Monday, 18 May 2009
Treatment compliance (edited)
It’s funny how some clients will find their way to do something if the therapist will just let them.
There is an inherent contradiction in any model of helping. Any such model rest upon the patient being compliant to the treatment. If a client does not comply to the treatment then it is a waste of time doing the treatment in the first place. Indeed in the DSM-IV there is a specific diagnostic condition that is used when a patient is not complaint with an important aspect of the treatment of the disorder - Code V15.81 Noncompliance with treatment - is its official title.
Some treatment models try to get around this by saying that the treatment approach and goals are decided on by both the client and the therapist. So it is a consultative approach they argue. But of course then the client just has to comply with that! So in any helping relationship or transference relationship between a helper and helpee there is always a component of compliance to the assumptions and model that the helper happens to employ.
This becomes a significant problem when dealing with the highly compliant client which is where I arrive at a guy who I recently worked with. He had a high Conforming Child ego state. Mind you these types of clients are wonderful to work with because they do and say all the right things. He did precisely that and it would feel good when he came to a session because I know things would go how they are supposed to go which made me feel good and like I was doing a good job. BUT he was highly compliant. He had to comply with the treatment in order to become less compliant - a contradiction. The therapeutic relationship directly contradicts the therapeutic goals.
However he did do some good work and in particular restructured his relationship with his partner to a much healthier form. So I am not discounting what he did BUT in his therapeutic alliance with me he was compliant. And this was always a worry in the back of my mind and had me stumped on how to deal with it. In theory terms he was not being his own Free Child, he was just conforming with what I was suggesting. So he was not being who he was but was just another facsimile of what someone else was telling him to be - in this instance, me.
And of course, as so often is the case with such individuals they complain of precisely that. I don’t know who I am, or I don’t know how to be who I am, or I have no understanding of my Free Child, or words to that effect, which he did complain of.
One of the things he very much liked to do was homework. Some clients like homework and some clients hate homework. Homework is a task that the client does in between the sessions, such as trying out a new behaviour with a spouse, or experiencing some sort of feeling, or not doing the dishes for the week and so forth. He would always ask for his homework task and he even got a special book that he would record what happened with his homework and his reflections over the week on his homework task. Then in the next session he would bring it in and read out what he had written over the week.
He had many homework tasks on various ways of accessing his Free Child or homework tasks on various ways of suppressing his Free Child. He did these vigilantly BUT I still had this nagging thing in the back of the mind that he was doing my Free Child and not his Free Child.
Then before his last session with me he actually rang and stated that something had come up and he had to reschedule, which he did. This got the therapist bells ringing in my head. He had never done that before and he had even stated previously how he would reschedule this and that so he could come to the next appointment time with me.
Then he arrives at the last session (which we had previously agreed was his last) without his homework book. He said that he been very busy that week and had forgotten what the homework was. I stated nothing and just smiled. He then talked again about this author who I had never heard of. He had mentioned this book before and how the writer wrote about the male and female parts of the personality. He felt that he was not enough in touch with his male part and how he used his female energy as a persona. I just smiled and said nothing.
He then proceeded to describe to me how this week he had a number of times expressed this male aspect of himself in various relationships with others. I just smiled and said nothing. He spent the week doing precisely the homework that was agreed upon. But he did not realise it. He had at last found a way to do it his way. I just smiled and said nothing.
Graffiti
18:02 Permalink | Comments (40) | Email this
Comments
Very cool. Sounds like a great relationship. Now can you write about noncompliant patients?
My therapist gave me a homework assignment last week. I usually do them very diligently, because of my perfectionist tendencies. However, this assignment is too hard, too scary.
Now I'm wondering if he will even want me to come back because I didn't do what he asked me to do. I'm planning on emailing him to tell him I didn't do it and to see if I should just skip my appointment until I'm able to do my homework, which might be never. I don't want to waste his time.
Posted by: Harriet | Monday, 18 May 2009
Also a nice post. I always have a really hard time with the "Yes Ma'am" dependent type patients. And I got nothin' about how to get around it either. I guess female empowerment type stuff - or, what I thought of with this guy you described - he needs to read Iron John! I even gave that to my boyfriend because I'd like him to be more assertive about expressing what he needs and wants.
On the other hand, a lot of docs (and I assume shrinks) really like these patients. I think my shrink sorta didn't like me, not because I was overtly noncompliant (I wasn't), but that I didn't agree on the treatment approach.
Posted by: myalterego | Monday, 18 May 2009
Whenever a therapist starts asking me to come up with goals there's problem. I have a hard time coming up with them. I've mumbled things about new object relations, but it never is well understood.
