If You Can't Lick 'Em, Join 'Em - The Power of Three

In my previous post, I discussed how Freud worked with Hans' father to treat Hans' anxieties and phobias. Hans' therapy was conducted primarily through a series of letters between Freud and the father. Together they would offer insights, interpretations and progress notes regarding the treatment.

The following case will demonstrate how I utilized the century-old Freudian technique in modern therapy. I received a phone call from a mother requesting her fourteen-year-old daughter be seen for an evaluation. The daughter was at sleep away camp when the camp director called the parents. The camp director was requesting a psychiatric evaluation, due to the fact, that their daughter had told the nurse she felt like cutting herself. She could not return to camp until they felt confident she would not hurt herself.

The background history revealed that the daughter from a young age was extremely rigid verging on obsessive, stubborn, moody and temperamental. They had seen nine other mental health professionals over the past six years, before meeting me. Upon hearing this, I knew that my time would be short lived. As predicted, by the third session the daughter told her parents that she wanted to stop therapy.

I can usually build a working relationship with an adolescent but there are cases when I am unable to build a working alliance. A popular way for an adolescent to express their objection to being in therapy is simply stop talking and that is exactly what happened in this case.

Clearly, you cannot force someone to speak and trying only strengths a stonewall resistance. Essentially, the therapist is left with a treatment destructive resistance meaning the treatment will end if talking does not begin. The intervention used was inspired by the case of Little Hans' and by the teachings of Hyman Spotnitz, MD.MED, and SC.D. the father of Modern Psychoanalysis. The parents helped me to understand and treat their daughter; just as Hans' father assisted Freud in the treatment of Little Hans'.

This type of intervention can only work if the parents are cooperative and in this case I was fortunate to have very cooperative parents. Initially, I will ask the adolescent's permission to allow their parents to join us in the session. If they agree, (I have never had an adolescent refuse) I reassure the adolescent that they are welcomed to contribute but they don't have to if they don't feel like it. I also add, "If I don't hear any objection from them that I will assume they are in agreement with whatever is being said in the session." The parent or parents are invited into the session. We respect that the adolescent does not need to talk in the session; so the dialogue is mainly between the therapist and parent.

"Many communications that have maturational effect reflect the old adage: If you can't lick'em join'em. Hyman Spotnitz wrote,

"The analyst often responds to "stonewall" resistance in that spirit, whether to bring the resistance into focus, to mange it, or help the patient outgrow the need for it. The term joining denotes the us of one or more ego-modifying techniques to help the patient move out of a repetitive pattern."

What proceeds is the therapist will ask the parent to help them in understanding their son or daughter. The parent is free to discuss whatever comes to mind and their concerns about their adolescent or events of the previous week, for example: (a failing test, argument with a friend, boyfriend breakup). The therapist has the opportunity to explore the parents thoughts and feelings and the adolescent's reactions. Usually, by the time these types of cases reach my office the parents have relinquished a lot of their parental authority to the adolescent.

By eliciting the help of the parent and using a joining technique to resolve the adolescents resistance to cooperate, several things occur. First, the treatment destructive resistance is resolved for the moment and treatment can resume. Second, the parent regains parental control by their refusal to let the adolescent dictate the nature of the therapy sessions. Third, the therapist has the opportunity to understand and resolve any dynamics that the parent is unaware of which maybe contributing to the adolescent behavior. Forth, the adolescent is changing even though they may not be speaking but by listening to the interchanges between parent and therapist. (In my experience, evey adolescent ends up communicating in these sessions)

Ultimately, a stonewall resistance can be successful managed with the assistance of the parents and by using a joining technique to remove the immediate obstacle to communication.

Spotnitz, Hyman, 1985. Modern Psychoanalysis of the Schizophrenic Patient, Theory and the Technique, Second Edition, New York, Human Science Press.

©2010 Wanda Behrens Horrell, All Rights Reserved

www.wandabehrenshorrell.com

wjb60@columbia.edu