Focusing vs CBT, and a partial review of Focusing by Eugene Gendlin
Chasing a link from NancyLebovitz on LW, I've spent a few hours this week reading Focusing, by Eugene Gendlin, which reads like a New Age-y self-help manual, providing instructions on how to focus on a 'felt sense' and attain a 'body shift', or 'felt response' including some troubleshooting for the various steps, and then cramming in a whole new manual in the last chapter or two called The Listening Manual, which provides explicit instruction on total listening, active listening, and listening in a group. Despite the weird (to me) language, I saw enough similarities between focusing and techniques that have worked for me to suspect that at least parts of it are quite useful for teaching techniques that I mostly stumbled on, and possibly the whole thing really is as good as Gendlin thinks it is.
A very quick summary, with excerpts from the notes I took.
First section: Psychotherapy is mysterious, in the sense that for every patient helped by a given technique, there are many other patients who don't seem to get any benefit from therapy, no matter how long they try it, and psychotherapists don't understand why there's such a huge disparity in their effectiveness. Gendlin and others pored through thousands of hours of taped therapy sessions to work out whether there was a different between sessions where the patient had positive outcomes versus those who saw little or no improvement. They not only found such a factor, they discovered that they could predict with a high degree of success whether a patient was likely to see an improvement just by listening to the first couple of sessions. This difference is focusing - successful patients know how to focus. They then developed techniques to teach people how to focus, and have had success with it. This book contains those techniques.
Problems are felt in the whole body, not in the mind, it is important to pay attention to the feel of the whole thing rather than intellectualise them.
Anecdotes about helping people with focusing.
Second section: How to focus.
1. Clear a space, aka put down your burden, aka make a list. Create a mental space to focus in by asking yourself what all your current problems and worries are, and then setting them aside to be dealt with later. Ask yourself "other than those, is everything fine?" until the answer is yes.
2. Ask yourself which problem feels the worst. You should have a vague sense of the whole problem as something like heavy/painful/sticky/etc. Mentally stand back and feel the problem in your body, ignoring any quick analyses, rationalisations, or criticisms offered by your conscious mind. Sit with the feeling of the problem and don't try to analyse it. The feel of the problem is your 'felt sense'.
3. Find a handle that fits the quality of your 'felt sense'. Avoid jumping to a quick answer, but sit with it until you find a word/image/phrase that feels like it fits. You should feel a slight shift/resonance when you find the right handle to tell you that it is the right one.
4. Check the handle directly against the feeling for resonance. There should be a felt response to confirm this. If you can't call up the feeling, wait and repeat the handle gently until the feeling returns (this might take a minute or two). Check for resonance until you get no more felt response.
5. Ask the felt sense what it is. Ask "what is it about this that makes me feel [handle]?", "what would it take for this to feel ok?", or "what is the most [handle] thing about this?". Ignore quick answers offered by your conscious mind and wait. A real answer should feel surprising, novel, or accompanied by a sense of a shift or change. Focusing should not feel like work - if you spend a few minutes here and can't get a shift, try again later or tomorrow.
6. Receive the felt response without judging it or drowning it in immediate reactions. Tell your immediate responses that you'll listen to them later, that right now you just want to pay attention to this new response. Sit with the shift, be with it, let it develop.
Troubleshooting for the first three steps of focusing, suggestions for alternate framings and methods.
6.5 Ask yourself "is that all? Do I feel fine now?" If the answer is no, go back to step 2 and repeat for your new felt sense.
Third section: The Listening Manual.
Total/absolute listening: Don't say anything except for backchannelling ("yes","uh huh") or clarification/repeating their points back to them. When they make a major point, repeat it back to them in your own words (or in their words, if you can't quite work out how to rephrase it yourself).
Active listening: Use your reactions and feelings to help the speaker. If you want, say your reaction but then repeat their reaction to your reaction to refocus it on them. Make your statements questions, not conclusions. If someone expresses an emotion and then moves right past it, invite them to go back and discover how it feels. Or if their words don't match the nonverbal emotions being expressed, ask about that.
Subsection on dealing with difficult or particularly troubled people:
Try to respond to anything positive they say and focus on the parts that make sense (eg. if they say "the aliens took everything away from me", respond "you feel like someone took something away from you?"). Ask them about things they are competent at so that they will be able to receive sincere and deserved compliments/praise.
