Human givens brief psychotherapy - working with the APET model
Joe Griffin, Ivan Tyrrell and Farouk Okhai
WHEN emotional needs are not met, for whatever reason, anyone can suffer distress. If the situation persists, more serious emotional disorders are easily triggered: anxiety, obsessional or addictive behaviour, depression, bipolar disorder, psychosis etc. At this point people often seek help. Then a new layer of problems arise centring around the best way to be treated.
Over the last year or so we have read with great interest the articles in various publications from the Royal College of Psychiatrists about different models of psychotherapy. It is heartening that psychiatrists have a strong interest in learning about the innovations that are taking place in psychotherapy but there is clearly a problem which needs facing (as the variety of articles published illustrates): that the often confusing world of psychotherapy and counselling - which is only slowly emerging into the light of scientific enquiry - is under attack.1,2 Periodically reports come out showing that neither does much good and both often do more harm than good.3,4 There are also ongoing academic arguments within the profession, and confusion outside, as to the difference, if any, between counselling and psychotherapy and who should be considered qualified, and on what grounds, to practise. Rarely do counselling tutors demonstrate the techniques they espouse in front of students with real patients. There are as yet no standardised assessment criteria for counsellors and psychotherapists across the different schools of therapy, and few courses directly assess their students effectiveness with real patients before qualifying them to practice.
Estimates vary but currently there are at least 400 different 'therapy' models on offer throughout the world5 - which indicates the general lack of shared perceptions about how best to help people. If there were 400 different models about how heavier than air machines might fly, people would not be in a position to confidently design and build aeroplanes that flew. In other words, psychotherapy is still at a primitive level of development.
This situation is clearly chaotic and bewildering for all concerned: members of the general public seeking help and those sincerely trying to help them. It also bothers neuroscientists like Professor Ian Roberstson of Trinity College, Dublin, who said recently, "I am dismayed at how counselling and psychotherapy practice in many areas has become wilfully divorced from evidence and science to the extent of becoming self perpetuating cults in some cases. No one has the right to pick and choose a theory as a matter of personal preference and then offer it as a service to someone when there is a possibility that that service might do harm. We have to move towards evidence based practice and away from cults and ideologies."6
In an attempt to resolve this confusing state of affairs members of European Therapy Studies Institute (ETSI) set about looking again at the evidence for what we, in all schools of psychotherapy, think we know. This was inspired by the common sense idea that therapy always works best when it operates, not from an ideologically commited standpoint, but from a real understanding of what it is to be a human being.
Many professionals are finding this investigation is bringing a refreshing clarity of thought and vision to the field, enabling people to see more clearly what is of value in any particular therapy method - and what is not. It quickly became known as the 'human givens' approach.7
The human givens approach draws its power from observation, research, clinical experience, the neurobiological and psychological sciences as well as our collected heritage of wisdom gathered from many cultures down the ages. It says that, to be effective, a psychotherapist has to be aware, not only of the basic physical and emotional needs programmed into us by our genes, but also of the nature of the resources endowed to us to get those needs met in the environment. These needs and resources together comprise the 'human givens' what nature has given us to help us fulfil our genetic potential. When needs are met well, we have a sense of purpose, achievement and a depth of understanding about our life. This promotes mental health. If our needs are not met we become disturbed. In the same way when we use our innate resources well we feel we are living to the full but if we misuse them we suffer and become prone to mental illness.
Few would argue that to feel valuable and fulfilled our emotional needs have to be met. That's one reason why this framework provides a strong platform to build agreement between schools of thought in psychiatry and psychotherapy with the aim that we can all become more effective. We can list some of the main emotional needs, along with some of the resources, as follows: Emotional needs include:
• Security - safe territory and the room to fulfil their potential
• Autonomy and control
• The need for attention (to give and receive it)
• A sense of status within social groupings
• Being part of a wider community
• A sense of achievement
• The need for meaning - (which comes from being stretched)
The resources nature gave us include
• The ability to develop complex long term memory
• Imagination which can allow us to envisage solutions to our problems and to understand other perspectives
• The ability to understand the world through metaphor - complex pattern matching
• An observing self - that part of us that can step back, be more objective and recognise itself as a unique centre of awareness
• The ability to empathise and connect with others
• Consciousness which enables us to question, analyse, learn and enrich our unconscious knowledge base
• A dreaming brain that preserves the integrity of our genetic inheritance every night by metaphorically defusing emotionally arousing introspections not acted out the previous day.
These needs and tools together are the human givens, nature's genetic endowment to us. They are handed down through the generations in our genes and, automatically (in undamaged people) seek their fulfilment in the environment. It is the quality of the way those needs are met that determine the physical, mental and moral health of an individual.
Just as the givens of human nature are interconnected and interact with one another, allowing us to live together as many-faceted individuals, it seems that different therapy approaches also need to interact if they are to be capable of addressing the different elements of who and what we are. Yet, as each new approach to dealing with human distress is launched upon the world, it immediately begins a process of entrenchment, digging itself into a rut by developing a systematic ideology that results in the development of techniques that are applied rigidly to every person with a problem.
The first thing the ETSI research group got out of the way was the myth that there is a difference between counselling and psychotherapy. The only useful differentiation the group could make was around the questions, 'how effective is this individual (counsellor, therapist, psychologist or whatever) at helping a person use their innate resources to get their needs met and deal with depression, anxiety disorders, anger, trauma and addiction etc.?' - not what they called themselves or how they were qualified. In this article therefore we use the terms interchangeably.
All major therapies seemed wonderful to some people in their heyday. Perhaps the most valuable thing Sigmund Freud's psychoanalytical therapy did at the beginning of the 20th century, for example, was to highlight and draw the attention of the Western world to the ancient insight that many of our everyday behaviours are largely controlled by unconscious processes. However, the value of incorporating this simple but important truth into our culture was then largely undermined by Freud himself. Operating out of unrealistic models of human functioning and psychology, based largely upon the mechanistic 19th century understanding of biology, he mounted a campaign for his ideas. Thus his powerful writings effectively muddied the waters of psychiatry, psychotherapy and counselling for the remainder of the last century. The development of complex psychoanalytical theories (which were never scientifically tested by Freud or his followers, only asserted as true) was based, in Freud's case, on only six published case histories, all of which were disasters from the point of view of his patients.8,9 The legacy of psychoanalysis and its offshoots is a disturbing story of misguided, often harmful, treatment.9
Behaviour therapy, which developed partly as a reaction to the unrealism of psychoanalysis, also contained a profound insight. While others were still grappling with the 'deep unconscious', behaviourists discovered that changing behaviour often helped people resolve problems. They made use of the knowledge that there are innate pleasure circuits in the brain which can be stimulated by certain behaviours. When people were shown how to structure more desirable behaviours - behaviours more rewarding than destructive ones - they found it easier to make healthy changes. And the reason this approach often worked was that, if people can get their physical and emotional needs met, they will not suffer from anxiety, anger, depression addictions and so on. When any counsellor clearly targets the elimination of behaviours that are stopping a person's needs being met they are bound to have success. Encouraging depressed people to get more physically and socially active, for example, not only leaves them with less time to negatively introspect, it stimulates an increase in serotonin production and thus helps to lift their depression. That is powerful therapy.
Unfortunately behaviourism in the way it was taught swelled into a total philosophy which allowed no dissenters. Students were told: there is no such thing as consciousness, there's no such thing as mind. What you think has no effect upon you. You are your behaviour and nothing else. Pure behaviourism became a gross distortion of what humanity is about. It undermined values and meaning in life and took away people's personal autonomy.10
We then had the growth of client centred therapy - active listening - developed by Carl Rogers nearly 60 years ago. His idea was that, if you truly listen to somebody with a problem, and let them know that you are really listening, by feeding back your understanding of what their problem is, you are delivering very powerful therapy. Now there is some truth in this. Patients do need to have their story heard in a respectful, non judgemental atmosphere. Sometimes when a person is temporarily emotionally overloaded, just to have their story heard in a supportive way is all that is required for them to calm down, get a bigger perspective on their life situation and chart a way forward. Most people who come to counselling or therapy, however, need more than support. They are emotionally aroused and therefore have to borrow someone else's brain for a while to help them lower their arousal so they can think clearly and learn how to move on. The counselling they need may involve social skills training, learning anxiety or anger management skills, getting help with an addiction, or being detraumatised from terrible past experiences that are influencing their present behaviour. So, although active listening is an important component of therapy, it is usually only a small part. But, with person centred counselling, again the inevitable happened. Active listening expanded into a philosophy which said: all anybody needs is for someone to really listen to them and a 'self-actualising principle' inside them will then manifest itself and sort all their problems out.11
This is beautiful idealism but is plainly wrong as experience shows. For example, you can listen to somebody with depression for ever and a day and they may still not come out of it, in fact they may become more deeply depressed. (This is why psychodynamic 'insight' therapy is contraindicated for treating depression - the depressive trance state has to be broken, not deepened.12) It could well be that one of the main reasons for the research findings that counselling is so often ineffective13 is that counselling training is still largely based on this active listening/self actualisation philosophy. Of course knowing how to listen is a vitally important skill, but much more is needed to effectively help people with emotional problems.
