MAGICAL MEDICINE: HOW TO MAKE AN ILLNESS ... - Invest in ME

375
The section beginning on page 49 of the Manual (“Implementation of therapy”) repeats what has appeared
earlier in the Manual (for example: “Because people with CFS/ME are likely to be particularly sensitive to, and
fearful of, a perceived over‐emphasis on psychological factors, a physical model of disease…is emphasised and used
throughout treatment”).
There were to be fourteen treatment sessions, the first of 90 minutes, the rest of 50 minutes, over a period of
five months; the first four sessions were to be weekly and subsequent sessions were to be at two weekly
intervals.
Session 1 is entitled “Information Gathering and Treatment Rationale” and the therapist must ascertain the
participant’s “thoughts as to what caused CFS”. Later in the same session, the therapist must ask: “What do you
think is causing your current difficulties” (but the “APT model” assumes “CFS/ME” is an organic disease, so
what else would be causing the participant’s “current difficulties”, and why describe an organic disease as a
“current difficulty”? This seems to indicate that the authors of the Manual do not actually believe that
ME/CFS is an organic disease).
The next question that the therapist must ask is: “Do you have any specific plans to resolve your current
difficulties?” – would this question be asked of people with multiple sclerosis?
Next, the participant is to be asked: “Have you come here today with any particular… goals….?” (the goal of
people with ME/CFS is to get better and to resume their premorbid life‐style).
Session 2 is entitled: “Review pacing model and individualise to the person with CFS/ME” and the participant
must “Continue self‐monitoring: Activities Must do/Like to do”. It continues: “An example of a patients (AfME
2003, 80) description is: ‘Accepting that recovery will come when you stop trying to be a superwoman….With progress
I have increased the activities undertaken” – this is inconsistent: the participant has been told that APT is not a
cure, but here the participant is being told that recovery will come if she stops trying to be a “superwoman”.
The clear implication is that ME/CFS symptoms are caused by a hectic, exhausting lifestyle and not by an
organic disease.
Session 3 is entitled “Planning how to implement pacing”. An analogy is to be used: “I use the image of a bank
account. I always have to be careful not to use the overdraft. I have to rest when I still have some money in my
account”.
Session 4 is entitled “Equilibrium between activity and symptoms”; quoting AfME 2003, 87, this is said to be:
“Aiming as far as possible to ensure that each day has around same level of activity. It works!” – but the participant
has already been told that the aim of pacing is to assist them to “set realistic goals for increasing their activity”.
Session 5 is entitled “Priorities and Standards of Activity”; participants are to be instructed: “Rest/relaxation
means no TV, reading, conversation, music”. Homework must include “Prioritising what you would need/like to do
and allocating energy to do it”.
Session 6 is entitled “Body Mechanisms and Activity Analysis”; the“rationale for treatment is re‐explained as
necessary”; the therapist must “Introduce Activity Analysis” and must also introduce “Energy Conservation as a
Concept”. Therapists are told that, according to AfME 2003, 253, “A person’s explanation of activity analysis” is
“Pacing means looking at my daily activities and breaking them down into achievable chunks”.
Sessions 7 – 12 are entitled “Review model and treatment aims”.
In session 7, there must be “Activity Analysis, alternating activities & activity modification…pacing means…
trying not to push too hard”.