The Doctrines of Psychology

The Doctrines of Psychology continued...

know how to get out. What may have been good at one point, or at least had some good thinking behind it, has taken on its own momentum and we don't know how to stop it. One example of this is supervision.

There cannot be a more over-supervised profession than that of therapeutic psychology. Of course when we first start out we need guidance and supervision. As we continue, peer support and advice from colleagues is just good sense. But the level of supervision expected of most practicing counsellors and therapists is just a nonsense. Of course its all good for the profession because it helps to keep people employed, and can be a nice little earner for the supervisor. But how necessary is it? And is it really serving the patient or client? My main criticism is not just about the amount, but the type of supervision that happens. People are generally supervised by colleagues from their own school of practice. All of the pre-suppositions (doctrines) of that school are endlessly re-cycled in a closed system and are never themselves under scrutiny.

When I was a monk, I was very critical of the daily routine of the Chapter of Faults. During this morning meeting, each brother would take it in turn to 'confess' breaches of the Rule or other misdemeanours. In theory it was a good opportunity to make community life work better. In practice, the things that really mattered were seldom mentioned. Instead trivial items like inadvertently saying Alleluia during Lent were 'confessed'. Supervision is only as effective as the honesty and awareness of the supervisee will allow. Regular supervision does not, I believe, guarantee good therapeutic practice. The only thing it guarantees is a regular income for the supervisor and the likelihood of the maintenance of dogmatic rather than effective therapeutic intervention.

Human Givens — What it is

I will start with a quotation from the Human Givens Website:

We all have basic emotional needs, such as the need for love, security, connection and control, and the self-esteem which arises from feeling competent in different areas of our lives. We also have the innate resources to help us meet these needs, including: memory, imagination, problem solving abilities, self-awareness and a range of complementary thinking styles to employ in various different situations. It is these needs and resources together, which are built into our biology, that make up the human givens.

When emotional needs are not being met, or when our resources are used incorrectly, we suffer considerable distress. And so do those around us.

Human givens therapists focus on helping clients identify unmet emotional needs and empowering them to meet these needs by activating their own natural resources in new ways. To do this they use a variety of up-to-date, proven, brief solution-oriented techniques.

I guess it would be true to say that the starting point for Human Givens is biology rather than psychology. It is understood that, as a species, we have certain innate needs and resources 'built in' to our system by the evolutionarily process. These are the initial point of reference, the 'givens' of our human nature. For any species to flourish it requires its needs to be met in a balanced way. A plant needs very little — water, light, nutrient in the soil and sufficient space for its roots and foliage to grow. But each species needs a particular balance of these to do well. Plants can sometimes survive under very poor conditions (as our house plants can testify), but they will not flourish if the balance of their needs is not met, and will die if some are missing altogether. The same is true of the human being, although the balance of needs to be met are more numerous and complex. Human history has shown us that people can survive the most appalling treatment and conditions, but only survive, not thrive.

The Human Givens approach is to recognise that when the innate needs of a person are not able to be met in balance by their (also) innate resources, that person will suffer. Some of the major needs are:

The need for autonomy and control.
The need for attention.
The need to be emotionally connected
The need to be valued
The need for meaning and purpose.
The need to be stretched — to 'go beyond ourselves'
The need for privacy and personal space

As well as these particularly human needs (some might say mammalian needs) there are also the basic needs of air, food, water, shelter, security etc that are common to most life forms. This of course is not unfamiliar ground, Maslow's hierarchy will come to mind for many people. Perhaps one of the differences with the HG approach, compared with other strictly psychological approaches, is that it is prepared to be pro-active in a way that would be anathema to other disciplines. This 'common sense' attitude to healing has ancient antecedence. From the Epistles in the New Testament we find; "If a brother of sister is ill-clad and in lack of daily food, and one of you says to them,'Go in peace, be warmed and filled,' without giving them the things needed for the body, what does it profit?"[6] This religious (I would call it humanistic) insight, precedes Maslow's hierarchy by some two thousand years and states quite simply a fundamental truth of human nature (often missed in medicine) that the needs of the whole person need to be addressed.

If a person comes to me depressed, my starting point should not be to assume that he or she had a traumatic childhood and will need years of psychological archaeology to discover the cause. No, it should be practical and here-and-now questions to start with. If a person is depressed because of bullying, it may be that they were bullied as a child, but is that where I want to go? No. Is that where the client wants to go? Almost certainly not. What is needed is swift relief of the symptoms of depression and to find a way to stop the bullying. A Human Givens therapist is willing to be pro-active with and for his or her client to find solutions to present problems. Like my colleague mentioned above in taking the agoraphobic client out for a hot chocolate, a little practical help can be worth months of 'isolated' therapy in the recovery of a client.

