CutTheCrap

Chapter 21 Cut the Crap Tall Tales and the Value of Lies Barry DuncanBefore I tell you about the most memorable lie of my career, thereis another story, a tawdry tale that inspired me to reflect abouttruth in psychotherapy, that sets the stage. Richard, a 29-year-old systems analyst, was referred by his company doctor becauseof his increasing distress and frequent absences. When I greetedRichard in the waiting room, he jumped out of his chair, got rightin my face—not three inches away—and demanded, “What areyou going to do for me?” Richard didn’t look too good. The 60-cent therapy words wouldbe agitated and disheveled. Tension and distress characterized hisevery move, and he looked as if he hadn’t slept in days—if he hadslept, it was surely in the clothes he was wearing. I tried to staycalm and just invited him to accompany me to my office, where-upon Richard raised his voice another notch and repeated hisquestion, and was once again too close for comfort. I was definitely freaked at this point but I simply replied that Ididn’t know if I could do anything for him but that I would trymy very best. Richard finally sat down on my couch and told hisstory, and the floodgates opened. Richard began suspecting his 127

128 Barry Duncan wife, Justine, of having an affair after he discovered footprints in the snow in his backyard. Consequently, he followed her, searched her belongings, and kept track of her whereabouts. But he could not find the incontrovertible evidence that he was sure existed. Throughout Richard’s growing mistrust, Justine emphatically denied the affair and told him he needed help. Perhaps in despera- tion, Richard began to secretly check Justine’s underwear for signs of semen, which would provide ironclad evidence of her unfaith- fulness (given there was no sex with him). Finally, Richard found stains on her underwear and took it to a laboratory, which confirmed the presence of semen. Justine still denied his accusations and insisted the semen was his. She stepped up her efforts to involve others, telling friends, family, his employer, and their own children, that Richard was sick and in need of hospitalization. Justine rallied many to her cause and filed for divorce. The company doctor concurred with her assessment, as did the first provider that Richard saw, a psychiatrist who offered an antipsychotic to ease Richard’s pain. After Richard’s first unsuccessful encounter with the psychiatrist, the company doctor was peeved. Perhaps hoping to admon- ish Richard into sanity, he had yelled, “Cut the crap!” Richard didn’t do much to disconfirm everyone’s assessment of his sanity. He was doing some pretty wacky things and looked more dis- tressed and haggard with each passing day. Richard told me that he was obtaining a DNA analysis of the semen to see if it was a match with his. While scrutinizing my every reaction, not in a threatening way but rather like a con- demned man waiting for a sentence, he nervously asked me if I believed him. So was Richard psychotic or was Justine a liar? Subsequently, I talked with Justine and invited her to therapy, but she declined. She was very persuasive and pulled out all the stops to describe Richard as hopelessly psychotic and in need of medical help, not- ing that Richard’s sister was also schizophrenic and lived in a group home. What would you say to Richard? I told Richard that I did believe him. Richard allowed himself a moment of relief, but pressed on and told me that the DNA test was going to cost a lot of money. He then leaned forward, stared

Cut the Crap 129uncomfortably, and asked me the big question: Did I think he wascrazy for spending all that money? I responded that peace of mind is cheap at any price. Richardbroke down and cried long and hard. He had been through a lot,and was starting to believe what many had told him—that he wasparanoid and needed medication. After a while, we started talkingabout what he needed to do to stop looking crazy while he waited onthe DNA results. If we took the affair as a given, and that her intentwas to make him look crazy as a loon, then everything he was doingwas playing right into her hands. Richard and I worked out a planto get normalcy back in his life: Return to work, start spending timewith his kids, and taking better care of himself. He did all of thosethings and continued to bide his time as best he could. Finally the results came in. Although Richard was greatly sad-dened when the DNA results confirmed that the semen was nothis, he was not surprised. Ultimately, the whole seamy businesscame to light, and Richard went about rebuilding his life. I wasboth relieved and heartened by the results. I had taken a bit ofa risk to believe Richard. Justine threatened legal action againstme for not insisting on medication, and the company doctor sug-gested I was acting unethically. In a sense I was vindicated alongwith Richard, but moreover, I was heartened that my belief in himseemed to make a difference regarding getting Richard back ontrack in his life—regardless of the ultimate truth of his story. I was so moved by Richard’s response, the depth of his wailing,to my simple act of believing him and understanding his desire toknow what was going on that I have never forgotten it. Richardtaught me that I have to believe my clients, pure and simple.Honestly, while Richard told me his story, I struggled with believinghim, which I knew was risky to our alliance. But I ultimately madea conscious choice, during that session, to believe Richard—thatit didn’t matter how bizarre it seemed or how classically paranoidit looked. I decided, at the very least, that my clients deserve to bebelieved. That was a significant event in my development as a thera-pist. From that day on, I no longer struggled with being a realitypolice officer. And while it’s true that sometimes people do lie, evenmaliciously, like Justine, I am willing to suspend disbelief until the“facts” appear, or maybe even into perpetuity, like with Nora.

