Using the « disadvantages of change » and other lessons from our mentors.

Communication à la dixième journée de Rencontre de Paradoxes, 15 octobre 2011
Katharina Anger, PhD and Barbara Anger-Diaz, PhD

A personal account of our experience with the inventors of the Brief Therapy model, including a specific piece of wisdom handed down by each of them.

In 1976, at the 2nd Conference commemorating Don D Jackson, who had been his colleague on the Bateson Project and founder of the Mental Research Institute (MRI), John Weakland spoke about Bateson, Erickson and Jackson as the mentors that most influenced the work of MRI’s Brief Therapy Center (BTC) team.  Thirty-five years later, it is our turn to remember and honor those BTC team members – our own mentors: John Weakland, Richard Fisch (Dick) and Paul Watzlawick.Katharina et Barbara

John, in that talk many years ago, suggested that right along with “hard work, heavy thinking and carefree observation” one cannot dismiss the importance of accident (in the way influences come about, relationships get formed), relating how he himself happened to become acquainted with Bateson in New York, and how through accidental connections the latter had come back to New York from California to get funding for a project looking at the paradoxes of abstractions in communication, and had asked John to join him in Palo Alto.  Accident, John implies, brings people together, and so we have our own to tell.

Barbara:
It all began with the summer of 1990.  My husband Manuel had been invited (by his company) to attend the Stanford Executive Program.  At the time we lived in Mexico.  I could not share in his activities at Stanford, not even his room, and so, having decided not to be left behind, I had to find something in Palo Alto for myself as well.  I vaguely remembered that there was a Family Therapy Institute there, but had to be reminded by my colleagues at my university that it was the MRI, about which I knew next to nothing. I was familiar with the Bateson Group’s article on the double bind, but had no idea of the therapeutic ramifications of that group’s thinking (having been trained in psychoanalytic therapy myself) – did not know about John or Dick, and barely recognized the name Paul Watzlawick.
I called, talked to Karin Schlanger who was in charge of residences at MRI, signed up for six weeks and got a room through MRI with two very old ladies, in whose house Paul Watzlawick had lived for no less than 20 years.  They were happy with me and invited Paul and his wife Vera for a Sunday waffle party which they occasionally gave for friends.  They also invited Manuel, and that started a friendship with Paul and Vera that was to last for all the years we were in California, and turned the nature of my relationship with Paul at the MRI into a much more private, confidential one.
Back in Mexico, while I was trying to figure out how I could manage to go to Palo Alto for a 9-month-training in Brief Therapy with John and Dick, Manuel was promoted by his company to manage the Americas, which required our moving to what is known as Silicon Valley.  I immediately signed up for that training.  We were four people being trained, and one evening I invited everyone (including Dick and John) to our house.  All evening long Manuel decided to challenge John, asking him what he was doing to guarantee succession to his work and that of the Brief Therapy Center so that it would not get lost after he died.  Dick sat in a corner observing and laughing all evening long.  Anyway, that initiated a closer relationship with John, his wife Ana, and Dick.
Later, when John became sick, I asked him if he could still come to dinner.  He said “sure”, asking if after eating he could lie down on our living room couch, from where he would speak out, commenting on the conversations that continued at the table, or say to Manuel:  “Aren’t you forgetting something?” – usually meaning the Cognac he was used to getting after dinner, or a cigar.

Katharina:
Personal experiences aside, we would like to share with you some memories of the work they did.  Although John said that no part of the work could be attributed to any one member of the team (the ideas having arisen out of the ongoing interactions among them), we have chosen to highlight approaches or techniques that remind us of each of them.

DICK (narrated by Barbara):

What can I say in just a few words about Dick?
The Brief Therapy Center was his project, and he was its director until he retired around 2006 (after 40 years).  He got it supported with funding by Don D Jackson, and in agreement with the others, set its parameters.  One of it was to frame it so as to be able to find out how much could be accomplished in 10 sessions, applying concepts, within a systemic approach, that had been fermenting since the Bateson project.  But let me state what Dick wrote for me just a few years ago:

“I’d say that Brief Therapy with us started when the three of us [John, Dick & Paul] felt that Family Therapy was changing in a way that we didn’t like; i.e. originally the concepts of it were clear, to the point and providing a very useful way of moving away from traditional therapy (mainly the work of Freud and his followers).”  …  but

