. (1986) Narrative form and the construction of psychological science. In T.R. Sarbin (ed), Narrative Psychology: the storied nature of human conduct. New York: Praeger. And:
Chapter 4 – ‘What’s the story’ – in Philippa Perry (2012) How to Stay Sane. London: Macmillan.
[20] In the Master Therapist Series of video tapes produced by the Albert Ellis Institute, each of the ‘master therapists’ used the A-B-C-D-E model as the invariable structure of their sessions.
[21] Definition of rapport = “A close and harmonious relationship, in which the counsellor and client understand each other’s words, attitudes, feelings or ideas, and communicate well with each other”.
[22] Nelson-Jones, R. (2001) Theory and Practice of Counselling and Therapy. Third edition. London: Continuum.
[23] Jacobs. E.E. (1993) Impact Therapy. Lutz, FL: Psychological Assessment Resources.
[24] We use a secular definition of ‘karma’ as meaning the results of all of our actions in the real world of this (the only) life we have lived so far (or the only life we can know about!) This combines both earned merit/demerit, plus accidents of being in the right or wrong place at a particular point in time. “Your karma is what happens to you. You don’t have to be very wise about that!” Werner Erhard.
[25] The Golden Rule, which goes back to ancient China, and is preserved in both Catholic dogma and in the thinking of Immanuel Kant, goes like this: Do not do unto others what you would not want them to do to you in similar circumstances. Or: Treat other people in ways that you would like to be treated.
[26] The Dhammapada (1973/2015) Taken from Juan Mascaró’s translation and edition, first published in 1973. London: Penguin Books (Little Black Classics No.80)
[27] The British National Health Service (NHS) supports the view that exercise is good for mood disorders, like anxiety and depression. Here’s their comment specifically on depression:
“Exercise for depression
“Being depressed can leave you feeling low in energy, which might put you off being more active.
“Regular exercise can boost your mood if you have depression, and it’s especially useful for people with mild to moderate depression.
‘Any type of exercise is useful, as long as it suits you and you do enough of it,’ says Dr Alan Cohen, a GP with a special interest in mental health. ‘Exercise should be something you enjoy; otherwise, it will be hard to find the motivation to do it regularly.’
“How often do you need to exercise?
“To stay healthy, adults should do 150 minutes of moderate-intensity activity every week.” In E-CENT we recommend 30 minutes of brisk walking every day, minimum. Source: http://www.nhs.uk/conditions/stress-anxiety-depression/pages/ exercise- for- depression.aspx) Accessed: 23rd February 2016.
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[28] Keirsey, D. and Bates, M. (1984) Please Understand Me: Character and temperament types. Fifth edition. Del Mar, CA: Prometheus Nemesis Book Company.
[29] ‘The healing environment’: An interview with Dr Ron Anderson, in Bill Moyers’ (1995) book: Healing and The Mind. New York: Doubleday. Page 25.
[30] Burns, D. (1999) The Feeling Good Handbook. London: Plume/Penguin Books.
[31] Gottman, J. (1997). Why Marriages Succeed or Fail: and how you can make yours last. London: Bloomsbury.
[32] Byrne, J. (2012) Chill Out: How to control your stress level and have a happier life. Hebden Bridge: CreateSpace.
[33] Nierenberg, G.I. (1987) The Complete Negotiator, London, Souvenir Press Ltd.
[34] Asch, S.E. (1956) A minority of one against a unanimous majority. Psychological Monographs, 70 (416). And:
Zimbardo, P. G., Banks, W.C., Craig, H. and Jaffe, D. (1973) A Pirandellian prison: The mind is a formidable jailor. New York Times Magazine, April 8th, 38-60. And:
Milgram, S. (1974) Obedience to Authority. New York: Harper and Row.
[35] Please see Appendices E(1) and E(2) above.
[36] E-CENT Paper No.18: Exercise is good for your body, brain and general health. By Renata Taylor-Byrne and Jim Byrne. Available online, here: https://ecent-institute.org/e-cent-articles-and-papers/
138 Please see our web page on ‘How to meditate – A brief introduction’, by Renata Taylor-Byrne and Jim Byrne, at ABC Coaching and Counselling Services. Available online: web.archive.org/web/20160323004156/web.archive.org/web/*/http://abc-counselling.com/id260.html
[38] Keirsey and Bates (1984); An online questionnaire on character and temperament: Available here: http://www.keirsey.com/sorter/register.aspx
[39] What is your attachment style? Online Questionnaire: http://www.web-research-design.net/cgi-bin/crq/crq.pl
[40] Our approach to stress management is outlined in Byrne, J. (2012) Chill Out: How to control your stress level and have a happier life. Hebden Bridge: CreateSpace.
[41] See our web page – ‘What is Transactional Analysis (TA)?’ – here: https://abc-counselling.org/transactional-analysis/
[42] Byrne, J. (2010b) Self-acceptance and other-acceptance in relation to competence and morality. E-CENT Paper No.2(c). Hebden Bridge: The Institute for E-CENT. Available online: https://ecent-institute.org/e-cent-articles-and-papers/
[43] ‘Transformational Chairwork: Five Ways of Using Therapeutic Dialogues’. A blog by Scott Kellogg, PhD; New York University. Available online: http://transformationalchairwork.com/ articles/ transformational-chairwork/. And:
Perls, F. S. (1969). Gestalt Therapy Verbatim. Lafayette, CA: Real People Press.
[44] We often use relaxation processes which were developed by Paul McKenna. For an example, please watch this video clip at YouTube: https://www.youtube.com/watch?v=6prbVluob5E
And also use Progressive Muscle Relaxation. Please see Renata Taylor-Byrne’s book: Relax Your Way to a Better Life.***
[45] For a description of Rational Emotive Imagery, by Dr Albert Ellis, please go to: http://www.billhanshaw.com/My_Office_Web_Page/Blog/Entries/2009/3/19_REBT_Rational_Emotive_Behavior_Therapy_%22Rational_Emotive_Imagery%22.html
[46] Paul McKenna has been involved in the recent development of Havening, a psycho-sensory technique for processing trauma, anxiety and stress. You can find a video introduction to this new technique at YouTube, here: https://www.youtube.com/watch?v=0C1liEFCZm4
[47] Krystal, P. (1994) Cutting the Ties That Bind: Growing Up and Moving on. Weiser Books.
[48] Taylor-Byrne and Byrne: ‘How to meditate – A brief introduction’. Available online: web.archive.org/web/20160323004156/web.archive.org/web/*/http://abc-counselling.com/id260.html
[49] Wallin, D. (2007) Attachment in Psychotherapy. New York: The Guildford Press. And:
Levine, A. and Heller, R. (2011) Attached: Identify your attachment style and find your perfect match. London: Rodale/Pan Macmillan.
[50] Keirsey, D. and Bates, M. (1984) Please Understand Me: Character and temperament types. Fifth edition. Del Mar, CA: Prometheus Nemesis Book Company.
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ABC Counselling and Psychotherapy, Hebden Bridge 