Business as Usual
by Carl Hammerschlag, M.D.
A middle-aged man came to see me under pressure from his wife. She had told him she would leave if he didn’t make some life changes. Both husband and wife expressed that their marriage was very important to them, but it was clear to us all that their marriage was near collapse. He told me he did not know what the problem was even though his wife had complained about his commitment to his work for many years. He acknowledged that he was highly committed to his work, but said it was important to them both and that he was very successful. He wasn’t completely aware, nor was he in agreement, that his business interfered on other levels of their lives.
His wife described the man’s work as his mistress and his only interest and hobby. He didn’t even take vacations without sleeping with his telephone by his side. At, and away from, home, where he wasn’t talking business he was reading financial magazines. He was not interested in his wife’s activities and was unwilling to converse about things of interest to her. They had virtually no social life as a couple.
When he arrived at my office the first time, his cell phone was clipped to his belt. He explained he was waiting for an important call. When it rang, he interrupted our session to talk at length on the phone. When I asked him if he thought the information that he was going to get from the phone was more important than what he might learn in my office, he replied without hesitation, that it was business and therefore very important.
I told him that if he couldn’t pay attention here in my office, it was clear to me he would not remain married. I asked him to turn the phone off. Reluctantly, he did so.
During the course of therapy, he agreed to follow my directions regarding an important intervention that I told them, could save their marriage. I prescribed what I knew would be an ordeal for him. He agreed to go on vacation with his wife to a place without a telephone or fax machine close by. He also agreed to let me provide all his reading material. I gave him a sealed package which I had already prepared.
His wife later reported that when they arrived at their destination, he opened the package and cursed, threw it against the wall and stormed out of the room. Inside the package was only one book. When he opened it, he discovered there were only blank pages and a pen. On the inside cover, I had written, “Dear John. Fill this book with whatever makes sense to you at the moment. You can choose to write in dialogue or in simple prose but you must write in this book every day. I ask that you come to this task with openness and truth, and to tell the truth of your experiences at that moment.”
He cursed, threw the book against the wall and stormed out. His wife picked up the book and read my note. When he returned, and continued to rail on, she said, “Why not write this down?” She pointed out that writing about how angry he felt might be useful for him and would certainly provide a topic for later sessions. Her words struck a key with him.
Later in the vacation, he found an interesting stone that was covered with lichen. He knew lichen was an organism formed by a combination of fungus and algae growing as a unit on a solid surface. Picking up the stone, he inserted it into a hollow he created in the pages and began to write around it. “Everything grows connected to something other than itself.”
He began to describe himself as the lichen feeding from the impersonal rock of business. He recognized he wanted to find another way to thrive. This moment of insight became the beginning of productive therapeutic expansions and of rebuilding the marriage between two committed people.
I chose this somewhat ambiguous but potentially powerful intervention because of what I learned from Erickson and other medicine men I have known. They taught me that the most important knowledge is that derived from life experience not from theories or equations. If you can help people look again at their present experiences and at themselves with different perspectives, they can create new directions. The process of psychotherapy is to find creative ways through which you make the invisible visible.
by Ricky Pipkin, Ph.D.
Hammerschlag had a client typically considered difficult–a reluctant participant in therapy wanting a specific outcome without realizing that a generalized change must be made to reach that outcome. Additionally, this man was clearly successful in many areas of his life and accustomed to making fact-based business decisions. It often is easier to factor out emotional content and disregard the importance of feelings and, in business, it often is more efficient. However, this couple was highly motivated to keep their marriage which provided needed leverage.
The problem in the marriage was not a “business” one–it was that the wife felt discounted and unimportant. Hammerschlag’s problem was twofold. First he had to capture the client’s attention; second, he had to make him understand that feelings and intangibles are important to a well-rounded life. As well as to relationships.
Directly confronting the inappropriate use of John’s cell phone during the session and telling him that, what he learned in session could save the marriage was a business-like approach to a multi-level symptom. He used language that John was used to and could understand. John’s willingness to continue participating in therapy without using his phone created an implicit contract.
The sessions before the important intervention of the vacation were preparation for John to expand his own perceptions. Every act of insight, of expansion, is the result of the prepared mind and some serendipitous moment. Finding a rock with lichen, knowing what lichen was, provided John a metaphor of his own making. He recognized that even a lowly lichen is a union of different things, joined together to create a different and more complex organism. The needs of each part must be nurtured.
The simple moment of finding the lichen-covered rock and following, in his own way, Hammerschlag’s instructions provided ways to understand himself differently. These changes were necessary in order for him to have what he really wanted-the the continuation of his marriage. This would not have occurred had not Hammerschlag first gotten John’s attention by using the techniques and language of business. Then, during the vacation, John was given only one concrete outlet for his thoughts and energies–self-examination in writing “the truth of his experiences of the moment.”
Erickson had a gift for creating and telling stories that patients could hear. He taught us all to look at our own blind spots and how to reach beyond them. Hammerschlag provided that for John by setting the stage for him to tell his own story about his own blind spots and to understand how to reach beyond them by the seemingly simple ambiguous and open assignment of writing on the blank pages, ”with openness and truth.”
Obviously, there was careful preparation so that John would be willing to go on vacation with no phone, fax or business reading materials. Hammerschlag’s success also demonstrates the value of using the client’s own language and world. The implicit contract between Hammerschlag and John ensured that the directions would be followed even though, as business, John could implement them in his own way.
Good therapy often appears much simpler than it actually is.