Recently I watched a public demonstration at a large psychotherapy conference conducted by a celebrated therapist with a female clinician in her forties. The therapist connected quickly with full attention, warmth, humor, understanding, and many other fine qualities that have been found to establish a successful therapeutic relationship.
What was striking to me was that in the first few minutes of the session, the woman offered—both verbally and nonverbally—all the information necessary to intervene effectively with the issue she presented: perfectionism. As I’ll explore further below, the way she thinks about and internally represents this problem has a relatively simple subjective structure.
With the right methods, one can quickly determine how someone “does” a problem like perfectionism internally, and then move quickly to alter the structure of this experience to transform a troubling lifelong pattern. For instance, the structure of most phobias—as well as most other troubling memories, and flashbacks in PTSD—is that the client recalls a horrible experience, steps into it, and reexperiences the intense feelings the original traumatic experience. When the client learns how to step out of that memory, and view it from a distance, as if it were happening to someone else in a movie, say, he spontaneously views the same events with equanimity, compassion, or some other more resourceful feeling.
In contrast, the structure of grief is exactly the opposite of a typical phobia. Here, a client separates from a positive experience, viewing it as if it were happening to someone else, so she doesn’t have access to the treasured feelings experienced with the lost person, leaving only a feeling of emptiness. When the client learns to step into that lost experience again, she can reconnect with the wonderful feelings that she had, and use those feelings to move on in her life. The interventions that can help with the reactions to trauma and extreme grief can be done without knowing anything about the traumatic event or the relationship being mourned.
In the session below, the celebrated therapist missed much of the information the woman offered, failing to follow up on the cues that could lead to a speedy resolution of her problem. A close look at the transcript (verbatim from the DVD) of the first few minutes of the session suggests that all of us have a long way to go to hone our skills in bringing more observational precision and effectiveness to our work, so that we can move as quickly as possible to offer our clients the help they need.
Client: I’m a therapist. I’ve been practicing for about eight years, . . . and I can’t seem to get . . . past my . . . wanting to be perfect . . . wanting to have every session be profitable.
Therapist: Must you get past that?
Client: In my own mind I want to be . . . to reach a point where I’m calm . . . with myself . . . that I can say, “That was good enough, . . . That was good,” and not worry. I worry.
Therapist: Yeah. Could you give me some example of that?
Client: So you want an example of worry?
Therapist: What kinds of things would bother you that you hadn’t been perfect about? That you think, in your own assessment, you really should be satisfied, “It’s good enough.”
Client: Well, I guess a big one would be when a client decides to quit doing therapy without closure—you know, has excuses why they’re not coming, and then disappears . . . [gestures to her right with her right hand] and despite after asking for closure, or asking if we can’t have a conversation about it, and not getting that [gestures with both hands in a circle in front of her]. My own disappointment [her right hand gestures toward her upper chest] and my own wondering.
Therapist: That really leaves you hanging, doesn’t it?
Client: Then I go to, “Well, I must not be very good at this . . .” [her left hand gestures to her right], despite the thousand other people that I might have seen and had good experiences with [her right hand gestures to the right in a large sweeping arc].
Therapist: Yeah, it’s not really fair, is it?
Client: It just takes one [her right hand gestures vertically in front of her chest, index finger up] to unngh.
Therapist: Well, I’d like to know your suffering. Tell me how you suffer with it.
Client: Oh, probably for a week, and then sporadically, maybe forever [she shakes her head from side to side]. I’m not sure [her right hand gestures to her right]. It seems to come and go, you know. Every time there’s a disappointment . . . [she gestures with her right hand to her right, in a series of movements, as if indicating multiple events]. Then it gets to join. . . [she gestures with both hands, palms facing each other slightly to her left]. All the past ones . . . [she gestures with her left hand palm up to her far left]
Therapist: They gather together.
Client: Then they gather together. . . [she gestures with both hands in front of her in a circular/spherical motion] and gang up on me sometimes.
The therapist then explored the client’s relationships in fairly typical ways, with questions like, “Who do you know who wouldn’t accept your mistakes?” “If I were to make a mistake, would you accept that?” “What would it take for you to feel that humanness and accept your mistakes?” and “Who would be the definitive person to forgive you?”
When the client doesn’t accept the presupposition that others are relevant to her issue, and responds, “I’m the only one. If I forgive myself, it doesn’t matter what someone else says” (a statement that I believe is true, and is at least arguable), the therapist replies gently, but emphatically, “That’s such bullshit. You’ve been brainwashed. Of course, other people matter to you! You’re vulnerable to the vagaries of other people’s opinions, insistencies, demands.”
Then the therapist proceeds to explore past relationships with questions like, “Let’s find out who’s getting’ you—who’s the definitive person who, if they forgave you, it would change everything.”
Initially the client doesn’t identify anyone in her life who’s relevant to this issue, and says she feels stuck. The therapist lists major family members—mother, father, brother, sister—as possibilities of others who might be relevant, but the client continues to have difficulty identifying anyone else relevant to her perfectionism.
