[An excerpt from The Patient Who Cured His Therapist: And Other Stories of Unconventional Therapy by Psychology Tomorrow’s Editor-in-Chief Stanley Siegel]
FATHER KNOWS BEST
“This is a very traditional midwestern family,” said Evelyn Ellis, a graduate therapist who had requested a consultation on a long-term case of hers. The family had just arrived and was seated in a waiting room outside. Evelyn’s file was perched on her lap, but as she reviewed the case, she didn’t glance even once at the file. She knew the story well.
“The father,” she began, “Ted Townsend, is a freelance packaging designer and appears to be quite successful at it, though it takes up a lot of his time because, well, he’s almost like a freelance artist or writer. He not only has to create the product, he has to go out and obtain work, sell his wares, his experience, his imagination, sell himself. So, he has a lot of external pressure and stress, day to day. He has a lot to worry about. But then, strangely, he also embraces a great deal of extra pressure at home, worrying about the rest of his family, worrying about every detail of their lives, in fact. I’ve been seeing this family for a long time, and the father’s constant worrying, his persistent anxiety, has the whole family on edge constantly, as if they all were emotionally clenched all the time because of his internal tension about them and their welfare. Session after session, that’s all they want to talk about. His anxiety pervades the family and dominates it, and I am feeling very frustrated that I haven’t been able to find a way to help alleviate their discomfort, because otherwise they present a nearly ideal American family.
“Let me add, by the way, that they love him; no question about it, his wife and two children, both adolescents, love him, and he loves them. But whenever he is not distracted by work, he’s peppering every one of them, with questions about subjects like the children’s performance in school, the way his wife drives the car, whether everyone uses seat belts, whether everybody is taking good care of their teeth, were they careful about the route they took home, did they listen to the weather reports-on and on. This year the oldest daughter is preparing to take the test for a driver’s li cense, so he’s been talking about that constantly. He reminds her every day about signaling before turning-and this at the dinner table. He must have told her four times that if she was in an accident while she was making a left turn, the accident was going to be her fault, according to the insurance companies, no matter what actually happened, because you’re always at fault when you’re breaking into traffic flow. Ask me how I know this so well. I’ve heard it repeated, so you can imagine how often the daughter hears it. He’s got her so tense that she won’t turn left if he’s in the same town. He cautioned her to drive only a big car, so that she would be less likely to get seriously hurt in her first accident, like it’s already a given. Here she is, staring down at French-cut green beans and a pork chop, and he practically has her programmed to have her first car accident and get it over with, when she hasn’t even taken her driver’s test yet.
“I have tried everything I can think of,” Evelyn said. “I even consulted with a psychiatrist, who saw Ted once or twice, basically agreed with me, and gave him a prescription for an anti-anxiety drug – Xanax, I believe. But the Xanax has no appreciable effect, either, which amazes me, because I took a Xanax once, when both my parents had been in an auto accident, and it’s a very powerful item. But on this man? Zero. It has no effect. Nothing seems to ease his anxiety. ”
Thus warned that both the therapist and the entire family had become completely focused on the father’s worrying as the primary problem for everyone, I chose my course. I determined to first diffuse that view if I could, because it did not seem to be leading anywhere, and then to look for an other opportunity. I asked Evelyn if she would mind my suggesting that she observe my initial encounter with the family from outside the room, through the one-way mirror, so that she could distance herself from the situation. Evelyn had no objection, but when I approached the family, introduced myself, and offered exactly that as my first suggestion, Ted Townsend immediately spoke up, seemingly as the representative of the entire family, and said, “We would be very anxious about that. I would like Evelyn to sit in with us, even if she were acting only as an observer this time.”
I had not addressed the question to him. I had asked everyone, making sure I made eye contact with the mother, Joan, a haphazardly dressed woman with short dark hair; the son, Wayne, a fifteen-year-old blond, athletic-looking young man; the daughter, Sarah, seventeen, also blond and quite lovely in a plain, wholesome way; and Ted, a balding, baby-faced man, neatly dressed, overweight, his bifocals perched precariously but somehow fastidiously on the end of his tiny nose.
It seemed that everyone in the family was in accord with Ted’s anxiety about Evelyn’s participation, though only he had articulated it. So if the whole family was equally anxious, then Ted might be the person who articulated the en tire family’s anxiety, not just his own. No one had disagreed with him. So my first suspicion was that the anxiety that everyone had identified as Ted’s problem might be an ex pression of the family’s problem.
Respecting that anxiety, which I took to be the whole family’s, I agreed that Evelyn could stay in the room, but then I said, “Tell me, why does everyone here think that Evelyn decided to invite me in to meet you?” Immediately Ted answered “She wants to get some fresh input, no doubt.”
