Fool 2

[ATAC editor’s note: Numbers before each entry represent minutes and seconds. Text in square brackets is added description. Text not in brackets is spoken text.]

[00:00] [Sketch of young woman and therapist sitting facing each other.]

[00:00:02.85] NARRATOR: The patient in this interview is an 18-year-old young woman, who was diagnosed as diabetic at age nine. Since that time, she has had recurrent hospitalizations, for ketoacidosis due to he failure to maintain her diet. As a result of her latest hospitalization, a consultation was requested from the Department of Psychiatry. After a brief interview with a medical student, she agreed to meet with a therapist. This is that meeting.

[00:31 [Therapist sits across from young woman.]

[00:00:32.53] INTERVIEWER: Now, we're starting it officially.

[00:00:34.67] YVONNE: [INAUDIBLE]

[00:00:35.99] INTERVIEWER: Officially.

[00:00:36.65] YVONNE: All right. Go ahead.

[00:00:39.35] INTERVIEWER: How come you're in the hospital? How come? I know it has to do with your diabetes. But I'm gong to pretend I don't know too much about it so we can get all of this right from the beginning.

[00:00:53.06] YVONNE: All right. Where do you want me to start?

[00:00:57.80] INTERVIEWER: You tell me. Wherever you think would be best.

[00:01:02.60] YVONNE: Why am I in the hospital this time?

[00:01:05.61] INTERVIEWER: We'll start there.

[00:01:07.59] YVONNE: All right. Well, my sugar was high. And I had an infection and that's one of the reasons why my sugar went up. And another reason was because I wasn't eating.

[00:01:26.61] INTERVIEWER: OK. How come? That's the next natural question.

[00:01:33.47] YVONNE: Well, I know I was supposed to eat. I just didn't have an appetite to eat. And where I was staying, I was sick and I was getting sick. And the people that I was staying with didn't see it. And--

[00:02:01.82] INTERVIEWER: Is there a reason they didn't see it?

[00:02:04.99] YVONNE: They didn't thoroughly trust me.

[00:02:07.69] INTERVIEWER: They didn't trust you. That's why they didn't see it?

[00:02:10.93] YVONNE: Well, they-- I'm doing some-- I'm kind of a comic.

[00:02:16.21] INTERVIEWER: Yeah, I knew you did [INAUDIBLE]. What do you do?

[00:02:19.84] YVONNE: I try to make people laugh all the time, you know. And when I do that, they don't see me-- they don't see the serious side of me when I do things. They still think it's a comedy. And when I told them I was sick, that I was kidding around. And i kind of got mad. And I didn't ask them to fix me anything to eat, you know.

[00:02:53.46] INTERVIEWER: You got mad because they didn't take you seriously.

[00:02:56.42] YVONNE: I kind of got mad.

[00:02:57.91] INTERVIEWER: And so then you didn't ask them to fix you anything to eat.

[00:03:01.47] YVONNE: No, because, you know, they were saying, nothing is wrong with you. You can get up and fix your own.

[00:03:08.12] INTERVIEWER: You had asked them to fix you something?

[00:03:10.09] YVONNE: No, I didn't

[00:03:12.16] INTERVIEWER: You didn't. OK.

[00:03:13.97] YVONNE: Because I knew that was what they were going to say, that I wasn't sick and I could get up and fix my own.

[00:03:20.25] INTERVIEWER: OK. What did you mean when you said that they don't trust you?

[00:03:26.18] YVONNE: Well--

[00:03:30.55] INTERVIEWER: That sounds like a terrible, rotten situation to be in, to not have people trust you.

[00:03:35.21] YVONNE: Yeah. And now, I've known them for quite a while and when I'm at home, and don't work, I spend most of my holidays here in Galveston. And this is the first time I've ever went to live with them. And I don't think they knew me well enough to let me come stay with them but they did, so, in a way they kind of trusted me and in a way, they didn't.

[00:04:11.66] INTERVIEWER: OK. How didn't they trust you?

[00:04:15.03] YVONNE: Well, for one, the lady that I was staying with, when she was working and I was home from school, she used to call me every 30, every 45 minutes to see what I was doing.

[00:04:29.59] INTERVIEWER: Oh, goodness, why would she do that?

[00:04:32.38] YVONNE: I don't know.

[00:04:33.45] INTERVIEWER: Does she do that to all the people that stay with her?

[00:04:36.62] YVONNE: I don't know.

[00:04:41.75] INTERVIEWER: No idea? I mean, that sounds crazy.

[00:04:43.58] YVONNE: This is why I say I think they didn't trust me because she used to call me every 30, 45 minutes to see what I was doing.

[00:04:50.41] INTERVIEWER: If somebody called me every 30, 45 minutes, I wouldn't think they trusted me either.

[00:04:54.83] YVONNE: Well--

[00:04:55.15] INTERVIEWER 1: I would sure want to know why in the world they didn't. Did you have any reason not to trust you?

[00:05:00.26] YVONNE: I don't know. I don't think so.

[00:05:03.42] INTERVIEWER: Might she have heard anything about you that would make her not trust you?

[00:05:06.96] YVONNE: She probably has.

[00:05:08.97] INTERVIEWER: Oh, what could she have heard?

[00:05:11.18] YVONNE: Well, for one, about last year, we met Dr. [? Baram ?] downstairs--

[00:05:16.80] INTERVIEWER: Yeah, Dr. [? Baram. ?]

[00:05:23.66] YVONNE: And it was last year of October. And I would stay at my grandmother. My cousin was staying there. And me and my cousin didn't get along. And so one morning, we got into an argument, and I pulled a knife on her.

[00:05:48.19] And next thing I know, my caseworker was at the house, two cops and two detectives were there. Took me to a neurological center in Beaumont. And I stayed there four days. They ran two tests on me and let me go home. And I told them I wasn't going home, so they sent me to this center called David Wade Center, Beaumont State Center for Human

Development. Stayed there for two months until I found me somewhere else to stay. And then I went and got my clothes from my grandma's house and moved out.

[06:25] [“It’s your job not mine” text on screen.]

[00:06:25.33] NARRATOR: In the first minute of the interview, Yvonne makes clear what the therapist is to expect from her. First, she wants him to do the work.

[00:06:35.44] INTERVIEWER: OK. Now, we're started officially.

[00:06:37.72] YVONNE: Officially?

