The Genesis of a New Approach to Mental Healthcare: 4Sight

David Straub
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I had been a software engineer and project manager for more than 20 years when I enlisted a psychologist friend of mine to help me with a personal project. A “self-help mental health web site for youth experiencing adversity.” We began in early 2015 deciding exactly what that would be. By early 2017 two things occurred. One was that we decided there was too much risk and liability involved in pursuing the proposed target market. The other was that I created the basis of the 4Sight Behavior Model. It happened like this.

My project partner was responding to my question around how psychological issues were categorized and he started with something like “well, you have your garden variety anxiety and depression issues, and then you have your more involved problems.” The thought then crossed my mind that people with depression inaccurately looked at the past, people with anxiety inaccurately looked at the future, and people with disorders and the like had problems in both areas.

If you’re a creative person like me, you’d understand why the song “Forget Domani” helped influence me. After all, at the core was the concept that there was no such thing as the present. That’s because, by the time our consciousness—or “slow brain” as Daniel Kahneman refers to it—is drawing a conclusion, our fast brain—driven by the physical sensations it creates from its conditioned response—is influencing that conclusion, even if that is via the absence of an appropriate emotion. More on this later.

The next breakthrough came as I tried to determine the source of those inaccuracies. Knowing enough about neuroscience and how our 1.0 brain is in place by age 3 and the importance of attachment per psychology, I surmised that a development issue was at work. So I wondered what were the basic things we learned as a child which lead me to the basis of the four social emotions theory.

We aren’t born with emotions. We are born with feelings. And it is via those feelings that our caregivers teach us about emotions. Of course, each of those definitions are unique, although we are able to group them into categories. The question then became what is the origin of those groups. It was at this point that my analytical bit-influenced mind came up with the notion that, as an infant and then toddler, we need to learn that, at a base level, there are things we should do and things we shouldn’t do. And, for each, we will either succeed or fail when doing them. Finally, to tie it all together, there are the optimal responses our caregivers should return so that we learn these emotions properly, ensuring we do the right thing and don’t do the wrong thing. It was at this point that I realized I had to devise terminology—or, really, to adapt existing phrases—and give them specific meaning. I also had to develop a taxonomy of sorts to tie it all together. To wit…

Our consciousness is composed of two and only two processes. Self-esteem, which is how we look at the past, and Self-confidence, which is how we plan the future. In order for each process to execute accurately, they each have two questions that must be answered which, in turn, correlate with what I refer to as the four social emotions. Accordingly,

For Self-esteem…
Am I good? (self-love) Which correlates with guilt. When one feels bad for doing the wrong thing.
And
Do I have value? (self-affirmation) Which correlates with shame. When one feels bad for not doing the right thing.

For Self-confidence…
Do I have discretion? (self-control) Which correlates with fear. The feeling one experiences when the future is unknown because they don’t know what to do (decide).
And
Will I persevere? (self-soothing) Which correlates with worry. The feeling one experiences when the future is uncertain because one is unsure of how something will turn out.

As for development, we learn these four basic skills in this way:

For self-love, we are cherished for our mere existence.
For self-affirmation, we are allowed to make choices and those choices are celebrated.
For self-control, we are allowed to make mistakes and, when we err, boundaries are set.
And for self-soothing, we are allowed to fail, and when that happens we are taught how to work through it.

There are many other corollaries. For example, self-esteem gives us the desire to act and self-confidence the ability to act. Also, “value” and “discretion” are, at least initially, determined by our relationship to others and “good” and “perseverance” are how we look at ourselves. Ultimately, after we have properly integrated these emotions, these references should all become internalized. And therein lies the problem. The next question was “how do development problems affect these emotions and what is the result as an adult?” That was the last element of the theory.

The thought was the over- or under-parenting, as I referred to it, was responsible for our under- or over-experiencing these emotions as an adult. As a result, our internal moral compass was not providing the accurate support we need to navigate the world according to the golden rule. So if a thought popped into our head or we experienced a situation, our body was not in alignment with what our higher-level reasoning would surmise for a given response. And if we either gave into this misleading emotion or failed to realize an appropriate one was absent, we would engage in undesirable behavior or not engage in the desirable behavior. The development scenarios looked like this…

For self-love/guilt, abuse would cause under-experiencing resulting in anger issues, and neglect would cause over-experiencing resulting in feelings of abandonment.

For self-affirmation/shame, ignoring us causes under-experiencing making us boastful, and criticizing choices would cause over-experiencing making us defensive and submissive even.

For self-control/fear, failing to set boundaries or ignoring them causes under-experiencing making us entitled, and spoiling or controlling causes over-experiencing because we don’t build a “discretion encyclopedia” for making decisions, and therefore panic.

Finally, for self-soothing/worry, ignoring our failure causes under-experiencing making us reckless, and criticizing our failures cause over-experiencing, making us timid.