“She’s probably frustrated,” said Joan, her voice taut.
“After all, she’s tried everything.”
“Evelyn’s gotten very attached to us,” Ted offered, as if protecting her. “It’s difficult for her to deal with us when we’ve become such good friends.”
“She’s like a grandmother, then,” I said, thinking about their protectiveness toward their therapist and about how mutually protective this family felt overall, even to the point of embracing their therapist.
Finally I asked the family the standard opening question:
“So, what do you think the current problem is, anyway?”
Ted shot a quick glance at Joan and said, not as a question but as a declaration, “You want me to go first.”
I took the remark to be a protective maneuver. I was the outsider; he was going to absorb whatever might be the impact of the first encounter with me. He then continued, fully embracing the family’s problem as his own.
“I’m having a tough time with the kids,” he said. “They’re growing older, and I can’t always protect them. They’re in a hurry to be independent, and they rebel, like all kids do, I’m sure. They don’t want to hear me. But they have to. They’re kids still, and they can only take so much.” “What is your reaction when they rebel?” I asked. “When they don’t want to hear you?”
“Well,” he mused, with a slight touch of self-consciousness, “I guess I feel like I’ve failed as a father.”
“In what way?”
“Well, I guess I’m a fairly old-fashioned guy family-wise.
It may seem funny to some people in this modern world, but when I think of family, my mind goes back to the best of the family TV shows, like Ozzie and Harriet and Leave It to Beaver, when people always talked out their problems and then agreed to behave in a certain, wholesome way toward each other, when there were no arguments, no fights, no sarcasm. I love that idea of family life, or that ideal, but we just don’t have that. Maybe you can’t have it. Maybe no body can, but we certainly don’t.”
Aware now of his increasingly obvious role as the guardian of the family, I asked Ted if he would mind my asking his children the same question as I had asked him: what did they think the problem was in the family? He gave me his permission. Sarah meanwhile seemed defiantly bored as she twirled a lock of her hair and stared off into the distance, so I addressed Wayne first.
Wayne looked at his father and ventured, “He worries all the time about everything I do. Whatever it is, wherever it is, whenever it is. It’s like being watched. It really gets on my nerves.”
“Maybe that’s his way of protecting you,” I said. “He seems to me to be extremely protective.”
Suddenly Sarah interrupted, “Whenever I’m watching television,” she said, ”and something bad happens to somebody – like a person in a story gets hurt, or mugged, or crashes a car – my father says to me, ‘That could happen to you, you know.’ Or ‘That’s probably what’s going to happen to you.’ I mean, like, give me a break, please.”
I said I understood her consternation.” But wouldn’t you agree,” I added, “that the world could be a dangerous place sometimes, and that you might need the kind of protection your father is offering, or is hoping to be able to offer? Don’t you think you might need his protection, even want it?”
“I suppose,” she said. “Yes, in fact. Yes. I just don’t want to be smothered in it.”
Then I asked a question that had been puzzling me since the beginning of the exchange. ”What about Mom, Sarah? Does she worry, too?”
“No,” she said flatly.
“Not at all? Never? Your dad takes all the responsibility for worrying.”
“Well, I don’t give her much to worry about. I don’t do things to worry her.”
“But every parent worries a little,” I prodded.
Sarah was becoming very uncomfortable. I think the rest of the family was, too. They seemed surprised and cha grined that we suddenly were discussing Joan, as if she were off-limits.
“Oh, my mom just sort of floats around all day,” Sarah said as she squirmed slightly in her chair. “She’ll start to clean the house, but then she’ll get into a crossword puzzle.”
She paused, as if she had gone too far. Then she decided to keep going.
“So, the house is a mess, if you really want to know,” she said. “It’s a sty. My mother just isn’t very organized. She’s funny. She’ll go an hour out of her way to take advantage of double coupons for groceries, using up in gasoline twice the amount she saved, and using up three times the amount of time. That’s where her time goes, out the window. She’s pretty disorganized.”
“I’m getting the impression that your mother doesn’t worry about anything, while your father worries about everything ” I said. “You have two very interesting parents: one who worries all the time, and one who doesn’t worry at all.”
I turned to Ted and asked, “How is it that you let her off the hook so easily? Your wife, I mean. It’s really very noble of you to do all the worrying. You take on this burden and allow your wife to be free from it. But I can’t help but wonder why it is so important to you that she is free from worry. Let me ask you a question. If Joan were to worry at all, what would you think she would worry about?”
