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The Method of Levels (MOL) is an application of perceptual control theory to psychotherapy, sometimes considered under the umbrella of Cognitive Behavioral Therapies (CBT). However, the MOL therapist does not propose or prescribe solutions or remedies. While the patient talks, the therapist is alert for any indication that some background thought has intruded. By asking curiously what they were just thinking or feeling, the therapist helps the patient shift their awareness to higher levels of perception. This process of ‘going up a level’ continues until the higher-level sources of contradictory goals come into concurrent awareness from a yet higher level, allowing an apparently innate process of reorganization to resolve the conflict that was distressing the client.[1][2]

History

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The Method of Levels originated in Powers’ phenomenological investigations into the mobility of awareness relative to the perceptual hierarchy.[3] He prepared a description of it for his 1973 book, Behavior: The Control of Perception, but the editor persuaded him to remove that chapter and the chapter on emotion.[4] He continued to demonstrate the technique at PCT conferences.[5] In the 1990s, David Goldstein of New Jersey (US) began using MOL in clinical practice with patients, and Timothy A. Carey, an Australian psychologist, also began using it and obtained a doctorate in clinical psychology primarily so that he could continue to develop and research it.[4] Carey, Warren Mansell, Sara Tai, Eva de Hullu, and their colleagues and students continue to research, practice, and teach MOL on several continents. Eva de Hullu (Open Universiteit, the Netherlands), Warren Mansell (Curtin University, Perth, Australia) and Ana Churchman (Manchester University, UK) are leading collaborative development of an accreditation program on PCT principles, under the umbrella of the International Association for Perceptual Control Theory (IAPCT).

Theory

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The theoretical foundation of MOL is the PCT model of satisfactory psychological functioning as successful control. Psychological disorders, in this view, are various forms of dysfunction due to disruption of successful control, psychological distress is the subjective consequence of an inability to control important experiences,[6][7] and by identifying and eliminating the source of distress a person recovers control. The most common source of distress found in practice is internal conflict, which has the effect of denying control to both systems that are in conflict with each other. Such conflict is usually transitory, but when conflict becomes chronic then symptoms of psychological disorder may appear. The conflict cannot be resolved while attention is focused on the experiences which are distressing, vacillating between incompatible goals. When the client has relocated attention above the level of the hierarchy from which the conflicting goals are set, an innate process called reorganization re-establishes satisfactory control.

Method

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The core process is to redirect attention to higher levels in the client's control hierarchy by recognizing ‘background thoughts’, bringing them into the foreground, and then being alert for more background thoughts while the new foreground thoughts are explored. When the level-climbing process reaches an end state without encountering any conflicts, the need for therapy may have ended. When, however, this ‘up-a-level’ process bogs down, a conflict has probably surfaced, and the exploration can be turned to finding the systems responsible for generating the conflict—and away from a preoccupation with the symptoms and efforts immediately associated with the conflict.

Research

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Carey's research into MOL began with the question whether MOL is sufficient in itself as an effective and efficient way of helping people resolve psychological distress. The result is clearly affirmative. More than two decades of case histories and practice-based evaluations by different therapists in different settings working with different people about a wide range of different problems show that nothing additional is needed to enhance MOL. MOL is used effectively as the sole therapeutic modality with adults and young people, in primary care and secondary care, in alcohol and other drug services, in pain management clinics, in schools, in prisons, and in different countries and cultures.

An advantage for research is that records of ongoing evaluation have been a feature of MOL since its introduction into clinical practice, because MOL was developed as a therapy within the routine clinical settings in which it would be used. Numerous evaluations of MOL used in different settings by different therapists have been published.[8] These evaluations include novel methodologies such as Time 1 and Time 2 rather than pre- and post-designs and benchmarking,[9]. Innovative metrics such as the efficiency ratio have also been introduced.[10] The evaluations have also included investigations into the perspective of patients as well as that of referring GPs.

In conjunction with another clinical innovation, Patient-Led Appointment Scheduling (PLAS), MOL has been demonstrated to reduce waiting times and improve access to services with no reduction of its effectiveness and efficiency as therapy.[11][12][13] In addition to the many evaluations of MOL in primary care settings, a randomised controlled trial in subjects with first-episode psychosis demonstrated that the retention in the trial at final follow-up was 97%, suggesting a successful feasibility outcome. The feedback provided by participants delivered initial evidence of the intervention for this population.[14][15] The approach may also be effective in the treatment of sleep disorders[16] and suicidality.[17]

