Charles Dickens’s A Christmas Carol
is one of my all-time favorite stories. Who doesn’t start sniffling when reading this classic tearjerker about Ebenezer Scrooge, a cold, bitter old man dragged on a terrifying midnight journey of self-discovery, from which he emerges transformed and redeemed? Miraculous conversion stories appeal to the wishful thinker in all of us. We want to believe that hitting bottom is the key to transformational change, a comforting daydream shared by many therapists.
I began clinical practice some 25 years ago, firmly committed to what might be called Christmas Carol
therapy. I secretly believed that change for every client was always a transformational session away. But the follow-up questionnaires I regularly sent clients a year after treatment told a different story. To my dismay, the clients who’d had the most dramatic experiences in therapy did the poorest a year later. It had to be the fault of the questionnaires! So I tried different ones, and persisted with my version of Christmas Carol
therapy--until I met Mattie.
Mattie showed up for an appointment that was actually intended for her husband, Patrick, who’d completed therapy with me five months earlier. Patrick had been convicted of misdemeanor domestic violence for pushing Mattie into a wall and court-ordered into a batterer’s intervention program, after which he was referred to me by the group leader.
In therapy, Patrick relived his ghosts of times past, including when he’d witnessed traumatic scenes of his drunken father battering his mother. The ghost of Patrick’s present soon became obvious: Mattie’s unhappiness reminded him of his mother and his own failure to protect her. But rather than elicit a deep need to redo the past and protect Mattie from harm, he blamed her
for making him feel bad. Through our work together, Patrick came to see the ghost of the future--divorce, isolation, desolation--and seemed to make some important discoveries about himself. He left therapy a new man, confident that he could use the fruits of our work to give Mattie the kind of relationship she wanted and deserved.
When Patrick called for a follow-up appointment five months after our therapy had terminated, I looked forward to seeing him again, but when I stepped into my waiting room and saw Mattie, one feature of her appearance shocked me: Fading but still ugly bruises on her cheeks and around one eye. Patrick had beaten her up and was now sitting in jail.
Once the jolt of Patrick’s dramatic treatment failure wore off, I began to focus on the question of what I missed in my work with him. I’d always counted on the big bang of therapeutically-induced emotional catharsis to create the kind of instantaneous “learning experience” that results in a life lived differently. What I’d forgotten was that true learning doesn’t come in a sudden breakthrough; it takes most people years of trial, error, practice, reinforcement of some behaviors, and active discouragement of others to become civilized adult human beings.
My practice of Christmas Carol
therapy didn’t account for what researchers call state-dependent and context-dependent learning and recall. Information learned in one mental state and social context is most likely to be recalled when in the same emotional state and social context, but unlikely to be recalled in other states and contexts. What we learn in a warm, accepting environment like therapy can hardly be accessible in aroused states and perceived hostile environments.
I began to realize that Christmas Carol
therapy, dependent on deep, emotional exploration of a client’s past hurts and their connection to current behaviors, followed by a fireworks display of catharsis, might actually be making the problem worse by creating a special context of learning that was unlikely to be recalled in their home, under the stress of high emotional arousal. The more effective alternative to this dramatic “transformative” therapy is the assembly line-like repetitiveness of developing healthy habits, which I like to call blue-collar therapy.To read Steven Stosny’s complete article from the November/December 2013 issue, “Blue-Collar Therapy: The Nitty-Gritty of Lasting Change,” subscribe to Psychotherapy Networker magazine.