The Iceberg Model of Human Behavior

In a previous post (Symptom Removal Vs. Psychodynamic Therapy), I explained the two major streams of thought in psychotherapy. In the first group that primarily focuses on working on the system, Cognitive Behavioral Therapy (CBT) stands out as the most well known approach. Psychodynamic approach, instead tries to get to the root causes of the problem hidden in the unconscious mind.

Symptom oriented therapists try to help people overcome their fears and anxiety in 10 to 20 sessions. However, psychodynamic schools criticize CBT as being a Band-Aid approach because the root causes have not been addressed properly. They argue that if you don’t solve the underlying issues, another symptom could appear in the future.

The unconscious oriented therapists; on the other hand, need several years to be able to explore all the deep root causes before helping the clients overcome their problems. They get criticized for their long therapy process because the clients keep suffering from the symptom until they are able to understand all the deep-rooted issues.

These two approaches have their strengths and their weaknesses. The first one may be faster but risks to be short lived. The second approach may help eradicate the cause but it takes a long time.

Is There a Better Approach? Yes! It is possible to combine these two streams of thoughts in order to get the best of each. For the last decades I have used an alternative method that combines these two approaches so you can get long lasting results in a short time. To explain it I will use the well-known iceberg model.

The Iceberg Model

Sigmund Freud (1856 – 1939), the most prominent figure of psychodynamic school, believed that much of the observable human behavior is caused by inner impulses beneath the conscious awareness of the individual. To explain this model Freud used the analogy of the iceberg. What we see is just a very small part of the iceberg; meanwhile, a giant portion is hidden beneath the surface of water.

According to this model, a symptom, like anxiety, is the tip of the iceberg. The psychotherapists that rely on the unconscious use the iceberg-model to split the human mind into two parts:

The conscious part includes what the individual is aware of. The person with phobia of flying would be conscious of certain thoughts (“What if the plane crashes and I die”), emotions (intense fear) and bodily reactions (perspiration, racing heart, muscle tension, dry mouth, et.).

2) The unconscious part includes images, forgotten or repressed memories, deep urges and existential fears and desires.

The approach I use has the power to address all the deep unconscious root causes. I seek this result working in a special way from top down: focusing on a apparently trivial portion of the symptom that can have a ripple effect downward toward all the deep unconscious issues. (Fig. 2)

All the cases you can read in my blog come from my private practice and my online sessions. For example when you read Katie’s story (I get anxious when my sister insults me) you realize that all I asked her was to do one apparently small and insignificant action. It looks as if what Katie did was not related to her problem. She didn’t have to talk with her sister; fight back; avoid her; etc. She had tried all of these solutions but none worked.

Katie’s small action started a ripple effect that in a very short time stopped her sister to insult her. As if by magic, her relationship with her sister improved and the older one began respecting her.

Although these changes may appear magical, there is a scientific explanation to them. You can easily call to mind the chaos theory or the butterfly effect that argues that a small cause can have large effects. This branch of mathematics has been applied to other fields such as biology, robotics and human behavior. It has proven useful to understand and predict phenomena such as abrupt climate changes, evolution, chemistry and other areas.

In summary, the iceberg model tells us that we have to take into consideration deep issues that are connected to the visible problem or symptom. However, none of the two extreme are efficient ways to solve human problems. Focusing primarily or exclusively on the tip of the iceberg or embarking on a long journey of deep unconscious issues, are both inefficient ways to help people solve their problems. An alternative method is to know exactly where to apply a small change that will have major positive consequences at a deep level.

Symptom Removal Vs. Psychodynamic Therapy

The field of psychotherapy offers a plethora of different and often opposing approaches. Hundreds of diverse schools of thoughts with their own techniques claim to have the solution to human suffering.

This fragmented and chaotic field appears to offer a vast selection of therapeutic approaches to choose from. However, when you observe them carefully, you realize that there are only two major categories, namely Symptom-Oriented Therapies and Psychodynamic Therapies. All schools of therapies fall under these two big umbrellas.

Cognitive Behavioral Therapy (CBT)

The most well known school of therapy belonging to the first category is Cognitive Behavioral Therapy (CBT). This approach overshadows the others mainly because it is dominant in the university setting, and also CBT-oriented research projects receive more funding. For these reasons, most professionals in the filed of clinical psychology receive their training in CBT or a modern version of it such as Acceptance and Commitment Therapy (ACT).

