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  #1  
Unread September 28th, 2006, 09:41 PM
teiuq1 teiuq1 is offline
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Default Labelling and Probabilities

I'm currently working with an individual who, by some intelligent twists of logic, is having difficulty accepting that labelling and jumping to conclusions are indeed cognitive distortions. I was wondering if anyone could give me any ideas to help.

Firstly we have gone over how labeling is erroneous. I have explained how it is innaccurate to make definitions based on particular actions, but my client insists that there is nothing wrong with this since we do it in everyday language for all things. My client used a few examples, one was that of a person who plays piano being correctly referred to as a pianist and another was a meat eater being correctly defined as a carnivore.

Secondly, we have gone over jumping to conclusions. My client has difficulty going outside for fear of encountering youths and being accosted. We have gone over how this is an example of fortune-telling but he insists that for him it is simply a matter of probability. He believes that by staying at home he minimizes the probability of having any such encounter, but by going out regularly he raises the probability.

I'd really appreciate any suggestions or ideas. Thank you.
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  #2  
Unread September 29th, 2006, 01:22 AM
Janet Doron Janet Doron is offline
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Default Re: Labelling and Probabilities

The discussion you have with your client over 'labelling' is a very valid discussion outside psychotherapy as well. Yes, we do it all the time, he is right, and yes, it can often distort our perceptions and emotional reactions as you are trying to point out to him. Labelling is commonly used in debate or public discourse to support or influence opinions, and your client is doing just that. In all discussions, if there is no agreement about a precise definition that will be acceptable to all sides, there is very little chance of convincing about a topic.
Examples:
When you read or hear of 'a killer' you tend to think of someone who causes others to die. When he is presented as 'a murderer' you perceive malicious intent and your emotional response is different.
The use (and abuse) of language and definitions underlies philosophic and political debate constantly. The definition of 'terrorism/terrorist' (a very commonly used lable these days) has not been agreed on even in the UN, precisely because of various implications that different definitions carry: if terrorism also implies instilling fear to achieve political goals by causing civilian casualties (as is outlined in some definitions), one cannot help but include the acts of some sovereign states as terrorism. So it all rests on definitions, of which there is often more than one.

You may wish to resort to a good dictionary in which different definitions of labels are listed, and you may try to get your client to see that his application of a lable is too vague (what does he specifically mean when he uses 'incompetent' or 'worthless' as a general lable). You may also wish to point out the difference between unambiguous, crystal-clear definitions, vs. definitions that are so inclusive as to be meaningless, misleading, and used only to serve an emotional point of view.
A 'pianist' is not anybody who plays the piano, but an expert whose profession is to play the piano. A carnivore is strictly a meat-eating species, and not a species that has meat as part of its diet. When used this way, these lables are acceptable. But when your client labels himself or others as worthless or as incompetent fools, he implies that this is _invariably_ the case, he doesn't see instances in which the opposite is true, and perhaps the way to go is to crystalize the definitions and to show that the 'always' factor doesn't apply: he is using his labels incorrectly.
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  #3  
Unread September 29th, 2006, 02:29 AM
Janet Doron Janet Doron is offline
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Default Re: Labelling and Probabilities

......to summarize and put it plainly, I'd approach by dissecting each 'lable' he uses specifically, rather than our well-known, general tendency to lable....
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  #4  
Unread September 29th, 2006, 01:30 PM
John Simon John Simon is offline
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Default Re: Labelling and Probabilities

I might suggest a couple of things. First, do you believe that you have really built up an alliance with this client so that he might be open to your discussion? Having these discussions too early in the sessions can make it feel like an attack by the client. The problem is that most people are working with idiosyncratic or private logic as they go about their daily lives. This logic solidifies over the years from childhood to adulthood. Breaking away from this mindset is difficult. You can indeed benefit from taking your time.

Regarding the probability issue, I think that your client makes a good case. It reminds me of a story that Milton Ericson used to tell. While working in a psych ward, one of his patients began putting paper over the windows and stuffing paper in the door locks because he thought that people were after him. The security staff wanted to extract him but Erickson went inside. He began to help the patient stuff the paper as a way to allign with him. Over time, the patient began to trust him. Erickson, over time, convinced the man that the security staff would not let anyone one the grounds who might hurt him. He then talked about the patient's family, friends, and the police and how they could protect him. The patient could now go around town without worry. Finally, Erickson suggested that the military and border patrol would keep out the bad guys and the patient was able to travel throughout the country. I bring this up to suggest that you align with the client first and then use the client's private logic to make changes. Direct confrontation of the cleint's ideas by the therapist often only leads to resistence by the client.

John
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  #5  
Unread September 30th, 2006, 03:05 AM
Carl Robbins Carl Robbins is offline
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Default Re: Labelling and Probabilities

First, I will assume that your client doesn't have a history of actually being assaulted and that his fears are not from PTSD. I will also assume that he does not live in a dangerous neighborhood (which might mean that his worries require constructive action to increase his safety - e.g. moving).

re: Probabilities

Your discussion about the probability of being accosted by going outside has the flavor of assessing the likelihood of an event with someone who has OCD.

I'd start by acknowledging the possibility of being accosted when leaving home and that staying home does, in fact, reduce that possibility. I'd also acknowledge that there is, in fact, genuine risk in going outside (as there is a possibility that you can get sick by touching a door knob and that we can never know FOR SURE that this won't happen).

A core issue for your client seems to be tolerance for uncertainty. Leaving our homes involves a willingness to live with the fact that an unlimited number of horrendous things can befall us when we venture into the world (e.g. 9/11 proved that a plane CAN fly into a building). Somehow, most people learn to live with this risk and not being 100% sure that something bad won't happen.

Jonathan Grayson points out that it's useful to distinguish uncertainty as a fact vs. uncertainty as a feeling. We all live with an infinite number of FACTUAL uncertainties all of the time. Try this thought experiment: Think of someone you dearly love and ask yourself if you know for sure that this person is still alive. Of course, you can call that person to check to make sure that he/she is ok, but how do you know that he/she didn't die as soon as you hung up the phone? YOU DON"T. So, as a fact, you spend most of your day living with the fact that loved ones can die at any minute. Distinguish these facts from the moments of FEELING unsure about specific possibilities.

You might ask the client what risks he takes when he is at home - there are many. Do you know how many people die every year from falling out of bed (there a surprising number!)? How about slipping in the shower and hitting your head? Ask the client to note that he, in fact, takes these risks all of the time.

Ultimately, one is faced with a cost/benefit analysis. What happens to your life and your goals when it is organized around minimization of all uncertainty and risk? Is that the life you want? How much of your avoidance of leaving home is actually about avoiding the FEELINGS of uncertainty and discomfort? If so, what are the costs of minimizing those feelings?

You might also ask the client how most people (not all) are willing to take the risk of leaving home. How does he imagine other people he knows might think about dealing with those risks?

Yes, leaving home requires courage. A life worth living involves taking risks. Otherwise, what kind of life do we have?

Last edited by Carl Robbins; September 30th, 2006 at 07:33 AM.
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