The more recent and currently popular approach, cognitive therapy, is clearly going the same way. It is based on the straightforward idea that, if we can get people to use their rational mind and question the evidence for their damaging negative belief systems, they can change. Helping people to make more realistic assessments of their life is powerfully effective, especially if they suffer from depression or anxiety. But in cognitive therapy we already see the same degenerative process at work. The original brilliant insight, which could be grasped at a single workshop, generated an enthusiastic following. But then pedantic people become involved and began writing complex books about it. Eventually ever more complex books about the complex books were written, littering psychology bookshelves, and people have now come to believe that several year's training is required to discover what cognitive therapy is all about before they can practise it on the public.14
Solution-focused therapy originated in the 1980's and has proved beyond doubt that it is possible to treat many people far quicker than was previously assumed. This is because, like cognitive, interpersonal and behavioural approaches, its emphasis is on the present and future. By using scaling, for example, it stimulates emotionally disturbed people to access their left neocortex and thereby gain control over the emotional excitation manifesting in their right cortex. And, by looking for and using patient's strengths and resources, helps them to focus on how things could be different. This is certainly useful. But again, because it is not operating out of a big enough organising idea where the therapists know why something can work, it too has become formulaic relying heavily on finding 'exceptions' to the presenting problem in the patient's life, asking the 'miracle question' over and over and complementing patients on their strengths. Applying such a methodology to a depressed person, for example, would not work if the person is depressed because of PTSD, social phobia or lack of social skills. If a person is disturbed because they don't know how to get their fundamental emotional needs met in the world they need more direction and help than this.15
It is an odd fact that therapies, as they become more established, tend to become more complex and formulaic. In extreme cases they ossify into a closed system of thought, unable to look at the totality of what it is to function as a human being. Cognitive therapy, for instance, focuses primarily on the rational aspect of the human mind as a means of lifting depression or anxiety. (We could equally accurately say that problems are caused by a misuse of imagination and that a solution is to help people use their imagination more effectively.16)
Schools of therapy or counselling typically develop jargon that makes them incomprehensible to outsiders. As a rule when an approach starts getting really complex and develops jargon - psychobabble - it does so to make up for its lack of effectiveness. Yet, because of the amount of time adherents of a school of therapy have invested in the approach, they feel increasingly wedded to it - and then an organic integration of the insights contained in other schools becomes impossible. That is why the human givens approach is so valuable - it helps therapists to step back and see how all these elements interrelate.
Many people who have worked with CBT, person centred or solution-focused models are attracted to the human givens approach because it gives them a solid framework of understanding to look at why some things they have been doing were more successful than others. The most resistance to it has come from those working with a psychoanalytical perspective who like to say that the human givens approach only deals with symptoms, not the underlying problems. But research and experience does not support them. When time is spent digging up everything you can remember of what went wrong in your life, and exploring problematic past relationships in an effort to 'understand', it does not improve confidence or give you the skills to deal with life today. Such psychological archeology was the dominant approach in therapy for a long time and it still lingers on in some quarters. Freud and Jung are historically important but have little practical relevance to modern psychotherapeutic practice and may well come to be seen as having held it back from developing more quickly.
So what is effective therapy? Until the 1970s studies seemed to find that all therapies were roughly as good or bad as each other at solving human problems.17 This was because, for the most part, therapists were rating their own effectiveness. More careful research has overturned that view. We now know that certain approaches are hugely effective in helping people and others much less so - some are even harmful. For example, when many hundreds of efficacy studies were looked at together, in a meta-analysis, brief therapy with a problem solving focus was proved more effective for the treatment of anxiety disorders, depression, pho bias, trauma and addictive behaviour than any long-term psychoanalytic style of therapy or drug treatments.18, 19, 20
The difficulty with all the above mentioned schools of therapy is that they were all formed before the huge upsurge in information about brain functioning that has become available to us in the last five years or so, due, in part, to massive technological advances but also to some major new scientific insights.
The cognitive model was first formulated some decades ago. While it signified a brilliant step forward in therapeutic treatment methods at the time (psychodynamic therapy was the predominate model then), it is clearly not in alignment with what we now know about how the mind/body system works and can seem slow and artificial. Typically patients are expected to learn the language of the model, monitor their thoughts and moods, fill in complex forms and perform various prescribed homework tasks. It's an unnatural way to carry on. The therapeutic relationship is very much one of the patient seeing an 'expert' rather than one of being a collaborative exercise between people in good rapport. Not surprisingly it often needs up to 12 or 18 sessions to make a significant improvement, and that's only in patients who can put up with such a way of working. Many patients find it difficult (due to their emotionally arousal making it hard for them to concentrate) and drop out disappointed.
By understanding the thinking behind the cognitive model we can see the importance of the new knowledge more clearly. Albert Ellis, the originator of rational emotive behaviour therapy, the first form of cognitive therapy, set out the structure of his 'thoughts cause emotional consequences' idea in his ABC model. A stands for the activating agent, the trigger event or stimulus in the environment that we are going to react to. B stands for the beliefs or thoughts we have about that event. C stands for the emotional consequences of those thoughts. So, the reasoning goes, something happens, we interpret it through our thoughts and core beliefs, and we have an emotion. In other words our beliefs and thoughts give rise to our emotions. The cognitive model states simply that if we change our patients' thoughts and irrational beliefs, "shift their perceptions from those that are unrealistic and harmful to those that are more rational and useful",21 then we will improve their emotional lives.
Another pioneer of in this field was Aaron Beck, who founded cognitive restructuring therapy. He concentrated primarily upon classifying and identifying what he regarded as the thought distortions which gave rise to all psychological disorders.22 Over the decades cognitive therapists have continued to add to and further refine these thought styles and belief systems, which include, for instance, catastrophic thinking, overgeneralisation, personalising, sensationalising, fault-finding, 'musterbation', nominalising, self-righteousness and disqualifying positive life experiences.23 We could see that most, if not all, of these thought distortions have one thing in common. They are all sub-categories of the black and white, polarised thinking style - fight or flight - that originates in the emotional brain. This key insight is missing from cognitive therapy.
Ellis, Beck and other writers on cognitive approaches state or imply in their writings that, when problems occur, it is thinking that is defective. We would say that this is less helpful than it might be since thinking driven by the emotional brain is always all or nothing, black or white, fight or flight. The more emotionally aroused the brain becomes, the more it reverts to the primitive logic of either/or thinking.
The weakness in cognitive therapy is the idea that it is always thought that causes emotion. Their methods work sometimes because there is an important connection between thought and emotion (and because cognitive therapists don't concentrate on the past but on concrete difficulties experienced in the here and now, which is the key to solving problems). But, by focusing on the idea that irrational thinking causes emotional disturbance, cognitive therapists are less likely to be as effective as those who look at their clients from the perspective of the human givens, which takes into account as much current knowledge about the way the brain works as possible. It is a given that any form of strong emotional arousal makes us more single-minded - and hence more simple-minded.
We are all more likely to get better results with our patients if our therapeutic technques accurately model how the brain really works. What follows is an updating of the old cognitive ABC model with the latest neurological findings of how emotion and thought are connected.
The APET model
The first public explanation of the APET model was given by Joe Griffin at the Redhill Post Graduate Medical Centre in Surrey, England, in May 2000. From that moment the trainee psychotherpists present, who were drawn from psychiatry, clinical psychology, social work and counselling, could see that it offered a more psychologically and physiologically accurate view of mind/body functioning for them to worlk from. Since then over 20,000 professionals attending MindFields College seminars throughout the country have been introduced to it.
