Witnessing the Unfolding of a Creative Technique in Psychotherapy:
from Breakdowns to Breakthroughs
By Mutaal Mooquin
A few decades from now, no book about psychotherapy techniques will be complete without including information about Green Zone Living, a technique conceived and developed by Dr. Khalid Sohail at his clinic in Whitby, Ontario. I knew Dr. Khalid Sohail only as a poet, writer, and humanist activist until I attended a seminar conducted by him and his colleague Bette Davis about Green Zone Living. To be green these days stamps one as an environmentalist. I am an active environmentalist—in my professional work as well as in my extracurricular activities. So, reading the e-mail about a seminar on Green Zone Living did not go unnoticed by me. After advocating for so many years green living in our energy use, our waste handling, and our water conservation, an idea about green living in ‘mind space’ was irresistible.
The information delivered at the seminar and gathered by a brief discussion, a video and a book did not satisfy my curiosity. So, I decided to explore further and asked Dr. Khalid Sohail and Bette Davis for an interview. They gracefully agreed. I wrote this article in order to make the information I gathered easy accessible and to provide an overview of concept and methodology. The idea of Green Zone Living stems from a sincere desire to help people in a dignified way with their emotional and psychological problems and to improve their quality of life. It helps by providing the tools and techniques to apply in day to day life to prevent mental health problems down the road.
Green Zone Living is a creative and unique application of cognitive behavioral therapy (CBT). Though in its entirety it is not limited to cognitive therapy its emphasis appears to be in that direction. CBT believes that the way we think determines the way we feel. Typically, CBT identifies debilitating or inaccurate emotions and thoughts in order to influence these behaviors by replacing negative with positive patterns. CBT is widely accepted as an empirical and cost-effective form of psychotherapy. According to A Guide to Understanding Cognitive and Behavioural Psychotherapies, “It can be used with groups of people as well as individuals, and the techniques are also commonly adapted for self-help manuals and, increasingly, for self-help software packages.”
The point of departure to understanding the uniqueness of Green Zone Living (from now on abbreviated as GZL) is to differentiate it from a typical CBT to which it belongs in a general way. It is the way GZL engages the participant and therapist in a humanistic interaction and the way it focuses on prevention rather than on diagnosis. There are two aspects of this differentiation from CBT: one of technique, the other of underlying principles.
In terms of technique, Dr. Sohail identifies three features. The first one is the way GZL engages the participants in creating self-awareness in their day-to-day life. The technique provides easy tools for that purpose. The basic tool is the concept of being in a green, yellow or red zone, a symbol taken from our traffic lights. “People are in the Green Zone when they feel relaxed and peaceful and are enjoying their lives. They are in the Yellow Zone when they are a little upset, frustrated or sad, and they are in their Red Zone when they get so angry, distressed and depressed that they start thinking and behaving irrationally.” This categorization process helps a person to efficiently recognize his or her state of mind and therefore stop when on a negative course, like one stops for a red signal light.
The second feature is the component of education. In GZL, the therapist does not treat the person as a passive patient but as an active partner in learning more about their unique situation. The participants (please note that I am not using the word ‘patient’ as the GZL approaches the ‘patient’ as a participant in self-education) are encouraged to learn and train themselves with or without the help of the therapists to apply the concepts of GZL in their daily lives and to cope with negative situations.
The third distinctive component is the use of writing as a therapeutic tool. With the help of therapists, a structured journal writing technique develops over time in many cases. But typically, the technique is explored to fit individual cases sometimes limited to journal writing. The writing may be shared between participant and therapists or it may remain private. Moreover, writing is not limited to journal writing. It also includes writing letters between therapist and participants or among the participants in case of family or group situation. As writing requires an active approach, practicing it reinforces the concept of cooperative participation by all instead of an approach of passive patient-doctor relationship.
Reflecting on distinct features of this approach, Dr. Sohail expressed the notion that it is not personal but a “humanistic” interact; between two individuals here and now, going to past only as a last resort, as medication is prescribed only as a last resort. He says, “My focus is not just on one clinical condition, I want to focus on participant’s personality and improve their quality of life. …Green Zone Philosophy is health and growth oriented rather than illness oriented like traditional medicine and psychiatry.”
According to Dr. Sohail, the technique evolved by applying the principles first to himself, then sharing it with friends and family and, finally, bringing it to the clinical practice. This process involved writing four books, making two videos and a website (www.greenzoneliving.ca) and conducting a seminar to introduce it to the public at large.
Before I introduce the distinct features of the underlying principles, I would like to cite an extract from a letter by Dr. Sohail. This will give the reader a glimpse of the man behind this innovative work. “When I was a teenager living in Peshawar, Pakistan, I used to visit all the libraries in town and read books in the literature, religion, philosophy and psychology sections. During those days I used to read Urdu books. One evening I found a 1000-page book on Freud and psychoanalysis. It was so fascinating that I fell in love with the mysteries of the human mind and decided that I will pursue my future unraveling those mysteries and serving people who suffer from emotional problems and mental illness. It is my professional attempt to transform breakdowns into breakthroughs. I believe in life long learning. I am far more transparent with my patients than most therapists I know. I tell my patients that I learn as much from them as they learn from me. I thank them for trusting me and sharing their life stories.”