Posted by: Lee | Tuesday, 19 May 2009
I love the pic of the oddly shaped tree. I think it's photo of my compliance level with most things.
Posted by: Lynn | Tuesday, 19 May 2009
Hello Harriet,
thank you for your comment. Why do you request a comment on noncompliant patients? Are you thinking you are one of those?
With the risk of being presumptuous after reading your comment if I was your counsellor I would say something like, Harriet you think too much.
If I suggest homework and it is not done, I simply take it as a diagnostic sign, like I did with the guy I just wrote about. I don't take it as a personal affront or feel like my time is being wasted. Some clients do homework and some don't is my thoughts on the matter.
cheers
Tony
Posted by: Tony | Tuesday, 19 May 2009
hello myalterego,
I would say that most therapists like compliant clients as they make you think your doing a good job and they aren't a hassle.
It is sort of sad sometimes. Its like the child at school who is compliant and who never makes trouble. They slip through the cracks as sometimes they can be suffering terribly with anxiety or depression but it never gets diagnosed until years later.
Not an uncommon report for adult clients to make when asked about their childhoods.
Cheers
Graffiti
Posted by: Tony | Tuesday, 19 May 2009
hello Lee,
With the risk of being presumptuous after reading your comment if I was your counsellor I would say something like, how come easy tasks end up being so hard?
I felt the same after reading your comment on the laundromat. You mention about doing laundry in a laundromat and end up with having to walk home in zig zags.
there is lots of homework in that one my friend!
Tony
Posted by: Tony | Tuesday, 19 May 2009
I am glad you like the tree picture Lynn,
And yes, I don't think your therapist would ever have trouble with you being overly compliant!
Hugs
Tony
Posted by: Tony | Tuesday, 19 May 2009
Tony,
I'm too non-complaint to do homework:P
I don't know why some easy things are so hard for me. There are a of of things other people consider hard that I can do and a number of basic skills that I can't do. I have a number of learning disabilities and those can be defined by dramatic unevenness is ability(I score 99th percentile on some tests and 12th of others). Maybe that unevenness somehow carried over to other areas of my life. I also just worry a lot which makes everything more difficult than it needs to be.
Like how tomorrow I restart therapy and I hate being late. So I'll allow an hour and a half to get there. It will probably take only a half hour. Not sure. Today I allowed an hour for a trip that took 10 minutes. -_- This trip is 2x as far in the same direction. So what I'll do is all walk around the neighborhood until it's 10 minutes before the appointment. During that time I'll avoid walking too close to the destination. Maintaining a 1 block distance at least. I wouldn't want to run into him if he's walking to his office and have him see how early I am. So when it's 10 minutes before the appointment I'll go in and h has a buzzer to her in his office. This is my first time going to his new office. I hate those buzzers. What if I press the wrong button? What if he didn't hear it? How long do I wait before repressing it? I have to check and re-check to make sure it's the right button before pressing it.
It's no wonder I need so much sleep. Everything is exhausting.
Posted by: Lee | Tuesday, 19 May 2009
Hi Lee,
I got exhausted just reading what you wrote!
Well at least we know what your payoff for the game is - exhaustion.
Lee states:
"Maintaining a 1 block distance at least. I wouldn't want to run into him if he's walking to his office and have him see how early I am." (end quote)
Why not?
Make that the first thing you tell him.
Hard homework for this week. A 1000 word essay on how many ways I can make pressing a buzzer hard work.
Hugs
Tony
Posted by: Tony | Tuesday, 19 May 2009
Tony,
Now that's homework I can do:P
Maybe I'll write a blog post later about buzzers.
He already knows about this whole thing actually. But there's a difference between being able to tell him about how crazy early I show up and how hard I work to hide it and him actually witnessing it. It's embarrassing. My mom's crazyness is all ego syntonic, but me I get to know how ridiculous I am.
Posted by: Lee | Tuesday, 19 May 2009
I will wait with interest for your blog on buzzer pressing Lee.
Tony
Posted by: Tony | Tuesday, 19 May 2009
Good post Tony.
Being OK in the relationship is more important to some clients perhaps and there are good reasons why the Free child hides behind the Conforming Child. Its great to be "yourself" if one has an idea what that self is.
kenoath
Posted by: kenoath | Tuesday, 19 May 2009
Tony?
Conforming (in society) is perhaps easier? But FC is dangerously more fun.
Posted by: roses | Tuesday, 19 May 2009
You are never presumptuous Tony. As for your response, "With the risk of being presumptuous after reading your comment if I was your counsellor I would say something like, Harriet you think too much."
Yes, I do. That would be a totally appropriate thing to say.
Posted by: Harriet | Tuesday, 19 May 2009
I can't comment on your other blog cause i don't know how. You took your last post off... the one about your sons - its gone... did you get some good advice?
