[An excerpt from The Patient Who Cured His Therapist: And Other Stories of Unconventional Therapy by Psychology Tomorrow’s Editor-in-Chief Stanley Siegel]
THE PATIENT WHO CURED HIS THERAPIST
Starting with the premise that failures often are quite functional, we can see that an apparent impasse in any kind of relationship often can be found to be accomplishing some yet undefined, undetermined purpose. When called upon by a colleague therapist, for instance, to help with a therapeutic relationship that she considered a failure, I was inclined to try to discover what such a failure could be accomplishing. As always, the discovery wrought surprises.
Buffalo, New York, Winter 1986
Judy Reed had been seeing Tom Martin on and off for two or three years. She told me that she had been stymied by what she saw as his steadfast refusal to reveal himself to her, to trust her, to open up and communicate with her. She had tried everything, she said, and she predicted that within minutes I would see what she meant. I would be confronted with an obviously intelligent, articulate, and fairly well-educated man who would converse in monotonic monosyllables, and at a pace that would have me squirming. Dark-eyed and slender, Judy was intense, articulate, and eager. Initially I was excited by her enthusiasm for the work. She did not appear to be offering me her most frustrating case to test me; she seemed truly desperate to help her client. “He is simply the most withdrawn person I have ever encountered,” she said. “No man is an island? This man is an island!”
Because she was so graphically convincing in her description, I had to step away for a few moments before the session began. I felt I had to erase some of the strength of her impressions from my mind. Later, I attempted to explain that seemingly odd, meditative departure to some assembled student therapists, wondering all the while if they considered me crazy.
I told them that once, while I was seated in the living room of an apartment, waiting for a friend to shower and dress, I had amused myself by staring at a crimson Christmas stocking hanging from his mantel. Emblazoned in neat script at the top of the stocking was his son’s first name, Paul, written in sprinkles of silvery confetti. I noticed that I could not look at the script without my mind forming the imaginary sound of the word Paul. I tried to force myself to see the symbols otherwise. What would “Paul” look like to me if I had just landed from another planet with another kind of written language, and I had never seen such symbols before?
The first symbol was like a tree leaning to the right, its boughs and branches growing only on its right side. The tree’s root proceeded in that direction, too, from ground level and then upward to the top of an adjacent short, round bush. It also leaned to the right, as did every symbol following. Connected from the second symbol’s bottom were two similarly short, vertical symbols of growth, as I tried to view them. They were connected from their bases to each other and finally to another right-leaning tree that bore no branches or boughs.
The exercise was nearly impossible, because my knowledge and memory of the word Paul kept getting in my way. I knew that the symbols existed apart from my knowledge and assumptions, but it seemed that I could not make myself see them without associating them with the sound Paul. Eventually I did it, but only for a fraction of a second. I saw “Paul” as an interesting scribble, unhampered by prior knowledge or prior impressions. I saw the symmetry of the symbols, their directional preference, their liquidity, their individuality, and their interdependence. They seemed like a scouting party of hieroglyphics, headed eastward under the leadership of their stoutest member. Then Paul jumped back into my head, and it was over. I could not retrieve it again.
I said I found it to be an exciting exercise and recommended that they try it some time, with numbers, with symbols, with people. An exercise in erasing crippling assumptions, it would both force and allow them to view a problem entirely differently, and I was about to do exactly that.
In preparation for my visit, and as standard protocol for visiting clinical lecturers, Judy Reed had suggested to her patient that their protracted impasse might bypassed by a second opinion. She had asked if he would be willing to participate in a consultation with a therapist from New York City who would be visiting as part of a clinical-teaching seminar. After asking for details about what exactly would take place and hearing her explanation that it would be a session observed by her and her colleagues and would possibly be of benefit to him and everyone else, Tom Martin consented.