If someone is acting in a destructive or self-defeating manner you can a) say how it makes you feel, b) point to what they're doing and ask them what it feels like, in a deliberately vague manner (ie. don't say "you were manipulating those people", say "interacting with those people" or something similarly vague)., c) try to find the usefulness in their behaviour and point that out (eg. respond to continual complaints with "you're saying what you need from people and calling a halt to what they've been doing"). If you're their only support, call others in to help or let them meet others you know. The (difficult/troubled) person should be present when being discussed by others trying to help. Don't neglect physical needs (job, housing, etc), mental help doesn't happen in a vacuum.
Explain yourself and your feelings without making your feelings their fault. Avoid "I feel that you..." because this is making it their fault. Be specific about the situation causing the feeling. If the words that come to you feel difficult to say, let them go and wait until new words come that you can say more easily. Don't give up and not say anything. Be charitable in your listening.
And a random quote from the troubleshooting section, quoted for truth: "Most people treat themselves less like a friend than like a roommate they don't like"
And now for how this relates to the 'best' known therapy out there, CBT. In short: it doesn't. Most of the techniques I was taught that are explicitly part of CBT seem to be the complete opposite of focusing. For example, let's say I have a party to go to, and I feel scared/anxious/reluctant about going. If i was CBTing, I would list out all the things I was afraid of with regards to the party, recognise them for the exaggerated/distorted ideas they were, and come up with more realistic/balanced alternatives for those thoughts, combined with a hefty dose of "and what's so bad about that?" directed at those fears. If I was focusing, I would tell myself "ok, I think I'm afraid of specific things X,Y,Z about the party, but I'll put those aside for now and see what my fear says if I listen to it directly", and then do so. So one involves enlisting your rational side, both to come up with reasons for your emotions and then to counter those reasons, while the other is more of a Zen thing of approaching the problem holistically and not analysing any of it. I was originally going to then draw some similarities between the steps of CBT and focusing, but the more I think about it the more it seems like there aren't any, and that a lot of the techniques that I've gotten reasonable mileage from have come from reading elsewhere or suggestions from my therapist that weren't directly related to the CBT framework.
I suspect that CBT is more popular partly because it's much easier to teach and apply, and because it looks and feels a lot more 'sciencey'. Also because I can't find any papers or studies anywhere about whether focusing actually gets better results than regular talk therapy, let alone the CBT branch.
A very quick summary, with excerpts from the notes I took.
First section: Psychotherapy is mysterious, in the sense that for every patient helped by a given technique, there are many other patients who don't seem to get any benefit from therapy, no matter how long they try it, and psychotherapists don't understand why there's such a huge disparity in their effectiveness. Gendlin and others pored through thousands of hours of taped therapy sessions to work out whether there was a different between sessions where the patient had positive outcomes versus those who saw little or no improvement. They not only found such a factor, they discovered that they could predict with a high degree of success whether a patient was likely to see an improvement just by listening to the first couple of sessions. This difference is focusing - successful patients know how to focus. They then developed techniques to teach people how to focus, and have had success with it. This book contains those techniques.
Problems are felt in the whole body, not in the mind, it is important to pay attention to the feel of the whole thing rather than intellectualise them.
Anecdotes about helping people with focusing.
Second section: How to focus.
1. Clear a space, aka put down your burden, aka make a list. Create a mental space to focus in by asking yourself what all your current problems and worries are, and then setting them aside to be dealt with later. Ask yourself "other than those, is everything fine?" until the answer is yes.
2. Ask yourself which problem feels the worst. You should have a vague sense of the whole problem as something like heavy/painful/sticky/etc. Mentally stand back and feel the problem in your body, ignoring any quick analyses, rationalisations, or criticisms offered by your conscious mind. Sit with the feeling of the problem and don't try to analyse it. The feel of the problem is your 'felt sense'.
3. Find a handle that fits the quality of your 'felt sense'. Avoid jumping to a quick answer, but sit with it until you find a word/image/phrase that feels like it fits. You should feel a slight shift/resonance when you find the right handle to tell you that it is the right one.