See also

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References

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  1. ^ Mansell, Carey & Tai 2012
  2. ^ Carey, Mansell & Tai 2015.
  3. ^ Powers 2009
  4. ^ a b Powers 2009, p. 121.
  5. ^ Meetings of the Control Systems Group, which is now the International Association for Perceptual Control Theory (IAPCT)).
  6. ^ Mansell 2005
  7. ^ Carey 2006
  8. ^ For example, Carey 2005, Carey & Mullen 2007, Carey & Mullen 2008, Carey, Mullen & Carey 2007, Carey et al. 2009 Carey, Tai & Stiles 2013.
  9. ^ Carey et al. 2017
  10. ^ Carey, Tai & Stiles 2013
  11. ^ Carey 2010
  12. ^ Carey 2011
  13. ^ Carey 2016b
  14. ^ Griffiths et al. 2018
  15. ^ Griffiths et al. 2019
  16. ^ Grzegrzolka, McEvoy & Mansell 2019
  17. ^ Macintyre et al. 2021

Further reading

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  • Bird, T.; Mansell, W.; Tai, S. (2009). "Method of Levels: initial steps in assessing adherence and the development of a qualitative framework for mapping clients' control hierarchies". The Cognitive Behaviour Therapist. 2 (3): 145–166. doi:10.1017/S1754470X09990158. ISSN 1754-470X.
  • Carey, T. A. (1999). "What makes a psychotherapist effective?". Psychotherapy in Australia. 5 (3): 52–59.
  • Carey, T. A. (Spring 2001a). "Investigating the role of redirecting awareness in the change process: A case study using the Method of Levels" (PDF). International Journal of Reality Therapy. 20 (2): 26–30. Archived from the original (PDF) on 2014-04-21.
  • Carey, T. A. (2001b). "The Method of Levels: Offering a different approach to peer counseling programs". International Journal of Reality Therapy. 21 (1): 13–16.
  • Carey, T. A. (2002). "Rebecca: A case study application of perceptual control theory". Psychotherapy in Australia. 8 (3): 56–59.
  • Carey, T. A. (2005). "Can patients specify treatment parameters?". Clinical Psychology and Psychotherapy. 12 (4): 326–335.
  • Carey, T. A. (2006). The Method of Levels: How to do psychotherapy without getting in the way. Hayward, CA: Living Control Systems Publishing. ISBN 978-0-9740155-4-5. OCLC 63193390. Retrieved 27 March 2024.
  • Carey, T. A. (2008a). "Conflict, as the Achilles heel of perceptual control, offers a unifying approach to the formulation of psychological problems". Counselling Psychology Review. 23 (4): 5–16.
  • Carey, T. A. (2008b). "Perceptual Control Theory and the Method of Levels: Further Contributions to a Transdiagnostic Perspective". International Journal of Cognitive Therapy. 1 (3): 237–255. doi:10.1521/ijct.2008.1.3.237. ISSN 1937-1209.
  • Carey, T. A. (2010). "Will you follow while they lead? Introducing a patient-led approach to low intensity CBT interventions". In Bennett-Levy, J.; Richards, D.; Farrand, P.; Christensen, H.; Griffiths, K.; Kavanagh, D.; Klein, B.; Lau, M. A.; Proudfoot, J.; Ritterband, L.; Williams, C.; White, J. (eds.). Oxford guide to low intensity CBT interventions. Oxford: Oxford University Press. pp. 331–338.
  • Carey, T. A. (2011). "As you like it: Adopting a patient-led approach to the issue of treatment length". Journal of Public Mental Health. 10 (1): 6–16.
  • Carey, T. A. (2016a). "Boundaries: A pluralistic perspective and illustrative case study of the patient-led approach to appointment scheduling". In Cooper, M.; Dryden, W. (eds.). The handbook of pluralistic counselling and psychotherapy. London: Sage Publishing. pp. 288–299.
  • Carey, T. A. (2016b). Hold that thought: Two steps to effective counseling and psychotherapy with the Method of Levels. Chapel Hill, NC: New View Publications. ISBN 978-0-944337-59-2.
  • Carey, T. A.; Carey, M.; Mullan, R. J.; Spratt, C. G.; Spratt, M. B. (2009). "Assessing the Statistical and Personal Significance of the Method of Levels". Behavioural and Cognitive Psychotherapy. 37 (3): 311-324. doi:10.1017/S1352465809005232. ISSN 1352-4658.
  • Carey, T. A.; Mansell, W.; Tai, S. J. (2015-06-05). Principles-based counselling and psychotherapy: A Method of Levels approach. London: Routledge. doi:10.4324/9781315695778. ISBN 978-0-415-73877-4. OCLC 898113412.
  • Carey, T. A.; Mullan, R. J. (2008). "Evaluating the Method of Levels". Counseling Psychology Quarterly. 21 (3): 247–256. doi:10.1080/09515070802396012.
  • Carey, T. A.; Tai, S. J.; Stiles, W. B. (2013). "Effective and efficient: Using patient-led appointment scheduling in routine mental health practice in remote Australia". Professional Psychology: Research and Practice. 44 (6): 405–414. doi:10.1037/a0035038.