I mentioned the swift relief from the symptoms of depression. This is where there is a real difference between HG and most other therapies. Coming from studies in brain function[7] and from Joe Griffin's twelve year research programme on the function of dream sleep and the REM state[8], highly effective therapeutic interventions are possible in a short time span. I cannot do justice in this short article to these new insights, but will do my best to give a brief outline.

In the centre of the brain lies the limbic system, this could be referred to as the 'mammalian' or 'emotional brain'. Part of the limbic system is the amygdala. This little gland is the 'watch-keeper' and scans the environment for anything it perceives as dangerous. It does this by pattern-matching to the brain’s memory store and to our innate 'alarm system'; (we are innately cautious of heights for instance).

If the amygdala picks up anything that matches a perceived threat (the match needs only to be metaphorical, not exact), it will send out the signals for 'flight or flight' hormones to be released — adrenalin and cortisol in particular. These chemicals make us ready for action, but there is a negative effect also. Because, in evolutionary terms, it was those who were able to act the quickest who survived — no good standing around thinking "I wonder if that is a hungry sabre-tooth tiger" — the release of stress hormones has the effect of blanking off the higher cortex. Evolution has 'designed' us in such a way that action takes precedence over thought. The more emotionally aroused we become, the less we are able to think straight. To put it simply, emotional arousal makes us stupid.

Secondary negative effects come also from the fact that the amygdala cannot tell the difference between a real and actual threat, a viewed threat (as in a film — who hasn't had sweaty palms in a really scary movie?) or our own imagination. A good imagination used wrongly — too much worry and rumination — will have the same affect on us as a real threat would; raised stress hormones and 'fuzzy' thinking.

Dream Sleep

Dream-sleep research, both Joe Griffin's and other people's, points to the conclusion that the job of dream sleep is to deactivate arousal levels left in the body from the previous day. By metaphorically pattern-matching to the previous day's unresolved arousal stimulus, the dream 'switches off' the stress stimulus response in the autonomic nervous system. It is only unresolved situations that require dream deactivation, any situation that has been 'acted out' in waking hours is already deactivated in the autonomic nervous system.

In a normally healthy person, there would be approximately twenty to twenty five percent dream sleep per night, and seventy five to eighty percent slow wave sleep. In somebody very stressed by events or worry, these proportions can become upset or even reversed. Because dream sleep is a highly active state and slow wave sleep repairs and refreshes the body, the result of an upset to the balance is mental and physical exhaustion. Waking feeling as though they have just run a marathon, the individual finds the next day even more hard to cope with and stressful; and so the pattern repeats itself. This is the cycle of clinical depression. It is a twenty four hour cycle that is likely to deepen and remain unless broken.

The Human Givens approach to treatment is often to bring down the client's arousal level as soon as possible. Using relaxation techniques and guided imagery, one aims to re-unite the client with their own higher cortex; successful work cannot be achieved with a client who has only 'half a brain' available to them. Explaining to a client the twenty-four-hour cycle of depression and its physiological aetiology is hugely empowering for them, Understanding brings the possibility of control. There are simple and practical things the client can do for themselves that will cut into the depressive cycle very quickly — to stop the ruminating and worrying (I know, easier said than done), to get a little exercise[9] (this will raise serotonin levels), become more socially active (if only in small ways), get a balanced diet and do some fun things. All these will help to lift depression very quickly[10].

Effective Model

There is a basic but effective model used by HG therapists; the APET model. One looks for the Activating Agent — what is it that is causing the stress — and this needs to be dealt with. There is then the Pattern match — what is the brain matching up to from previous experience. Then there is Expectation and Emotion engendered by the pattern match and finally the Thinking which comes after the emotional arousal. This is where there is a difference with classical CBT which would say that thought causes emotional reaction. Emotional arousal comes first.

The amygdala triggers the stress hormone response before the higher cortex has even become aware of what is going on. Once activated, the stress hormone response dulls down our thinking ability and we become the 'victims' of our own brain chemistry. An example of this happening would be a student who has done all the work necessary for a good degree. Unfortunately he is very anxious about examinations. The amygdala picks this anxiety up as a real threat before the higher cortex can have a calming effect. He comes out of the examination room saying "my mind just went blank". People living with chronic stress, real or perceived, are 'run' by their emotions because the thinking brain is unavailable for the job.