“We each agreed that Family Therapy was becoming enlarged in its concepts and more unfocused in their ideas.  In our discussions about it we started to talk about “doing something” and that led to deciding we would focus on ideas to make the therapy “cleaner” and “briefer”.  I went to Don Jackson and told him what we wanted to do and asked him to help us by providing us with funding.  At first, Don was equivocal.  So I told him I was going to go ahead with our project even if he didn’t help.
“He smiled and said, “I’ll get you the funding” and within a month or so he got someone to fund us for two years.  And we began.”
Central, we think, was his continued collaboration with John (even after their work Tactics was published in 1982) to make therapy as efficient (“cleaner”and “briefer”) as possible, turning it into the minimalist type of therapy we try to practice, yet with steps and positions very clearly defined.
At the BTC, Dick supervised untiringly, and we team members, other than the big three, always considered ourselves to be on the “hot seat” when it was our turn to see a client.  Of course to be successful, there was a great emphasis on cutting short, saving time, and so when a client told all sorts of details  considered not germaine to the problem being worked on, Dick taught us (by example) to interrupt the client as soon as it was clear that the client’s meanderings were not relevant with:  “For the sake of saving time, let me interrupt you and get back to…”.  And yet Dick, who always analyzed very closely, never let the client off the hook when he wasn’t clear about what the client was saying – in other words, he took time for that!
Dick was methodical and we tried to learn from that.  When we were distracted by a disagreeable client, he would smile and say: “In therapist heaven you could say what you feel like”, implying that however here – not therapist heaven – you  had better be strategic.  Dick would not be distracted by intellectual rhetoric, and always stuck to what was concretely in front of him.  He, more than any of the three, it seems to us, emphasized reducing the problem to something workable.  Therapists often are faced with a client who sits back as if expecting the therapist to do a miracle, without any apparent intention of working to induce a change in their own situation.  Dick gave us the freedom of choosing who in the system we want to work with, and always urged not to work harder than the client.  It led us to recognize that going “slower” than the client was an important motivational tactic.
And then there was the Dick teaching how to teach, always striving to make things clearer, more useful, e.g. with his exposition declaring that there were basically three types of therapist interventions: procedural, of opportunity and planned.  All the things we do as therapists to proceed with brief therapy – the questions we ask to help define the problem, to help the client prioritize, to reduce it to something workable, the steps themselves that we follow, the instructions we give, etc. – not only help us implement the therapeutic process, but actually constitute interventions in and of themselves, for surely asking enough questions to turn a problem into something manageable is generally helpful to clients.  Then there are the things we say that occur more spontaneously, and certainly in a less planned fashion, where we fit in comments when the opportunity comes, like offering a reframe where perhaps a symptom is connoted positively, offering the client a different perspective, or the stories we occasionally tell to illustrate or to facilitate a change of view, the opportunities we take to make 180 degree comments – all made on the spot (although no less strategic) in attempts to intervene .  And then there are the planned interventions, referring to what is said or done in the next session as a result of discussing or thinking about the case after the previous session, in a planned manner, or the homework assignments we give, or anything we do as a result of planning the session.  We have found that thinking of interventions in this way is quite helpful, often helping us become even more strategic when we say anything to the client.

JOHN (narrated by Katharina)

My accidental introduction to the MRI happened in the summer of 1990.  As stated, my mom was at the MRI due to her own set of accidental circumstances that summer and while there she was diagnosed with cancer.  I went out to be with her for surgery which was scheduled at the time of MRI’s annual summer symposium.  On that first day, I went to hear Paul’s famous introductory lecture.  I’m sure many of you have heard variations of that same wonderful talk!  I was a psychologist in New York at the time, training in psychodynamic psychotherapy and destined for psychoanalytic training.
Listening to Paul that morning challenged many of the tenets I had been taught.  Primarily the normative stance (and the belief that the therapist knows how things should be) and the idea that one could create change without necessarily understanding how the problem began.
Actually, that one could focus on a problem at all rather than on the developing transference was anathema to my training.
Over the next several years I undertook to learn Brief Therapy.  I often say that my mother’s cancer gave me brief therapy and in many ways changed my life.  In those early years, I worked most closely with John Weakland.  I spent hours examining John’s therapy (both in vivo and on tape) – something that was not so easy to do given his propensity to mumble – and I had the opportunity to question him about what he was doing.  Most often his responses were immediate and he would refer me back to chapters in the texts.  Sometimes, however, he would pause, even ask, “Do I do that?” and then search for an explanation as to why he might intuitively be doing a particular thing.
One such technique is something I have come to call “challenging beliefs”.  I first became aware of it in obvious places where John would challenge assumptions clients made.  In viewing the tapes with this intervention in mind, however, I noticed that he did this routinely whenever someone expressed a strongly held belief.  I liken it to inserting a question mark whenever he heard an exclamation point.  When asked, John admitted that he was not aware of doing it so routinely but reasoned that it is precisely in a person’s rigidly held beliefs that they are likely to get stuck.  Furthermore, by challenging beliefs, one opens the possibility that there may be alternative ways of looking at a situation.

John could challenge directly, or by more subtly questioning as when he would say, “I can see where you might need to see it that way,” or, by just raising an eyebrow.  In working with this technique I have learned that a subtle approach works better because an overt challenge may be met with a further digging in of heels.  A more subtle challenge is often enough to suggest – without force – the possibility of alternative ways of viewing a situation and therefore of behaving in the situation.

