An Introduction to Behavior Modification, Cognitive-Behavior Modification, and DGB Cognitive (Rational-Empirical) Dialectic-Humanistic-Existentialism...
In Behavioral Psychology -- or 'Behaviorism' -- they have a simple 2-phase model of human behavior that goes like this: 1. Stimulus; 2. Response. Call this the 'Behavioral Stimulus-Response Model'. We perceive a stimulus -- and we respond.
Then 'consequences' happen -- first environmental and then self-consequences. Behavioral Psychology calls these consequences -- particularly the environmental ones -- 'conditioners'. They 'condition' our future behavior by the nature of the 'positive' vs. 'negative' impact -- 'pleasure' vs. 'pain' -- that they have -- or at least are perceived to have -- on our lives and, more specifically, on our physical, mental, and emotional well-being.
The focus in Behavioral Psychology -- or Behavior Modification or Behavior Therapy --is on what might be called 'external determinants' or 'external, environmental consequences'.
Change the external consequences -- change the external conditioners -- and you change the future behavior. Or so the behaviorists argue. From a DGB perspective, the Behaviorists offer a one-sided, external perspective -- or 'locus of control' where the 'environment' (researcher, manipulator, man in control of the behavioral therapy) is 'changing the external environmental factors, determinants, or conditioners, to meet the therapeutic goals established by both the therapist and the patient or -- more manipulatively -- the researcher/therapist/institute himself/ herself/itself.
The 'freedom vs. determinism', 'Behaviorism vs. Cognitive Therapy', 'Behaviorism vs. Humanistic-Existentialism' -- all of these slightly different but inter-connected arguments are all various renditions of the: 'Which came first -- the chicken or the egg?' -- argument.
I spent about a year arguing/debating with one of my first readers on Hegel's Hotel on the issue of 'freedom vs. determinism' (Paul Baioni from I believe Texas? or New Orleans? was my debating adversary. If you are out there Paul, I would welcome an email from you...). I don't think that either of us really came to any resolution on the argument and maybe even partly/ got 'lost in the use of each other's words and their abstract meanings'...
I remember that Paul had one concept that I liked -- even a 'dialectic distinction' between two compatable and/or opposing concepts: 'IP' meaning 'Individual Philosophy' vs. 'SP' meaning 'Social Philosophy'.
However, here is we got 'stuck' in our 'freedom vs. determinism' impasse. Paul believed in a 'fatalistic approach to life' where 'personal and social experiences cause the evolution of a person's Individual Philosophy; in contrast, I held on to a more 'freedom-existential' position of our existing Individual Philosophy at least partly if not mainly determining the particular way in which we 'perceive', 'interpret', 'evaluate', and 'learn' from our personal and social experiences.
Today -- as more of a 'Rational-Empirical-Dialectical-Humanistic-Existential' (REDHE) than I was even three or four years ago -- my argument runs like this:
Personal and social experiences influence the evolution of our Individual Philosophy-Psychology (IPP) -- and in turn -- our Individual Philosophy-Psychology (IPP) influences the particular way in which our personal and social experiences are perceived, interpreted, evaluated, responded to, and 'generalized into memory-learnings'...
My supervisor-sponsor-professor-evaluator of my Honours Thesis back in 1979 -- Dr. Donald Meichenbaum -- was in the process of integrating 'Cogntive Therapy' with 'Behavioral Modification' techniques. He was aiming to help clients change or modify their 'internal self-talk'.
While I was rebelling -- still am -- against what I viewed as the 'manipuative-anti-humanistic' philosophies and techniques of the likes of B.F.Skinner as can be found in his 'Behavioral Utopian' book 'Walden 2', I welcomed the more 'cognitive-oriented approach' of Dr. Meichenbaum as it fit with my evolving background in General Semantics and Cogntive Therapy. Meichenbaum's work represented a more 'internal locus of control' philosophy and a very significant 'internal delving of the cognitive dynamics' inside the infamous 'Stimulus-Response' Model and the 'black box' of Behaviorism.
So when I started to write 'Evaluation and Health', I was seeking to build a more 'Cognitive-Humanistic' model -- a contrasting perspective and model to the 'hard' Behavioral Psychology line of thinking. In Dr. Meichenbaum's work, I found a professor who was in the process of integrating both philosophies -- Cognitive Therapy ad Behavioral Psychology --into a more harmonious marriage union, this he just had accomplished in his 1977 book, Cognitive-Behavior Modification . And I approached Dr. Meichenbaum with the idea of writing an essay on the potential contributions of General Semantics (primarily the work of Alfred Korzybski and S.I. Hayakawa) to Cogntive Therapy -- and by extension from Meichenbaum's integrative perspective -- Cogntive-Behavior Modification.
