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A READER'S TREASURY
Provocative Therapy
Chapter: Psychotherapy
by
Frank Farrelly and Jeff Brandsma
Published by Meta Publications/CA in 1974
Book Review by Bobby Matherne ©2007
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What's so provocative about Provocative Therapy? Inquiring minds want to know. I first read this book back around 1977 or so, and then my friend Tom Mellett wrote me recently about a comment that I made calling him the "Fritz Perls" of the Steiner group. Tom said he considered himself more as the Frank Farrelly of the email group. That sent me to my library in the hallway at Timberlane to locate Frank's book, and it was nowhere to be found. I searched my Library database and sure enough, it was listed as OUT, on loan to my daughter Maureen since 1998. I called her and she knew exactly where to find it, and after I retrieved it from her, I read it all the way through a second time for this review.
The answer to my initial question above came to me full force when I found myself ROTFL rolling on the floor laughing when I read the case studies titled, "Tragedy Revisited" and "Clem Kadiddlehopper." Frank discovered that deep pervasive change could come about quickly in his clients if he simply reacted honestly, told them the harsh truth, or consciously or unconsciously provoked them.
First the example of "unconscious provocation" that worked admirably, er, or at least very well in achieving a good outcome: "Tragedy Revisited." Frank had begun consulting outside of the hospital and taking cases on referral from colleagues. The case was to interview the wife of a patient who was hospitalized for paranoid delusions to get some data to clarify the basis for the mans paranoia. The colleague even suspected her of actually being unfaithful, but in multiple interviews, she had denied that to be the case. Frank woke up late that Monday morning, dressed hurriedly, and rushed out to the isolated farmhouse where she lived. Here's what happened in Frank's own words.
[page 12, 13] In the interview the wife sat on a couch across the living room from me. I leaned forward with my elbows on my knees, my legs spread apart, intently trying to get across to her that we really needed to know about this matter: if she had not been engaged in this kind of behavior, then her husband was paranoid; on the other hand, if she had been, then we were holding her husband in the hospital under false pretenses. Throughout the interview she avoided eye contact with me and seemed to be staring at my nondescript tie with a vague, preoccupied look on her face. To my surprise she openly admitted the whole thing and went into great length about whom she had had sexual relations with while her husband was at the hospital and prior to his admission.
I drove away from that interview with my chest puffed out, feeling elated, very skillful, and a real "pro." I also gloated over the fact that my colleague had worked unsuccessfully on precisely this point for a year, whereas I had been able to elicit the information in a single interview. And I thought, "Man, real skill will win out."
My elation lasted until I arrived at the county courthouse. I went to the toilet to urinate, found that my fly had been open during the entire interview, became beet red in the face from acute embarrassment, and stayed in the room for five minutes because I was so rattled. Upon returning to the hospital I told the ward staff exactly what happened. They guffawed uproariously at my whole "new approach to treatment": "Open Fly Therapy," was the appellation they gave it. Psychologist friends stated ponderously that this proved the dictum, "Change the stimulus, and you change the response." (The patient, it should be added, was rapidly discharged with recommendations for outpatient therapy for him and his wife.)
There were several lessons to be learned from my chagrin. I realized that alongside of the pain and tragedy in this field are some of the funniest things I ever heard and that the comic as well as the tragic mask seem to embody the main themes. In the clinical field. I learned to laugh at myself, at my mistakes, to share my "bloopers," and that other clinicians could often be sympathetic or supportive if I were open about my professional work.The next case began as a sincere experiment to maximize the therapist's honesty and openness. Frank and the ward psychologist were both to be present for this experiment, and they made this deal with each other: "Not only were we to be congruent in general with the patient but also with each other; if either of us said something to the patient that the other did not like or felt uncomfortable with, we would immediately 'call each other on it,' ask the patient to wait right there in the room with us, and 'thrash it out' then and there with each other." [Page 13] Well, as the poet Robbie Burns famously wrote, "The best laid plans of mice and men gang aft a-gley."
[page 13] After I set things up, the patient came into my office and immediately asked, "Are we tape recording this?" The patient presented an inimitable sight: he was without his false teeth, he had a shock of red hair standing four inches straight off his head looking as thought he were holding an electric fence. He had two squinty little pig eyes, a bulbous tomato nose, and talked like Red Skelton's Clem Kadiddlehopper.
I promptly went into hysterics, holding my aching sides and laughing until tears streamed down my face. The psychologist froze, cringed away from me, frowned, and stated, "Frank, that's no way to what are you doing?" I gasped out through gales and guffaws of unstoppable laughter, "I can't help it he's so screamingly funny!"Wow! There's an open and honest response, and talk about congruent! Clearly the ward psychologist would have never reacted the exuberantly honest way that Frank did. He would have taken the traditional calm approach and the patient would have continued to be hospitalized indefinitely. What was the result of Frank's guffaws? The patient improved and was soon discharged.
