The distinction between content and process is one that many people talk about, but very few pause to think about in any detail. When we communicate with a client, we can use a process intervention or a content intervention, or a single intervention could include both. Each kind of intervention can be useful (or not useful) but they are different, and it is useful to know which kind of intervention you are doing so that you can anticipate the kind of response you are likely to get.

The most important difference is that a process intervention invites the client to think of the same content using a different process, without the therapist introducing any additional content. This is completely respectful of the client’s world, so you don’t need to know anything about that world in order to offer them new choices. It is very simple and elegant, and it is very difficult to impose your opinions, values, etc. A process intervention is also typically very rapid.

In contrast, a content intervention introduces specific content as a way to change the client’s response to what they experience. That can also be very useful, and it may be exactly what they need. But since it introduces content from your world into theirs, it risks imposing your opinions and values on the client, and sometimes those may not fit well into their world.

Let’s start with some ridiculously simple examples of the content/process distinction, and then move on to others that are more interesting and relevant to therapy. If you have a cup of coffee, the coffee is the content, and the cup is the process, which in this case is a “container,” it keeps the content in a particular place and shape. A different container, such as a jar with a tight lid would supply a different kind of process to the same content. The cup of coffee can be tipped over and spilled (a different process), while the jar with a lid would continue to contain the coffee if it were tipped over. If you change the liquid from coffee to tea, or soda, or dandelions, that would change the content, but the process would be the same.

Sensory Modalities When we are aware of an event in real time, we can be aware of it in any one or more of the five different sensory modalities (visual, auditory, kinesthetic, taste and smell). Each of these modalities is a distinct process, and since each is sensitive to different aspects of a given event, each will carry significantly different content information about the same event.

One of the simplest interventions is to ask a client to attend to one or more sensory modalities that they are not attending to, in order to expand the scope of their experience of an event, or a memory of an event. “When you look at that image, what are the sounds that accompany it?” or “What is the sound of that event?” is a pure process intervention. The client supplies any change in the content (the particular sounds that they hear).

In contrast, “That probably sounds awful, like a screen door slamming,” or “Can you hear that conversation in your head as if it were a pleasant babbling brook?” introduces content on two different logical levels simultaneously—on the sensory level, a particular sound (screen door slamming, or babbling brook) and also at a higher level, an evaluation and categorization of the sound—that it is “awful” or “pleasant.”

If our representation of an event omits any of the sensory modalities, we will have less information than if we had input from all five modalities. Our evaluation of an event is in response to the information received; when this information is only partial, we may have a very different response than if we had full information (and vice versa).

For instance, a visual image of a food might look very attractive, but if we add in the actual taste of it, and/or how it would feel in our stomach if we ate it, the same food might become much less attractive to us. A Playboy magazine centerfold may look fantastic; but if you add in a whiny voice with many demands, or the smell resulting from not taking a bath for a week, it’s probably not nearly as appealing. Sometimes the reverse will be true; the visual image might be unattractive, but if the taste and feel are added in, it might become quite alluring. The same is true of any event that is recalled in memory, or any representation of a forecast of a future event.

Submodalities Within each sensory modality there are smaller process aspects or subdivisions within each modality—each of which is represented in the brain as a separate neurological processing mode. For instance, in the visual modality, an image can be large or small, close or distant, bright or dim, black and white or color, panoramic or framed, etc. In the auditory modality, a sound can be loud or soft, near or far, high or low, fast or slow tempo, melodic or staccato, etc. In the tactile kinesthetic system, a sensory feeling can be felt in any part of the body, both from touch sensors in the skin and internal sensing of position, tension, etc. The feeling can vary in intensity, extent, pressure, rough or smooth, hot, warm, cold, etc. Just as each of the five sensory modalities is a different process, each submodality is also a somewhat different way of processing the same content, and each will include or omit some information.

Perspective In the visual modality, the position from which an image is seen is a very important process variable. Seeing an event from out of your own eyes will always be different from seeing the same event as if we were looking out of someone else’s eyes, or out of the eyes of a disinterested observer, or from any other particular location in space. The ability to choose to take a different perspective is the basis for a wide variety of human skills and abilities, including being “objective,” empathizing with someone else, knowing clearly what I want in a given situation, etc.