Before I continue any further with my own work here, both now and back in 1979, I would like to introduce you to a synopsis of the work and life of Dr. Donald Meichenbaum who has had a significant impact on the evolution and growth of clinical psychology, research, and psychotherapy in North America. I have picked out this interview that I just found on the internet, taken in 2002, between Victor Yalom (the interviewer) and Dr. Donald Meichenbaum (the interviewee). I will add a few editorial comments at the end of this interview, and then pick up the essay again on another day. -- dgb, May 10th-11th, 2009.
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An Interview with Donald Meichenbaum, PhD
Cognitive Behavioral Therapy & Trauma
By Victor Yalom, PhD
See Donald Meichenbaum on DVD!Sections in this interview:
The Interview
Trauma and Hope: The Melissa Institute
The Desire to Help and a Story about Mom
Paradigm Shifts in Psychotherapy
People Have Stories to Tell
Change in Trauma Clients
The Search for "Expert" Therapists
How Meichenbaum's Work Has Grown
About the Interviewer
About the Featured Therapist
About Donald Meichenbaum
The Interview
Yalom: Dr. Meichenbaum thanks for meeting with me today.
Meichenbaum: I welcome the opportunity to be part of your interview series.
Yalom: I am interested in knowing what got you into the field of clinical psychology.
Meichenbaum: I started my undergraduate career at City College of New York and from there I went to the University of Illinois in Champaign where I obtained my Ph.D. in Clinical Psychology. I started out in graduate school as an industrial psychologist and I was hired as a research assistant to conduct group observations at a local veteran's psychiatric hospital. I became fascinated with the patients and decided to switch to clinical.
Yalom: Why did you go into psychology?
Meichenbaum: I grew up in New York City where one naturally becomes a "people watcher." I was always fascinated by the process of trying to understand human behavior. As a youth, I was interested in how people come to engage in destructive aggressive acts like the Holocaust. On the other side, I grew up in a home where caring for others was important. These two influences led me to choose psychology.
Yalom: How did you end up at the University of Waterloo in Ontario Canada?
Meichenbaum: From Illinois I went to Waterloo, in part because they offered me a job. Waterloo was a new University and it had much promise. Also, the Chairman of the Psychology Department was Richard Walters of Bandura and Walters fame. He was a brilliant psychologist and I had an opportunity to work with him. Unfortunately, he died soon after I arrived, but Waterloo turned out to be a wonderful setting and I have stayed for 33 years until I took early retirement a few years ago.
Yalom: What are you doing now?
Meichenbaum: If you live in Ontario, Canada, and you retire, one of the things you do is go to Florida for the winter (with a large percentage of the Canadian population). Besides the weather, the main activity that brings me to Florida is that I have become the Research Director of The Melissa Institute for Violence Prevention and the Treatment of Victims of Violence, in Miami, Florida.
Trauma and Hope: The Melissa Institute
Yalom: Can you tell us about The Melissa Institute? How did it emerge? What does it do? Why Melissa?
Meichenbaum: There is no way to allay the emotional pain of such trauma, but rather they try and find some meaning in the tragedy. Melissa was a young lady who grew up in Miami and she was going to Washington University in St. Louis. A tragic thing occurred. She was car jacked and murdered. Now when such a tragedy befalls a family, their relatives, friends and neighbors, one of the ways people try and "cope" is to transform their pain. There is no way to allay the emotional pain of such trauma, but rather they try and find some meaning in the tragedy. Hopefully, some good can come out of such a profound loss.
As you know, one of my areas of specialization is studying the impact of trauma (as I discuss in my Clinical Handbook on Treating Adults with PTSD). A friend of Melissa's parents read the handbook and attended one of my workshops. She put me in touch with Melissa's parents and one thing led to another and with the friend, Dr. Suzanne Keeley, we established an Institute in Melissa's name.
Yalom: What does The Melissa Institute do?
Meichenbaum: The Melissa Institute is designed to bridge the gap between scientific findings and public policies, clinical and educational practices. The Melissa Institute is designed to "give psychology away" in an effort to reduce violence and to treat victims of violence. It is not a direct service Institute. Instead, it provides services in three areas. First, it provides graduate student scholarships in support of doctoral dissertation work in the areas of violence prevention and treatment of victims. Second, it provides training and education in the form of workshops and conferences. We hold an annual May conference, (next year will be a conference in New York on the aftermath of September 11), and conduct other trainings for various members of the community, as well as school children (e.g., on bullying). Third, and most importantly, The Institute provides consultation to various public agencies in the area of violence prevention.
On a personal note, it has been fascinating for me to consult to the Mayor's office, the Public Defender's Office, the District Attorney, the Juvenile Assessment Center and to other agencies. After some 30 years of research and clinical practice, I have been struggling with how I can have a larger impact. How could I use all that I have experienced and learned to make the world less violent for my new grandchildren? (For more information on The Melissa Institute activities, please visit the website www.melissainstitute.org).
As you can see, I have not fully retired. I do not just spend my time on the beach.
Yalom: What do you miss about the academic setting, if indeed you do?
