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This editorial introduces the special issue of The Cognitive Behaviour Therapist on Control Theory and CBT. The various routes through which Perceptual Control Theory (PCT) can inform CBT are explained and a range of theory, research and practice articles are introduced. Each focuses on encouraging and validating a Control Theory perspective to the clinical practice of cognitive behavioural therapies.
I have been asked to describe how Perceptual Control Theory (PCT) and Method of Levels (MOL) came into being, and as I approach the age of 82 that seems a prudent request. Some parts of the following should probably be taken more as a reconstruction than a verifiable record of the past, but I will strive for realism.
Dismantling studies are used in psychotherapy in order to understand the important components of treatment. Typically, this has occurred so that people could understand the unique contributions provided by cognitive versus behavioural techniques. Recently, mindfulness-based approaches have apparently added a third dimension to the dismantling enterprise. Dismantling is seen as an important way of understanding the change process in psychotherapy and, therefore, clarifying how we might most effectively promote change. The way in which an entity is dismantled, however, exposes assumptions about the nature of the entity and its organization. In this paper we argue that dismantling studies in psychotherapy have perhaps generated more confusion than consensus and have provided little practical benefit for clinicians. We suggest that the phenomenon of control might provide a unifying perspective from which to approach the integration of behavioural, cognitive, and mindfulness approaches. In one sense all these seemingly different approaches are doing the same thing and it is this ‘thing’ we highlight in this paper.
Recently, autobiographical memory theorists proposed that intrusive imagery contains important information about goals. This study examined thematic links between approach and avoidance goals in two groups: a clinical group (n = 22) and a non-clinical group (n = 24). Participants completed the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM), Goals Task and an imagery interview. In the total sample, almost 90% of reported imagery matched at least one goal. Eighty-five percent of clinical participants reported imagery that matched avoidance goals, whereas only half of non-clinical participants' imagery matched an avoidance goal. The majority of imagery was found to be associated with a particular memory or a collection of memories for similar events. These findings support proposals that intrusive imagery contains important information about goals, and in particular states of the world to be avoided. Clinical implications and directions for future research are discussed.
Method of Levels (MOL) is a form of cognitive therapy based on Perceptual Control Theory (PCT). This paper presents the initial steps towards four methods of establishing the validity of MOL. First, the session was rated by two independent experts for its adherence to MOL using a newly developed 6-item scale based on the Cognitive Therapy Rating Scale. Second, each therapist utterance within a session of MOL was coded and categorized in terms of the therapist's goal to test for adherence to the two specified goals of MOL. Third, a macroanalysis of a MOL session utilizing interpretative phenomenological analysis hypothesized the control hierarchies involved in a client's presenting problem and their zones of conflict. Fourth, a microanalysis of a brief interchange between the therapist and client explored its adherence to PCT. These methods of establishing validity are introduced and explored for later use in larger scale studies. The limitations of the present study and suggestions for future research are discussed.
The Method of Levels (MOL) shares many similarities with other therapeutic approaches and is perhaps most distinguishable by what it does not include rather than what it does use in sessions. MOL has two basic steps which are followed in an iterative procedure until the patient/client experiences a change or shift in their understanding and experience of a problem. This article explains the steps and uses examples and suggestions for practice to promote understanding.
This article considers the pros and cons of using Method of Levels (MOL), a therapy based on Perceptual Control Theory (PCT). Five concerns about PCT are that it is an early theory, is not well known, originates from outside psychology, implies that established theories are inaccurate and has a mechanistic approach. Five positive features are that it explains how ‘control’ works, takes a phenomenological perspective, is grounded in biology, integrates many disciplines and has an evidence base. Five features of MOL can raise caution: it is not well known, emphasizes intrinsic change, requires the therapist to let go of control, concentrate intensively and use alternative evaluations of outcome. There are major advantages: it is a simple process to learn; theory-practice links are clear, it is ‘ultra cognitive therapy’ – focused on the present moment, client-centred and enables shifting in perspective, promotes service empowerment, and has an evidence base. This article will help therapists make an informed choice about using MOL.
This paper looks at issues regarding case formulation in psychotherapy. Case formulation is well recognized as being helpful in the conceptualizing of psychological problems and as a useful tool in the practice of cognitive therapy. Control, as opposed to behaviour, is increasingly being seen as that human process most relevant to psychopathology. We look at the diagnosis and treatment of a small number of people, treated in a naturalistic setting, who were selected without any specific criteria other than being people whose problems were treated using the Method of Levels, a form of cognitive therapy based on the principles of Perceptual Control Theory, and who completed both pre- and post-treatment questionnaires. We then consider how the problems these people presented with, and their treatment, might be formulated as a result of taking this approach.
The psychological treatment offered to clients is important. However, an equally important consideration may be the way the treatment is delivered. Reducing waiting lists and improving access to services are priorities for many health services. So is increasing patient control over their own health-care outcomes. While waiting times and access to services have typically been addressed by increasing the numbers of clinicians available, our work suggests that a strategy of providing patients with the ability to determine the frequency and duration of their treatment may be an option that is simpler, more effective, and financially more attractive. After describing policy and ethical guidelines as well as empirical and theoretical information, we provide data from our work in one GP practice about the improvements in waiting times and access to services that occurred when we adopted an approach that allowed patients rather than clinicians to decide how the organization of treatment would occur. There seem to be many benefits to this approach; however, it may also raise dilemmas for clinicians when patients' preferences differ from their own. Ultimately, these conundrums can only be reconciled by the individual clinicians based on their attitudes to mental health problems and service provision.
This paper provides an overview of perceptual control theory (PCT) in relation to understanding severe and enduring mental health problems. The core principles of control and conflict are reviewed in relation to understanding the experiences associated with psychotic disorders. The therapeutic application of PCT known as the Method of Levels (MOL) is described and an overview of how this might be a useful approach to use with people experiencing psychosis is provided. The benefits and difficulties of using MOL to work with people experiencing psychosis are described including case illustrations of preliminary work based on the application of MOL in clinical practice. It is concluded that PCT is a useful framework for understanding severe and enduring mental health problems and there are potential benefits in using MOL as a therapeutic intervention. Further research examining the effectiveness and feasibility of MOL as a specific treatment for psychosis is recommended.