Giving Therapy Clients a Little Push for Big Change

Balancing Long-Term Therapy Goals with Instant Remedies

David Waters

It was the kind of tense stalemate between an angry, critical father and an increasingly withdrawn teenage son I'd seen many times through the years. Greg was a single parent who seemed to regard every exchange with his shy, 14-year-old son, Tad, as an opportunity for a "corrective experience."

Rather than focusing on Tad, Greg spent many of our sessions talking about how bad his father had been. In short, therapy wasn't going anywhere.

Finally, in one session, I decided to get Greg's full attention. As he launched into yet another rant about his father, I said, "Forget your damn father, Greg, and focus on helping your son!" I tried to say this with just enough mock exasperation that I wouldn't sound like a critical dad myself. I went on, "You came here because you couldn't connect with your son, but every time you approach him, you get tangled up in all your old anger toward your father. It's time to cut it out! Your father's already done enough harm. Don't let him come between you and your son."

Greg was stupefied, and incredulous. "Forget my father ? Stop having these feelings ? What the hell kind of therapist are you?"

"Good question," I replied. "I'm the kind of therapist who hates to see the same painful pattern repeated over and over, and, today, I'm a therapist who hates to see long-dead fathers ruin the bond between their sons and grandsons. So your father isn't welcome in this room, for the time being. I don't want to hear a word about him until further notice. I want all of your attention on your son, and on the present. I want you to focus on doing what your father couldn't do, instead of repeating what he did."

I knew from Greg's response---a mix of startled anger and hesitance---that I'd gotten his attention with my statement in a way I hadn't been achieving with therapy-as-usual.

Learning to Fly

What first made me fall in love with being a therapist was the idea that I could make a living by having conversations that cut through everyday pretenses, got directly to the heart of the matter, and helped people change their lives. My play-therapy supervisor used to say to me, "Dave, 'play' refers to the child, not the therapist!"

But I wanted to make things happen! I was too impatient to wait while a child came up with his own version of a game, so I'd help him out a little by teeing it up for him. After watching him roll the same car back and forth in the sand tray for three sessions, I'd say something like, "Let's race the cars around the track and see which one goes faster."

To me, the most radical and interesting innovation was family therapy, with people like Jay Haley and Salvador Minuchin and Carl Whitaker doing things that scandalized the therapeutic old guard. Imagine my excitement when I discovered this brand-new, brave new world! At the family therapy workshops and externships I began attending, film clips would be shown of dramatic breakthroughs and amazing turnarounds.

The Limits of Creativity and Change


That was then, and this is now. Today as a profession---and as a society---we're much more fearbound and rule conscious than we used to be. Many professionals live in terror of making a mistake, getting sued, and being politically or socially or bureaucratically incorrect. Yet the sacred space of the therapy room is the ideal place to really exercise your creativity. What individuals can accomplish together in a private, protected undertaking is as amazing as it ever was.

Of course, the search for new tools and more dependable methods is common in this field, a profession in which it's so easy to develop doubt about one's effectiveness.

In these days of Managed Care and Therapeutic Minimalism, my biggest concern about therapy is that we don't ask enough of it. Too often, we don't push ourselves or our clients hard enough to make the changes that make a real difference in people's lives. It's taken me more than 30 years to realize that it's the combination of two strange bedfellows---imagination and repetition---that holds the key to change.

I still cherish and nurture my ability to sometimes make a dramatic intervention that gets my clients' attention, but today, when it works, I immediately recognize that I have a new task: keeping it in our sights. Today I know that good therapy requires a whole second sequence that builds on insights and carries clients forward in a variety of ongoing, daily events.

To move clients out of their ruts, their numbness, and their stuck places, we need to get their attention and start their adrenaline going at a rate that wakes them up and helps them to experience the fullness of life again. Creative Big Moments can be indispensable for this. It's something to strive for in therapy, to recognize and cherish when it occurs, and to help clients build upon in their daily lives. But the Big Moment needs many little moments to make it stick.

This blog is excerpted from “The Big Moment". Read the full article here. >>

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Topic: Professional Development

Tags: breakthrough | conversation | ED | family | family therapy | good therapy | imagination | Jay Haley | learning | psychotherapy | talking | TED | therapist | therapy | Psychotherapy Networker | clients | Salvador Minuchin | race | big moment | big moments | David Waters

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