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Wednesday, 10 February 2010

SDS Debate: Award Winning Neurologist Challenges Our Therapy Practice

Here's a question for you: What do your clients spend most of their time talking about when they are with you?
• About how worthless they feel?
• About their negative core beliefs and how to challenge them?
• About their damaged histories and how these might be overcome?
• Or what they have been doing over the last week, month?

Marc Jeannerod may not be a name you're familiar with, but he is an internationally recognised expert in cognitive neuroscience and experimental psychology. His research has highlighted a significant process that is both theoretically interesting and contains very challenging implications for our practice.

Firstly, he has found that at a neurological level, the brain operates in exactly the same way when “simulating an action or behaviour as it does when actually doing it." In other words the same areas of the brain are used in exactly the same way when we talk about or visualise an activity or action as those that are used when we actually do that action.

Secondly, we have known elsewhere for a while that repeatedly using the same areas of our brain reinforces such connections and makes them MORE LIKELY to be used in the future.

Putting the two together suggests that what our clients spend their time visualising or thinking about increases the likelihood of them doing those things in the future. Basically, if our clients spend their time with us talking about their inactivity or inability (even when thinking about how to overcome it) INCREASES the likelihood of them continuing with their inactivity or inability.

The implications for us are more than just trying to make our clients "more positive". Firstly and most importantly, it has major implications for the agendas and protocols that both we and our clients use. Any time spent NOT talking about "successful" activity (as defined by the client) is at best a wasted opportunity and at worst – reinforcing the problem. Even if we only spend 50% of our time with clients talking about the problem, this is 50% of time spent on reinforcing the problem. Secondly, talking about "overcoming the problem" is little better – unless it focuses on what the client wants to be doing instead. Focusing on how to overcome a problem is not the same as focusing (e.g. visualising) on actually overcoming the problem.
For those of you who are wondering where ‘listening to the client's worries in order to engage them’ comes in, the answer is in the question. Attending to the client’s inaction, confusion, or distress is a necessary activity to engage the client initially, but should never be a central tenet of helping because despite best intentions it ultimately leads the client back to the place where they do not want to be.

If this issue interests you and you'd like to explore it further, or even if you fundamentally disagree with it, I'd love to discuss it with you.

You can do this in a number of ways:
• You can reply to this email directly
• You can post your reply on the SDS Blog (http://sdsmedia.blogspot.com)
• Or even better – come along to one of the SDS Seminars "All New Brief Solution Focused Therapy" (http://www.skillsdevelopment.co.uk/seminars.php?courseid=70). Anyone who has worked us with before will know I love lively, honest, and considered debate.

Looking forward to hearing from you and working with you again.

Take care

Paul

Paul Grantham
Consultant Clinical Psychologist

11 comments:

  1. yep I agree, unless the solution is built into the therapeutic process, clients just ruminate about their terrible past and present and can't but help to reproduce it.

    ReplyDelete
  2. In response to Jonathan.. What!!!!!!!!???????

    Paul

    I have attended and enjoyed your seminars in the past and hope to again. I absolutely agree with Mr Jeannerod and have realised for years now that visualising or fantasising experiences can be just as rewarding emotionally as the real thing. We all have sexual fantasies for example and the fact that Brad Pitt never has to see my bad bits makes being with him all the more exiting!!!! The other side of the coin though, is when we actualise these activities ( however I know Brad will never happen!!) sometimes the reality is never as good as what we imagined. How often I have imagined what a holiday, event or a particular activity would be like and then can be somewhat disappointed with it. But when time goes on we then move on to what else we would like to do and can visualise again some new experiences and we eventually recall the past events more positively than they actually were at the time.
    It is important to get clients to visualise a "good place" that can be realistically achieved so they are not disappointed when they cannot get there. Maybe could this be a positive therapy for people who would not be able to do certain things but could be taken there in some virtual reality way??
    I have been in this job so long that I only listen to clients trials and tribulations once and then tell them ok we have been through that lets move on and create new and more positive experiences. I have been particularly influenced by what was quoted in one of your seminars " what can we do if nothing we can do will do......do nothing". I have taken this on board even in my own personal experience.

    So ta very much Paul


    Diane Duffy
    Social Care Officer

    ReplyDelete
  3. Hi Paul

    Increasingly, I am noticing that almost everyone who presents for
    therapy has problems with anxiety, & often panic also - my belief, when
    wearing my ecopsychology hat, is this is a result of the ever
    increasing separation from Nature, the earth, normal seasonal cycles etc
    and also an underlying collective consciousness about the demise of our
    planet.

    EFT would view this anxiety and the list below of what clients talk
    about as symptomatic of a past trauma (can be quite subtle such as a
    break from an attachment figure at a key development time) which is
    preventing the normal flow of energy or Chi in the body.

