direct, experiential grasp of these matters, as opposed to a mere intellectual comprehension or analysis. mr. banks suggests that his philosophy is best understood not intellectually but by "listening for a positive feeling;" and a grasp of hr is said to come through a series of "insights," that is, shifts in experiential understanding. teaching of health realization health realization ("hr"), like sydney banks's philosophy, is deliberately not taught as a set of "techniques" but as an experiential "understanding" that goes beyond a simple transfer of information. there are no steps, no uniformly appropriate internal attitudes, and no techniques within it. the "health of the helper" is considered crucial; that is, trainers or counselors ideally will "live in the understanding that allows them to enjoy life," and thereby continuously model their understanding of hr by staying calm and relaxed, not taking things personally, assuming the potential in others, displaying common sense, and listening respectfully to all. facilitators ideally teach in the moment, from "what they know" (e.g. their own experience), trusting that they will find the right words to say and the right approach to use in the immediate situation to stimulate the students' understanding of the "three principles". rapport with students and a positive mood in the session or class are more important than the specific content of the facilitator's presentation. evaluations of health realization a 2007 peer-reviewed article evaluating the effectiveness of hr suggests that the results of residential substance abuse treatment structured around the teaching of hr are equivalent to those of treatment structured around 12-step programs. the authors note that "these results are consistent with the general findings in the substance abuse literature, which suggests that treatment generally yields benefits, irrespective of approach." a small peer-reviewed study in preparation for a planned larger study evaluated the teaching of hr/innate health via a one-and-a-half-day seminar, as a stress- and anxiety-reduction intervention for hiv-positive patients. all but one of the eight volunteer participants in the study showed improved scores on the brief symptom inventory after the seminar, and those participants who scored in the "psychiatric outpatient" range at the beginning of the seminar all showed improvement that was sustained upon follow-up one month later. the study's authors concluded that "the hr/ih psychoeducational approach deserves further study as a brief intervention for stress-reduction in hiv-positive patients." a 2007 pilot study funded by the national institutes of health evaluated hr in lowering stress among somali and oromo refugee women who had experienced violence and torture in their homelands, but for whom western-style psychotherapeutic treatment of trauma was not culturally appropriate. the pilot study showed that "the use of hr with refugee trauma survivors was feasible, culturally acceptable, and relevant to the participants." in a post-intervention focus group, "many women reported using new strategies to calm down, quiet their minds and make healthier decisions." co-investigator cheryl robertson, assistant professor in the school of nursing at the university of minnesota, was quoted as saying, "this is a promising intervention that doesn't involve the use of highly trained personnel. and it can be done in the community." the visitacion valley community resiliency project (vvcrp) was reviewed by an independent evaluator hired by the pottruck foundation. her final report notes that "early program evaluation...found that the vvcrp was successful in reducing individuals’ feelings of depression and isolation, and increasing their sense of happiness and self-control. the cumulative evaluation research conducted on the vvcrp and the hr model in general concludes that hr is a powerful tool for changing individuals’ beliefs and behaviors." in the summary of case studies, the report goes on to state, "the vvcrp was effective over a period of five years of sustained involvement in two major neighborhood institutions...at influencing not just individuals, but also organizational policies, practices, and culture. this level of organizational influence is impressive when the relatively modest level of vvcrp staff time and resources invested into making these changes is taken into account. the pivotal levers of change at each organization were individual leaders who were moved by the hr principles to make major changes in their own beliefs, attitudes, and behaviors, and then took the initiative to inspire, enable, and mandate similar changes within their organizations. this method of reaching "critical mass" of hr awareness within these organizations appears to be both efficient and effective when the leadership conditions are right. however, this pathway to change is vulnerable to the loss of the key individual leader." research efforts on effectiveness pransky has reviewed the research on hr (through 2001) in relation to its results for prevention and education, citing about 20 manuscripts, most of which were conference papers, and none peer-reviewed journal articles, although two were unpublished doctoral dissertations. (kelley (2003) cites two more unpublished doctoral dissertations.) pransky concludes, "every study of health realization and its various incarnations, however weak or strong the design, has shown decreases in problem behaviors and internally experienced problems. this approach appears to reduce problem behaviors and to improve mental health and well-being. at the very least, this suggests the field of prevention should further examine the efficacy of this ... approach by conducting independent, rigorous, controlled, longitudinal studies...." since at least 2008 peer-reviewed