[00:06:39.30] INTERVIEWER: Officially.

[00:06:40.11] YVONNE: All right. Go ahead.

[00:06:42.89] INTERVIEWER: How come you're in the hospital, Yvonne, how come? I know it has to do with your diabetes. But I'm going to pretend like I don't know too much about it so we can get all this right from the beginning.

[00:06:56.55] YVONNE: All right. Where do you want me to start?

[00:07:01.55] INTERVIEWER: You tell me. Wherever you this it would be best.

[00:07:06.05] YVONNE: Why I'm in the hospital this time.

[00:07:09.03] INTERVIEWER: We'll start there. All right.

[07:12] [“It’s not my fault” text on screen.]

[00:07:12.92] NARRATOR: Second Yvonne is not going to accept personal responsibility for her actions. Instead, she will blame it on others.

[00:07:21.04] YVONNE: Well, my sugar was high. And I had an infection. And that's one of the reasons why my sugar went up. And another reason is because I wasn't eating.

[00:07:37.59] INTERVIEWER: OK. How come? That's the next natural question.

[00:07:44.45] YVONNE: Well, I know I'm supposed to eat. I just didn't have an appetite to eat. And where I was saying, I was sick. And I knew I was getting sick. And the people that I was staying with didn't see it.

[08:09] [“Figure this out if you can” text on screen.]

[00:08:09.73] NARRATOR: Third, Yvonne is going to keep parts of her story to herself. As a result, what she says is inconsistent and confusing.

[00:08:18.44] YVONNE: Well, I knew I was supposed to eat, I just didn't have an appetite to eat. And where I was staying, I was sick and I knew I was getting sick. And the people that I was staying with didn't see it.

[00:08:43.72] INTERVIEWER: Right. Is there a reason they didn't see it?

[00:08:49.45] YVONNE: I had a feeling they didn't trust me.

[00:08:52.18] INTERVIEWER: They didn't trust you? That's why they didn't see it?

[00:08:55.54] YVONNE: Well, they-- I'm doing some-- I'm a kind of a comic.

[09:00] [“The resistant patient” text on screen.]

[00:09:00.76] NARRATOR: This is going to be a difficult patient to work with. She is evasive, passively uncooperative and is laying back, waiting for the therapist to commit himself. The agenda for this interview has not been discussed beforehand by the patient and the therapist. Nevertheless, they both know what it is, her recurrent hospitalization for ketoacidosis due to her failure to maintain her diet.

[00:09:25.17] At the time of this interview, Yvonne has been on a medical ward at the hospital for about three weeks. It is only a matter of time in this interview, until the therapist must broach discussion of the obvious problem. These early minutes of the interview constitute a period during which both the patient and the therapist are checking each other out.

[00:09:44.97] He finds out that she will be an elusive quarry. She finds out that he refuses to rush into things. Like her, he will not commit himself. They both play a waiting game.

[00:09:57.14] Milton Erickson has noted that for some patients, withholding, the resistance, and other types of uncooperative behavior are to be expected. These behaviors are part of the patient's problem and should be accepted by the therapist with the same good grace that he shows to the patient's other symptoms. Accordingly, this therapist has not commented on the inconsistencies in Yvonne's stories. He merely accepts them as information about how she will deal with him.

[00:10:26.30] He is giving her a powerful new experience that she has seldom had before. He will not fight with her. Yvonne has a way of saying certain things that tempt others to confront her. For example, she tells a rambling shaggy dog story, explaining her confusion as to why others do not trust her. Her tale ends with her pulling a knife on a cousin. This surprise ending only provokes the therapist to utter a somewhat louder um, hum.

[00:10:56.15] Having failed to entice or provoke the therapist into the open, Yvonne goes on with her story. She can be expected to escalate her efforts to smoke him out.

[11:06] [Sketch of young woman. “Nothing bothers me” written beneath image.]

[11:07] In this next sequence, Yvonne makes a serious attempt to provoke the therapist by insisting that nothing bothers her. Given the power of this particular maneuver, she has probably had much past success with it, since it is almost certain to upset anyone trying to help her.

[00:11:25.49] INTERVIEWER: I can tell you have a very complicated story to tell. I'm only hearing parts of it.

[00:11:31.03] YVONNE: And you want to hear the whole thing?

[00:11:32.99] INTERVIEWER: Well, I need to hear a lot it. I know that.

[00:11:36.92] YVONNE: It all started when my mother died, put it like that.

[00:11:39.97] INTERVIEWER: Started when your mother died.

[00:11:41.38] YVONNE: Yeah.

[00:11:43.28] INTERVIEWER: OK. Tell me the story. I guess I'm going to have to need all of it to get all the good parts of it, the bad parts too.

[00:11:51.24] YVONNE: Good parts and bad parts. Well--

[00:11:53.05] INTERVIEWER: Are you willing to tell it all?

[00:11:54.56] YVONNE: Yeah. Why not?

[00:11:57.05] INTERVIEWER: Lots of patients aren't. Did you know that?

[00:12:00.02] YVONNE: Well, it doesn't bother me at all. After my mother died, nothing doesn't bother me.

[00:12:06.48] INTERVIEWER: OK, well, let me know if something bothers you.

[12:10] [“Basic Assumptions

1. People tend toward health.2. People are ambivalent about changing” text on screen.]

[00:12:10.48] NARRATOR: This is a resistant patient who could easily provoke others into struggling with her. The fact that this therapist does not do so is consistent with his theory of how people change. The theory is founded on a two part basic assumption. First, over time people will tend toward health or adaptation. But second, they are inherently ambivalent about making such change.

[00:12:33.58] This ambivalence sets the stage for the impact of interpersonal components of change and failure to change. Specifically, people are reluctant to give up old gratifications in

order to accept new burdens. They tend to complain about such anticipated changes. Too often, such complaints invite helpful others to push them to accept what they should. Such pressure does not help. Instead, it tends to make people dig in their heels and fight back.

[13:03] [[figure]

Description: The figure is labeled as “Positive Feedback Loop.” One side of the figure is labeled as “1st Party: Reluctance to Change” The other side is labeled as “2nd Party: Pressure to Change.” The two are connected with cyclical arrows to signify they are connected with one another.

[end figure]]

[00:13:03.30] Under these conditions, a positive feedback loop is often created which blocks change rather than facilitates it.

