Therapeutic Impotence – When All Else Fails

April 24th, 2011

At the emergency service, I took a phone call from Michael, a man about 30 years old who had severe difficulties all his adult years. He had been into hard drugs; he had been diagnosed as having agoraphobia, obsessive compulsive disorder, depression and anxiety. He had pain “all over his body” which had been investigated with no cause identified. He had various interpersonal difficulties; he hardly had any friends or family contact. His mother did visit and assist with shopping, but he had no car and did not go anywhere except with assistance from his mother.

What happens when we give advice or perform some great therapeutic intervention that works? The person may go away satisfied, or partly satisfied and find a new problem to be focussed on, and to test your therapeutic skills. Yet therapists get paid to intervene, and it can be useful. However, there are many occasions when the client has tried many therapists and many techniques to no avail.

Sometimes the best way to help a person is to not help!

One option then is a technique described in the Brief Therapy literature as “Declaring Therapeutic Impotence.” [See reference below for more information.] This is when the therapist listens to the person and his/her problem, sympathises regarding their frustration and the seriousness of the problem, but says they are not sure what to do, and suggests that they need to meet again and perhaps then they can work out what to do. Sometimes this is not a technique, but the truth.

Michael did have some work skills but had not worked for 10 years. It sounded to me that it was going to be hard work on the phone with this man. But having been inspired by re-reading Solution-Focussed Therapy books I launched into questions that would identify this man’s better times and his achievements, no matter how small.

His achievements were not difficult to find at all. I thought it was a positive that he was not suicidal, given his misery, his chronic pain, and isolation. But more obvious was the fact that he had given up using speed for 3 years. He described that he had been addicted, having used it “all my life.” And he had also not used marijuana for the last 4 days, compared to his normal daily use. I thought these were terrific achievements, and evidence that he had capabilities that he could draw upon to reclaim his life. But over the course of at least 75 minutes I could not make any significant headway in terms of identifying progress around his depressed mood and anxiety symptoms.

Nonetheless he did have some hope, and he persisted with my questions. He seemed quite committed to making changes, but we grew quite tired through such a lengthy phone call. Searching for times when he was even a little bit happier, he could only think of a time when he had taken a pain-killing tablet. Eventually we decided that we would end the call, but I would ring him again, 8 days later. Despite my lack of “success” he probably did form the impression that I tried hard.

When the day came for me to ring again, I was not really sure what I would say; there was not really any progress in the last session that I could use to build hope and encourage him to continue.

When I did call, he was glad that he “did not miss me” (confirming that we had built some degree of connection.) He was going out (!) and he did not have long to talk. He was going out to meet some friends that he had got re-acquainted with, who shared his main passion for music; he had already seen them once since our phone conversation.

I had formed the impression that he was severely agoraphobic; yet he was going out, the second time in a week! He had been miserable, experienced chronic pain, and now was doing remarkable things.

He explained to me that he knew I couldn’t help him, and that “you have to pull yourself out of it.” He said he realised, “I have to face my fears with a smile.”

I expressed my genuine amazement, congratulated him and wished him well. I was ending that employment so I did not offer to contact him again. I don’t know how he is continuing. I hoped that if any therapist meets him in the future, s/he will not get caught up with his problems. I hope s/he will seek and discover this success (and others) and help him remember how he moved himself on, so he can do more of what works for him.

I am a ‘fan’ of Solution-Focussed Therapy; I love the stories that I hear. People seem to be struggling so much and then do the amazing. Our job often is not to make it happen, but to notice when it happens. The client, and perhaps many others fail to notice significant occurrences; we need to make a big deal of what they do (or have done in the past)….so they can’t forget it, and they wonder what else they might be able to do.

With the man above it was easy to be amazed. From the outset he impressed me as being committed to improving. He confirmed this by initiating changes when he knew he couldn’t rely on me.

I generally don’t aim to apply the “therapeutic impotence” option, and I’m not really advocating it. His story is a reminder of clients’ capacity to change, despite our limitations. Would we have been as helpful if we had got in with another pill, or shock treatment, or other offerings?

Sometimes I think people will do better if we get out of their way. But we should always be optimistic. People do change. We need to believe in them and find ways to foster their ability. They all have this ability.

(The End)

Reference for “Declaring Therapeutic Impotence.”
http://books.google.com/books?id=YNdF4rqbouIC&pg=PA166&lpg=PA166&dq=%22therapeutic+impotence%22&source=web&ots=mqErb2KIQ-&sig=OKZIHqsJVIeRXVdevqnQGQkMqU8#PPA166,M1


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