130 Barry Duncan Nora was a delightful 7-year-old who suddenly started soiling herself when she was at school. The problem had persisted through pediatrician visits and an EAP counseling service that ultimately made the referral to me. In the first session, I saw Nora and her mom, Kathleen, together for a while, but Nora didn’t say much and Kathleen indicated that she wanted to talk to me privately. So I escorted Nora to the waiting room and showed her the toys, books, and TV. Kathleen expressed her concerns as well as her belief that the encopresis was related to the death of Nora’s biological father, who was recently killed in a car accident. Although Nora never knew her father, Kathleen believed the death was largely responsible for Nora’s soiling problem. As I tried to wrap my head around that, Kathleen spent most of the session talking about how Nora had been abandoned by her father as well as all the things that had been tried to help Nora with the problem. I learned a lot but unfortunately it didn’t leave much time for Nora. After commiserating with Nora about the toughness of her problem and how embarrassing it was, I asked her what she thought it was about and what she should do about it. Nora couldn’t wait to tell me about this very mean third-period math teacher she had, Mr. Miller, who wouldn’t let her go to bathroom. Nora said that she repeatedly raised her hand to be excused but that he ignored her and that was why she soiled her pants. I was appropriately indignant and told Nora that this just wasn’t right. Unfortunately, it was time to end the session and other clients had already arrived. So I told Nora that we would get into this more in the next session and figure out what to do about it. The next week I asked Kathleen’s permission to start out with Nora to both explore Kathleen’s hypothesis regarding the biological father but also to hear the full story about mean Mr. Miller. We played a couple of games together while we talked, but not much came out of the discussion about her biological father. But Nora came to life when I mentioned Mr. Miller. Nora hated this guy. With unbridled energy, she described situation after situation in which he always gave her a hard time and not others. Mr. Miller particularly favored boys, and it was Nora who got in trouble whenever boys would pick on her. She described one incident in detail in which a boy next to her pulled her hair three times before

Cut the Crap 131she punched him, which resulted in Mr. Miller standing her in acorner and writing her name on the board. Regarding the soilingproblem, Nora explained, she just couldn’t get to the restroom intime. Mr. Miller, Nora said, allowed the kids to go to the restroomby rows, and that was the way it was done, regardless of Nora’sneed to go quicker. Nora asked and was ignored; she waved herarms and was overlooked; and she stood up to no avail. As Noratold me about this heartless teacher, she became more animated,demonstrating each of her failed attempts to get his attention withall the attending frustration. I couldn’t believe what a jerk this Mr. Miller was. I asked Norawhat she thought could be done to set this guy straight and offeredto call him (after I talked with Kathleen) to see if I could get to thebottom of this. But Nora had a different idea. She thought it betterto have her mother write Mr. Miller a note. She even knew whatshe wanted the note to say. It was important that it properly puthim in his place, essentially scolding him and telling him that hehad better let Nora go to the bathroom. This sounded like a goodplan, especially given that this solution was Nora’s and she wasparticipating in a meaningful way in our work together. I invitedKathleen to join our discussion, and Nora and I presented thenote idea to her mom. Although Kathleen looked confused anda bit out of sorts, we composed the note right there. I continuallychecked out what we were writing with Nora to ensure that thenote captured her sentiments. Nora was very happy with the noteand put it in her purse to take to school to give to Mr. Miller. Sheskipped happily to the waiting room. The note must have reallyput that guy on notice because Nora never soiled her pants again. But that’s not the whole story. After Nora and I shared her planwith her mother, Kathleen asked once again to speak to me alone.She told me that Nora’s math class was actually her fifth periodand that her teacher was a woman—in fact, Nora had no maleteachers; and, finally there was no Mr. Miller at all in the school!Kathleen was a bit at a loss about what to do about this and wasworried that Nora’s lie reflected deeper psychological issues. I reas-sured her that children have rich fantasy lives and that I wonderedif this was a way that Nora has devised to solve her soiling prob-lem. I suggested that we implement the plan anyway to see what

132 Barry Duncan would happen and that we could immediately regroup if there was no movement, so to speak. So this impassioned, compelling story of the malicious Mr. Miller, with all its attending nuance and detail, was a lie, a big fat fabrication. But it worked. Nora defeated the poop problem. Perhaps it was Nora’s way of “externalizing the problem” or sav- ing face with an embarrassing situation, or maybe Kathleen was right and it was Nora’s way of working through issues about her biological father and his death. Who knows? Follow-up revealed that the problem had vanished and that Nora stopped talking about mean Mr. Miller. Although one can speculate many reasons why Nora suddenly took control of her soiling problem, the fact remains that the lie served a purpose and was somehow ther- apeutic. Nora helped me to continue my reflection about lies and the truth in psychotherapy. Most lies are decidedly not malicious in nature, and it may very well be that clients have very good reasons for lying, and perhaps, sometimes a lie can even be just the ticket. Barry L. Duncan, PsyD, is director of the Heart and Soul of Change Project and author of The Heart and Soul of Change and On Becoming a Better Therapist.

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CutTheCrap

by Barry Duncan on Dec 12, 2010

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CutTheCrap — Document Transcript