DK: Our blog is about attending to the effect of relationships, most specifically family relationships on mental and emotional health. When we describe clinical experiences there is an implicit description of the process of psychotherapy. What does the psychotherapist do and say? Many think of psychotherapy as an investigation in search of an explanation, an interpretation. What I do in experiential therapy is to work to create experience in the interest of change. Sometimes the change is sudden. Most often it is slower. Slower change can be called ‘growth’. Language is used to describe experience, but language can be used to create experience as happens in this clinical report.

The following clinical story is an example of intuitive attention to symbolic relationships. The therapeutic benefit relies on the loose hold that language has on the reality to which it attends, and gives evidence that words are not simply tools but machines. Therapeutic experience occurs out of being playful with language and relationships:

The Case: There were three middle-aged sons managing a sizeable and successful Property Management & Real Estate firm. However, they were under the direction of their widowed 83-year-old mother. Their father, who had developed and directed this sizeable firm, died three years previously. Their mother, appointed by her husband at the end of his life, became the matriarchal CEO of the family business. She was vigorous but troubled. She had limited business experience, and in effect was dependent on her sons  to give her direction in how to direct them. In her agitation she called her them  constantly about the business, about dealing with her dead husband’s possessions.

Unknown-1The mother was having trouble making decisions, but resisted turning power over to her sons. She asked their advice, but dismissed their suggestions. The sons agreed their mother was depressed and wanted Dr. T, my friend and colleague, a well-known family doctor, with a therapeutic mindset to see their mother. Her status and the family’s prominence made him uneasy. He wanted to include a psychiatrist in the treatment, myself. “No”, said the sons, she does not want psychiatric help. She does not ‘believe’ in psychiatrists.” My doctor friend went ahead. He saw her twice, then told me about it one morning when I was in the Department of Family Medicine to do a consultation seminar with the residents.

He reviewed her problems with me, a series of fairly concrete complaints about her sons’ behavior and issues related to running the family business, and her attempt to maintain the system in the way she believed her husband would have wanted.

I listened, then gave him a more elaborate variation of the following, “You could say, ‘This certainly is a large and difficult set of problems for you to be dealing with all by yourself. It sounds like you are stuck with being both father, mother and CEO. I suppose the best solution would be for me to marry you, but in order to do that I would have to divorce my wife and that could take a long time. Or, another idea, I could arrange for you to adopt me and make me your oldest son, then we could run the company together, but I know your sons would be upset if I tried to assume any authority. They wouldn’t listen to me.’”

My friend chuckled, “Sure, Keith, that’s amusing, maybe you could say something like that, but not me.”

UnknownThree weeks later. “Dave, do you remember me telling you about the family matriarch and you suggested I say something I didn’t think I should say? Well I saw her ten days ago and near the end of the interview, I was feeling perplexed again, not certain what to do or say. I heard myself saying almost exactly what you suggested. It just came out as we were approaching the end of the session. I could scarcely believe I was saying it. She just looked at me for a long moment, then changed the subject, as though I hadn’t said anything. She decided not to make another appointment. I was upset with myself, and you. I thought I made a mistake and I was very disturbed about the situation. But yesterday her son called and said, ‘I don’t know how you did it, but our Mother is a different woman. The number of phone calls has dropped. She is much easier to talk with, she just isn’t as anxious as she was. Thanks so much.’”

Then three months later my Family Medicine friend, Dr. T, called to tell me that the matriarch made a $45,000 donation to the Department of Family Medicine, so that a fund could be established for the purpose of teaching young Family Physicians to do what Dr T. did.

images-8This was an unexpectedly good outcome. But we weren’t sure what he had done. When she was troubled, viewed as depressed, what did her behavior signify? How did I know to say what I did? I was being playful with language about symptoms and relationships. I am not sure where those comments came from except long term implicit awareness of symbolic and experiential family systems, awareness of family relationships that simultaneously embody past, present and future. Part of it came from what I know of psychodynamics, part of it came from the spontaneous logic of language and part of it came from my parallel play mindset, which I have described elsewhere. The comment that occurred first in our conversation was based on my intuitive perception of a symbolic system, what I refer to as the not articulate-able totality of concerns, made up of a blend of fears and hopes. There is a totality of concerns in every family.

My view is that Dr. M’s comment affected her symbolic (subjective) organization; it had a non-intellectual effect in the realm of symbolic experience, and provided what turned out to be a refreshing immersion in absurdity. Part of Dr. M’s reputation and his adequacy as a family doctor was based on the care and attention he brought to clinical work. His patient, the mother,  felt cared for and expected to be helped by him. Perhaps he teased her in a way that refreshed her, in a way that no one had in a long time. Therapeutic teasing, teasing with caring, is a novel experience of the kind that can be richly therapeutic.

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