The "Steps" of Redecision Therapy
A young trainee of mine from Italy recently asked if there is a step-by-step process is of doing Redecision Therapy (RT). I understood that he was asking for a map: “First you do this, then you do this, then you say this…” I thought, “great question.”
Since I am consistently teaching my approach to RT by using my charts, it might make sense to imagine I use them as a linear approach to conducting therapy: “First you determine the Despairing Decision, then you identify the Defiant Decision, then teach the person their Coping Behavior…”
If you are using the charts, you know there is not an obvious or prescribed order. There is no step one, then step two. My teachers, Bob and Mary did intimate an order, first by getting the contract.
They emphasized creating a contract that was exact and in accordance with the request of the patient. “Here is what I would like to change….” Then they proceeded to identify the Injunction involved and the impasse created by it. They then moved to regress the person into an early scene where he or she could make a redecision, thus they believed resolving the impasse.
There was a certain order to the work they demonstrated even though saying that oversimplifies what they did. I always say I wish everyone could have seen them work when they were at the top of their game. It was something magical to behold. People literally came from all over the world to watch them work and learn from them.
As you know from my writing, I see the contract as the agreement from the patient to be in therapy and for the person to accept me as their therapist.
This means that she or he is giving me permission to listen to them literally, to look at them in a manner that would be considered rude (staring) in polite society and to ask deeply personal questions.
Many of you have also heard me cite the passage in the Bible where Jesus comes upon the cripple by the pool. He has been beside the pool waiting for many years to enter it when the waters were agitated. That was the time when the pool was believed to offer healing. Except that the man was crippled which prevented him from getting to the pool during those moments. So, he had been there a long time.
When Jesus comes upon him, he doesn’t say, “How about I heal you?” He says, “Do you want to get well?” It is not hard to imagine the man retorting angrily, “Why do you think I have been sitting here all these years?” But he doesn’t. He says he indeed wants to get well.” Then according to the Bible Jesus heals him.
We do a version of that. It would be easy for someone to say, “Why do you think I am sitting in your office?” It is easy to understand how someone might evince this attitude. But we are looking to gain an understanding. Does the person want to get well? If he or she does, good. It’s hard work and takes a lot of effort.
Eric Berne was in the habit of using percentages even when he did not have hard data to support them. He would say things like one had an ailing group if the attendance rate was under a certain percent. In the same way he stated that a high percentage of people come to therapy not to change their scripts but to further them. He had a point. “Well, I tried therapy. It didn’t work.”
I take it upon myself to understand the issue(s) that bring people to my office. But I do not expect them to be able to see their “blind spots” or to know the most powerful Injunctive Messages (IMs) affecting their lives. Those are for me to diagnose and share with them.
When you or I go to a physician it is because we have symptoms. We may have an inkling of what our diagnosis might be, but she is the physician, and we are the patients. In that situation, left up to our anxiety and imagination, we might imagine something worse than our actual diagnosis. When she does make a diagnosis, we are free to ask questions concerning the evidence. We are free to question a diagnosis, but the physician makes it.
In other circumstances, we might underestimate the seriousness of our symptoms and rule out the possibility of a diagnosis that demands immediate action. This can have tragic, even fatal results as shown by how many people have died because they recognized they had some symptoms that a heart attack might be taking place but discounted them.
Many of you reading this have read or heard the story of my first encounter with Dr. Friedman, the author (along with Diane Ulmer) of Treating Type A Behavior and Your Heart. I arrived at his offices for our first interview. He was interested in me from an earlier phone conversation and because of my educational history, as well as my professional credentials.
At the end of the interview, he asked me if I could recount for him all the Type A Behaviors (TAB) I had demonstrated in the previous hour. Not really. (It would be like one of us asking a person after an initial appointment, “What IMs and Coping Behaviors (CBs) did you manifest during this session?”)
So, with my permission (very important), he ran through a list of ten or so behaviors I had demonstrated. As he said them, I recognized the correctness of his observations. He educated me. He also tested me to see if I wanted to argue with him, deny what he said, and prove myself correct, trusting my own diagnosis over his.