[13:16] [[figure]

Description: The figure is labeled as “Positive Feedback Loop.” One side of the figure is labeled as “1st Party: Reistance to Change” The other side is labeled as “2nd Party: Increased pressure to Change.” The two are connected with cyclical arrows to signify they are connected with one another.

[end figure]

[Editor’s note: Above figure changes to below figure at mid-sentence at 13:19.]

[figure]

Description: The figure is labeled as “Positive Feedback Loop.” One side of the figure is labeled as “1st Party: Refusal to Change” The other side is labeled as “2nd Party: Insistence upon Change.” The two are connected with cyclical arrows to signify they are connected with one another.

[end figure]]

[00:13:16.25] A positive feedback loop can escalate reluctance to change into resistance to change, and eventually into refusal to change.

[13:21] Yet this process of escalating resistance is not inevitable. If left relatively alone, the resisting person will often change on his own. True, any such change will typically be preceded by much grumbling. But the person may still make the change, complaining all the way so long as no one tries to push him into it.

[13:43] [Failure to change

1. Foot dragging provokes others to push them to change.

2. “Deliberately” provoking someone to oppose them.]

[00:13:43.40] As a final point, it should be noted that the interpersonal contributions to failure to change come in two forms. In both cases, someone else pushes the individual to change. In the first case, the individual's foot dragging may result in someone else trying to help them. This help can then be resisted and change blocked. In the second case, if foot dragging does not spontaneously produce a rescuer, the person may make a calculated or semi-deliberate provocative comment to seduce someone into fighting with him. As we have already seen, the patient Yvonne, tends to make exactly this kind of provocative comment.

[00:14:22.84] YVONNE: Well, it doesn't bother me at all. After my mother died, nothing doesn't bother me.

[14:30] [“The dance of power.”]

[00:14:30.23] NARRATOR: Up to this point, the therapist has been biding his time and gathering information. Now the time has come for the next stage, a dance of power, during which the therapist will constantly challenge the patient by refusing to challenge her. This is an exceedingly powerful maneuver because Yvonne is defending against change by provoking people to try to help her.

[00:14:51.81] This process probably began without her active help, in part, because of the life-threatening nature of the change that she needs to make, and in part, because of the all pervasive limitations that her diabetes subjects her to, Yvonne has inevitably been subjected to strong pressure to do the things that she must. And the more she has been pushed to accept these limitations, the more she has fought them. As a result, Yvonne is probably developed a general resistance to anyone telling her what to do about anything.

[00:15:24.76] Therefore, this above all else, the therapist must refuse to do. He must never push her directly. Only by removing such pressure can the therapist free her up to change on her own. When the therapist refuses to push, then perhaps for the first time, she will feel some internal pressure to change. And so the dance begins.

[00:15:50.89] INTERVIEWER: So, what's your problem, Yvonne?

[00:15:56.09] YVONNE: My diabetes, for one.

[00:15:59.03] INTERVIEWER: OK. What about for two?

[00:16:01.94] YVONNE: Bad childhood, you could put it like that. OK.

[00:16:06.29] INTERVIEWER: What's your problem, though? What needs to change? Obviously I can't change your diabetes. I can't make that go away and I can't make your bad childhood go away. You're stuck with that too.

[00:16:18.90] YVONNE: Yeah. Well, I could say one reason just start doing things I'm supposed to do, eat regularly. That's one of my problems, I've got a bad appetite.

[00:16:41.72] INTERVIEWER: You don't eat right.

[00:16:43.18] YVONNE: Right.

[00:16:43.66] INTERVIEWER: OK.

[00:16:45.61] YVONNE: That's the only reason I know because I take my medicine, my insulin. It's just that--

[00:16:51.70] INTERVIEWER: Do you always take it?

[00:16:52.71] YVONNE: Yeah. Just got a bad appetite.

[00:16:57.49] INTERVIEWER: Which is as bad as not taking your medicine.

[00:16:59.58] YVONNE: Right.

[00:17:04.87] INTERVIEWER: OK.

[17:06] [“I just have a bad appetite.” Sketch of young woman and therapist sitting facing each other. She holds a fishing pole and tackle in front of the therapist.]

[00:17:06.81] NARRATOR: End of round one. Yvonne tries to get the therapist to react to her bad appetite ploy. Watch her eyes during this exchange as she tries to get the therapist to come out and fight with her.

[00:17:19.30] YVONNE: That's one of my problems, I've got a bad appetite.

[00:17:23.95] INTERVIEWER: You don't eat right.

[00:17:25.35] YVONNE: Right. OK. That's the only reason I know because I take my medicine, my insulin. It's just that--

[00:17:33.45] INTERVIEWER: Do you always take it?

[00:17:34.87] YVONNE: Yeah. Just got a bad appetite.

[00:17:39.13] INTERVIEWER: Which is as bad as not taking your medicine.

[00:17:41.24] YVONNE: Right.

[00:17:46.67] INTERVIEWER: OK.

[17:49] [Sketch of young woman and therapist sitting facing each other. She holds a fishing pole and tackle in front of the therapist.]

[00:17:49.15] NARRATOR: The therapist has refused to respond to her bait. She will have to try harder.

[00:17:53.94] INTERVIEWER: Well, What do you want me to do for you? Want me to give you a good appetite, is that you want?

[00:18:01.30] YVONNE: What do you want to do? Doesn't make me the difference. I tell you, nothing doesn't matter to me anymore.

[00:18:07.82] INTERVIEWER: Do you want to die?

[00:18:10.47] YVONNE: We all got to go sometime.

[00:18:11.96] INTERVIEWER: OK. Are you ready to go now?

[00:18:13.64] YVONNE: Why not?

[00:18:14.93] INTERVIEWER: OK, so you're--

[00:18:15.79] YVONNE: Life isn't treating me any good.

[00:18:17.62] INTERVIEWER: So have you thought about killing yourself?

[00:18:19.88] YVONNE: No.

[00:18:21.28] INTERVIEWER: That would be obvious way to end it all.

[00:18:24.78] YVONNE: Right.

[00:18:26.75] INTERVIEWER: But you haven't thought about that yet.

[00:18:28.21] YVONNE: No.

[00:18:29.61] INTERVIEWER: Think you might?

[00:18:32.00] YVONNE: Probably if things get worse.

[00:18:36.87] INTERVIEWER: My guess is things may get worse.

[00:18:39.52] YVONNE: I thought about that too. I think that too.