    I agree with the theory below........I probably see this in a more
    simplistic way ( & energetically also when I use Meridian therapy ).
    Basically reframing, visualising, creating a light trance state and
    laying down new positive messages about strengths and choices - these
    are all ways that I work. EFT, which I use in combination with
    Counselling ( not for all however), is a concentrated way of doing this
    - first the "problem" is acknowledged and accepted - I believe it is
    essential to do this bit first before correcting the imbalance otherwise
    there is a risk of suppression - and then we move into the preferred way
    the client would like to be ( feeling, behaving, thinking ). It is
    effective and fast. For example, after only one session the client
    often has no more panic attacks; anxiety is reduced to a point where the
    client is not focusing on it and healthy sleep patterns are restored.

    Thanks for the interesting stuff you send out,
    Annie

    ReplyDelete
  4. I totaly agree with this approach and often use some aspects of IPT urging clients to make small changes week by week and to see things as a challenge rather than a threat. If seen as a challenge they are more likely to rise to the occasion. To put the subject another way Therapy is challenging, and as therapists we must rise to the occasion as well.

    Regards
    Eileen

    ReplyDelete
  5. Hi Paul
    I am coming to the end of a speech and language therapy degree and have been on a number of placements. Two most recent have been working with clients with traumatic brain injury (TBI). It just struck me when I read Marc Jeannerod's theory that brain injury rehab probably is an example of therapists working from this viewpoint.
    Very often these people tend to perseverate on topics of difficulties they are having post-injury with daily living, understanding or speech, and particularly memory, and often they have poor insight into their condition and talk a lot about wanting to return to how they were before the injury. A key component of TBI rehab in SLT is 'goal mapping' where the client identifies anything which they see as goals for their furure. A lot of talk takes place around these and what they might already be doing to achieve or move towards these goals. There is therefore a focus away from the problems through this approach, and although clients' concerns are acknowledged, the emphasis is also very much as you described - on 'doing' the rehab. not just visualising how things might be better. Education (explaining what brain injury is and how it comes about) is considered a key component of rehab because it helps with coming to terms with changes, and practical solution-focused therapy then includes developing and practising strategies to overcome memory,planning and organising difficulties etc.
    Just thought you might be interested to have these thoughts!
    Kathy

    ReplyDelete
  6. Dear Paul,
    But what about that whole Rogerian tenet that if you allow the client
    to express all their negativity, then that paves the way for more
    positive thoughts + feelings to come through? You have to be careful,
    as a therapist that you don't look as if you're trying to suppress a
    client's true feelings. It's cathartic and therefore therapeutic to
    allow a client to let go of all their negativity. Sometimes being
    'positive' is not the appropriate state for someone to be in. I always
    remember as a student on my counselling course, watching a short film
    about a young man who had leukaemia. It was called 'The Right To Be
    Desperate' because the only place this man could express his feelings
    of desperation, was in the counselling room. In front of his friends +
    family he had to be 'strong' and this is often what happens to a
    person.
    Yours, A.T.

    ReplyDelete
  7. Thank you for this timely communication.
    I am currently working as a volunteer facilitator with a Mental health Charity (CLARITY). We usually review the week, what they did how they felt.
    I admit to being fond of Kelly so I support the notion that we have a choice as to how we view the world. I will discus this communication with my fellow facilitators personally I think it makes a great deal of sence.
    I am a retired SALT who has always had a keen interest in cognative Neurological approaches to remediation.
    Yours gratefully
    M.E.

    ReplyDelete
  8. Paul

    It seems to me that lot of what you're referring to is incorprated in
    NLP theory and practice. Any thoughts or comments?

    Regards

    Paul

    ReplyDelete
  9. Seems to me that Therapy is aimed at helping people to function despite
    their painful feelings and the therapy session offers the opportunity to
    practice doing just that ie to be successful in real time .

    A.H.

    ReplyDelete
  10. Hi Paul,

    Yes, I agree with you!

    "What you focus on flourishes!" (as someone said) and "Your consistent
    thoughts become your reality!" (said by someone else!)

    I learnt early on in my EFT work that the sub/unconscious mind doesn't know
    the difference between a real and a vividly imagined event, so what you say
    makes perfect sense to me.

    I don't know how much you know about EFT, but it's all about accepting
    yourself as you are, (complete with whatever problem you may have) and then
    choosing to be something more positive - in effect, moving away from the
    problem.

    I attended your Anxiety day in Nottingham before Christmas and really
    enjoyed it.

    Kind regards,

    L.

    ReplyDelete
  11. Dear Paul,

    I am so glad to read your email and that inspired me a lot to know more. I am a Community Development Worker for
    mental health. My work is always around Black Minority Ethnic communities
    where it is difficult to talk about health and mental health issues.
    Working within communities I do experience a lot about what the starting
    question says. We are basically a signposting service to help people to the
    relevant services and how to access them.
    Kind Regards
    Farhat

    ReplyDelete

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