He entered the room. I sat opposite him, my back to the two-way glass. I told him we would be videotaped if he didn’t mind. He nodded his head toward the left very slightly, and raised one eyebrow almost imperceptibly in a gesture that I took to mean a contraction of a shrug, which in turn meant either “No problem” or “If it’s my permission you want, you’ve got it.” Dark-eyed, he had a receding hairline that emphasized a pleasant, roundish face, one you might expect to see on a priest or a pharmacist.
He sat down, crossed his legs, placed his hands in his lap, and seemed for all the world to be comfortable. I asked him how he felt. He shrugged and said, “Fine,” and then after a pause, added, “thank you.” We laughed together at his belated politeness. I asked how long he had been coming to the center for sessions; he answered, “Several years, on and off. Two years.” I asked how he had started, what had prompted his coming in the first place.
“My girlfriend brought me here,” he said.
Right away I had a therapist experiencing difficulty communicating with a patient who had not come to her with any problem of his own. The patient’s girlfriend had brought him to the center. What was her problem?
“Why? Why do you think she brought you?” I asked.
“She doesn’t feel that I communicate well. I guess I don’t talk to her enough about how I feel.”
So far he was merely telling me what he thought he ought to be telling me. The easy trap would have been for me to then ask how he felt. If he didn’t tell me, his girlfriend and his therapist and I would all be in the same predicament. But instead I asked, “What happens when you don’t express yourself?”
“She gets angry with me,” he said. “She tries harder.”
“Well, then what happens? What do you do next?”
He paused for a long time. As it turned out, this was the answer to my question. She tried to get him to express himself, and he paused. She tried harder; he paused longer. That frustrated her, and not only her.
“I don’t know what to do,” he said finally. “She’s angry, and I’m the cause.”
“Do you get angry in response?”
“No,” he said calmly. “But I feel bad.”
“You feel that you’re disappointing her,” I declared.
He paused again, but contemplatively, not artificially, not frozen with dread or muted by shame or confusion. He was taking his time, thinking about the suggestion. I waited. The silence in the room seemed long but not threatening.
Most patients would have felt obligated to break it. Tom did not. He was content to think, and I was curious enough not to interrupt him. He seemed serene. He was serene.
After ten seconds or so, he said, “Yeah.”
Now I let some time pass. I would share in his tempo, his pace. I found it increasingly remarkable that this man felt no uneasiness during any of the vast lulls in our talk. He wasn’t trying to impress anyone. He wasn’t trying to convince anyone. He seemed to feel no social needs, to harbor no anxieties about what I might have been thinking. It was not as uncomfortable as I might have thought it would be, either, although I am certain that it presented a problem to the observers, especially Judy, Tom’s therapist. If his serenity bothered his girlfriend, and possibly Judy, as well, now here were two serene men. One was believed to have a problem that required fixing; the other was the expert called in to fix it.
The therapist who had framed Tom as withdrawn now had a dilemma. In deciding to meet Tom on his own wave length, I also was deciding – and, in fact, declaring – that it was not bad to be this kind of man. I was conscious of it at the moment I entered his universe. It became very clear to me that I was not going the active route that his therapist had taken; she had focused on qualities she saw as opposite hers. I was finding sameness, respecting Tom’s absolute calm. I didn’t know what I was going to do yet, but I could see what was going on, and I could actually experience the depth of his serenity. Then, of course, I began wondering why a therapist in the face of such a peaceful man would want him to be otherwise. Maybe she had a problem.
Tom’s universe, by the way, was much less pressured than ours. I enjoyed my time in it. If he felt no obligation to fill the temporal spaces between questions and answers, there was no need, to me, to fill any. It became fairly relaxing, in a way, and peaceful. .
“Are you disappointing her?” I asked after some time.
Another long pause before he said, “I don’t know.”
“Could it be that she doesn’t appreciate you?”
He looked down and to the right, in further contemplation, almost as if he were puzzled by this “new” notion: That his girlfriend’s problem with him could be hers and not his, that his therapist’s problem could be her own, too. I let another five seconds go by without a response and then said, “You seem quite serene to me.”