You might laugh. Lots of people found it easy to disregard his status as the world’s leading expert on TAB and sought to prove him wrong. Fortunately, I did not, and he knew he had a willing student who wished to learn.
Remembering the context that brought the individual or couple to our office, we begin to educate them about the larger picture of their lives. Lots of folks believe they know the solutions to their problems or at least are sure of who is to blame for them. It is the rare person who can see the larger context. I often reassure people who feel embarrassed that they did not realize something that I had just made obvious, “It is difficult to see the picture if you are standing in the frame.”
In a moment of revelation, when someone has just learned an important truth, he or she will often say some variant of, “I wish I had known this ten years ago.” To this sincere lament, I will say, “I am so glad you are having this insight today and not ten years from now.”
The statement about the picture frame is true. I had studied both of Dr. Friedman’s books, but I did not “see” my TAB in real time until he gently laid it out in front of me. He had no trouble seeing it. It was obvious to him.
In the same way, we see things and hear things the patient is not aware of. Any of you who have been around me while I am working know that I often say, “I am not going to laugh at that” when someone is laughing or smiling while describing something unfortunate, painful, or tragic. Most often the person had no conscious awareness of the laugh or its meaning.
Frequently my intervention is challenged as the person discounts the seriousness of what they are saying. “Oh, come on doctor, I was just being funny.” In the Transactional Analysis literature this sort of humor is referred to as a “Gallows Laugh,” coming from the gruesome tradition where someone who was about to be hanged was expected to entertain the audience before being executed. The audiences probably laughed. Not so funny for the person giving the show. (Using this metaphor, we are implying the person is unknowingly “tightening the noose” with each unconscious laugh).
I know to make that sort of intervention because I know how to recognize the CBs. I can see sadness on someone’s face. I can hear the anguish in a person’s voice. I can hear a Despairing Decision: “It doesn’t seem like I really matter.” I recognize defiance.
I am allowed by the patient to “hear” their words literally. “Oh, that will be the death of me (ha ha).” Again, I might say something to the effect of, “I am not going to laugh at the idea of you being dead.” “Oh, Doc, lay off it.” No, I won’t lay off. Why? Because I have permission to hear exactly what is said in a literal way.
Have you ever noticed when your physician is performing an exam he will say, “I am going to listen to your lungs or chest” as he puts on his stethoscope. If you say, “Please don’t,” he will respect your desire not to be touched in that moment. At least, I hope he will.
The same is true for us. We are saying, “May I ‘touch’ you and tell you what I hear or see?” If we are respectful, people will tell us if we can proceed or not. “I’m not ready to talk about that now.” Fine.
Besides, a physician is not personally criticizing someone when she says, “You have a heart murmur,” or “Your blood pressure is high.” It is information that the person may or may not have known, but the individual needs to know. We all know folks who have serious medical or psychological problems and who don’t want to know.
When I confront a person about an inappropriate laugh, I am not accusing the person of being feckless. I am saying, “You have a behavior that concerns me.” I am not saying, “I want to criticize you and make you feel badly.”
Dr. Friedman confronted me about my TAB. During the interview he transmitted to me how warmly he was feeling toward me and made frequent references to my capability. He liked my personality well enough that within a couple of years we became friends. He confronted my behavior.
The behavior he confronted was damaging to me, even though I could not see it because it was so integrated into my life. Remember, I knew the material theoretically. I had read both his books. But I was standing in the frame. He wasn’t. He was “outside” looking in.
The CBs are integrated into our patients’ lives. They don’t see them. Or if they do, they will often say, “That’s just who I am.” No, it isn’t. They are learned behaviors that were once useful and are now destructive.
In this same manner, we confront the CBs because they are potentially damaging to peoples’ very lives, their ability to feel attachment, their sense of identity, their confidence in themselves in the Practical World, and their ability to feel secure while living life.
Where we begin with any one person on the charts is anyone’s guess. I am often asked if I give a copy of my charts to every person I see. No. Why? Good question. Lots of answer present themselves. For some, they would be overwhelming. For others they would look at them from a place of detachment. For many others, they wouldn’t be interested in them. I want to establish my interest in the person, before indicating I am more interested in showing off my material. And the list goes on.
