In this chapter we talk about different things that can
be called techniques, ideas or special ways. They all have in common that
they are useful in many different situations and that creative and curious
therapists (those who read this book) can modify them and create many
other ‘special ways’. The names we have given the different ideas are
pretty coincidental and most of them fit under different headlines.
Ceremonies and rituals are cultural phenomena that mark
change. They can be very useful to stress and highlight differences
When clients have done things they didn’t think they
were capable of doing we try in different ways to help them create meaning
around what happened. We clamor "Wow!!!, we ask them "How did
you DO that?" we say "Congratulations!" etc. All these have
in common that they are markings that can create a difference that is a
difference. One way to do this even stronger is to make something special
– a ceremony – out of the event, either in the therapy-room or in the
home.
You make a party to celebrate something; a birthday, a
marriage, a house warming party etc. When clients have attained for
instance abstinence for a longer time than at any previous occasion this
can be something worth celebrating. The hard work it took is acknowledged
and may become a difference that is difference.
Jakob lived in a very close family that loved parties.
When Jakob had given his girlfriend all his syringes and she had ‘buried’
them, the much-impressed therapists suggested the family should throw a
‘funeral party’.
As Jakob had started to constructive things for himself
the therapists suggested that the theme for the party should be ‘For the
burial of the kid and for welcoming the adult’.
Afterwards they all guaranteed that this was a party
they’d never forget.
Diplomas are received when something has been
accomplished. Having learnt to drive a car, to swim or having finished
training as a therapist.
With us it sometimes happens that both young and old
clients receive a diploma when they have struggled with their problems and
have made progress in their life.
Helped by her parents Viktoria has managed with a
difficult social situation. Drug abuse, phobias, separation from a
drug-abusing husband, two small children.
In the final session the therapist (SE) returns after
the break and says: "I have something for you."
"Oh," she says, smiles a little, blushes
shyly and says: "Is it a diploma?"
"How did you know?" asks the therapist and
hands it over. She doesn’t get any response. Viktoria and her parents
read and shine.
Our experience is that it is useful to hand over a
diploma in a very solemn way. We usually do it standing. We shake hands.
We bow and congratulate and the audience (family, team, and network)
applauds. Sometimes we bring the whole team in and everyone shakes the
client's hand. The ritual and ceremonial element is important.
For many clients the change from being someone
receiving advice to someone giving advice is an important moment.
We explain that we are very impressed by what the
client accomplished. We have met and will in the future meet clients with
similar problems and we wonder how and what the client did to solve his
problem and what kind of advice he or she has to other clients with
similar difficulties.
The response is often written down and almost
invariably handed back to the client (see for instance Cecile page *).
This is a concept we borrowed from Ben Furman who
described it in a book "Lösningar för missbrukare" (1991).
The therapist asks the client to imagine himself a few
years into the future. The problems are solved and the client is satisfied
with his life. The client is suggested to think that he is throwing a
party to which he invites everyone that contributed to the problem being
solved. "Who will you invite and how will you thank each one of them?"
This work is fun, thrilling, creative and much
appreciated by clients and therapists alike. It’s always easier to talk
about possibilities in the future than problems in the past, as it is
easier to tell how you solved the problems when you imagine that they are
already solved. Another aspect is that the therapist takes a clear and
unambiguous position. The client will use his resources to solve his
problem. The question is not if, but how and helped by who.
Milena returns to therapy six months after she
terminated a first series of sessions. She feels insecure in her new
situation, is doing well in school but she has difficulties to protect
herself from her husband and her father. She is also unhappy after a short
but intense love affair. She shows rapid progress but in the fourth
session MS behind the mirror thinks that nothing much is happening. He
suggests HK (therapist in the room) to do ‘acknowledgement therapy’,
and HK, who feels insecure about doing this, asks him to come in and do
it.
MS asks: "Suppose that three years have passed,
everything is going well and all your problems are solved. You decide to
throw a party and you invite everyone that has been important to thank
them for what you are and have become. Who do you invite and what do you
say to them?"
