Bridges of Hope Theory & Concepts
		by Peter Labouchere E-mail: peter@bridgesofhope.info Website: www.bridgesofhope.info KEY CONCEPT 1 PROBLEM FOCUS and OUTCOME FOCUS When there is a particular issue to deal with, people can respond in a different ways.  One way is to focus on the problem and ways of stopping, fighting or getting away from the problem (Problem Focus).  This response asks problem focussed questions:             Problem-focussed questions  What is the problem?  Who or what caused it?  Where did it come from?  Why have you got this problem?  What other implications does this problem have?  How can you stop or get away from this problem?  Another way is to identify and focus on what you want and how to get there - how to resolve any issues you have so that you can progress towards achieving your future goals and dreams.  This response asks positive outcome focussed questions:            Outcome-focussed questions  What do you want?  How many different ways are there to get there?  What else will you have when you get there?  What support do you need?  What is the first thing you need to do now?  If you wish to test and experience for yourself the effect of these different types of question, do the following: Think of any issue or problem you are currently facing. Answer the problem focussed questions with regard to this issue. When you have finished, notice how you are feeling. Answer the outcome focussed questions with regard to the same issue. When you have finished, notice how your feelings have changed. The sort of questions we ask ourselves and others can lead to either a problem or outcome focus. These impact differently on the feelings people have about an issue and their motivation to resolve it.  Problem-focused questions often elicit some useful information about the problem, and merely enabling someone to talk about their issue and provide some relief. However, such questions generally leave people feeling de-motivated and still stuck in the problem.  The outcome-focused questions generally produce less analysis and more creativity, resulting in feelings of empowerment and enthusiasm to do something about an issue, and a sense of progress towards resolving it. The problem focused approach to HIV / AIDS has contributed greatly to awareness raising and to the analysis and understanding of the current situation. This is vital to any planning process. The issues surrounding the pandemic are huge and complex and these need to be explored and their realities acknowledged and understood. However, focusing just on the risk, consequences and prevalence of HIV / AIDS often produces a 'Fear Response', which ignores, rationalises, or denies the reality of the problem (see "The Use of 'Fear Appeals' in Public Health Campaigns and in Patient/Provider Encounters", Dr Kim Jayne). In some circumstances this focus may even reinforce a fatalistic belief about the inevitability of HIV infection, with corresponding high risk behaviour. We naturally move towards whatever we focus on most, and how we imagine our future to be. Hence the best way to solve the problem is not to focus on the problem, but on the outcomes that we really want in our individual lives, families, communities and programmes. To effect sustainable change, we must enable people to make their own well-informed choices about what they do, linking these choices to achieving what is really important to them in life (i.e. their own values-based desired future outcomes.) The rationale for these assertions derives from studies of best practice in personal and organisational effectiveness, some basic human neurology, and experiences of applying these ideas in participatory HIV/AIDS training tools in various African countries. In the literature on personal development and personal effectiveness, a strong positive outcome focus consistently emerges a key characteristic of effective people, though phrased in different ways. Stephen Covey's empirically based book 'The 7 habits of highly effective people' identifies 'start with the end in mind' as one of them; Ron Holland's most fundamental prescription for personal achievement is 'Relax and visualise the future as you desire it'. The degree to which communities and organisations have collective commitment to a clear vision and desired outcomes also correlates closely with their success in achieving them. "Behaviour is influenced by visualised images.  A strong image leads to behaviour consistent with the image being held in the mind's eye. It does not matter whether the image is one of reality or something totally imaginary"  (Ronald Shone: Creative Visualisation).  