Although a process change in perspective provides different content, that content emerges completely out of the client’s experience; the only thing the client is asked to change is the process. Being able to shift perspective is a major skill that enables flexibility and choice in responding to a situation with wisdom and balance. When the different perceptual positions are “aligned,” the usefulness of these different positions is enhanced immeasurably, because the different sensory elements are sorted and arranged for greatest clarity.

Phobia In a simple phobia, the content is what the person is afraid of: spiders, mice, water, heights—even stuffed olives, which is my all-time favorite. Mainstream psychology has classified phobias by content—arachnophobia, musophobia, aquaphobia, acrophobia—but they haven’t yet gotten around to giving a Greek or Latin name to an intense fear of stuffed olives. Most psychotherapies attempt to resolve a phobia by focusing on the content, its history, its symbolic meaning, its development over time, or its place in the dynamics of a family system, etc.

However, what is important in a phobia is not the content, or the past events that caused it, or the current context, etc. What is important is the process in the present. Someone with a phobia responds to an external stimulus by recalling an unpleasant traumatic memory. This process is not a problem in itself; we all sometimes respond to external stimuli in this way. What is important is that someone with a phobia remembers it by being back inside it, as if it were happening again in the present. As a result, they have all the same horrible feelings that they had in the original experience, often with the same intensity.

The phobia cure changes the process that the client uses to recall the memory, so that they are outside the experience, as if watching it on a movie screen. Now it is as if they are watching someone else go through the experience, so they have the feelings of an observer instead of those of a participant. That is a very different feeling in response to the exact same content. Instead of the fear, shock, etc. that they felt in the original traumatic event, now they can have feelings of compassion, or sadness, being glad that it is happening to that other person, or whatever other feelings they would have if they watched someone else go through that horrible experience in real life.

The same process can be used for any disturbing traumatic memory, from mild unpleasantness up to and including PTSD flashbacks. Some people use this process spontaneously; despite undergoing truly horrible experiences, they never experience PTSD symptoms. A few years ago I heard a radio interview with a woman who was arrested in Bahrain for treating injured political protestors during the “Arab Spring.” She was repeatedly severely beaten and raped for many weeks by many men—certainly a “history” that most therapists would consider adequate to cause PTSD. But in describing her memory of those experiences, she said calmly, “When I think of those events, it’s like they happened to someone else.”

Since the process is what is important, a therapist using the phobia cure doesn’t need to know anything at all about the content of the phobia to resolve it. The the therapist doesn’t have to explore the content, probe the symbolic meaning, history, development over time, or its impact on the family system, etc. And the client doesn’t have to reveal any of the sensitive or shameful details of what happened, so it is much simpler and less unpleasant for them. The therapist only needs to know that the client has a very rapid unpleasant response to a memory or cue. Since the same procedure can be used for any content, this greatly simplifies the therapist’s task.

Sometimes the cue that triggers a phobic response is something that is not actually dangerous, but only what the client happened to be aware of at the moment of peak arousal in the original traumatic event. I don’t think that anyone has ever been attacked or harmed by a stuffed olive, but if the client was looking at a stuffed olive at a moment of the intense fear, it may become the trigger for it. A client who had a phobia of not seeing her feet happened to be looking down at her feet in shallow muddy water at the moment of peak terror after falling off a boat. These and other examples clearly indicate that the content is really irrelevant to the phobia; it just happens to have been the stimulus that got associated with the emotion, and became a trigger for it.

This focus on process rather than content is a revolutionary paradigm shift that was offered to the field of psychotherapy over 35 years ago, in the book Frogs into Princes. Most therapists spend a great deal of time “working through” clients’ unpleasant past experiences, and usually that involves some form of re-experiencing, “prolonged exposure” or “emotional expression.” Given that someone with a phobia has probably re-experienced it intensely hundreds or thousands of times already, it seems unlikely that simply doing the same thing a few more times in therapy would be useful.

The shift of attention from content to process was a shift that many therapists found very difficult to accept. My wife Connirae once demonstrated the phobia resolution process to a group of therapists with a woman who had a phobia of heights. Before doing the process, the woman was trembling and sweating when she put one foot on the second rung of the ladder, and couldn’t go higher. After doing the process, she climbed to the top of the ladder, cheerful and relaxed. A psychiatrist who had observed the entire process spoke up and said, “Excuse me, you’re a nice lady, but you just can’t do that.” One might think that therapists would be happy to learn a quick and effective way of working in this way. Unfortunately, it is has been largely ignored by mainstream psychotherapy, and most therapists are unaware of it.

