Treating William Shakespeare

Giving clients’ fantasies and symbols the weight they deserve

Posted Mar 17, 2015

 The single most important issue in teaching a skill is getting students to attend to the relevant consequences of their behavior. In sports, winning is often the ultimate goal, but athletes won’t improve if they respond only to ultimate victory. Victory will reinforce everything they did in that game, even their mistakes. In arithmetic, the right answer is often a good sign, but if it was arrived at by luck or intuition, the student will get worse at arithmetic, not better, so teachers ask kids to show their work. In therapy, the reinforcers for therapists are often the money received, attendance at sessions, signs that the patient looks improved, and reports from the patient that the therapy is working. All of these reinforcers have problems parallel to victory in sports and the right answer in arithmetic. Outcome measures, whether at the end of sessions or the end of the therapy, have the same problem. Therapists need to potentiate a different sort of information as reinforcing, one that will keep them on the right path, analogous to playing the short hop in baseball or watching the football until it is caught.

Many therapy supervisors, however, still teach that the therapist cannot make mistakes, making it impossible to learn to get better at it. Others allow therapists to feel rewarded when clients thank or praise them or claim to be getting better or just show up. This produces a technique driven by praise and outward signs of success, which clients produce for a host of reasons besides actual progress. Attendance and payment can mean that the therapist has done some things well, but it can just as easily mean that the therapist has done nothing to challenge the client. Clients may praise therapists also for a variety of reasons, not least of which is perceiving therapists as emotionally dangerous and wanting to appease them. Clients, like children, consciously appreciate being spoiled, and they should no more be consulted on technique than children should be consulted on whether it is a good idea to stay up late or eat vegetables.

The overarching problem is the power differential in the therapy, a differential that is required if the therapist is to have an effect. Clients tend to believe that therapists are much more expert than they are, analogous to dentists or estate lawyers. Further, therapists usually get the last word on what is going on, and clients don’t want to be told that they are sick or at fault, so they adopt a defensive posture. Also, clients have cognitive biases either in favor of thinking that the fee has been worth it or against thinking that they could have been acting more productively all along.

Asking which of the things I did that worked and which didn’t is exactly the same as asking which things the patient does in response I should feel rewarded by. Most therapists don’t even listen to a patient’s ensuing behavior as a source of information about the last thing they said or did. This is partly because therapists want to believe that progress depends on the patient and not on them, and partly because therapists don’t know how to make sense of what the patient says next. Freud thought that any new material, any new recollection, was a good sign, but that too is awfully convenient for the therapist. A therapist started a session saying, “What do you want to work on today?” The patient, who grew up on a farm, said, “I’m not sure. For some reason, I just thought of the day my dad killed the puppies. He said we couldn’t afford to keep animals as pets.” A good therapist should hear this as a statement that this business of being so work-oriented reminds this patient of its emotional expense. She has in effect accused the therapist of killing her puppies. If I tell my students not to start sessions that way because it is like killing puppies, they may or may not believe me. But when this patient tells this therapist the same thing, the therapist ought to listen up.

This is an example of what I call poetry, a verbal metaphor or analogy that contains the client’s experience of what the therapist did. The earliest version of this that I have found was in an article by Gregory Bateson and others in 1956 (although the concept of transference can be reframed as a poetic commentary on the relationship). The therapist was late for a session and apologized, and the client told a story about a friend who missed a boat that almost sank. The client was poetically communicating not only that the damage was nearly fatal to the therapy, but also that the therapist had missed the boat. Robert Langs organized his approach to therapy around such communications.

In talk therapy, we try to change our patients by saying things in their presence. This puts us in a dilemma every time we say something. Either the patient’s ensuing speech is a reaction to what we just said, in which case we have to consider its content as what we reminded the patient of, or the patient’s ensuing speech is not a reaction to what we just said, in which case we have to ask ourselves how we hope to change the patient if we are saying things that have no effect. Are we inviting the patient’s symbolic representations of their experiences or are we deflecting them? We are taught all our lives to tactfully ignore what other people say and do, and social tact from both parties is the single greatest obstacle to real therapy.

Another way patients react to therapists is what I call theater, staging mini dramas that enact the pattern perceived in the therapist’s behavior and designed, like real socially relevant theater, to subvert the power structure. These bits of staging are also called projective identifications, maneuvers whose purpose is to communicate by putting the therapist in a role, by making the therapist feel something that is still unspeakable. A therapist asked me for advice on what to do when an adolescent client does his homework during a session. She asked him why and he said he “had to.” I asked if she had done something to make the sessions seem more like school than like therapy, and she acknowledged that there was a manual to get through. She also said she was taking notes on a clipboard during the session, but she “had to.” Here, the client seems to be staging a bit of burlesque, showing the therapist what it’s like to talk to someone with a clipboard.

So my view is that clients are constantly telling us or showing us what we need to know, but we don’t listen. We don’t listen partly because we are not good at understanding analogy, and we avoid what we are not good at. We don’t listen partly because we are told by supervisors that we don’t need to. And we don’t listen because we can get away with it, foisting our dominant narrative—that everything we do is helpful—on our less powerful clients.

A way around this deafness is to treat your client as if he or she is William Shakespeare, a superb poet and dramatist. Shakespeare’s genius was his ability to put into immortal words the fantasies and symbols that occurred to him when contemplating the human condition. But apt fantasies and symbols themselves are within the reach of all of us, as witnessed every night in our dreams. Treating clients like a group of Shakespeares ensures that we will give their fantasies and symbols the communicative weight and interpretive effort they deserve.