Pressure is a Therapeutic Necessity

April 24th, 2011

From my essay Therapeutic Impotence one can get a sense of the positive value that sometimes comes from being under pressure. Too much pressure can cause people to flounder, or even suicide, so maintaining hope is vital. Sometimes however, intervening to alleviate the pressure of clients and families can ease the pressure we feel as staff, but to the detriment of clients.

People make all sorts of choices in life. They will sometimes behave and speak as if they cannot do something (eg they cannot walk and so need a wheelchair or a carer; they cannot manage their money and so involve someone to hold their ATM card; they say they cannot use public transport which excuses them from looking for work…) What evidence exists for their claims? Often it is their statement alone.

Family Effort

I once gained a family’s agreement to disregard their son’s claim that he was too paranoid to use public transport. The family and I met, including the son. I outlined my proposal that the parents should make sure he was outside the house before the father left for work. If the son did not cooperate, and would not get dressed, the parents were to put him and his clothes outside, and not let him in before 5pm – it would be up to him to entertain himself, which might include using public transport or not.

He used public transport the first day. He reported that he felt so free. He too hadn’t believed in himself. Doubt, in the form of limiting beliefs can be infectious.

Low Expectations

Family members and staff often want to help someone in difficulty; it makes us feel good, and often someone might need help, initially. But if it develops into an ongoing pattern it becomes difficult to differentiate between inability and unwillingness. Some clients are deemed unable to clean the house they live in; they reportedly lack ‘motivation.’ However when they want to access more marijuana, they find the motivation for the things they really want.

Consequences?

What are the consequences for lacking motivation to clean their home? Often it can be that a support person is employed to do it “with them,” but they might end up doing most of it. Or they learn that they can only develop sufficient motivation if someone else is giving them a ‘pep talk.’ Or a kind parent will visit regularly to ensure they do not live in squalor. With some individuals there are too few negative consequence that might propel the client to make the effort personally.

In my essay,There’s an Underlying Biological Illness, I’ve written how families can be divided about what demands / expectations to place on the symptomatic individual. Even single parent families can experience division where a grandparent or an ex-spouse is involved. Where families are unsure what to expect, they are easily guided by professionals.

What is the effect when those professionals are working from a biological paradigm? This often implies that the person is not capable and so not responsible. Just as one might help someone who has a broken leg, family members might help their loved one. And support / involvement is important, but not the sort that alleviates the pressure to change, or the sort that communicates a belief about inability.

It does not necessitate acting harshly. The young man who cooperated in using public transport did not oppose my proposal for his parents to ensure he was outside. I suspect he knew I was aware of the family difficulties, and he was willing to cooperate in my effort to resolve them.

Yet not all individuals will cooperate and willingly let go of the advantages of being helpless, or of being aggressive. What are the options for individuals and families when this occurs? Do we hold them responsible? Do we enlist the family as a force to influence the individual? Do we assume the individual is ‘sick’ and unable to behave differently until s/he is treated and becomes motivated to help her/himself, or give up the drugs etc?

Pressures in Normal Life

You may recall your experience of having to push yourself to make a change. Perhaps this was about changing from a job you had grown tired of, but did not want to face the prospect of job interviews. Perhaps it was about dating, as a solution to being single; or perhaps leaving a marriage.

Often we change after a period of anguish. We benefit greatly from stretching ourselves, but before crossing the ‘point of no return’ you likely hesitated, perhaps for many months.

    Often it is the pain of things being the way they are that creates the necessity to act.

When we take the pressure off clients, they may well be less likely to act. Where families or individuals accept the idea of an ‘illness’ as the cause (of low motivation, bad temper, drug use, bizarre behaviour, irresponsible choices etc) and hope that medication will easily change things, are we doing them a disservice? Are we adding to the problem?

Inability or Choice?

Solution-Focussed therapy uses “scaling questions” with clients’ goals – this amounts to asking the client to rate out of ten their commitment to their stated goal – “If ten out of ten means that you are willing to do anything and everything to make it happen, and one out of ten means you think it’s a good idea, but you are really not that interested in doing anything about it, where would you put yourself at this moment?”

When asking clients this question about a particular goal (or wish,) the therapist will soon discover whether the client is committed to that goal. If s/he answers eight or higher, you can expect the client will undertake action towards the successful completion of that goal. Depending on their score, the therapist has different options for responding.

This question immediately identifies which goal(s) the client is interested in working on. They may not be at all interested in the goals that we or the family might hope for; it becomes clear why they are not taking the necessary steps. Then we can consider whether the family (or other social systems such as the police/courts) can be influential?

When the individual is not choosing to work towards goals deemed appropriate by the family (resuming study / work, cooperating at home, cleaning their room…) or the society (cease drugs or other antisocial acts) should we label that as ‘illness’ or choice?

    We have a choice here.

The Family’s Choices

If the problems are not defined as an ‘illness,’ the family may legitimately become impatient with certain behaviours. This may be more useful than being tolerant (of drug use, sleeping 12 – 14 hours a day, watching TV, not contributing domestically.) The family may stress over their situation and need help to consider the most useful strategies; but they can often be more influential than strangers.

The family may invite professionals to change the situation with the symptomatic individual and one must take care; the pressure they feel may be necessary to motivate them to work for change.

Just as in the title, pressure can be necessary for change. Crises can be opportunities for individuals and families.

How do we best use the opportunities and communicate hope with the client?

(The End.)


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