Long pause. “I do?”
Short pause (I wasn’t quite as serene). “You do.” The pace must have been driving the observers nutty.
He paused again, then said, “I’ve had a lot of practice” – a remark whose significance absolutely slipped by me until much later.
“It’s puzzling to me,” I said, “because I don’t know why you would want to change that. I don’t know why anybody would want to be less comfortable or less serene.”
“So, how is it that people, or at least women, don’t understand what kind of man you are?” I asked. “You’re extremely sensitive to what other people think?”
“Quite a bit, yeah.”
“Well, that clarifies something for me.”
“What does it clarify?” He was suddenly curious.
“Well, my experience with you, which has been brief, is that you are a man endowed with some wonderful qualities. You are content, serene. You are generous, to the degree that you care so much about how your behavior disturbs your girlfriend, you have come to therapy sessions for two years. Yet the woman you live with does not appreciate those things about you. And somehow you have accepted that their view of you is better than your own view of you.”
I stopped. He pondered. Another ten or fifteen seconds passed. He rubbed his forefinger under his nose. He stared down and to the right. At length he said: “Could be.”
“What is your view of the therapy that has happened so far?” I asked. “It’s been a long time. Two years.”
Huge pause. He did not want to say to a therapist that therapy was a waste of time, though I suspect he felt it was.
“Are you addicted to it?” I asked.
“To the weekly counseling sessions? I don’t know,” he said, lapsing into more deliberation. “It’s an interesting question. I never thought of it. I haven’t thought of myself as addicted to it. I don’t know.”
“Is Judy Reed addicted to you? You know, your therapist?
“I don’t know. Maybe she is.”
“You have some suspicion to that effect.”
“What would make you think that?”
“Maybe because she sought me to participate in this consultation. Maybe she wants… maybe she’s addicted to her desire to see a change in me.”
Another long pause. I knew what I was going to do now. I thought of Judy’s description of him, one of frustration, not one of respect. Neither his girlfriend nor his therapist respected or appreciated this man. They had failed him and had then accused him of failing them; and convincingly, too, evidently. The therapist’s failure was simple: she merely took over the job of the girlfriend in not respecting Tom Martin and in insisting that he behave differently. In effect, the girlfriend had said, “You need help in being the person I want you to be. I will introduce you of a professional person who agrees with me, and she will help you fix yourself so that you can more closely resemble my idea of you.”
A popular psychological myth declares that it is always better to be an expressive person, not to be withdrawn or retiring. In many cases, this is how women want men to be, and how therapists want patients to be. And in many cases I’m sure it is better to be expressive. For Tom Martin, however, that would have been alien. It simply was not him.
“It’s sad, isn’t it?” I said, referring to Judy’s addiction.
“If it were true, it might be. I don’t know if it’s true.”
“Well,” I ventured, “how are you going to cure your therapist?” I wanted to tell him that not only was he all right, but in his serene kindness he was serving needs in both his girlfriend and his therapist.
He grinned, but he thought about the question. “Cure her from what?” he asked. “Trying to change me?”
“I don’t know,” he said, grinning again.
“Can you be her therapist?” I asked him.
“I don’t think so.”
“I think she needs to be cured by you.”
“If and when I cure her, then what?”
“Then she won’t need you anymore. Then perhaps she’ll understand what a lovely man you are.”
“How do I cure her?”
“Well, suppose I bring her in, and you give it a try.” I waited, and then added, “You’re a very competent man. You can rely on your creativity and your competence. I think that you can find ways in which to let those important people in your life know what kind of man you are, what fine qualities you are endowed with.”
“What would that do for me?” he asked. “How will that make me feel better?”
“Don’t you want to be appreciated?”
He did not answer. I decided it was time to do something, and I rose and announced that I would go outside to the observers’ room and invite Judy Reed in. I said that he would be her therapist instead of the other way around. She seemed nervously amused at the idea. In fact, everybody in the observers’ room seemed nervous. The tables had turned. It was clear that Tom had become a stand-in for a character in his therapist’s life.
