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The Importance of Trust and Curiosity In Treatment

Turns out that one of the most important aspects to addressing any emotional, mental health or addiction problem is learning to be curious.  Over the years, numerous studies of the application of different psychological theories have failed to show any factor about a particular theory which made the application of that psychological theory better than another.  The only factor in all of these studies that has made a difference in the efficacy of the application of any psychological theory has been the relationship between the patient and therapist.  In other words, in terms of the therapeutic improvement of the patient to whom different theories are applied, the most important factor has been not whether someone was a Freudian, or a Jungian, or an object relations therapist, or a behaviorist, but the nature of the relationship between the therapist and patient.

What this tells us is that for any mechanism of emotional change to work, there has to be trust in someone, or something, outside of oneself.  Once there is sufficient trust in a therapist, a support group, or a positive and supporting belief system outside of oneself, then change becomes possible.

Once the possibility of change is present, the question then becomes – what is the additional ingredient that needs to be added to trust in order for change and healing to occur with emotional diseases.  More and more studies suggest the other ingredient needed is curiosity.

The development of this understanding has occurred as we see a movement toward integration in the various forms of psychotherapy.  The most significant impact on psychotherapy in recent decades has been the introduction of the psychological practices and techniques employed for centuries in Buddhist psychology.  These practices center around various forms of meditation and the therapeutic value involved in meditation practices.

Although there are parallels in most of the world’s great spiritual and religious traditions, the psychology of meditation practices is most developed in Buddhism. These practices have been examined thoroughly in a secular fashion under the names of relaxation response training and mindfulness meditation.  There is now a substantial amount of scientific information from studying meditators showing the distinct beneficial effect on the brain of meditation practices.  Studies of brain electrical activity by researchers of meditators before and after a two-month course in mindfulness meditation found a significantly increased activity on the left side of the prefrontal cortex, an area of the brain associated with joy and serenity.  Other scientific findings have shown an increase in antibody reactions of meditators to flu vaccines.  Very interesting studies are now underway looking at the effects of meditation on the amygdala, the brain’s fear center, as well as on the caudate nucleus, which is that area of the brain associated with obsessional thoughts and compulsive behavior.

In meditation practice what happens is that the meditative state becomes a way in which the person withdraws attention from the outside world and habitual patterns of perceiving that world.  There is a decreased pre-occupation with how one’s own emotions are affected.  The meditator is taught to be curious in observing the rise and fall of one’s emotional states.

What has been most interesting is that the therapeutic tradition which has taken meditation most seriously has been cognitive behavioral therapy.  Cognitive behavioral therapy, when it emerged some years ago, was a break from therapy that sought to explore one’s inner feelings and the origins of those feelings from one’s family dynamic.  Cognitive behavioral therapy focuses on what is the underlying thought that precedes an emotion or feeling.  Cognitive behavioral techniques then focus on correcting the irrational thinking that underlies difficult emotions.  Cognitive behavioral therapy has been found to be one of the most effective therapies in dealing with depression.

Cognitive behavioral therapists have now seen the benefit of combining their approach of understanding the underlying thought processes which precede emotions with the techniques of meditation.  This new combined approach is called the “third wave” of cognitive behavioral therapy.  Other names given to this new approach are dialectical behavior therapy, acceptance and commitment therapy, and mindfulness-based cognitive behavioral therapy.  Dialectical behavior therapy has been shown in application to be one of the most effective theories in helping individuals with a difficult class of problems that traditionally have been most resistant to therapeutic treatment.

Acceptance and commitment therapy builds on the non-scientific tradition of Alcoholics Anonymous in its motto, “Control is the problem, not the solution.”  The goal of this kind of therapy is to change the patient’s relationship to the symptoms that are the problem rather than treat those symptoms as the enemy.  It is a recognition that attacking the problem directly is a little bit like trying to rescue the tar baby from the briar patch.  The more one fights the symptoms, the more entangled in the problem one becomes.  Acceptance and commitment theory works to try to surrender that engagement.  This idea is captured well by what the Buddha is supposed to have said, “Pitting what you like, against what you do not like, is a disease of the mind.”

Cognitive behavioral therapists have always considered that a first step for the patient is to be able to distance him or herself from the depressive thoughts or anxieties.  This is much of what meditation is able to achieve.  Cognitive behavioral therapists then help the patient to question underlying irrational thought processes.  This is like the meditators injunction to be curious about what the thoughts and feelings are that arise in the mind during meditation.

Once one becomes curious about one’s thoughts and feelings, rather than embattled with them, an emotional distancing occurs, which allows for a shift in the patient’s perspective.  This change of focus allows for the incorporation of more positive underlying thoughts and feelings to guide the person’s emotional life.  Because an old irrational behavior pattern based on negative thoughts is often easily triggered, the daily practice of meditation helps to prevent the old program from re-establishing itself.

Initial clinical results using these newer integrated therapies are very encouraging.  Control studies have shown that dialectical behavior therapy has lowered the rate of mutilation and suicidal behavior in women with borderline personality disorders.  A study of acceptance and commitment therapy involving psychotic patients has shown that this therapy helped them dismiss delusional voices in their head and reduced their re-hospitalization rate by 50% over four months.  Another study has found that depressed patients who receive mindfulness-based cognitive therapy were only half as likely to relapse as those who had standard counseling and medication.

These newer methods have also been used in treatment of eating disorders, work-related stress, and addictions.  All of this is suggesting a coming together of different streams of psychological thought to more adequately help individuals struggling with emotional issues. For all of us who wish to keep a good mental health outlook, it provides a take-home message.  Be sure and have something outside yourself that you trust and can rely on.  And, consider meditation as a practice to help you learn to be curious about your own emotional processes.  If you are having difficulty with depression, consider a therapist who has expertise in allowing your curiosity to be put to work to create the kind of shift in thought process and emotions which will be beneficial to you.

– by Don Carroll

The North Carolina Lawyer Assistance Program is a confidential program of assistance for all North Carolina lawyers.  The Lawyer Assistance Program has two outreaches: PALS and FRIENDS.  PALS addresses alcoholism and other addiction; FRIENDS depression and other mental health problems. 

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