28. Quantitative/Qualitative Concrete/Abs - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
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28. Quantitative/Qualitative Concrete/Abs

Therapist Resources > Therapy Books > Out of Dev Chrysalis Intimacy/Relationship

Out of the Developmental Chrysalis in Intimacy and Relationship Therapy
by Ronald Mah

Individuals who have not been allowed to interpret from a spectrum of experiences, abstract concepts, especially if they have been frequently punished, learn each concrete rule as distinct from earlier and future experiences.  Each quantitative experience is not or only minimally transferred as instructive to any new experience.  They need to get specific permission or approval to deal with each experience.  Each interaction is experienced as unique and unrelated to prior learning and has little or no applicability to future circumstances.  They have not internalized a qualitative perception of life and living that they can actualize consistently and confidently.  Such individuals in therapy need to be overtly trained to interpret from series of experiences.  The therapist facilitates such training by helping them negotiate and accept formal operations rules and most importantly, work with them to identify their application in diverse situations.  It is the second part of this therapeutic task that is often the most time consuming part of therapy.  The lack of consistent formative experiences of childhood under parental guidance must be compensated for by therapy in session under the therapist's guidance.  The therapist guides the individual, couple, or family's experiments at home under the therapy-empowered internalized parental consciousness of the client or clients.  Fortunately, individual resiliency allows for developmental energy to re-assert itself, seek satiation, and ultimately promote mature progression into formal operations.  The greater combined wisdom and skills of the therapist and the adult individual or individuals (partners or parents) in therapy is purposeful in comparison to the individual or one or both partners having had the bad luck to lose the parent lottery.

When the individual, couple, or family returns each week to complain or report on good, benign, to poor interactions, the therapist helps them de-construct the behaviors and choices conceptually.  With successful interactions, productive or successful behaviors and choices are reframed in terms of positive principles.  The positive emotional consequences of reactions and responses are explored.  The therapist may prompt, "Why did that work?"  "Why did that feel good?"  "How come you were able to do that this time?"  Or, the therapist may provide interpretations or validation- "By putting it away, you let her know you cared."  "You got it this time that his questions meant he wanted nurturing."  "That's how men showed love in his family."  The therapist wants the individuals to both know why the behaviors worked and what behaviors worked, and the relationship between the "why" and "what."  

While recognizing the developmental lag or regression cognitively under stress, in an appropriate yet seemingly contradictory strategy, the therapist should also use the formal operations maturity of the individual or couple to aid the therapeutic/relationship's process.  Their cognitive maturity allows the clients to become more insightful, introspective, and articulate of their own and the relationship processes, and enlists and empowers them in the therapeutic process.  However, the therapist should not be fooled that this insight, introspection, and verbal articulation means individuals can follow through behaviorally without training.  With problematic interactions (which will be more common initially), alternative behaviors and choices are examined to connect them to negative principles.  The negative emotional consequences of reactions and responses are identified.  Prompts can include "What didn't feel right about that?"  "What did that mean to you?"  "Does that remind you of someone else?"  "When did you feel like that before?" Interpretations can be offered.  "Sounds like you felt dismissed."  "Putting it down would have showed you that she cared."  "He didn't know doing that was a really hurtful."   Intent may be checked.  "What was that about?"  "Did you intend to snub her?"  Insight work to process errors and "bad" interactions after the fact, however are useful only if specific behavior plans can be derived from it.  Alternative positive affirming behaviors representative of positive principles are discussed for substitution in future interactions.   "What would have worked for you?"  "Do you know what you wanted?"  "How can you let him know what's really going on?"  "How can she say it, so you can be OK with it?"  

Processing both positive and negative situations leads to the individual, couple, or family planning for insight, awareness, and behaviors to be more productive for the next encounter or challenge.  Greater productivity would initially be based on quantitative changes.  The therapeutic goal of qualitative change is based on a process of quantitative re-building or retrofitting of the deficient concrete operations functioning of the individual or individuals.  The therapist's conceptual therapy goals may be five-fold:

1. conceptual growth to formal operations processing,

2. identification and reduction of regression to developmentally immature processing,

3. development of concrete positive behaviors,

4. reduction of negative behaviors, and

5. a clear connection between behavior and concepts.  