This chart can help you summarize the full picture:

chart depicting 4Sight model

This may sound simplistic, I understand. However, sometimes the simplest explanation is the best, per Occam’s razor. So I put it to the test. Granted, I am bootstrapping my startup. While I wish I had the funds—and lengthy time—to put the system through an official clinical trial—I did have at my disposal a vehicle. I have always advised people; personal development or life coaching as they may be referred to. In many cases, I would be covering that which is normally done in therapy. However, since I have no real psychology background or related certification, I’m neither going to call it that or diagnose or treat people. Then again, I didn’t need to. I now had the basis for my own system. So I began integrating all this above information with my advice. That’s when it started to click.

A typical discussion would be some innocuous conversation like when you get to know a person better. What they do. How they look at life. Where they were born. Very typical stuff. Then I’d ask them what their challenge was and listen to what they thought was going on. All along I’m collecting something I refer to as “markers.” Basically, that’s a behavior that is suspect and is tied to at least one or more of the under- or over- experiencing emotions traits. After I heard enough to confirm my suspicion, I would then tell them what their childhood must have been like in order for that problem to develop. In 100% of cases, the guess was correct. I took it a step further.

In 2019, a friend was helping me refine my LinkedIn profile to make it more professional. I had “Emotions Expert” on it and he said I had to take it off, there was no such thing. So I did. Then, a couple days later I was like, “No, damn it. I am an expert. And I am going to prove it”. At that moment visions of Lucy from the Peanuts cartoon and her “The doctor is in” booth popped into my head and the rest was history. I built my own version and began bringing it to street fairs during the summer of 2019 in my hometown city of Portland. The response was overwhelming. Better yet, I refined my “analysis” scheme and could both quickly figure out what was going on with a person as well as identify their childhood dysfunction.

At that point, I began to focus on the content itself and how I could apply and scale this knowledge. I still do coaching and the typical scenario is my working with someone who has been stuck in therapy for years or is otherwise unable to make progress on some key issues in their life and, with the 4Sight mentoring from me, within one or two sessions they are able to obtain more improvement than they had in the preceding years. However, for more challenging situations it can take up to five sessions. I set that as the max because, at that point, I have given them all the knowledge they need and it is really up to them to implement that information, preferably with the help of their support system (friends and/or family). To give you a better idea of what I’m talking about, let’s look at two recent people I’ve worked with, L and J. First, a little background.

The improvement process is driven by the CORE system, which is an acronym for Commit, Observe, Reflect and Edit. The first step Commit is somewhat symbolic as it asks the question “do you believe your behavior is accountable to others?” This is essentially what the golden rule suggests. I ask it because, without it, a person is refusing to be responsible for their behavior in which case I will be unable to help them. By the time they come to me, however, they are implicitly agreeing to this concept. They realize there is a problem with their behavior and that it is up to them to do something about it.

An important aside needs to be mentioned here. Before I was talking about over and under experiencing emotions. It should be noted that, for the most part, people who seek help are over-experiencing emotions. The end result is, as expected, a problem for them. People who under-experience the social emotions have behavior issues as well, but those issues are not necessarily a problem for them. Well, as long as no one objects, and that’s part of the dynamic that goes on in society. Those under-experiencing emotions take advantage of those over-experiencing and the latter group doesn’t do anything about it, at least not to the offenders directly, and therein lies the issue. The cycle is enabled. I digress. Let’s get back to CORE.

After Commit is Observe, and that stage has the critical requirement of determining if a person has emotional regulation. After all, if a person can’t control what they feel or, more importantly, are unable to stop it from bleeding into their behavior, improvement will be prohibited. This was the case for L. She would experience conflict—which is the key marker for determining that one or both people in an interaction were behaving in an emotional/irrational manner—and was unable to resolve it. Going back to what I was saying before, the fact that she was over-experiencing emotions and that the other party may very well be under-experiencing them, it was going to be up to her to correct the situation.

At this point, two elements come together to help the individual. In most cases, when a person lacks emotional regulation, they have had a pretty dysfunctional childhood. As a result, they don’t know how to respond. They only know how to react and survive. The first element involves their “mastering the art of not responding.” What I typically do is have them learn a self-soothing routine under optimal circumstances, meaning when all is peaceful. This includes their learning how to get in their body so they can realize when physical sensations are influencing them. Essentially it is a type of mindfulness. However, the goal is to come up with mnemonic devices—a muscle-relaxing routine, visual imagery, memory recall, etc.—to be used under pressure so they are able to think in the heat of the moment

The other element has to do with what is called the 4Sight Model analysis. It’s basically an inventory built around the 4 social emotions theory. The key advantage is that it gives people a key piece of information in understanding their emotional regulation issues. Essentially what is going on is that L is experiencing echoes from her childhood. She is present in a situation that, via her subconscious, is reminding her of a dynamic that was present when she was growing up. As we talk through this I learn that L was routinely harshly criticized by both her mother and older sister. Here’s how this key learning dynamic comes into play.

