[An excerpt from The Patient Who Cured His Therapist: And Other Stories of Unconventional Therapy by Psychology Tomorrow’s Editor-in-Chief Stanley Siegel]
Despite the early hour the thermometer outside registered scant digits below triple figures. Steamy summer moisture clouded the city air. A handsome man wearing a stylish Italian-cut suit – with shirt, tie, highly polished shoes – and a thick woolen multicolored ski hat, approached me in a room of the East 79th Street branch of the New York Public Library and asked quite bluntly if I knew about psychology. He had pulled down the hat to cover his ears. I saw nobody at any other table.
I was deep into my third year as a practicing psychotherapist. Books and papers about psychology were spread out before me like newspapers at a Louisiana crawfish boil. I was busy and did not want to be distracted. Straining to maintain a noncommittal expression, I looked up at the summertime Ski Hat Man.
“Psychology?” I asked blankly. “No, I don’t know anything about psychology.”
“Well, let me ask you a question, anyway,” he nearly bellowed. “Do you think the CIA and FBI could be monitoring my conversations through my hat somehow? Is that possible?”
Wondering, “Why me?” I answered that although the question struck me as interesting, I didn’t know. I nodded toward the research librarian and told the man, “You know, she might be able to help you. She’s very good at finding things out.”
The man thanked me politely and approached the research librarian’s desk.
“Do you think the CIA and the FBI could be monitoring my conversations through my hat?” he asked, pointing to his head.
She must have heard us already, for she had reached for a hefty volume and was placing on the desk by the time he arrived. “I really don’t know offhand,” she said, “but we might get some help from this book. It’s a directory of federal government agencies. Let me see…”
She was not mocking him, and the calmness of her approach to the resource material suggested that she was not merely humoring him, either. It seemed to me that she had decided simply to treat his concern as legitimately as he did and proceed from there. Ashamed of myself, but only slightly, I marveled at her instinct, because I had been half intentionally, half instinctively developing a similar approach to my own work.
The research librarian appeared to be having little success finding answers, but while she perused her book, another man stride to her desk, apologized for interrupting, and then interrupted. “I’m sorry. I overheard your question,” he said to the Ski Hat Man. “I hope you don’t mind my intruding, but I happen to know that you are correct in your suspicions. They can do it, and they do do it. They’ve been monitoring my dialogues for years, through my transistor radios, through my television, and even – strange as it may sound – through the buckle in one of my belts!”
“I knew it!” said the Ski Hat Man.
The research librarian held up a slip of paper and said, “I’ve found some telephone numbers for you, numbers for both agencies, the CIA and the FBI. Here, you can call and ask yourself.” The Ski Hat Man took the paper, and the two men wandered off to another room, conversing about the inconveniences of being spied upon.
I felt like applauding. The librarian had responded to an eccentric with the same respect that she might have offered anyone else, and as a result a man not suffering from his illusions had discovered another man not suffering from the same kind of illusions. Presumable, a valuable friendship thus was struck; mutual needs were served; fears were comforted.
Furthermore, it was entirely possible that neither of these two new acquaintances would consider the other’s apparent illusions bizarre, problematic, or symptomatic of any mental or emotional disorder, or even consider them illusions. On the contrary, each was gladdened to have encountered the other. The supported each other’s point of view. Together they could enjoy a universe that, though different from mine, was quite satisfactory, and one from whose perspective they might even think of my universe as aberrant, strange, unrealistic, illusionary, even neurotic. They were in the process of discovering a new relationship, and the possibilities for its success were limitless. All I knew about them so far was that they complemented each other and supported each other in a way few others could. If a friendship developed out of this chance encounter, it surely would be an exquisite union.
