Saturday, August 16, 2014

Radical Emotional Honesty

Humanistic Therapy

Carl Rogers has been a long time favorite psychologist among psychologists, and his Humanistic/Client Centered Therapy has found many practitioners and advocates since its creation in the late 1930s. While Rogers' complete theory and methods are well beyond the scope of this article, his approach has several notable characteristics which were unique in his time, and which have inspired many other therapists since.

Back then, the only schools of psychology that existed are the two which are now considered "classical"; Freudian psychoanalysis (and subsets like Jung's work) and Pavlovian behaviorism. While the "classical" schools tend to treat people as machines being examined under a scientific microscope, Rogers saw people as being real humans, with real lives, real problems and real feelings. Whereas even today many schools of psychology (and especially experimental psychology) tend to refer to psychologists as though they're a separate, impartial and superior species, Rogers recognized that psychologists were just normal people also with their own problems, feelings and limitations.

The central tenet of Rogers' theory was that 'psychological maladjustment' results whenever a person "denies awareness of significant sensory and visceral experiences, which consequently are not symbolized and organized into the gestalt of the self structure". Put another way, emotional insanity means denying any part of your experience. This is a theme that I've seen and written about over and over; in buddhism and taoism, Acceptance and Commitment Therapy, the Diamond Approach, IFS and elsewhere. Rogers' approach was unique, however, in that he emphasized curing this with emotional honesty and also how important it is for the therapist to maintain a non-defensive, benevolent attitude towards their client(s). I should note that IFS emphasizes the latter but not the former.

Due to the success of Rogers' methods in treating a variety of classically "difficult" clients, and due to its allowance for both the client and therapist to be normal humans beings, Humanistic therapy spread like wildfire and is still popular today. It has also influenced numerous other schools of therapy directly or indirectly including NLP and IFS.

Frank Farrelly and Provocative Therapy

During the 1960s, a therapist by the name of Frank Farrelly developed an extension of humanistic therapy which he called 'provocative therapy'. Unlike Rogers, who had primarily worked with people who attended therapy voluntarily, Farrelly worked in an asylum with people who often did not want therapy, and who even liked living in an asylum and getting free room, board and drugs.

When Farrelly began practicing as a therapist, he used the same Freudian psychoanalysis that all psychologists learned at the time. After a colleague introduced him to Rogers' work, Farrelly quickly found that it caused a revolution in his practice. Suddenly he was able to achieve amazing results with clients that none of the other psychologists in his office could get an inch from. He continued practicing Rogerian client-centered therapy until a series of events caused him to accidentally discover an even more radical approach.

The first case was a woman who was suspected of cheating on her husband, but refused to talk to any of the other therapists about it. When Farrelly was assigned to go out and interview her, she surprisingly confessed to everything, which he later learned to his embarrassment and the bemusement of his colleagues was due to the fact that he had forgotten to zip his fly in his rush to make the appointment. Later on he had a difficult schizophrenic patient which he was making no progress with after many sessions. One day with this schizophrenic, Farrelly was bored out of his mind from the patient's drolling monologue and decided to fall asleep right there on the spot. The schizophrenic was utterly shocked at this behavior and suddenly began expressing an interest in making actual progress for the first time since Farrelly had begun work with him.

Humor and the Devil's Advocate

After this, Farrelly began to actually purposefully employ such methods to shock and disrupt his patients out of their dysfunctional routines. He found that since a person with psychological problems generally believes absurd things, the best way to approach such a person is to take their absurdity and run with it. By taking their absurd propositions and drawing an even more absurd conclusion, by agreeing with them and then exaggerating or understating details, by mocking them in a friendly manner, by confronting them when they're lying or trying to take advantage of the situation, by purposefully misinterpreting what they say, by using puns, non-sequitur, and so on. When put together, to the client or patient it's as though their own dysfunctional behavior has become the butt of an elaborate joke. The therapist in this case is basically externalizing what he sees in the client, while exaggerating things to make it more obvious to the client how other people actually see them.

Farrelly also liked to "play the devil's advocate", actually taking the side of the patient in continuing to display their dysfunctional tendencies. Instead of arguing with the patient and telling them to change, he would agree with them, elaborating things that they might think, listing off benefits of their dysfunctional behavior, and even encourage them to behave worse. By doing so, he was actually taking the place of the person's inner voice and driving it outside, where the person could then choose to argue against it themselves.
In a typical situation provocative therapy takes a three-pronged approach. First, by using humor to make it obvious how other people see the client, second by playing the devil's advocate in order to allow the client to face their own inner dialogue, and third by using confrontation in order to maintain a therapeutic context and to prevent the client or patient from derailing or taking control of the interview (intentionally or otherwise).

Emotional Honesty in Provocative Therapy

Although provocative therapy employs many different specific techniques, the choice of their usage still comes down to doing whatever is the most emotionally honest and which has the most positive impact. To that end, humor is not necessarily appropriate in every situation, for example Farrelly admitted that when confronting a rape victim he would still have to tread very carefully and make sure that he was well calibrated before attempting anything highly provocative. Sometimes what is most appropriate is to be emotionally supportive or compassionate, and sometimes the best result is to have a client crying rather than laughing.

Every person and situation is unique, but if you know what any human's natural tendencies are and if you are well in tune with your own feelings then it is possible to get an intuitive sense for what is most needed in any given case. However with provocative therapy this also carries a great danger, because if at any time the therapist loses their emotional composure they will end up projecting either weakness or hostility to the client. If that happens then the therapist either loses their credibility as a leader or ends up coming off as a douchebag, respectively. While the former is usually recoverable, I can hardly even recall all of the various relationships I've lost due to the latter. Sometimes I might get a second chance, but a lot of the time they never speak to me again. I've even had at least one case where I managed to chase them off during the very first interaction and then never saw them again. This can make learning provocative therapy very difficult and discouraging in spite of its profound effectiveness.

Provocative Therapy and Ericksonian Hypnotherapy

Provocative therapy and Ericksonian hypnotherapy are like two sides of the same coin. On the one hand, Erickson's "utilization" approach to hypnosis and therapy was often very provocative and sometimes even recognizable as standard provocative therapy. On the other, Frank Farrelly often found his clients "spacing out" during intense provocative therapy sessions, which annoyed him until someone told him about Ericksonian Hypnosis and he recognized and began utilizing those trances for therapy (although not hardly at Erickson's level). Provocative therapy can thus be seen as an extension of and as an explicit codification of Erickson's approach to therapy. The reverse, however, is less true since Erickson's work encompassed many things which provocative therapy never incorporated, such as trance phenomena, indirect associative focusing and so on.

I should also mention that Richard Bandler and John Grinder also studied Farrelly's methods, which were highly influential especially for Richard Bandler's approach to therapy. However, they never formally codified provocative therapy (which fits poorly into the overall mechanistic model of NLP) and in spite of the fact that most of the crazy stories they tell from the early days center around provocative therapy, they hardly ever mention it (or Frank Farrelly) anywhere. This is at least one of the reasons why people who read about and train in NLP have so much trouble reproducing the results that Bandler and Grinder achieved.             

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