You’d better believe it: Accepting and working within the client’s own reality
University of Liverpool
This paper looks at ways of assisting those with distressing or ‘unusual’ beliefs which work within the client’s own reality rather than concentrating on belief modification. It will discuss the benefits of using this approach in practice for the individual practitioner, client, and for the profession.
In recent years numerous studies have been carried out showing that many people who have not been in contact with the psychiatric services have beliefs that could be classified as delusions (e.g. Van Os et al, 2000) and this is something the profession seems keen on promoting. Slightly less well promoted are the findings that obsessions seem to be on a continuum with delusions, overvalued ideas and ‘normal’ beliefs (e.g. Kozak & Foa, 1993) - perhaps this is partly due to the way services are organised, often having a clear separation of ‘psychosis’ and ‘not psychosis’. The recent findings (Peters et al, 1999) demonstrating that it is not the ‘delusional’ beliefs themselves that lead to people coming to the attention of mental health services rather it is the inability to cope those experiences are also becoming widespread knowledge in the psychology world.
I can believe that there is a conspiracy against me or that people can telepathically read my mind and this is seen as fine. Yet if for whatever reason I become distressed by this the only help I’m going to be offered involves suggesting I would be better off if I didn’t believe that and sending me searching for evidence to see if my beliefs are ‘supported’. If the differences are in coping would it not make sense to try and increase a person’s ability to cope with their experiences rather than only offer belief modification?
The work I have been involved in concerns accepting the individual’s unusual or distressing beliefs, and helping them to cope with and live with that reality, rather than considering whether they are misinterpreting events. In this paper I will outline this approach and describe the benefits of adapting current approaches to take more of this slant.
Rather than simply seeking to replace one term e.g. ‘delusion’ with another such as ‘unusual beliefs’ I prefer to be free from psychiatric categories altogether. In my research I was interested in the experience of those with all kinds of distressing or unusual beliefs and realities - among those taking part in my research some had been told they had delusions, others obsessions, others still had avoided any such definition being given to them. I interviewed 15 people about the ways they used to cope with their unusual or distressing beliefs, and also had email discussions with people who also had these kinds of beliefs but who had found support outside of mental health to help them deal with their experiences. Following on from this, with a voluntary sector mental health organisation, I set up a self help group and training service following the approach of working within the individual’s own reality. This work is a direct expansion of the Hearing Voices Network’s position of accepting the voice-hearers own belief system and explanation for their voices. Ron Coleman & Mike Smith (1997) give an example of this by describing ways of working with voices held to arise through telepathy.
But isn’t this colluding?
Many will have been taught that accepting a client’s beliefs at face value and helping them to live with that reality is ‘just going along with them’ or colluding and should not be done. But what exactly is colluding - respecting people who do not have psychological or psychiatric explanations for their experiences? Rather than worrying about colluding with clients perhaps we shouldn’t be colluding with the idea that there is one way to think and that everyone who has unusual experiences or beliefs is misinterpreting the world.
Accepting people’s own realities and unusual or distressing beliefs follows on from social constructionist ideas that there is not one correct or true way of viewing the world, rather there are many different realities all constructed within different contexts (Burr, 2003). While experimental psychologists may say phenomena such as telepathy, spirits or aliens do not exist there are large communities where these are seen as very real experiences – where scientific evidence and explanations are not seen as superior or the only way of defining real (James, 2001). Even keeping within psychology, branches such as Transpersonal are open and accepting to such experiences.
As for beliefs that seem to be unsupported by evidence, most will realise that the world is not a simple evidence based place. If for example, the Government is tapping individuals’ phones they are hardly going to leave evidence of this occurrence lying around. Similarly, if beings from other planets have put an implant in someone’s brain for the purposes of covertly monitoring them then they are also likely to have the motivation and technology not to leave any evidence for what they are doing. Conspiracy theory researcher Robin Ramsay (2004) who has spent much time investigating various claims, considers that with all the cover ups and misinformation that is existent in today’s society - ‘I am paranoid but am I paranoid enough?’
Putting this into practice
When working in this way, accepting the client’s reality and allowing them to talk about their beliefs and experiences without aiming to suggest that they may be misinterpreting the world is usually the best place to start. Taking such an approach of not trying to change people’s belief system can be protective against feelings of alienation and the depression and emotional distress associated with not being believed, which can unfortunately result from more mainstream techniques. Similarly, individuals’ alternative or ‘unusual’ beliefs - even when they are frightening or otherwise unpleasant- can often make up a large part of individuals lives and their identity. Viewing oneself as for example, successfully managing to cope with persecution would understandably lead to a better self identity than seeing oneself as being vulnerable to interpreting the world wrongly. By accepting, rather than attempting to change their beliefs it is possible to maintain clients’ self esteem and protect against depression associated with the loss of these beliefs and identity. Finally taking such an approach creates a safe place for people to focus on psychological issues, or situations, that they see as a priority.
