Humans have the capacity to be able to survive due to their ability to alter experiences through changing their perceptions and beliefs about the world we live in.
However, at times we may attempt to avoid unpleasant experiences by simply not thinking about them, and just trying to think about the pleasant. This is called “experiential avoidance” in the Acceptance and Commitment Therapy (ACT) model.
The catch is that we are then stuck in a negative cycle of hating the experience we are avoiding, a mental ‘action’ which in itself produces some of the very feelings we are trying to escape.
As Wilson and Murrell (2003) write in their chapter on values-based interventions, “our culture teaches that positive thoughts and feelings are good; negative thoughts and feelings are bad and ought to be removed, diminished or at least minimized” (p 5). They write that a central aim in schools and workplaces is to develop higher levels of confidence and self-esteem, and to always be cheerful and optimistic, and that negative thoughts are to be ‘punished’ in some way unless they can quickly be controlled and moved away.
They describe a scenario heard all too commonly in the public sphere. A lonely adult tells a friend she believes no one will ever love her. The friend may try to be helpful and tell her, “Don’t think like that! That’s not true, or at least not true forever!”
Treating Schizophrenia
In 2008, while working in the aged care sector as a psychologist, I was asked by a general practitioner to assist him with a patient diagnosed with schizophrenia. The GP wrote up a mental health care plan, and wondered if some psychological intervention might work, stating he had tried different medications with little success. He could not get the patient out of his bed and into any sort of normality.
When I first saw John (not his real name), a 55 year old male, he was lying in his bed, quilt over his head, curtains drawn, in a very dark room which smelled of sweat and dirty clothes and some urine. I sat with him for the whole time (sessions were of about an hour). Although at that time I was not well versed in Acceptance and Commitment Therapy, I realise now I had used at least some of the techniques.
I introduced myself as Peter, and that I was a psychologist, just wanting to sit with him to chat, and asked him a few questions. When he remained silent I told him I knew he was afraid of some terrible things happening to him, and that these were experiences no one would like another person to have. But, I told him, we all have frightening experiences in our lives, and I proceeded to share some of the times I was afraid, depressed and even had thoughts of being suicidal years ago.
Then I asked, “What’s happening for you right now John?”
“I’m being torn apart by lions, and there’s blood all over me.”
I told him that must be an awful feeling, and sat there attempting to fully empathise with his plight. “Is that why you are hiding under the quilt – to try to get away from them?”
“Yeah, but it’s not working – they follow me around everywhere, and I can’t do anything about it.”
After a pause I asked, “Would you like me to see if we can do something about this together?”
“Yeah, but I don’t think it will help. No one is able to help me.”
I then proceeded to ask him about his life, his history, his parents, his siblings (he told me he had a brother who was a drunk, and in more trouble than he was), his youth, education and work history. He explained he had been many things, but the jobs that he was most proud of were as a circus worker, where he was a unicyclist; and when he was a brick stacker and handler. “I was the fastest stacker – often twice as fast as anyone else,” he exclaimed proudly.
This ended the session, and I asked him if it would be okay I if came back the following Friday to chat some more. He responded, “Yes, but I don’t think it will help. The lions are still going to be here!”
Over the following weeks I would enter his room, and find him hiding under the blankets, the curtain drawn, and the window shut. I would pull over the single chair, sit next to his bed, say hello, and ask him how he was feeling. The same thing, week after week, but slowly he would come out from under the sheets, and he would look at me – talking about his plight.
Case Study of a Values-Based Intervention
After he mentioned he was a Christian, I then asked him further about this, and how that has affected his life in the past, and how that affects him now. He explained although he was brought up as a Catholic, this did not play much of a role in his troubled youth and adulthood, and he would drink a lot with his brother when he had money from work.
He then explained that since becoming a Christian a few years ago, he had been paying World Vision for sponsoring a child in Vietnam. He needed help with this, because he had received a letter from the child’s carers about reviewing his yearly donations, and he needed to inform the Public Trustee (the Government financial controller for those unable to manage their own financial affairs) that they needed to send World Vision a financial gift for the child for him.
By this stage he began sitting on the bed after I came in, because he would ask me to call the Public Trustee to help with this donation. I was required to disclose to the Trustee my interests in his case, and for John to give them permission to speak to me. I discussed with the Trustee what John wanted, and asked him to send World Vision an authority for an increase in payment, and a gift of money to the child.
After some time and form filling, letter writing and further calls to the Trustee, this was achieved.