Human neurology offers an understanding of why this is so, most simply explained by relating computing terminology to our incredible bio-computer, the human mind. We each 'program' our mind's information filter, the reticular activating system (RAS) with our self-image, beliefs, values, what we focus on and think about most, and how we imagine our future to be. The RAS then filters and uploads to our conscious mind those elements of our experience which are consistent with and help us realise the mental programs we have set up. Hence it is vital that we program the RAS with what we want, not what we want to avoid. I have emphasised that our outcome focus must be positive; if we have a negative outcome focus, our RAS will act just as effectively to ensure that we achieve this. The danger of a problem-focused approach is that we risk the problem becoming a negative outcome focus. The contrasting responses of people who discover they are living with HIV and AIDS provides one example of how these ideas apply in practice: The problems facing PLWHAs are complex and multi-faceted, and in many ways a problem focussed response is natural. An HIV positive test result can be interpreted as demolishing life dreams, leaving no future, leading variably to depression, ambivalence about re-infection / infecting others, a rapidly depressed immune system and earlier onset of AIDS. Other PLWHAs in apparently similar or worse situations have responded in a way which enables them to live many healthy and fulfilling positive years. What makes the difference? One key factor is the extent to which we are able to establish and focus on what we really value and want to achieve in life, even if we are living wiht HIV. Studies by Neil Orr and others identify a positive outcome focus as one of the defining characteristics of long-term non-progressors (people who have lived with HIV-infection for over 10 years without developing AIDS.)     KEY CONCEPT 2 USE OF SYMBOLS, METAPHOR AND STORY TELLING In many countries, people use proverbs, symbols, metaphors and story telling to put over messages.  The stories we are told and that we tell ourselves help to create our identity and values. Some people find it difficult or embarrassing to talk directly about things like sex.  Stories and symbols can make it easier for people to explore such issues and remember the key messages.  If we also involve people in creating the story, it makes it fun and interesting, and brings out some of the important feelings and emotions that affect how we behave.  Bridges of Hope uses symbols like dangerous water and safe bridges to explore HIV/AIDS issues and understand them in a new way.  "An endangered society is one whose members can no longer change the stories they tell themselves."    Jerome Bruner  in Acts of Meaning (1990) In some high-prevalence countries and communities, where AIDS is having a major impact, many of the stories in circulation are of illness, death and suffering.  While the reality of the situation should be acknowledged, it is important for people in such situations to re-vitalise and create stories for themselves about the possibility of a long and healthy life in which they achieve their dreams and goals.  The Future Islands activity in particular helps people to do this. "You are the storyteller of your own life, and you can create your own legend or not." Isabel Allende KEY CONCEPT 3  PRESENTING THE CHOICES AVAILABLE TO EACH  PERSON Bridges of Hope does not promote any particular response to HIV and AIDS issues.  It is designed to promote awareness of the full range of possibilities and choices available, and build knowledge, skills, values and beliefs that will support a healthy and long life. In the Walking the Bridges activity, the bridges of "Abstinence", "Faithfulness" and "Condom" clearly present the choices available to each person, in a way which allows each person to make their own decision depending on their age, beliefs, character and way of life.    KEY CONCEPT 4 ASSOCIATION AND DISSOCIATION   People often have bad experiences and feelings about HIV/AIDS, (for example of a friend dying of AIDS or the fear of finding out that they themselves have HIV).  It is often easier to talk about these issues in a detached, dissociated way, as though you are watching what is happening from the outside.  The Bridges of Hope Activity 'Using Card Characters to explore relationship issues' provides a way for people to examine, discuss and reflect on the HIV/AIDS issues they may be facing, without having to talk directly about their own personal experiences and feelings. If you give each participant a 'character' which clearly does not represent them personally, it allows them to discuss these issues in a dissociated way.  Their issues and problems are not their personal ones - they belong to the character they are playing.    In the Bridges of Hope Activity 'Your Future Island', participants are invited to vividly imagine their future as they would like it to be, as though they are tehre now, experiencing all the sensations and good feelings of being there.  This activity is most effective when participants become strongly associated with their future as they imagine it.   KEY CONCEPT 5 ANCHORS AND ANCHORING In our minds we naturally create a link between a particular stimulus - something we see, hear, feel, smell or taste - and other things we were experiencing or   thinking about at that time.  Thereafter, whenever we get the same stimulus, it triggers the memories and feelings of the other things we experienced at that time.  This is called an 'anchor' for those memories and feelings. There are anchors linked to all the different senses.  