In the therapeutic world it is often thought to be the case that, for the client, it gets worse before it gets better. That may be because we are making it worse. If a man comes into therapy because he has suffered a relationship breakdown, he may just need help in seeing that actually, going out every night with his mates is not conducive to a good relationship. If we spend weeks going into every painful event of his life — given what we know about the working of the amygdala — he will almost certainly end up with depression even if he did not have it to start with.

From my own practice I can see that using the HG approach to therapy (and more besides) is hugely helpful and effective. I have seen clients who have been depressed for months or even years, and in just a few sessions they are 'up and running again'. Often the remaining problem is dealing with the side-effects of medication and the 'dis-continuation symptoms' as the pharmaceutical industry euphemistically calls them. PDST is also treated extremely effectively; again this comes from knowledge of what actually happens in the brain and the use of the REM state to 're-programme' the brain. I have seen clients who have suffered for years and undergone months of different types of counselling, only to be cured of their PDST in one or two sessions using HG methodology.

Where from here?

I believe that the Human Givens approach gives the psychological therapeutic community an opportunity to ask itself some difficult questions. It throws up a challenge to dogmatic psychology which is well over due, and it offers some interesting, useful and therapeutically beneficial understandings and techniques that we can all benefit from.

There is a risk of course, that HG could become as dogmatic as those it criticises. I think this is less likely to happen than in other schools of therapy because of its research base; it is always ready to modify its teaching in the light of new evidence. But the danger remains, and it remains particularly so because different schools remain entrenched in singular ways of thinking and practice. There is a real threat of an 'us and them' bunker mentality arising between HG practitioners and other methodologies, which is clear to see already between other therapeutic schools of thought.

My hope is that the insights and practices of the Human Givens school of thinking will be widely discussed, used and criticised. In the therapeutic community we need to show an openness of thought and practice that will serve our clients and patients better than religion has often served its clientele. There is a lot of argument and discussion at the moment about the regulation of counselling and psychotherapy. It would do those involved no harm to read some of the early Counsels of the Church, who was 'in' (orthodox) and who was 'out' (heretics) and what practises and beliefs were acceptable, and what were not. If we are not careful in the therapeutic community, we are in danger of repeating history. Just as the world-wide church has lost a great deal of credibility in the eyes of modern people, very largely because it has been too inward looking and cared too much about its own internal 'niceties'; we too are in danger of also being judged and found wanting.

I fear that the registration process in this country is, and will increasing become, a method of increasing the power base of 'orthodoxy', suppressing 'heretics' who challenge the received wisdom. There is enough difference in current therapeutic practice to recognise that no one way has the monopoly on psychological healing. Most of the methods, schools and techniques have some merits — although I have to say some of the older dogma based institutions seem to show little to recommend them today — but none have all the virtues.

A way forward is surely to be more critical of ourselves as a community. We desperately need to discard outdated dogmas and ideas, often stemming from the nineteenth or early twentieth centuries, and aim towards a more researched based, outcome oriented philosophy. Certainly let there be differences: Practitioners are unique human beings, and this will, or should be able to find expression in the therapeutic setting. These differences however should not become rigid dogma that excludes other techniques and force our therapeutic interventions into a 'one size fits all' model. The history of the Church has been one of reluctant change and dogmatic intransigence. I hope the therapeutic community will not go the same way.

There is a saying in church circles that "many a church organist will have to answer in heaven for their good taste in music." Too often congregations have to suffer what the organist thinks is good for them, rather than what they actually want or need. Is this not all too often what happens in therapy? A single model or approach is foisted upon the hapless client regardless of their actual needs. It seems to me that a good therapist should be like a jazz musician, able to improvise and 'jam' as needs demand, supplying what the client actually requires, rather than what the therapist’s 'good taste' dictates.
There is an old story that comes from Hindu tradition; what it signifies is certainly true of the church and religion, perhaps as a therapeutic community we might take it to heart as well?

When the guru sat down to worship each evening, the ashram cat would get in the way and distract the worshippers. So he ordered that the cat be tied up during evening worship. After the guru died, the cat continued to be tied up during evening worship. And when the cat died, another cat was brought to the ashram so that it could be tied up during evening worship. Centuries later, learned treaties were written by the guru's scholarly disciples on the liturgical significance of tying up a cat while worship is performed.

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References

This article first appeared in Volume 33, No, 5 (2006) of Self and Society - A forum for contempory psychology

CHRIS SCOTT works part time for the HNS in a Primary Care Trust as an organisational consultant, and is also in private practice. A one-time monk, he has been an ordained Anglican priest for over twenty four years, and is also a member of the BPS, AHPP. HGI and BACP. His recently published book Lifting the Lid on Depression is a self-help book using Human Givens principles.