Provocative Therapy: Kill or Cure!

Provocative Therapy turns all accepted wisdom about therapy on its head. Here is a therapy in which the therapist makes fun of the client’s problems, blows them up out of all proportion and suggests crazy and surreal solutions seemingly off the top of their heads. So why does it seem to be effective?

Provocative Therapy turns all accepted wisdom about therapy on its head. Here is a therapy in which the therapist makes fun of the client’s problems, blows them up out of all proportion and suggests crazy and surreal solutions seemingly off the top of their heads. It is certainly all about thinking outside the box! It does seem however, when used as a conscious technique, which the client agrees to, to be pretty effective. How come?

The idea is that the therapist plays “devil’s advocate”, siding with the client’s “problem”, or rather with the part of them which is ambivalent about change, about fighting or letting go of the problem, in order to wake up the healthy part of the person. The British Provocative Therapy website presents case studies (although not, unfortunately, tapescripts!) involving clients with anxiety, panic attacks, and psychosomatic complaints, although it is hard to envisage how this method would help someone suffering from bereavement, say, and encouraging a suicidal client to go on and do it because they are useless does not seem the best idea either.

The idea is to call out certain dormant resources in the client. There are five of these: affirmation of self worth, appropriate self assertion, ability to realistically defend oneself, ability to perceive reality in a differentiated way rather than relying on global generalisations about the world, and ability to communicate affection and vulnerability in personal relationships. They are all about effective “functioning”, no more and no less. The therapist elicits these resources by the use of various strategies, with humour as the key.

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I was actually motivated to look into provocative therapy at a client’s request. He was in search not of understanding or empathy, but of a great big kick so he could free himself from entrenched patterns, which he could see right through and was heartily sick of.

The approach is suggested to be particularly effective with “resistant” or “yes, but” clients, and recommended to therapists who cannot seem to “get the process moving”, who feel they are coming up against brick walls at every turn.

Provocative Therapy is the brainchild of Frank Farrelly, a therapist who worked with the founder of Person Centred Therapy, Carl Rogers, in the 1950s in an inpatient therapy programme and, unsatisfied with the results his clients were getting, started to develop a different approach, more in line with his own personality.

My first impression on reading a bit about the approach (I am no expert!) was that a form of brief therapy, looking for resources in the client rather than giving time and energy to the “problem”, is now rather a mainstream way of working, although it will take awhile for the stereotype of the navel-gazing patient lying on the couch for years on end “finding themselves” to dissipate.

The other thing that struck me was that the theoretical “contrast” between Farrelly and Rogers in the 1950s — one breaking the therapy “rules” or constraints, the other being totally self-effacing and waiting ad infinitum for the client to progress in their own way and at their own pace (even if they themselves are going absolutely crazy wanting to be helped to move forward) — no longer really holds, if it ever did.

Client-centred therapy has changed into Person centred therapy, based on the person of the client and also the person of the therapist, who within obvious ethical guidelines, is free to use his or her own self as genuinely as possible in the service of the client. Other therapeutic orientations too are moving more and more away from the idea of the therapist as a blank screen emitting predictable interventions and more towards individual, creative, and in a sense personal responses from therapists. I have often found myself laughing with clients and creating absurd metaphors and images, collaborating with various sides of them, giving them voices, names, making fun of the ones who are causing trouble. It happens naturally.

The sense of freedom can be intoxicating. As long as the relationship is collaborative (and provocative therapy from the outset selects a client group who specifically sign up for it) it can be a great feeling not to defer to those all-consuming problems, not to grant them the serious consideration they demand — not even to respect them! Why listen, after all, to that voice in your head that constantly tells you that you are worse than everyone else, or that you are going to pass out for no apparent reason, or that you can never be happy? The experience of being able to play around with the material in your life, in yourself, can be really empowering, and also dissolves the tension of having to think of the right solution. Maybe a totally crazy one will do instead! Maybe just moving your attention, feeling the tension dissolve, just the physical act of laughing with someone else, will break open that pattern.

This is my experience, referring to the theory I have read. The practice looks a little different — and I worry about the potential for a power differential and the consequences for the ego of the therapist. But frankly those things can go wrong in any form of therapy. At the end of the day the client knows, somewhere, if they can get to it, what they need. And while some need a holding space, others just need to drop that tension — they know in their heart of hearts that they could just stop it.

And so the case studies inform us that panic attacks can be solved by keeping a mop in your car (but only if you’re male and Scottish), that women with compulsive cleaning habits can find a more relaxed attitude to cleaning by being told how what a wonderful thing they are doing and how their job is after all to serve their husbands in every possible way, and that dreaming up ever more gross worst-case scenarios for people with IBS can remove their symptoms completely!

The jury is out…any comments?

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