[18:42] [Sketch of young woman and therapist sitting facing each other. She holds a fishing pole and tackle in front of the therapist. He holds a coiled snake in his hands.]

[00:18:42.30] NARRATOR: In round two, Yvonne has resorted to her most powerful maneuver, nothing matters anymore. This time the therapist takes some note of it, but still does not challenge it directly. He goes with the resistance by accepting and extending it. By extending it far beyond her original intention, the therapist overloads it. Watch this fast moving sequence again.

[00:19:05.26] INTERVIEWER: Well, what do you want me to do for you? Want me to give you a good appetite? Is that what you want? What do you want to do?

[00:19:14.45] YVONNE: Doesn't make me the difference. I tell you, nothing doesn't matter to me anymore.

[00:19:19.54] INTERVIEWER: Do you want to die?

[00:19:22.17] YVONNE: We all got to go sometime.

[00:19:23.68] INTERVIEWER: OK. Are you ready to go now?

[00:19:25.34] YVONNE: Why not?

[00:19:26.62] INTERVIEWER: OK, so--

[00:19:27.12] YVONNE: Life isn't treating me any good.

[00:19:29.37] INTERVIEWER: So have you thought about killing yourself?

[00:19:31.42] YVONNE: No.

[00:19:32.98] INTERVIEWER: That would be the obvious way to end it all.

[00:19:35.50] YVONNE: Right.

[00:19:36.95] INTERVIEWER: OK. But you haven't thought about that yet.

[00:19:39.85] YVONNE: No.

[00:19:41.31] INTERVIEWER: Think you might?

[00:19:43.70] YVONNE: Probably if things get any worse.

[00:19:48.58] INTERVIEWER: My guess is things may get worse.

[00:19:51.22] YVONNE: I thought about that too. I think so too.

[19:54] [The snake is now attached to the young woman’s fishing pole.]

[00:19:54.43] NARRATOR: The therapist has refused to be intimidated by her nothing matters ploy. This particular battle is by no means over. But the therapist has begun to unmask his power. He will not fight against her. He will fight by going with her.

[00:20:10.59] INTERVIEWER: I suspect that you have had such a rotten childhood and that you feel like you've been treated so unfairly so many times, even being treated unfairly by life, because you have diabetes on top of everything else, that my guess is that you react--

[00:20:36.99] [FINGER SNAP]

[00:20:37.81] --just like that to anything that's out of place. And in all likelihood, something that somebody else would see as being this unfair, you see it as being this unfair.

[00:20:52.97] YVONNE: Yeah, I'm with you.

[00:20:56.48] INTERVIEWER: Because you've got a-- you're sensitive to that. Right?

[00:21:01.41] YVONNE: Right.

[00:21:03.83] INTERVIEWER: And I can understand that.

[00:21:08.47] YVONNE: Glad somebody agrees with me.

[21:11] [“You’ve had it bad.”]

[00:21:11.87] NARRATOR: A rhythm is developing. The therapist earlier pushed her to back off from our nothing matters stand by extending it to its logical conclusion, suicide. Now, he has switched to accepting, endorsing, and justifying her sense of being treated unfairly.

[00:21:34.30] INTERVIEWER: So, it's for that reason that I ask you what it is that you'd like from me. There really isn't anything that I'd like from you, other than maybe an answer to that question. Obviously, in one sense I'd like to see you not be quite so sensitive and not be unhappy and I'd like to see you eat right so that you don't keep screwing up your system and have to go to the hospital. Obviously, I'd like that. But I'm not going to try to push that on you because you may not want that. I think there's too many do-gooders in this world trying to tell people what to do.

[00:22:16.28] YVONNE: Right.

[00:22:18.00] INTERVIEWER: I would far rather that people choose for themselves. So I ask you, what is it that you do want?

[00:22:28.87] YVONNE: What is it that I want?

[00:22:30.20] INTERVIEWER: Yeah. Maybe that's not even the right question. Maybe the right question is, is there anything you want to know? Maybe you don't.

[00:22:40.44] YVONNE: I don't.

[00:22:43.73] INTERVIEWER: It makes me wonder, of course, why you wanted to go ahead and meet with me. You must have thought I had some things that I wanted for you.

[00:22:53.69] YVONNE: I don't want anything because there's nothing that people can give me that's going to make me happy.

[00:23:02.68] INTERVIEWER: I think you're right.

[00:23:04.41] YVONNE: They can give me something, I'd be happy for the moment, but that's it. It doesn't last.

[00:23:10.31] INTERVIEWER: Absolutely, it doesn't last. You're right. It's true.

[23:15] [Drawing of therapist with fish hook in back of shirt.]

[00:23:15.50] NARRATOR: The therapist has made overt his position. He will not try to push anything on her that she does not want. And he makes a mistake in the process. In spite of himself, he gets hooked by the strength of her insistence the she does not want anything. He begins to challenge this directly and then backs off in mid-step. Listen to the shift in the therapist's tempo as he scrambles back to agreeing with her after being hooked.

[00:23:42.05] INTERVIEWER: So I ask you, what is it that you do want?

[00:23:47.03] YVONNE: What is it that I want?

[00:23:48.70] INTERVIEWER: Yeah. Maybe that's not even the right question. Maybe the right question is, is there anything that you even want at all? Maybe you don't.

[00:23:58.62] YVONNE: I don't.

[00:24:01.91] INTERVIEWER: It makes me wonder, of course, why you wanted to have to go ahead and meet with me. You must have thought I had some things that I wanted for you.

[00:24:11.93] YVONNE: I don't want anything. Because there's nothing that people an give me that's going to make me happy.

[00:24:20.75] INTERVIEWER: I think you're right.

[00:24:22.56] YVONNE: They can give something and I'll be happy for the moment, but that's it. It doesn't last.

[00:24:28.46] INTERVIEWER: Absolutely, it doesn't last. You're right. It's true. Even for people who don't have a bunch of people running around being treated as unfairly as you've been treated, and even for people that don't have the burden of diabetes to carry, even they don't stay happy all the time. You must stay happy a whole lot less of the time than they do.

[00:24:57.55] YVONNE: Yeah.

[00:24:58.99] INTERVIEWER: And it doesn't last.

[00:25:00.43] YVONNE: Because being a diabetic is hell.