[page 14] "No, it's okay, that's been the trouble. I try to make people laugh, then they laugh sometimes when I don't want them to, and I get hurt and mad and into trouble." Bingo! (Our experiments continued on a weekly basis, the patient was much improved, and was discharged a month or two later.)
What might the ward psychologist have done? He likely would have been incongruent, saying one thing and meaning something else. Frank gives us a great automobile metaphor to describe what incongruent means. "Grinding one's gears," to those who never drove a clutch car in the 1950s or earlier, meant to switch gears without pushing the clutch all the way in or attempting to force a gear change that the transmission was not otherwise ready for. The teeth of the two gear sets did not mesh, but rather spun across each other, literally grinding each other's teeth away! And making a loud and obvious comment about your lack of skill in shifting gears. With the synchromesh transmissions and automatic transmissions of today, few drivers of today ever "grind their gears."
What Frank learned was that patients can hear when the therapist "grinds his gears" in a session and most of the patients are so used to the incongruence that their expectations for a real cure are very low. When such patients meet provocative therapy ala Frank Farrelly, they awaken and their expectations soar! Someone understands them and won't give them, as the "Dangerous Psychopath" told Frank bluntly, "no shit off the wall." [Page 15] Frank had developed an automatic transmission approach to therapy that removed the gear grinding.
[page 14] One thing in my mind was very clear: that radical congruence, if held constant, was very helpful to patients in interviews; that I could not only laugh at patients without detriment to them but even with help to them; that laughter towards patients was not inevitably "demeaning their dignity". I also felt very freed up in interviews. I wasn't "grinding my gears" and my responses towards clients weren't going in one direction while my thoughts, reactions and feelings were going in another.
How can therapists expect patients to listen to what other people tell them and make changes from their feedback if their own therapists do not congruently listen to them? Only by active listening and radical congruence can the therapist begin to join the world of the patient and thereby be of any help to the patient. After all, therapy patients get feedback from people all around them every day, not just in therapy, and ignore it, so the patients' listening skills need some help. Only if the therapist is able to model good listening skills in the session with the patient, can the patient learn to listen actively to others and garner help from their feedback.
[page 17, 18] "So the therapist's task is to get the patient in touch with this feedback either by (1) the therapist himself telling the patient, or (2) by getting the patient to listen to what others tell him spontaneously (and this feedback, one of the most potent sources of change, is available every hour of every day); (3) and finally getting the patient to ACT on this information.
Frank respected his mentor, Carl Rogers, but began to have problems with the two client-centered approaches that Rogers found most useful.
[page 20] Two images that seemed to have real meaning for Carl at this time, when speaking of the role of the therapist, were the roles of midwife and horticulturist. The horticulturist, I remember his saying a number of times, merely provided the appropriate conditions for the seed's growth. In the same way he felt this was what the therapist did to provide growth for the client(1). And the midwife, another analogy he used a number of times, did not create the person but merely assisted in his birth.
When Frank began to vocalize his approach, he got immediate feedback from a colleague that his approach was more along the line of the one conceiving the baby than the one assisting at its birth!
[page 20] I was becoming increasingly frustrated in my work with patients and clients using the client centered approach and waiting for the client to initiate most if not all actions and behaviors. And I remember distinctly the meeting in which finally I vented my frustration and told the project clinical meeting, "I'm sick and tired of trying to be a horticulturist or a midwife. I'm not any good in either role. What I want to do is to pry apart these people's shells, penetrate through to their core, and inject some LIFE into them." (In saying this I was pulling my hands apart, throwing my fist forward, and suddenly opening my hand with splayed fingers to indicate "injecting some life in them") Allyn Roberts, who was listening, chuckled and stated, "Frank, you're so phallic!"
Even though the Rogerian approach called for Frank to respond in a supportive manner, Frank soon learned that his own natural approach was to tell the truth, to treat the patient like an adult who can take the truth undiluted and though it be strong medicine, heal themselves in the process. In a field where recidivism is so high, he learned to warn patients that going home from the mental ward will be the biggest challenge they will have faced and thereby gear them up to meet the challenge. One need only watch the movie "Woman Under the Influence" to learn how crazy-making one's family can be when one returns home cured and all the family mechanism which drove one crazy are still in play when one arrives there. Watch in this next passage how he is tempted to lie to the patient, at first, but catches himself.
