I will never forget the Correys, who were referred to me by their family doctor in western Nebraska. As is not unusual in our vast, rural state, they flew to our sessions by private plane. Frank was a wealthy businessman and realtor. Donna was a housewife. They had a 16-year-old daughter. Every other week for a year, I saw them, during which time I tried pretty much every trick in my therapeutic arsenal. I spent hours discussing their case with trusted colleagues and read up on their particular problems. I don't know how many nights' sleep I lost worrying about how to get these folks on the right track. And in spite of all my efforts, the Correys were one of my most spectacular failures.
From the moment I met the Correys in my waiting room, I was baffled about why they were together. Frank was tall, good looking and suave; Donna dowdy and sullen. They were both in their mid-forties, although Frank looked younger than that and Donna older. She barely bothered to greet me, and stared resentfully at Frank. As soon as we were seated, Frank jumped in to complain about Donna's spending. He was clearly used to being in charge, confident and eager to explain their situation. And Donna was used to being passive and angry.
Frank explained that even though they lived in a town with only a grocery store and gas station, a town one hundred miles from the nearest mall, Donna used catalogs and the shopping channel to spend nearly $8,000 a month. I couldn't believe I heard him right, and actually asked him to repeat the figure. I tried to keep my expression mild and non-judgmental, but inside I was appalled. I can go months without buying anything but groceries, and have not spent $8,000 on consumer goods for myself in my entire life.
According to Frank, Donna tried to keep her spending secret. He only discovered the extent of her extravagance when he found credit card bills or his secretary noticed that his business accounts had been cleaned out. Ironically, even though Donna "owed" Frank more than $50,000 for unauthorized spending, she had little to show for it--no boats, fur coats or new cars, just boxes of shoes, clothes and household gadgets. Of all the questions and reactions I had to this case, my big question was--how could anyone stay married to such a loser wife?
I generally divide an intake into thirds: one-third for the presenting problem, one-third for some contextual information and one-third for a discussion of therapy. And I give each person a chance to explain the situation. Frank blamed Donna's spending on her depression and low self-esteem. He said he would be happy if only Donna would cook, clean and limit her spending to $1,000 a month. I thought to myself, "Climb a low mountain, Frank."
When her turn finally came, Donna pointed out that Frank was a millionaire and the sums she spent were insignificant. She complained that Frank was almost never home, and when he was home, he stayed in the basement managing his stock portfolio on his computer. She said, "Frank's moody and he takes no interest in us unless there is a crisis." She agreed she was depressed. She had once been active in her community, but in the last few years she had withdrawn from everyone but her daughter.
Ah-ha, I thought, now I get it. Her spending was functional. It kept Frank's attention. Frank worked all the time to keep Donna in dough, which she then spent rapidly to punish him for working. He worked to avoid a dull, depressed wife, while she spent to deal with her loneliness and sense of inadequacy, brought on partially by Frank's neglect. Still, even though I had a crisp intellectual formulation of the case, I suspected from the first that I wasn't quite on target. I couldn't get over Donna's spending and I was impatient with her stolid, stubborn demeanor. I felt sorry for Frank that he was stuck with such a lump.
At the end of that first session, I made a few recommendations to the Correys --that they tear up their credit cards, that Frank come home for dinner a couple nights a week and that they have a date as a couple. I suspected Donna was clinically depressed, so I encouraged her to exercise and to buy a copy of David Burns's Feeling Good
. Neither one of them was happy with my suggestions. Frank insisted time demands made it impossible to spend more time with Donna. Meanwhile, Donna refused to cut up her credit cards. But they let me bully them into agreeing to try these assignments and we rescheduled for two weeks later. I sighed as they left.
Right after our first session, the cast of characters expanded. Donna scheduled an appointment with a psychiatrist, who prescribed antidepressants and wrote me a letter saying that she thought the real problem was Frank, who was invested in his wife's being labeled sick and was a mean son of a bitch, although she said this in medical jargon. The psychiatrist didn't see Donna's spending as any big deal, and what's more, she actually liked Donna, whom she described as having a keen sense of humor and good insight.
I was baffled by the psychiatrist's take on this case. I didn't see any meanness in Frank. How could the psychiatrist have missed his charm? And where was Donna's sense of humor when she was with me and Frank? I explained the discrepancies in views by recalling that the psychiatrist was recently divorced and perhaps angry at men. I knew she was a major consumer herself.