I tell her that, as a child, she neither knew that what was going on was wrong nor did she have the skills to fix the problem. Now, she has both faculties. However, she isn’t feeling like she does because her body is telling her it is the same. Emotional misalignment. What she needs to do to correct the situation is dispel the myth. She needs to write new stories with a different ending. In effect, add new memories. Over time, her subconscious, which can only operate on conditioned responses, will start to change as it has new memories to reference. When enough of them are present, the momentum of the old conditioned response will be reduced and eventually altered. The great thing is that all this advice makes total sense to her and gives her needed resolve. When she is (incorrectly) feeling threatened in a situation she is now thinking of her sister and mother. She knows that what they “taught” her was wrong and that what these people are doing to her now may very well be wrong as well. Most importantly, she is in her head using her higher-level reasoning to process the dynamic of what is going on. She is observing and no longer reacting.

At this stage L has now caught up to the other person I am going to talk about, J. J was able to quickly understand the emotional regulation concept as well as implement it. She needed to learn the next process in CORE, Reflect.

We don’t have any emotions encyclopedia or laws of behavior. This is essentially what I teach people. I let them know that there are rules. There is behavior that is never appropriate—abuse as it is defined—and there is behavior that is never desirable, selfishness as we specifically call it. When this information is presented to people it makes total sense to them. It is self-evident. This is also the case for what goes on during Reflect. It teaches a person how to implement these rules with the dynamic in which they are challenged.

At the base of Reflect is the question “is this my problem or is this their problem?” Going back again to the over- and under-experiencing emotions concept, there is a key insight to understand. We are never given a specific definition to emotions. We just kind of surmise what they are. In line with that, we tend to not question what they are. This was the case with J. I explained to her that Shame is the negative feeling we experience when we don’t do the right thing. However, in her case, she wasn’t taught what the right thing was. The right thing is that we are all responsible for our own happiness and independence. We are not here to serve others. Sure, we should help them out whenever possible. However, that means taking care of ourselves first and also recognizing that it is our choice to help others, not our responsibility. She was taught the latter which was the conundrum.

To a large extent, J’s mother abdicated her role as caregiver. Her mother also, to J’s detriment, fell into the belief that women were here to serve men. As a result, it became J’s job to not only take care of her mother, but her two brothers as well. This is how catharsis usually happens. I ask J whether or not she thinks she is responsible for them. She says no which is correct. Then I ask her how she feels. What she then figures out is that she is, in effect, experiencing shame without realizing that is what it is. She is feeling bad for not doing what she was incorrectly taught was the thing to do. She is experiencing unwarranted shame.

For J, it only took two sessions with a number of follow-up text messages. In pretty much all of those exchanges, she questioned what she was feeling and just needed confirmation from me that the feelings were misleading her. She was dispelling the myth. In the end, in order to remediate our behavior, we need an arbiter of sorts. That’s what a therapist should do. However, they not only lack the “rules of behavior” reference system, they also include something else that is their downfall. Bias. What I realized I am able to do is to come up with a universal mechanism for judging behavior. It should very well be free of any cultural or socio-economic preferences. The key is not in identifying what is a disorder. It is how do you resolve conflict, which brings up the last step on CORE, Edit.

When we have a problem with someone, there is a very specific method we can use to resolve it. Even if we are wrong in our assessment of whose problem it is, we can end the conflict. We can either decide that it is something that we are going to allow and are, therefore, not able to bring up again, or it has crossed a line and we are going to stop interacting with said person. It stresses personal responsibility above all else and it isolates those who cause the problem. That includes a person who will automatically isolate themselves if they follow the rule and always find others to be at fault. To some extent, it becomes a foolproof process.

I should point out some key differences with the current approach to therapy. Rather than focusing on a disorder, it focuses on the root cause. This is a fundamental difference that enables the person struggling to understand what is going on and manage the process for improvement. Also, because all the nomenclature is original and non-stigmatized, working through issues with your ecosystem—all those with whom you interact on a regular basis—is not only recommended, but it is natural. In fact, to a large extent, I am teaching people how emotions are supposed to work in a group dynamic.

CORE itself is an ACT-like (acceptance and commitment therapy) system, which incorporates influences from many widely-accepted practices, including mindfulness as mentioned, but also DBT and general philosophical approaches like the golden rule. Nonetheless, what separates 4Sight from anything else out there is its 4 social emotions theory and the targeting of the root causes that drive undesirable behavior. What’s more, due to its inherent “open dialogue” approach, it’s really more of an encyclopedia of behavior. We go on to define what abuse is as well as what is selfish behavior, connecting the fact that the latter must be minimized in order to maximize the output of the group per John Nash’s game theory proof. We must do not only what is best for us, but also what is best for the group. A healthy and vibrant society depends upon it. Now we have the reference system to not only know how to do that, but also know how to rear children and remediate adult behavior to get to that all-elusive utopia.

 

For more information, please contact the author at [email protected]

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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