Milena thinks for a while and starts a little
hesitantly: "I would invite my parents, the two of you and Morgan (her
ex-husband)."
"What do you thank them for?"
"My father I would thank for teaching me to stand
on my own." She hesitates a couple of seconds and then goes on:
"My mother I would thank for giving me self-confidence. Morgan I
would thank for teaching me to paint. My son brought sunshine into my
life, my social worker helped me out of the fog, and you two helped me go
from words to action."
"Both the words and actions were your own,"
answers the therapists and she smiles proudly.
Father is very disappointed
with Torleif. He feels so hurt and so bitter. He can not imagine what
could be different that would make him think it would be possible to
forgive his son. It’s the last thefts that made it. He had really
started to believe that Torleif had changed and ‘had given him
everything’. Now he punishes Torleif all he can ‘to make him
feel something of what he feels’. At the same time he can’t
imagine what would be a reasonable punishment. He has thought of the
possibility that ‘the cure may be worse than the ill’, but
still can’t change this.
Mother doesn’t know what to do. She finds her
husbands position to extreme but she wants ‘to give the children the
right signals’ and show them that the parents are collaborating. She
is confused but ‘finds some comfort in religion’.
We talk alone with Torleif about the situation, while
the parents wait outside. He is filled with shame and despair over having
failed his parents' confidence. He laments over the fact that no
punishment can ever satisfy his parents and hence bring him relief. We
explain to him that he has missed the whole point with the punishment. The
most important part of a punishment is that ‘it makes the sinner
forgive himself’, and we discuss with him till we find a punishment
that would bring relief to his feelings of guilt. Something that would
make him feel that he ‘expiated his sin’. He is immensely
relieved after this and says that he never saw it like that, ‘like
something he could do for himself’.
We then end the session together with the parents. We
explain that we understand their dilemma and that they are right in not
being able to find any punishment. No one can help anyone else ‘to
expiate their sins. Penance is something you do for your own sake.’
The parents nod in confirmation. We explain that we talked to Torleif
about this and we have agreed with him that penance is something private.
But as we are also social beings it also needs to be public – that
penance can be recognized as such for it to work – but yet it is mainly
private. We then ask them to pay attention to what they see Torleif do
that to them means that he is ‘expiating his sin’. We point out
that it is important that they note for themselves what they see and that
they do not discuss it with each other or with him.
They are relieved and smiling when they leave.
One sometimes talks about the power of the written word
and means that that which exists in black and white is more valid than
what has only been said. One can also go back that which is written down
and read it many times.
People have different ways to remember; some remember
best what they see, other remember what is said and some remember best
what they have written.
For these reasons ‘notehelp’ is often useful for
clients who need to remember important things.
One way we used notes is that the therapist and client
writes down important points on a note and the client brings the note home
and keeps it in his pocket, his wallet or his dressing table. (Memory-note,
message to oneself).
When the client or a family-member doesn’t want to
discuss or argue about a particular question he can write down what he
wants to say on a note. The note is then put in a place where it is
guaranteed to be seen or given without verbal comments (message to
others).
Antonia is 18 years old and just out of intensive care
after a suicide-attempt. No one considers her hashish-abuse or her eating
behavior (anorexia-boulemia) as the real problem. Everyone including her
therapist seems influenced by the idea that her problem has ‘its roots’
in her history of sexual abuse.
For the first quarter of an hour, Antonia’s mother
and therapist ask her lots and lots of questions but despite apparent
efforts on Antonia's part the only answer she can find is: "I don’t
know."
"How did you do it not to be totally devastated by
your terrible experiences?" asks the therapist, but Antonia looks at
her helplessly and answers "I don’t know." Mother's eyes are
watering in face of her daughter's obvious desperation and helplessness.
The therapist looks increasingly concerned and worried, and so does
Antonia.