The Correys did have a few dates, mostly dinner at the nearest restaurant, a Pizza Hut 30 miles from their home. But the dates didn't generate any romance. Donna didn't exercise and hated Feeling Good
. I found myself resenting the failure of bibliotherapy. After all, books always helped me. Donna eventually agreed to cut up her credit cards and to attend Debtor's Anonymous, which meant Frank flew her in for a group meeting once a week. They actually liked these meetings, although Donna didn't really reduce her spending. Somehow, no matter how carefully Frank and I tried to control her, Donna found ways to charge stuff or order junk over the Internet, Although she said the medication helped, Donna was still mildly depressed and still not cooking or going out in her community. Frank stayed mad about Donna's spending, although not that mad. Meanwhile, no matter how therapeutically neutral I tried to be, I remained appalled by her extravagance.
By now our sessions had lost any therapeutic momentum. Increasingly, I felt as if I were dragging a barge across the desert. The couple would fly in, report little change in Donna's symptoms, Frank's work habits or their relationship, and fly out. Both said they were dissatisfied with the relationship, but after 22 years of marriage, neither was considering divorce.
The less progress I saw in our sessions, the harder I tried. I utilized every technique I could think of. I tried paradoxical techniques and prescribing the symptom. Thud. I saw them alone and encouraged Frank to draw a line in the sand. Thud. I saw Donna alone and encouraged her to find women friends, go back to school, get a job, take walks or find a volunteer commitment she could enjoy. Thud. I recommended a vacation, which they half-heartedly tried and both hated. Thud. I encouraged them toÂ communicate their needs, set up a budget and work on their emotional relationship. Thud. Thud. Thud.
My exasperation and confusion peaked during one session in which, as Frank itemized her wasteful spending, Donna actually fell asleep. After I woke her, I asked Frank how he felt about Donna's sleeping. He insisted that he didn't mind that much. After all, Donna was tired. At that point, I almost jumped out my own office window.
How could I work with someone who was about as different from me as a woman could be? Donna was passive, preoccupied with consumer goods and she actively disliked exercise. She was bored by trees and prairies and had no interest in education. That boggled my mind. How could anyone not be interested in education? I knew I was being judgmental, but I was convinced that I knew how to be happy and she didn't. There was no question in my mind that my way of being in the universe was better than hers.
I felt more sympathy with Frank, who was at least a hard worker. Also he was a high-powered salesman and could sell me on his excuses, his interest in making things better. But I didn't really understand Frank either. He wasn't much more cooperative in therapy than Donna, especially with my insistence that he tell his wife what he would and wouldn't put up with and then hold that line. In fact, as I worked harder and harder to fix this couple, they seemed to become more locked into their original problem behaviors.
Finally, I had it with the Correys. When Frank found that Donna had opened a new line of credit and charged another $10,000 of purchases, I fired them. I can still see the three of us in our last session, me earnest and serious, trying to hide my anger and wishing them well with a different therapist, "who would offer them a fresh approach." There was Frank, not as unhappy at being fired as I would have hoped. In fact, he was a little rude to me, as if I were an employee who no longer mattered. And Donna, smiling for the first time since we had met. As they left my office, she said almost kindly, "Don't be too hard on yourself, we are nutty and we're hard nuts to crack." There, for the first time, was the sense of humor the psychiatrist saw.
I thought a lot about the Correys in the months after our termination. I'd ignored the wisdom that people only change when they feel deeply accepted for who they are. Instead, I'd let my own values about spending prejudice me against Donna. And I had other values conflicts as well--over reading, education, gardening and the importance of taking action.
A wise therapist once told me that our first task in any therapeutic encounter is to find something to respect in our clients. Without respect it's impossible to really help anyone. I realize I flunked Therapy 101. I didn't respect Donna and I let that important fact slide. I suspect Donna sensed my lack of respect and that's why she fell asleep in our sessions. She had no connection to lose with me. The big lesson from the Correys was that I need to find something I can truly and authentically respect or I need to get out. I can't pretend respect. And without it, there is nothing on which to build a therapeutic alliance.
Being a therapist is intellectually taxing, emotionally draining work, and respect is what fuels the process; it's what gives us a reason to care. Without it, the work is mechanical, for us and our clients. With no respect, there can be no connection, and without connection, therapy loses its meaning.This article originally appeared in the November/December 2010 issue of Psychotherapy Networker.Want to read more articles like this? Subscribe to Psychotherapy Networker Today!>>