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De Method of Levels (MOL) Is Een 'Ultra' Cognitieve Gedragstherapie Ger Schurink, Oktober 2017

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De Method of Levels (MOL) Is Een 'Ultra' Cognitieve Gedragstherapie Ger Schurink, Oktober 2017 De Method of Levels (MOL) is een 'ultra' cognitieve gedragstherapie Ger Schurink, oktober 2017 Cognitieve gedragstherapie gaat er van uit dat problemen beïnvloed en in stand gehouden worden door iemands cognities en gedrag. Door het onderzoeken en veranderen van die gedachten en dat gedrag nemen psychische klachten af. Dat is precies wat de MOL op een zeer efficiente manier doet. Cliënten moeten in een MOL-sessie hun aandacht voortdurend focussen op pijnlijke onderwerpen waar ze liever niet mee bezig zijn. Ze moeten zich uiten over hoe ze hun problemen op dat moment ervaren. De emotionele lading moet toe nemen en veranderen als ze zich uiten. En er moet een verschuiving in de disfunctionele cognities ontstaan naar evaluerende cognities, vanuit een perspectief dat de probleemsituatie overstijgt. De MOL is een vorm van ‘conversationele’ exposure en cognitieve herstructurering in één. Gedragstherapeuten herkennen in de MOL de socratische methode en elementen uit de motiverende gespreksvoering en de metacognitieve therapie. De MOL kan misschien beter begrepen worden door te kijken wat het weglaat dan wat het omvat. Er wordt geen gebruik gemaakt van psychoeducatie, probleemanalyses, holistisch theorieën, gedachten-schema's, exposure- oefeningen en huiswerkopdrachten etc. Niet dat deze technieken niet helpend zijn; de MOL claimt dat die niet nodig zijn voor verandering. De MOL biedt een efficientere, toegankelijkere, makkelijk te trainen en client-vriendelijkere vorm van therapie dan steeds complexere verklaringsmodellen en behandelmethoden in de huidige GGZ. De MOL is een minimalistische transdiagnostische gespreksmethode: eenvoudig en effectief voor alle vormen van psychisch lijden, ongeacht de symptomen! De MOL is gebaseerd op de Percepual Control Theory (PCT) en kan op zichzelf staand toegepast kan worden en ook helpen om “traditionele” cgt-interventies te verbeteren. De PCT stelt dat psychisch lijden voortkomt uit conflicten tussen overtuigingen, doelen of waarden. Net als bij de socratische dialoog, is de aanname dat de cliënt de kennis en oplossingen al in zich heeft en de therapeut een gids is, die niet zozeer de weg weet maar wel kan helpen de weg weer te vinden. De kern van de MOL is vragen stellen, zodat cliënten zichzelf beter gaan begrijpen en zelf antwoorden vinden. De belangrijkste taak van de therapeut is héél gedetailleerd geïnteresseerde vragen stellen over het gespreksonderwerp en dóór te vragen als er ‘verstoringen’ opgemerkt worden. Dit zijn de (non)verbale veranderingen in een gesprek zoals aarzelen, een andere gelaatsuitdrukking, wegkijken, onrustig bewegen, aparte woorden of een evaluerende opmerking. Op dat moment is er meestal sprake van belangrijke gevoelens of gedachten die vluchtig op de achtergrond aanwezig zijn. Door deze in het gesprek telkens de volle aandacht te geven neemt de emotionele lading toe en wordt de cliënt zich steeds bewuster van allerlei kanten van het probleem en waar de angel precies zit. Er ontstaat een perspectief dat het oorspronkelijke probleem overstijgt. Vandaar het woord ‘levels’ in de MOL. Met deze inzichten lost het probleem zich vaak op of de cliënt ziet manieren om het zelfstandig verder aan pakken Bij de MOL heeft de cliënt zelf de regie, hij bepaalt zelf het gespreksonderwerp, of en wanneer hij een volgende afspraak wil. Elk gesprek is op zichzelf staand en er is geen behandelplan. De therapeut houdt de aandacht van de cliënt steeds héél dicht bij het onderwerp en is spaarzaam in het geven van uitleg, interpretaties, adviezen of oefeningen. De MOL kan veel vragen en twijfel oproepen bij hulpverleners omdat de werkwijze en de achterliggende theorie afwijkt van het gebruikelijke. En afwijken van de bekende weg is nodig omdat steeds duidelijker wordt dat er nog veel ruimte voor verbetering is, zoals Michelle Craske dat diplomatiek zegt. Ook binnen de VGCt dringt steeds meer door dat behandelaars in de praktijk tegen de beperkingen van de stoornisspecifieke werkwijze aanlopen. (Bron: VGCt Nieuws 01/2017). Er gaan steeds meer stemmen op om een meer transdiagnostische benadering te volgen bij het begrijpen en verhelpen van psychopathologie. De MOL sluit precies aan op deze visie en is een veelbelovende transdiagnostische gespreksmethode. Net zoals als bij de ACT en de MBCT het geval was, is het te verwachten dat de MOL en de PCT in de komende jaren geleidelijk een wezenlijke invloed gaan krijgen binnen de cognitieve gedragstherapie. Inmiddels zijn er workshops en cursussen MOL geaccrediteerd door de VGCt en andere verenigingen als nascholingscursussen. Ook de British Association for Behavioural & Cognitive Psychotherapies accrediteert MOL-workshops