More attempts with coping-questions don't lead
anywhere. In desperation mother cries out: "You have to talk about it
Antonia. You have to talk about it!" With increasing desperation
Antonia answers: Everyone keeps nagging me about that I have to talk about
the abuse, but I don’t want to – and I don’t need to either."
The desperation in the room is felt all the way through the
one-way-mirror. Antonia stares on the floor and the on the teams request
the supervisor (MS) walks into the room.
"When I sit and listen to you talking I get two
ideas that I would like to share with you Antonia." Antonia is still
staring on the floor. "I start thinking about these glass-doors they
have in big ware-houses. If they are well polished there is a risk that
you walk right into them. I think you have put up such doors around you to
show limits of who you are and show your boundaries. I think it’s good
you did that. That is healthy." Antonia looks up and looks him in the
eyes. "I see your mother and your therapist really trying very hard
to help you, but unfortunately they walk straight into the glass-door as
it is so well polished." Mother nods confirmingly towards MS while
Antonia holds his gaze and maybe nods ever so little. MS continues:
"My other idea is that I would like to write you a
health-certificate. A health-certificate because you learnt to protect
yourself and show in a clear and healthy way what you want and don’t
want – and because you know what you need."
It’s mother who reacts: "It’s so good to hear
you say this. So good. It’s like a stone falling from my chest,"
and she lifts her hands to her breasts. Antonia looks at her wide-eyed and
slowly tears fill her eyes. Mother opens her arms and mother and daughter
hug in tears.
The therapist and the supervisor take a break and
leaves mother and daughter by themselves. They return together to the
therapy-room and say:
"We decided to write a health-certificate. Here
you are." Antonia takes it and reads carefully. It says: "Hereby
it is certified that you, Antonia, is not half as sick as other think you
are." When setting up the next appointment with the therapist she
says:
"This was the best that ever happened to me. I’ll
put this in my ‘important-folder’ and when things are really
bad I’ll take it out and look at it.
When she returns two weeks later she says she feels
good. She has looked at the certificate a couple of times. She has also
been able to ‘keep her limits’ in several new situations and mother
agrees with her that they don’t have to come back before two months.
It was incomprehensible to Donald (page *)
how he had succeeded to do the 11 things on the ‘tricklist’ that
helped resist the urge to use gas. When he had 7 items on the list he took
the list home, but it was first when he came up to 15 that it was clear to
him that he himself had control over what he chose – gas or trick.
The therapist (MS) asks Cecile in the fourth session:
"I meet other girls and boys in similar situations, who are
struggling with their problems. What advice would you like to give
them?"
She thinks for a long while and then responds: "1.
Live normally, do what you normally do and don’t lock yourself in. 2.
Seek those who support you. 3. Seek yourself away from those who pity
you."
MS writes down her answers and she brings the note home
with her.
A month later she is raped and gets seriously
depressed. She locks herself into her apartment and goes to bed. On her
dressing table is the note with advice to others. After 48 hours she sees
the note and reads it. She decides to follow her own advice and gets up.
The same day she contacts her friends and the police.
Bernadette's parents can see that she is improving, but
their worry won’t pass.
"If 10 means that you are entirely ok and 0 the
contrary, where are you at today?" asks the therapist (MS).
"6-7" she answers.
"Where on the scale is there a risk for
relapse?"
"When I’m at 5.5 it starts getting
difficult," answers Bernadette and the parents look even more
concerned.
In the summary of the session the therapist suggests
that Bernadette should put up ‘today's figure’ on the door of the
refrigerator. The parents then only need to be worried if the figure falls
below 6.
During 2 weeks the parents pull a sigh of relief every
morning as they see figures that are 6 and higher.
In the example page *
there is an example of how one can use notes.
Leonardo's father was encouraged to experiment with
communicating by notes instead of talking, to see what difference this
made. He prolonged the idea by himself and set up a poem to Leonardo on
the mirror in the bathroom. Three weeks after he got an long longed for
appreciating comment from his son.
"When I want to tell him something he did well, I write it on a
piece of paper and hand it over to him. It becomes a little special
then". The therapist and the mother smile together.
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