This was the case in a session with a man who is in the habit of discounting any change and where John said, “There seems to have been a change but it probably is a fluke.”  Here John preempts the man’s tendency to discount, but his use of the word “probably” introduces the possibility that it is not a fluke.
Challenging can take many forms.  It can come as a positive connotation when something that is perceived as “bad” gets put in a positive light as in the case of a woman who was rear-ended in her car and complained about her subsequent anxiety about driving.  John responded, “I might say that whatever we do here, I don’t recommend that you get totally relaxed on Highway 17.  That you preserve a degree of vigilance.  It’s a dangerous road.”
Challenging can take the form of a reframe or an effort to normalize as with a client who complains that he has an obsessive need to look at women other than his wife.  In this case, John asked, “What’s the difference between obsessive looking and what other men call normal?”
Actually, much of what we do in therapy is to challenge people’s beliefs about the problem and the solution.  The fact that we try to get clients to do something that is 1800 from what they have done in the past to fix their problem challenges their beliefs about what it takes to fix the problem.  The suggestion that people “go slow” (an intervention often used by John) challenges the belief that one can not move quickly enough towards a solution to a problem.
Much as I observed in John’s work, I too find myself challenging as part of my dance with clients – often without a plan – as a way to loosen the knot that is the problem, pulling a little at this aspect or that, until I find a thread I can follow to untangle the situation.

PAUL

In our therapy, we cultivate an intervention generally associated with Paul’s work known as “the disadvantages of change.”  It is an intervention that is made with certain regularity – that is, with most clients – whether in the first session, midway or at the end of the therapy.  Paul would regularly ask: “If your problem went away, what then would you have to face?  And I’m interested in your answer number two.”  Answer number one invariably being everything would be great if the problem were resolved.

The “disadvantages of change” can take various forms.  It can be implied in a reframe, as with Katharina’s case of the lady with insomnia, whose husband recently retired and follows her around like a puppy, and to whom the therapist said: “I wonder if your being awake later at night doesn’t give you some breathing room?”

The intervention suggests that the client reconsider his or her intention to change, for implicit is the message that every change brings about other changes, that may not all be welcome, or that one may also lose those aspects of the problem that provide some gain.  Of course interventions of this kind may contain more than one message, and satisfy more than one objective.  Because clients often get solicited and unsolicited support for making a change, our implying that there may be disadvantages to making that change entails moving in a direction (180°, therefore counterintuitive) quite opposite to that of the client’s intuitive attempts at solving their problem.

So too, it is a kind of “go slow”, “don’t’ change”, “be careful before you venture out” intervention to counter the client’s eagerness to rapidly move towards making a change.  Slowing down becomes useful; not only because it represents a change from a previous outlook, but because it also affords the client the possibility of considering other alternatives.  So there is a strategic advantage to using this kind of intervention.

We in our own work have come to think that there is also an ethical imperative for us therapists – especially those of us who focus on provoking a fast change – to be aware of and convey to our clients that change may have unintended consequences.
In working with a rape victim who is trying to get her previous life back, we are likely to suggest that the problem is not her current over-caution, but rather the rest of us walking around recklessly, without regard for possible consequences.  In other words, regaining one’s innocence, if it were possible, would be an enormous disadvantage.
This interplay between the strategic and ethical considerations is nicely demonstrated in an old BTC case where the client came complaining that although he otherwise had an exciting, successful and satisfying life, he had not had a meaningful lasting relationship with a partner.  Paul kept calling me, asking me to convey the message that many people would envy the client for the life he led (with all the freedom of moving and choosing that it entailed), and thus, one might say, implicitly challenging the client’s view that a committed relationship was essential for his wellbeing and happiness.  This intervention, implicitly conveying that there may be disadvantages to changing, repeated a few times, seemed to have worked, for after about 6 or 7 sessions the client came in to the session with the view that although he originally thought we were crazy for suggesting that his life was good as it was, he began to realize himself that he is a sensitive person who likes to enjoy life’s small details and that worse than not being in a relationship might be being with someone who could not appreciate the same things.  In this case, although the client did not give up his desire for a relationship, he was no longer pressured and unhappy at not having one – that is, the problem was no longer a problem.

We are indebted to John, Dick and Paul for the rich model they have given us.  And as we work with and expand our exploration of the therapy laid out by these brilliant mentors, we continue to ask ourselves: What is in the work that we haven’t articulated or understood or explored or expanded well enough that would further enhance our practice?

Barbara Anger-Diaz et Katharina Anger © Paradoxes

Pour citer cet article : Barbara Anger-Diaz et Katharina Anger, Using the « disadvantages of change » and other lessons from our mentors. 2011. www.paradoxes.asso.fr/2011/10/using-the-disadvantages-of-change/
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