The main goal of CBT, whether in its classical form or its modern versions, is to reduce the symptoms. CBT therapists use techniques to help their clients gain control over their symptom. For example if you were afraid of flying, they would teach you how to control your physical reactions using relaxation techniques. They would also challenge your beliefs and irrational thinking that flying is dangerous, and teach you a technique to cancel your negative self-talk.

Psychodynamic Therapy

On the opposite side, you find Psychodynamic Therapies. The representative of this stream of thought is Psychoanalysis. This approach seeks ways to help the person to gain an insight into their core identity and unconscious desires. Psychoanalysts believe that you need to address the underlying causes of your problem before you can get rid of your problematic symptom. If the clients gain a deep understanding about themselves, they could overcome the symptom.

The chief goal of dynamic therapy is to gain insight first. This is accomplished through a long process of analyzing the unconscious defense mechanisms rooted in the first childhood experiences and exploring one’s neurotic traits and the relationships with one’s parents.

For example, if you sought their help for the fear of flying, they would investigate your past, seeking the root causes of your problem. They would ask you about childhood memories, your relationship with your parents, your fear of death, and other aspects of your core self.

To summarize, if the symptom-oriented therapists see the observable irrational fear as the problem, the unconscious-oriented therapists consider the underlying causes that are below your conscious awareness as the problem. I must also admit that in the past few decades the gap between these two opposing streams of thought has become less wide.

Which Approach is Better?

It is tempting to simplify a complex field such as psychotherapy. Nowadays, most therapists are eclectic and use a combination of approaches. So maybe this is not a good question to ask. A better question is: which therapist is most competent?

When you want to assess the effectiveness of a school of therapy, you must keep an important detail in mind. A therapeutic approach, including all its techniques, is like a toolbox. Simply owning a set of tools does not guarantee that you are a competent craftsman. Craftsmanship requires not only the most sophisticated state of the art tools but also the skills to use them. Thus, you can find exceptional therapists in either category.

As we said, the competency of a therapist is the key to make or break the effectiveness of a specific approach. Next to this ability comes the usefulness of the tools. Therefore, when you look for a therapist, you are better off focusing on their competency as a professional rather on their school of therapy.

Why People Leave Psychotherapy Prematurely

counselling

Needless to say, most psychotherapists dislike when their clients decide to quit therapy prematurely. They have a variety of reactions. Some become upset when their clients complain about lack of results, and there are also those psychotherapists who throw a temper tantrum when someone informs them that they want to abandon therapy!

One of my clients (I’ll call her Joanne), a forty year-old woman, broke up with her partner because she caught him in bed with another woman! He kept contacting her on a daily basis. She felt attracted to him but was not sure about her feelings. Joanne told me that she was still in love with him but didn’t want to continue the relationship. She was anxious because her mind wanted to forget her ex but her heart desired him. She needed help to clear up her thoughts and emotions.

I asked her what she had done so far to solve her problem. Joanne explained that she had been seeing a psychotherapist for ten sessions without any positive results. She had spent about $700 for a therapy that wasn’t helping. For this reason, on the tenth session, she informed the psychotherapist that she decided to quit.

As soon as her therapist heard that Joanne didn’t want to continue the therapy, she became upset and threw a temper tantrum! The psychotherapist, a psychiatrist specializing in psychoanalysis, criticized her by saying things like:

“You can’t stop our therapy now because you are worse than you think you are.”

“You will continue your blind steps.”

“That trip you mentioned with your son, it’s just an excuse. Instead of spending your money on this trip, you should be coming to therapy twice a week!”

After few weeks, Joanne sought my help. It took Joanne three sessions to sort out her mixed emotions and clear up her thoughts. She overcame her anxiety and was congruent about her decision to avoid her ex and start her new life.

Most therapists don’t realize that they are selling a service. People have the right to hire and fire them. Clients bring a problem and want a solution. Competent therapists know this. First of all they are good at what they do and in most cases are able to make a difference in the lives of others. Secondly, they don’t get upset or blame the client for wanting to drop out prematurely.

It’s true that there are some clients that are difficult to work with and they sabotage the treatment. However, most people seeking help have a desire to cooperate, and if they show any resistance is because of fear of change. A professional therapist must have the necessary skills to help clients solve their problems, regardless of their degree of cooperation and resistance. Labelling a client as “resistant to change” denotes mediocre therapeutic skills.