[00:25:05.38] NARRATOR: Evidently the mistake was recoverable. Yvonne is navigating to volunteer some information and is beginning to show a hint of emotion. In the sequence that follows, Yvonne will repeatedly test out this new kind of therapist. She will vacillate back and forth from revealing herself and her emotions to trying to provoke the therapist to come out in the open and fight. All these provocations he will sidestep, deliberately misinterpret, or take them over for his own purposes.

[00:25:34.40] YVONNE: Being diabetic is hell. Especially when you're young. I caught it when I was nine. I'm 18 now, I'll be 19 next month. Because you grow up, you can go to parties, but you can't have all that kids have. Can have all this cake and ice cream when you're young, all the [? candied moors ?] And when you're older, you still can't have all the wine and the liquor you want.

[00:26:06.80] INTERVIEWER: Right. It's unfair.

[00:26:10.75] YVONNE: Right.

[00:26:12.75] INTERVIEWER: It's absolutely unfair.

[00:26:14.36] YVONNE: That's why I don't go.

[00:26:16.69] INTERVIEWER: That's why you don't go to parties?

[00:26:19.51] YVONNE: Right. House parties. Now I'll go out sometime but I go out by myself. I'm the only one know what I'm drinking. Because if I go out with a whole bunch of kids after a football game, they'll say, you're not drinking any? So you're drinking? So what? [INAUDIBLE] It's bad.

[00:26:46.17] INTERVIEWER: What did you used to tell them what happened before you stopped going?

[00:26:51.23] YVONNE: I never did go, start going.

[00:26:54.41] INTERVIEWER: Well, you must've because you're just telling me the kinds of things that they would say. When did that happen?

[00:27:01.65] YVONNE: Well, friends would always let them. I didn't say anything, just left them-- [INAUDIBLE] me home.

[00:27:08.91] INTERVIEWER: How did you feel when they said that?

[00:27:11.21] YVONNE: It felt terrible, for one.

[00:27:13.43] INTERVIEWER: Feel ashamed, or something like that?

[00:27:17.33] YVONNE: No. I just felt that I was different. And I didn't want to be different.

[00:27:26.18] NARRATOR: I understand.

[00:27:28.07] YVONNE: Not-- Right now I want to be different.

[00:27:31.04] INTERVIEWER: The worst thing in the world when you're a kid is to be different.

[00:27:33.92] YVONNE: Right.

[00:27:34.39] INTERVIEWER: Because other kids give you a hard time and you feel bad.

[00:27:39.15] YVONNE: Right now, I don't mind being different. Because everywhere you look around, people doing the same thing. I don't want to do the same thing. I want to do my thing.

[00:27:53.13] INTERVIEWER: What is it that you want to do?

[00:27:54.55] YVONNE: Nothing.

[00:27:55.94] INTERVIEWER: That's the way you want to be different, by doing nothing?

[00:27:58.45] YVONNE: Right.

[00:28:00.28] INTERVIEWER: And means doing stuff like not eating and going to the hospital and smoking pot and probably some other things I don't know about yet.

[00:28:10.45] YVONNE: Yeah, I guess so. Because like I said, it doesn't make me any difference any more.

[00:28:18.19] INTERVIEWER: How about sex? Is that part of being different?

[00:28:23.18] YVONNE: Rephrase that question if you can.

[00:28:25.53] INTERVIEWER: Yeah. You said that you wanted to be different from other people. And one of the ways-- the ways that you're talking about being different that I know about so far, have to do with your being-- I don't really mean this word, but just sort of know what I mean, rebellious.

[00:28:43.08] YVONNE: Yeah.

[00:28:43.45] INTERVIEWER: OK. Not eating when you should, smoking pot when you know people are going to hassle you about that. And You told me your taking birth control pills. So that makes me ask about sex. I wonder what--

[00:28:57.25] YVONNE: I'm not taking them anymore.

[00:28:59.58] INTERVIEWER: Oh, no? Are you still having sex?

[00:29:02.08] YVONNE: No.

[00:29:02.97] INTERVIEWER: Because that would be a way that you could be rebellious. That would be a good way. You could go and get pregnant.

[00:29:07.05] YVONNE: Right. That's why I stopped.

[00:29:11.03] INTERVIEWER: Think you might do it anyway?

[00:29:12.66] YVONNE: No.

[00:29:14.92] INTERVIEWER: OK.

[00:29:16.69] YVONNE: It might be hard but I can do it.

[00:29:21.41] INTERVIEWER: OK. So how else are you being different?

[00:29:36.43] YVONNE: I don't know yet because I haven't seen-- I having been out in good while to see what people are doing for me to be different.

[00:29:48.47] INTERVIEWER: I have a crazy thought. You have to bear with me. A lot of therapists are pretty sane but I have crazy thoughts from time to time. I just throw them out.

[00:29:58.37] YVONNE: All right.

[00:29:59.63] INTERVIEWER: Sometimes they make a little bit of sense, but as often as not, they're just off the wall.

[30:07] [“The crazy thought.”]

[00:30:07.08] NARRATOR: The therapist has finally reached a point where he is ready to take some initiative and make an active move. Up to this point, he has been mostly reacting. To cope with this resistant patient, he elects to use a favorite tactic of his, the crazy thought. In doing so, he is deliberately assuming a one down position that is analogous to the well-known tactic of courtroom lawyers.

[30:31] [“I’m just a country boy” text on screen. Image of therapist wearing a country hat and piece of straw sticking out of his mouth.]

[00:30:31.46] With this kind of an introduction to the message he wants to get across, the therapist can say almost anything and not have to take responsibility for having said it. In addition, he is not required to argue the point if the patient disagrees with it. This particular strategy is an interesting one because the patient almost invariably, is aware that the therapist is putting one over on him. He knows something is going on, but he can't quite put his finger on it. When done with flair and in a non-threatening manner, the crazy thought leaves the patient mildly disoriented and subliminally aware of the therapist's power. The therapist has put himself, or at least this thought, in the one down position and gained strength by being weak.

[00:31:17.29] The crazy thought is a bit like the schizophrenic who can freely utter the most devastating truths during family therapy and get off scot-free. There's power in being crazy. Watch Yvonne's expression as she is confronted with the subtle strength of such craziness.

[00:31:38.24] INTERVIEWER: You have to bear with me. A lot of therapists are pretty sane. But I happen to have crazy thoughts from time to time and I just throw them out.

[00:31:44.92] YVONNE: All right.

