Real Therapy vs. In Treatment: The Role of Repetition

Entry for 21 November 2009:

We loved watching the American/Israeli television series, In Treatment, which preoccupied us for two months this past September-October as we patiently watched the 40+ episodes at a rate of 5/week, just as it was intended to be watched. However, one thing that I found a bit disturbing was the fact that the therapy sessions in the TV series appeared to be no more than 20 minutes long, less than half the standard therapy session duration of 50 minutes.

After we finished watching In Treatment we decided to take a look at the real thing, and began working our way through Les Greenberg’s Emotion-Focused Therapy Over Time set of 6 sessions, with additional spoken commentary by Les. After a bit of experimentation we decided that the best way to properly appreciate these is to watch the first 25 minutes of a session, then to go back watch it again with Les’ commentary. In this manner we determined that we could get though a session in two evenings. At this point, we’ve reached the halfway point, having finished session 3 in both versions.

Part of the fun of watching this series is that we know Les, but the fact is, the series is very good: The client, a psychiatric survivor with multiple hospitalizations feels absolutely real, just like the clients that we often see in our clinic settings. She talks at Les, she externalizes, she starts to change then gets ahead of herself, crashes and gets stuck. Les does great work, too good in fact for my students today in EFT-2, who felt de-skilled and intimidated. He also messes up (occasionally) and gets frustrated.

But the thing that struck me when comparing Les’ work (and my work as a therapist also) is the amount of repetition in comparison to In Treatment. That is, there is very little repetition in In Treatment, but there is a lot of repetition in Les’ and my work. When something is stuck we go over it a couple of times, just to see if it will get unstuck; when something new comes out, we repeat it at least twice, and even ask the client to repeat it. Repetition Rules!

It’s easy to see why there is relatively little repetition in In Treatment: The writers were afraid of boring people and wanted to fit a session into a half-hour slot. They were afraid to put too much repetition into the script, because they thought it would rob the program of dramatic vitality. The result is what my grandmother used to call “giving it the fictional treatment.”

In fact, repetition may be an important – but overlooked – aspect of therapy. Once, during the late 1980’s, I was showing Les and Laura a video of my work with a client from the Toledo Depression Project. I complained that I couldn’t understand why my client was still struggling with an issue that we’d already worked over in therapy a couple of times. Les quoted a Gestalt therapy maxim to the effect of, “You have to work through an issue seven times before it sticks.” More generally, it seems to be important that new information be repeated in order to give the client time to let it soak in, that is, to reinforce or consolidate it. Cycling through material repeatedly gives the client more time to process an experience. For example, it is common for new details or connections to emerge when a client with post-traumatic stress difficulties tells their trauma narrative again. Repetition is part of a process of slowing down and dwelling that can be important for helping the client to dig deeper into their experience and to access key emotion schemes and the experiences associated with these.

So repetition can be important in therapy, and is yet another example of a quite broad principle of information science: Redundancy signals importance. In other words, if you want to communicate that something is important, repeat it as many times as it takes to boost its salience to the level desired.

Also, as the Danish theologian Kierkegaard once said, there is no repetition, which means that nothing gets repeated exactly, so you never know when something important is going to jump out, almost by chance, the third time around. And this is an example of another important principle, this one from complexity theory: Self-organizing processes tend to develop by capitalizing on chance, waiting for something new and important to fall out randomly, and then going with it. Complexity scientists think that complex, self-organizing processes, from galaxies to life to brains to cultures, develop in this way. Why not our clients too?

November Steps: Variations on a theme by Takemitsu

Entry for 14 November 2009:

The temperature drops as Autumn progresses, first from 10-15 Celsius, and now in the past week, varying between 5 and 10 Celsius. The trees lose their leaves, too, in stages, rowan, birch, elm and finally oak. And the days grower shorter, as if counting down by steps also, imperceptible until we notice we've lost more hours of daylight: 12 hours (solstice)... 10 hours (mid October)... in a few days, our daylight will drop to 8 hours... before gradually settling toward 7 hours at winter solstice.

These are our November Steps, as we descend into late Autumn. The phrase from the title of a wonderfully evocative piece of music by Japanese composer Toru Takemitsu for traditional Japanese instruments (biwa, shakuhachi) and orchestra.

November is an appropriate time for letting go, for grieving what cannot be and had lived only in the life of our imaginations; it is also a time for feeling grateful for what is possible and real, that is, for giving thanks (thanksgiving). In fact, I think that these two movements of the psyche are really the same movement: to let go of what has passed (or was never more than a hope or dream) is to be grateful for what is there for us now. I have been trying to live this these past few weeks, living in a way that feels both sad and at points even mildly depressed, as if in mourning; but paradoxically this November state of mind at the same time seems affirming, grounded, peaceful.