It occurred to me that my work, psychotherapy, was less a way of understanding individuals than of understanding the relationships between people, what brought them together in the first place, what needs and gifts their relationships addressed, what changes they made to accommodate each other; what the origins of their complementary strengths and weaknesses were. After all, much of our idiosyncratic behavior, good or bad, has its origins in the idiosyncrasies of our parents, with whom we had our very first relationships. Much of what we look for in new relationships – friends, lovers, or our children – offers us the same kinds of support and even conflict that comforted us in our earliest relationships. Bizarre, crazy and antisocial are sublimely relative terms, often absolutely unrelated to the function of the accused’s behavior. Their meaning depends wholly on the perceptions of somebody else, and the comparative comfort or discomfort their manifestations cause somebody else.
Early in my studies, I discovered that my developing therapeutic aesthetic responded to lectures and literature from followers of what was then considered a news school of thought. With excitement, I immersed myself I the ideas of the pioneers of these theories – Murray Bowen, Carl Whittaker, Jay Haley, Nathan Ackerman – who themselves had rebelled against the tenets of traditional psychotherapy. All of their ideas were loosely gathered beneath the categorical umbrella of Family Systems Therapy, then a catch-all phrase for a variety of emerging theories and methods. They shared in common the premise that an individual’s problem, rather than being purely dysfunctional, might actually function to support the stability of a relationship, usually within a family. They therefore gave the “problem” a positive connotation and then treated it as part of a relationship system, thus moving away from an individual model. While I was still developing my own ideas, I became attracted to and joined with other students and professors who felt similarly. I learned about and ultimately embraced the ideas of Salvador Minuchin, a pioneer practitioner and the originator of a family systems model called Structural Family Therapy.
Shortly after attending seminars with Minuchin at the Philadelphia Child Guidance Clinic, I met with Peggy Papp, a senior faculty member at the Ackerman Institute for Family Therapy in New York, and began studying with her. A year later, Peggy invited me to join her and Olga Silverstein as a colleague in an innovative research project at Ackerman, organized to develop short-term treatment models, particularly for people with extreme behavioral symptoms. The protocol on the Brief Therapy Project was a team approach in which one therapist conducted therapy with the family while the other team members monitored from behind the observation mirror. The rooms were connected by a telephone intercom. The observing team members could use it to call in comments, questions, and observations to the therapist interviewing the family.
During the course of a single session, the therapist and team would interrupt the session to discuss the information collected and to agree on an intervention that the therapist would then offer to the family.
One strategy called for the therapist to report to the family that she was in disagreement with her team members. The therapist, in her messages, generally supported and encouraged her family to change, while the other team members reported on the risks and consequences. In this way, the family’s dilemma about change was dramatized. Eventually, Peggy Papp named the developing technique “The Greek Chorus,” because in Greek tragedies the chorus always predicted the ominous consequences of the players’ deeds.
In our second year of working together, Peggy, Olga and I restructured the technique, so that we would all be present in the consultation room together with the family, each of us representing a previously agreed-upon position on the family’s options for change. We reserved this extremely powerful method for use with families who presented extreme and acute symptoms and who reported that they had failed in previous therapy. We obtained legal releases from the members of these families, along with their permission to videotape and study the consultations – not only to facilitate their therapy but for later use in research and in teaching. We used several cases from this project to introduce our Triadic Debate method to an international conference held in New York. We compared our methods with the famed Milan Family Studies Center, renowned for their innovative, paradoxical approach.
During my tenure at the Ackerman Institute, as I grew to become a senior faculty member myself and director of the education program, my earlier ideas solidified and became stamped with my own signature.
My therapeutic role, as I now saw it, was vastly different from that of the traditional psychotherapist. It was not to analyze an individual and somehow repair what we determined were his or her isolated imperfections. From a family systems perspective, none of it was isolated; no behavior existed out of context.