When working in this way, put aside your own reality and belief system and enter the other persons, take what they say at face value, and by thinking creatively and laterally try find ways to help them cope with situations as they perceive them to be. Many of the problem solving and anxiety management strategies commonly used in psychological interventions, such as creative thinking or planning in advance for difficult situations, can easily be applied to the approach of accepting and living with different beliefs and realities.
Within this general approach, there are several more specific strategies that may be of use when using this way of working in practice.
Looking at the literature, such as books and websites specific to the content of the client’s belief can be useful in finding ways of coping. For example, the book ‘Practical Psychic Self Defence’ contains methods of protecting the self from threatening experiences including attacks by spirits, ghosts, and experiences related to telepathy. Being in contact with others who have similar beliefs, or at least knowing that such people exist, can be useful in getting practical and emotional support, and for knowing that one is not alone in their beliefs.
As an example, a client says that spirits are harassing or likely to attack them they could be helped by trying some of the following. According to the spiritual literature displaying certain objects, or doing certain rituals, are held to repel negative spirits, so reading about and trying some of these methods may be of use (Bruce, 2002). Similarly there are various techniques such as creating and maintaining a visualised shield of light, colour or glass surrounding oneself that can be used as a protective measure against spirits and other phenomena (Bruce, 2002). In addition, knowing a spirits name is widely believed to give an individual control over that spirit and make it easier to deal with it (Rowan, 2001). Furthermore, some believe that malevolent spirits are not drawn randomly to their victims, rather the attraction stems from the negative energy being broadcasted by the individual because of deep emotional issues that are not resolved (Oester, 2002). In order to encourage these types of spirits to leave, and discourage others from coming, the underlying emotional issues must be solved to stop negative energy being broadcast. This final method has clear links with psychological understandings as to why distressing or unusual beliefs occur and their ways of management.
There will not always - probably in most cases - be a large literature base on the exact content of an individual’s belief system, nevertheless by thinking creatively similar strategies can be used. My research showed that many people, both those who had been in the mental health system and those who had not, found that doing certain activities or strategies allowed them to feel less distressed, safe, and more in control. One man experienced what he called ‘a little known reality’ - a complex reality involving society being a highly racist place with many cover-ups going on, and he would become very afraid that racist gangs would murder him. He planned in advance that if he felt the gangs were nearby he would wear various devices (given to him for this purpose by the psychiatric services) that would prevent an attacker causing serious harm. When he went out he would wear other items disguised under his normal clothes for the same purpose. He described using such strategies as allowing him to stop being ‘paralysed with fear’, more able to cope as he knew what he needed to do if the gangs came, and generally felt more able to deal with and live with his reality.
It is likely that some of these ways of coping may be seen as ‘safety behaviours’ and something not to be encouraged. But again I would argue that this concept is only valid while we remain in the psychological paradigm, and continue to see unusual or distressing beliefs as being incorrect, but understandable, ways of viewing the world. For example, if the possibility that alien abduction is a genuine occurrence is accepted, and it is recognised that is widely held among believers that displaying iron objects can prevent abductions, then giving this as a suggestion to someone terrified they will be taken is no less sensible than suggesting those fearful of being attacked on the streets carry an attack alarm.
As most will be aware, having different, bizarre beliefs can often lead to problems either for the individual themselves or as a result of others reaction to them and their behaviour.
Again, by working within the client’s own reality ways of getting around such problems, or alternative ways of coping can be discovered. This could include disguising a persons coping method when in public so not to get negative reactions from others. So the person who wears tinfoil on their head when in public to try and stop others reading their mind could make this less noticeable, by for example, wearing a hat over the foil thereby allowing them to have their beliefs but live in a world that does not share them.
For others their initial attempts at coping may lead to further problems, and so without attempting to change the individual’s ‘unusual’ beliefs, alternatives that serve the same function can often be found. One person I spoke to was very worried about mould getting on herself and had to repeatedly wash her hands after touching certain objects, she later found an alternative which was to wear latex gloves to protect her hands and disposing of them after use. Others used more meditation type techniques, one man was highly afraid about becoming dirty so would take baths all day. He found an alternative to this which he felt gave him the same amount of protection which was to say to himself ‘pretend you are in the Gobi desert, miles from water, with your camel beside you who will protect you from all troubles’ he said this to himself several times a day and found he could go all day without taking a bath, and by pretending he was in the desert he was able to wash only the average amount. This has links to the more generalised way of using White Light as a protective measure frequently reported in the spiritual and New Age literature. Encouraging people to respect other people’s rights can be useful too, for example stating that even if others are spying on you or plotting against you then that does not give you the right to go and physically harm them.