[00:31:46.34] INTERVIEWER: And sometimes they make a little bit of sense but as often as not, they're just off the wall.

[00:31:52.89] YVONNE: All right. I

[00:31:55.98] INTERVIEWER: Kind of have this feeling that when you were a kid, you were different. And you didn't have anything to say about it. You were stuck with it. God made you different. Life made you different. And you had other people telling you you were different. You didn't like that one bit. You were mad about it. Still mad about it today. Now you're a grownup. And you have a little bit of control over what you do in your life. You're not quite so much pushed around as you were earlier. You can fight back.

[00:32:45.76] My crazy thought is that you kind of look around at other people and see how they are. And that somehow that you feel that maybe you're getting even with them by being different from them on purpose. I told you it was crazy.

[00:33:04.92] YVONNE: You're right.

[00:33:06.46] INTERVIEWER: You mean I'm right?

[00:33:07.41] YVONNE: No.

[00:33:08.15] INTERVIEWER: It's crazy.

[00:33:08.59] YVONNE: You're right, it's crazy.

[00:33:10.80] INTERVIEWER: OK. I have to live with that. I told you, I say crazy things.

[00:33:16.44] YVONNE: The only thing I can say about it is, you're wrong.

[00:33:19.37] INTERVIEWER: OK.

[00:33:20.29] YVONNE: It's not getting back at them. Because I have nothing against them. They haven't done anything for me to get back at them.

[00:33:28.00] INTERVIEWER: Though somebody has.

[00:33:30.59] YVONNE: Yeah, some people do. But not me because like I say, I want to be different. And when I see, like I said, people are doing the same thing now. Everybody's doing the same thing. Everybody's doing the same dance. Everybody is smoking the same weed. Everybody is buying the same jumpsuit, same color shoes, same style shoes. I do want to be like everybody else. I want to be different.

[00:34:08.81] INTERVIEWER: Do they try to make you be like them? Do people give you subtle kind pressure, suggest you should become like them?

[00:34:18.15] YVONNE: Yeah. Lost of people. But just on some situations, you're right to get back at them, but not all of my situations. Like people can tell me something and they're right, but I don't want to do it because I want to do my own thing.

[00:34:43.96] INTERVIEWER: I understand that. I understand that.

[00:34:46.70] YVONNE: And I do it different even though I know they're right.

[00:34:51.29] INTERVIEWER: You can't make your choice if somebody else is trying to tell you to do it. So sometimes, even though you know it's not the best thing, you go ahead and choose that because at least that is yours--

[00:35:02.83] YVONNE: Right.

[00:35:03.22] INTERVIEWER: --rather than theirs. I can understand that.

[35:06] [“I Won’t”]

[00:35:06.27] NARRATOR: This marks a turning point in the interview. Yvonne has defined the real problem. How can she have some autonomy to make her own decisions when so many people try to tell her what to do? Her solution to this dilemma is her symptom, stubborn defiance, even if it hurts her. The interview now moves into a new phase.

[35:28] [“The dance of intimacy.”]

[00:35:28.25] Her defiance is the issue that must be explored and it must be handled appropriately by the therapist. He must win her cooperation without criticizing her or she will

withdraw again. He must get closer to her and use their growing relationship to help disarm her defiance.

[00:35:46.82] What transpires is a dance of intimacy. The therapist will slowly, but with increasing speed and assurance, use Yvonne's defiance to increase the intimacy between himself and her. But first, the extent and the meaning of her defiance must be explored.

[00:36:05.05] YVONNE: But I don't want to do it, because I want to do my own thing.

[00:36:08.13] INTERVIEWER: I understand that. I understand that.

[00:36:11.60] YVONNE: And I do it different, even though I know they're right.

[00:36:16.21] INTERVIEWER: You can't make your choice if somebody else is trying to tell you to do it. So sometimes, even though you know it's not the best thing, you go ahead and choose that, because at least that is yours, rather than theirs. OK. I understand that. OK. so there's some strength down inside you, some determination. Yeah, there's a lot of determination.

[00:36:41.47] YVONNE: A whole lot.

[00:36:41.73] INTERVIEWER: OK.

[00:36:42.45] YVONNE: A whole lot.

[00:36:43.27] INTERVIEWER: I probably shouldn't underestimate how much there is.

[00:36:47.95] YVONNE: I think like this. There's a whole lot of revenge. Put it like that.

[00:36:52.06] INTERVIEWER: Ah, revenge.

[00:36:53.17] YVONNE: Yeah.

[00:36:54.25] INTERVIEWER: Against?

[00:36:55.83] YVONNE: Yeah.

[00:36:57.50] INTERVIEWER: Against who?

[00:36:59.19] YVONNE: A whole lot of people.

[00:37:04.79] INTERVIEWER: Who can you get even with for the diabetes? That's the biggest problem because you're stuck with that every day.

[00:37:11.76] YVONNE: Right.

[00:37:12.69] INTERVIEWER: Who can you revenge against for that?

[00:37:14.26] YVONNE: Nobody. Because I inherited that. I didn't inherit all the other stuff.

[00:37:26.07] INTERVIEWER: That's a problem. I mean really, that's a big problem for you. Because you know, yeah, sure, a lot of people have treated you unfairly. And I can see you being mad and wanting revenge for that.

[00:37:41.90] YVONNE: Well, I'm not mad.

[00:37:43.80] INTERVIEWER: But that stuff is in the past. It doesn't stay with you, necessarily.

[00:37:48.46] YVONNE: It does me.

[00:37:50.13] INTERVIEWER: It just sort of burns inside of you.

[00:37:51.82] YVONNE: Right. I've been burning ever since.

[00:37:54.66] INTERVIEWER: I suspect that the real thing that burns inside of you even more is the diabetes.

[00:38:01.97] YVONNE: [INAUDIBLE], yeah.

[00:38:03.24] INTERVIEWER: Because there's nobody you can be mad at for it. But you're stuck with it every single day. And it's responsible for a lot of these other problems. IT sort of gets it your way and makes you be isolated from other people and all this kind of stuff.

[00:38:20.76] YVONNE: I've been blaming people for so long, that's why it kind of makes me mad because I have nobody to blame for my diabetes.

[00:38:29.52] INTERVIEWER: I would guess that-- you know, you said there's a lot of strength and determination down inside of you, I would think there's probably every bit as much anger as well.