John stated that he felt so grateful for my help, and then I could see I had gained his trust. He started to open up more about what was going on for him, and he would sit next to me as I showed him some materials on my laptop, showing him ways to deal with his trauma and emotional experiences.
I talked to him about this Diamond within him, that was beautiful and perfect (a symbol of the life-force in his body). I told him God had created this Diamond, and that it would always be part of God. He told me the next time I saw him that he started to feel better about himself, as if there was something about him that was okay, even good.
I need to explain here, I see God as the universal energy of life and love which flows throughout the Universe (in line with quantum physics). However, I do not impose my own values onto others, instead simply working with whatever their beliefs are to enable them to move forward into a more functional life.
Nearly every time I visited I asked him how the lion experience was going. He told me that although the days were getting better and he would get out of bed now during the days, that his nights were still filled with terror, and he would feel the lions tearing him apart, and feel the blood all over him.
I asked him if we could try a different way of seeing this experience, and provide a different story around it. He agreed to try it, but said he felt sceptical. I said I wanted to bring in his Christian beliefs, to see if he could relate to that, and for him to tell me if it made sense. So I asked him to picture, at night, him standing under the cross of Jesus, and to feel his blood dropping onto him. To sit there praying for Jesus to help him feel happier and alive again.
The next time I saw him he said he was able to picture and feel the cross scene, but that the lions kept coming back and tearing him apart. I suggested we would keep doing this for a few weeks, and let’s see how it went. In the meantime I began looking for pictures of Jesus with a lion in the picture. I found one with what looked like Jesus with a lamb in his arms, and a lion standing next to him. I printed it off and gave it to John at the next visit.
I asked John what he felt when he saw the picture – “Wow, this is beautiful. Look at the lion, so calm, next to Jesus.”
“Well,” I said, “have a look at the lamb in his arms. That is you. How does that feel?”
“Oh, perfect!” and a huge smile showed on his face. My heart felt such joy at this response, that I became teary when I heard his statement and reaction.
“So let’s hang this up on the wall, and before you go to sleep and when you wake up, just say ‘Thank you Jesus for the help you are giving me!’”
From that time on John said he was feeling much stronger now – more alive, not so worried anymore.
And in the weeks that followed we explored other ways to improve his life. I told him I rode a pushbike and ran and swam for exercise. He said he wanted to do more exercises like that. (When I first met him he was overweight, about 110kg.)
When I asked him what he would like to do, he wanted to go to where his goods were stored to pick up his unicycle. But where could he ride it? He checked with the care facility and was given permission on the proviso that a carer was with him the whole time.
So John began the process of seeking permission and making arrangements to to pick up his unicycle.
In the meantime he began an exercise regime – in his room he would do pushups, situps, crunches, and jumps, increasing them week by week. This he did from then on, until he was a fit and slender person.
After he had retrieved the unicycle, he practised every day in the facility’s carpark. When he could ride well (like riding a bike really isn’t it? You never really forget!), then he started to add other activities, like twirling a hula hoop around his arm while he was riding the unicycle.
From then on he would ride the unicycle to a local Police Citizens Youth Club (PCYC) across the bridge. He told me whenever he rode his unicycle across the road, pedestrians would cheer him on, and he could see Japanese tourists taking pictures of him as he rode.
He was also asked by the care facility’s management to ride and do the tricks at the yearly facilities show. He felt so good about what he was able to do; he was helping other residents on his floor with their tea, and at mealtime with any needs they might have.
I will always feel joy when thinking of John, and how we worked together to make his life fully functional and psychologically flexible. He now experiences life in ways that give him so much joy, through his ability to live his values of loving connection with others, for physical and mental health and vitality, and spiritual values such as love and connection with a greater power.
It’s been a privilege, John. Thank you for sharing your journey with me …
Author: Dr Peter Noordink, BA, Grad Dip App Sc, PhD, MAPS.
Dr Peter Noordink is a Brisbane Psychologist with over 25 years’ experience in areas such as pain management, aged care, suicide prevention, improving self-worth, teenage issues, and helping middle aged men and women deal with the problems of midlife. He uses a very gentle approach to explore issues which are currently impacting on one’s general and psychological wellbeing.
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Reference:
- Wilson, K.G., & Murrell, A.R. (2003). Values-Centred Interventions: Setting a course for behavioral treatment. In S. C. Hayes, V. M., Follette, & M. Linehan (Eds.) (in preparation). The new
behavior therapies: Expanding the cognitive behavioral tradition. New York: Guilford Press.