Meichenbaum: I do spend the summer months in Waterloo, so I have maintained contact with the University. I miss my colleagues and the daily research activities with my graduate students. I also cut back on my clinical practice and I now spend my time engaged in consultations with a wide array of clinical populations in various settings including psychiatric facilities, residential programs, centers for treating individuals with brain injury and individuals with developmental delays. I am still a "people watcher."
Yalom: You mentioned that you also are involved with trauma patients.
Meichenbaum: Yes, I was involved in consultations on an array of traumatic events including the Oklahoma City bombing, the Columbine school shootings, and now the aftermath of the September 11 events. These various forms of violence have led me to write a Clinical Handbook on Treating Individuals with Anger-control Problems and Aggressive Behaviors. This practical therapist manual fits well with my efforts as Research Director of The Melissa Institute.
Yalom: Your work sounds both gratifying and intellectually stimulating, but it doesn't sound like you're retired.
Meichenbaum: It is rewarding. I cannot think of a more important problem to focus my attention on than the reduction of violence.
The Desire to Help and a Story about Mom
Yalom: Getting back to your desire to help people. Therapists often go about helping people in ways that are based on their own experiences in life. Do you have a sense of how personal experiences in your life have affected your clinical work?
Meichenbaum: A couple of years ago, I wrote a chapter entitled "A Personal Journey of a Psychotherapist and His Mother". In it, I began with an anecdote that may answer your question. My mother, who lived in New York, came to visit me in Canada soon after I took early retirement. I had to tell her the news about my early retirement. My mother looked a bit puzzled upon hearing of my retirement and then paused and asked, "What am I supposed to tell my friends? I'm still working and my son, the Professor, is retired!"
Now when my mom visits she comes with stories. She is a big "story teller". But, she has a special way of telling stories. She not only tells you about an incident in her life, but she also tells you about the feelings and thoughts she had before, during, and after the incident. Moreover, she provides editorial commentary on what were useful thoughts and what were stress-engendering thoughts and moreover, what she could have done differently. On one recent visit, it dawned on me that I ate dinner with my mother each day of my formative years and listened to such stories. For example, my mother would say:
"I said to myself, Flo, so you moved the heavy box? I knew I shouldn't have done that. Then, I got down on myself for making such a foolish decision. 'What will I tell Donny?' But, then I thought why get down on yourself, because all you were doing was trying to help." � And so the story continued.
Yalom: What did you learn from this story with your mother?
Meichenbaum: As my mom would say what you do is "New York Therapy". You try and teach people... to talk to themselves differently, to change the stories they tell themselves and others."For this you get paid?" I came to realize that the form of cognitive-behavioral therapy that I have been working on for my entire career was in some sense a way to validate my socialization process. As my mom would say what you do is "New York Therapy". You try and teach people (schizophrenics, hyperactive children, aggressive individuals, traumatized individuals) to talk to themselves differently, to change the stories they tell themselves and others. "For this you get paid?"
Yalom: I didn't realize your mom was one of the originators of Cognitive-Behavior Therapy (CBT).
Meichenbaum: I think she would be willing to share credit with others. I could give a scholarly answer about the origins of CBT ranging from Immanual Kant to Freud to Dubois to Adler to Kelly to Ellis and to Beck. But, I like to give credit to my mom who recently died of cancer. You can trace the scholarly lineage in my Handbooks.
Yalom: I know the intellectual roots of your inspiration also run deep, but it is particularity refreshing to hear you speak outside of the traditional academic jargon and learn of your personal connection to your work. That is what we expect of our clients, namely, their ability to learn from their lives, so why not therapists.
Paradigm Shifts in Psychotherapy
Meichenbaum: I have become fascinated with the nature of story telling that patients offer themselves and others and how their stories change over the course of therapy.
Yalom: It sounds like this relates a lot to the ideas of narrative constructions.
Meichenbaum: If you look at the evolution of cognitive behavior therapy you can find a shift in the models employed to explain the nature and role of cognitions. In 1960's and early 1970's, I (and others) was viewing cognitions within the framework of learning theory. Cognitions were viewed as "covert behaviors" subject to the same so-called "laws of learning", as are overt behaviors. Now, I don't believe that there are laws of learning" that explain overt behavior, let alone cognitions. In the 1970's and 1980's, the computer metaphor became prominent and cognitions were viewed within the framework of social information processing. Concepts of decoding, mental heuristics, attributional biases, self-fulfilling prophecies, and the like were used to explain the role of thoughts and feelings played in overt behavior.
These first two conceptual stages were heuristically useful, as they yielded the development of self-instructional training, stress inoculation training, and various cognitive restructuring procedures. (See Meichenbaum's Cognitive-Behavior Modification : An Integrative Approach for a discussion of these origins.)
More recently, as the role of meaning, with all of its developmental and contextual-cultural influences, has come to the fore, I (and others) have begun to explore the usefulness of a constructive narrative perspective. I have written about the importance of this theoretical shift in various places, including the two Clinical Handbooks.
