What if there were a few basic principles and methods that make therapeutic change far simpler and easier—and much more enjoyable for both client and therapist—than most people think is possible? And what if we could often bring about that change in a very short time by modifying a few unconscious processes? Not only is this possible, but there’s already a coherent body of knowledge and practice to guide us in eliciting change in the moment, confirmed by longer-term follow-up in the real world.
I’ve deliberately refrained from naming this approach to keep it from being dismissed as yet another of the thousand or so named models out there, most of which are only different rebrandings of existing therapies with slight variations. If we must have a name for this way of working with internal processes, let’s call it essentials of therapeutic change. It’s a rich tapestry woven from many different threads, from cognitive linguistics to clinical hypnosis, developed by studying the work of therapeutic greats such as Milton Erickson, Virgina Satir, and Fritz Perls, as well as the work of a few outstanding researchers, like Daniel Kahneman’s two systems of thinking and Thomas Gilovich’s work on regret. Developed largely outside of mainstream academia, many different practitioners have been involved in its growth over at least four decades. Few of us could be called originators; most are fieldworkers or adapters.
Much of the development has come from eliciting overlooked, often unconscious, aspects of the before-and-after experience of clients who have recovered from a problem. For instance, people who were no longer depressed had internal images of the future that were large, bright, and colorful; but when they were depressed, their images were small, dim, and colorless. This suggested that helping a depressed client adjust his or her unconscious images of the future to be larger, brighter, and more colorful could be useful. It sounds far too simple to be true, but the videos and feedback from clients speak with authority.
Of course, some complex issues are still difficult to treat with this approach, but many common ones that clients bring to therapy—anxiety, phobias, grief, shame, guilt, self-judgment, critical internal voices, unwanted habits, and general overwhelm—can be dependably resolved with established procedures, usually in the course of a single session.
To make this approach as user-friendly as possible, here are seven practical principles for making sense out of the case study that follows. You can easily test and confirm each of these principles in your own experience, or in your work with clients.
1. Many problems that bring clients to therapy are caused by unconscious processes over which they have no conscious control. By unconscious I don’t mean Freud’s seething cauldron of inhibited desires: I simply mean aspects of our internal experience that we don’t usually notice, like the size, closeness, and color of a troubling memory image, or the tempo, tonality, and volume of a critical internal voice. If our problems were the result of conscious processes, we could just stop doing them, as satirized in Bob Newhart’s short YouTube video in which the therapist listens to the client’s problem and then responds with his universal solution: a loud, emphatic “Stop it!” But since most problems are caused by unconscious processes, that’s where we need to direct our interventions.
For instance, a client might say, “That screwup I made is right in my face,” while gesturing with his palm close in front of his face as his head recoils slightly. If you imagine having that experience yourself, you can notice that if that image of the screwup were smaller and farther away, or off to the side or behind you, the content of the image would be easier to deal with. It takes only minutes to ask clients to try these kinds of process changes, and to find out the extent to which they’re useful in changing their problematic response. I often tell clients, “I’m the authority on what might work; you’re the authority on what does.”
2. Change the cause, not the symptom. Using the metaphor of a malfunctioning car, if your car is smoking, shaking, and making ugly noises, those are important signals of a problem. They may give you some indication about what the problem is, but they’re never what needs to be changed. Filtering the exhaust, using vibration dampers, or soundproofing won’t solve the problem in the car’s engine.
In the same way, unpleasant feelings are important signals that something is wrong, but they’re only symptoms of an unconscious cause. For instance, feeling depressed is often a signal that someone has an internal image of a bleak future. Or perhaps there’s a low, slow, internal voice saying, “It’s hopeless.” To change the feeling, he or she has to change the image or voice that elicits the feeling.
3. Discover the unconscious processes that elicit feelings. These processes are mostly outside of our awareness, but they can become conscious if we pay attention to them. The client’s gestures, direction of gaze, and other nonverbal behaviors often reveal important aspects of their internal experiences. For example, if a client talks about a troubling memory while gesturing in front of her with hands two feet apart, this tells you where her memory image is, and how large it is. Once we’re aware of the process, we can try simple interventions. If the therapist reaches out in the same spatial location and says, “Tell me about that memory again” while moving his hands somewhat closer together and farther away from where the client gestured, that’s an unconscious invitation to see the memory as a smaller image, at a greater distance, which usually makes it less emotionally disturbing, and thus easier to address and learn from.
