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Review for Behavioural and Cognitive Psychotherapy 2006 Part 3
British Association for Behavioural and Cognitive Psychotherapies
The Method of Levels:
Timothy A. Carey
The broad church of cognitive behavioural therapies has spawned many ‘new wave’ approaches: mindfulness, compassionate mind, acceptance and commitment therapy (ACT) and attentional training, to name but a few. Do we really need another? After reading The Method of Levels, I would answer with an emphatic ‘Yes’. This therapy manual describes a technique based on Perceptual Control Theory (PCT; Powers, 1973, 2005). Strictly, it is neither cognitive nor behavioural, but draws its origins from the cybernetics movement of the 1940s to 50s. So much for a new wave approach? Actually PCT still appears fresh and refreshingly challenging today.
The basic tenet of PCT is that the function of all living things is to control their environment via the control of their own perception. It is an ‘inside-looking-out’ approach rather than the ‘outside-looking-in’ approach of conventional behavioural theories. According to PCT, control is achieved in humans through a hierarchy of homeostatic systems whose purpose is to achieve a specific goal (or reference value). At a lower level, these goals represent perceptual features (e.g. degree of muscle tension), at a mid level they represent experiences such as ‘doing the dishes’, whereas at much higher levels they represent self concepts such as ‘being valued by others’. Psychological distress is seen to arise from the prolonged, unresolved conflict between different hierarchies (see also Mansell, 2005). For example, an individual may have a goal to be the ideal parent and also the ideal worker, so that they spend time oscillating between the two goals and feel inadequate at both.
The Method of Levels (MoL) is a fundamentally simple technique to allow clients in therapy to shift their current awareness up to higher levels in their control hierarchies. In doing so they become aware of their internal conflict, which facilitates the conditions for clients’ own resolution of the conflict – a process known as ‘reorganisation’. Reorganisation is not a willed process, but occurs as the client turns their attention to ‘background thoughts’ about the conflict that appear at the edge of their minds. The appearance of background thoughts is often noticeable to the outside world by a sudden change in affect, such as a fleeting smile. The MoL technique involves encouraging awareness of the current conflict and then focusing on any background thoughts and bringing them into awareness, where they can be articulated by the client. The book provides the example of a man who was debating in his mind the pros and cons of whether to remain in his house for a year or to sell it for the financial gain now. During therapy, he was brought round to focus upon the process of balancing these pros and cons, and what it meant to him. His thoughts about this process shifted; he realised that he did not have to weigh one decision up against the other; he could value both sides of the argument by living in the house for some time and then selling later. While this may seem quite a prosaic example, it shows how allowing a client to going a level above the current dilemma provides the insight that can resolve issues in a way that staying at the same level (and generating more pros and cons in either direction) cannot. The Method of Levels does not include any formulations, written techniques, or any advice, psychoeducation or interpretations from the therapist. It merely encourages a higher level of awareness throughout the session.
The book provides a very clear and accessible explanation of PCT and the Method of Levels, in a refreshing personal style that explains by example and analogy rather than trying to persuade or cajole the reader into accepting the approach. The volume is peppered with examples of dialogue and questioning, and includes a DVD of an MoL session.
While reading about the MoL technique, I was struck by its relationship with methods such as developing mindful awareness of thoughts, and letting go of thought control strategies (e.g. Wells, 2000). The method also has similarities with Motivational Interviewing in its focus on maintaining the current awareness of an internal conflict. Of course, internal conflict as a marker of psychological distress goes back a long way, before modern psychotherapy, but there is little written on methods to promote the clients own, independent resolution of the conflicting issues. The Method of Levels differs from earlier approaches in its purity of purpose, simplicity of technique, and its requirement for the therapist to let go of all attempts to advise or present interpretations to the client, even as far as having no implicit agenda for what direction the client should take (e.g. to confront fears, tolerate distress or show a reduction in symptoms).
I think that certain readers will struggle with this non-directive approach, and some clinicians may be concerned about its ethical consequences and the difficulties of treatment evaluation. I would suggest that the book serves best as an introduction to this approach, but only experiencing the therapy with these techniques (on both sides) can really provide a deeper understanding necessary to fully evaluate it. The book is certainly strong on theory but unfortunately low on evidence. Moreover, the suggestion that the Method of Levels is the only technique that follows from a PCT perspective is not fully justified. One could argue that many tools and techniques provided in contemporary CBT can have the capacity to raise the client’s awareness of conflicting issues in a similar way. The Method of Levels places the locus of change, and therefore the responsibility for change, firmly in the client’s own mind, rather than attributing it to an external technique. This is clearly laudable and would seem more likely to endure. Nevertheless, the book could contain more detail on how the MoL technique literally raises awareness up successive levels, maybe with the use of accessible diagrams, or ideally, with some sound empirical evidence.
In summary, despite its lack of empirical gravitas, this book is one of a kind. It represents the first real step of a process of resurgence of a highly intuitive model of the mind, in a current climate that is ripe for this innovative approach. In a paradoxically non-MoL style, I strongly urge you to read this book - you can check out the chapters online. But beware, it could lead you to permanently change your theoretical viewpoint and clinical practice. For me, the journey is only just beginning.
Warren Mansell, University of Manchester
Mansell, W. (2005). Control theory and psychopathology: An integrative approach. Psychology and Psychotherapy: Theory, Research and Practice, 78, 141-178.
Powers, W. T. (1973/2005). Behavior: The Control of Perception. Chicago, IL: Aldine / Benchmark Publications.
Wells, A. (2000). Emotional Disorders and Metacognition: Innovative Cognitive Therapy. Chichester, UK: Wiley.
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