The Problem with ‘Christmas Carol’ Therapy

Debunking the Myth of Instant Transformation

Steven Stosny

Scrooge-smCharles 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.

Topic: Professional Development

Tags: blue collar therapy | breakthrough | Christmas Carol therapy | transformation

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9 Comments

Friday, November 15, 2013 2:00:57 AM | posted by Psychotherapy Networker » Our Habits, Ourselves
[...] to Steven Stosny, the author of the Psychotherapy Networker November/December 2013 cover story, psychotherapy too often fails to help clients like myself make changes in their lives because of [...]

Tuesday, November 12, 2013 10:53:21 PM | posted by CAROL L SHUTTLEWORTH
I wonder how this therapist's experiences and new insights square with the "today's client" focus of previous issues that emphasizes the expectation of significant change after only one session and the exhortation that therapists must expect to be able to provide this?

Tuesday, November 12, 2013 10:33:11 PM | posted by richardl2
A large part of my practice is servicing Clients for Child Protective Services (CPS) in Texas. Even though the legal system takes Domestic Violence (DV) more seriously. There is still a tendency to downplay DV in Texas and CPS is very slow or reluctant to address DV issues. I have been involved in cases where DV is ignored in Service Plans for offenders or is minimized or at times ignored in the course of some cases. Also, DV is not considered to be a form of Child Abuse at this time.

Tuesday, November 12, 2013 9:09:51 PM | posted by Larry Liebgold
While a small portion of Domestic Violence clients are truly "Intimate Terrorists," the majority benefit from treatment and do not reoffend. It's disappointing to see the minority used to define the entire cohort.

Tuesday, November 12, 2013 8:35:07 PM | posted by PAULETTE ROCHELLE-LEVY
Thanks for reminding me. In CA a one-time course is mandated. I took mine 20 years ago. I think I need a refresher which I just signed up for!

Tuesday, November 12, 2013 8:26:03 PM | posted by Mark Sullivan
We live in a quick fix society and so we convince ourselves that even destructive emotions rooted deep in our character can be exorcised quickly. As a religious person I've seen and believe in miracles, but character change takes time. As my pastor likes to say "change is right foot, left foot, right foot, left foot ... "

Tuesday, November 12, 2013 7:25:34 PM | posted by erikam
The "Aha Moment" is rewarding at the moment it occurs, probably more so to the therapist than client. Without PRACTICE across the board in different contexts, it's but a flash in the pan
fleeting a best with the client returning to the well traveled paths (and neuro pathways) of the past.
At least that has been my experience over the last 30 years. I am no longer reveling in the aha moments of my work or seeking them out. Gradual change is what I have learned to believe in and help my clients embrace. Thanks to the author for the honest presentation.

Tuesday, November 12, 2013 5:35:13 PM | posted by Carla Clements
Barbara, you took the words right out of my mouth. Another example of our profession failing abused women. I also use Patricia Evans' work regularly. Domestic Violence does not come from a failure to understand the hurt that is caused. It comes from an absolute absence of empathy, for one thing. Some therapists get sucked in by tears or expression of regret, failing to recognize that the batterers tears are for his own pain, not the victim's.

Tuesday, November 12, 2013 4:58:46 PM | posted by Barbara Fillips
It's disturbing to me that training in the dynamics of domestic violence is not mandatory, across the board for therapists (and for police people, lawyers, etc.). In CA it's required training for MFT's and other therapists. In NY where I now practice, there is absolutely no required training for MFT's or MSW's. In fact there are no CEU requirements here at all. Domestic Violence, whether verbal and psychological or with physical abuse ( also) is a serious fly-under-the-radar dynamic that is all too pervasive in our culture, in our world. It's the underlying dynamic of oppression. An invaluable resource who I think explains and educates very well is Patricia Evans (at verbalabuse.com or patriciaevans.com). What's needed is education—for therapists and for clients. This therapist, unfortunately, did not receive it; she thought the abuser would change (whereas an education would have given her great pause) and she would have known that his partner was most likely in grave danger; and if she could have worked with her, she would have known how to safely and effectively help. This therapist is not alone, by any means. I commend her for writing in the Networker about her experience with these clients and for engendering this important conversation. Hats off!