The A in APET stands for the activating agent, a stimulus from the environment, just as in the cognitive model. Information about that stimulus, taken in through our senses, is first pattern-matched by the brain for significance to innate knowledge and past learnings, hence the P, which in turn gives rise to an emotion, E, which in turn may inspire certain thoughts, T (though thought is not an inevitable a consequence of emotional arousal).24
This is a model that is much more in tune with reality. It can not only help therapists, but throw light on numerous other phenomena: How a virtuoso violinist performs the immense complexities of a concerto the ethereal harmonies, melodies, tones, changing rhythms and moods - and thereby entrances an audience; How we recognise an old friend we haven't seen for twenty years; Why are there not millions more car crashes every day as motorised populations around the world negotiate complex urban road systems at speed; How a farmer knows exactly the right moment to begin harvesting; How we learn; Why placebos work; What happens in our minds when we start to laugh before something funny happens; In what subtle way does a craftsman know when his work of fine art is complete; How we pick up what someone else is feeling, and why we sometimes feel anxious without a conscious reason for it.
The importance of perception
The active ingredient in effective psychotherapy always centres around meaning - changing the meaning of something is what effective counsellors do. The APET model is about the order of events in the way the brain perceives meaning and reacts to what it perceives. Perception, and the way we react to our perceptions, depends on the brain's ability to pattern match to innate and learned knowledge. The inborn patterns - templates - are so fundamental that no reality can exist without nature presetting them into organisms in the first place. Although we talk about pattern matching, in a way it is more accurate to talk about pattern perception. This is because it is not so much that we actually hold a template and seek the match of it, we actually perceive reality through the template. In other words, what we perceive are the meanings that we attribute to certain stimuli.25
This was demonstrated startlingly clearly in cases where cataracts were removed from people blind from birth. Arthur Zajonc describes the outcome of one such operation: "In 1910, the surgeons Moreau and LePrince wrote about their successful operation on an eight-year-old boy who had been blind since birth because of cataracts. Following the operation, they were anxious to discover how well the child could see. When the boy's eyes were healed, they removed the bandages. Waving a hand in front of the child's physically perfect eyes, they asked him what he saw. He replied weakly, 'I don't know.' 'Don't you see it moving?' they asked. 'I don't know,' was his only reply. The boy's eyes were clearly not following the slowly moving hand. What he saw was only a varying brightness in front of him. He was then allowed to touch the hand as it began to move; he cried out in a voice of triumph: 'It's moving!' He could feel it move, and even, as he said, 'hear it move,' but he still needed laboriously to learn to see it move. Light and eyes were not enough to grant him sight. Passing through the now-clear black pupil of the child's eye, that first light called forth no echoing image from within. The child's sight began as a hollow, silent, dark and frightening kind of seeing. The light of day beckoned, but no light of mind replied within the boy's anxious, open eyes.
"The lights of nature and of mind entwine within the eye and call forth vision. Yet separately, each light is mysterious and dark. Even the brightest light can escape our sight.26
So, for everything we become aware of, there is a pre-existing, partially completed, inner template, innate or learned, through which we literally organise the incoming stimuli and complete it in a way that gives it meaning. These metaphorical templates are the basis of all animal and human perception. Without them no world would exist for us. They organise our reality.
With this understanding we can see how crucial meaning is when helping people who are using inappropriate patterns through which to understand their reality. Obviously if attention is kept locked by strong emotions of depression, anxiety, anger or greed that frames the meaning of life for us and the pattern needs adjusting closer to reality. If a person has a mental template that the world owes them a living, for example, they need an input to correct that, otherwise they will always see their interactions with other people through this parasitic viewpoint and fall foul of the people around them. Likewise, someone who idealises the opposite sex is doomed to disappointment until a more realistic template is set in place.
Patterns of perception in our brain always seek completion in the environment and each perception is 'tagged' with emotion. Emotions are feelings which create distinctive psychobiological states, a propensity for action and simplified thinking styles.27 They originate in the limbic system and it is here and in the thalamus that all basic patterns are stored.28 This system is continually on the lookout for physical danger, monitoring information coming through our senses from the environment. It does all this prior to consciousness. There is an emergency short cut or fast track in the brain via which signals potential threat recieved via our senses in the amygdala, before they reach the neocortex, the 'thinking' brain. This allows the 'emotional' brain to respond instantly to threat by triggering the 'fight or flight' reflex, and happens before the conscious brain knows anything about it.29 In other words, we unconsciously interpret each stimulus in terms of "Does it represent a danger, or is it safe?" Perhaps even more fundamentally, "Is this something I can eat, or is it something that can eat me?" or, "Is it something I can approach or something I should get away from?" The conscious mind is presented with the end result of this analysis - what the emotional brain considers the significant highlights.
The information that comes into conscious awareness arrives up to half a second after the reality has been experienced unconsciously.30 In other words, human beings experience conscious reality after it has actually occurred. It is what happens in that half second that is significant. Information, processed subconsciously at enormous speed, is compared to patterns already existing in the brain derived from previous experiences. On this basis the emotional brain decides whether what is happening now is threatening or non-threatening. Only after this filtering process has occurred is information sent 'up', if necessary, into consciousness.
Our perceptions are is always accompanied by emotions, ranging from very subtle to extremely strong. Emotions exist at a stage prior to language. They are the only language available to the subconscious mind for communicating the significance of patterns. It is the emotions that propel the higher cortex towards deciding an appropriate reaction to a particular situation. We become conscious of a feeling of anxiety, distrust, anger or attraction, and the higher neocortex then has the choice either of going along with it, or questioning it. That is when thoughts come into play.
In summary, if an emotion is strong, the signal will take the fast track route and trigger a response before the neocortex has had time to get involved. This is what happens when someone suddenly feels anxiety in a dark alley and runs away from a possible attacker in the shadows. It is also what happens in non-emergency situations which certain individuals respond to as if they were emergencies because they haven't learned to adjust an inappropriate pattern from the past: for instance, when aggressive men automatically hit out at others before they have even had time to think what they are doing and why.
When the emotional arousal isn't quite so strong, the information can take the 'slow' track which involves the neocortex. In such circumstances, in the dark alley, it is the neocortex which may decide that the shadows are in fact empty and that the feelings and thoughts which they have prompted need modifying. At this point the conscious mind is acting as part of a feedback loop to the pattern-matching part of the mind, sending the message, "I think this pattern needs adjustment. I'm imagining things. Calm down."
It is the job of the conscious mind to discriminate, fill in the detail and offer a more intelligent analysis of the patterns offered up to it by the emotional brain. The 'either/or' logic of the emotional brain is its most basic pattern - one that goes right the way back to earliest life forms, unicellular creatures - and this, crucially, is the foundation on which much of our behaviour and thinking rests.
The fact that all emotions operate from a binary, black and white, good or bad, perspective has had huge consequences for human evolution and history. The emotional brain is necessarily crude in its perceptions and the degree to which the fight or flight reflex is activated is the degree to which our thinking becomes polarised - more black or more white. When the emotional temperature rises, the emotional brain 'hijacks' (to use Daniel Goleman's memorable term) the higher, more recently evolved, cortex and quickly begins to blank out the more subtle distinctions between individual stimuli. (When one is in danger of losing one's life, the ability to make fine discriminations must be shut off, so that we can act promptly and instinctively to take strong self preservative action.) So, with emotional arousal there is only a right or a wrong, all or nothing, black or white perception. Everything operates out of these two extremes.
If we look around the world today, wherever we see prejudice, discrimination, conflict, violence, torture and inhumane behaviour it is invariably accompanied by high levels of emotional arousal. The people doing these things are not different from the rest of us. Even the most intelligent person can behave like an ignoramus when emotionally aroused. And an atmosphere of continuous emotional arousal maintains ignorance because, when the higher neocortex is inhibited, no one can see the bigger picture. Black and white, emotional logic eliminates fine discrimination. As the old saying goes, "The coarse drives out the fine." Or, to put it more colloquially, high emotional arousal makes us stupid.
The higher neocortex evolved partly as a means to discriminate the thousands of shades of grey that exist between black and white. It has the capacity to modulate emotional responses - stand back and explore subtle implications and complexities, look at bigger contexts, analyse - but to do that it has to be able to interact with the emotional brain, which is only possible if the emotional brain isn't too highly aroused.
We all know it is impossible to communicate normally with people who are too highly aroused. This is because, in their aroused state, they cannot process data contradictory to their black and white thinking. They cannot give attention to another viewpoint. As we've seen, high emotional arousal locks the attention mechanism, effectively putting the person into a trance state where they are confined to viewing the world through an inappropriate pattern or template, limiting their perception of reality. The best tactic when trying to communicate with a highly aroused person is to buy time and do whatever is necessary to bring their arousal level down first.