“Her mother,” Ted said after a long pause. “Her mother lives in New Jersey. She’s old. She’s alone. Joan’s father died five years ago. Joan gets very anxious about her mother. I see the long-distance calls on the phone bill. She calls New Jersey often.”
“So she’s close to her mother.”
“Yes. If anything were to happen to her mother, Joan would no .doubt hit the panic button.”
“So, Ted,” I said, now conscious of this man’s self-sacrificial habit of distracting his disorganized, anxious wife from spiraling through her own worries. “I take it you worry a great deal about your wife?”
He looked at me as if surprised, and then shrugged as if on second thought he merely had heard me state the obvious.
“Yes, I do,” he said. “I worry about her all the time.
Everybody else thinks I spend all my spare time worrying about the kids, and, all right, I worry about the kids on weekends,” he added, chuckling. “But Joan, I worry about her all week long. I do. Honestly. Every day. You’re absolutely right.”
Joan watched him intently, wide-eyed, like a squirrel pausing between bursts of movement.
“And she gives you plenty to worry about,” I added.
Everyone laughed, Joan with a stiffened sort of relief.
“If something happened to her mother, Ted, do you think that Joan really would fall apart?” Ted paused again.
“If her mother were to pass on? Is that what you mean?
Oh, sure. For certain. I worry about that, her falling apart. She holds a lot in, my Joan, and it’s not easy to pick up the hints. But I’ve known her a long, long time, and I believe it’s entirely possible that if something happened with her mother, Joan could drop right off the edge.”
Joan twitched and grimaced involuntarily. The kids now were watching her intently. “Has she ever done it?” I asked. “Has she ever lost it, dropped off the edge?”
“Well, it’s not that she’s run off screaming into the night, but, well… this is hard – I hope this doesn’t hurt you, my saying this – but there are signs sometimes. Joan will all of a sudden announce at ten-thirty at night that she’s going shopping, for instance. Well, all right, other people go shopping at night, usually they plan it, or they’re people who are daytime jobs. It isn’t some impulsive thing they don’t just go off to the all-night supermarket because it s ten-thirty. I mean, like, Joan has spent hours in the middle of the night cleaning the attic! I swear, I’m not making this up – she takes stuff out of the attic and brings it down to the garage to be ready for the weekly rubbish pickup – at three o’clock in the morning. I mean, when it happens, I don’t have a good sense of where she is. And, yeah, it frightens me a little, and I worry about that. I do worry about her. She’s my wife.”
I nodded. I was very moved, frankly, and impressed. I said I needed a few moments to organize my thoughts I but that I did have ideas I wanted to convey to them before they left. I said I would like to exchange some of these ideas with Evelyn, because I knew of their concern for her, and I said that if they could make a recess and give me ten or twenty minutes, I would like to speak again to them briefly.
I took my break. I thought about the case, exchanged some ideas with Evelyn, and returned to the room to tell them what was on my mind.
I addressed myself to Ted.
“I’m very impressed with you,” I said. “You have been doing such a thorough job of taking on the full-time burden as the worrier for your family that I can’t tell you what deep respect I have for who you are and what you’ve done. I think you’ve been doing a job that this family has needed done rather desperately, and I think that you’ve taken it on despite the difficult role it has placed you in and its consequences. It evidently has made you the perceived source of the very problems you have protected everyone else from. You have done all the worrying for your entire family, with the ironic consequence that the family sees your worrying as the problem it is most worried about. It is remarkable what you have accomplished.
“Thank you,” I said. “I appreciate your saying that.”
I managed to recognize that your wife has needed you in a very profound way, and how faithful you have been in your concern for her and her peace of mind.”
”Thank you again,” he said, with heartfelt sincerity I continued, “You have given Joan license to be care free, free-spirited, while you’ve functioned as the mother hen, worrying about the children as if you were both parents, not just one. Yet I know that you have been worried, too, about what would happen to her if you were not protecting her, about whether without you, she might not go off the deep end, or panic, or become dangerously disorganized. By providing the right amount of distraction for her and then taking the brunt of her criticism, you have created the illusion that you are the source of the family’s discomfort. You are not. You’ve provided a smokescreen.
“I think it might be important for you and everybody else in the family if you were to find out just what would happen if you were not there to distract your wife from her worries. I believe that your worrying has been very valuable to her, and I don’t think you should give it up entirely. It occurs to me, as I am telling you this, that it makes perfect sense now why you would not have responded to your medication. Your body will not allow you to abdicate this role that you have embraced. It would be too dangerous. So, I don’t think you should give up worrying entirely – I think your worrying probably is necessary – until we know what direction your wife’s behavior will take if you are not doing all the worrying. So, you should worry some, but I would like to recommend that you contain your worrying to, say, one hour a day.”
