PRESENTING PROBLEM

 While supervising an intern, I used Storytelling TherapyTM to help her overcome an obstacle in the treatment of her client. Supervision is not therapy, per se. However, the context of supervision and of psychotherapy is similar because the intern seeks the knowledge and wisdom of the supervisor's experience to benefit her work.
The intern had insisted the client understand his thoughts and behavior, but found the client "resistant" to "seeing what he was doing." The obstacle was a common theme for the intern.
As the intern's personal and psychological conflicts had entered the context of the supervision, and some form of intervention was indicated. The complication, however, is that the supervisor should not practice psychotherapy on an intern. At times, this can be a difficult, yet necessary, boundary to respect.
 
 
HOW STORYTELLING THERAPY WAS USED

 Storytelling Therapy emerges as an excellent resource. It can convey essential messages toward the intern's personal and supervisory needs without crossing the boundary of practicing psychotherapy on her.
I suggested that the direct, confrontational approach was doing little for the client and exhausting her in the process. I told the following story to the intern because I wanted her to overcome her wish to confront the client when confrontation was contraindicated. Second, I wanted to give the intern an alternative method of therapy that she could use to accomplish the therapeutic goals she and her client had jointly worked out.
Bear in mind the primary objective of this story was to help the intern overcome her obstacles in becoming a better therapist, not to address the therapeutic needs of the client. The main message of this story was to communicate to the intern that an implied and metaphorical approach can be a good alternative when the confrontational approach fails.
 
 
STORY TOLD
The Subjugation of A Ghost
 
"A husband whose wife was on her death bed, granted her the wish that he wouldn't get involved with another woman after her death. The dying wife said that if he broke his promise, she would return as a ghost and make his life miserable.
"But sure enough, after a mourning period of 90 days, the husband met another woman. As time went on, they decided to become married. Soon after the decision, the man became plagued by the ghost of his deceased wife. He couldn't sleep because the ghost visited him every night reminding him of his promise. And clever too, was this ghost. The ghost knew everything he thought, felt and did throughout the day. Desperate, the man sought the counsel of the Zen master of the village.
" 'Your deceased wife has returned as a ghost,' observed the Zen master. 'Whatever you say or do, whatever you give to your bride to be, the ghost knows. She must be a very wise ghost. Really, you should admire such a ghost! Next time she appears, bargain with her. But be strong, because she's tough. Put a bag of soybeans on the night stand. When she appears, tell her that she knows so much that there is nothing you can hide from her. Tell her you will break the engagement if she can answer just one question. Then reach in the bag and grab a large handful of soybeans. Ask her the exact number of soybeans you hold in your hand. If she cannot answer, you will know the ghost is a figment of your imagination and will trouble you no longer.'
"That night, when the ghost appeared, the man complemented the ghost, told her that she knew everything, and made the bargain.
" 'Indeed,' replied the ghost. 'I know you went to see the Zen master today.'
"The man reached into the bag and grabbed a handful of soybeans. 'How many soybeans do I hold in my hand?' he asked.
"The ghost disappeared and troubled him no more."
(Paraphrased from Ross, Nancy Wilson, The Subjugation of a Ghost in The World of Zen, Vintage Books, New York, 1960, pages 82-83).
 
 
OUTCOME

 By telling the story to the intern, I communicated several messages both literal and implied:
• Joining with the client will help decrease resistance. If the Zen Master had told the man in the story that the ghost was simply a figment of his imagination, resistance would have been increased.
• Complementing the client's skills of resistance as tools of survival will help the therapeutic relationship; confronting them as an impediment to therapeutic progress or unwittingly showing annoyance will not.
• The direct, confrontational approach exhausted the therapist and did little for the client. In this case it influenced the client to dig in deeper to resist therapy even more.
• If frustrated with a client, get some help. This is honorable and time tested.
• Caring too much can harm the therapeutic process.
• Telling a nonthreatening story can be a good way to decrease resistance.

PRESENTING PROBLEM

A 30 year old married woman came to me for therapy and advice. Betty (not her real name) thought her mother's behavior was bizarre. After a few sessions of psychotherapy, Betty's mother was admitted to a psychiatric hospital with a diagnosis of paranoid schizophrenia.
As a working mother of a 20 month old child, Betty was scared that she, too, was either paranoid schizophrenic or harmed in some way by her mother's mental illness.
 
 
HOW STORYTELLING THERAPY WAS USED

 The goal of therapy was to help Betty understand how her mother's mental illness may have affected her own thoughts and feelings. A second goal was to ease her concerns about her own mental status. Betty was remarkably confused, but not schizophrenic.
I provided Betty with information about schizophrenic symptoms, age of onset, the nature of a thought disorder and the problems that families of schizophrenics can develop.
 
 
STORY TOLD
I told Betty a "Success Story Of A Previous Client."
 