My role was to understand the relationships between or among people, to find out how they influenced each other’s actions, served each other’s needs, complemented each other’s strengths, and then teach these same people what they had revealed to me. Even individuals who approached me with what they perceived were personal emotional problems had relationships in their pasts that had profoundly influenced their behavior and their reactions to their present and future reality. They might be honoring a filial legacy, clinging to a stabilizing tradition, freezing a moment in time, or creating an illusion that transcended time and postponed a departure from a family loyalty. If they knew and appreciated the past origins of their reactions to their reality, they could choose new reactions to change their present. If people in apparently troubled relationships were dissatisfied, I could learn what had satisfied them in the first place, what emotional debts they might have incurred to achieve stability, and I could identify the possible opportunities for change and acknowledge the risks involved.
For example, a man and a woman meet, learn about each other, and fall in love. They are attracted by each other’s positive characteristics; they want to serve each other’s needs, encourage and appreciate each other’s strengths, assist each other, complement each other. To this end, for the good of each other, they make a dramatic change in their lives; they form a union intended to be permanent, a relationship based on trust, honor, loyalty, and generosity. The change has initial consequences that may be relatively easy to adapt to, and later, long-term consequences that may present more difficulty. In forming the relationship, they develop patterns for protecting the relationship while still preserving their individual integrity; methods emerge for new consequences that one day may be viewed as problems rather than solutions – when they have a child, for instance. Regarding the nurturing and education of the child, each parent is equipped with lessons learned and loyalties forged in different families, perhaps from different group loyalties, different ethnic, economic, cultural, religious, and social traditions. They may disagree, each for the good of the child, each out of loyalty to a different past. The child grows to perceive the conflict and, consciously or otherwise, alters her behavior or changes her life to soothe it or to postpone any feared negative consequences. Maybe she becomes chronically ill, thus drawing attention away from the conflict. Maybe she misbehaves or fails in school, thus achieving a smokescreen dilemma to distract potential combatants and stabilize the family. Mired in her apparent failure or chronic illness, the family then consults a therapist. If the therapist understands the origins of the conflict and knows the foundations of the relationships, he will see that the “problems” may be solutions and the “failures,” achievements.
I realized that people who came to therapy already had changed their lives to accommodate the sharp turns and sudden twists that life’s milestones can create, and which can destabilize relationships. After making a series of such changes to avoid instability, we sometimes find we have created a new instability. Eventually we may forget that our original intent was honorable and generous, as the consequences of our adaptations are accompanies by unexpected guests – more consequences. The therapist who can find the way back to our motives for the changes we have made might also be able to offer a prescription for embracing different options, different changes that produce the same stabilizing results – but without dishonoring the past that motivated us initially. After learning the origins of a person’s behavior, my next challenge was to summon the imagination to offer creative alternatives for change.
My approach to psychotherapy, therefore, started from the premise that we already are all right, or are merely striving to return to being all right; that rather than trying to suppress our powerful, aggressive urges, we are constantly trying to repair wounds we might have suffered, always with the hope of returning to our noblest ideal selves; that negative or crazy behavior is often founded in honorable pursuits. I thought that our admiration of heroic self-sacrifice was a natural human inclination.
I found the positive nature of the approach to be personally fulfilling, even exhilarating. I had long suspected, both intellectually and emotionally, that humans are more inclined (however slightly) toward generosity than they are toward acquisitiveness; more charmed by each other’s integrity than they are impressed by clever duplicity; more prone to self-sacrifice than to destructive invasion; more covetous of genuine joy than of momentary satisfaction. I think we like our heroes more than we like our villains because we are motivated in our daily meanderings by a patently human need to be more heroic, to behave better toward each other, generation after generation; and ultimately to improve on the behavior of our ancestors, while trying to remain loyal to such lessons as they learned and tried to pass on. This view of psychotherapy is a way to confirm that suspicion and apply it practically.
Generally speaking, I first detect how a problem functions within a relationship and introduce a new definition of the problem, describing what it accomplishes. Next, I identify and articulate the possible consequences of change, often using the elements of surprise, direct intervention, and even homework as techniques. Dramatizing the dilemma in these ways suggests what possible futures without the problem might be like. Because my approach is active and directive, as well as respectful, the length of therapy is often appreciably shorter than other kinds of therapy.