Here are some examples: The smell of a particular perfume can be an anchor for the memories and feelings you had about someone who used to wear that perfume. A piece of music can bring back memories and feelings about someone you once danced with to that music. The same thing can be a positive anchor for one person, but a negative anchor for someone else.  Stepping onto a bus could for one person be a positive anchor for travel and adventure and excitement, but for someone else it could be a negative anchor of fear and worry because it brings back memories and feelings about an accident on a previous bus journey. Here are some anchors we have used in Bridges of Hope: Activity: Future Islands creates and uses some positive anchors which participants can use to help them stay on the bridges and move towards their future island. The island each participant has created can act as a visual anchor.  If they look at it again at some point in the future, it should again trigger the thoughts and feelings they experienced when they first imagined being on their island during this session. In Activity: Walking the Bridges, a specific trigger is created to anchor positive feelings like confidence and strength to succeed at what you want.  Anchors and the anchoring process can also be used by trainers and peer educators to access feelings of calm and confidence when they start a training session.   KEY CONCEPT 6 DIMENSIONS OF INFLUENCE ON BEHAVIOUR (based on the Neurological Levels model developed by Robert Dilts) For behaviour change to take place and be maintained, it must be supported in all the different dimensions (or 'neurological levels' as Dilts calls them), as shown here and illustrated with the example of condom use: Dimension llustrative example: Use of Condoms Environment (Where?) Are condoms that suit you readily available at an affordable price in your area.  Can you get them easily?  e.g. if a young boy or girl wants to buy condoms, but the shopkeeper refuses to sell to them, this is an issue of Environment for the boy or girl, but of Belief/Values for the shopkeeper. Skills (How?) Do you know how to use them properly? Do you have the skills to confidently negotiate condom use with your sexual partner(s)? Beliefs and Values (Why?)       Do you believe that unprotected sex puts you personally at risk of HIV infection? Do you believe that condoms are really effective at reducing this risk? Do you believe that the benefits of using a condom outweigh the costs and disadvantages?   Do you believe that sex can be enjoyable with a condom? Do you value your own life and health, and that of others, to always play safe? Do you believe that a woman or girl has the right to insist on condom use, or to refuse sex if the man does not agree to using a condom? Do you believe that using condoms is sinful? What do you believe other people will say and think of you if you use condoms?  Does this concern you?  How much do you value their opinion? (This is sometimes called subjective norm.) Identity (Who am I?) What is your sense of yourself, your self-image, your mission in life? If a young man thinks of himself as "I am a responsible, caring man", this will support him using a condom.  However if he thinks of himself as "I am a trendy, cool, macho stud" using condoms may conflict with his self-image.   Even if he can get condoms easily (environment), knows how to use them properly (skills) and believes they are effective (beliefs and values), this self-image may prevent him from actually using them.   KEY CONCEPT 7   CHALLENGING AND CHANGING LIMITING BELIEFS It is important to accept responsibility for the choices we have, and develop ways of thinking that help us. Some people have a way of thinking that puts them 'at effect'.  They say things like: 'I have to behave in this way.  I have no choice'; 'I can't do anything about my situation. It is someone else's fault - the government, the school, my parents, my partner etc'; 'It is God's will, so why should I do anything.'  Someone living with HIV might say: 'HIV is destroying my immune system and AIDS will kill me; that is my fate and I can't do anything.'  This way of thinking does not help the person; it can leave them feeling depressed and powerless.  Statements people make that start "I can't", "I have to" and "It is impossible for me to" demonstrate limiting beliefs which leave the speaker no choice or alternative possibilities, and they are therefore disempowering. Other people have a way of thinking that puts them 'at cause.'  They say things like 'I am responsible for my own decisions and behaviour and what happens as a result.'    Someone living with HIV might say: 'There are many things that I can chose to do now to keep my immune system strong so that I can still have a good life that I want.'  This way of thinking empowers people to act and live is a positive way that enables them to achieve more, whatever their circumstances. Here is a way of challenging and changing limiting beliefs and helping people move from being 'at effect' to being 'at cause'.    When someone says "I can't", "I have to" or "It is impossible to" do something, respond with questions like those on the right side of this table.  