Eventually she focuses on her mother’s habit of frequently “shooting her down.” “I’d have a dream or an idea, and think I could do that,’ and she’d say why I couldn’t.” The therapist says, “What would you like to say to her about that?” engaging her in a dialogue with her mother.
Client: Keep your opinions to yourself; I want my dreams.
Therapist: Could you tell her more about that?
Client: When you do that, it kills something inside me. I deserve to have my dreams nourished, and that’s what I want from you, and if you could do that, I’d like that.
Therapist: And how do you think she’d react to that?
Client: She’d probably cry and say, “I didn’t know.”
Therapist: And then what would you do?
Client: I’d probably cry and hug her.
Therapist: Yes, how lovely. You could almost cry now.
Client: Yes, I almost did.
Working with history in this way was clearly important and healing to the client, and it will change how she thinks about her mother in relation her mother’s “shooting her down.” However, the mother’s shooting down her dreams and ideas isn’t the same as her feeling that she has to be perfect, and this intervention will have no effect on that.
When the client asks, “What does this have to do with perfectionism?” the therapist replies, “Let’s talk about her perfectionism. Is there some way that you could forgive her?” and engages the client in further dialogue with her mother in which she identifies how her mother has judged her. Later the client forgives her mother for her judgment of her. This working with history will change the way the client thinks about her mother’s perfectionism. Although valuable in itself, this won’t necessarily change the client’s perfectionism. Many people can forgive others’ mistakes, yet be very harsh and unforgiving of their own.
Therapeutically, one can approach any problem historically in this way, as a complicated issue requiring many sessions of digging into unhappy memories and the enduring legacy of family dysfunction and other burdens from the past. But there are ways of working with the present structure of a problem—created by that history—that are often much more rapid and effective.
Changing Structure Directly
At some time in their life, everyone has experienced what the client in the transcript above is concerned about—being disappointed with their own behavior, and then “crashing,” as some aspect of their self-concept “crumbles” in response to the disappointment. This client wants to “get past” “wanting to be perfect.” Since no one can be perfect, this clearly indicates that she has unrealistically high standards. But what’s the structure of her experience that’s indicated by the words “unrealistically high standards”?
To understand this structure fully, we have to make a brief digression into the importance of where images are located in our personal space, particularly in relation to how we experience time. For instance, think of something simple that you’ve done before, like going to a movie. Remember a time in the past when you went to a movie, and notice where your internal image of this event is located in your personal space in relation to your body (not the geographic location of the movie or the theater).
Then think to yourself, “I could go to a movie today,” and notice the location of this image.
Now imagine for a moment that you’ve decided to go to a movie next month, and notice where that image is located.
Events occurring at different times will be located in different locations in your personal space. If this isn’t already obvious to you, think of all three events simultaneously, and notice their different locations.
My image of going to a movie in the past is to my left and somewhat below eye level. Today is directly in front of me. Next month is to my right and a bit higher than eye level. This is one of several typical ways of organizing events in time. Many others visualize past images behind them, tomorrow in front of them, and next month farther away in front of them. Whatever arrangement you find, that indicates how you locate events in your personal space in order to keep track of their order in time.
The Client’s Structure
This client has all her successful experiences with clients collected and located on her right side, as indicated by her right hand’s sweeping gesture to the right as she says, “the thousand other people that I might have seen and had good experiences with.”
In contrast, all her disappointing experiences with clients “all the past ones” are collected and located on her left side, in her past.
When this client experiences a new disappointment in the present (“It just takes one“), she puts it together with (“It gets to join”) all the other failures in the past (“All the past ones”), and “they gather together . . . and gang up on me sometimes.” At that point, all she can see is her failures, so she feels terrible, because that’s the opposite of what she wants and values. Her positive self-concept literally disappears, and her feelings “crash.” That’s how one disappointment can become “disproportionate and block out everything else.”
Having successes and disappointments separated in space like this is inherently unstable: it’s much too easy to slip from attending to the group of successes and feeling great, to attending to the group of failures and feeling terrible, as this client does. When someone’s successes are represented in one sensory modality (for instance, visual images) and the failures are in another modality (for instance, auditory voices), the separation is greater, and the instability is greater. Our attention is always limited in scope, and we often attend to one or two modalities and completely ignore one or two others. For instance, when you’re attending intently to what you see, you may temporarily ignore the sounds around you, or what you feel in your body.
As long as people pay attention only to successes, they’ll be perfectionistic, because they’re trying to respond in a way that matches that unblemished group of successes. They’ll be reluctant to admit a failure (“denial”), because they feel so bad when they “crash” as a result.
This description of the structure of this client’s problem makes the solution fairly obvious. The unstable separation between successes and failures needs to be eliminated by integrating failures with successes in the same location in her personal space. When they’re interspersed, she’ll be able to see her occasional disappointments surrounded by her many successes, giving her what’s often called a “balanced perspective.” Mixing together failures and successes in the same location will make her self-concept stronger and more resilient, and at the same time make her more open and responsive to the corrective feedback provided by mistakes. However, this integration has to be done carefully and gently, or she may experience even more of the unpleasantness she already has.
