Assumptions in Psychotherapy

Jurriaan Plesman BA(Psych), Post Grad Dip Clin Nutrr

The various forms of psychotherapy all derive from the philosophical assumptions of therapy. Most psychotherapists have often a unique and personable view of personality based on these assumptions.

It would be very difficult to find a hypnotist who would questions the assumption that we have a "subconscious mind", or a behaviourist raising doubts about human behaviour being learned, or a psychoanalysts who would object to the idea that human behaviour stems from early childhood experiences, or a Rational Cognitive Behaviourist who believes that innate attitudes are irrelevant to our actions.

These are the assumptions of psychotherapy which differentiate one psychotherapist from another. An assumption is basically a major premiss that is accepted as being true or as certain to happen, without proof. These assumptions, once accepted, generate inevitable logical consequences that will create an cohesive structure to the theoretical background of a particular psychotherapist. Thus as a psychotherapist, the therapy I practise are equally based on fundamental assumptions, that are different from many other therapists. I, for instance, have questioned the assumptions of many psychologists, and this has lead me to conclude that most psychological theories are dead wood, or psychological debris that we need to sweep aside, if we want to develop our own theory or assumptions.

I feel that many therapists tend to confuse "management techniques" with proper treatment (or "cure') of a disorder. Thus psychiatrists manage mental illness by the prescription of drugs, without "curing" the underlying biochemical imbalance responsible for mood disorders. This is a typical example of a management technique.

People with anxiety disorder are told to do "breathing exercises" which may be a valid "management technique", but does nothing to "cure" anxieties. Drug addicts, withdrawing from drugs, are advised to exercise strenuously each day to reduce withdrawal symptoms, or to do "meditation" or "yoga" as techniques to "manage" their symptoms. One feature of management techniques is that they need to be repeated periodically. One may have to take AD medication for life. Some management techniques are healthier than others. For instance daily exercises, meditation and taking your dog for a walk, or pursuing a hobby may be healthier than drinking coffee to give you a lift or even smoking pot. Hence managing an illness is not necessarily to cure it and some management techniques may be preferable to others.

I could go on and point out assumptions underpinning other psychotherapies, but such criticism would simply imply that there is a clash of assumptions or major premisses. It would be better to discuss my assumptions in psychotherapy, to emphasize some of the differences.

I would like to summarize my assumptions that are fundamental to my approach to psychotherapy and that seems to distinguish it or could be in conflict with the majority opinion among psychotherapists.

Major Premiss #1: Most forms of mood disorders are due to a biochemical imbalance that needs to be treated FIRST, before considering psychotherapy.

It is difficult to say that this is an "assumption", because the statement is either true or false. The proposition can be tested by medical tests. In fact, it implies that before any therapy is undertaken, the person needs to be medically assessed for metabolic disorders, that are known to be responsible for mood disorders. Specialists in this area of medicine are Nutritional Doctors and Clinical Nutritionists. It is my firmly held belief (assumption), that therapists who ignore the biological aspects of mood disorders are not in a position to fully understand emotional disorders. See: Silent Diseases and Mood Disorders

This does not mean that I do not recognize mood disorders (or depression) that are environmental in nature and are not necessarily caused by biochemical disorders. Traumatic events and stressors of life do interfere with the production of feel good neurotransmitters and this could cause a person to feel depressed, as in bereavement or rejection of love. But most people who enjoy good health recover from these events and are able to resume life. This is not the case with endogenous depression when people seek the assistance of psychotherapists.

Many people with depression suffer from a low self-esteem and the question is whether this is the cause or the consequence of depression. Most people have problems considering the possibility that a metabolic disorder - constantly bombarding the person with stress hormones - could be responsible for a low self-esteem. A low self-esteem has been reported to be caused by depression. Stella Chess et al p.282. Some people do not recover from traumas and continue to have abnormal psychological experiences for which they seek the help from therapists.

Major premiss #2: Most of mood disorders can be treated by nutritional means.

