I read an interesting Paper on the relationship between ‘change’ and ‘control‘ as guides in the therapeutic journey. Some of these features are discussed elsewhere but I want to look at this specific Paper in more detail on this page. I’d like to identify some difficulties presented by this model in order to drill into the more helpful elements. What attracted me to this Paper was the statement:
Therapy will be effective only when the client’s reorganization system— not the therapist—has managed to come up with a solution to the client’s problem
Understanding the Change Process Involved in Solving Psychological Problems: a Model-based Approach to Understanding How Psychotherapy Works by Richard S. Marken and Timothy A. Carey
Does it not sound a bit like the ‘message’ on this website? The problem is that these writers’ soon depart from their ‘client-centredness’. A complication I have mentioned before.
The Perceptual Control Theory (PCT)
For a start, the authors label their approach the Perceptual Control Theory (PCT) model of human functioning. Their aim is to understand the nature of psychological problems using that Model. Their contention is that “improvements in effectiveness, efficiency and accessibility have been hampered by a lack of understanding of how psychotherapy works“. They suggest that current accounts of the change process create their own problems when solving therapeutic dilemmas.
There are limitations in all models of change but I am not so sure about their alternative. It seems to add to the number of models, rather than integrate what is already around. Their own ‘part-answer’ is not bringing our understanding together.
It would appear that Marken and Carey’s part-answer is to describe what happens when people move from one state of psychological distress to another – or even to contentment or satisfaction. They want to explore the skills involved in making that move happen. Stage models of change have been offering similar explorations for decades.
Changing levels of distress
I can see that just noticing the change from a state of distress to less distress is important, but the important question is who identified the state of distress and what is done about the observation? The direction in which change has moved, and by how much, are key questions. The Subjective Unit of Distress (SUD) is just that – it is subjective – and each of us have a unique perspective on it. There is an example of a safe experiment using the SUD can be found at:
https://your-nudge.com/practical-relaxation/
Furthermore, I have concern about how they will achieve their ambitions through the generation of new skills. Although seemingly non-controversial, the authors’ go on to assert that psychological ‘problems‘ require new skills. That statement presents a few dilemmas for this website:
- as it is wary of the word ‘problems’, and
- it places value on identifying and developing your existing skills.
Separate out skills or create a conversation?
Whatever the direction of change, I say that an effective therapeutic relationship depends on a conversation between old and new skills. I can see that my ‘problems’ may arise from limitations in applying my existing skills, but my psychological health can be advanced by honing my existing skills and developing new skills. The categorisation on offer in this Paper is ‘digital’, rather than interactive. It is one thing and another, rather than one thing with another.
This way of thinking appears to suffer the same fate of research that apportions a certain ‘percentage’ of influence to one factor, rather than another. Interacting ‘percentages’ can work toward a new ‘whole’ but any one ‘percentage’ sheds little light.
Psychotherapy based on PCT appears to be aimed at directing re-organization to the source of the ‘problem’. This re-organisation will reduce conflict and discomfort. Contrary to the view of the Perceptual Control Therapy (PCT), I see conflict as a necessary part of the change process. It needs to be just noticed.
This experience may create distress, but it a necessary (not sufficient) experience in the learning and change process. My distress draws my attention to an obstacle on my scenic route. It helps me to recognise there is an obstacle. That recognition is needed to decide what to do about it next.
Where do control issues fit?
I accept that ‘control’ is part of a driver in my problem-solving as this page identifies. Safe experiments that take account of the Locus of Control (LOC) may help me at one time, or another.
….. but control is only one of many obstacles I will meet on the scenic route. It is but one factor that will generate the small victories and small defeats I need to reorganize my world view. Discomfort may prompt me to control that experience yet there will still be times when that same discomfort helps me to create new skills, perspective and insights. Without that discomfort, obstacles may not be seen and this can create a ‘discount’; a label can only helps if it casts light on what is to do next.
True, there will be an inconsistency between what I say, what I think or what I believe and that is no less true for any ‘client’. Have a look at this page on blueprints, redprints and greenprints. Therapy can exist to meet inconsistency and highlight tensions by brings in another person with their own point of view. They may offer an insight that moves things on. One aim of therapy is to bring in a joint understanding of the situation; by definition, a different understanding.
Often that new perspective emerges from casting light on ‘dissonance’; that is, the gap that exists between our stated intentions and our actual behaviour.
Even so, this Paper does cast some interesting light on the art of safe experimenting. I want to comment on some specific possibilities that emerge from Perceptual Control Therapy (PCT).
Building up small, safe experiments
In practice, the writers highlight that that there is a general change process at work. Any therapy can make that process work but people have to make it work! When the client contributes to the shaping of that process then a more effective may emerge. This requires that the client is an active agent in psychotherapy. As a consequence, the question: how does psychotherapy work can be replaced by how can clients use the resources of psychotherapy to achieve the benefits they desire. This is a point that Marken and Carey make and it provides the common ground with this website. The issue, then, is what is that client contribution and how does a therapist relate to it?
Understanding the client as an active agent is important and it highlights the change process as a subjective phenomenon. It is something that happens in or external world and in our internal world. There is a parallel process going on between our neuronal structures, our experiences and our place in the family and community.
Further leads to consider
Welcome: Welcome to Find Your Nudge
Parallel processes: Parallel Processes: different relationships in therapy: therapists, clients, their families and supervisors.
Lived experience: Your lived experience is not enough
Making connections: Connect