Alternative or unusual beliefs only usually become a problem when individuals become preoccupied by them and so encouraging people to expand other aspects of their lives can be helpful in distancing themselves from, and becoming less distressed by, their alternative beliefs. Similarly helping people to raise their self esteem and self worth can enable them to be less bothered and more able to cope with their ‘different reality’ or unusual beliefs. These were popular strategies among people I met through my research – common to those with a wide range of beliefs and experiences. Approaches such as these have been reported elsewhere, Rufus May (2004) describes an example from his work of Ben, who stated that he was being persecuted by the local bus drivers who were shouting abuse at him. The help offered did not involve investigating whether Ben was making perceptual errors but rather accepted the experience as being real and building up Ben’s self-esteem and coping strategies so he was no longer bothered by the actions of the bus drivers.
Similarly, encouraging people to get involved in other activities particularly those they feel are important and worthwhile, building up their social networks and relationships with others, and being helped to feel better about themselves can be helpful in making their distressing unusual or alternative beliefs less central and troublesome in their lives. The importance of making relationships with others who allowed them to feel valued and accepted was something that particularly came out in my research as something to aid coping, with several people that remembering the kindness and acceptance shown to them had stopped them taking their own lives.
Challenge the medical model not clients reality
Many psychologists are critical of medical model which states that different realities or unusual beliefs are caused by ‘faulty’ biological processes, yet how different is this from the prevalent cognitive model stating that these experiences are a result of ‘faulty’ or biased ways of thinking?
What has really struck me since I have been involved in this area is the number of people who have stated – with a kind of pride – that although their beliefs can be frightening or problematic, this is their reality and it is something others should respect, not try and change. Such views along with the demands for a right to be different that are emerging in the survivor movement share many similarities to ‘disability pride’. It is perhaps hardly surprising in today’s society which seems to be obsessed with normality that some people do not want to be encouraged to think in more ‘rational’ ways, even when their experiences cause them problems. Offering people help to cope with and live with their beliefs not only respects those with such views and helps them in a way they will value, but is also an effective tool against the medical model.
Helping someone to live with a unshared reality is something a drug cannot do - a drug can’t protect someone against ghosts wanting to attack them, nor can medications give someone assistance to cope better in a dangerous world filled with cover-ups and conspiracies, neither can they help someone deal with the knowledge that they have special insights that no-one else yet possesses. By continuing to collude with psychiatry and focusing on encouraging people to interpret and interact with the world in a more ‘rational’ way psychologists will always remain as only an ‘add on’ to psychiatry - to be called in when the drugs fail to ‘work’.
By promoting a different definition of help, one closely allied with survivor definitions, advocating that people’s beliefs reflect different ways of experiencing the world and so should be accepted and helped live with - a real alternative will be proposed, leaving the pharmaceutical companies and biological psychiatry in a diminished position. I was recently at an event where there was a heated discussion between a drug rep and a group of individuals with a more psychological perspective over treatments for voice-hearing. This quickly turned into a ‘my evidence is better than your evidence’ argument which went on for some time until a someone commented that her voice-hearer friend didn’t want to stop hearing voices, even the unpleasant ones, they were part of his life and he wanted to live with that. This silenced the rep, his statistics and studies seemed pointless when presented with this approach, he was able to sell his drug aiming to eliminate voices no more than he could sell a drug to cure homosexuality. By becoming more open-minded, accepting that there is not one true reality but many ways of experiencing and interpreting the world these experiences can be taken out of the medical paradigm.
Respect client autonomy
By working within the individual’s own reality it is often possible to work collaboratively with those seen as difficult to engage, lacking insight, or non-compliant. Through my work in this area I have encountered numerous such individuals who say they are only prepared to speak to me as I do not question that their beliefs might not be correct, or try and get them to think or act more ‘normally’. It is therefore possible that by using this approach, psychologists and others would be able to work with those who might otherwise refuse help. Most psychologists will be aware of the negative consequences of compelling people to do things they do not want to do and of treating them against their will so will want to be knowledgeable of as many alternatives as they can. This approach may provide one such alternative, and in these situations the methods I have been discussing may be particularly of use and so I would encourage their use.
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Kozak, M.J. & Foa, E.B. (1993). Obsessions, Overvalued ideas, and delusions in Obsessive Compulsive Disorder. Behaviour Research and Therapy, 32, 343-353
James, A. (2001). Raising Our Voices: an account of the Hearing Voices Movement. Hansell: Gloucester
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Peters, E., Day, S., McKenna, J. & Orbach, G. (1999) Delusional ideation in religious and psychotic populations, British Journal of Clinical Psychology 38: 83–96.
Ramsay, R. (2004). In Defence of Paranoia. Paper presented at Paranoia – what can we know about it and how? Manchester, July 24.
Rowan, J. (2001). Ordinary Ecstasy: The dialectics of humanistic psychology. Hove: Brunner-Routledge
Van Os, J., Hanssen, M., Bijl, R.V., & Ravelli, A. (2000) Strauss (1969) revisited: A psychosis continuum in the normal population? Social Psychiatry and Psychiatric Epidemiology 26: 287–92
Address: The School of Medical Education, MBChB Office, 2nd Floor, Duncan Building, Daulby Street, Liverpool L69 3GA. Email: firstname.lastname@example.org
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