Mr. Satuday Night

I want to teach you a simple family therapy technique. It is the whole of family therapy, really. Not that you can't learn from it if you're not a therapy doc. Maybe you can.

Deep breath.

We use big words like process, meta-message, homeostasis, triangulation, and the like. But the most complicated lessons are more intelligible without all that jargon. Process is one of them.

Do you remember the movie, Mr. Saturday Night?

I haven't seen it in years and can't remember the entire plot. I keep meaning to take it out and watch it again. But I usually remember the key messages in films, the ones that family therapists take out and mull over to eventually tell over when the time is right.

It's about a comedian, Buddy Young, Jr. (Billy Crystal) and his brother Stan (David Payner). Buddy has all the ego; he's a performer and he's brilliant, but he emotionally and verbally abuses Stan, his accountant for many years. We watch them age, Stan more gracefully than Buddy.

One of the things Buddy does well, for all his faults, is teach Stan process. After he tells a joke, or better yet, enacts the joke, performs a sight gag, Buddy says to his brother, See what I did there?

That's process. What he does, is process, not usually what he says. If you can see what Buddy does to make his audience laugh, you get process. It's much more than telling a joke. Families do this, too. Everyone in a family behaves in ways that make everyone else respond. Except usually, if they're in family therapy, they're not getting laughs.

Forget Mr. Saturday Night for now. Let's use a typical family therapy example that a student presented to me in supervision. He tells it over like this.

It was great. We were sitting in your office and Don (15) completely ignored his mother's request to stop playing with his cell phone. But he put the phone away when his father asked him to. So I asked the father, "Why do you think Don listens to you and not to her?"

"Because she never makes him do anything," Dad replied.

My student was very proud of his question and how the father got involved, how dad thought about it and proffered the interpretation about the content. But it's times like these that I press an imaginary buzzer and say bzzzzzzzzzz to indicate wrong and I say as much. Wrong.

"What's wrong?" asks the student.

Give me your best shot.

"I thought that went well, actually. We were making the point that mom has to get tougher to get respect."

And who made the point?

"Well, Dad did."

So this is a chidish, him beating on her in front of the children? (a chidish is Hebrish, a combination of Yiddish and Hebrew, meaning something new).

"I suppose not."

Well, we really showed her.

"I guess it didn't accomplish anything."

It didn't accomplish anything because the student got sucked right into the family system, played into their family hand, joined the family discussion about "safe" content. The problem isn't really about the kid listening to one parent over the other. That's "safe" content that allows Mom and Dad to disagree, probably to avoid intimacy, which as we've already established, scares almost everybody.

Most functional couples will disagree about parenting but they find ways to do it together without egregiously annoying one another. They talk about differences and find resolutions without putting one another down, especially in public.

This couple had a fight in my office so that someone, theoretically the therapist, would stop them from fighting destructively. What my student witnessed was a family enactment of their biggest problem.

After they hurt one another, couples will retreat to their own respective little corners and won't come out for awhile. Kids are very uncomfortable with this. They want their parents out of the ring altogether. They want their parents to be happy. So a kid will lure his parents to my door by becoming the "identified patient." You have to misbehave to do that.

Kids are very smart, so they do that.

I told my student that one of the things he might consider doing with families is commenting on process. You try to make the family aware of what they're doing. You ask, DID YOU SEE WHAT HE (anyone in the family who does just about anything) JUST DID THERE?

Or

(to the group) DID YOU SEE WHAT JUST HAPPENED HERE?

Someone might say, Well, so and so insulted so and so. Or So and so isn't listening.

Then you can say, Why don't you guys talk about that.

Even if they look clueless and say nothing and act as if they didn't see anything, you don't interpret for them. You don't fall into that same old trap of being the smart, wise old doc with all the answers. You say, Why don't you (anyone) talk to him (anyone else) about either (anything) or (anything else).

You get 'em talking. If they hurt one another you stop them. Wait, I'll cry. You can't do that here. Now talk about . . .And do it nicely.

And as soon as it makes sense, you dismiss the young sacrifice, ask it to wait in your waiting room while you talk awhile to its parents, keeping in mind that the goal is for them to talk to each other, to love each other and express that. Take that risk.

Leave your office happy.

Junior is superfluous, really. Once you have the 'rents alone you can cut right to TherapyDoc's favorite list of questions (Q) and directives (D) that a therapist could care less about but which are far more interesting any day of the week than talking about how to punish Junior.

(Q) So how did you two meet?

(D) Talk to each other about how it feels to be in this predicament at this stage of your relationship

(D) Talk to each other about what you could have, should have done differently over the years. . .

If you feel resistance you can start a little more softly with,

(Q) What was he like as a baby?

(D) Tell her (him) when you first noticed that Junior stopped looking you in the eye?

(D) Tell her (him) how it was for you when Junior left for nursery school.

(Q) Did you two argue when he was a baby?

Then crescendo with a vengeance to

(Q) Did you two argue when you were engaged?

(Q!) Why do you think that was?

(D) Tell him (her) how you felt about (pick content)

(Q) Did you think it wouldn't last, this marriage of yours? DO you think it will last?

(Q) What's it need, really, your marriage?

And that's just the short list. Your objective is to track back to better times. Everyone likes you when you get them to talk about happy times. And the goal, of course, is that they like you so there's a chance of trusting you and coming back to see you so you can help them get out of their corners, get out of the ring, and into the sack.