en meerdaagse trainingen. Roz Shafran, Professor of Evidence-Based Psychological Treatment, University of Reading, UK over de PCT en de MOL: Perceptual control theory and the associated “Method of Levels” therapy is a new form of cognitive behaviour therapy designed to help people to reflect on their thinking and behaviour in a way that helps them become more flexible and adept at reducing their own distress. Method of Levels treatment is designed for all forms of mental health problems, and such a “transdiagnostic” approach will help to ensure that it is implemented in clinical practice. Literatuurlijst Method of Levels en de Perceptual Control Theory Er zijn inmiddels tientallen publicaties over de MOL en de Perceptual Control Theory waar de MOl op gebaseerd is. Hieronder staan de belangrijkste en meest toegankelijke publicaties. Alsawy, S., Mansell, W., Carey, T. A., McEvoy, P., & Tai, S. J. (2014). Science and practice of transdiagnostic CBT: A Perceptual Control Theory (PCT) approach. International Journal of Cognitive Therapy, 7, 334-359. Carey, T. A. (2011). Exposure and reorganization: The what and how of effective psychotherapy. Clinical Psychology Review, 31, 236- 248. DOI 10.1016/j.cpr.2010.04.004 Carey, T. A. (2017). Sta daar eens even bij stil! Twee stappen om effectief helpende gesprekken te voeren. (verschijnt in najaar 2017) Vertaling van: Carey, T. A. (2008). Hold that thought! Two steps to effective counseling and psychotherapy with the Method of Levels. Chapel Hill, NC: Newview Publications. Carey, T. A., Mansell, W., & Tai, S. J. (2015). Principles-based counselling and psychotherapy: A Method of Levels approach. London: Routledge. Carey, T. A., Kelly, R. E., Mansell, W., & Tai, S. J. (2012). What’s therapeutic about the therapeutic relationship? A hypothesis for practice informed by Perceptual Control Theory. The Cognitive Behaviour Therapist, 5(2-3), 47-59. doi:10.1017/S1754470X12000037 Higginson, S., Mansell, W., & Wood, A.M. (2011). An integrative mechanistic account of psychological distress, therapeutic change and recovery- The Perceptual Control Theory approach. Clinical Psychology Review 31 (2011) 249–259. Mansell. W. (2009). Perceptual control theory as an integrative framework and method of levels as a cognitive therapy: What are the pros and framework and method of levels as a cognitive therapy: What are the pros and cons? The Cognitive Behaviour Therapist, 2, 178–196. Mansell, W., Carey, T. A., & Tai, S. J (2016). Method of Levels gesprekstherapie. Een transdiagnostische benadering. Amsterdam: Uitgeverij Hogrefe. Vertaling van: A Transdiagnostic Approach to CBT Using Method of Levels Therapy: Distinctive Features. London: Routledge, 2012. Marken, R. S., & Carey, T. A. (2014). Understanding the Change Process Involved in Solving Psychological Problems: A Model-Based Approach to Understanding How Psychotherapy Works. Clinical Psychology and Psychotherapy. DOI: 10.1002/cpp.1919 Marken, R. S., & Carey, T. A. (2015). Controlling People: The paradoxical nature of being human. Brisbane: Australian Academic Press. Powers, W. T. (2009). PCT and MOL: a brief history of Perceptual Control Theory and the Method of Levels. The Cognitive Behaviour Therapist, 2(03), 118-122. Tai, S. J. (2016). An Introduction to Using the Method of Levels (MOL) Therapy to Work with People Experiencing Psychosis. American Journal of Psychotherapy, 70(1), 125-148. WEBSITES www.methodoflevels.com.au www.iapct.org www.pctweb.org www.mindreadings.com www.livingcontrolsystems.com www.iaact.net www.gerschurink.nl www.methodoflevels.nl A Transdiagnostic Approach to CBT using Method of Levels: aanbevelingen bij het boek van CBT-experts Uit: Mansell, W., Carey, T. A., & Tai, S. J. (2012). A Transdiagnostic Approach to CBT Using Method of Levels Therapy: Distinctive Features. London: Routledge. Compilatie: Ger Schurink, april 2017 The hallmark of all living things is that they are self- organising to achieve goalssurvival and reproduction in the firrst instance. Goals of course can also be in conflict, creating disorganisation. In this landmark book, Mansell, Carey and Tai describe Perceptual Control Theory to explore these issues and as a way of taking a transdiagnostic and goal- oriented approach to mental health problems and therapy. Highly accessible and innovative, the book brings many fresh insights to old problems. A book of high quality, scholarship and usefulness, this volume is a delight to read and learn from. Paul Gilbert, OBE, Professor of Clinical Psychology, University of Derby; Past President of the British Association of Behavioural and Cognitive Psychotherapies; Fellow of the British Psychological Society This book provides an innovative and effective new approach to understanding psychopathology and treatment. Based on Perceptual and Control Theory, Method of Levels helps the clinician implement questions and interventions
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