[page 21] In 1963 I was working on an adult female ward and was having a last interview with a patient who was to be discharged that day. I was speaking of what she could anticipate when she returned home. She anxiously stated, "My family is going to be watching my every move." I responded supportingly: "No, they won't." Suddenly the "light turned on" again and I said, "Yes, you're right, they will be watching you like a hawk. They're going to be wondering if you're going to be like you were when you had to come to the hospital. During the first week they're going to be 'charting' your behavior every hour in all of your roles as wife, housekeeping, mother and cook and your husband's going to be checking you out as a sexual partner, too, and watching your expression of feeling and anger. During the second week they're going to 'continue the observation' but will probably remark to themselves, if you're maintaining an even keel, that 'she seems to be in good control as long as we closely supervise her.' In the third week they're going to be saying to themselves, 'It's too good to be true, could it be possible that she's changed?' During the fourth week they're going to be saying to each other behind your back, 'She has changed but will it hold up?' And during the fifth week they're going to be saying directly to you, 'You have changed, thank God!' During the sixth week they will drop their 'charting', and from there on out, if you maintain a basically even keel, you're just going to be treated like everybody 'else. The point is, you can change the picture that your family has of you in their heads by engaging in the exactly opposite behaviors on your part and holding them all the time, and it won't take you anywhere near as long to change your 'rep', your reputation as you did in getting it. And it won't take any more effort, maybe even less, to act sane than it did to act like a nut."
What was the result? Exactly what Frank predicted. The family even talked of a "miracle" taking place in the patient. This outcome convinced Frank that other patients could change their behaviors if they chose to. He began to see that long, intense therapy sessions were not required.
[page 22] The lesson that came out of this experience was that people did not have to be seen "for five days a week for seven years," as some clinicians at the time were saying was necessary for some of these disturbed patients with whom I was working. It struck me that that was clearly impossible and it occurred to me that "if it's impossible, it's not necessary." We would simply have to find better and shorter ways of reaching and helping these people.
It's highly possible that it was this book that inspired me to tell some of my callers into the Crisis Line that their situation was hopeless(2). I wrote about this earlier in my review of Pragmatics of Human Communication this way:
When I worked on the Crisis Line many years ago, I would occasionally get phone calls from people who would ask for help with a problem and when you offered them a solution, they would slough off the suggestion with such comments as, "That wouldn't work for me." "I already tried that." and so on. No matter what the suggestion or how many suggestions one offered, they countered with a good reason why that wouldn't work. Finally I took to using the following process. After identifying that this person was one of those types for whom no suggestion would work, I would stop suddenly and say, "I've listened carefully to your problem and all the reasons you've given me why none of the suggestions I offered will work for you, and I must tell you that in my professional opinion your situation is hopeless." This advice was offered as a suggestion similar to the other ones that they had refused and they would invariably just as strongly refuse that suggestion. They might bring up a suggestion I made earlier and say, "What if I do x?" I'd recant for them the reason they had previously told me why x would not work and that would force them to overcome their objection. Suddenly the roles were reversed, they were working to find solutions for themselves and I was the one casting doubt on every suggestion they came up with.
When I had the occasion to work eight hour day shifts at the Crisis Line office, I would listen to the regular day counselor offer suggestion after suggestion to certain callers for hours upon end, to no avail so far as I could tell. When one of these callers got on the line with me, it took me about ten minutes. As soon as I recognized the type, I'd use the "hopeless" maneuver, and interrupt their endless game called, "Why Don't You, Yes, But?" It was given this name by Eric Berne in his book, "Games People Play." I came to call these people, my "Yes, Butter's" and actually enjoyed moving them off their favorite game and into taking positive actions to change their lives. Actions that they actually had come up with themselves, and which I only reflected back to them. Saying, "Your situation is hopeless" was exactly what they needed to resist, to push against, and to push themselves into healing and sanity again.
When Frank told a patient that he was hopeless after only 91 interviews, amazing things happened to the patient. He left the road to nowhere and started quickly on the road to recovery.
[page 26] At this point I "gave up" and said to him, "Okay, I agree. You're hopeless. Now let's try this for 91 interviews. Let's try agreeing with you about yourself from here on out."
Almost immediately (within a matter of seconds and minutes, not weeks and months), he began to protest that he was not that bad, nor that hopeless. Easily observable and measurable characteristics of his in-therapy behavior started changing. For example, his rate of speech markedly increased, his voice quality changed from a dull, slow motion, soporific monotone to a more normal tone of voice with inflections and easily noticeable affect. He became less over-controlled and showed humor, embarrassment, irritation, and far more spontaneity.This was the turning point for Frank Farrelly and he marks his wild stab at saying, "You're hopeless" as the beginning of provocative therapy. It is unfortunate that too often science is taught as if the theory under study were actually created in the systematic way it is presented in the lecture. That is never the case. It often starts as wild guesses, dreams, or flashes of intuition or insight. He quotes from Wm. H. Blanchard who pinpoints the process for discovering a discovery:
[page 3] It is a convention in the scientific world to report the emergence of a new theory as though it emerged slowly and inevitably from the analytical throttling of data. The scientist is pictured as plodding through his method, discovering some discrepancy in experiment results and myopically tracking this discrepancy until he stumbles over the doorstep of theory. Actually, far more often than not the theory springs into the scientist's vision as a wild surmise, and he spends most of his time searching for facts to fit it.