This client spontaneously identified the location of her successes on her right, and failures on her left. But if a client doesn’t, you can simply ask, “When you think of your successful interactions with clients, where do you think of them in your personal space? . . . And I’m sure that there must have been times when you weren’t successful with a client; if you think of one of those now, where is that in your personal space?”
If I were working with the client in the transcript, I’d ask her to gently and cautiously move one image of failure from her left over to her right to join the successes in that location, while being very careful that it didn’t expand and cover up her successes. Nonverbally gesturing slowly from one location to another with closely cupped hands makes this verbal instruction unambiguous and easy to follow. Then she could move over another failure or two, one at a time. I’ve done this with hundreds of clients in less than a minute, and all have found it easy to do. The typical observable response is immediate physical relaxation, as they’re released from having to meet that impossible perfectionistic ideal.
The result of this intervention would be that she could see a large number of successes, interspersed with a few disappointments, creating a perspective that would make the failures much easier to accept. With successes outnumbering disappointments in one location, denial of failure would no longer be necessary, so she’d be much more likely to recognize and accept mistakes when they happened, and to be responsive to corrective feedback. Integration prevents the strain of trying to be perfect, and eliminates the instability that results in periodic “crashes,” making her self-concept more durable.
An even more elegant way to accomplish this integration, particularly when someone has a lot of disappointments, is to take one of them and change it in some way into a success. This can be done by “videotape editing,” in which clients start with a movie of the failure experience and alter their behavior until it’s satisfying to them. It can also be done by any other change method that seems appropriate.
For instance, the client in the transcript might decide to revise the movie of her work with a client so that she asks the client for feedback much more often during their sessions to track their progress, and notices both the verbal and nonverbal response. In that revised movie, she has frequent, ongoing information from her client about how the session is going. Then when a client terminates without explanation, she’d know much more, and not be faced with the uncertainty that she ruminated about and interpreted as a “failure.”
When a failure has become an example of a success, it can easily be moved into the location of the other successes, preferably with some kind of subtle coding as a reminder that it’s a success that was created by transforming a failure. For instance, if the client has visual images, this coding could be a border, tag, or different color or shape. Then the client can do this with other failures, either one at a time or by grouping them into a category of similar experiences, until all or most of them are transformed into positive examples. This transformation takes a little longer and is more difficult to do conversationally. However, the results are much better than simply moving a few failures into the same location as successes, and it can be applied in situations in which the client has a large number of failures, for which the previous method doesn’t work as well.
This client offered all the information needed to understand the structure of her problem in less than two and a half minutes at the beginning of the session. Resolving her problem would usually take only a little longer, making it an example of what might be called “briefest therapy.”
At this point, a skeptical reader will likely have a few questions, like “Can this kind of approach really work that fast to achieve lasting change?” and “If it does work, why isn’t it more widely known and taught?”
The first question is much easier to answer than the second. Yes, it does work that fast, most of the time, with specific problems in which the structure is consistent and has been well characterized. These include phobias, troubling memories, grief, shame, guilt, changing bad habits, problems with self-concept, transforming anger into forgiveness, changing troublesome internal voices into helpful allies, and eliminating physical allergies when the allergen is known. With some problems that are more complex, I can successfully resolve many underlying issues like shame, guilt, and self-concept, which improves the client’s life, yet still not reach their desired outcome.
The second question has so many answers it would take another article to discuss them all thoroughly. Probably foremost is the widespread belief that usually underlies the first question: that it isn’t possible for someone to change so quickly. Years ago, my wife demonstrated the phobia cure for the staff of an army hospital with a woman who was afraid of heights. After the 10-minute process, when the woman happily climbed a tall ladder, one of the psychiatrists who’d witnessed the entire process, said, “You’re a nice lady, but you just can’t do that.”
There’s a huge difference between researching and creating something that works, and promoting and marketing it. Neuro-Lingusitic Programming (NLP) was developed by two nonprofessionals, Richard Bandler and John Grinder, who went out of their way to insult academia and professionals generally, and to scorn traditional research—definitely bad marketing.
Many people have taken a weekend training in NLP, gone back to their practice, and found that what they’d learned didn’t work as magically as the demonstrations in the workshop. I don’t know anyone who thinks that they could take a weekend training in violin from Joshua Bell and become a virtuoso, but many apparently think that they can take a short training and quickly become skilled in working with the mind—one of the most complex systems in the world.
Although straightforward, NLP is complex and differentiated—there’s a lot to learn. There are many different perceptual skills, ways of gathering information, and understanding the problems that people have, and many different processes and techniques that can be used to resolve them. All of these have both verbal and nonverbal aspects, and all can be systematically taught, but they need to be practiced thoroughly, and they require a different mind-set than most clinicians are used to. Nevertheless, this way of working is gradually finding its way into mainstream psychotherapy, and I continue to believe that as it becomes more accepted and researched, it’ll increasingly reveal its potential to improve our profession.
Steve Andreas, MA, was a developer of NLP methods and the author of Six Blind Elephants, Transforming Your Self, and Virginia Satir: the Patterns of Her Magic. He was coauthor, with his wife Connirae, of Heart of the Mind and Change Your Mind—and Keep the Change.