ASCAP July 1994
Teleonomic psychotherapy
In
We
talked about Interpersonal Psychotherapy (IPT, 2) and Cognitive-Analytic
Therapy (CAT, 3) as being particularly consonant with our views, and Russ
mentioned Harry Stack Sullivan's The Psychiatric Interview which I am
determined to read. Our evolutionary
biological approach sees the brain and all the behaviour it produces as evolved
through natural selection, because these behaviours have been successful over
hundreds of millions of years in the struggle for survival and in the contest
of sexual selection. We are aware that
what now exists may not be adaptations in the sense of George Williams, but it
makes sense to us to regard them so for heuristic reasons; and therefore all psychopathology can
be viewed as adaptive behaviour, or as exaggeration of adaptive behaviour, or
as distortion of adaptive behaviour, possibly due to the mismatch of present
times and the EEA. This latter
possibility was particularly well illustrated by Kalman
Glanz and John Pearce (4) together with the use of
the conbcept in therapy.
The
principles of our contribution to psychotherapy can be listed as follows:
1.
Psychopathologies represent primitive strategies which are not under
conscious/voluntary control, and can be replaced with voluntary strategies to
achieve the same end in a more satisfactory way (5). Our analogies from other systems include the
response to cold, in which the primitive, involuntary response of shivering can
be replaced by the voluntary response of switching on the central heating; and the response to
bright light, in which the primitive response of pupillary contraction (or
blinking) can be replaced by the more recently evolved response of buying a
pair of sunglasses.
In
this vein we regard depression as a primitive form of submission, which can be
replaced by voluntary submission (or other voluntary strategies for resolving
conflict). Compulsive checking may be a
primitive form of insurance, and compulsive cleaning a primitive form of
microbe avoidance; although
in these cases it appears more difficult to replace them with more rational
strategies. Regression is a primitive
strategy for eliciting more parental investment, and can be replaced by more
mature care-eliciting behaviour such as arranging therapy to help one through a
stressful period (6). Attacks of
hyperventilation may represent the inappropriate triggering of a primitive
response to impending suffocation (7).
2. We
are impressed with the widespread occurrence of agonistic behaviour and hierarchy
formation among vertebrates. We see
humans as also having dispositions to the primitive behaviours evolved to
manage social hierarchies, like behaviours to maintain both high and low rank,
and behaviours for changing rank (8).
These behaviours are discouraged in most cultures, but occur in places
in which society has little influence, such as the school playground, the
prison cell and the marital bedroom.
We
note that very few animals can maintain cooperative relationships with
same-sexed conspecifics of the same social rank, and that the human capacity to
do so is a recent evolutionary development.
Therefore we might expect problems in this area, and we can point to
case reports from existing psychotherapies in which the task has been to enable
patients to develop these symmetrical relationships.
3. We
accept that much of the variation in relating and in relationships can be
accounted for by two dimensions, those of upperness/lowerness
and closeness/distance so lucidly described by John Birtchnell (9,10). The poles of
these dimensions also reflect human needs, so that in assessing any patient, or
any relationship, we should ask whether needs for upperness,
lowerness, closeness and distance are being met, or
whether there are any disagreements about these needs between the patient and
those to whom he or she relates closely.
4. We go
along with Michael Chance that any disagreement as to these dimensions may
change the character of relating from hedonic to agonic, and this "agonic
mode" may continue until processes of reconciliation have taken place
(11). The agonic mode is one in which
the participants are oriented towards fighting, and this not only distracts
their attention from more useful pursuits, but also has psychophysiological
effects which may be subsumed under "responses to stress". Moreover, the agonic mode is one in which the
primitive response of the involuntary subordinate strategy (ISS) is likely to
be triggered in one of the contestants (5).
So we can sum up our contribution as follows:
What is likely to be wrong? Some form of hierarchical stress, with
conflict over a particular issue or over the matter of rank itself; or difficulty in
establishing equal relationships. Or disagreement as to the "horizontal dimension" of closeness\distance
(such as the recursive conflict between intrusiveness and withdrawal, the
breach of agreed continuance by death or separation, and the breach of agreed
exclusivity by infidelity).
What to do about it? Replace a primitive strategy with a rational
one. Switch from the agonic to the
hedonic mode (by reconciliation). Get
the hierarchy sorted out so that everyone agrees with whatever asymmetry in
social relationships, if any, is necessary for the dyad or group to
function. Ensure needs for closeness and
distance are satisfied.
After
recovery from depression or whatever, strengthen the social base by extending
interests and social network. Try to
mend any existing feuds, and mobilise old friends who have lost touch.
These
are not earth-shattering revelations.
Some of our recommendations are included in the practice of much current
psychotherapy. But they are not included
in all psychotherapies, and in those that they are, they are not formulated as
clearly as they might be. We hope that
our approach will enable psychotherapists to take a systematic view of possible
teleonomic problems, and have at their disposal the
techniques of therapy which seem most logical from a teleonomic
point of view. Having said that, we
agreed that we should look at various psychotherapies, and identify those which
already include the above principles, and also those that do not.
1.
Sloman L, Price J, Gilbert P & Gardner R. (1994) Adaptive function
of depression: psychotherapeutic implications. American Journal of
Psychotherapy, in press.
2. Klerman GL, Weissman
MM, Rounsaville BJ & Chevron ES (1984) Interpersonal
Psychotherapy of Depression.
3. Ryle, A. (1990) Cognitive Analytic Therapy. Active Participation in
Change.
4. Glantz, K. & Pearce, J.K. (1989) Exiles from
5. Price
JS, Sloman L, Gardner R, Gilbert P & Rohde P. (1994) The
social competition hypothesis of
depression. British
Journal of Psychiatry, 164, 309-315.
6.
Nesse, R.M. (1990) The evolutionary function of
repression and the ego defences. The Journal of the
7. Klein
DF (1994) Suffocation false alarm theory of panic disorder. Paper presented at the Annual Meeting of the
American Psychiatric Association,
8. Price
JS & Gardner R (1994) The paradoxical power of the
depressed patient: a problem for the ranking theory of depression. British Journal of Medical Psychology
(submitted and still undergoing assessment).
9.
Birtchnell, J. (1990)
Interpersonal theory: criticism, modification and
elaboration. Human Relations, 43,
1183-1201.
10.
Birtchnell, J. (1993) How Humans Relate: A New Interpersonal Theory.
11.
Price, J.S. (1992) The agonic and hedonic
modes: definition, usage, and the promotion of mental health. World Futures,
35, 87-115.