We watched as Judy sat in my chair and waited for Tom to speak.
“I’m supposed to cure you,” he said, eliciting a burst of laughter from two people in the room with me. Tom laughed, too. “How long have you been having these problems?” he joked, to more laughter. “Mr. Siegel says that you have an addiction to me, that you don’t appreciate me. You don’t appreciate my fine qualities: I’m serene and I’m comfortable, and you must not appreciate that, because you’re trying to change that, to change me. And there is another person who tried, who also does not appreciate me: my girlfriend.”
Tom put his hands together, fingertips to fingertips, as if in prayer.
His analysis was perfect, as far as I was concerned: the perfect dilemma presented by the idea of change. He was content with himself; they were not. If he were to make them happy, he would have to change. If he changed, he might not be content anymore.
“So, I’m going to cure you,” he continued. “I don’t know how. You know, a lot of people would love to be as comfortable as I am, or at least as comfortable as I sometimes appear to be.”
She nodded in agreement. “I think I’m becoming aware of that,” she said, “aware that you’re a lot more comfortable. I think that I probably misjudged you, or didn’t see it.”
Long pause. Tom was openly communicating with one of the women who had been trying unsuccessfully to get him to do just that. Paradoxically, in explaining the potential perils of change, he was changing. “You don’t appreciate me,” he said.
“Why not?” she asked, trying to regain her former role.
“Why do you not appreciate me?” he said, suggesting by his tone that only she could answer the question.
I thought, “Nice move, Tom.” In the room where I sat, there were many stunned faces. Not only was Tom expressing himself, he was openly challenging his therapist’s persistent negative view of him.
“I guess because I thought you should be different,” she said. “Maybe in some ways, not be so serene.”
”The whole Alcoholics Anonymous prayer is based on serenity, ” he said, startling me.
“Alcoholics Anonymous!” I said, out of earshot. I turned to one of the observers familiar with the case history, Linda Duly, a colleague in Judy’s study group.
“Tom Martin is in AA?” I asked.
“Yes, for some years,” she said. “This is pretty remarkable what’s happening here. You probably also ought to know, given the circumstances, that Judy’s husband doesn’t talk to her very much and that it troubles her deeply. In fact, her marriage is pretty tense right now. In fact – God, it’s all shaping up – according to Judy, her father is as withdrawn and distant as Tom Martin appears to be. That distance always has been a problem in Judy’s family. In our study group – where we examine each other’s family dynamics – Judy revealed that at an early age she became her mother’s ally in trying to get the father more involved with the family. What’s becoming clear to me is that Judy appears to have recreated the same relationship with her husband as her mother had with her father, and then recreated it again here with this patient. It’s really amazing.”
“She’s very consistent, isn’t she?” I said.
Linda looked at me quizzically but fondly as well. “Your cup is always half full, isn’t it?” she said.
I said I viewed Judy as someone who was constantly trying to repair a ruptured relationship from her past, someone who was therefore always hopeful, always patient, because she was still trying to repair an old relationship. “If she’s still trying,” I said, “then somehow she must still believe that it can be repaired and that it is worth the effort. I’m not reading that positiveness into the situation, either. I’m quite convinced that it’s there. I’m convinced that we are better than conventional psychology has made us out to be.”
Tom, meanwhile, was still acting as his therapist’s therapist. “The prayer is based on serenity,” he said. “The first half of it says to grant me the serenity to accept what I can’t change. But then they throw in, ‘Give me the courage to change what I can.’ And then they add, ‘… and the wisdom to know the difference.'”
Judy was weeping softly. “I think that I didn’t know the difference,” she said, her fingertips massaging her forehead.
“Is there something wrong with being comfortable?” he asked.
“I guess not. Maybe I was trying to change my discomfort, thinking that I knew what was better for you.”