Clients will often hold the third and the fourth goals: increased positive behaviors and reduced negative behaviors without any awareness of the relevance of the other goals.  The first goal and second goals are the means to the third and fourth goals.  Conceptual growth and reduction of regression, which includes dealing with attachment needs is often the key to change.  However, the fifth goal of connecting concepts and behavior is the work of therapy.  It is not as glamorous, but without it progress in processing will not change behavior.  Many if not most people come to counseling and therapy knowing what does not work and knowing what they need to do.  The issue is somehow they are not being able to get themselves to do it and/or how and why they sabotage it.  Therapy needs to work from sound principles but also must do so through the pragmatics of how to make it happen.  Concrete interventions, in this case- specific questions to serve the conceptual therapy goals include:

What does that mean?  

So, what are you going to do?  

What is your specific plan?  

And, if that doesn't work, what is your plan?  

How are you going to make time… schedule this communication?  

Where is it going to happen?  

What about disruptions or interruptions?  

What are you going to give up to make this happen?  

How do you screw up these great plans?  

How have you screwed them up before?  

What's your plan to keep from screwing up good intentions again?

Usually the plan has been and remains to "try harder."  In other words, the plan is to take what has not and does not work and do more of it.  Why?  Because magic will make it work… this time!  The therapist may want the individual, couple, or family to leave with a specific plan, specific alternative plans, corrective plans, concrete schedules, and so forth.  Therapy must quantify principles by identifying doable behavior.  The therapist should not assume that individuals can quantify formal operations principles by themselves to apply them to real life.  If they did, they would not be in therapy.  When the individual, couple, or family gets past conceptualization, understanding, and acceptance, the dramatic or sexy part of therapy is mostly done.  Next comes, the hard work of practice.  Stosny (2010) comments about regression of progress after termination of therapy are just as true within therapy.  "Unfortunately, the assumption that couples will continue at home to employ the skills and insights they learned in their therapist's office ignores one of the most powerful of neurological principles: habituation.  Repeated neural associations become habituated, as summarized in Hebb's rule, 'Neurons that fire together wire together.'  More recent neurological research suggest that habits never die: they merely hibernate.  If cues that once triggered them recur, the habituated response returns, even after years of dormancy.  In fact, under the stress and distractions of modern living, even our more successful couples are likely to revert to their pretreatment interactive habits and forget what they learned in therapy" (page 21).

Repeatedly applying the qualitative analysis of interactions to identify positive and negative behaviors leads to quantifying the principles of healthy relating.  Practice occurs within the therapy session, but true practice occurs in the real world of life outside therapy.  Mindful practice is necessary to counter-balance negative habituation and to develop the quantitative frequency and consistency that allow each partner to become habituated with new patterns of interaction.  Habituation can be seen as the qualitative consequence of accumulated quantitative changes.  Attempting to skip or rush through this often extended and arduous developmental rule ignores virtually all the basic rules of development.  As the new parental or authoritative figure, the therapist must hold the individual, couple, or family to the process or risk repeating fragmented attachment and relationship development.  Practically speaking, early therapy will often consist of negative interactions in session and/or regular reports of negative interactions at home to be deconstructed in session.  
As the individual, couple, or family becomes conceptually more grounded and able to activate behavior at home, the frequency, intensity, duration, resonance, and damage or benefit of negative interactions should go down and the similar quantitative gains from positive interactions should go up.  Weekly reports should reflect this.  Eventually, there will be fewer negative reports and more positive reports along with a greater confidence in personal functioning, and in the case of the couple or family in their ability to manage their relationships.  This may take weeks, months, or years depending on quality of attachment injuries, negative habituation, other development, life stresses, and the skills of the therapist.  This change in the sessions would be indicative of more secure attachment, habituation, cognitive and emotional development, and qualitative shifts in relationship that would lead to therapy coming to an end.

3056 Castro Valley Blvd., #82
Castro Valley, CA 94546
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
office: (510) 582-5788
fax: (510) 889-6553
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