Resolving Grief The process in grief is the exact opposite of a phobia in two ways. Someone with a phobic response is stepping back inside a negative experience; someone who is grieving is stepping outside of a very positive one, feeling only emptiness and longing for the lost good feelings. Accordingly, the process for resolving grief is the exact opposite of the process used for a phobia, namely stepping back into the treasured experience to recover the good feelings that they had with that person, a pure process intervention. Many therapists think about “grief work” as “learning to say goodbye” but this is exactly backwards—they really need to say “hello” again and reengage with the good feelings they are presently separated from.

Many grieving clients remember the fight, accident, or death that ended a relationship, rather than an event that represents the good experiences that they enjoyed. However, the ending of the relationship is not what they miss and yearn for. When this is the case, it is crucially important to change this content to a representation of what was positive about the relationship, because this is what the person misses and longs for. This is a content change that must be done before doing the process intervention, because stepping back into a fight, accident, or death scene is neither pleasant nor useful. In a recent conference workshop I asked for someone who experienced grief, in order to demonstrate the grief resolution process. The first two people who volunteered were troubled by remembering the end of the relationship. As soon as I asked them to change the content to a special moment, they no longer experienced grief. In the grief process there are both content and process interventions, and both are useful.

Decisions Making a decision has both a content and a process. The content might be whether or not to marry, or buy a car, or eat another cookie, or any of the many thousand of decisions that we make every day. The process that we use is the series of mental events that we use to think of options, evaluate options for their desirability, and finally choose between them. Typically, each of us has one basic decision process, no matter what the content of the decision is, though there will always be small variations to adapt to the content. For instance, a decision about music will usually require an auditory evaluation step, while a decision about food will usually require a taste evaluation step, a decision about a shirt might require both a visual evaluation of how it looks, and a kinesthetic evaluation of how it feels on your body.

Some people have a decision process that works very well, while others have a process that doesn’t work well at all, or only works well in certain contexts. Since this is a more complex process than a phobia, there are more opportunities for processing errors. For example, a person may not have a way to think of additional options, or they may represent options only in one major modality (visual, auditory, or kinesthetic) rather than all three, omitting vitally important information. They may think of an option as a still picture rather than as a movie, again omitting important information that is only available in a movie that extends into the future. They may use only one (or a few) criteria in evaluating options, or they may oscillate between different criteria. They may try to decide among many options at once, rather than taking only two options at a time, and discarding the less desirable one. If the decision process is faulty, the resulting decisions will be unsatisfying, irrespective of the content, even if many desirable options are available. (For more detail on decisions, see chapter 16 of Heart of the Mind.)

Communication When we communicate, we usually attend to the message that we want to send—the words that are primary in conveying the content. The process that we use to communicate the content is everything else—the volume, tone, tempo, hesitations, melody of the voice, and the visual information offered by the posture, facial expressions, tilt of the head, proximity, body tension, hand gestures and movements, the clothes we are wearing, the larger context—and all the ways in which these separate aspects are linked together into repeating patterns.

That “everything else” is a huge amount of information that far exceeds our limitation of 7 +/- 2 “chunks” of conscious attention that George Miller identified over a half century ago. If most of our attention is focused on the content—and often also on the other person’s response to it, we have only a tiny bit left to notice a few aspects of that “everything else” that is going on. Accordingly, most of this process information is not conscious most of the time (though it can become conscious with a shift of attention). This “everything else” of the process may convey far more important information—particularly about the relationship between you and the other person—than the content being expressed.

The tricky part The distinction between process and content is not fixed, but is dependent on what is attended to, and the context. A process can become the content of another process. For instance, if you pay attention to voice tone, or any other process, then what had been process becomes the content, and the process becomes something we might call “observing,” or “noticing,” or “evaluating.”

A world event is a content that is processed by our sensory modalities and submodalities to yield what we call our experience of the event. Then that experience becomes the content that is processed by language to become a verbal communication. That communication can then become the content that is processed by linguistics (words, grammar, syntax, etc.)

In this article, both “process” and “content” have become the content of a process that might be called “describing” or “understanding.”

Exploring the shifting dance between process and content requires some mental gymnastics that few of us can do easily; if you think you understand this clearly, then you probably don’t.

Hopefully this short article can begin to sensitize you to some of the differences between content and process, the beginning of an interesting and very useful exploration that can often make sense of what otherwise be very puzzling and confusing. For further reading about this, read my book, Six Blind Elephants.