Tag: Theory

Reversal Theory “On The Couch”

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Reversal Theory “On The Couch” 

This one’s not going to make much sense if you haven’t been following the Reversal Theory series, but if you want to check them out, here’s #1, #2, #3, and #4.

Here, as promised, are some RT-based techniques (and tweaks on classic techniques) that I’ve used in really cool and fun ways in therapy, to good effect. 

 

  • Intake Questions: Most clinical interview/intake questions are aimed at determining the client’s presenting issues and background information for diagnostic purposes. Sometimes, questions are included about clients’ expectations for therapy, their goals, and their perceived strengths.
    • RT transformation:
      • How much do you experience yourself as being serious and goal oriented? In which area of your life do you experience the best sense of “achievement”? In which area of your life do you experience that the least?
      • Playful/enjoyment; Being like others/fitting in; Being an individual/freedom; etc.
  • Cognitive Therapy: Thoughts, feelings and behavior are all connected, and that clients can overcoming difficulties and meet their goals by identifying and changing inaccurate, maladaptive thoughts. First steps are identifying maladaptive thoughts, evaluating them for accuracy/utility, and then  developing reasonable counter-thoughts, which clients tend to struggle with.
    • RT transformation:
      • The opposing nature of the RT states gives a quick, easy way to begin identifying potential, but reasonable, counterthoughts. For ex, clients often have anxiety provoking thoughts such as “this  storm is very dangerous” or “I can’t do well at this and that’s awful”. Clients tend to try to create counterthoughts in the same state, and these can be hard to swallow or not very accurate. For ex, “this storm isn’t all that dangerous” or “Maybe I am good enough at this after all”
      • Changing states creates fresh, conceivable options. For ex, “This storm is fascinating and awe-inspiring”  or “I don’t need to do well at everything to be valuable.”
  • Couples Work
    • Couples are taught to identify the RT states they are in during typical conflicts. They re-enact the conflicts in session, with an emphasis on “getting into the partner’s state” (each in turn) to improve empathy, reflection, and problem solving.
    • Techniques to help couples see from their partner’s perspective include overt state-disclosure, switching seats, mimicking partner’s posture/expression/tone, letting the partner “paint the picture,” guessing the partner’s state, and state-mapping
  • Group Work
    • This is a psychodrama-type technique I call “the gauntlet.” Two rows of 4 pairs of players (“auxiliary egos”) line up and each speak from the opposing states on the problem the protagonist has identified. The protagonist (the client who is doing the current work) “walks the gauntlet” and listens, makes comments, moves players (sit down, back up, etc.), turns the volume up and down, etc., in an improvisational way.
  • Guided Imagery
    • In the Eight Rooms technique (specific to Reversal Theory) an individual or group is instructed by a leader in a guided imagery session. The participants envision a hallway with eight rooms, four on each side. Each pair of rooms represents a pair of RT states. The participants are instructed to enter each room and fill it with colors, objects, scents, memories, and anything that helps to define each state for them. For example, a telic room may have paneling on the walls, a large clock, diplomas, and a work desk. A paratelic room may have brightly painted walls, a hammock, a tiki bar, loud music, and a bubble-machine. The participants are instructed to use as many senses as possible and not to limit themselves to ordinary furniture or objects. They are encouraged that, after the guided imagery, they will be able to use their memory of each room in order to induce the state desired at the time.

COmment below: What ways can you imagine using RT in session? 

 

 

 

Psychodiversity

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Psychodiversity 

Welcome to the 4th Reversal Theory blog! In this “episode,” I hope to tie all of these concepts together for you in a way that will show how Reversal Theory can be a great addition to your therapeutic repertoire – in terms of conceptualization and even treatment planning!

Popular in both the professional and lay communities is the idea that mental stability equates to mental health. However, Reversal Theory posits precisely the opposite, that people are healthiest when they exhibit the fluidity to be able to experience satisfaction in all eight states at appropriate times. As Apter (2007) says, “The reversal theory view is that a certain kind of instability is essential for a full and happy life: one should be able to pursue the satisfactions of serious achievement, but also at other times the more frivolous joys of play; one should be able to feel the warm agreeableness of bring a ‘good citizen,’ but also from time to time the keen pleasures of defiance and independence; one should be able to experience the pride of personal strength as well as, on other occasions, the comforts of modest humility” (p.187). This ability to experience all of the states and their attendant satisfactions is known as psychodiversity. Combined with an adequate frustration tolerance, a functioning internal measure of satiation, and the ability to respond effectively to situational factors, including other people, psychodiversity defines what it means to be healthy – to be able to work, love, and play effectively.

Let me give a few examples of how the concept of psychodiversity plays out in therapy…

  • Have you ever used Lazarus’ multi-modal therapy model as a way of identifying different areas of life that need to be treated for a holistic approached? What about the pie chart with physicals health, social health, spiritual health, emotional health, etc?
  • How often do clients come in complaining of being “stuck”? They often need help to get the satisfactions from a state they don’t have much practice in, or in learning how to switch states to fit their situations. 
  • All those different presentations of depression that the DSM5 can’t quite seem to cover? When the main characteristic is low self-worth, consider an autic-mastery kind of depression, where the client isn’t able to acheive the satisfaction of that state, but is in it often. When the main characteristic is boredom consider a paratelic-depression. Lack of motivation? Telic depression. Loneliness? Self-sympathy depression. Alienation? Conforming depression. This gives us a way not only to help clients learn how to derive the satisfaction from a state they’re stuck in, but also to focus more on and gain more value from switching to other states, too. 
  • Anxiety is a classic telic-disorder. The focus on danger, on the importance of success (or of not-failing), the future-orientation… And we often try to manage it in a telic way only (reducing anxiety) rather than also using the tool of switching to the paratelic state. 
  • What are the personality disorders but various combination of autic stuckness? 

I’ll do another blog post in the near future about some specific RT-based techniques and tweaks-to-techniques that I have found really helpful. In the meantime…

 

Comment below: Now that you know plenty about RT to start posing really interesting questions to yourself… how could you see this working in therapy? 

 

 

 

 

First, do no harm.

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First, do no harm. 

Despite the DoDo bird’s insistence, not all therapies are created equal. 

This won’t be a post explaining evidence based practice, or common factors, or how diagnostics should impact our therapy plans, or how psychodynamic therapy gets an undeserved reputation just because CBT is easier to manualize. (All possibilities for another day!) For today, I think it’s worthwhile to talk about how sometimes we had really interesting ideas and they turned out to be wrong. Some therapies have evidence demonstrating not just that they don’t work as well as other therapies, but that they don’t work at all or they actively damage clients! YIKES! 

Examples that might surprise you?

  • Critical Incident Stress Debriefing for PTSD
  • Grief counseling for normal bereavement
  • Relaxation treatments for panic disorder

Check this article by Scott Lilienfeld out here. 

 

Comment below if there’s one of those other topics you’d like me to write about, or if you have ever gotten training in any of these harmful therapies, or (heaven forbid!) you know someone who uses them.