And you definitely want to do some individual work with ALL of them. Early as possible. Especially with Junior. It hasn't been easy being Junior.

But the family will do best if you teach process. Without process they'll never stop playing Who's the Better Parent? Or Who's the Worst Kid?

And they'll NEVER get under the covers together that way.

Interpreting, chatting with the patients, holding court, this is what therapists who haven't been trained in family therapy do when they think they're doing family therapy. These are psychodynamic, individual therapy techniques. And they're great for individual work.

But you have the family in your office. MAKE 'EM TALK TO EACH OTHER.

This way they don't have to depend upon a professional for the rest of their lives. It's not about learning one lesson. Face it, nobody remembers anything for more than a week. (See The Five Minute University on U-Tube.)

Okay. Back to Mr. Saturday Night. If you haven't seen the video and plan to see it, don't read any farther.

At the end of the movie Buddy, always the star, is seeing pretty hard times and Stan, always in the proverbial shadow, is retired but happy. The men are old, well into their 80's and they're reminiscing.

Stan says something to the effect that he wasted years of his life working with Buddy. Buddy defends himself. I didn't take your life, Stan. I gave you one.

Then Stan tells over the line I've repeated a thousand times in therapy, and now you probably will, too, at least once, to someone.

Yeah, but you could'a been nicer.

I just love that line.

Did you see what I just did there?

Copyright 2007, therapydoc

Staying Connected

I'm not going to get too wordy here because it's Monday and the implications are scary, so much to do. But the lesson here is worth a quick post.

The "he" in the story could be a female or a Martian, there are no true identifying features in this post.

Several years ago I had a professional acquaintance who called to give me a head's up that she had referred her father to me for therapy. Her father's sister committed suicide and she worried her father was at risk.

He called that day, and I couldn't get him in immediately, told him it would have to wait a couple of weeks (!). Could he wait? Sure. I've waited this long.

He presented with two Axis I disorders, severe anxiety and dysthymia (ever-present depression, the low-grade fever thing). You would think the two can't co-exist, but they can. You're never depressed ALL of the time. You're never anxious ALL of the time.

His sister had just committed suicide. I should have done that a long time ago, he whispered

Would you want this case?

Past retirement age, our guy still worked, very responsibly, even though each day he felt inadequate.

He had been in and out of therapy for over thirty years.

His crippling anxiety, which surely did come from severe childhood emotional abuse, made parenting (and partnering) very difficult. His wife left him while the children were small (she took them with her), and he never had any meaningful contact with the kids after that, even though they begged him to talk to them, to be a part of their lives. He just didn't have the social skill to listen or to talk. There were four children. Four children, no contact. It really does happen.

Never had anyone discussed repairing his cut-offs with his children. The therapies, according to him, all addressed his relationships with his parents, his marriage, and his childhood problems, his lack of sexual/relationship attachment.

See, it's not that difficult, this case. There is a universal need to be loved by one's parents, and a universal need to be loved by one's children, and that can be repressed, of course. But it's there. And it has to be addressed if meaning in life is at all important.

Tiny steps, of course, he had to make the first moves, the calls, the visits, the toys for the grandchildren, the birthday cards and gifts. He didn't have to really talk very much at all to anyone in this therapy, but he eventually did, all on his own. It's a behavioral family therapy. Say hi, visit, go to the grandkid's baseball games. Quick guerrilla visits. Hi, Bye.

Put yourself on the map. You don't need to be a star.

No idea what those other therapies were about. Don't care. He did so well.

It's just an example, right? Anyone could see the need for that kind of intervention.

Was he still at risk? I thought so. You know how it is when people feel a little better. They have the strength to hurt themselves, whereas they hadn't before. But the thought of hurting the little ones like that, the grandkids, served as a deterrent. He said as much. And I lay on guilt big-time when it's deserved.

But I kept an eye on him over the years.

What's lovely is that I never even had to bring any of his children into my office to do that family therapy. The family system was in the room, everyone was in his head.

That's how you need to think.

Copyright 2007, therapydoc

Schizophrenia , Genetics, and the Double Bind

Oy, there seems to be some confusion:

If ANY of you get the impression from this blog that schizophrenia is caused by family behavior, think again! That erroneous thinking was common in the sixties, family therapists, believe it or not, had perpetrated such nonsense with talk of the "double bind." Even I, who trained in the early 80's heard this kind of misinformation at the Family Institute of Chicago.

A double bind is a situation in which a person has to make a decision, but no matter what the choice, he loses. In a family context that person is the kid. The kid will either upset one parent or the other, or will somehow sacrifice himself. That behavior, that self-sacrifice, is the "schizophrenia."

For example, let's say, one parent says, I really, really want you to visit grandma after school. But the other says, Don't even think of visiting your grandmother after school. That's a double bind.

Family therapists, especially the Italian school in the sixties and seventies, proposed that double binds made children behave in ways that seemed "psychotic." The word they used, and it's a marvelous word, is

schizophrenogenic.

Schizophrenia, according to these docs, was caused by family dynamics.

NO, NO, NO. We're a lot smarter now. We're sure it's from a genetic predisposition. Pretty sure, that is. Schizophrenia often presents for the first time when a person with a genetic predisposition is under social stress or in an unusually stressful context, like academia, being away at college.

Sorry for the confusion if there was any.

copyright 2007, therapydoc