Posted by: roses | Wednesday, 20 May 2009
Man! I was so cranky last night.
For no particular reason. Every little thing seemed so big and it just made me angrier and angrier. Then my son took the little one at around 8.30pm and i went to bed and slept. He came back up at around midnight, and though he slept badly -intermittently - i feel so much better today.
Sleep is so important isn't it?
I hear on the telly - been up, off and on since pretty early this morning - that its a tad rainy over there. Rain these days is pretty rare (unless you live on the Queensland coast! Ouch!) so i hope you get to sit back and watch, hear, feel and taste it. Wonderful stuff really.
Happy day to you and yours...
Posted by: roses | Wednesday, 20 May 2009
Yes kenoath,
It is great to have a sense of what yourself is. Personally I don't have a problem with that one so I have to imagine what it must be like for others.
Also I find it a bit difficult to comprehend those who say they have a sense of being a fake and it is only a matter of time until others find out.
Tony
Posted by: Tony | Wednesday, 20 May 2009
Hello Harriet,
I am glad that I was appropriate but I will still try to be presumptuous. Some times it is remarked that those who think to much are 'dead from the neck down'!
Tony
Posted by: Tony | Wednesday, 20 May 2009
A cranky Roses? Why am I not surprised.
Maybe you should do some anger work Roses
Go Grrrl!
Tony
Posted by: Tony | Wednesday, 20 May 2009
"I am glad that I was appropriate but I will still try to be presumptuous. Some times it is remarked that those who think to much are 'dead from the neck down'!"
Tony - first of all, I don't want to think too much - I realize that it is NOT a good thing, but thanks for reminding me anyway. I don't choose to be this way, and I am in therapy to hopefully address this, although there are a multitude of issues I need to address, so I'm not sure when we're getting to that.
As for being "dead from the neck down" I think my husband might disagree with you.
Posted by: Harriet | Wednesday, 20 May 2009
Well Harriet I am glad that hubby would disagree!
For some reason my comments have been trying to provoke you a bit, not too sure why.
Graffiti
Posted by: Tony | Wednesday, 20 May 2009
So...
Why are you not surprised?
I don't want to do any anger work. I don't want to be angry - its annoying!
I can't think of anything to be really angry about. Well, i can think of heaps of 'things' i suppose, that do make me angry...
Why do you think i need to do some anger work?
I don't want to do any anger work.
Nope.
Night...
Posted by: roses | Wednesday, 20 May 2009
I like the angry and annoyed Roses.
So yes Roses, don't do any anger work
You seem to be a bit of a fiery character which I think is good and is good top have in the blogosphere and here on my blog
Have a good night
Tony
Posted by: Tony | Wednesday, 20 May 2009
"Well Harriet I am glad that hubby would disagree!
For some reason my comments have been trying to provoke you a bit, not too sure why."
Yes, I've noticed that and I hope you've noticed I haven't taken the bait.
Perhaps you should do some introspective thinking to figure out why you are trying to provoke me.
Posted by: Harriet | Wednesday, 20 May 2009
Or maybe I shouldn't think about it too much Harriet,
What would that achieve?
Graffiti
Posted by: Tony | Wednesday, 20 May 2009
It's up to you. If you'd like to grow as a person, which I think can be a good idea for most people, it might be worth a few minutes of thinking to see why you have this inclination to provoke me.
Or don't. Whatever.
Posted by: Harriet | Wednesday, 20 May 2009
You are right Harriet and I do apologise for my recalcitrance.
I promise none furthermore
Graffiti
Posted by: Tony | Wednesday, 20 May 2009
Ooooo. Compliant Graffiti. Is that even possible??
Oxymorons everywhere it would seem.
Posted by: roses | Thursday, 21 May 2009
Now Roses,
Are you trying to provoke me to provoke Harriet!
My life script has a place for powerful women, so maybe that is why the likes of you, Harriet and Annabel all get on so well with me.
Conformingly yours,
Tony
Posted by: Tony | Thursday, 21 May 2009
Yes Tony, i won't do anger work just now.
I have an assignment due in a couple of days and need to settle emotional flow till its done. I don't know if that's what i'm supposed to do but i do know that it helps with completing tasks A LOT.
Its easy to do but only safe for a short period of time. For me anyway. I can't know for anyone else of course. Though one can tell if someone has been shut off for a long time - they kind of look like they ate too much and haven't been to the loo for ages. You know... bulgy eyes, rounded shoulders (because of the abdominal pressure), restlessness, their skin doesn't look quite... honest? I think that's the word.