professional journal articles on its effectiveness have been published. see c.l.polsfuss, a.ardichvili articles in "organizations and business" section below. criticism in a criticism of the philosophy of sydney banks and, by implication, the hr approach, bonelle strickling, a psychotherapist and professor of philosophy, is quoted in an article in the vancouver sun as objecting that "it makes it appear as if people can, through straightforward positive thinking, 'choose' to transcend their troubled upbringings and begin leading a contented life." she goes on to say that "it can be depressing for people to hear it's supposed to be that easy. it hasn't been my experience that people can simply choose not to be negatively influenced by their past." referring to banks's own experience, she says, "most people are not blessed with such a life-changing experience.... when most people change, it usually happens in a much more gradual way." strickling, however, displays by her very criticism, a lack in understanding of the health realization approach which has nothing at all to do with "choosing" or "positive thinking". the west virginia initiative for innate health (at west virginia university health sciences center), which promotes hr/innate health and the philosophy of sydney banks through teaching, writing, and research, was the center of controversy soon after its inception in 2000 as the sydney banks institute for innate health. initiated by robert m. d'alessandri, the dean of the medical school there, the institute reportedly was criticized as pushing "junk science," and banks's philosophy was characterized as "a kind of bastardized buddhism" and "new age." william post, an orthopedic surgeon who quit the medical school because of the institute, was reported along with other unnamed professors to have accused the sydney banks institute of promoting religion in a state-funded institution, and harvey silvergate, a civil-liberties lawyer, was quoted as agreeing that "essentially seems like a cover for a religious-type belief system which has been prettified in order to be secular and even scientific.” there is, however, no organised religion associated with the principles uncovered by mr. banks. a dr. blaha, who resigned as chairman of orthopedics at wvu, was quoted as criticizing the institute as being part of a culture at the health sciences center that, in his view, places too much emphasis on agreement, consensus, and getting along. other professors reportedly supported the institute. anthony dibartolomeo, chief of the rheumatology section, was quoted as calling it "a valuable addition" to the health-sciences center, saying its greatest value was in helping students, residents, and patients deal with stress. reportedly in response to the controversy, the wviih changed its name from the sydney banks institute to the west virginia initiative for innate health, although its mission remains unchanged. support for specific tenets of hr from other philosophies and approaches some of the tenets of hr are consistent with the theories of philosophers, authors and researchers independently developing other approaches to change and psychotherapy. a large body of peer-reviewed case literature in psychotherapy by milton erickson, m.d., founding president of the american society for clinical hypnosis, and others working in the field of ericksonian psychotherapy, supports the notion that lasting change in psychotherapy can occur rapidly without directly addressing clients' past problematic experiences. many case examples and a modest body of controlled outcome research in solution focused brief therapy (sfbt), have likewise supported the notion that change in psychotherapy can occur rapidly, without delving into the clients' past negative experiences. proponents of sfbt suggest that such change often occurs when the therapist assists clients to step out of their usual problem-oriented thinking. the philosophy of social constructionism, which is echoed in sfbt, asserts that reality is reproduced by people acting on their interpretations and their knowledge of it. (hr asserts that thought creates one's experience of the world.) a major body of peer-reviewed research on "focusing", a change process developed by philosopher eugene gendlin, supports the theory that progress in psychotherapy is dependent on something clients do inside themselves during pauses in the therapy process, and that a particular internal activity – "focusing" – can be taught to help clients improve their progress. the first step of the six-step process used to teach focusing involves setting aside one's current worries and concerns to create a "cleared space" for effective inner reflection. gendlin has called this first step by itself "a superior stress-reduction method". (hr emphasizes the importance of quieting one's insecure and negative thinking to reduce stress and gain access to "inner wisdom," "common sense," and well-being.) positive psychology emphasizes the human capacity for health and well-being, asserts the poor correlation between social circumstances and individual happiness, and insists on the importance of one's thinking in determining one's feelings. work by herbert benson argues that humans have an innate 'breakout principle' which provides creative solutions and peak experiences which allow the restoration of a 'new-normal' state of higher functioning. this breakout principle is activated by severing connections with current circular or repetitive thinking. this is heavily reminiscent of health realization discussion of the principle of mind and of how it is activated. finally, resilience research, such as that by emmy werner, has demonstrated that many high-risk children display resilience and develop into normal, happy adults despite problematic developmental histories.