Yalom: In terms of theoretical shifts, you are one of the few writers to directly confront how to treat co-existing anxiety and depression, which is so common in clinical practice. Indeed, in the video training film you demonstrated how CBT can be applied when these clinical conditions co-occur. What were you attempting to illustrate in this video?
Meichenbaum: This teaching film was an interesting exercise because the producers wanted me to demonstrate short-term CBT intervention (12 sessions) with a patient who experienced both anxiety and depression. Not only that, they wanted me to reduce all 12 sessions into a one hour film. If you had to make such a one-hour film, what would you put in it? What exactly would an "expert" therapist demonstrate? What does the research literature suggest as being critical to include?
I should note, parenthetically, that the area of "expertise" interests me a great deal. With a colleague, Andy Biemiller, we wrote a book called Nurturing Independent Learners (Brookline Books Publishers) in which we reviewed the literature on expertise in various areas such as athletes, musicians, teachers, students and clinicians.
People Have Stories to Tell
Yalom: Can you speak more about nature of stories and change in therapy?
Meichenbaum: If you work with people who have been victimized as a result of having been raped or sexually abused, or exposed to intimate partner violence, or some other form of violence, you soon come to see that the nature of their "stories" changes over the course of therapy.
Yalom: How so?
Meichenbaum: One of the things that becomes apparent when you work with people who've been victimized is they have a story to tell. One of the things we know is that people who have been victimized and have shared that story do better than those who have not. Moreover, if you work with those clients over a period of time, as I have, one of things you come to realize is that the nature of their story changes.
At the outset of therapy, they may view themselves as "victims", as "prisoners of the past", as "soiled goods". This is more likely if the individual has been repeatedly victimized.
At the outset of therapy, they may see themselves as "unlovable and "worthless" and view the world as being unsafe and their situation as being "helpless" and "hopeless". As one patient observed, "My life is a glob of misery, a total personal tragedy." The patients' beliefs in themselves and others have been "shattered".
Yalom: That reminds me of a song by Sting to this effect: "I've been shattered, I've been scattered I've been knocked out of the race, but I'll get better." As you describe patients' feelings as expressed in their stories, it becomes clear how important the therapeutic alliance is to this change process.
Meichenbaum: Very much so. In the safety of the therapeutic alliance, the therapist listens compassionately, emphatically, and in a nonjudgmental manner to the patient's accounts. One of the things that becomes very interesting is that collaboratively, in the safety of the therapeutic relationship, you start to see the story of the trauma change.
But more is involved as the therapist can help the patients attend to features of their "stories" that are often overlooked. What did the patients do to endure and survive the abuse? In short, the therapist helps the patients tell the "rest of the story" and to consider the implications of such survival skills for coping in the future.
The therapist helps the patients move from viewing themselves as a "victim", to becoming a "survivor", and even to the point of becoming a "thriver", as patients come to help others and transform their pain into something good that may come from their experiences. The therapist can use a number of clinical skills and the "art of questioning" to help nurture the patient's sense of personal agency in this transformation process. The "thriver" is someone who still remembers, but can use that pain more effectively. Patients learn to develop their own voice and not repeat the "stories" that were conveyed by victimizers.
Change in Trauma Clients
Yalom: Can you give an example of this change process?
Meichenbaum: ...how individuals use the memory of the loss to make changes is a task of therapy. Take Melissa's parents as an example. Their daughter was victim of a senseless brutal murder. The emotional pain and loss that surviving members experience do not go away as attested to by the survivors of the events of September 11. The question for patients is how to muster the courage and to transform their emotional pain into something good that will come of it.
As I discuss in some detail in the PTSD Handbook, the adage that "thou shalt not forget", becomes a personal directive; for forgetting would dishonor the memory of the lost one.
Instead, how individuals use the memory of the loss to make changes is a task of therapy. In Melissa's case, her parents helped establish an Institute in her name. If they could prevent one more Melissa from dying, then maybe she did not die in vain. Patients do not need to create an Institute to heal. Their Institute may be a small personal way to "find meaning". This constructive narrative perspective that I am advocating is not unique to cognitive-behavior therapy. A number of psychodynamic therapists such as Schafer and Spence have been strong advocates of a narrative perspective, as has the developmental psychologist Jerome Bruner.
Yalom: How does your concept of narrative construction fit in with the narrative therapies of Michael White and David Epston?
Meichenbaum: I think there is some overlap theoretically, but there are also differences in terms of specific interventions. My commitment to cognitive-behavioral interventions highlight the role of behavioral change, namely, the value of helping change the nature of the "stories" patients tell themselves and others as a result of personal behavioral experiments they engage in.
As a cognitive-behavioral therapist, there is still a critical role for skills training and relapse prevention in the therapy regimen. So the focus of therapy is not delimited to just trying to have patients change their stories. There is also a need for the therapist to collaboratively address the other clinical needs that patients experience, especially in those instances when comorbid disorders occur.
Since PTSD often co-occurs with such additional problems as anxiety, depression, substance abuse and anger, there is a need for therapists to attend to these clinical areas.