The Charts are an imperfect map designed to aid with the accurate diagnosis of IMs with the goal of healing the damage wrought by them. Ultimately, they have been created for the sole purpose of healing. “Do you want to get well?” “Do you wish to seek healing?” “Do you even believe healing can take place?” The charts may or may not be a useful tool in the process of the therapy itself in real time.
This has been a long prequel to what I want to share with you in this paper, the response to my young friend who asked about the steps of RT. Here is what I wrote:
Dear Friend,
I have also been thinking more about the "steps" of redecision therapy. I gave you the answer, "To be seriously smart," which was being a smart ass on my part since that is not a "step."
In that spirit here are a few more "steps" that have come to me:
To be curious
To be a dedicated listener
To have the courage to observe
To trust your brain
To be well read in literature and the natural sciences, not just our field. Only reading psychology and journals will rot your brain and spoil your spirituality. The first question Dr. Friedman asked me once we were done with our pleasantries was, "Dr. McNeel, what do you read?" We talked often. He always asked me, "What are you reading?"
To keep alive the numinous in your life, the ability to experience awe and to be overcome with joy. To know that there is more to life than what we see. To remember St Augustine who said, "We live beyond the bounds of our bodies." Einstein said, "Either there are no miracles, or everything is a miracle."
To read poetry to keep the metaphorical portion of your brain alive. Otherwise, we can die of boredom while doing therapy.
To notice that you think involuntarily about psychotherapy (I have never had to "make" myself think about therapy. My brain does it naturally).)
To possess "empowered tenderness"
To remember that ten years from now you will be amazed at how little you knew at this time and that you will have the same experience ten years after that.
To discard things that don't work or match up with your personality.
To have the courage to confront, being confident that you are confronting beliefs and behaviors that are destructive to the person, not confronting the personality of the client.
To do your own work throughout your life so that being in your presence is safe for the client.
To be able to easily apologize when confronted with an error and to be friends with the phrase, "Maybe I was wrong."
To find joy in your work, so that is the reward and not the gratitude of our clients. Their gratitude is wonderful, but it is the icing on the cake, not the cake. The cake, the reward that never fails is the joy we take in this hard and tedious work. Remember when Jesus healed the ten lepers, only one returned to thank him.
To know that sometimes this work will make you feel terrible and do it anyway. There are moments when you will have your heart broken. And if your heart can't be broken, think of being an accountant instead, but not a therapist.
And later, I wrote him,
“Another "step" in doing redecision therapy is to have what I call a PHILOSOPHY OF JOY AND SUFFERING.”
Along with that second letter, I enclosed my article, “A Philosophy of Joy and Suffering. The short version of that paper is that we are not in control of either. Naturally, we wish to limit suffering and maximize joy. They exist in both the best and worst of circumstances. We often see people during their suffering. It is important that they know it comes to all of us and does not represent failure. And it is possible to get through it. Facing our suffering and allowing ourselves to be helped is a foundation stone of courage.
Joy comes to all but is often unrecognized in the moment it is taking place. Our job is to identify it when it is present and help the person to know it is taking place. It is a foundation stone of awe and wonder.
Both occur in the present moment, not in the future or the past. If someone is vividly reliving either one from a past memory, that experience is still in the present moment. It is happening before our eyes and ears.
Remember, the contract is the permission by the person to be seen and heard in the present moment, apart from the content of the person’s words or the story that is being told. “As you are sharing with me your daughter’s upcoming marriage, you sound sad.” “No, no, I’m very happy about it.” “Well, the expression on your face and the sound of your voice is sad.” “Oh, I suppose it does remind me that my father refused to attend my wedding.” “Please tell me more. I’m listening.”
I like to say that I wish to arrive at my office with three capacities available to me: my intuition, my curiosity, and my warmth, Well, those three things and a box of Kleenex. With that, I am prepared to sit before someone and ask, “How can I be of help to you today?” And then we are off into the unknown, looking to see how this person can be helped to grow and learn, always with their healing in mind.
If you like what is written here, then keep learning. If it makes you think, even disagree, then enjoy being hooked. It is a discovery without end.
Warmly,
John
May 17, 2023