Those counsellors and psychotherapists who recognise that people suffering with emotional problems are locked into a restricted view of reality know that their key role is to open up that view. An effective counsellor has the skills to disempower the strong emotional templates that 'lock' their clients into disabling viewpoints and help them access more helpful ones so that they can operate out of a bigger pattern. This is known as reframing.
When we take account of brain physiology we can see that the fastest way to start helping a distressed person is to first calm them down, thus releasing their higher cortex from the mental paralysis caused by excessive emotional arousal. Clients are then more able to help themselves escape from their predicament.
Three vital principles
From what is known so far about brain function, we suggest that we can draw out three principles that are vital for therapists and counsellors to understand if they are to deal effectively with the most common emotional disorders, such as phobias, post-traumatic stress, anxiety, anger, clinical depression and addictions:
• the brain works principally through an infinitely rich pattern-matching process.
• emotion comes before thought - all perceptions and all thought is 'tagged' with emotion.
• the higher the emotional arousal, the more primitive the emotional/mental pattern that is engaged.
By studying therapy models with these fundamental principles in mind, we can more easily see their strengths and weaknesses. Any therapy that encourages emotional introspection, for example, is unlikely to be helpful for most common problems. This explains why efficacy studies repeatedly show that psychodynamic and person centred approaches to treating depression or anxiety tend to prolong or worsen the condition while any form of therapy which focuses on distraction will lift it.31, 32,33
That there is emotional accompaniment to all perceptions may not seem obvious. However, when the emotional accompaniment is not there it stands out in bizarre ways. For example, Capgras' syndrome, which results from brain damage to connections between the temporal lobes and the amygdala, has the effect of making sufferers think that people they love and care about are impostors.34 Although the parts of the brain that pattern match and recognise familiar people are still working, the damage prevents the integration of all of the emotional associations, feelings and meanings associated with, for instance, one's parents or spouse. These don't get activated and, in the absence of such feelings, the person's brain jumps to the conclusion: "This person can't be my father/mother/husband/wife!"
Normally people don't give a second thought to the feelings that accompany seeing their parents or partners because the brain accepts those feelings as normal, and doesn't bring them into consciousness. All unremarkable emotions are neutralised in this way - a fact that makes the phenomenon difficult to observe until an exception demonstrates it, as with this particular type of brain damage. People with Capgras' syndrome are severely disabled by the ensuing lack of emotional connection to their perceptions.
So, even though the most common of perceptions have feelings associated with them, we only become aware of feelings and our thoughts about feelings when they are somehow unexpected - surprising. Surprise is the common element.
When the neocortex is not too emotionally aroused it can employ ever more subtle evaluation procedures. The neocortex is in a state of continual flux from second to second, minute to minute and hour to hour.35This has to be so. We would not be the adaptable creatures we are otherwise. The neocortex is nature's solution to the need for adaptable responses to an ever changing environment. By gifting us with innate instinctive patterns that are not totally programmed, and giving us the ability to add to these patterns almost infinitely, nature made us into the remarkably flexible, talented creatures we are and made it possible for us to delve ever further into the nature of reality.
Every researcher and writer on the subject describes this incredibly complex organ, the neocortex, in awed tones. It has literally billions of potential neuronal connections and the almost inconceivable ability to continually remodel itself according to the richness of input coming in through the senses from the environment. It continually makes new connections, strengthening valuable ones and dissolving old ones that it no longer finds useful. It can hold on to and store whatever information is pertinent to its current reality and use that store of connections to modify the emotional responses received from the emotional brain - a complex fine-tuning operation. It is this continual refining of the metaphorical pattern-matching process that allows us to discriminate ever more accurately between the polarised extremes of the emotional brain's black and white responses.
Using the APET model
Using the APET approach (activating stimulus processed through the pattern-matching part of the mind, giving rise to emotion, giving rise to thought) provides many more points of intervention than simply helping clients to challenge their belief systems directly, as in cognitive therapy.
Human givens therapists are acutely aware, for example, of how influencing the activating agent, the A in APET, can dramatically improve people's lives. If someone is depressed because they are being bullied at work, they can be encouraged to think about practical options to alter the situation - perhaps even, in extreme cases, changing jobs.
One young married woman suffered vomiting fits every time her critical and somewhat interfering mother-in-law visited, which was very frequently. She was encouraged by the therapist to be sick in front of her on the kitchen floor, and then rush to her room, leaving her mother-in-law to clear up. This had the effect of changing the frequency of the mother-in-law's visits (the activating agent) and gave the younger woman back control in her own home. The vomiting stopped.
The principle of changing the activating agent can also be seen at work in a social context. For example, in New York in 1980 a remarkable project to clean up the city's subway system got under way in the belief that the impetus to engage in certain kinds of antisocial behaviour comes not from particular types of people but from the nature of the environment. Billions of dollars were invested in cleaning and rebuilding the subway stations, and removing all graffiti from trains or replacing trains that were beyond recovery with shiny new, clean ones. The instant any graffiti appeared on a surface it was removed. If a train was defaced it was taken out of service and returned to its pristine state. Within six years the clean-up was complete. The same zero tolerance policy was then enacted on crime. Even minor misdemeanours were prosecuted. The crime rate in New York, even for serious offences, fell dramatically, all because, when a signal goes out from the environment that 'this is not a place to behave in a criminal way', the brain pattern to behave antisocially is not elicited.36 In other words, the activating agent had been changed.
Changing the patterns in someone's mind by stimulating their imagination, reframing their experiences, using metaphors, telling stories and appropriate humour are time honoured ways to get people unstuck. This is why effective counsellors and psychotherapists are good natural storytellers.
Human givens therapists are also aware of the pattern-matching process in the linguistic phenomenon known as nominalization, when an abstract noun is produced by taking a verb or adjective and turning it into a noun.37 A politician might change the verb to modernise into the noun modernisation. He will then say things like "what we need is modernisation", as though modernisation were something concrete that you could buy, see or touch. These are words that hypnotise both the listener and the speaker because, to make sense of them, you have to go on an inner search to find a pattern-match to what they mean to you ... because they always mean something different to whoever hears them. That is why they are stock-in-trade words of politicians, preachers and gurus.
People use this kind of language to hide ignorance, protect territory and deceive and manipulate people. Jargon, psychobabble and 'culty' language is almost entirely made up of nominalizations.
Examples of negative abstractions - words and phrases - include: black cloud, evil, misery, despair, depression, worthless, useless, hopeless, anger, fear, gloom, low self-esteem. If therapists are not aware of the pattern-matching process in themselves, such words can lead them to identify closely with the misery of their clients. The way to deal with such words is to turn them back into the process from which they came. When a patient says, for example, "I have all this anger in me," the counsellor should respond by saying, "what exactly is making you angry. People don't have anger in them, like blood, they become angry because something has upset them."
Examples of positive nominalizations include: happiness, love, creativity, integrate, resources, joy, insight, learnings, power, awareness, spirit, truth, beauty, consciousness, enlightenment, possibilities. Although these words are typically used by advertisers, gurus and politicians to manipulate people, many of them can be knowingly used by therapists and counsellors to send clients on a constructive, useful, inner search to help them access more useful patterns of behaviour. It can have a powerful therapeutic effect to say to someone something like, "after listening to you I know that your unconscious mind has many strengths and resources that you can bring to bare on your situation which, coupled with your integrity and creativity, can open up new possibilities, that provide the help you need and transform things for you."
Thought patterns can be changed directly and consciously of course, provided the person isn't too emotionally aroused. The new thought is fed back into the emotional brain and helps moderate or change any inappropriate pattern matches that are happening and therefore the emotional consequences. But, when a person is highly emotionally aroused, it is far more effective to calm down their emotions first so that the neocortex can function more intelligently. They can then more easily see all the shades of grey between the emotionally driven black and white frames of reference they are stuck in.