Over time three categories – three kinds of matrices of problem-solution combinations that entangled people and distracted them from better enjoying their lives – emerged. Thus, this book is divided into three sections, with stories that illustrate my approach, my discoveries, and I hope, my appreciation of and affection for the human being.
The section called “Exquisite Unions” includes four stories about people who, like the two spied-upon men in the library, manage to find each other, and to find in each other the perfectly, almost mythically complementary attributes that allow us to fulfill each other. One couple, in “Final AIDS,” is gay. In “The Immaculate Misconception” we find that an exquisitely matched married couple has agreed to sacrifice a human need, to abdicate a divine as well as a natural right, for their integrity of their incredible relationship. In “Double Cross,” a betrothed man’s apparently bizarre behavioral problem is discovered to have generously spared his fiancée from a perfectly conventional kind of heartache; and in “Jingle Jangle,” a typically repetitive marital fight keeps a family true to the histories of its members.
Failure, another sublimely relative characterization often serves the needs of a relationship. I have seen clear evidence that children sometimes misbehave or, say, fail in school, despite superior intelligence and great talent, because subconsciously they are sacrificing themselves for the good of their immediate family. One young boy I encountered somehow consistently thwarted the curative effects of a medication irrefutably proven to reverse his condition and end his suffering. His very physiology found the medicine, and he remained chronically ill. How? Why?
By ominous coincidence, which was no coincidence at all, we discovered that the boy’s parents’ attentions were focused on his illness and not on their own deteriorating marriage. Within the family organism the boy, having discovered that his illness could keep the family together, had assumed the role of attention-getter. When everybody in the family became aware of the sacrificial function of his illness, and then paid some attention to repairing the marriage, or at least resolving its dilemma, the boy began to respond to the medicine and recovered completely.
Hence, a section of this book is called “Achieving Failure,” showing people who achieve failure because this allows them to achieve functional goals essential to their relative well-being.
Looking at someone’s behavior as probably positively functional is automatically more respectful of the person herself, and I have long been drawn to that view. Sometimes its results are quite surprising. In the story that gives the book its title, “The Patient Who Cured His Therapist,” I intervened in a case wherein a fellow professional was completely frustrated by her patient’s uncommunicative behavior. After a short time I found myself admiring the patient and wondering instead about the intensity of the therapist’s frustration. My re-focusing was based on appreciating him and sympathizing with her, my emphasis less on curing than on learning first, then revealing what I had learned. My approach assumed that the uncommunicative patient probably was acting in his own best interest and – for what reasons I would try to learn and understand – not that he was behaving badly and ought to have corrected himself.
In “Getting Crazy,” a woman described as a societal failure engaged regularly, and at the risk of going to jail, in what I eventually called “responsible shoplifting.” In the eyes of the professional therapeutic community, she was a failure. Well-meaning counselors had advised her for years to stop shoplifting because, they said, such behavior was crazy and irresponsible.
I saw the situation from a different perspective. Given her family history, I considered her too responsible and not crazy enough. Furthermore, I thought I heard in her story the possible answer to her dilemma, a solution that honored her past. The choice to change her life’s direction was hers.
In ‘Holocaused,” three grown children conspire to achieve failure, one more spectacularly than the other, as a means of protecting their parents’ marriage while simultaneously adhering to the messages of their ancestral families. When they are taught to view their failures as functional, as loyal, even as generous and loving behavior, they are freed to control the extent to which they choose to continue to fail. They can allow themselves success. But – again, emphasizing the consequences of change – my colleagues and I recognized that although change would liberate the members of a younger generation who had thus far failed and suffered for the family’s history and stability, the cost of such change would be borne by the older generation. Would they pay? Would their children let them pay? We had to point out the options and let the family decide.
