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Soft Shock Therapy

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The Art of Speaking the Unspeakable

By Cloe Madanes

We’re now so firmly in the era of standardized, manualized, empirically validated, insurance-friendly, client-soothing psychotherapy that it’s easy to forget the radical origins of our field. In late 19th-century Vienna, Freud shocked conservative, straight-laced, bourgeois society with his radical ideas (i.e., the psychic challenges adults face mostly stem from childhood sexual traumas) and treatments (i.e., all talk, all the time). Similarly, even if all the creative, new movements in the field—behaviorism, Gestalt therapy, humanist psychology, cognitive behavioral therapy, family therapy—weren’t equally revolutionary, in their day they all had at least a certain out-of-the-box quality. Today, however, it often seems that the only unbreakable rule for doing therapy is never to surprise, never to be anything other than soothing, neutral, nonconfrontational, usually non­directive, and pleasant, and never to shock anyone—not clients and certainly not the insurance companies that reimburse their treatment.

But there are times when clients are deeply stuck, not just in the unhappy circumstances of their pain—the failing marriage, the unrelenting depression, the crippling anxiety—but in the unshakable sense that nothing they do will make any difference. Having tried and tried and tried to make things better—usually, of course, by engaging in the same ineffective behavior over and over again—they give therapy a go. Often, they’ve seen several therapists; sometimes they’ve even been in therapy of one sort or another, talking about their “insoluble” problems, for years.

In fact, most of the clients I now see are consultations referred by desperate therapists who haven’t been able to move things forward. If I’m not going to give these clients a version of the same old thing that hasn’t worked before, I have to do a kind of therapy that some would consider provocative, even outlandish. I must come up with a new perspective, a new kind of strategy, one that the clients don’t expect.

Most of these clients—even though they may be successful in certain areas of their lives—are stuck feeling that their negative emotions are uncontrollable, their relationships unchangeable, their circumstances unalterable. They’ve come to believe in the ineradicable unchangeability of their unhappiness: thus it has always been; thus it will always be. It follows that they’ve lost all sense of perspective, all capacity to see any possible humor or lightness in their problem or in their lives. Emotionally and cognitively, they’re trapped in their own sad story.

In these cases, the approach that I’ve found most useful is a kind of soft shock therapy in the form of a humorous paradoxical directive. By consciously and knowingly directing clients to do something preposterous and absurd, but uniquely suited to them and their dilemma, I aim to upend their expectations of therapy and life. Before you recoil in horror, know that I never ask them to do anything immoral, illegal, dangerous, or humiliating. But I do ask them to do things that’ll help them find the humor in their tragedy, and I always explain the rationale behind my directive.

Tragedy and humor are closely interconnected. Freud is noted to have said there’s no such thing as a joke, meaning that humor is the way humans deal with the saddest, most tragic circumstances of life. By using humor to help clients reconstruct their problems—almost make parodies of their own dilemmas—I help them acquire a healing distance from their woes, learn to take themselves less seriously, and gain more perspective about themselves, even more wisdom.

Playful, humorous strategies can be like therapeutic life preservers, which keep both therapist and client afloat until both can get back to shore. Often humor can help clients gain different, more useful perspectives, helping them regard their stories less as melodrama and more as comedies of error, less as tragic romance and more as epic adventure. People frequently become helpless when things don’t go a certain way or meet certain expectations. But humor is a natural way to accept that surprising things happen, readying people to adapt to new life conditions and learn to tolerate or even enjoy them. In this sense, humor is a trigger for change because it reboots the emotions and enables us to look at our situation with fresh eyes.

Following a technique used by stand-up comedians, therapists can set up a serious, even solemn atmosphere and then give an unexpected, humorous directive. One of the ways I use this technique in therapy is with a typical problem presented by husbands: they complain that their wives want to talk constantly about unpleasant matters, be it money, in-laws, the children, or their lack of intimacy. At dinner together, on a walk, during a visit with friends, even on vacation, the wives bring up the same issues. Of course, they want to be heard; being heard makes them feel understood and loved. But the husbands become overwhelmed by the negativity that seems to permeate every interaction and end up incapable of hearing their wives at all. The tenor of these “conversations” is all too familiar: the wife nags endlessly while the husband repeatedly tries to change the subject or sinks into sullen unresponsiveness, which just makes matters worse.

In these situations, I’ll typically explain how important it is to contain these unpleasant conversations to a specific time and place, instead of letting them invade the couple’s entire life. I ask the couple to decide on a day and time, once a week, when they’ll meet for lunch. I tell them to bring notebooks in which they’ll have listed their issues and to take turns discussing them, knowing that the issues may not be solved and that this might be one of many conversations that they’ll have in the future. It’s important that these meetings always be on the same day at the same time, and that they happen in a public place, like a restaurant, so the couple doesn’t start screaming at each other. I tell them that these issues won’t be discussed at any other time, unless it’s a dire emergency. When they’re both nodding solemnly in unison, agreeing to the weekly meeting, it’s time for the comic punch line.

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1 Comment

  • Comment Link Wednesday, 26 March 2014 15:30 posted by maia khubashvili

    Really enjoyed the article and read it with the smile on my face! I feel that humor can be used therapeutically which I have done previously in my work but I have not attempted using paradoxical behavior modification interventions like the author of this article. Thanks for sharing!