This helps people to change from thinking they have no choice to realising they do have choices and possibilities for change. Examples of disempowering statements people make which put someone 'at effect' Questions you can ask in response which can lead the speaker to expand their limiting thinking and recognise the choices they have.  As a woman/girl, I have to do what the man/boy says. I cannot do anything. We cannot change our culture. It is impossible for men to abstain for more than a few days. Parents cannot talk to their children about sex. What would happen if you didn't? Who says? What stops you? What would happen if you did? How do you know? Has it ever been different? e.g. Has a man ever managed to abstain for more than a few days? e.g. Have parents ever spoken to their children about sex?   The questions in the right hand column prompt a line of thinking which moves people from a perception that they have no choice to realising that they do in fact have choices and possibilities for change. They are then at cause when: "I have to" becomes "I choose to" and "I cannot" becomes "I choose not to". A typical exchange might go like this: Parent: I cannot talk to my children about sex. Response: What would happen if you did? Parent: I would feel so embarrassed. Response: So you could in fact talk to your children about sex, but you would feel embarrassed doing so. Parent: Yes, I suppose it is possible. This sort of intervention is very quick - as soon the other person recognises and acknowledges that there are other possibilities and that they have some element of choice in the matter, their limiting belief has been dislodged.  This paves the way to explore newly acknowledged choices (from this example, the conversation could then progress to ways of overcoming embarrassment when talking to your children about sex.)  This technique also provides a strategy for challenging gender stereotypes and changing beliefs about gender roles, thereby opening up new choices and possibilities for both women and men.   KEY CONCEPT 8 NLP  (Neuro Linguistic Programming) Some of the concepts introduced above have a foundation in NLP, and the creator and author of Bridges of Hope is himself a qualified Master Practitioner of NLP.  Here are some definitions of NLP: The study of excellence and how to reproduce it.      John Grinder (co founder)   A powerful and practical approach to behaviour change embodied in a set of concepts and techniques based on the study of the structure of subjective experience   NLP is to psychology what engineering is to science Peter Labouchere Neuro - our nervous system, the way we experience our world through the five senses (visual, auditory, kinaesthetic, olfactory and gustatory). Linguistic - the language and non-verbal communication systems through which our neural representations are coded and ordered.  Language is how we give meaning and also how we communicate with others, including our non-verbal and unconscious physiological signals. Programming - borrowed from computer science to denote the way in which our neurological systems have established patterns and sequences of thought and behaviour.  We have the ability to change and install new 'programs' to achieve specific goals and outcomes.   NLP is about: The ability to be your best more often Accessing all resources available to you Modelling human excellence Realising human potential Exploring questions like:  What works? What is the difference that makes the difference? Upgrading the software of the human bio-computer     NLP Pre-suppositions and re-framing NLP pre-suppositions or assumptions are statements which are not necessarily proven to be universally true, but are selected because they are helpful.  For example: A map is not the territory (Korzybski)  Our mental maps are merely how we currently represent our world to ourselves using sequences and combinations of representational systems.  Our mental maps, not reality, dictate how we act in any situation.   There is no fixed meaning to any event - just the meaning we individually attribute to that event.  We can choose to reframe the meaning we attribute to a particular event in a way that is helpful to us. The meaning of a communication is the response that it elicits. Memory and imagination use the same neurological circuits in the brain and potentially have the same impact. The resources we need to make a change are already within us. If one person can do something, others can learn to do it (within physical and environmental limits). There is no failure, only feedback. (Below is an example of someone who applied this pre-supposition.) "There is no failure, only feedback" The inventor of the electric light bulb, Thomas Edison, had tried about 400 different unsuccessful designs when a reporter asked him what it felt like to have failed so many times.  "Failed!?" he retorted, "I have not failed even once.  I have succeeded in proving that those 400 ways do not work, so I must be nearer finding the way that does work."  After another 250 attempts, Edison finally came up with the first successful design of an electric light bulb.