Introduction to

Method of Levels

International online course 2021

Dr Warren Mansell¹

Dr Sara Tai¹

Dr Eva de Hullu²

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1 Division of Psychology and Mental Health,

School of Health Sciences, University of Manchester, UK

2 Faculty of Psychology, Open University, the Netherlands

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all rights of this presentation reserved by the authors. Do not distribute.

Recorded lecture

Dr. Warren Mansell presents an introduction to Method of Levels

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Interactive Zoom lecture recorded on October 5th, 2020.

Edited by Eva de Hullu

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Plan

• 1st hour
• Introductions
• The background of Method of Levels
• Why do we need a new talking therapy?
• The basics of Method of Levels
• Control
• 2nd hour
• Conflict
• Reorganisation
• How to do Method of Levels
• Latest evidence
• Q&A 1 hour after 1 hour break.
• Homework before group sessions
• Observation of MOL
• Practice Generating Questions
• Post questions at Discourse forum

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The Background of Method Levels

• Developed from perceptual control theory in the 1950s by Bill Powers
• Became a counselling approach / therapy in 1990s - Tim Carey
• University of Manchester since 2006 - Mansell & Tai
• Widely disseminated to 1000+ professionals internationally
• Practised exclusively by 30-100 professionals internationally
• Sheffield, Nottingham, London; USA, Australia, Netherlands, Canada
• Primary & secondary care mental health; high schools; business; forum theatre - to date
• Extensively researched but no large controlled trials; not in NICE

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A plaster cast does not mend a bone – it provides the environment in which a bone can heal by itself.

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Therapy provides an environment in which patients can get themselves better.

Why do we need a new talking therapy?

• Modest recovery rates from current counselling & therapy
• Time for screening & assessment of severity & diagnosis
• Yet most change occurs in the first session
• Multiple diagnoses & symptoms in one person
• ‘Expert-led’ – clients can feel like ‘a problem to be solved’
• Assume a fixed number of sessions, e.g. 8 weekly sessions. Too few? Too many? Not the right time or pace? High non-attendance rates.
• Therapies are complex, technique-driven & always changing

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The Basics of Method of Levels (MOL)

• The client books their own appointment
• The client talks about the problem of their choice
• The counsellor/therapist tracks what the client is saying and doing closely
• The counsellor/therapist is naturally curious, asking about the problem & the client’s experiences right now
• Otherwise, the counsellor/therapist keeps ‘out of the way’
• Counsellor/therapist has goals but no specific techniques
• Assumes that change happens spontaneously within the client
• Assumes that the client knows when they no longer need MOL

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So how did we get to this point?

So how do we know what helps people who might be struggling ?

• What do you think it is about what the therapist/ supporter does that actually makes the therapy/ support work?
• Why do these things work?
• Why might these things sometimes not work?
• If a therapist/ supporter could only do one of these things every time they gave therapy/ support, which thing should they do?

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Why Might Control be Important?

• Life is control – an uninterrupted process of specifying, creating, and maintaining – a process in which all that is not essential is free to change, preventing change in what is essential. (Bourbon, 1995, p. 151 )
• Making something happen the way you want

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“All psychological distress and emotional difficulties can be understood as the consequence of a person experiencing reduced or loss of control”

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William T. Powers

1973;2005

The Goldilocks Theory of Life

• too hot, too cold, just right
• too few, too many, just right
• too black, too white, just right
• too neat, too messy, just right

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WHY

HOW

WHAT

Relates to specific control processes/ actions/ short term experiences

Relates to individual values/ principles about the self, world and others

Experience being discussed

People use behaviour to make their experiences more as they want…..so things feel

‘just right’

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Think Goldilocks!

WE ARE ALL �CONTROL FREAKS!�

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And that’s not a

bad thing!

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We need to control to survive

What is control and why is it important?

• Homeostasis is control; this is essential for life
• Now: temperature; blood sugar
• Coordination & movement for any activity relies on control

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So how do we understand more about how control works?

Can you tell what a person’s goal is by watching what they do?

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Rubber band exercise….