Yalom: You mention anger in passing yet I know you have spent quite a bit of time and study on anger which resulted in your writing new book, Clinical Handbook in Anger Control.
Meichenbaum: Yes, in a number of settings in which I consult the patients (children, adolescents and adults) have a history of victimization (up to 50%) and they evidence problems with emotional dysregulation, where anger comes into play. I am often called upon to help frontline staff and therapists to deal with potentially violent and aggressive patients. The Anger Handbook provides practical examples of how to assess, and treat such patients.
The Search for "Expert" Therapists
Yalom: What did you learn about what works in therapy from you research and study of expert therapists?
Meichenbaum: Experts know a lot, and moreover, their knowledge is organized in an efficient, retrievable fashion.In general, three features characterize experts.
Experts know a lot, and moreover, their knowledge is organized in an efficient, retrievable fashion. They have a good deal of knowledge - declarative ("knowing what", strategic ("knowing how") and conditional ("knowing if - then relationships").
Secondly, they use this knowledge in a strategic flexible fashion.
Third, expertise develops as a result of deliberate practice - practice that is designed to achieve specific goals. In fact, there is some suggestion that expertise does not develop until you have been at an activity for several years.
One very interesting thing that comes out of the literature on expertise: -whether you study chess players or chefs- you are unlikely to become expert until you're at it for several years. Why should it take so long to become an expert? Or, for some, they might say "so little." So a good, expert therapist has a lot of knowledge about patterns, about strategies. And they hang in there.
Yalom: So I get a sense of what the qualities of an expert therapist are, but in your view what do they attend to or do differently in the session?
Meichenbaum: Let me enumerate what my research has shown to be the core tasks of therapy. I have discussed them in detail in the Anger-Control Handbook. First, the "expert" therapist needs to establish and maintain a therapeutic alliance. This is the "glue" or key ingredient for nurturing change.
Second, inherent to all forms of therapy is some form of education. I don't mean didactic instruction, but rather Socratic interactions. I spell out the innumerable ways that therapist can engage in the educational process over the course of treatment. These include the "art of questioning", the use of patients' self-monitoring, modeling films, the use of "teaching stories", and the like.
Other core tasks of therapy include nurturing patient's hope, teaching skills and ensuring the likelihood of generalization. I have included in the Anger-Control Handbook a checklist of how to increase the likelihood of generalization, as well as ways to engage in relapse prevention and self-attribution training (i.e., making sure that patients take credit for change).
The therapist needs to ensure that not only do patients have intra- and interpersonal skills, but also that they apply them in their everyday experience. Patients also need to come to see the connections between their efforts and resultant consequences. Moreover, given the high likelihood of patients re-experiencing their problematic behaviors and given the episodic nature of chronic mental disorders, there is a need to help patients develop relapse prevention skills.
The expert therapist attends to these core tasks in a consistent, creative manner, tailored to each patient's needs.
Yalom: Are there additional core tasks that need to be considered when working with patients who have been victimized?
Meichenbaum: It is not just that "bad" things happen to people, but what people tell themselves and others as a result of having been victimized that is critical.If the patient has been traumatized, then there are five additional core tasks that need to be considered. These include addressing the specific needs in terms of safety and the specific PTSD or complex PTSD symptomatology, as well as any comorbid features.
There is also a need to help patients share their stories and consider not only what they experienced, but also what are the implications, what are the conclusions they draw about themselves and others as a result of having experienced trauma. What is the nature of the "story" that patients fashion as a result of having been victimized?
It is not just that "bad" things happen to people, but what people tell themselves and others as a result of having been victimized that is critical. Out of the sharing of these accounts, the therapist helps patients co-construct "meaning" and transform their pain into some activity that permits them to continue functioning.
Other core tasks include helping patients develop strategies in order to avoid victimization. Patients also have to be encouraged to associate with and nurture relationships with prosocial non-victimized others. Not delimiting their life to being a "victim".
Yalom: Can these same core tasks be applied to other clinical populations besides individuals with PTSD?
Meichenbaum: Yes. For example, in the recent Handbook on Treating Individuals with Anger-Controls Problems, I discuss various ways to establish a therapeutic alliance with aggressive angry individuals who may be persistent perpetrators. There is a need to understand the "mind-set" of individuals who engage in such aggressive behaviors. There is also a need to educate clients about the distinction between anger and aggression. By use of collaborative goal-setting, the therapist can nurture hope. There is a need to teach self-regulating skills and interpersonal skills and to take the steps required to increase the likelihood of generalization or transfer.
I enumerate a variety of skills that may be taught including relaxation, self-coping skills, relapse prevention skills, and the like.
In the Handbook, as I noted earlier, I have included a behavioral checklist so therapists can assess how "expert" they are in implementing these core tasks. Moreover, since a percentage of individuals who engage in violent behavior have been victimized themselves, there is a need to address therapeutically the impact of such experiences on the development of their belief system.