Therapy delivered from the APET model produces faster results and also dispenses with the need for the complex language which cognitive therapists have evolved to teach patients how to classify and challenge their thinking. Once a person is emotionally calmed down they can be given the information they need, either directly or through metaphor, to help them see their situation from multiple viewpoints. What is happening in effect is that they are learning to employ a finer, more discriminating pattern - a more accurate representation of reality. This is easily demonstrated and can be filmed for training purposes with filmed follow ups.38
Very many complementary and behavioural therapists already recognise the importance of relaxation in calming people down so that they can engage more effectively with their higher neocortex.39
The APET model offers a unifying theoretical basis for why any therapeutic technique that is successful works. For example, with an understanding of the metaphorical pattern-matching function of the brain, and of how our instinctive templates are first programmed in the womb and after birth during REM, we can see how any therapy that directly accesses the REM state, guided imagery for example, can help clients reprogramme patterns of response that are unhelpful to them.40
Until recently hypnosis was treated with awe, incredulity or hostility within the psychotherapeutic community. Practitioners either seize on it enthusiastically or deny and reject it. But research by a leading exponent, psychiatrist Milton H Erickson, and others strongly indicates that hypnosis - focusing attention - is one of the most powerful psychotherapeutic tools available to us. It is so powerful precisely because it accesses the state of consciousness in which nature programmes the brain and can reprogramme it.24 (This means that, like any powerful tool, hypnosis can be misused - and frequently is.)
The APET model also integrates metaphor therapy and storytelling with other effective approaches. When a more useful metaphorical pattern is offered to clients, they have the capacity, through the brain's own pattern matching process, to decipher the metaphor for themselves, with the result that their solution is 'owned' by them rather than imposed on them by the therapist. Because it is the clients themselves who have made the connection, the connections are all the more 'hard-wired' and more firmly established. The method also enables rapport to be maintained because, if a client doesn't feel that a particular story or metaphor is relevant to them, they can just let it go past them, without feeling they have rejected 'advice' from the therapist. (Often, however, the meaning of a pertinent story will penetrate at a later date.)
Reframing, widely recognised as a core skill in effective counselling, works in the same way. All human development involves reframing whereby we learn to see another, larger, aspect or dimension to a situation. A reframe replaces a pattern that has become deficient in useful relevance and offers up a richer, more appropriate one that opens up the models of reality in our brains so that we can see new possibilities that we hadn't previously realised were there.
All effective therapy involves reframing. The determining factor in a person's happiness is not just what happens to them in life but how they interpret experience, or how they 'frame', or put meaning to, life events. Some 'frames' empower us and some disempower us. When someone unconsciously assumes that their way of perceiving reality is the only way, then a major shift can occur when another view is unexpectedly demonstrated to them. After such a reframe it is virtually impossible to maintain the problem behaviour in the same way.
As well as providing an organic basis for understanding and integrating the active ingredients within the more potent therapeutic methodologies used today, the APET model also provides a clear theoretical understanding of why certain psychological conditions arise. With this understanding we can look afresh at such debilitating conditions and see how they could be better treated.
A panic attack, for example, is the inappropriate setting off of the fight or flight reflex, the emergency reaction which prepares the body to deal with physical danger. Nowadays most of us are rarely in the presence of life-threatening events and yet that doesn't stop many people experiencing panic attacks, usually resulting from a progressive rising in background stress levels until the point where one more stress - the straw that breaks the camel's back - sets off the alarm reaction triggering the fight or flight reflex.
When this first occurs, not surprisingly people don't understand what's happening to them, why their heart is pounding, why they are sweating, why their breathing is accelerated, and so they jump to the alarming conclusion that something must be seriously amiss with their body. This causes a further rise in the alarm reaction, a further release of adrenaline, and even more intensified panic symptoms.
When we experience extreme alarm during a panic attack the brain, naturally enough, is desperately scanning the environment to find out where the threat to its survival - as the amygdala sees it - might be. Not surprisingly, in many people, an association is made with an element in the environment where the panic attack occurs. If it first occurs in a supermarket, for example, the emotional imprint may lead an individual to avoid supermarkets in future, even though the panic attack was caused not by the supermarket but by raised stress levels. Once the faulty association has been made, the fight or flight response will continue to fire off every so often, pattern matching to any environment that has similar elements in it to that of the supermarket: a post office, a bank, anywhere with bright lights or crowds or queues. People thus affected may then progressively avoid all these places and gradually the noose of agoraphobia grips them, hindering their interaction with life itself. In the worst cases, they become confined to home, terrified of the outside world.
A combination of relaxation, behavioural therapy and cognitive therapy is useful in treating this condition. Sufferers are taught to calm themselves down and progressively re-engage with life. It can take many sessions of therapy and practice. This whole process, however, is accelerated if we first detraumatise (using the fast phobia cure) the memories of their most frightening panic attacks. As a result the brain will cease to pattern match in a destructive way when they enter each new, previously frightening, situation. Once the disabling emotional memories are processed, people can progress more rapidly through the situations that they had previously been avoiding.
This same technique is used by human givens counsellors to deal with all severe phobic responses.
Post Traumatic Stress Disorder (PTSD)
With the understanding that people can suffer long-term traumatisation if the imprint of a life-threatening event is embedded in the amygdala - which continually scans the environment, pattern matching to anything similar to elements of that event - we can use psychological techniques to remove the imprint and 'convince' the amygdala that the imprinted template is no longer necessary for survival. One of the little acknowledged breakthroughs in psychotherapy in recent times has been the development of an effective and relatively painless way of doing just that.
The technique, now commonly called the fast phobia cure, evolved out of the technique promoted by Richard Bandler, one of the co-founders of Neurolinguistic Programming (NLP). He, in turn, was inspired by observing the renowned psychiatrist and hypnotherapist Milton H. Erickson detraumatise people. The method is variously known as the fast phobia cure (because it is most often used by hypnotherapists for curing phobias), the 'rewind technique' (which is the name preferred by clinical psychologists) and, by those who practise NLP, the V/K dissociation technique (the V stands for visual and the K for kinaesthetic - feelings).
By discovering the psychobiological explaination for why it works the ETSI research group was able to refine and streamline the technique to make it easier to teach and carry out. Clinical experience shows it works reliably with almost all cases of post traumatic stress disorder and phobia, but until 2001 there was no satisfactory published explanation for why it works.41
This trauma resolution method is not difficult to learn to do, provided the practitioner has the aptitude and sufficient spare capacity to devote concentrated attention to the traumatised individual they are working with. Many medical and psychiatric professionals have attended one-day training workshops run by MindFields College to learn the technique and have subsequently been able to help even the most severely traumatised people. Obviously, the more practice one has in using the technique with real cases, the more skilled one becomes.
What this technique achieves, when employed by a competent practitioner, is the taking of a traumatic memory and turning it into an ordinary memory. This is done by bringing the client's observing self into play while keeping them at a low level of arousal. In removing traumatic memories in the way we recommend, the observing self is enabled to view the troubling pattern of memory and, using the neural connections between the limbic system, where the trauma is 'trapped' or 'imprinted', and the neocortex, reframe it as no longer being an active threat to the person.
This is an artificial way of doing what nature does with all learning (another process that is a human given). All of us have memories of events that were emotionally arousing or even life threatening at the time, which we can now look back on and tell an amusing anecdote about. Those memories have moved out of the amygdala's traumatic store, so-to-speak, into ordinary functioning memory.
We would say that, because trauma is such a disabling problem all psychiatrists should understand this technique and either learn how to do it or know competent practitioners who they can refer patients to.
Obsessive compulsive disorder (OCD)
OCD can take many forms but is most often seen in repeated washing and checking behaviours. Again, often the background trigger is raised stress levels, which may be due to anything from physical illness, a fright, not getting enough sleep to business worries, a relationship breakdown or stress around examinations.42 Some people have a propensity to develop this disorder in response to raised stress levels.
OCD is a complex neuropsychiatric process characterised by a homogenous core of three main symptoms:
1. intrusive, forceful and repetitive thoughts, images, or sounds that dwell in the mind without the possibility of rejecting them
2. imperative needs to perform motor or mental acts
3. doubt or chronic questioning about major or minor matters.43
Sufferers of OCD may be, in effect, responding to post hypnotic suggestions implanted accidentally by environmental factors - they lose track of time and forget how long they have been performing the obsessive behaviour, or whether they even have, and so start all over again. Losing track of time and amnesia are common hypnotic phenomena.
Clearly a pattern match is fired up in the brain and then embedded deeper and deeper by repetition - much as in addiction behaviour. Changing such deeply entrenched patterns is not easy but is possible in many cases and working from the APET model offers multiple ways in which to go about it.
One key step, for example, is to help the person take a step back so that they can observe themselves and their behaviour. There are a number of ways this can be done with the help of a therapist. Once the patient's core identity has been separated from the problem and they recognise that the OCD behaviour is not who they are, it is possible to stop it. (Indeed one can often effect dramatic recoveries in many conditions by making that distinction very clear to a person.)