Ted laughed. Then the kids laughed.
“I’m serious. When do you worry the most?”
“When I come home from work.”
“Okay, I’d like you to worry every day, as you have been, but instead of at random, do it for one hour, and in the presence of your wife, so that she can be reassured. You will continue therefore to have this job at least part-time, and while you’re protecting your wife, you’lll also have plenty of time about your life, maybe even seek some pleasure. In this way you’ll be able to continue to remain faithful and protective but without worrying all the time. You’ve been so extremely helpful and protective, but with the consequence that you haven’t had much fun.”
“That’s true,” Ted nearly whispered.
“Perhaps we also will be able to find out what Joan is so afraid of, and what will happen to her.”
“I’m out of practice at not worrying,” said Ted. ·
I grinned. “I have confidence in you,” I said. “Anyway, it’s like riding a bike. Once you learn how not to worry, you never forget the rudiments.”
He smiled. It was a broad and captivating smile of rec ognition, acceptance, enrichment, and gratitude. It filled me up.
While my solution seemed like a quick fix for what was perceived to be the problem between Ted and his children, I knew that his recognizing the usefulness of his anguish was going to result in a profound change in his perception of himself, and in the other family members’ perception of both him and themselves individually. No one could expect that he would stop worrying immediately, even according to a schedule he would prescribe for himself, but in time, I thought, he might stop. And then his wife would have to assume the responsibility for her own worrying.
Once again I had learned that the problem in a family was ot a problem but an attempt at solving a problem. Changing the way the family attempted to cope with Joan’s anxiety and her disorganized approach was bound to have consequences. I knew that and suggested as much. If reorganizing Ted’s worrying meant he and the children were going to be liberated to a certain degree from its weight and constancy, someone would wind up with the slack, and it would have to be Joan. Because of the entire family’s mutual protectiveness, the process no doubt would take time but it would happen.
Seven months later, I received a telephone call from Joan, who was visiting her mother in New Jersey. She said her whole life was topsy-turvy, and she wanted to see me. She said that Ted pretty much had stopped worrying, and now she was worrying, and she didn’t think she could handle the burden.
I said I thought it would be unwise for me to see her without seeing the rest of the family at the same time. ”I know how your family works,” I told her. “It would be too much of a betrayal to see you without them present.” I promised I would schedule an appointment for the entire family the next time I was in Chicago. I gave her a date for my next visit and the telephone number of the place I expected to be staying.
They never called. I don’t know exactly what happened, though the therapist who first consulted me did tell me that the family had managed months before to construct an adaptation to accommodate Joan’s anxiety. She had not seen them, either, since around the time of Joan’s call to me. I am confident that if Joan reached a point where she absolutely could not bear her burdens, her family would have found a way to spare her. Since she did not call again, she and her family more than likely conspired either consciously, or otherwise to design a fine alteration in the pattern, which ultimately protected her. And of course, Evelyn, their therapist – “grandmother,” would always be on hand.
This morality play of a case is an elegant example of how a family – parents and children together – colluded to create an illusion that protected one parent from an overdose of anxiety by targeting the other and unconsciously conspiring parent to exaggerate his place in the family.
The configuration is very common in families; sometimes a spouse sacrifices himself, sometimes a child or a grand parent. While it is usually an act of devotion on the part of the member who deflects the negative attention by absorbing it himself, if the sacrifice extends over time, it can be come a self-sacrifice that wears away at a person’s hopes and dreams.
The fiction that the family creates often serves to stabilize the family in response to unidentified threats to that stability. The “Achieving Failure” section of this book contains other examples. This case happens to be a fairly extreme example, wherein the father evidently showed his willingness to take on the pivotal negative role, and all of the children joined wholeheartedly in the conspiracy, protecting the troubled, anxious mother from the residual effects of her anxiety over her own mother.
I don’t think there was anything particularly dramatic about my intervention in this case, but the pattern is so common and yet so commonly overlooked, that the family almost always is surprised at my approach and my discoveries. When I see such a rigid and universally accepted description of a symptomatic member of a family, with almost no deviation on anyone’s part, I know both theoretically and intuitively that the family is telling me a kind of useful fiction. If everyone agrees with the story, it’s almost certainly a meaningful conspiracy that masks another story. If they all agree that they have identified the problem, the problem they have identified probably is hiding a greater problem. So, I can immediately begin a search for who and what their conspiratorial story is protecting, and when I detect it, I try to unbalance the artificial equilibrium they have created with their mythology. Once the family members are jarred loose from their agreed-upon myth, they have the opportunity to be as creative in forming new interactions as they were in forming their presenting problem.