"I had a client a few years ago. Unlike you, he was a man. I'll call him Joe, although that's not his real name. Joe's mother had what was believed to be paranoid schizophrenia, but also had manic-depressive features. (Betty's mother had manic features.) Joe told me a story that may be of interest to you.
"The story Joe related was that his mother once asked him to vacuum the living room carpet. Joe did the job and when he had finished, she looked down at the carpet and said, 'You didn't vacuum the carpet!' Joe argued that he had done the job, but mother insisted that he hadn't. She pointed to two specks of lint on the carpet, barely perceivable to the average person. (I pointed to a similar speck of lint on the carpet.)
"Joe's mother said, 'If you had vacuumed, those spots of lint wouldn't be there.' Joe argued that he had simply missed those spots or that the vacuum wasn't capable of getting them.
" 'No,' said mother. 'You didn't vacuum.'
"Now this example of denial and countless other episodes like itgrowing up with a mentally ill person can be a terrible thingmade Joe confused as to what was real and what was not real. Some of the things his mother said were strange and he knew something was wrong.
"But mentally ill or not, she was still his mother and the supreme authority. Her perceptions conflicted with his. Joe was angry, sad and confused. He wasn't sure if he had vacuumed or not.
"As I worked with Joe over a period of many months, he stopped taking the medication that his family doctor had prescribed. He still had some problems, mostly with anger and sadness. But through our work together, he became more trusting of his perceptions, and his judgment improved. He learned to talk more openly about his feelings and he got a promotion at work.
"Joe learned that much of his confusion was derived from trying to reconcile his own perceptions with the denial of his perceptions by his schizophrenic mother. And most important, he learned that he was neither stupid nor crazy."
 
 
PATIENT OUTCOME

 The effects Joe's mother had on him paralleled the effects Betty's mother had on her. The message of the story is clear. Growing up with a schizophrenic mother can make a person confused about what is real. It can make them depressed, angry and sad. Betty and Joe didn't have thought disorders, they had mood disorders. The story I told to Betty clarified the distinction and began her process of healing.
 
 

PRESENTING PROBLEM

A client called me on the phone in a panic. She had a great deal of generalized anxiety about her upcoming marriage. Because it was a crisis call, my goal was to redirect the client's attention as quickly as possible. I began redirecting her anxiety using the Storytelling Therapy method of creating mental and visual images. Soon her panic subsided and she became more rational.
 
 
TELEPHONE CONVERSATION
I told Betty a "Success Story Of A Previous Client."
 
Ken: Hello?
Client: Hi! Do you have a minute?

Ken: Well... [Before I can answer, the client is rambling hysterically.]
Client: My daughter is really pissing me off! I'm getting married next week and I won't have my daughter come between me and my new husband. She's not going to ruin my marriage

Ken: What's your daughter doing to ruin your marriage?
Client: [Client is unable to specify what the daughter is doing to ruin the marriage. She is loud, unfocused and rambling.]

Ken: What does your fiancee have to say about your daughter's behavior?
Client: He's OK with her. [More panic and rambling speech.]

Ken: Where's your future husband now?
Client: He's here in the house. [More panic and rambling speech.]

Ken: Where in the house?
Client: At the table. [More panic and rambling speech.]

Ken: And what's he doing at the table?
Client: What's that got to do with anything? [Client sounds surprised, and seems to find the question laughably irrelevant. She laughs a bit and is less rambling.]

Ken: I think it's important what he's doing at the table. But if you don't want to say, I can live with that. [This is a pivotal step because it offers the client a choice to continue her hysterical way or to let me take the lead. In order decrease her panic, she will have to focus her internal resources toward a specific image, that of her fiancee at the table.]
Client: (Hesitating a few moments.) No, no. That's OK. He's eating dinner. Although I really don't see what that has to do with anything! [Client is becoming less hysterical.]

Ken: Well, that's good. It's good that he's eating dinner. Tell me, what's he having for dinner?
Client: What do you mean, 'What's he having for dinner?'

Ken: Quite literally and simply, 'What 's he having for dinner? Is it fish, meat, chicken...[Client interrupts my sentence.]
Client: Well, let me see. I don't know (Hesitating) It's chicken

Ken: Well, what kind of chicken?
Client: What do you mean, 'What kind of chicken?'

Ken: Well, is it baked chicken, breaded chicken, fried chicken....?
Client: (laughing, but almost spontaneously) It's baked chicken.

Ken: And where did he get this baked chicken?
Client: (Laughing, spontaneously but thinking for a moment as if trying to remember.) At a takeout restaurant near us.

Ken: And how did he get it? Who went to the restaurant to get it?
Client: We both drove over.

Ken: And your daughter? Did she go with you?
Client: No.

Ken: And what else is he having for dinner? Certainly, he's not eating a piece of chicken on plate with no side dish. Like broccoli, or fries or something.
Client: (Laughing, spontaneously) Cole slaw. He's having cole slaw with his chicken.

Ken: Anything else?
Client: Uh, mashed potatoes.

Ken: Nothing to drink?
Client: (Laughing openly) O.K. I get it. Thank you.

Ken: Not a problem.
Client: Bye.
Ken: Bye. 
 

PATIENT OUTCOME
 
Throughout the conversation, I asked the client to focus on a specific mental image. By the end of the conversation, she realized she had more important things to concern herself with than the unfounded fear her daughter was trying to ruin her marriage. I could have delved into her underlying fear that she would ruin the marriage herself and suggested she was irrationally projecting her fear onto her daughter in a paranoid fantasy. Instead, I thought it wiser and more expedient to have her dissolve her panic attack by forming and focusing on an internal mental image.