How Meichenbaum's Work Has Grown
Yalom: Do you think you are a better therapist now than say 20 years ago?
Meichenbaum: I would like to think so. Remember it takes about seven years to become an "expert" at any activity.
Yalom: In what ways do you think you are a better therapist? .
Meichenbaum: I now focus more on what patients have been able to accomplish in spite of the exposure to multiple stressors and how patients can use such resilience to address present needs.
Before answering, I wish I had hard data that the patients outcomes are better now than when I began. The data on level of therapists' experience and treatment outcomes may give one pause in drawing any conclusions. On the other side of the equation, I believe that the patients I am now seeing are more distressed than those I saw 20 years ago. They also have fewer resources and supports.
In terms of specific changes in my approach, I believe I have become more strengths-based in my therapy approach. I now focus more on what patients have been able to accomplish in spite of the exposure to multiple stressors and how patients can use such resilience to address present needs. I have come to appreciate the value of having patients be collaborative, and in fact even one step ahead of me, offering the advice I would otherwise offer.
I have written a book (with Dennis Turk) on Facilitating Treatment Adherence that convinced me of the need for the "expert" therapist to anticipate and address issues of noncompliance, resistance, and barriers to generalization throughout therapy. One cannot "train and hope" for transfer, but must build these issues into treatment from the outset.
Yalom: I can see that many things have changed in your work. What has stayed the same in your work?
Meichenbaum: I have still maintained my desire to help and to respect my patients. I have always had a commitment to integrate empirically-sound treatment approaches with a clinically sensitive compassionate approach.
I have tried to be sensitive to the role of racial and cultural factors and the need for an ecologically sensitive treatment approach. I have always been hopeful about human behavior and the ability of psychology to make a difference.
My current involvement with The Melissa Institute provides me with an opportunity to implement that dream. For example, The Melissa Institute recently had a conference on ethnic diversity and the implications for assessment and treatment. I became supersensitive to the issue of culture when I taught at the University of Hawaii on several occasions.
The "expert" therapist needs to be sensitive to how culture impacts on the expression, course and treatment receptivity of patients. For example, research indicates that depression looks different cross-culturally - a lesson I learned in Hawaii. Or what constitutes risk and protective factors among delinquent youth in the Miami Juvenile Assessment Center varies by age and gender. I believe it is crucial for the clinician to develop an appreciation of the role of culture and a questioning of what makes someone an "expert" therapist.
Yalom: I am really struck by the scope of your work. To take a wide angle view of your career paints quite a picture, so please indulge me for a moment. Your studies range far and wide covering varied clinical populations of psychological trauma, head injury, medical and psychiatric patients. You have pushed the field ahead in terms of developing new cognitive behavioral treatment approaches such as stress inoculation training and self-instructional training. And now you are in the midst of refining cognitive therapy from a cognitive narrative perspective. Professionally, you have extended yourself to influencing public policy and clinical and educational practices with The Melissa Institute. You may be "retired", but your curiosity and passion still seem very much alive.
Meichenbaum: The sense of inquiry and the desire to help that were there when I began this journey in the 1960's are very much alive in the year 2002. The urgency for social action is even more pressing.
Yalom: It has been a pleasure speaking with you and thanks for sharing your thoughts with our readers.
Meichenbaum: Thank you very much.
Copyright © 2002 Psychotherapy.net. All rights reserved. Published April 2002.
If you have comments on this interview, please send them to comments@psychotherapy.net or submit them in our Guestbook.
About Donald Meichenbaum, PhD
Donald Meichenbaum, PhD is Professor Emeritus of Clinical Psychology at the University of Waterloo, and founding member of The Melissa Institute for Violence Prevention and Treatment. He holds the dual distinction of having been voted "one of the ten most influential psychotherapists of the century" (reported in the American Psychologist) and being the most cited psychology researcher at a Canadian university.
About the Interviewer:
Victor Yalom, PhD
Victor Yalom is a psychologist, group & couples therapist, and cartoonist in San Francisco, as well as founder & president of Psychotherapy.net.
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DGB Editorial Comments on The Interview
I must say that it is interesting to track the course of Dr. Meichenbaum's career and life since I crossed paths with him all so briefly and lightly in 1979. I have the greatest respect for his life work, even more so in reading this interview now, and seeing what he accomplished between 1979 and 2002. In terms of the 'essence' of his Cogitive-Behavior Therapy, I particularly like the story about his mom, the ideas of 'internal narrative story-telling' and idea of 'shifts in paradigm' -- both for Dr. Meichenbaum as a therapist 'moving more and more inwards into the area of covert behaviors, self-talk, and narrative constructions' from his earlier training as a 'Behavior Modification Researcher and Clinician'; and also a 'shift in paradigm' for the patient/client in therapy who is getting better and moving away from the role/personna/self-stereotype of 'victim' and/or 'victimizer' to the role of 'survivor' and 'thriver'.