4. Adjust, don’t eliminate. Many approaches try to abolish a troublesome process by eliciting a competing response, such as teaching an anxious client to think of a soothing context, slow his breathing, or relax her muscles. It’s much easier and more effective to make small changes in the troublesome process itself. For instance, if you hear an internal voice saying, “We’re going to crash!” in a fast, high-pitched voice, you’re likely to feel anxious. Disputing the content of what the voice says will have little or no effect. However, if you hear the same anxiety-producing words—“We’re going to crash”—spoken in a slow, low, bored tone, with a hint of a yawn, you’re likely to experience full-body relaxation without any conscious effort. The process is almost always more important than the content. For example, a sarcastic tonality can completely reverse the meaning of any set of words.
5. The importance of gesture and language. Since a major part of your communication with a client is nonverbal, it’s important to make sure that your gestures congruently specifiy and support the change you ask a client to make. If you say, “Move the image of that critical colleague in front of your face around to a location behind you,” many clients will be able to do that easily; they’d just never thought of doing it before. However, if you first gesture to where their image is, and then pantomime grasping it and moving it behind yourself with your hand, that will make it even easier for clients to succeed in following your instructions. Doing this is also a clear nonverbal message that you’re taking on their experience as if it were your own, signaling respect and empathy in a way that’s far more subtle and impactful than the formulaic verbal, “I understand.”
6. Our internal world is a representation of our external world. If a threat comes closer in the external world—let’s say you’re visiting Yellowstone and a bison approaches you at a good clip—you’ll react more fearfully than if you see it from a distance. The same is true in our internal world: when a threatening image moves closer and becomes larger, it evokes stronger feelings, and vice-versa. Imagine a snarling pitbull coming rapidly toward you. Now imagine the same dog, still snarling but backing up and moving away from you, and notice how your feelings are different. Knowing that the internal world is similar to the external lets us predict how a given internal change might help a client become less reactive. Asking a client to “put a frame around that image,” for example, will typically result in seeing the internal image as flat, rather than 3-D, since most framed images we’ve seen are flat. A flat image appears less real and is therefore less likely to elicit a strong emotional response.
7. Point of view is a key process element. Any memory (as well as any image of the future) can be experienced either as being inside it (reliving it) or being outside it (seeing it as a detached observer). For instance, imagine sitting in the first car on a roller coaster just as it begins its first big descent. As you feel a breeze ruffling your hair, you can see your hands gripping the safety bar in front of you as you look down at the ant-sized people far below. Now imagine sitting on a park bench, looking up, and seeing yourself far away in the roller coaster. This is a choice in point of view that everyone has, but most people don’t realize they have this choice until it’s suggested to them.
When a client remembers a terrifying memory by being inside it, that experience elicits what’s called a phobia or a PTSD flashback. If he steps outside that experience and views the same event as an objective observer in a movie theater, his terror response will diminish.
Anxiety didn’t prevent Joan from doing things; it just made her miserable. An accomplished professional in her mid-60’s, she had a PhD in business and had held several high-level positions in successful companies. Now she was in full-time private practice as a hypnotherapist specializing in treating PTSD. Petite and smartly dressed, with short graying hair and an impish smile, Joan told me she experienced strong anxiety whenever she was facing a challenge, particularly when she was alone and potentially helpless. A recent example: she’d driven alone more than 700 miles across the desert from Arizona to Colorado to participate in my workshop, and had been anxious during the whole trip. So when I asked for a volunteer to demonstrate a method for resolving anxiety, Joan had hesitated briefly and then raised her hand.
When I asked her to imagine being in a situation where she got anxious and to tell me about the experience, she reported hearing a fast, high-pitched, internal voice yelling, “I can’t do this!” over and over, followed by a flood of anxious feelings.
