Using the continuum technique to counteract dichotomous thinking

One of my favorite techniques is the continuum technique used to address dichotomous thinking. This technique consists of helping the client to spell out his or her criteria for the two dichotomous categories in question and then taking specific real-life examples and testing whether they really fall completely in one category or the other. When it turns out that the real world isn't dichotomous, the client is asked to use a 0-10 rating scale instead of dichotomous categories. For example:

"Gary" was an individual who, among other problems, persistently labeled himself as "incompetent" despite his skills and accomplishments. When this was explored in therapy, it became clear that he had strict idiosyncratic standards for competence and viewed competence dichotomously. He and his therapist addressed his dichotomous thinking in the following way:

Therapist - It sounds like a lot of your tension and your spending so much time double-checking your work is because you see yourself as basically incompetent and think "I've got to be careful or I'll really screw up."

Gary - Sure. But it's not just screwing up something little, someone's life could depend on what I do.

Therapist - Hmm. We've talked your competence in terms of how you were evaluated while you were in training and how well you've done since then without making much headway. It occurs to me that I'm not sure exactly what "competence" means for you. What does it take for somebody to really qualify as competent? For example, if a Martian came down knowing nothing of humans and he wanted to know how to tell who was truly competent, what would you tell him to look for?

Gary - It's someone who does a good job at whatever he's doing.

Therapist - Does it matter what the person is doing? If someone does well at something easy, do they qualify as competent in your eyes?

Gary - No, to really be competent they can't be doing something easy.

Therapist - So it sounds like they've got to be doing something hard and getting good results to qualify as competent.

Gary - Yeah.

Therapist - Is that all there is to it? You've been doing something hard and doing well at it, but you don't feel competent.

Gary - But I'm tense all the time and I worry about work.

Therapist - Are you saying that a truly competent person isn't tense and doesn't worry?

Gary - Yeah. They're confident. They relax while they're doing it and they don't worry about it afterward.

Therapist - So a competent person is someone who takes on difficult tasks and does them well, is relaxed while he's doing them, and doesn't worry about it afterwards. Does that cover it or is there more to competence?

Gary - Well, he doesn't have to be perfect as long as he catches his mistakes and knows his limits.

Therapist - What I've gotten down so far [the therapist has been taking notes] is that a truly competent person is doing hard tasks well and getting good results, he's relaxed while he does this and doesn't worry about it afterward, he catches any mistakes he makes and corrects them, and he knows his limits. Does that capture what you have in mind when you use the word competent?

Gary - Yeah, I guess it does.

Therapist - From the way you've talked before, I've gotten the impression that you see competence as pretty black and white, either you're competent or you aren't.

Gary - Of course. That's the way it is.

Therapist - What would be a good label for the people who aren't competent? Does incompetent capture it?

Gary - Yeah, that's fine.

Therapist - What would characterize incompetent people? What would you look for to spot them?

Gary - They screw everything up. They don't do things right. They don't even care whether it's right or how they look or feel. You can't expect results from them.

Therapist - Does that cover it?

Gary - Yeah, I think so.

Therapist - Well, let's look at how you measure up to these standards. One characteristic of an incompetent person is that he screws everything up. Do you screw everything up?

Gary - Well, no. Most things I do come out OK but I'm real tense while I do them.

Therapist - And you said that an incompetent person doesn't care whether it comes out right or how they look to others, so your being tense and worrying doesn't fit with the idea that you're incompetent. If you don't qualify as incompetent, does that mean that you're completely competent?

Gary - I don't feel competent.

Therapist - And by these standards you aren't. You do well with a difficult job and you've been successful at catching the mistakes you do make, but you aren't relaxed and you do worry. By these standards you don't qualify as completely incompetent or totally competent. How does that fit with the idea that a person's either competent or incompetent?

Gary - I guess maybe it's not just one or the other.

Therapist - While you were describing how you saw competence and incompetence I wrote the criteria here in my notes. Suppose we draw a scale from zero to ten here where zero is absolutely, completely incompetent and ten is completely competent, all the time. How would you rate your competence in grad school?

Gary - At first I was going to say three but, as I think about it, I'd say a seven or eight except for my writing, and I've never worked at that until now.

Therapist - How would you rate your competence on the job?

Gary - I guess it would be an eight or nine in terms of results, but I'm not relaxed, that would be about a three. I do a good job of catching my mistakes as long as I'm not worrying too much, so that would be an eight, and I'd say a nine or ten on knowing my limits.

Therapist - How would you rate your skiing?

Gary - That would be a six but it doesn't matter, I just do it for fun.

Therapist - So I hear several important points. First, when you think it over, competence turns out not to be all or nothing. Someone who's not perfect isn't necessarily incompetent. Second, the characteristics you see as being signs of competence don't necessarily hang together real well. You rate an eight or nine in terms of the quality of your work but a three in being relaxed and not worrying. Finally, there are times, such as when you're at work, when being competent is very important to you and other times, like skiing, when its not very important.

Gary - Yeah, I guess I don't have to be at my peak all the time.

Therapist - What do you think of this idea that if a person's competent they'll be relaxed and if they're tense that means they're not competent?

Gary - I don't know.

Therapist - It certainly seems that if a person's sure they can handle the situation they're likely to be less tense about it. But I don't know about the flip side, the idea that if you're tense, that proves you're incompetent. When you're tense and worried does that make it easier for you to do well or harder for you to do well?

Gary - It makes it a lot harder for me to do well. I have trouble concentrating and keep forgetting things.

Therapist - So if someone does well despite being tense and worried, they're overcoming an obstacle.

Gary - Yeah, they are.

Therapist - Some people would argue that doing well despite having to overcome obstacles shows greater capabilities than doing well when things are easy. What do you think of that idea?

Gary - It makes sense to me.

Therapist - Now, you've been doing a good job at work despite being real tense and worried. Up to this point you've been taking your tenseness as proof that you're really incompetent and have just been getting by because you're real careful. This other way of looking at it would say that being able to do well despite being anxious shows that you really are competent, not that you're incompetent. Which do you think is closer to the truth?

Gary - I guess maybe I'm pretty capable after all, but I still hate being so tense.

Therapist - Of course, and we'll keep working on that, but the key point is that being tense doesn't necessarily mean you're incompetent. Now, another place where you feel tense and think you're incompetent is in social situations. Let's see if you're as incompetent as you feel there.....

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