Student and Therapist Newsletter Archive
   - Belief

+ Do patients need to believe? - December 05

December 05
This used to happen to me a lot at the sort of functions we all attend at this time of year. The get-together, the dinner party, the bar-be-que, the partner’s office party.

I’d meet new people, we’d get chatting and the conversation would inevitably swing around to occupations. When it was my turn I’d stumble through my latest explanation of CST and leave everyone suitably confused.

Just when I’d think I was off the hook and the conversation was going to move on, that person would pipe up.

You know that person, the one who’s in every fifth or sixth group of new people you meet. The one who feels obliged to ask the questions they think other people are to stupid to think of, let alone ask. The one who takes every opportunity to flex their intellectual muscles at anyone within earshot.
They’re not really interested!
They’ve no intention of coming to see you!
They’ve no intention of telling anyone else about what you do!

They’d preface their question by doing something with their head, either a conceited wiggle or a questioning head tilt. I don’t know why they all do thus but they do.

‘So, does the person coming for treatment have to believe in what you do?’

They’d follow this with more head stuff, usually the slow knowing head nod.

I’d trot out my standard answer. ‘No the person doesn’t have to believe in it, at all. It helps but it’s not required.’ I liked to deliver this answer almost like a challenge. I could never match the head wiggling/nodding/tilting thing though.

This question used to annoy me, oh you noticed, and I would get a bit defensive, oh you noticed that too.

In hindsight I understand why I ended up with so many difficult patients back then, what with the challenge and all.

Fast forward to a couple of years ago.

Stay with me here.

I’m talking with one of the therapists I’ve trained. They’re telling me about a prospective patient.

‘This person asked me if I can help them with their chronic fatigue.’

‘Good.’ They don’t look like it’s good. ‘No?’

‘No.’

‘What’s the problem?’

‘Well I’ve never treated someone with chronic fatigue before.’

‘So?’

‘So they want to know if I can help them, they say they’re a bit sceptical and they want me to reassure them and . . well . . I don’t know.’

‘Don’t worry about it. I’ve treated loads of people for chronic fatigue. You’ll be fine.’

‘It’s not me I’m worried about, it’s them. It’s alright for you, I’m sure you’d get results, I just don’t know if I can.’

‘Oh I see.’

I pondered momentarily and then I had a sort of epiphany. All the years of answering the, ‘Does the patient have to believe?’ question coalesced into a profound insight.

‘Believe, they may not, believe YOU must.’

‘Pardon?’

‘I said it’s more important that you believe you can help them than if they believe you can.’

They looked at me dumbstruck as the import of what I had just said sunk in.

‘Did you just put on a Yoda voice?’

‘No, I just had something in my throat.’

‘You don’t get out much do you?’

‘Look it doesn’t matter how I said it. It’s what I said that counts. If you don’t believe they can get better with you then they won’t.’

‘That’s what I was afraid of.’

‘Look salesmen have known about his stuff for years.’

‘Do they use the Yoda voice too?’

‘I’m talking about dominant realities here.’

‘Dominant realities?’

‘Yeah, it’s a well known fact among salesmen and psychologists that if you get a group of people together, whomever believes in their reality the most will dominate the others.’

‘Whomever?’

‘That’s how sales are made. The salesman believes his vacuum cleaner is a fantastic product and these people’s lives will be vastly improved if they buy it. He believes it so strongly that the people start to believe it too and buy the vacuum cleaner.’

‘Oh I see, you’re talking about kidding yourself. If I kid myself into thinking that I can help this person I stand a much better chance of kidding them.‘

‘No, I’m not saying you kid yourself. I’m saying you need to believe it.’

‘If you tell me to, ‘Feel the force.’ I’m leaving.’

‘Actually, I don’t really think of it as believing, I just sort of expect it. When someone comes to see me I just expect that they will get better. I’m not kidding myself, I just think, "They’ve got a body. They’re breathing. Their body is designed to fix itself. All I have to do is feel what it's trying to do and then help it where it's getting stuck. There’s no good reason why they shouldn’t get better."’

‘Fine, but how do I believe, if I don’t really believe?’

‘Good question. What you need to do is, you need to let the spirit of Elvis enter you heart. . . . no come back . . I’m kidding . . Look, I hear what you’re saying. . ‘

‘Really?’

‘See, it’s easy for me.’

‘Well finally you admit it.’

‘No, that’s not what I mean. I have lots of frames of reference for people getting better. That’s one of the benefits of experience. All those frames of reference support my expectation that the person will get better.
You, on the other hand don’t have enough frames of reference yet. Which leaves you with just one thing determining the outcome.’

‘What’s that?’

‘The way you think about it.’

‘The way I think about it.’

‘The way you think about it.’

‘Stop saying that and tell me what you mean.’