”If I change my comfortableness and my serenity, that would mean being uncomfortable. I don’t want to do that. When people become uncomfortable… bad things could happen. What could happen?” he asked. “What could happen if I was not serene, not comfortable?”
“I don’t know, but I should have asked a long time ago.”
Exactly, I thought. I decided to interrupt. The paradox already had occurred. By entering his universe, I had disrupted the pattern, gotten Tom to tell me who he was rather than how he thought he should change. Paradoxically, he had changed. He had changed his perception of himself. Now I wanted him to take advantage of the opportunity to express to one of these pursuing women who he was and how he was not going to change, and maybe why. If he expressed it to Judy, I thought, it might serve as a model for how he might later express himself to his girlfriend.
Outside, I told Tom that I wanted him to cure her by teaching her to be serene. I told him that he was the expert, she his student. He returned to the chair and tried more or less unsuccessfully to continue. I interrupted him again and asked him to stand up and tell her why he deserved her appreciation.
Standing, he folded his arms and said, “How can I teach you to be serene? Don’t take risks. If you never risk anything, you’ll never be uncomfortable. Don’t change anything. If you try to change things, that, too, can lead to discomfort. Don’t try to change other people. Appreciate them as they are. Appreciate their qualities, and don’t try to change them. If you try to change them- ”
“I lose out,” she said.
“You can lose out. You can lose serenity that way, by trying to change other people, by trying to control them. All role-playing aside, that I know to be true. Because I’ve tried to control and change people a lot in the past. And it gives me a lot of discomfort, a lot of – whatever the opposite was of serenity – whenever I tried to do that. But the key to that is knowing the difference. Knowing what you can change and what you can’t.”
“I believe it,” she said.
“Good.” He paused, then smiled. “Is it because I’m standing up?” he asked gently.
“No,” she said, looking up at him and smiling slightly herself.
I knocked again. “I think you’ve done well,” I told Tom. “You can sit down.” I walked to his chair and placed my right hand on his shoulder. “I think that she probably needs another session with you. Probably one more. Would you agree?”
“I agree,” he said.
“So, we’ll stop for now. But you can see if you can fit her in your appointment book.”
“I’ll have to see my secretary,” he said. We laughed, all three of us.
Judy later told me that she subsequently met several times with members of her family, particularly her father, and discussed his isolation and his withdrawal. He told her that he always had felt excluded by his wife and her family, with whom Judy had become very involved as daughter and granddaughter, and that after a while he had stopped risking feeling their rejection by just keeping to himself, especially around them. Following those conversations, Judy said, she eventually forgave her father.
Judy also told me that Tom had seen her for one more session, and that he and his girlfriend eventually had separated. I don’t know what happened after that. But I thought about him often, and I incorporated that case into lectures about achieving failure.
Tom Martin had refashioned himself into a serene man in a heroic effort to change from alcohol-dependent to alcohol independent. Was he to change again and become expressive in order to satisfy the needs of the women in his life? He was afraid to, but he felt obligated to, because he had accepted their perception of him as a withdrawn, noncommunicative, and therefore a failing personality. Once his perception changed, he first began to appreciate himself better, then became expressive enough to say that he wanted their appreciation but was not going to change to get it. That in itself represented a profound change, so Tom moved on and evidently left the others behind.
His “failure” in therapy with Judy Reed had protected his serenity. Judy’s failure, meanwhile, gave her an opportunity to continue to attempt to repair her relationships with men in general, with her father and her husband specifically. Her stubborn persistence stemmed from an indefatigable optimism about fixing those old relationships, just as heroic, in a way, as Tom’s steadfast refusal to yield to her notion of what should have been his behavior. In the wrong place, Judy’s optimism served her purpose rather than Tom’s therapy. In turning the tables, we provided the opportunity for the failure between them to become success. Tom articulated his serenity, ending Judy’s failure, and then he rid himself of both women who refused to respect his success at achieving serenity. And Judy recognized and repaired her relationships with her men, so that she no longer needed to fail as Tom’s therapist.