[00:38:41.91] YVONNE: So anger makes my determination?

[00:38:45.14] INTERVIEWER: I don't know if it does. I'm just saying that it may be real strong. I suspect you're also real angry. Because you have more than good reason to be that way. I mean, you've been treated dirty by life. You got juvenile diabetes and that's a big pain in the neck.

[00:39:06.92] YVONNE: Yeah.

[00:39:07.88] INTERVIEWER: Gets in your way every single day. It tells you what you have to eat, tells you when you can eat it. It will make other people around you try and tell you what to eat and when to eat it if they know what those things are. It makes other people, like kids when you were growing up, treat you cruelly because they don't understand.

[00:39:42.00] And it's had a lasting effect on you. And you can't get away from it. It's affected your entire life. And if something dominated my life as much as that has dominated yours, I'd be pissed off as could be. I think I'd be dishonest with you if I didn't admit that that's probably how I would feel and how you feel.

[00:40:32.23] YVONNE: You're right.

[00:00:00.00]

[00:40:58.30] INTERVIEWER: Well, unlike those other people who have treated you dirty, that you could possibly get even with, by fighting back in whatever way would work, there's no way to fight back against your diabetes.

[00:41:17.87] YVONNE: No, there's not.

[00:41:20.71] INTERVIEWER: And as much as you'd like to eat something different or not eat at all, you know that you have to go ahead and do that. And I think that really gets under your skin. It's like, it's a fact of life. You can't get away from it. You can't get away from anything more than you can stop time. Impossible. You're stuck with it.

[00:42:03.75] And much as you'd like to do something else, it's still there. And it says, you have to eat this and this and this and you have to eat three meals a day. And you can't eat those other things and you can't eat too much. I think that gets under your skin. I think you'd like to be able to find some way to get even about all that mess. And it says to you, you have to do this.

[00:42:33.73] I mean, that's what your sickness says to you. It says, you have to live your life this way. Or at least, the doctors tell you that. Your body tells you that you have to live your life this way because of the diabetes and I don't think you like that one bit. I think that burns inside. And you're stubborn. I know you're stubborn.

[00:43:00.15] [LAUGHING]

[00:43:01.12] I know you are.

[00:43:03.57] NARRATOR: Why do you say that?

[00:43:05.16] INTERVIEWER: Because I can see it. I mean, I know strength of character when I see it and I know you're a stubborn person.

[43:13] [Sketch of young woman. Arms crossed to show defiance.]

[00:43:13.76] NARRATOR: The therapist has vividly described her life situation, the strength of her anger, and her stubborn defiance. Now he is forcing her to accept what he has said by reframing her anger as strength of character. Moreover, he is seducing her.

[43:29] [“You’re beautiful when you’re angry.” Sketch of therapist on bended knee kissing woman’s outstretched hand.]

[00:43:30.01] As this exchange develops, the patient finds herself in a very paradoxical situation. She is unable to be effectively resistant because each time she tries, the therapist will use her resistance to pull her closer to him. Resistance usually causes interpersonal distance, but she will find that her therapist has somehow changed the rules of the game.

[00:43:54.22] INTERVIEWER: I think you'd love to be able to find some way of getting even about all of this. And it says to you, you have to do this. I mean that's what your sickness says to you. It says you have to live your life this way, at least the doctors tell you that. Your body tells you that you have to live your life this way because of the diabetes. I don't think you like that one bit. I think that burns inside. And you're stubborn. I know you're stubborn.

[00:44:29.52] [LAUGHING]

[00:44:31.41] I know you are.

[00:44:33.30] YVONNE: Why do you say that?

[00:44:35.05] INTERVIEWER: Because I can see it. I know strength of character when I see it and I know you're a stubborn person. And there are times when you say to yourself, I'm not going to do it. And I don't care if I wind up going to the hospital. I'm not going to do it. That's just the way I am. And I think that's just the way you are. And I don't think that that's a crazy idea. I think that one's right.

[00:45:08.50] [LAUGHING]

[00:45:11.01] YVONNE: No, it's not crazy. It's definitely right. You're 100% right. Yeah, if I have to stubborn to do my own thing, yes, I'm stubborn.

[00:45:27.75] INTERVIEWER: Even if it means doing yourself in, you will be stubborn and do your own thing.

[00:45:33.68] YVONNE: Right.

[00:45:34.98] INTERVIEWER: It doesn't make any difference how many doctors tell you that you have to eat or friends or relatives or anybody else who tells you have to do it the right way and watch your diet, when you get to feeling stubborn, if that's the way you feel--

[00:45:51.14] YVONNE: I think I'm stubborn all the time.

[00:45:52.92] INTERVIEWER: It's just-- yeah. You don't wind up in the hospital all the time. I understand that. It's possible to be stubborn but not act on it all the time. I'm sure your stubbornness is built into your character. It's there. And it don't go away. So we're making a difference here. The last thing in the world--

[00:46:14.92] YVONNE: It doesn't make any difference.

[00:46:15.74] INTERVIEWER: Huh?

[00:46:16.53] YVONNE: It doesn't make any difference at all.

[00:46:18.07] INTERVIEWER: I know.

[00:46:19.32] YVONNE: None at all.

[00:46:21.45] INTERVIEWER: So-- Because nothing doesn't bother me.

[46:25] [Sketch of young woman and therapist sitting facing each other. She holds a fishing pole and tackle in front of the therapist.]

[00:46:25.97] NARRATOR: Here it is again, Yvonne's most tempting bait. She has tried this several times before and the therapist has refused to bite the hook. This time will be different. Armed with the relationship he has built with her, he will now take her on.

[00:46:42.62] INTERVIEWER: So we're making a difference here. The last thing in the world--

[00:46:46.13] YVONNE: It doesn't make any difference.

[00:46:47.32] INTERVIEWER: Huh?

[00:46:47.71] YVONNE: It doesn't make any difference at all.

[00:46:49.64] INTERVIEWER: I know.

[00:46:50.90] YVONNE: None at all.

[00:46:53.02] INTERVIEWER: So--

[00:46:53.73] YVONNE: Because nothing doesn't bother me.

[00:46:56.79] INTERVIEWER: Nothing doesn't bother you.

[00:46:58.45] YVONNE: Nothing doesn't bother me.