Finally, in “The Wall of Sheets,” I tell how my co-therapist and I fared in a long and frustrating series of sessions with a married couple whose ancestral loyalties were so strong so honored, so deeply rooted, that they had created a sustained failure in their relationship. The continuance of the failure defined the relationship itself. The failure was crucial to the relationship. We needed months to recognize it, and moments to honor it.
Bluntly put, I’m not interested in restructuring psyches. I’m interested in how a person can see his structure, his history, and his loyalties, and do something about the lessons they teach, if need be, or to accept and appreciate them, if not.
I see therapy as art, as an extremely subjective art, too, collaborative and communicative between the therapist and his client – two human beings, one with tremendous experience with his own troubles, the other supposedly possessing vast knowledge of other people’s troubles, not to mention their statistically recorded patterns and clinical names.
In a way, the process sometimes seems as simple as the cliché that requires walking a miles in the other person’s moccasins before judging her behavior or advising her that she must change it. If a therapist can learn, understand, and then absorb a person’s culture so that he can truly empathize – walk the mile in her moccasins – the therapist is much better equipped to assist her in rewriting her own story. Looking at the science as an art, therapy for me is as personally involving as creating a painting, or, better yet, as singing in harmony, its turns and maneuvers as much an expression of my own personal aesthetic as the patient’s problems most probably reflect her own. If I accept the patient’s problem not as pathology, not even as fact, but as simply her story, I can both react to the story – share its sadness or its frustration – and engage, in concert with her, toward the purpose of helping rewrite the story, change its direction, create a new narrative.
Thus, the stories in the third section, “Transcending Illusions,” illustrate the extent to which a therapist tries to become involved in entering another’s universe. Illusions that often seem out of context sometimes require that the therapist participate in them, even join them, before the context is discovered. They seem to be disconnected sometimes, but clinical research repeatedly shows their undeniable connections to past relationships. In one of the “Spaghetti Stories,” I try and try and try to find the connection, not knowing what I’m looking for or how to go about it. I never learn the purpose of the illusion, but I do learn that it serves a purpose, because the patient so ardently protects and controls it. In the other “Spaghetti Story,” I again don’t learn the context, but by honoring the illusions, I discover a way for the person to manage them, control them better, function with them. In “Sin’s Syndrome,” the illusion more obviously serves the needs of a relationship, protects loyalty to an honorable code of conduct, and establishes an ironic fidelity to a family unit – but it is a solution whose consequences can become desperately costly. In “Father Knows Best,” the illusion of one member’s culpability is accepted by the entire family in the interest of protecting another member who is not yet ready to accept her responsibility.
My hope is that stories like those in this volume help show an entirely different view of relationships, give a new perspective on apparently problematic behavior, on so-called failures among members of couples, families, extended families, and even communities, because so often such problems represent noble, generous, and positive self-sacrifice on the part of the symptomatic members.
In such one-session stories as “The Immaculate Misconception,” “Getting Crazy,” and “The Patient Who Cured His Therapist,” the therapeutic – stages – respect, involvement, inspiration, intervention, and, sometimes, magic – merge perfectly to create new stories. In stories of more extended, multi-session therapy, such as “Jingle Jangle,” “Double Cross,” and particularly “Holocaused,” the process of discovery is more cumulative, though no less exquisite, and the stories extended to novella complexity.
The Patient Who Cured His Therapist is intended to illustrate those discoveries about relationships that I have found so exciting rewarding during the part twenty years, to offer their example as possible alternatives for people, and to provide the reader with amusing, compelling, entertaining, and enlightening true stories, gleaned from my memory, my notes and my videotaped recordings of sessions with patients.
Each of the three categories, “Exquisite Unions,” “Achieving Failure,” and “Transcending Illusions,” illustrates manifestations of my view. Each story, in its own way, illuminates the fundamental positiveness of my view, an attribute I hope the recalling and retelling of these stories someday will make contagious.