“Resistance” is a key word in therapy, and like all key words, it can be used – or abused – to blanket more truth than it reveals. For example: you are in therapy; you sense an impasse and decide that you want to quit the therapy. Your therapist, protecting himself, may then categorize your desire to quit as “resistance.” That diminishes its significance, convinces you that you have created the impasse, and perpetuates the impasse under the guise of therapy for a resistant patient. The patient, out of respect for the therapist and his authority, may comply with the therapist’s view by remaining in therapy but likely will also wisely hold on to his problem, having recognized that he is misunderstood by his therapist.
Frankly, it is often the therapist’s resistance that results in an impasse-resistance to understanding the patient’s dilemma or to recognizing the incorrectness of his own prescription, whether stated or covertly implied by his pattern of inquiries. Frequently, the therapist is following the rules of his own history as well as the rules of his profession. He reaches an impasse with his patient because part of the patient’s pattern violates the therapist’s allegiance to his own history. The therapist winds up trying to get the patient to change behavior that actually solves a problem, because that behavior reminds the therapist too well of a problem of his own. When the therapist does not understand the potential consequences of such a change, the patient develops a mechanism of refusal – appropriately so, though he doesn’t know it – because subconsciously he does know that such change is fraught with consequences his therapist is not aware of or chooses to ignore.
The defensive therapist interprets this as the patient’s resistance to therapy – as opposed to resistance to the therapist. This collection’s title story, “The Patient Who Cured His Therapist,” is a classic example of the problem. An impasse is perpetuated by a therapist who resists recognizing her own unresolved conflict, on the one hand, and the integrity of her patient, on the other.
In this case, it took a third party – me – to recognize and be able to analyze the situation, and to see how the therapist’s attempted solution to the case was defeating everybody. (That alone struck me as ominous – and it still does, whenever I ponder the implicit dangers of the artificial sanctity of the patient-therapist relationship. How wise are we, as patients, to entrust so subjective a science to the interpretive view of one practitioner, let alone to ensure, through a nearly sacramental secrecy, that his performance will go forever unexamined?)
At any rate, I intervened in the pattern of Tom Martin’ s therapy very early in the proceedings, by declaring him “serene,” a positive quality, instead of the negative “withdrawn” or “resistant.” I solidified the intervention by further suggesting that the women in his life did not understand his serenity. He was jarred by so respectful a characterization. I described him as content yet so generous at the same time that he would regularly see a therapist in order to soothe his girlfriend’s discomfort with his contentedness; moreover, that he would remain in therapy for two solid years in order to salve the therapist’s discomfort with this same pacific quality of his.
While he pondered this new and complimentary way of looking at himself, I further suggested that his therapist might be addicted to change and might be struggling, against his best interests, to serve her addiction by forcing him to change. So, the second intervention was to convince him that if he wanted this seemingly interminable therapy to end without his wanting to sacrifice his serenity, he might want to cure his therapist of her addiction to changing him.
Once I learned that he was a recovering alcohol addict, I was sure he could do it. He had on his hands an addictive person who had not come to terms with herself, could not sit still with her own anxiety about a man who was not communicative in a way that made her comfortable. She was compelled to change him to make herself more comfortable. She was resisting, refusing to understand the importance of the alcoholic’s being the protector of his own: serenity, because of her own addiction to change. I hoped I was using the moment between the therapist and the patient as a metaphor for their other relationships – patient and girlfriend, patient and mother, therapist and husband, therapist and father – so they might be able to transfer their discoveries to those relationships.
It was ironic for me, a therapist, to be taking a position that communicating openly and directly is not always the best course. It usually is, and in a society where communication is given the status of high art, “uncommunicative” men tend not to measure up to the standard. That may be true for many men, but the professional community must also recognize that many other men have good reasons for their own, ways of communicating however it may displease their more conventionally communicative partners. Again, we cannot judge behavior – silence, for instance – out of context.