Let us now explore the underlying principles. Unique in psychotherapy practice, GZL incorporates the principles of diverse schools of thought in a flexible manner. The most prevalent schools are: Intra-psychic principles of Psychoanalysis, principles of Intrapersonal school of Harry Stack Sullivan, Humanistic principles of Third Force or Humanistic psychology; principles of Murray Bowen’s Family System Theory, Sartreian existential approach and Victor Frankl’s Logo-therapy. However, clearly, work on the ‘floor’ and its application in the clinic and in self-help superseded the conceptual or research work in a laboratory.
Any account of threads woven into the organic whole of GZL must start with Psychoanalysis founded by Sigmund Freud. Dr. Sohail becomes very animated when talking about Freud and his ideas. One can spend hours listening him talk about it. His passion stems from the fact that Freud so ably used scientific approach in unraveling the mysteries of mind—discovering and formulating the workings of the ‘subconscious’—
the great iceberg whose tiny tip is the ‘conscious’. “I was most intrigued by the defense mechanism of Rationalization stating that many human behaviours are inspired by unconscious motives but later on, our mind creates a rational explanation for irrational acts.”
But since Psychoanalysis can be a lengthy process, according to Dr. Sohail, he studied and incorporated techniques of Peter Sifneos and Habib Davanloo who developed Short Term Dynamic Psychotherapy. This treatment approach accomplishes in a few months what takes classical psychoanalysis years. In addition, psychoanalysis has its limitation and can be helpful only in certain situations. That is where the inter-personal approach of Harry Stack Sullivan opens up the other vistas. Sullivan considered anxiety a result of conflicted interpersonal relationships and low self esteem. His ideas of “Good me, Bad Me and Not Me” are at the core of the Sullivanian approach. “Receiving positive feedback fosters positive attitudes and so is the reverse. Bad becomes so big that it breaks down the self generating disintegration of personality.”
The next expansion to the GZL approach was the adaptation of Murray Bowen Systems Theory to Family Therapy. According to this approach the “basic unit of human relationship is a triangle.” Dr. Sohail says, “After discovering the concept of triangulation I realized why in some situations of marital therapy I was not successful because one spouse perceived me as siding with the other spouse and both of us ganging up on her/him. When I feel that one spouse is having difficulties trusting me, I invite my co-therapist Bette Davis to balance the triangulation.”
Through this evolution of a “wholistic” approach, the incorporation of Victor Frank’s Logotherapy, Abrahm Maslow’s humanism and Eric Fomm’s integration of a cultural approach were a natural progression. Frankl’s logotherapy is based on the idea that human sufferings become more bearable if they find a meaning in a person’s life, while Maslow focused more on “healthy people especially those who had reached the heights of their personal, professional and creative growth … the self-actualized people.” Eric Fromm’s approach incorporates the effects of cultures on human development. His ideas were of great significance for Dr. Sohail to understand trans-cultural conflicts to which immigrants are subjected.
The account of GZL cannot be complete without describing the influence of Albert Ellis who “is generally considered to be one of the originators of the cognitive revolutionary paradigm shift in psychotherapy and the founder of cognitive behavioral therapies” According to Dr. Sohail, “Bette Davis has a keen interest in that philosophy and I have learnt a lot about Rational Emotive Therapy from her. Being a co-therapist she has been a great asset to our clinic. She has also helped me in creating books and producing videos on Green Zone.”
This brought our conversation towards the working of the clinic itself. “After working in psychiatric hospitals for two decades I decided to start my Creative Psychotherapy Clinic in 1995 with the help of Anne Aguirre Henderson to develop my own model. Green Zone Therapy has been a gradual evolution of my philosophy and practice. Alongside learning from all these philosophers I have added my own flavour to the practice.”
Here is a brief summary of the seven steps that according to GZL can lead to a healthy, happy and peaceful lifestyle.
Step 1. Become aware of your Three Zones of living: Green, Yellow and Red. The visual metaphor of traffic lights provides an easy anchor point to categorize and work upon your emotional states. These are tools to facilitate awareness of self communication with others.
Steps 2 – 4: The Three Rs: Recognize the changes in emotional zones; recover from Yellow and Red Zones; and restrain from going back to Yellow and Red Zones. These steps “help people learn not to react to other people’s Yellow and Red Zones. In this way people identify their triggers and then they find healthy ways to deal with them.”
Step 5: Create Green Zone Relationships. In some cases you may need finding “a mediator that can be a friend, relative, minister or a therapist to bring back your relationship into your Green Zone.
Step 6: Create Green Zone Social Environment. This includes creating healthy environment in your family, schools, job, business or social organizations. This may involve developing an Emotional Raincoat (group of like-minded people) to cope with Red Zone toxicity until you find healthier alternatives.
Step 7: Create Green Zone Life Style. Discover your special gift by starting with a daily Green Zone Hour. Get in touch with your Natural Self and do things you like to, want to and love to do. Examples are hobbies for which you feel passionate; volunteer work to contribute to the community.
These steps may appear plain and straightforward. In application, they grow rich in content and sophisticated in form. They are no less than guide posts on the long trail of self-discovery. The hallmark of this approach is the attitude displayed towards the people with emotional problems. This approach is reflected in Dr. Sohail’s positive words showing respect towards others and a conviction in the power of self healing, “What is important is to see the human being behind the suffering. It is important to shift the focus from “what is wrong with you” to “how great the potential you have”. Quoting once again Dr. Sohail, the founder of GZL, “… In every person there is a centre and at the core of this centre is the green zone. There is this healthy part within every self; the green zone of a person. [Unfortunately] that green zone is often pushed away by the yellow and red of the social environment. … Often it can be recovered and reclaimed by a person’s own activism using the principles of Green Zone Living, sometime with and sometime without outside help.”