[00:47:01.71] INTERVIEWER: Well, I'll tell you what. I tell you what, Yvonne. I don't believe that. But I know that you're so stubborn, that even if I were able to prove it, just the way I could prove two and two is four, you wouldn't admit it. So I am not even going to try.

[00:47:21.04] [LAUGHING]

[00:47:22.52] YVONNE: No. You can't prove it. You cannot.

[00:47:27.40] INTERVIEWER: I wouldn't even try. You wouldn't believe it.

[00:47:31.35] YVONNE: Because you couldn't.

[00:47:32.83] INTERVIEWER: You wouldn't admit it. I know how stubborn you are. Last thing in the world I'm going to try and do is challenge you. Last thing. Wouldn't get me anywhere.

[00:47:45.94] YVONNE: I'm going to say, nothing doesn't bother you anymore since my mother died. I might get nervous about somebody doesn't last.

[00:47:55.35] INTERVIEWER: Nervous? No, it's not the nervous that bothers you. It's the being mad that bothers you.

[00:48:02.16] YVONNE: You wouldn't believe how stubborn I am. When my mother died, I couldn't even cry. I couldn't. I never cried since my mother died.

[00:48:15.37] INTERVIEWER: You wouldn't cry.

[00:48:18.71] YVONNE: I wouldn't or I couldn't?

[00:48:20.09] INTERVIEWER: Stubborn means you wouldn't.

[00:48:22.45] YVONNE: Well, I guess you could say I wouldn't, as I think about it.

[00:48:32.88] INTERVIEWER: Were you mad that she died on you?

[00:48:34.63] YVONNE: Yeah, very. I was mad that she left me behind to face all these dirty people. That's why it doesn't bother me any more. Nothing doesn't bother me.

[00:48:54.51] INTERVIEWER: Uh, I won't try and convince you you're wrong.

[00:49:00.12] YVONNE: See, now can't you see, since I'm explaining that to you, nothing doesn't bother me?

[00:49:06.71] INTERVIEWER: No. I can't see. I understand the stubbornness.

[00:49:13.93] YVONNE: You can't see that? Now you're being stubborn.

[00:49:18.94] INTERVIEWER: I might be. Sometimes I am.

[00:49:21.79] YVONNE: You're stubborn.

[00:49:23.25] INTERVIEWER: Sometimes.

[00:49:25.52] YVONNE: If you can't see that.

[00:49:28.51] INTERVIEWER: You're stubborn too. We should probably change the subject, though. We'll have an argument about who's more stubborn.

[00:49:37.00] YVONNE: I'm not going to argue with you.

[00:49:39.04] INTERVIEWER: Good.

[00:49:39.27] YVONNE: Because--

[00:49:40.03] INTERVIEWER: Will you promise to stubbornly refuse to argue with me?

[00:49:43.87] YVONNE: (LAUGHINGLY) Yes.

[00:49:44.30] INTERVIEWER: OK. It's a deal.

[49:49] [“The art of being ‘stubbornly’ engaging.”]

[00:49:49.24] NARRATOR: The therapist has successfully combined his position of refusing to fight with fostering the relationship between them. He continues to state his own position, but refused to fight her about it. He will continue to do this.

[00:50:03.75] INTERVIEWER: OK. Well, let's see. I'm a therapist and I work with people, help them with different things. Unlike some therapists, I refuse to do anything with people that they don't want to do. There are others who try, even though you don't want it.

[00:50:33.57] YVONNE: Yeah.

[00:50:34.02] INTERVIEWER: You may have run into some of that. There was a consult to psychiatry to come over and talk with you last week. That's how I got involved in this. OK?

[00:50:52.45] YVONNE: Was it [INAUDIBLE], right?

[00:50:55.72] INTERVIEWER: Yeah, uh,huh. She came over and talked with you. And I mean, you know why they asked psychiatry to come in. Here's this girl. She knows that she's supposed to watch your diet. She keeps screwing it up and coming in the hospital. So we have the psychiatrist talk to her. And get her head straight so that she'll go and eat her diet right. Well, if you didn't understand that you were supposed to watch your diet, maybe I could do something for you. Right? But you understand perfectly well. It's a matter what you want to. And you're stubborn.

[00:51:41.20] YVONNE: I thought you wasn't going to call me that any more.

[00:51:44.20] INTERVIEWER: Well, I said I wouldn't argue with you any more.

[00:51:47.64] YVONNE: All right.

[00:51:48.97] INTERVIEWER: But stubborn. So gee, I'm not going to try and convince you to eat right. I mean that's crazy. I'd be a fool. I don't want to be a fool.

[00:52:09.30] YVONNE: I agree that you would be if you tried.

[00:52:13.47] INTERVIEWER: So I guess the question I have for you is--

[00:52:17.09] YVONNE: Is it-- first let me ask a question. Is it crazy?

[00:52:20.02] INTERVIEWER: Is what crazy?

[00:52:21.20] YVONNE: The question.

[00:52:23.63] INTERVIEWER: What question?

[00:52:24.41] YVONNE: You're about to ask me.

[00:52:27.03] INTERVIEWER: No.

[00:52:27.48] YVONNE: All right.

[00:52:30.19] INTERVIEWER: You let me know if you think it is though.

[00:52:32.01] YVONNE: All right.

[00:52:33.34] INTERVIEWER: OK.

[52:36] [“Is that a crazy thought?” Sketch of girl tripping therapist as she points to a blue cloud over his head.]

[00:52:36.93] NARRATOR: Yvonne finally wins one with her therapist. She caught him off guard with her mischievous question. And for the first time in quite awhile has wrested the initiative from him. But look how she did it. She used on him the same mischievous teasing that he has been using on her. This symmetrical maneuver of Yvonne's marks the end of the dance of intimacy.

[53:00] [“The dance of negotiation.”]

[00:53:01.91] The interview now moves into its closing phase. The question is, can this resistant patient be enticed into working in therapy? She certainly can't be talked into it. In the last few moments of the interview, the therapist will refused to push her and she will ask a series of questions that indicates her interest, while simultaneously committing her to nothing. The therapist will respect this.

[00:53:27.48] All that matters is her behavior, not what she says. To try to get her to admit that she wants to work on her problem would be an error that could only provoke her resistance. Such an admission would meet the therapist needs, not the patient's. Therefore, the therapist will accept as perfectly respectable her need not to admit this. It matters only that she come back.

[59:48] [Sketch of young woman and therapist sitting facing each other.]