‘You don’t KNOW what the result is going to be when you treat this person. It’s in the future. The only thing you can do with the future is think about it, which leaves you two options. You can think the person is NOT going to get better or you can think they ARE going to get
better.’

‘and that’s going to make a difference?’

‘Yes and no.’

‘Always the yes and no answers with you.’

‘What would you say if I told you that we are making up our reality as we go and the main thing that influences it is the way we think. Things are the way they are because we expect them to be that way.’

‘I’d say you’d lost the plot and were a couple of steps away from the funny farm.’

‘In that case I won’t tell you that and by the way calling a psychiatric institution the funny farm is not very politically correct, you know.. ‘

‘Me not politically correct? You’re one of the least politically correct people I know. You take pleasure in being politically incorrect. I’ve seen you at parties, remember?’

‘Fair point. Look, what have you got to loose by being open to the possibility that the person is going to get better?’

‘I’ve just never been into that whole positive thinking thing.’

‘It’s not really positive thinking, it’s more like . . selfish thinking. You’re thinking about the future in the way you’d like it to be.’

‘Does it really make a difference?’

‘It makes a huge difference if you do it in the right way.’

‘Which is?’

‘The first thing to do is get a very clear picture of the future you want. In your case it would be you supporting this person to move through chronic fatigue successfully. The clearer the image the better. As you think about this outcome you’ll notice you get an uncomfortable feeling in your gut. That uncomfortable feeling is what has kept your current expectations in place.’

I could see I was making progress.

‘You’ve lost me.’

‘Okay, ever thought about winning the lottery?’

‘No . . Yes.’

‘Okay, did you think about all the things you could do with the money?’

‘Yes.’

‘That’s usually where most people stop. A sort of fantasy, up there with being able to fly or having X-ray vision. If they thought they were REALLY going to win the lottery it would be disturbing for them in ways that they never suspected.
It would literally rock their world.
The statistics on lottery winners show that a high percentage of them end up back where they were financially within a couple of years of winning. Which I see as a desperate struggle to get back to their old version of reality as fast as possible.’

‘So it’s more than just positive thinking?’

‘If all we had to do was think positively, we’d have things appearing in our lives all over the place at a ferocious rate. It would be like living in a nightmare where everything you thought about would appear in front of you as soon as you thought about it. Things you wanted and things you didn’t want but couldn’t stop thinking about.’

‘. . . or the one where you go to a party and everyone keeps running away from you screaming and then you catch your reflection in the mirror and you’ve got the head of a shark. . ‘

‘Focus.’

‘Right.’

‘There are reason’s why we expect things to be the way they are. With the lottery winner they could have a deep belief that money is bad and if they have lots of it, they’ll be bad too. Without them knowing about that belief they will try and find unconscious ways to get rid of the prize
money as fast as possible.’

‘So that’s what you meant about struggling to get back to their old version of reality as fast as possible.’

‘Precisely.’

We were making great progress.

‘Yeah well that’s the thing about unconscious stuff, it’s unconscious. How do you know about stuff . . you don’t know about, huh?’

Okay, we were making progress.

‘It’s true, you will do your head in thinking about it like that. There IS a way of starting to become aware of it though. It begins with getting a clear picture of what you want and then asking yourself how you would feel about it if it REALLY happened.
If you can get into how you would feel in that situation and as you’re doing that you also scan your body, you will find it will be making you
disturbed somewhere.
When you look into that disturbance you will get more of an idea of what has been stopping you having the result you want.’

‘How so?’

‘Like the lottery winner believing that money was bad. As soon as they had lots of money that belief was challenged. The money made them very uncomfortable.
If, prior to winning, they had got a clear picture of how their lives would be with the extra money and how they would feel in that life, they would have discovered that it made them uncomfortable.
If they had looked into what that uncomfortable feeling was about they would have discovered the belief about money being bad. They could then have started to work through the belief and when they finally did win, it would have made the process of coming into money much more enjoyable.’

‘So you reckon I have some unconscious belief about treating this person with the chronic fatigue?’

‘I dunno. I think you’ll find out if you get clear about the outcome you want and then listen carefully to how it makes you feel.’

‘Okay I’ll give it a try.’

‘Try you must not, do you must.’

‘Cute.’

Having this chat made me verbalise what had been brewing in me for a couple of years. The question of whether the patient believes in what we are doing is secondary to what we, as therapists, believe is possible.

If there is a difference between the results we would like to be getting and the results we are getting then the onus is on us to sift through ourselves and discover why we are getting the results we are.

It reminds me of a cartoon I saw recently. Santa Claus is lying on the psychoanalyst’s couch looking perturbed. The analyst is saying to him. ‘It doesn’t matter what other people think – the important thing is that you believe in yourself.’

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