Dual Roles in Psychotherapy: Lazarus Sez Psychologists Ain't Dead Yet.

Dual Roles in Psychotherapy: Lazarus Sez Psychologists Ain't Dead Yet.

I've mentioned elsewhere my discontent with "therapy" as a listening and questioning process in which, research tells us, the therapist can be replaced by a computer program. I've also have few heroes but gained two in the past weeks: Arnold Lazarus and Jeffrey Rudolph.

Lazarus, witty, insightful, and sometimes gently crude, shows off his insights much in the style of a fencing master: either building trains of oblique thrusts and parries or sometimes just sticking his sword straight into whatever dummy opposes him. He's both elegant and fun, author/editor of 18 books and 300 papers, and founder of Multimodal Therapy, one of the major schools of cognitive behavior therapy. Rudolph has associated with Lazarus for 20 years and is a key exponent for Multimodal Therapy.

This duo came to Allentown on the back skirts of hurricane Isabel and delighted members of the Lehigh Valley Psychological Association on the topic of dual roles in psychotherapy. Ah, yes, Virginia: not all therapists wear uniforms, watch a clock, and hear confessions for an HMO. Rudolph, for example, took a lady with OCD to a supermarket in Manhattan and rubbed zucchinis with her. Lazarus took a lovely female client to dinner but was caught by a member of his licensing board. She was cured of her fears of dining in public and he kept his license.

A Return to Older Ways

Psychologists have been honed to practice defensively, to show feelings surgically, to admit fault never, and never to share personal information or activities with clients. This posture grew from shenanigans in California in which sex and aggression were part of many fad psychologies in the '60s. The pendulum of niceties, however, now swings back the other direction towards our instincts and reinstatement of our membership in the human community.

There are plenty of chances for fun and not every crisis can be anticipated. Lazarus will play tennis, share dinner or theater, and sometimes trade personal favors. The phobic lady felt tomatoes, apples, and lettuce with Rudolph. He picked up the fruit and she put her hand on the back of his. "Aha! If this fruit is contaminated, you will be infected through me and we will both die." He then slid his hand from between hers and the fruit. They repeated this procedure several times and next rubbed a zucchini in the same manner. Enter produce supervisor: "Hey, you can't do that stuff here. You have to buy the damned thing first and take it home!" The lady then laughed: "You know, this IS kind of nuts." She was cured...

I like their affect, behavior, and thinking. It has been difficult for me to embrace therapeutic formalism, separating myself from the traditional roles once played by shamans. Those same roles are taken now by ministers, teachers, parents, grandparents, nurse practitioners, social workers, and, bless them all, waitresses and hookers. And contract violations in these allied health professions are handled by spite, threats, fists, and personal lawsuits, not by licensing boards.

Of course, there are risks in our opting for humanity: risks from produce managers, a.k.a., annoyed relatives (who sometimes have an investment in our client's failure), traditional psychiatrists (who already hate behaviorists for other reasons), and members of the state board (who apply abstract general rules to our very particular conduct in order to protect an abstract general public)?

There are other complications that we may anticipate. Some clients have been trained that therapy is "about them" and view our personal disclosures as taking up their time. Some people have an exaggerated sense of their own value: that is, their favors to you are magnified whereas your favors to them are minimized and they, therefore, feel cheated. (My God! I'm paying you all this money and you need me to pick up your tennis racquet? If I didn't have to pay you, then it would be MY tennis racquet, not yours!") Still others will suddenly miss an angora sweater and conclude that you must have stolen it during a home visit intended to treat hoarding. (It happened to Lazarus!)

Bottom Lines

First, we admire client resilience that keeps them from making rapid changes (in any direction!) but deny its existence when we expect that our mistakes will cripple them forever. Most of us, however, know that "shared environment" from parents often accounts for 2-10% of long term outcomes in children. Which therapists claim to have more influence than parents? And is our influence more a function of "nonshared" environment, the environment that the client selects for himself from whatever we offer? And if the latter, then "harm" is an outcome of both experience and individual selectivity for those experiences.

Second, the National Psychologist published an essay by Lazarus several years ago: tons of mail was evenly divided into applause or rotten fruit. Thus, it is still true that boundary violations can have a stigma once carried by homosexuality: outing can incur firings, fines, shame, gossip, poverty, career deaths, and worst of all, negative publicity for our profession. Such things will often depend on who finds out what you did and where they are in your hierarchy.

Third, choose your partners carefully. There are many with whom you will never want to share love, alcohol, or a trip to the market and some of them pay to sit on your couch. Thus, you need to magnify and use the same precautions that you apply to non therapy social contacts. And, like having a date with a UMass feminist, you establish goals and methods with your partner before you embark on an adventure.

Lazarus promised to defend any of us who, with good intentions, reached through a fence. He has co-edited a book, Dual Relationships and Psychotherapy (with Ofer Zur, Springer, 2002, about $50).

JB

Copyright, James Brody, all rights reserved, 2003

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