Dr. Meichenbaum lists his main academic influencers (in addition to his mom and her role in teaching him the benefit of 'more encouraging as opposed to more discouraging self-talk'). These academic influencers included: Immanual Kant, Freud, Dubois, Adler, Kelly, Ellis, Beck.
My academic influences at this time overlapped. Kant I had not yet read at least in any understandable fashion. I, like most psychology students, had learned the basics of Freudian Psychoanalysis. Dubois I had heard about but did not investigate his work. Adler I was just starting to become exposed to. I would join The Adlerian Institute for 2 years in 1980 and 1981. Kelly, Ellis, and Beck -- I was familiar with all of them, and quoted them in different parts of 'Evaluation and Health'.
On top of this, I was influenced in my writing by Nathaniel Branden from 'The Psychology of Self-Esteem', Ayn Rand indirectly from Nathaniel Branden, Maxwell Maltz from his best-seller 'Psycho-Cybernetics', and Erich Fromm from 'Man For Himself', 'Escape From Freedom', and 'The Sane Society'.
My final -- and most dominant -- influence at the time was General Semantics through the work of the founder of GS, Alfred Korzybski, and his main student, S.I. Hayakawa.
Alfred Korzybski should be ideally taught in every philosophy program whereas, in reality, he is probably taught in none.
Alfred Korzybski is, to my way of thinking, the greatest epistemologist in the history of Western philosophy -- better than Kant, Locke, Hume, Aristotle, Rand, Bertrand Russell, one of my other favorite epistemologists, Sir Francis Bacon, and finally Wittgenstein whose work is very similar to Korzybski's but Korzybski's is better (they lived around the same time, wrote some similar things, and I haven't determined who influenced who yet, or whether that influence was mutual or not at all). Korzybski's classic book on General Semantics is called, 'Science and Sanity: An Introduction to Non-Aristolean Systems and General Semantics' (1933).
It was Alfred Korzybski's main student and co-worker -- S.I. Hayakawa -- who broke me into the study of General Semantics through his book, 'Language, Thought, and Action', and my Grade 12 and 13 English teacher, Mr. Kress, who made this book the course textbook in 1972-73. 'Language in Thought and Action' was first published in 1949 and has been through 5 editions including at least the last one, I believe in 1990, that was written with his son, Alan.
I was proud to receive the following email from Alan Hayakawa (Senator S.I. Hayakawa's son) on March 15th, 2009 after he had read one of my political essays denouncing the present direction of The Republican Party. I hope Alan doesn't mind my sharing this email with you as I don't know what his present political involvement is. (I will check with him and take it off if he does.)
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David,
I got a big kick out of your suggestion that the Republican party should follow S.I. Hayakawa rather than Sarah Palin ... not likely, but a fine idea.
I'm Alan Hayakawa; S.I. (Don) Hayakawa was my father. And I'll bet you didn't know that between his graduate work at McGill and his time at Wisconsin, he drove a cab for a while. I believe it was in Montreal, although I could be mistaken.
Alan Hayakawa
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Language in thought and action
by Samuel Ichiye Hayakawa
About this title: An introduction to the study of semantics, which examines human interaction through communication, toward a more sophisticated understanding of the role of language in life, the complex functions language performs and the way language, sometimes without knowing, shapes our thinking.
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From the internet...google...S.I.Hayakawa, Language In Thought and Action...
S. I. Hayakawa's Language in Thought and Action has been one of the course's handbooks for a memorable number of years already, but the manner in which it has been used has changed somewhat over the years.
Although the basic concern of the book is with «informal» semantics (not the formal brand of semantics concerned with, e.g. the computation of truth-value), i.e. the «symbolic» way in which utterances are used to convey meaning, it also raises the more cognitive issue of how language affects human thought and conditions behaviour, and addresses the resulting «ethical» question of how language should be used to achieve cooperation and understanding rather than confrontation and conflict. These questions (though viewed in a somewhat «optimistic» perspective) give the book additional value as one of the pioneering works in «critical linguistics», a discipline which was to develop only much later.
Reading the book, students will progressively collect a «toolbox» of notions by means of which they will in due course be able to analyse texts at a level beyond the visible «surface» of expression, and thus be encouraged to approach texts «critically», and notably to recognise, assess and if necessary denounce linguistic manipulation -- whether by politicians, advertisers or teachers; and this mode of reading will contribute considerably to the global understanding of texts which is part and parcel of the «licence» pragmastylistics and critical discourse analysis courses.
Students are presumed to be thoroughly familiar with the contents and the vocabulary of the book. This is important, since without adequate knowledge of the contents of the various chapters, much personal reflection on the texts to be read during the exercise sessions and the licence years will become more difficult. So it might be a good idea to start reading immediately.
The book will introduce a number of concepts which you will increasingly grow aware of in your own «Niagara of words», i.e. your personal linguistic universe: books, papers, journals, libraries, films, songs, videos, cartoons, radio broadcasts, advertisements, etc. The point of the course is to encourage you to recognise the workings of language in your linguistic environment, not to just learn them as «subject matter».