An example of how working from the human givens is so much easier occurs with the way human givens therapists and counsellors treat depression. Here we can clearly see how different the human givens approach is to older models.
It has been shown that depression is associated with memory bias - either a better memory for negative events or a poorer memory for positive events and experiences. This has led to the widely accepted theory that the onset of depression somehow facilitates access to negative memories which, once recalled, serve to exacerbate and lengthen the depression.44 The more that we go back over the stories in our lives the more we are increasing and programming in the saliency of those patterns. Somebody in depression who is continually resurrecting negative life experiences is programming those negative templates into their unconscious mind. Therefore new stimuli coming in to their conscious minds, before ever reaching consciousness, are being matched up and scanned by negative templates to draw out what is negative in those experiences. Perceptions are continuously subconsciously biased by the negative templates that are programmed in as a result of negative rumination.
In cognitive therapy, people may be asked to challenge their conviction that everything they do is always wrong or hopeless by recalling successes and achievements. But the memory bias and reinforcing of negative patterns makes it hard for a depressed person to recall good memories, so it isn't easy for them to generate a more positive attitude to life, however much they are willed to. Therapy based on the APET model, however, can take a more diverse and creative approach to shifting unhelpful patterns, particularly through the use of metaphor and story, which impact on the unconscious mind more directly and powerfully than reason.45
We work from the new understanding that depression is essentially a REM sleep disorder. These are some of the facts that lead us to this conclusion. Researchers have known for some time that depressed people have a very high level of physiological arousal.46 We also know they do a lot of negative thinking (worrying).47 We know too that depressed people typically suffer from insomnia and other sleep disorders, have disturbed REM sleep and wake up exhausted unable to activate or motivate themselves. Observations in sleep laboritory experiments have repeatedly shown that depressed people dream much more than non depressed people and, if you wake up depressed people at the beginning of REM periods their mood lifts dramatically.48 It is also known that both antidepressants and certain forms of psychotherapy are often effective in lifting clinical depression49 and annxxiety disorders.50 But there has never been a clear understanding that links all these facts. With the discovery of why we evolved to dream51, however, we have the missing piece of the jigsaw puzzle that brings all this information together in one clear picture: a complete psychobiological explanation for clinical depression. It is this that human givens therapists use to good effect.
Dreaming is the means of discharging emotionally arousing introspections from the previous day that haven't been expressed. Depressed people are excessively negatively introspecting because of a failure to get their essential emotional needs met. Emotional arousal automatically forces the brain into a reactive, black and white mode of thinking, reducing its ability to think in more subtle, objective ways. So, after a setback, someone with an essentially pessimistic outlook will inevitably catastrophise their interpretations of life events and excessively introspect about these interpretations, which puts excessive pressure on the dreaming process and distorts the REM sleep system causing excessive autonomic arousal discharge, leading in turn to physical exhaustion and subsequent clinical depression.
We can now see that all therapies that are effective at lifting depression break this cycle. (All antidepressants reduce or normalise REM sleep. All effective psychotherapies break the negative introspection cycle and focus the client on solving problems and engaging with life again.)
The depressed person's black and white thinking style is fuelled by the emotional brain's ancient response system. The attributional style of a depressed person precisely echoes the reactive, all or nothing, response system in the brain: fight or flight, good or bad, love or hate, near or far. Rapid eye movements are caused by the PGO wave triggering off the orientation response in the brain
During REM sleep there is a massive firing of the PGO orientation response. The eyes dart about during REM sleep because they are trying, even though closed, to scan the environment in response to this. However the source of the arousal is internal: the introspections from the previous day.
The implications for lifting depression
• Depressed people are highly aroused, so in order to work with them cognitively, or in any way at all, it is first necessary to calm them down using any relaxation skills that are appropriate - breathing retraining, massage, guided imagery or relaxing hypnotic techniques.
• Stop emotional introspecting by whatever means. (Any therapy or counselling that encourages prolonged emotional introspection is toxic. This is because, firstly, emotional arousal makes us stupid and results in black and white thinking, and, secondly, because excessive arousal, resulting from negative emotional introspection, distorts the REM sleep mechanism and thereby leads us into clinical depression.)
• Focus patients' attention outwards: get them physically active (aerobic exercise), focus them on pleasurable activity, problem solving, improving relationships, get them to challenge their black and white thinking etc.
• Get patients to see how things could be different by actively using their imagination in a positive way with visualisation or hypnosis. This step is missing from most approaches to treating depression. It is our clinical experience that people are not often easily lifted out of their low mood unless this is well done.
Once one understands the APET model it is easy to see why some counselling is ineffective or harmful. Counsellors are often trained to encourage emotionally arousing introspection in their clients about what might be 'causing' their problems. The emotional arousal this produces locks the client's attention on negative patterns of thought and behaviour. This leads, almost inevitably, to a period of negative rumination and the cycle of depression can set in. The process, however unintentional, can, therefore, accurately be characterised as nocebo therapy.
When counsellors encourage people to remember, and get emotional about, negative life experiences - bringing to the fore destructive patterns - they are actually going against nature's inclination to promote survival, health and wellbeing. And that's why some people say they go to see their counsellor feeling miserable and come out feeling suicidal. The essence of good therapy, on the other hand, is placebo therapy - focusing clients' attention on problem solving and solutions.
Metaphor, storytelling and learning
If these ideas are true to reality and the brain is fundamentally concerned with matching metaphorical patterns, it follows that this is the most wonderful natural tool for learning. Learning is a process of refining patterns of perception built upon a foundation of instinctive patterns and later learned patterns. All learning is an extension of existing patterns in the student. We are referring here not to learning facts by rote, in effect just storing up a series of bits of information, but to real learning - interacting more effectively with the environment, and developing the ability to discriminate and discern a greater subtlety of the patterns therein and how they connect up with our own inner perceptions. If real learning is about the ability to discriminate patterns, as counsellors or teachers our aim must be to introduce a new more constructive pattern to clients'/students' brains, or refine an existing one, so that they can see reality more accurately.
The way creative breakthroughs are made in science illustrates the power of this approach. The breakthrough 'ah hah' experience comes when scientists recognise that a pattern which works in one area of reality can also be applied in another. They take a pattern that explains one phenomenon and use it as a metaphor to explain what is going on in a different phenomenon.
For example, if we take current theories of light, and the metaphors that are used to explain them, on the one hand we have the theory that light is a stream of particles travelling like bullets in sequence in a beam. And, on the other, we have a metaphor which explains other aspects of light as a wave. Both these metaphors have the capacity to explain a peculiarity of light - that sometimes it can appear to behave as a wave and sometimes like a sequence of bullets.
One of the most famous metaphorical insights concerns Kekule's discovery of the structure of the benzene ring: one of the most important discoveries in the history of chemistry. He had been trying for years to solve the problem of the molecular structure of benzene. Then one afternoon, as he was puzzling over the problem, he began to doze. He saw atoms gambolling before his eyes. Then he saw larger structures in long rows, twisting and entwining in a snakelike motion, until they looked just like snakes. One of the 'snakes' proceeded to seize its own tail. He awoke with a jolt to realise that the structure of benzene must be a closed ring - a solution suggested to him by the image of the snake swallowing its own tail.
Conveying new, desired patterns in a metaphor or story is perhaps the most effective way of all to refine patterns (although there are other effective methods, such as modelling desired behaviours). Psychiatrist Milton H Erickson, whom we regard as the most significant clinician and psychotherapist of the 20th century, was a master storyteller who put this skill to good effect in his work.52 Often the teachers who most influence pupils' education are those who use anecdotes and stories to make their lessons come alive. In a counselling training context, we ourselves use stories and case histories to illustrate our theoretical principles in order to bring those principles alive. All good communicators use stories for that reason.
If clients are missing some piece of the jigsaw puzzle of life we could offer them a story about another client with a similar problem and how their behaviour changed, conveying the desired new pattern in an indirect way, or we could tell an appropriate traditional story. The world's stories, oral and written, contain a fantastic cornucopia of wonderful patterns which chart the possibilities of understanding ourselves more profoundly and help us engage with the world more fruitfully.