4. Check the handle directly against the feeling for resonance. There should be a felt response to confirm this. If you can't call up the feeling, wait and repeat the handle gently until the feeling returns (this might take a minute or two). Check for resonance until you get no more felt response.
5. Ask the felt sense what it is. Ask "what is it about this that makes me feel [handle]?", "what would it take for this to feel ok?", or "what is the most [handle] thing about this?". Ignore quick answers offered by your conscious mind and wait. A real answer should feel surprising, novel, or accompanied by a sense of a shift or change. Focusing should not feel like work - if you spend a few minutes here and can't get a shift, try again later or tomorrow.
6. Receive the felt response without judging it or drowning it in immediate reactions. Tell your immediate responses that you'll listen to them later, that right now you just want to pay attention to this new response. Sit with the shift, be with it, let it develop.
Troubleshooting for the first three steps of focusing, suggestions for alternate framings and methods.
6.5 Ask yourself "is that all? Do I feel fine now?" If the answer is no, go back to step 2 and repeat for your new felt sense.
Third section: The Listening Manual.
Total/absolute listening: Don't say anything except for backchannelling ("yes","uh huh") or clarification/repeating their points back to them. When they make a major point, repeat it back to them in your own words (or in their words, if you can't quite work out how to rephrase it yourself).
Active listening: Use your reactions and feelings to help the speaker. If you want, say your reaction but then repeat their reaction to your reaction to refocus it on them. Make your statements questions, not conclusions. If someone expresses an emotion and then moves right past it, invite them to go back and discover how it feels. Or if their words don't match the nonverbal emotions being expressed, ask about that.
Subsection on dealing with difficult or particularly troubled people:
Try to respond to anything positive they say and focus on the parts that make sense (eg. if they say "the aliens took everything away from me", respond "you feel like someone took something away from you?"). Ask them about things they are competent at so that they will be able to receive sincere and deserved compliments/praise.
If someone is acting in a destructive or self-defeating manner you can a) say how it makes you feel, b) point to what they're doing and ask them what it feels like, in a deliberately vague manner (ie. don't say "you were manipulating those people", say "interacting with those people" or something similarly vague)., c) try to find the usefulness in their behaviour and point that out (eg. respond to continual complaints with "you're saying what you need from people and calling a halt to what they've been doing"). If you're their only support, call others in to help or let them meet others you know. The (difficult/troubled) person should be present when being discussed by others trying to help. Don't neglect physical needs (job, housing, etc), mental help doesn't happen in a vacuum.
Explain yourself and your feelings without making your feelings their fault. Avoid "I feel that you..." because this is making it their fault. Be specific about the situation causing the feeling. If the words that come to you feel difficult to say, let them go and wait until new words come that you can say more easily. Don't give up and not say anything. Be charitable in your listening.
And a random quote from the troubleshooting section, quoted for truth: "Most people treat themselves less like a friend than like a roommate they don't like"
And now for how this relates to the 'best' known therapy out there, CBT. In short: it doesn't. Most of the techniques I was taught that are explicitly part of CBT seem to be the complete opposite of focusing. For example, let's say I have a party to go to, and I feel scared/anxious/reluctant about going. If i was CBTing, I would list out all the things I was afraid of with regards to the party, recognise them for the exaggerated/distorted ideas they were, and come up with more realistic/balanced alternatives for those thoughts, combined with a hefty dose of "and what's so bad about that?" directed at those fears. If I was focusing, I would tell myself "ok, I think I'm afraid of specific things X,Y,Z about the party, but I'll put those aside for now and see what my fear says if I listen to it directly", and then do so. So one involves enlisting your rational side, both to come up with reasons for your emotions and then to counter those reasons, while the other is more of a Zen thing of approaching the problem holistically and not analysing any of it. I was originally going to then draw some similarities between the steps of CBT and focusing, but the more I think about it the more it seems like there aren't any, and that a lot of the techniques that I've gotten reasonable mileage from have come from reading elsewhere or suggestions from my therapist that weren't directly related to the CBT framework.
I suspect that CBT is more popular partly because it's much easier to teach and apply, and because it looks and feels a lot more 'sciencey'. Also because I can't find any papers or studies anywhere about whether focusing actually gets better results than regular talk therapy, let alone the CBT branch.