Mary, Mary, quite contrary
How does your garden grow?
I love these two lines as they contain the words ‘contrary’ and ‘grow’. This article is about how the practical use of the concept of contrarianism can help us heal ourselves physically and psychologically, as well as grow as individuals.
I studied medicine because I wanted to work with people – not because I was fascinated by medical science. Medical school was a huge shock to me because my teachers taught me next to nothing about humanity, psychology, philosophy or communicating with other people. The six year program I completed was all about medical science. This can be fascinating of course and because it deals with life and death, is obviously one of the most important branches of science. It is a privilege to study how DNA unravels and replicates, the miracle of anatomy and the magic of physiology.
The problem (when I went to medical school in the 1970s and I don’t see that many improvements now) is that the education of doctors is deterministic and mechanistic. Although lip service is paid to ‘treating the patient as a person’ the approach to the medical problem is much the same as how a motor mechanic would diagnose and treat a car with a problem. In short the patient, although a person, needs to be treated as an object of medical science.
After a few years in practice, I still didn’t feel I was working with or receiving people in the way I had imagined. Thus, when I discovered homeopathy, it simply blew me away. Here was a system of medicine that emphasized the patient’s subjective experience of his/her illness. This fact, more than the story of Hahnemann, Kent and the rest, more than the concept of similia similibus curentur itself, was what drew me to this remarkable tool in medicine.
Fifteen years into my practice as a homeopathic doctor, I began to feel disappointed with my treatment of psychological problems. Homeopathy was helpful but did not seem to be enough. Results didn’t last as long as I’d hoped they would. I’d studied Rogerian client centered therapy in the past and although this approach complements homeopathy very well (as I’ve written in my book The Homeopathic Conversation1) it seemed to require a lot of sessions to achieve results. Then I discovered Provocative Therapy…
Provocative Therapy is the art of using humor and reverse psychology in brief psychotherapy. It was discovered by a Rogerian-trained psychiatric social worker, Frank Farrelly in Madison Wisconsin in the ‘60s.2 Having seen a psychiatric in-patient at Mendota State Institute fail to benefit from 91 sessions of client centered counseling, Farrelly inexplicably ‘told’ the client that he agreed with the client’s hopeless prognosis about his case. He agreed that it was unlikely that the patient would ever be discharged. Farrelly was astonished by the client’s response to this spontaneous use of reverse psychology. The client became animated and energized by Farrelly’s ‘provocative’ remarks and started to insist that there must be a way for him to improve and leave the institute. Farrelly cheerfully and warm-heartedly ‘disagreed’. The patient insisted more forcefully and Farrrelly realized that he had stumbled on something immensely powerful – the therapeutic use of reverse psychology in psychotherapy. He called it Provocative Therapy because the patients are therapeutically ‘provoked’ into discovering, asserting and enacting theirown solutions to their problems.
I have now incorporated Provocative Therapy into my medical homeopathic practice for over 15 years and continue to be astounded by how quickly it can produce profound behavioral change. Of course it’s not for all patients – no system of psychotherapy ever is. I have found it useful in treating patients with many issues such as obesity, relationship problems (including the problem of not being able to find the right partner for a relationship!), all sorts of addictions, work problems and financial issues.
The two central hypotheses of Provocative Therapy as stated by Frank Farrelly are:
1. If provoked by the therapist (humorously, perceptively, and within the clients own internal frame of reference), the client will tend to move in the opposite direction from the therapist’s definition of the client as a person.
2. If urged provocatively (humorously and perceptively) by the therapist to continue his self defeating, deviant behavior, the client will tend to engage in self and other enhancing behaviors which more closely approximate the societal norm.3
I find these sentences to be essentially homeopathic in nature. This is clearly the law of similars in action in the world of psychotherapy.
Provocative Therapy: the patient moves in the opposite direction to what the therapist ‘recommends’.
Homeopathy: The body responds in the opposite direction to what you would expect the medicine to produce (if given to a healthy volunteer in material dose).
Homeopathy and Provocative Therapy both act paradoxically and are examples of therapeutic approaches that illustrate contrarianism in action. I find the two approaches blend very well in medical practice and patients are fully capable of understanding the fact that both are examples of a contrarian principle.
I have also found that one or two sessions of Provocative Therapy can be a great aid to the taking of the case. Of course I take the case in the normal way of the classical homeopath and then try to come up with a single remedy to suit the case. As all homeopaths are aware, this is not always an easy process! Sometimes – as I’ve pointed out in The Homeopathic Conversation – it can pay to try something different. I’ve pointed out how the making of images, the essence of Art Therapy, can be most useful in the taking of the homeopathic case. Humor can also be a useful and powerful tool in gaining vital homeopathic information from our patients. In my recent teaching workshops, participants have been particularly interested in learning about the use of both humor and image making as an aid to taking the case.
Most homeopaths will occasionally joke or laugh with their patients. This is natural and often indicates that rapport has been established. However it is also possible to use a little Provocative Therapy to gain information that was not acquired in the normal case taking process. My patients know from my website that I am trained in Provocative Therapy, so they are not flabbergasted when I suggest a short ‘bubble’ of Provocative Therapy within a homeopathic consultation. This is never done in the first couple of consultations, but only when I feel that I am missing vital information about the case. Most patients readily give me permission to do 5-10 minutes of Provocative Therapy. What I have found in these short sessions is that patients show rather than tell me homeopathic information about themselves. Not only have I often picked up a valuable psychological symptom this way, but sometimes even physical clues. I remember demonstrating a ‘bubble’ of Provocative Therapy to homeopaths in Germany. A lady doctor volunteered for a short session. During the session, when she was a little embarrassed, she started to pull at her collar in an attempt to loosen it. I had not noticed this about her before but now she was showing (rather than telling) me a vital homeopathic symptom.
Training to become a provocative therapist takes considerable time and effort and you do need to have a certain type of personality. However all homeopaths can (and should in my opinion) learn how to use humor and reverse psychology creatively in the process of taking the case. This can be learned in a single day’s workshop designed for homeopaths. The most important thing I teach in these workshops is Frank Farrelly’s Golden Rule of Provocative Therapy:
Do not attempt Provocative Therapy (or humor) in a clinical situation unless you have affection in the heart and a twinkle in the eye.
When this rule is obeyed, patients encounter a doctor who is saying very strange and funny things about them. However his body language is expressing care, love and compassion for their suffering. This ‘double whammy’ is capable of having a powerful therapeutic effect on patients. The word ‘provoke’ is derived from the Latin pro vokare which means ‘to call forth’. The process of Provocative Therapy, just like the process of homeopathy, paradoxically ‘calls forth’ the solution to the patient’s problem – the very solution that was always within them but needed to be provoked to emerge.