Dick Robertson (950902.2136CDT) responded to the thread I started on the
application of PCT to a psychotherapy case with a 9-year-old boy. Dick, sorry
for the long delay in my response to your post.
With respect to the case, sessions have slowed down to once a week with me
(individual therapy) and once every two weeks with the Psychiatric nurse who
referred the boy to me (family therapy).
School has started and there was a crisis in which the boy wanted to stay in his
mother's classroom instead of his own. He was given a choice of returning to
his own classroom or the parents would have to consider sending him to a private
school. He was allowed to look through his classroom window every 10 minutes or
so to verify that his mother was still in her classroom. He accepted this limit
and was able to stay in his own classroom. He reacted to the choice with anger
expressions and thought the therapist (the nurse) was being mean.
In a session with me, his father gave him the choice of being with me for 30
minutes and the father would stay downstairs or the father would go outside. He
rejected the choice and the father went outside. The boy had an anger attack
and punched and kicked the door and window. He stopped when I said that I would
have to restrain him if he continued. After 10 minutes or so, I called the
father back in and we processed what happened. The father tried to reassure the
boy, and I thought the father was very sincere, and that we had a really good
talk. However, when the father excused himself to go to the bathroom at the
end, the boy felt compelled to look out the door to make sure that the father
did not leave.
This is a very emmeshed family. The boy has been the center of everything for
the parents and paternal grandparents. It must be scary for this boy for the
emmeshment to be reducing. It must feel like abandonment even though it is not.
He is fighting the change in the family.
Dick's post contained a lot of general issues about PCT applied to
psychotherapy. I will reply to them in another post.
···
From: David Goldstein
Subject: Re.: Another clinician heard from
Date: 09/15/95, 06:12 pm
Dick Robertson (950902.2136CDT) responded to a thread which I started on PCT
applied to a psychotherapy case. In a previous post, I gave an update on the
case. In this post, I will address one of the more general issues which Dick
raised.
Selection of therapy goals--The choices are: base it on what the patient wants,
or base it on what some other person wants for the patient including the
therapist.
Dick points out that a PCT therapist would likely be oriented to working on
therapy goals which comes from what the patient wants. However, if the patient
is doing something which is illegal or self-harmful or frustrating to
significant others, such as in the case of adolescents referred to a
residential treatment center, then this approach has its limits. For example,
if the basic reason an adolescent is placed in residential treatment is because
he/she steal things, a therapy goal of learning how to steal things in a way
which reduces the risk of getting caught might be what the adolescent wants but
would not go over well with the parents, referring agencies, police/court
system.
Dick points out that a PCT therapist would be likely to assume the viewpoint of
the patient as much as possible. The target problem, say stealing things,
would be examined to see what it really does for the patient, namely, what
experiences the patient is controlling by means of stealing things. Once these
desired experiences can be clearly defined, the therapy goal becomes: Other
than stealing, how can the patient have the desired experiences. Once this has
be done, the patient is in a position to choose which one of several ways to
obtain the desired experiences is preferable. The stealing approach has its
down side which some of the alternatives may not have.
The PCT therapy approach is similar to all other therapy approaches which looks
at what the symptom means rather than taking it at face value. Perhaps it is
different in how the meaning is defined. One tries to identify dimensions of
experience which are present at the time the action occurs and are being
controlled by means of the action. I don't think that any other therapy
approach defines meaning in this way.
···
From: David Goldstein
Subject: Re.: Another clinician heard from
Date: 09/17/95, 01:25 pm
[From Dick Robertson] (950918.2010CDT)
Nice job David. The example you describe, of an individual whose
behavior has resulted in other people taking a hand in it, is the
most complicated type of case for therapists. It brings into focus
the kinds of problems that Ed and his crew have been addressing in
this "applications thread too." PCT clearly has already contributed
in a major way to this problem by highlighting the need for each
person's goals to be met by action of the other, which either
supports (As Gary's old experiment of pulling on the same band that X
was holding) or is indifferent to the control efforts of the S (as
Bill P's demonstration of having a person write something unwittingly
because of E's disturbance of his control efforts - just the right
disturbance, of course). That's a 180 different from the approach of
that guy who put the magnum opus of trying to control prisoners
behavior from the outside. Give us some more examples of how you do
it with your delinquents.
Best, Dick