A Common Sense Approach to Trouble

A Grand Unifying Theory of Psychotherapy

Keith R Wilson

Jan 29

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Of all the troubles you might have, psychotherapy can help you with only some of them. If you need more space in your home, hire a builder; if you’re broke, get a job or apply for welfare. Legal troubles require lawyers, spiritual trouble calls for clergy, and a toothache demands a dentist. What are shrink-type problems? There’s only three of them, says Purton Campbell in his book The Trouble with Psychotherapy: Counselling and Common Sense.

The first is what he calls type A trouble, related to being disconnected from people or alienated from life. In this category he puts loneliness, grief, meaninglessness, and emptiness. People with type A trouble may not care about anything and have no place to belong. He also adds those who are out of touch with reality or living in a world of their own.

Type B trouble arises when your beliefs and actions are out of sync; when you want to stop a habit, but are unable to; when you can’t get certain thoughts out of your mind; when you’re scared of things you know will never hurt you; when you do things you later regret; or, when you put things off you need to do.

When you have type C trouble, you don’t know what you want; you feel weak, hopeless, ambivalent, or confused. You don’t understand yourself. You can’t articulate your feelings. You’re a mystery to yourself. You would take action if you could only figure out what to do.

If you’re accustomed to thinking of shrink-type problems in terms of mental illness, you can’t help but read Campbell’s three types and put mental disorders into them. Type A seems to be for folks who range from psychotic, manic, and narcissistic, to sociopathic, and depressed. Type B has everything from phobias, OCD, and PTSD, to paraphilias, eating disorders, and addictions. In type C is borderline personality, dissociative disorder, and the dysphorias.

However, I would urge you to resist thinking in terms of mental illness. Those names of mental illnesses are purely descriptive. We took all the psychological symptoms of distress, found groupings, and called each group a mental illness. That’s like arranging the books in a library by the color of their covers, not by what’s within. It would have made more sense to classify distress by underlying causal factors. Of course, we can’t. We don’t know what the underlying factors are. No single psychological theory is broadly accepted, and neuroscience has yet to give us the answers.

Moreover, a great many, if not all mental illnesses straddle several of Campbell’s types. For instance, depression can be type A, B, and C equally well. Folks with ADHD can be confused, putting them in type C; feel like a misfit, in type A; or frustrated with themselves, landing them in type B. By the same token, an addict, lost in denial, intoxicated with a fantasy world, and impervious to the concerns of his loved ones, can spend years with type A troubles. When he starts to get ambivalent about change, his troubles change to type C. When he’s committed to recovery, but is often relapsing, he’s got a bad case of type B.

If your head is still stuck in the conceptual world of mental illness, you’ll be surprised Campbell put raving mania in type A, right alongside the melancholic who won’t get out of bed. A scrupulous person with OCD may be uncomfortable finding himself in type B, along with the pedophiles. But Campbell is looking past appearances, which can be deceiving, to identify the underlying causes. The causes are not disease states or character flaws, but the puzzles that result when we face inevitable conflicts between self and world.

All three types, have to do with the dialogue that occurs between each person and the rest of the world. You need the world to tell you what is real, planes rarely fall from the sky. At the same time, you might get messages from within, I’m scared to get on that plane. Type B troubles arise when the messages from within are dominant. You get type C when the message from the world drowns out your own feelings. In the case of type A, the trouble comes from not participating in the dialogue at all.

Campbell’s types can bring clarity to setting goals and selecting modes of treatment. You can ask yourself, am I confused (type C), frustrated (type B), or in a world of my own (type A)? Depending on the answer, you can get help to sort out your confusion, create a plan for change, or join the rest of us.

Not every shrink-type problem requires that you find a shrink. Common sense solutions work most of the time. It’s only for the stubborn issues that you need paid help. If you have type A trouble, are lonely, alienated, or empty, then the obvious solution is to make a friend, join a cause, or find something meaningful. You can find new friends wherever people gather: at work, at play, on dating apps, volunteer opportunities, clubhouses, classes, self-help groups, and bars. If you’re grieving, then find others who grieve. You can find causes in politics, religion, creating things, and helping others. You can find meaning by identifying and standing up for your values. However, sometimes type A troubles are not so easily solved. No causes fire you up. No meaning speaks to you. You can’t make connections, you feel lonely despite them, or connections bring another kind of trouble. Then you need to go to therapy.

What’s a therapist going to do for type A trouble? Well, for one, he’s a connection. He’s a professional, trained to connect to lonely, alienated, and empty people. A wise therapist will go slow, easy, and won’t scare you away with judgement or demands. If you can find a Person-Centered Therapist, that would be perfect because that kind of therapy focuses on creating a safe atmosphere of empathy, acceptance, and sincerity. If you have a lot to say, then look for Narrative Therapy and tell your story. If talking is not your thing, there’s art therapy. It doesn’t really matter what you do with your therapist, as long as you are together.

I’ve had a lot of clients with type A trouble. I generally use Person-Centered or Narrative Therapy, but sometimes I’ll turn to art. When I worked at a program for the seriously mentally ill, we had milieu therapy. That is, we created a safe place for them to go, where they could meet others like them, and gave them something to do. If they had hallucinations, delusions, or unregulated behavior that kept them separated from the world, we had medication that could help them with that. However, medications by themselves will never enable an alienated person to re-connect with the world.

Sometimes a bad habit, like an addiction, is behind the alienation. In that case, I might do some Motivational Interviewing, which puts the client in the driver’s seat in the journey towards change; but mostly I’d be focusing on building relationships, first with me, because they’re in my office, and then with others. This is the rationale behind harm reduction programs that cater to the needs of active addicts in the hope that not only will lives be saved, but links will be established that can later be the path to recovery.