Somebody who is struggling with an addiction might benefit from hearing the ancient Greek myth about Odysseus who, on his way home to Greece after the battle of Troy, had to pass the island of the sirens. He had been told by the enchantress Circe that all sailors who passed that island were lured to their death on the rocks if they heard the sirens' song. But she had also told him a way to hear the sirens' magical music and survive. She told him to order his sailors to put softened beeswax in their ears, to stop them hearing the singing, and then have them tie him fast to the mast, giving them instructions that, no matter how much he urged or pleaded with them to turn the boat towards the island, they should merely bind him faster and continue on their course, past the island. This was done. When Odysseus heard the sirens' song, he wanted with every cell of his body to go to the island but, because he had forewarned his crew, they ignored his signals to change direction, bound him even more tightly to the mast, and eventually they passed the island. Odysseus was released by the crew, enormously grateful that he had been enabled to survive - and that he had escaped being dragged to his doom.
This powerful metaphorical template with all its allusions and implications can be used to show how a drug or addictive experience may be extremely seductive and yet destructive. It also metaphorically sets in place a template for how people can reorganise their internal resources to fight it.
This form of learning can be used if appropriate in conjunction with cognitive behavioural approaches to increase the chances of a successful outcome.
To recap, to help educate clients who are stuck we have to help them understand what is blocking them from getting their needs met. This is done through refining their patterns of perception, helping incorporate these patterns into their own perceptual apparatus and creating a more healthy, outward focus on life. If those patterns are not already active, the job of the counsellor is to help draw them forth, thus providing a stronger and more accurate lens through which the client can perceive reality. Using metaphor is one of the most powerful ways this can be done.
This whole process can be greatly speeded up by using nature's own tool for accelerated learning - REM sleep - where, in the foetus and early months of life, nature lays down the instinctive templates that will later seek out their completion in the environment.53
We now know that we can directly access that same cortical organisation through hypnosis. (The state of deep hypnosis is analogous to that of REM sleep.) Anyone can be put into hypnosis by replicating any part of the pattern by which nature triggers the REM state, such as muscle relaxation, inducing rapid eye movements, (as in the 'focus your eyes on my swinging watch' technique and as used in Eye Movement Desensitisation and Reprocessing [EMDR]),54 inducing hemispherical switching to the right neocortex by visualisation (a necessary stage of pre-sleep) or by firing off the brain's orientation response (as when a stage hypnotist suddenly pushes down on his subject's shoulder and gives the instruction "Sleep!"). The orientation response focuses attention and is firing continually during dreaming.55
The brain absorbs new ideas and information best when in a receptive, open, uncritical trance state. Once patterns have been absorbed and understood they can be looked at consciously and 'checked out'.
(One of the drawbacks of modern media is that, whenever new ideas are proposed or discoveries announced, they are immediately placed in the firing line of confrontational criticism. The absorption stage is bypassed. This is why, for example, debating programmes on television and radio are often unmemorable and unsatisfying.)
In counselling, when we relax people and focus their attention, we create the same hypnotic REM state in which the brain is at its most receptive, able to absorb information noncritically. That is the ideal time in which to offer stories and metaphors to clients' unconscious minds to help them transform their perceptions.
To demonstrate the levels of meaning and the values that can be extracted from such a story we can look at one which adults could easily dismiss as trivial - the story of the Ugly Duckling.
On a farm a little bird is raised by a duck but feels itself to be very different from all the other ducklings who keep mocking it for being big and ugly. In due course, the ugly duckling becomes so unhappy it decides to run away, leaves the farm and goes in search of his destiny. But every animal it meets laughs at him for being so ugly and he learns that he can ignore them and not get upset by their stupidity. Eventually he finds a little pond where, despite feeling isolated and lonely, he learns to look after himself and survive through the long, cold winter.
As the months pass by, changes happen within him, although he is unaware of this. One day, in early spring, the pond is still and calm, and in the water he sees the reflection of a line of beautiful swans flying high overhead. He wishes with all his heart that he could somehow be with them. The swans call down saying: "Why don't you join us?" And he said: "How can I, an ugly duckling, fly with beautiful birds like you?" And the swans laugh and say, "But look at your reflection," and the duckling looks at his own reflection in the still pool and realises that he has transformed into a swan. The former ugly duckling is able to join the swans as an equal on their journey.
All children resonate with that story because, at some time, every child feels isolated from their fellows, an outsider who doesn't fit in. There are times in life when we feel rejected, when we have to go it alone, when we have got to find the courage to last the course, when our emotional needs are not being properly met. But the template in the story contains more than that. It shows us that, if we approach those times with courage, changes will automatically occur. We can learn from the very deprivations that seem so problematical and, if we persevere and seek out an appropriate environment, our talents and potential can blossom. The story holds out the optimistic prospect that the individual, and perhaps the human species, has somewhere to go; that there is a destiny awaiting us, if we have the courage to seek it, to stretch ourselves and sustain our spirit during troubled times.
Further subtleties include the profound truth, that we can only see clearly when we are calm. If the water on the pond had been disturbed the ugly duckling would not have been able to see what he was like. In other words, children hearing this story are given the template that they need to be in a calm emotional state before they can accurately perceive what they actually are.
At an even deeper level, we might draw out the idea that the emotional brain is like an ugly duckling, but, if we are willing to retrain our responses and cultivate and refine our perceptions, we can become more intelligent and raise ourselves up. It's only, as it were, by escaping the world of the ugly duckling that the true potential of the individual can emerge. And the price that has to be paid is that we may have to go against some of the prevailing orthodoxies within society and tread a lonely path for a while.
The patterns in such a rich story stay with us all, like a protective talisman, for the rest of our lives.
In counselling, when we relax people and focus their attention, we create the same hypnotic REM state in which the brain is at its most receptive, able to absorb information uncritically. That is the ideal time in which to offer stories and metaphors to clients' unconscious minds to help them transform their perceptions.
The APET model is at the heart of human givens therapy. The four letters stand for specific processes through which the mind/body system works. These processes are currently being explored by neuroscience and psychology in many direct ways and are not dependent on psychodynamic ideologies.
The A is for an activating agent: a stimulus from the environment. The P is for the pattern-matching part of the mind, which in turn gives rise to an emotion, E, which can produce T, thoughts.
But these letters also contain a powerful metaphor which enriches the idea. The first three spell 'ape' and that gives us the idea of an ape, a more primitive creature than us, telling us what to do.
So we have this ancient emotional mind that can order us about, tell us what to do, control us: a mixture of primitive and conditioned responses, greeds and selfish desires which, when roused, can cut us off from the richer and more subtle templates, located in the right and left hemispheres of the higher cortex and the frontal lobes, through which we can experience more of reality.On the other hand, if we break up the letters slightly differently, we have 'a pet'.
A pet is an animal that was originally wild, but its nature has been constrained - domesticated to serve the needs of a master. This is a cooperative relationship. The pet serves the needs of the master and, in return, the master takes care of the needs of the pet. That is the civilising process we humans have to go through - domesticating the emotional brain, the wild, instinctive creature within us.
Since human givens brief therapy is based on innate abilities it can be mastered rapidly by clinicians with the requisite ability and commitment.
Training is offered by day long seminars and workshops on a regular basis at hospitals and universities throughout the UK. The post graduate diploma course in human givens therapy runs in London, York, and Bristol and requires attendance at a minimum of five seminars and five workshops plus two weeks intensive training and mastery of the required reading list. Proficiency is assessed by means of a written exam and submission of video taped therapy sessions with patients. Support groups of fellow clinicians practising human givens brief therapy exist in many areas.
1 Dawe, R. M. (1994). House of Cards: Psychology and psychotherapy built on myth. Simon & Schuster.
2 Dineen, T. (1996). Manufacturing Victims: What the psychology industry is doing to people. Robert Davies.
3 "Pulling findings from the trials, it seems that patients referred to counsellors felt themselves better understood and listened to and were more likely to declare themselves satisfied with their treatment but there was no actual difference in patients' ways of coping with their difficulties or their knowledge of what needed to be changed in their lives. There was no difference in social adjustment between those who were counselled and those cared for just by GPs." Counselling in primary care: a systematic review of the research evidence. British Journal of Guidance and Counselling. (2000), 28, 2, 215-231.
4 Danton, W, Antonuccio, D. and DeNelsky, G. (1995). Depression: Psychotherapy is the best medicine. Professional Psychology Research and Practice, 26, 574. This meta analysis showed quite clearly that psychodynamic approaches to treating depression made depressed people more depressed.
5 Miller, S. D., Hubble M. A., and Duncan B. L. (1995) No more bells and whistles. Family Therapy Networker, vol.19, no 2.