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It’s all Perception …

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PERCEIVE

COMPARE

ACT

• ‘Behaviour is the control of perception’ (experience)
• We have multiple ‘internal standards’ (or goals) for our current perception (experience)
• Distress is related to loss of control

Reference Value

Conflict

Why being controlled by others is irksome

• Being controlled is doing things that you wouldn’t have done if not for someone else.
• Being told to do by others doesn’t always bother us - “Pass the salt, Honey”

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But……

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• Having to stay late at work to please your boss vs. go home to family.

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Adapted from Carey, T. 2018

Why being controlled by others is irksome

1. You do want to do it, and you do it (passing the salt).
2. You both don’t want to do it and do want to do it at the same time (staying late at work) = CONFLICT
3. You don’t want to do it, and you don’t do it (sweeping out the store).

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Adapted from Carey, T. 2018

Why being controlled by others is irksome

You both don’t want to do it

and do want to do it 

at the same time (staying late at work).

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this is the problematic one

as it puts you in conflict

with yourself.

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Adapted from Carey, T. 2018

Why being controlled by others is irksome

Being in conflict with yourself means you can do something about it…..

• Have awareness of what you want – your goals
• Consider others’ goals and the relevance to you
• Be flexible in your own thinking

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Thinking about control

• ‘Behaviour is the control of perception’ (experience)
• We have lots of just-right states
• Successful functioning involves reducing conflict and balancing one’s goals into a coherent whole

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Some clinical examples

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What goes on when people benefit from talking about a problem?

1. Sustained attention on a problem/ experience
2. External expression of the experience
3. Change in emotional state – connecting with the ‘felt sense’
4. Shift in perspective or point of view to higher-level, evaluative perspectives

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(Carey, Kelly, Mansell & Tai, 2012)

How is conflict resolved? Reorganisation

• Need to take account of both of the goals in conflict
• No predetermined answer
• Must be a trial-and-error process of change that ‘stumbles’ to the right solution. This is reorganisation. Innate process of learning.
• Need to
1. focus reorganisation on the right place
2. keep it focused so that spontaneous changes take place
• Active ingredient of change across all therapies
• MOL attempts to ‘distil’ this process

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If change is reorganisation…

• Solutions will be successful when both sides of the conflict are accommodated
• Solutions will be unpredictable and novel
• Time needed for change (to resolve a conflict) will vary…the first solution might not be the best one
• Sometimes things get worse before getting better
• Change will not be linear
• Logical problem solving might be ineffective
• Advice will be of limited value
• “Resistant” people might be operating from one side of a conflict

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People can get themselves better

• ‘Therapeuticness’ is helping people be exposed to experiences and develop awareness of their own new perspectives of the problem
• Awareness is instrumental to the process
• Necessary to redirect awareness to increase exposure to those parts of the problem that otherwise are attended to only fleetingly….less in awareness

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Two goals of MOL

1. Encourage people to talk ‘freely’ about a problem & pay attention to the experience of the problem as a range of thoughts that pop into awareness

→ Ask questions curiously

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• Look for signs that might indicate that someone has had a thought pop into their head and bring it into their awareness

→ Ask questions curiously

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Carey, Mansell & Tai (2013)

Curious Questioning

Is not about:

• Teaching
• Guiding
• Leading
• Suggesting

But is about:

• Exploring
• Discovering
• Playing
• Learning
• Connecting

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Curious questions

Exploration/ shifting attention and broadening awareness to facilitate new perspectives:

“If this glimmer of hope goes away I will just forget my needs and isolate myself.”

• “How sure are you of that right now?”
• “How does that sound to say that out loud?”
• “How much of the hope would need to go?”
• “What are you thinking of as you are telling me?”
• “How does ‘forgetting your needs’ work for you?”
• “How is it going thinking about this right now?”. �

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Some pointers….

• Focus on what’s happening for the client
• Focus on the process of thinking
• Avoid interpreting...follow the conversation through disruptions
• Don’t guess/ make assumptions
• Refrain from being traditionally empathic …..”how do you experience talking about that?” rather than ”that must be difficult to talk about”
• Avoid giving advice

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Time

• What happens to it over time?
• Has it ever changed for the whole time you’ve been aware of it?
• What makes it change?
• Does it change in a regular, rhythmic, pulsating sort of way or in some other fashion?