  • Goldstein, D. M. (2007). "Method of Levels therapy: Helping the normal change process within a person when normal change doesn't seem to be happening by itself". The International Journal of Healing and Caring. 7 (1): 1–17.
  • Goldstein, D. M. (29 October 2007). The MOL Therapy Case Study of AF. Presented at the CSG 2008 Annual Conference.
  • Goldstein, D. M. (29 March 2009), Perceptual Control Theory Psychotherapy (PCT Psychotherapy)
  • Griffiths, R. M. (8 September 2016). "Conflict and Psychosis". Next Level. Retrieved 9 December 2024.
  • Griffiths, R.; Mansell, W.; Carey, T. A.; Edge, D.; Emsley, R.; Tai, S. J. (September 2018). "Method of levels therapy for first-episode psychosis: rationale, design and baseline data for the feasibility randomised controlled Next Level study". BJPsych Open. 4 (5): 339–345. doi:10.1192/bjo.2018.44. PMC 6094182. PMID 30140445.
  • Griffiths, R.; Mansell, W.; Carey, T. A.; Edge, D.; Emsley, R.; Tai, S. J. (October 2019a). "Method of levels therapy for first-episode psychosis: The feasibility randomized controlled Next Level trial". Journal of Clinical Psychology. 75 (10): 1756–1769. doi:10.1002/jclp.22820. ISSN 0021-9762. PMID 31240723. S2CID 191638657.
  • Griffiths, R. M.; Mansell, W.; Edge, D.; Carey, T. A.; Peel, H.; J. Tai, S. (2019b). "'It was me answering my own questions': Experiences of method of levels therapy amongst people with first‐episode psychosis". International Journal of Mental Health Nursing. 28 (3): 721–734. doi:10.1111/inm.12576. ISSN 1445-8330.
  • Grzegrzolka, J.; McEvoy, P.; Mansell, W. (1 May 2019). "Use of the Method of Levels Therapy as a Low-Intensity Intervention to Work With People Experiencing Sleep Difficulties". Journal of Cognitive Psychotherapy. 33 (2): 140–156. doi:10.1891/0889-8391.33.2.140. PMID 32746389. S2CID 150433287.
  • Macintyre, V. G.; Mansell, W.; Pratt, D.; Tai, S. J. (2021). "The Psychological Pathway to Suicide Attempts: A Strategy of Control Without Awareness". Frontiers in Psychology. 12: 588683. doi:10.3389/fpsyg.2021.588683. PMC 8012495. PMID 33815194.
  • Mansell, W. (June 2005). "Control theory and psychopathology: an integrative approach". Psychology and Psychotherapy: Theory, Research and Practice. 78 (2): 141–178. doi:10.1348/147608304X21400. PMID 16004696.
  • Mansell, W. (2009). "Perceptual Control Theory as an integrative framework and Method of Levels as a cognitive therapy: what are the pros and cons?". The Cognitive Behaviour Therapist. 2 (3): 178–196. doi:10.1017/S1754470X08000093. ISSN 1754-470X.
  • Mansell, W.; Carey, T. A. (2009). "A century of psychology and psychotherapy: Is an understanding of control the missing link between theory, research, and practice?". Psychology and Psychotherapy: Theory, Research and Practice. 82 (3): 337–353. doi:10.1348/147608309X432526. ISSN 1476-0835.
  • Mansell, W.; Carey, T. A; Tai, S. (2012). A transdiagnostic approach to CBT using method of levels therapy: distinctive features. The CBT distinctive features series. Milton Park, Abingdon, Oxon; New York: Routledge. doi:10.4324/9780203081334. ISBN 9780415507639. OCLC 774499959.
  • Mansell, W.; Goldstein, D. M. (2020). "Method of Levels Therapy". The Interdisciplinary Handbook of Perceptual Control Theory. Elsevier. doi:10.1016/b978-0-12-818948-1.00013-7. ISBN 978-0-12-818948-1.
  • Powers, W. T. (2009). "PCT and MOL: a brief history of Perceptual Control Theory and the Method of Levels". The Cognitive Behaviour Therapist. 2 (3): 118–122. doi:10.1017/S1754470X08000111. ISSN 1754-470X.
  • Powers, W. T. (15 December 2022) [2010], The Method of Levels: a Cognitive-Therapy synthesis, Edgartown, Massachusetts, USA: International Association for Perceptual Control Theory, retrieved 27 March 2024 Republished from Powers, W. T. (16 August 2010), The Method of Levels: a cognitive-therapy synthesis (PDF), archived from the original (PDF) on 2011-07-14
  • Richer, J. M. (2020). "Perceptual control theory: A Paradigm Shift?" (PDF). Human Ethology. 35 (1): 79–90. doi:10.22330/he/35/079-090.
  • Scholte, T. (2023). "Reorganization as anti-oppression: PCT, the Method of Levels, and the Theatre of the Oppressed". The Interdisciplinary Handbook of Perceptual Control Theory, Volume II. Elsevier. pp. 349–378. doi:10.1016/b978-0-323-91165-8.00014-7. ISBN 978-0-323-91165-8.
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