6 Robertson, I. (2000) This trembling web: the brain and beyond. The New Therapist. Vol 7, 3.
7 The 'human givens' concept was developed as part of a human givens therapy training programme for therapists and counsellors developed by several members of the European Therapy Studies Institute (ETSI). The first formal presentation of the 'human givens' approach was made in a series of seminars on effective anxiety management prepared by ETSI and attended by over 3,000 health workers throughout the UK in 1997. The huge number of enquiries for literature on this approach led to the development of a professional training course.
8 Dewdney, A.K. (1997) Yes we have No Neutrons - A tour through the twists and turns of bad science. John Wiley & Sons.
9 Webster, R. (1995) Why Freud was Wrong. Harper Collins
10 Julian Jaynes, writing on Behaviourism says, "But the single inherent reason for its success was not its truth, but its programme ... with its promise of reducing all conduct to a handful of reflexes and conditional responses developed from them, and generalising the spinal reflex terminology of stimulus and response and reinforcement to the puzzles of headed behaviour and so seeming to solve them ... In all this there was a heady excitement that is difficult to relate at this remove. Complexity would be made simple, darkness would be made light, and philosophy would be a thing of the past ... off the printed page, behaviourism was only a refusal to talk about consciousness." Nobody really believed he was not conscious, and there was a very real hypocrisy abroad, as those interested in its problems were forcibly excluded from academic psychology."
Jaynes, J. (1976), The Origin of Consciousness in the Breakdown of the Bicameral Mind, p.15, Houghton, Mifflin Co. Boston
11 "When I can sensitively understand the feelings which they are expressing, when I am able to accept them as separate persons in their own right, then I find that they tend to move in certain directions. And what are these directions in which they tend to move? The words which I believe are most truly descriptive are words such as positive, constructive, moving towards self-actualization, growing towards maturity, growing towards socialization ... to discover the strongly positive directional tendencies which exist in them, as in all of us, at the deepest levels."
The Carl Rogers Reader (1990), Constable, London p.28
"In Roger's view (1980) what psychologically troubled people most need is not to be analysed, judged or advised, but simply to be heard - that is, to be truly understood and respected by another human being. Therefore the primary effort of client centred therapists is to apply all other powers of attention, intuition and empathy to the task of grasping what the client is actually feeling."
Abnormal Psychology, 5th edition, p.193, McGraw Hill (1988)
12 Yapko, M. (1992) Hypnosis and the Treatment of Depressions. Brunner Mazel, New York.
13 Mental health promotion in high risk groups. Effective Health Care (1997). vol 3, no 3.
14 The following excerpt from a recent book by psychologist Adrian Wells, one of the more innovative and original contributors to cognitive therapy, shows how easily the language of cognitive therapy becomes impenetrable to an outsider and how the process of complexification of theory continues apace. "Schema theory represents a general framework for exploring and conceptualising cognitive behavioural factors in the maintenance of anxiety. However, for cognitive therapy to evolve and for treatment effectiveness to increase, specific models of cognitive - behavioural factors associated with vulnerability and problem maintenance are required. Specific models based on generic schema theory principles have been advanced for panic disorders (Clark, 1985), social phobia (Clark & Wells, 1995) and obsessional problems (Salkovskis, 1985; Wells and Mathews, 1994). These approaches have attempted to integrate schema theory with other psychological concepts considered to be important in specific disorders. The aim in all of these cases is the construction of a model that can be used for individual case conceptualisation for guiding the focus of interventions, and for generating testable model-based hypotheses. Even when specific models are lacking, case conceptualisation and treatments may be based on operationalising basic constructs of the general theory on a case by case basis."
Wells, A. (1997) Cognitive Therapy on Anxiety Disorders, p. 14, John Wiley & Sons, Chichester & New York.
15 Gopfert, M. (2002) Advances in Psychiatric Treatment, vol. 8 p 156, 157.
16 Yapko, M. (1992) Hypnosis and the Treatment of Depressions. Brunner Mazel, New York.
17 Luborsky, L. and Singer, B. (1975). Comparative Studies of Psychotherapies: Is it true that "everyone has one and all must have prizes?" Basic Books, New York.
18 Danton, W, Antonuccio, D. and DeNelsky, G. (1995). Depression: Psychotherapy is the best medicine. Professional Psychology Research and Practice, 26, 574.
19 Danton, W., Antonuccio, D. and Rosenthal, Z. (1997). No need to panic. The Therapist, vol 4, no 4.
20 Roth, A. Fonagy, P. et al (1996). What Works for Whom. The Guildford Press, New York, London.
21 Ellis, A. (1971) Growth through reason: verbatim cases in rational-emotive therapy. Wiltshire Books.
22 Beck, A. (1976) Cognitive Therapy and Emotional Disorders. New American Library.
23 McMullin, R. E. (1986) Handbook of Cognitive Therapy Techniques. W. W. Norton.
24 Griffin, J. and Tyrrell, I. (2000). The APET model: Patterns in the brain. Human Givens Publishing.
26 Zajonc, A. (1995) Catching the Light. Oxford University Press.
27 Goleman, D. (1996) Emotional Intelligence. Bloomsbury, London.
28 LeDoux, J. E. (1998) The Emotional Brain. Weidenfeld & Nicolson.
29 LeDoux, J. E. (1993) Emotional memory systems in the brain.Behavioural Brain Research, 58.
30 Libet, B. (1983) Time of conscious intention to act in relation to onset of cerebral activity (readiness-potential); Part 3: The unconscious initiation of a freely voluntary act. Brain, 106, 623-42.
31 Danton, W., Antonuccio, D. and DeNelsky, G. (1995) Depression: psychotherapy is the best medicine. Professional Psychology Research and Practice, 26, 574.
32 Danton, W., Antonuccio, D. and Rosenthal, Z. (1997) No need to panic. The Therapist, 4, 4.
33 Griffin, J. and Tyrrell, I. (1999) Psychotherapy and the Human Givens. European Therapy Studies Institute.
34 Johnson, R. (1997) This is not my beautiful wife ... New Scientist, 22 March, 1997.
35 Robertson, I. (1999) Mind Sculpture. Bantam Press. Professor Robertson beautifully described our brains as "vast, trembling webs of neurones ... in flux, continually remoulded, sculpted by the restless energy of the world."
36 Gladwell, M. (2000) The Tipping Point. Little, Brown and Company.
37 Bond, T. and Tyrrell, I. (2002) Human Givens: radical psychology today. Vol. 9. No 1 pp 24-29.
38 See, for example, Radical Psychology TV training films: visit www.radicalpsychologytv.org
39 Griffin, J. and Tyrrell, I. (1998) Hypnosis and Trance States: a new psychobiological explanation. European Therapy Studies Institute.
41 Griffin, J. and Tyrrell, I. (2001). The Shackled Brain: How to release locked-in patterns of trauma. Human Givens Publishing.
42 Yaryura-Tobias, J. A. and Neziroglu, F. (1997) Biobehavioural Treatment of Obsessive-Compulsive Spectrum Disorders. W. W. Norton.
44 Teasdale, J. D. (1988) Cognitive vulnerability to persistent depression. Cognition and Emotion, 2, 247-274.
45 Griffin, J. and Tyrrell, I. (2000) Breaking the Cycle of Depression. Human Givens Publishing.
46 Nemeroff, C.B. (1998) The neurobiology of depression. Scientific American, 278, 6, 28-35.
48 Vogel, G. W. (1979) The Function of sleep. Drucker-Collins et al (eds) Academic Press, New York 233-250.
49 Danton, W., Antonuccio, D. and DeNelsky, G. (1995) Depression: psychotherapy is the best medicine. Professional Psychology Research and Practice, 26, 574.
50 Danton, W., Antonuccio, D. and Rosenthal, Z. (1997) No need to panic. The Therapist, 4, 4.
51 Griffin, J. (1997). The Origin of Dreams. The Therapist Ltd.
52 Erickson, M. H. (1982) My voice will go with you - The teaching tales of Milton H. Ericksson. Ediited with a commentary by Sidney Rosen.
53 Griffin, J. (1997). The Origin of Dreams. The Therapist Ltd.
54 Shapiro, F., and Forrest, M. S. (1997) EMDR. Basic Books.
55 Morrison, A. R. and Reiner, P. B. (1985) A Dissection of Paradoxical Sleep, McGinty, D,J., Drucken, C. Morrison, A. R. and Parmeggiani, P. (eds.), Brain Mechanisms of Sleep, Raven Press, New York, 97-110.