Thorough knowledge of the book will be assessed at the various BA3 examinations, but familiarity with its categories and concepts will be presupposed at MA level as well. Questions at the written and oral exams may be content- as well as vocabulary-oriented, or may require students to comment on a text or other piece of language from a critical semantic perspective.
The BA3 Hayakawa "Scrapbook" Assignment is based on two things :
1. Hayakawa's suggestion (Language in Thought and Action, 5th ("pink") ed., p. 229, that students should start a "scrapbook" of linguistic observations;
2. The course summary in 36 key notions and the subsequent list of examples.
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And from another website on Hayakawa and 'Language in Thought and Action'...dgb
Some Notes on "Language in Thought and Action" by S I Hayakawa and Son, 1990.
Published by Harcourt Brace Jovanovich, Publishers, NY.
by Charlie Notess, Loveland, CO
Last Updated: 8-26-2000
I wish to give much credit to S. I. Hayakawa for continuing to update and publish this book. I believe that every High School senior should read and understand the contents before graduating. Too many writers on current affairs discuss the polarization in our society, yet do not mention the ideas in this book as an important contributor to problems of polarization in our society
Robert MacNeil, in the introduction, wrote: "Hayakawa tells us how to use that which is most human in us - our talent for abstraction and awareness of language - to make us less belligerent, less fearful, more cooperative, more reasonable people."
Little children are often too specific in their definitions. A newspaper is what the newsboy delivers". A definition at too low a level of abstraction does not help us comprehend what the speaker means. Is it that newspaper that the news boy threw on the little boys driveway or is a news paper also what one finds in a news stand? On the other hand, dictionaries give definitions at high levels of abstraction.
Levels of Abstraction are presented on pages 85-95 in Hayakawa's book. Page 103 summarizes, with good examples how levels of abstraction or generalizations are used by bigots, some political candidates in the US, and the media, to mislead voters. The term Republican tells us very little about the actual candidate. Although many view all Republicans as conservatives, the term is too high a level of abstraction. A good example, of how meaningless the term is, is Colorado State congressman Bill Kaufman, a progressive Republican. As Hayakawa says, "The picture of reality created inside our heads by the lack of consciousness of the abstracting process is not at all.." the description of the real person, once we get to know him.
Some people spend a lot of time in the delusional world of prejudice and hatred based on levels of abstraction that are too high. Serbs, who under Tito, worked and socialized together with Muslim Bosnians, turned to distrusted all of them and killed them under the rule of Milosovic. Fear is a big part of such delusional actions.
On page 107, Hayakawa tells how, because he looks Oriental, "he is credited (or accused) of having an "Oriental mind." Since Buddha, Confucius and Mao Tse-tung... all have "Oriental minds", it is difficult to know whether to feel complimented or insulted". Shapely blonds and Blacks have similar problems that in many cases leads them to develop very insecure self images.
On page 129, he says some very important things about two valued orientations (you are wrong and I am right). Congress does not conduct much of its serious business on the floor in front of TV cameras. What is on TV is for the voters and constituents and is polarized into two value debates.
The Open and Closed mind is summarized on pages 131-3. Rokeach of Michigan State described how there are 4 options for how a listener might react to a speaker and his/her statement.
1. accept the speaker and accept the statement;
2. accept the speaker and reject the statement;
3. reject the speaker and accept the statement;
4. reject the speaker and reject the statement.
Open minded persons can react to all four options, whereas closed mind persons will react only to #1 & #4. The leader of the USSR, Lenin, only reacted to #1. If he trusted the speaker, but rejected his statement, he would view the speaker as unconsciously on the enemy side. If he distrusted the speaker, he rejected even statements with which he agreed. Thus Lenin would only listen to option #1. People with closed minds apparently feel threatened and are fearful. The are two-valued people, through and through.
Reasonably secure and well organized persons enjoy their belief system, but they are also open to information about views that they disbelieve. You can empathize with persons who believe in other political ideologies and/or who believe other religions.
Abstraction is illustrated on pages 175-6. There is a good example of how to escape from two-valued debate in thinking about social problems. We need to get beyond the narrow world of two-valued logic. It works for arithmetic and engineering, and it seems to attract viewers for TV shows, but it does not help in reaching consensus on social issues.
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Good ideas never die,
Sometimes they just go to sleep,
Or retreat back in Anaxamander's 'Aperion',
Jung's 'Shadow',
Perls' 'Background',
Lie in hybernation,
For periods of time,
Only to be re-awakened,
In new contexts,
By new writers, new philosophers, new speakers...
Re-vitalized,
Integrated in new directions,
A Hegelian dialectic evolution,
That never stops,
No Utopias...
Just new integrations,
New evolutions,
And new applications...
What goes around,
Comes around,
Both good and bad,
Let's continue with 'Evaluation and Health'...
-- dgb, May 10th-12th, 2009.
-- David Gordon Bain