“Notice where the feeling of anxiety starts, and where it goes to,” I said. After some searching, she reported that it started as a feeling of tightness in the back of her neck, then came around her right shoulder, traveled down the right side of her body and into her groin. “As the feeling moves along this path, tell me a little bit about the size of the path,” I continued. “Does it start out small and get larger as it goes down, or is it all the same size?”
Joan replied, “It’s big, immense,” gesturing broadly with outstretched arms. Although it may seem strange that someone could feel a feeling that’s partly outside the body, that’s what many people report. When I asked what color it was, she told me it was white.
“This last question may seem a little bit weird,” I said. “As it goes from your neck down your body, which way does it spin?” Joan quickly gestured with her right hand.
At this point, we were finished with information-gathering and ready for the intervention. “Joan,” I said, “I want you to imagine yourself in one of these situations that’s made you anxious—like driving across the desert to get here—and feel it start in your neck and move down your body. But this time I want you to reverse the direction of spin, change the color from white to one you like better, and add some sparkles to it. Just do that, and find out what happens.”
After a few moments, Joan said, “It feels better. It feels a lot better.” She looked mystified. “It’s really nice. This whole side of my body is relaxing. I’m breathing better.” The change was instantaneous, and her verbal report was congruently confirmed nonverbally. “Would it be OK for you to have this response instead of the old one?” I asked. She immediately responded, “Oh, yes!”
“If you put yourself in the situation that used to make you anxious, what’s it like now?” I asked. Shrugging, Joan said, “It’s easy.” Her new response was qualitatively different, not just a reduction of intensity in her old anxious response. But would it last?
“Some people need a little bit more practice, and that’s what I’m checking for,” I told her, pointing out that if her new response wasn’t automatic in the future, she now had something that she could do on the spot, on her own, to ease the anxiety. Then I asked her to test her new response repeatedly in her imagination. “Think about other situations that you used to get anxious in, and see if you can get the old response back,” I suggested. I did this for three related reasons: to make sure that she had no objection to the new response, to be sure the new response was dependably automatic, and to see that it had generalized to all the different situations in which she used to be anxious.
As Joan imagined several of these, she mused to herself, “One would be in the future, looking at finances, and that’s fine now.” She paused, imagining another situation. “Driving back home, fine. If I get in a place where there’s no cell reception, well, there I am, and I’ll deal with it then.” At the end of the session she said, “What a wonderful gift!”
This way of working with the largely unconscious structure of present experience—in contrast to working with the history that created that structure—makes therapeutic change much more like reprogramming a computer: just find out what isn’t working in the client’s experiential software and offer simple interventions to alter the process. This simplicity has made it easy for many to dismiss the resulting changes as superficial quick fixes, presupposing that they don’t address “deep” issues and won’t last. Though clients are often initially skeptical of this approach—and real-world results are the only way to test it dependably—I’ve never yet had a client complain, “That was just too fast. Couldn’t you have taken longer?”
As I mentioned earlier, some clinical issues are still difficult to resolve quickly with this approach, though the list gets shorter each year. For instance, complex PTSD is a tangled mixture of terrifying flashbacks, guilt, shame, regret, anxiety, disappointment, and depression, often compounded by years of self-medication with drugs and the consequences of poor decisions resulting from that. It’s hard to disentangle and address all those different aspects, even when there are dependable processes for each of them individually.
Keeping these and other limitations in mind can be useful in maintaining a sense of balance and perspective. But they don’t overshadow the immense pleasure and importance of being able to resolve many simple client problems rapidly, making therapy much cheaper, effective, and more available to so many who need it.
This blog is excerpted from "Adjusting the Unconscious" by Steve Andreas. The full version is available in the March/April 2017 issue, Round Hole, Square Peg: If It Doesn't Fit, Don't Force It.
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Illustration © Michael Stanley
Tags: Anxiety | anxiety and depression | anxiety attack | anxiety relief | anxiety symptoms | anxiety treatment | body | body language | brain | brain plasticity | change | changes | clinical creativity | communication exercises | complex trauma | creative | creative counseling | creative counseling techniques | creative therapy | creativity | Erickson | hypnosis | imagination | Milton Erickson | Perls | PTSD | Steve Andreas | Unconscious brain | Virginia Satir