Although nutritional therapy means putting a person on a healthy and natural diet, nutritional therapy really means treating specific nutritional disorders that are known to be responsible for mood disorders. Thus being on a "healthy" or "natural" diet is not sufficient AND could be the very reason for emotional problems. It happens to be the case that most people with mood disorders are found to be hypoglycemic - as a result of prediabetic insulin resistance - according to a medical test designed by Dr George Samra. Hypoglycemia has depression and other mood disorders among its symptoms.

See GTTH.

Samra, Dr George (2002), The Hypoglycemic Connection II, One Stop Allergies, Kogarah Sydney, here.

Hypoglycemia can itself be a symptom of other diseases as for instance in Bipolar Disorder, who are often found to be hypoglycemic as well.

Other factors to be considered are allergies and food sensitivities. Many of these can be found by completing a daily food diary as explained here or by reading books or articles on allergies. Detecting and treating allergies is a huge medical topic and sometimes patients need to be referred to a Nutritional Doctor for proper diagnoses with Antinuclear Antibody Tests.

Another vast range of possible illnesses affecting moods are digestive disorders. The simple reason is that these diseases can interfere with the proper absorption of essential nutrients that are forerunners of feel good neurotransmitters.

In fact, there are many other diseases that can affect our "mental' well-being as has been explained at:

Diseases Associated with Emotional Disorders

Major premiss #3: Psychotherapy is strictly a "here-and-now" kind of therapy.

This assumption aims at bypassing what I call "the debris of psychological theories". People tend to have a misconception that if you have an explanation for a psychological problem, you have the "cure" of the illness.

Thus if we see a young woman, who has an extreme low self-esteem, we may find that she has been sexually abused as a child. We naturally tend to assume that her sexual abuse has something to do or even could be the cause of her present day behaviour. According to some psychological theories, her past history gives us an explanation of her present-day behaviour. Some therapists or parents may - intentionally or intentionally - even create false memories to explain abnormal mood disorders (Various magazine reports). A person under stress may fall victim to delusions in some circumstances. But by the same token, her present behaviour can also be explained - not by her past - but by her present experiences, if, for instance, she has a metabolic disorder, or if she has a negative self-image. She would lack the social skills to handle people or form any close and loving relationships. All these factors are treatable in the here-and-now without having necessarily to know anything about her social history.

The behaviour of an alcoholic jealous husband who has beaten his wife could easily be explained by his social history. We may find that he was brought up in a family where parents were alcoholic and violent. He reported that his mother had multiple extramarital relationships with other men. This could easily explain why he walked around with an attitude "that women cannot be trusted". He beat his wife, because according to him she came home late one night and told him "a lie", claiming that she met some female friends. In fact, she told him the truth, but he simply did not believe her and now his marriage is on the rocks.

Indeed, his social history gives a good explanation for his present behaviour, but has it any therapeutic value? If we assume, as I do, that causes of present day behaviour lie in the here-and-now, and not in the past, his behaviour can also be explained by his present day jealousy stemming from a very low self-esteem - "why would any woman (including my wife) be interested with me". Other factors are his addiction to alcohol and anger-control issues, all of which are signs of a metabolic disorder. They operate in the here-and-now and can be treated in the here-and-now. There are many other factors that can be treated regardless of any knowledge of a person's social history. We do not need a social history to treat him now. In fact his social history could stand in the way of immediate treatment!

Social histories provide interesting explanations of behaviour, but they usually have little therapeutic value. My assumption is that the causes of behaviour lie in the "here-and-now". We cannot change the past, we cannot use our parents as scape goats for present day behaviour, nor blame our peers, or society or whatever else is happening in our present environment. We are the cause of our behaviour. We simply need to to tackle biological aspects first and then learn the social skills, in the here-and-now, to earn our rewards and happiness, regardless and in spite of our past!

It is therapeutically more efficient to assume that all causes of human behaviour occurs in the here-and-now, and that although personality development may have an interesting past history culminating in present behaviour, that behaviour can be radically changed by interventionist therapeutic techniques that ignores the past and looks strictly at present day aspects of personality; such as metabolism, self-image, assertiveness, communication skills, and one's values system.

I have crystalized this approach in:

Principles of Psychonutritional Therapy