From then on, Frank began systematically adding new strategies to his form of therapy. He wanted a name for it, but rejected the name "Provocative Therapy" at first because of its sexual connotations. A colleague tried to talk him into using it and came up with this clincher: "You do spend time talking about sex, don't you?" Here's a simple strategy which seems too trivial to do much good. If a client stresses the "I cannot", Frank humorously agrees and spews a litany of doom and gloom messages that one's actions stem from economic, social, psychological, or cultural necessities, etc., over which one has no control until finally the client gives up and admits the "will not." Frank actually believes that the client can but wills not to and he doesn't rest until the client agrees, at which point real change in the client has happened.
[page 41] Clients have far more potential for achieving adaptive, productive and socialized modes of living than they or most clinicians assume Doom and gloom prognostic statements regarding clients' lack of ability are rampant in the clinical field and are probably much more a reflection of the individual clinician's subjective reaction of helplessness and hopelessness than any objective statement regarding the client.
When does Frank start his provocative therapy strategies? Many times with the first words out of his mouth. Here's an example:
[page 61] An obese patient enters office.
C: May I speak with you Mr. Farrelly?
T: My God, the Goodyear blimp has slipped its morrings!But it may come at any point in the interview. Suppose a client begins to get angry. Does Frank try to talk the client out of being angry? No . . .
[page 60] C. (Angrily, loudly): You'd better quit talking like that or I'll . . . T. (Interrupting, evenly, starring steadfastly at client.): If you want to throw a tantrum, why, go ahead, be my guest. (Changing his voice tone to enthusiasm.) Why, hell, here at this hospital we have what I call a temper-tantrum room for people like you who need to have temper tantrums. Actually, the rest of the staff call it the seclusion room, but I think temper-tantrum room sounds better, don't you?
Ever wonder what therapists spend their time doing in those three-times-week sessions? Frank tells us plainly what they do: a lot of hinting instead telling outright. Hinting takes up a lot of time. Just think how much it would cost to have a water pump replaced if your auto mechanic used this strategy of fixing a problem. "Do you think it may be a hose leaking or something more serious? Our time is up now we'll talk more about that when you bring your car in next time."
[page 61, 62] Too many therapists feel that, as one trainee put it, "You can't just come right out and tell the client your reactions to him or your hypotheses or judgments about his behavior." They usually predict dire results if they were to do so "Well, the client would get upset!" In various situations responses to that have been, "Hell, he's upsetting me, his family, the court, his employer, the rest of the world, so why not upset him for a change?" or "This is the client's third illegitimate pregnancy, so let's try something different; instead of understanding her needs, her conflicts, etc., get her to understand how everybody around her is upset and the community doesn't like it. If she would start meeting someone else's needs, some of hers would get met in the process." Many therapists prefer to eternally hint to the client rather than tell him bluntly and quickly.
"The human mind needs truth just as human lungs need air." This is a beautiful metaphor by Frank which summarizes the situation. One can imagine the thousands of clients across the country sitting in the stifling air of small therapy rooms which are filled with half-truths, insinuations, and hints instead of truth. They are the modern "huddled masses yearning to breathe free" as Emma Lazarus wrote in 1883. Obviously she was not talking about the air quality of Europe versus the United States of America. It was the quality of truth and freedom that our United States have that she referred to in her famous poem engraved within the pedestal of the Statue of Liberty. Frank Farrelly is a "wild and crazy guy" whose provocative approach to therapy blew fresh air into therapy rooms across the world and changed forever the way therapists viewed their clients and their job.
---------------------------- Footnotes -----------------------------------------
Footnote 1. Cf. "Necessary and Sufficient Conditions of Psychotherapeutic Personality Change," Psychology Today (January, 1957), 10.
Return to text directly before Footnote 1.Footnote 2. These Crisis Line calls came in at home between 2 and 6 AM which was my shift while I was working a day job. My wife, Del, who was awakened by the calls, told me as she copy-edited this review, "I couldn't believe you were saying that! I was surprised and concerned at first when I heard you do that, and then I was amazed later in the call when the person on the other end was pulling for options they had previously declared would not work for them."
Return to text directly before Footnote 2.
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