Type B troubles require different help. If you have type B trouble, you’re already very motivated for change and know just what you need to do. The first thing to try are the apps, self-help groups, books, and manuals devoted to helping you change your habits. You often don’t need a therapist, as much as a coach, someone to help you set goals, break them down into more easily achievable objectives, measure your progress, cheer your success, and make you accountable for following through. Doctors can prescribe medication to quell your anxiety, so you can get on that plane; boost your confidence, so you can ask for that raise; or give you medication to help you get off the alcohol, drugs, and cigarettes you already use to manage your feelings.

If none of the common sense methods work, or if they just cause another set of problems, then it’s time to see a therapist. Depending on his training, he could use Systematic Desensitization, Hypnosis, EMDR, Motivational Enhancement, Solution Focused Therapy, or Neuro-Linguistic Programing. There are also a hundred different forms of Cognitive Behavioral Therapy to choose from. You’re almost certain to get some form of relaxation training, whether they call it mindfulness, meditation, bio-feedback, deep breathing, guided imagery, or progressive muscle relaxation. The idea is to quiet the messages you are getting from within, I’m scared to get on that plane, so you can hear the message, planes rarely fall from the sky.

The people with type B trouble I’ve worked the most with have been addicts, struggling to stay clean. Then it’s often a matter of identifying the need their drug promises to fulfill, finding it somewhere else, and remembering to choose the alternative. That last part is the hardest for people because it’s imperative to stop the process towards relapse before the ball gets rolling. For that reason, I often painstakingly go over everything that happened prior to relapse, so we can identify ways to intervene. The name for this technique is CBT.

If you have type C trouble, you can start a journal, take up the expressive arts, record your dreams, or take an hallucinogen. All these will amplify your inner voice. You can talk it out with a trusted advisor, a friend, family member, clergy, or a mentor; but it must be the type of person who won’t tell you what to do. You need to find your own voice.

Here again, a therapist who has a Person-Centered approach seems made to order, as does Narrative Therapy. If you need more facilitation, then there are loads of other therapeutic approaches that can help you find your voice. Freud, Jung, and all the psychoanalysts give us penetrating insights into unconscious motives and direction. Internal Family Systems is a popularized psychodynamic theory that does the same. Schema Therapy can reveal your schemas. Gestalt Therapy can help you work out ambivalences, and Existential Therapy helps you grapple with the big questions. All those methods will give you a new place to look to find your voice. They will give it a language when it’s ready to speak.

Most of the type C clients I’ve worked with have type C trouble because something or someone has taught them their feelings don’t matter. Others just want to learn more about themselves. They’re in therapy for personal growth, rather than to relieve immediate suffering. Recovering addicts are also in type C when they remain in therapy long after they stop using, having solved their type B trouble. They’re exploring the issues that led to their use, asking themselves type C questions.

Many of the personal growth clients do not have a mental illness diagnosis; or as is the case with the recovering addicts, they are in remission. Clients with borderline personality or a dissociative disorder are a different story. They tend to act out their ambivalence in ways that get everyone confused and frustrated. In that case, a close cousin of CBT, called Dialectical Behavioral Therapy (DBT), may be the best choice.

Campbell’s scheme lets therapists help their clients without medicalizing every little thing. The source of trouble is not an illness, but the way they process information. Does the world upstage your feelings (type C), do your feelings upstage what the world is trying to say (type B), or have you gotten so tired of the world and feelings arguing that you turned off both their mics (type A)? When I explain Campbell’s theory to people, they get it. It’s common sense. On the other hand, when I try to explain the Oedipus complex or serotonin reuptake inhibitors, all I get are blank stares.

Campbell also gives us a coherent theory to support eclecticism. Most therapists are eclectic. Many begin their careers devoted entirely to one school of thought. The Freudian will say her clients’ troubles are the result of unconscious forces, so she reveals those forces with interpretations. The Cognitive Behavioralist will say irrational beliefs are behind it all, so he disputes the beliefs. The Narrative Therapist will say dominant stories are keeping the client down, so she’ll help them tell a new story. The Gestalt therapist will say parts of the person are at war with each other, so he’ll conduct a peace conference. The psychopharmacologist will say it’s all chemical, so she prescribes a medication. However, it’s just a matter of time before they all encounter someone with whom their favorite techniques doesn’t work. Then the therapist will either refer the client out, go on using the ineffective technique until the client leaves, or try something else. When the therapist tries something else, he becomes eclectic.

Eclectic therapists collect a vast number of techniques that are not supported by the theories they hold. If the cognitive behavioralist believes all problems stem from irrational beliefs, why is he interpreting dreams? If the psychopharmacologist believes it’s all chemical, why is she having the client talk to his father in an empty chair? They are using those techniques because they work some of the time, but the therapist’s underlying theory is inconsistent. When a therapist sticks to one school of thought, she has a coherent psychological theory that justifies the techniques she used. But an eclectic therapist has a vast array of techniques but no rationale behind them. He doesn’t know the real reason behind a client’s troubles. Eclecticism has a type C problem.

Cambell’s solution is to give us a grand unifying theory of psychotherapy that eclectics like me can use. When a client has a type C problem, making the unconscious conscious is just the thing. When type B comes along, I turn into a cognitive behavioralist. I have a good reason to be Person-Centered when I’m dealing with type A. I have a purpose for all the tools in my toolbox. It’s as simple as ABC.