References:

Ogrodniczuk JS, et al. “Strategies for Reducing Patient-Initiated Premature Termination of Psychotherapy,” Harvard Review of Psychiatry (March–April 2005): Vol. 13, No. 2, pp. 57–70.

https://uit.no/Content/418448/The%20effect%20of%20CBT%20is%20falling.pdf

Why the Traditional Model of Psychotherapy is Ineffective

traditional psychotherapy

One of the problems with almost all psychotherapists is that they try to help you based on the theories of their respective school of therapy. Constrained by their invisible framework, such psychotherapists explain and interpret your fear and anxiety from their theories of reference.

This means that your problem (and all its accompanying symptoms) have to match their model of a disorder; leading to two subtle but important realities with dramatic consequences. First, if you, with the help of the therapist search for the ‘why’ of the problem, the finding would always be ‘presumed causes’. This means that the so called causes were in actuality constructed by their adopted theories and their respective school of therapy. Another problem appears when they interpret your fears and anxiety in the light of their theories; the building blocks of your problem are distorted. Again you and your fears and anxiety must match their theories.

People who always keep asking ‘why’ are like tourists who read the guide book while they are standing in front of a monument; they are so busy reading about the building’s history, origins and so on that they don’t look at it.
Ludwig Wittgenstein

When discussing fears, phobias and anxiety, it seems logical to ask what is at their root. But at the heart of such inquiry lies the assumption of a linear relationship between cause and effect. From this lineal way of thinking, in order to solve a problem it seems necessary to go back in time in search of the cause. And since the cause must come before the effect, one must investigate the past.

However, this traditional model has become obsolete. More than a century ago the fields of physics and natural sciences have undergone a major change replacing lineal cause and effect with a circular one. Scientists like Einstein, Heisenberg, Bateson, Maturana, Prigogine and Watzlawick (among many others) have contributed to dismissing the old and obsolete linear causality and adopted the circular one which is more in harmony with contemporary understanding of reality. However, most schools of psychotherapy have attached themselves stubbornly to traditional models of mind and behavior.
Read more

Different Types of Psychotherapists

Aside from their schools and their techniques, individual psychotherapists fall into these four categories:

The Nurturers

Nurturing psychotherapists are serious but have a warm approach. They are excellent listeners and paraphrase back to you what you told them. They often stand up and hug you or cry with you if necessary. They help you to accept your fears and anxiety and give you tips to rearrange your life and the life of others to accommodate your problem. The result is that your condition worsens over the years. for example, If you are afraid of going to the shopping mall on your own, they suggest to keep asking for help and having others come with you and continue to offer you reassurances. In short, they please you in every way except for solving your problem. They often become an unwitting accomplice of your fears and anxiety and foster a relationship marked with emotional dependence.

The Interrogators

Interrogating psychotherapist are those that ask the most detailed questions and take a long time to give an initial assessment. I’m reminded of a movie producer that came to see me for his anxiety attacks. He told me that he had taken anti-anxiety medication but stopped taking them because he felt he was “totally absent”. After which he started therapy with a psychologist who took 10 sessions just to assess his anxiety in all its details. Interrogators are good listeners like “the Nurturers” and in addition they are good at excavating deep into your inner life. They do not offer you a shoulder to cry but want to know all about your fears, anxiety and even your dreams – in great detail.

The Buddies

Faithful buddies do not have a serious or formal attitude; rather they are warm and always available. They give you their cell phone number to call them if you had a panic attack or needed an urgent chat. The psychotherapists that assume this role, actually don’t need any degree or training, since all they need is a warm personality and a bit of common sense. You recognize them because they offer you the kind of advice that you could get from a friend that is a sensible person. The difference is that the latter is free.

Paid buddies often talk about books that they have read and recommend you to read such and such to help you with your fear and anxiety. The relationship is so warm and friendly that you feel guilty to leave, even though you realize that you haven’t benefited a bit from them. You stay because they have become a part of your life and you wouldn’t betray a friend. Well, the fact that you pay them is a minor detail. After all, you might reason, they are my psychotherapist and I have to pay for their time.

The Weird Ones

Fortunately weird therapists are rare. Most of them are not certified or licensed but have attended training courses and read psychology books. Among them you might find some NLP practitioners who may throw a glass of water on your face to stop your repeating patterns of phobia and anxiety. I recall many years ago, one of these practitioners told me that he picked his nose every time a female client burst in tears. He explained that he wanted to break her limiting pattern of anxiety. They call it pattern interrupt and explain that her brain would associate the unpleasant sight of someone picking his nose with anxiety and thus she would not want to feel anxious.