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Size

• How big is it?
• Is it always the same size?
• Does it ever get bigger or smaller?
• Can you make it change size?
• Is it still the same size now that we’ve been talking about it?

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Distance

• How close is it?
• How far away is it?
• Can you see it clearly?
• Does it move further away or closer towards you?
• Is there a particular distance where you like it to be?
• Does it feel like it’s inside or outside your head?

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Space

• Whereabouts is it while we’re talking?
• Does it stay in the same place if you turn around or bend down?
• Does it take up the whole space or are there other things there as well?
• What happens when other things come into the same space?
• How does it stay there – is it floating or hanging there by some means?

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Form

• What shape is it?
• Does it have any edges?
• Are the edges clearly defined or blurry or do they sort of just fade out?
• Can you see around behind it?
• Is it three dimensional or more like a drawing on a piece of paper?
• Is the shape constant or does it change?
• Is it a solid and hard shape or is it able to be shaped and moulded?

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Colour

• What colour is it?
• Is it solid or can you see through it?
• Is it a uniform colour or does the colour change?
• Is the colour bright and shiny or more dull?

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Texture

• How would it feel to touch it?
• Is it smooth or spiky?
• Is it the same all over?
• Is it warm or cool?
• What thoughts do you have when you handle it?
• How do you touch it – do you pat it slowly or poke it or something else?

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Weight

• How heavy is it?
• Does its weight ever change – does it feel lighter at different times perhaps?

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Feelings

• Are there particular feelings that go along with it?
• What feelings do you become aware of when you’re thinking about it?
• Is there sometimes more than one feeling?
• Do the feelings stay there constantly – are they always the same intensity?

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Movement

• Does it stay in the one place or move around?
• How does it move – does it have easy, smooth movements or is it more jerky and rapid?
• Does it move in a gradual way or does it jump from one spot to another?
• Can you tell where it’s going to end up once it starts moving?

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“I have been pushing myself so hard this week that I feel I am going to blow my lid and lose it!”

post your MOL question in the chat. Try to vary the questions, ask about different aspects of the quote.

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Feedback from services

“Our techniques and ways of working have changed. We are less ‘mechanical’ in the way we work by focusing on the present moment processes. Now the rapport and engagement we have with our service users is a lot better. The changes they have made have led to a real difference to their lives.”

Dr Phil McEvoy, Manager, Six Degrees Social Enterprise

Six Degrees is a ‘Low Intensity’ IAPT Service that serves a population of 225,000 deals with c.5,000 referrals / year.

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Pragmatic case series of Method of Levels

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Carey, T. A., & Mullan, R. J. (2008). Evaluating the method of levels. Counselling Psychology Quarterly, 21(3), 247-256.

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, 3, 311-324.

Tai, S., Lansbergen, M., Kelly, R., Wade, M.,Mullan, R., Carey, T. A., Sadhnani, V., & Mansell, W. (in prep). A case series of a patient-scheduled, transdiagnostic psychological intervention delivered by novice therapists.

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, 405.

Pilot RCT in Primary Care �

• N=29 (out of 55)
• 17 MOL (up to 8 sessions; M = 5)
• 12 Contact Service with treatment-as-usual (M = 4 sessions of CBT)
• Intention-to-treat analysis
• Significantly greater change in MOL group on anxiety & depression

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Bird, Tai Hamilton & Mansell, in prep

Latest Findings…

• Clients in MOL talk for a larger portion of the session than the therapist compared to other therapies (Macintyre et al., 2019)
• MOL therapists ask 3x as many questions and very little else, unlike other therapies (Macintyre et al., 2019)
• Being in control and talking freely is closely related to helpfulness of MOL (Cocklin et al., 2017)
• Shifts in awareness can be assessed during MOL session (Grzegrzolka & Mansell, 2019; Higginson & Mansell, 2019)
• Asking about disruptions helps the client to explore problem (Cannon et al., 2019) and it shifts awareness upwards (Potempska et al., 2019)
• Clients are more able to talk about conflicts, and allow spontaneous thoughts, after MOL (RoC scale – Bird, Morris; Griffiths; Churchman)

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2012�

2015�

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www.methodoflevels.com.au

�www.pctweb.org

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www.methodoflevels.nl

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