They feel like a lead weight and moist... umm, they need a good cry. When you look at them they have layers of faces looking back at you; i guess they feel the pressure of being needed - pulled and pushed from all directions. Lots of young mothers with heaps of young to very young kids look like that. Its as though there are times when they receed back into the deeper faces to get respite so they don't look as though they're 'in' or 'aware' - like the movie "Multiplicity" one of me is just not enough. They run on automatic so we're always dealing with a robot - machanical.
"Some one please help me."
That's the only emotion seen on their face fleetingly; it happens when they're tired or about to burst.
Its pretty yucky.
There's a smell or something in the atmosphere around them that makes you feel just that little bit uncertain. You begin to initiate compliance (fairly delibrately) into your behaviour for safety reasons.
Oh my goodness. Talk about raving! I'm off to do my assignment now. Happy Thursday! Its my birthday tomorrow. *Giggles* - i'm pretty excited... i've never been 47 before.
Posted by: roses | Thursday, 21 May 2009
"Now Roses,
Are you trying to provoke me to provoke Harriet!"
Who... Me???
Absa - bloomin - lutely! Only because its good for you.
and...
"My life script has a place for powerful women, so maybe that is why the likes of you, Harriet and Annabel all get on so well with me."
Well that's where you are in error. I'm not a powerful woman so maybe we don't get on as well as you think. Or, maybe your in the middle of a life script redecision. Or, maybe i don't know myself so well. Or... *shrugs*
I hope you have a nice day regardless of the weather...
Oh yeah.. i meant that the concept of 'graffiti' and the meaning of 'complience' are perhaps at odds with each other?
Happy day Mr Cheeky
Posted by: roses | Thursday, 21 May 2009
Roses,
Happy Birthday to you. Hope you had a good one. I guess you did something today for the first time - you became 47!!
Kahless
xx.
Posted by: Kahless | Saturday, 23 May 2009
Graffiti,
I always wanted homework; which is why I guess I generally didnt get set any.
Apart from encouragement from one T to be a rebel, which then again was discouraged by another.
I got why. Both were right for different reasons.
Oh and you know why you provoke. Its fun. Yet I know you only provoke in a nice way with warm intentions.
K.
Oh and my first part of this comment made me recall something as a kid. Ok, I was a "good girl" at school. Even in life a "nice" person. That however allows you to do something every now and then, out of main character trait, and get away with it. I remember my maths teacher (a nun) at school. If someone didnt know the answer to a question she used to make them sometimes stand for the duration of the whole lesson. In the end I used to manipulate her quite nicely. If I didnt know the answer to a question I used to have my hand up dead straight, confidently, almost lifting myself up off my seat to say "pick me." Of course she didnt then. She wanted to pick on someone who she thought didnt know the answer.
Her catch-phrase was "if your hands not up, then stand up."
Sometimes alternatively if I knew the answer, I pretended to half heartedly put my hand up, all doubtful. That way she would choose me and I could deliver "an uncertain" (not!) but always correct answer.
I did love maths though, probably cos I was good at it.
I guess I am trying to say, sometimes compliance, can hide non-compliance. Let someone put you in a box, then it gives you some freedom to operate outside of that box.
Or whatever.
Posted by: Kahless | Saturday, 23 May 2009
Tony,
Wrote a post on buzzers:P
http://talesofacrazypsychmajor.wordpress.com/2009/05/22/buzzers/
Posted by: Lee | Saturday, 23 May 2009
Thanks Kahless,
47 is pretty much the same as 46. No new surprises yet - but then... there's a whole year to go yet *giggles*.
I think allowing people to put you in a box and then work your way around from there is brilliant! For a time it works - but does it work all that well now?
Sounds like a great idea to me... Cheers!
Posted by: roses | Saturday, 23 May 2009
After 5 years with the same therapist, I don't tend to comply at all. I just swear and laugh when I don't want to do something, and somehow that becomes the work....
Posted by: hullaballoo | Monday, 25 May 2009
Hello Kahless,
it does sound like you had that nun teacher sorted out well and I think you make a good point about being boxed in and the freedom involved with that
Graffiti
Posted by: Tony | Monday, 25 May 2009
Hello Hulla,
It sounds like there could be some hullaballoo in your sessions. That sounds like good therapy - swearing and laughter therapy.
you don't seem to me to be the compliant type somehow.
Perhaps its your heritage like William Wallace.
See we are connected - William Wallace and Mel Gibson!. Did you hear that Mel has dumped his wife for his much younger pregnant girl friend!!
Graffiti
Posted by: Tony | Monday, 25 May 2009
It doesnt sound like you are being compliant in regard to Aboriginal alcoholism and dual relationships Tony.
kenoath
Posted by: kenoath | Tuesday, 26 May 2009
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