Saturday Adventure: Campsie Glen

Entry for 14 November 2009:

This week's Saturday Adventure: Campsie Glen, north of Glasgow, above Clachan (=village) of Campsie. Valley-canyon cut into the Campsie Fells by the Glazert Water, in full spate after recent rains. Waterfalls cascading down the glen, some from side streams running off the bracken rust-coloured moorlands on either side of the glen.

Every time I go out for a run here, I run up Cleveden Road to the top of the hill, before descending steeply to the canal. From the top of the hill, for just a few minutes, I’m usually able to see the Campsie Fells before me, about 10 miles to the north. Sometimes (but not too often) they stand out bright in the morning sun. Sometimes they are completely obscured by cloud. Usually, like this morning, they are somewhat indistinct, shaded by clouds or mist.

On a clear day, the westernmost hill of the Campsie Fells stands out from the rest stretching away to the east. I have heard locals refer to the Campsies as the “sleeping soldier”, although this phrase is more commonly used to describe the island of Arran. The westernmost hill is the head of the soldier, and it’s the part I generally see most clearly as I reach the top of Cleveden Hill and start down the other side.

As is often the case on Saturdays, we got off to a late start and reached Clachan of Campsie only about 2 in the afternoon. It was very quiet. We hiked up the glen, along the Glazert Water, not very far, because the path is blocked by warning signs borne by quite large carved wooden hands. We turned around, came back, poked around a couple of the small shops and the old graveyard, with its tumbled-down chapel and grass- and moss-covered grave stones. We stopped at the little café/gallery there and had tea, hot chocolate and a plate of cheeses, oatcakes and a small salad. Then, with darkness already starting coming on at a bit before 4pm, we drove over to Lennoxtown, where we turned up the Crow Road driving a mile or two until we reached a vista point overlooking the Campsie Glen and its surrounding countryside. This is another nearby place that is definitely worth further exploration, not far at all from Glasgow, but wild-feeling, dramatic and beautiful.

2009 Faculty of Education Graduation in Barony Hall

Entry for 7 November 2009:

I missed the previous two years’ graduations, because I was either out of town or ill. This year, however, I was able to make it, and so, a bit before 10 this morning I collected my academic regalia, caught the train to High Street Station, and walked up the road to Barony Hall.

Barony Hall is another one of those converted churches, a beautiful late Victorian gothic revival structure made of the luminous red sandstone that is so characteristic of Glasgow. The University of Strathclyde uses it for ceremonial events, such as graduations.

Many people were unhappy when it was decided last year to stop holding Education Faculty graduations in the Francis Tombs Hall on the Jordanhill Campus. It was traditional, familiar, and if the weather was nice, people could spill out onto the well-tended grounds of the campus. (It was also right next to my office, which I could therefore use to put on my cap, gown and hood.) All these things are true, but graduation in Barony felt much grander. As we processed into the old cathedral-style church, like some large and highly dressed choir, the place was packed with people. We took our places in what used to the sanctuary of the church, and looked out at the people assembled. The sun was shining through the stained glass windows at the back (east end) of the hall: Graduates filled the transept to our right and the front rows; behind them, their families and friends were packed in – including four of our part time tutors. They were there to support the students they’d nurtured through the intensity of the last years’ Fulltime and Monday Part-time counselling diploma courses. It was a magnificent scene, easily beating the sports arena/football field/commercial hall settings favoured by American universities and high schools, or even the auditorium we’d been having graduations in at Jordanhill.

Scottish graduations apparently value efficiency along with pomp and ritual: There was a grand marshal wielding the Official Mace, but there was no invocation or closing benediction. The platform party was not introduced and the parents, spouses, siblings, spouses, children and grandchildren of the graduates were not thanked. There was no long, often boring speech from a visiting dignitary with little or no connection to the University. Instead, there was a very brief greeting from the Deputy Principal of the university, Ann Hughes, and then the Dean began reading the names of the graduates as they trooped across the front of the platform. First, they knelt or bowed before the Deputy Principal, who capped them: That is, she placed her cap on their head for a moment, symbolically transferring her wisdom and authority to them. Then they were hooded and congratulated. All told, there were about 125 graduates at the ceremony. Once this was finished, the Deputy Principal gave a short speech congratulating the graduates and enumerating the recent accomplishments of the Faculty of Education. When she mentioned the Counselling Unit’s getting the Charlotte and Karl Buehler Award from APA’s Division of Humanistic Psychology, the counselling unit graduates, seated to our left in the transept, spontaneously burst into applause. Then the Deputy Principal finished her talk, invited everyone to the reception across the street in the Lord Hope Building, and that was it. The bagpiper started playing and led us out of the Hall. Forty-five minutes.

At the reception, I went around looking for students to congratulate, taking pictures of them and having pictures taken with them. They were all beaming. They been through a lot, personally, professionally, emotionally, as well as academically, and felt deservedly proud. I feel proud of them also.