People change and grow in response to a challenge.

Clients can change if they choose

"I do not function because: I cannot

I will not

Faire passer le client de cannot à will not

Clients have far more potential for achieving adaptive, productive, and socialized modes of living than they or most clinicians assume.

The psychological fragility of patients is vastly overrated both by themselves and others.

The client's maladaptive, unproductive, antisocial attitudes and behaviors can be drastically altered whatever the degree of severity or chronicity.

Adult or current experiences are as at least if not more significant than childhood or previous experiences in shaping client values, operational attitudes, and behaviors.

The client's behavior with the therapist is a relatively accurate reflection of his habitual patterns of social and interpersonal relationship.

People make sense: the human animal is exquisitely logical and understandable.

The expression of therapeutic hate and joyful sadism towards clients can markedly benefit the client.

The more important messages between people are non-verbal.

First hypothesis: If provoked by the therapist (humorously, perceptively, and within the client's 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.

Second hypothesis: If urged provocatively (humorously and perceptively) by the therapist to continue his self-defeating, deviant behaviors, the client will tend to engage in self and other-enhancing behaviors which more closely approximate the societal norm

Provoke the client to engage in five different types of behavior:

1- To affirm his self-worth, both verbally and behaviorally.

2- To assert himself appropriately both in task performance and relationships.

3- To defend himself realistically.

4- To engage in psycho-social reality testing and learn the necessary discriminations to respond adaptively. Global perceptions lead to global, stereotyped responses; differentiated perceptions lead to adaptive responses.

5- To engagein risk-taking behaviors in personal relationships, especially communicating affection and vulnerability to significant others with immediacy as they are authentically experienced by the client. The most difficult words in relationships are often "I want you, I miss you, I care about you" to commit oneself to others.

Most of the maneuvers of patients must be avalaible to the therapist to be used in the service of therapeutic change and strategy. Thus the therapist may engage in obvious lying, denial, rationalization, invention (e.g. of instant research), crying and zany thinking.

The single most succinct label for the role of the provocative therapist is that of the Devil's advocate. The therapist sides with and (if succesful) becomes the negative half of the client ambivalence toward himself, significant others, and his life's goals and values.

The provocative therapist approaches quickly tose areas about which the client sends messages telling the therapist to avoid. The therapist can deal with anger, chaos, shouting and a disorganized interview; these events do not signal the termination of the therapeutic encounter because the provocative therapist's comfort range is quite broad in regard to client's interview behavior.

The therapist tries persistently for a high responsivity rate, for much "give and take", i.e. a fast moving, short, clipped, emotive interaction sequence in an effort to provoke the client into reacting spontaneously in order to bypass the client's censoring and "canned" set responses.

Ex.: An obese patient enters the office.

"May I speak with you Mr. Farrelly?

"My God, the Goodyear blimp has slipped its moorings.

Come right out and tell the patient my reactions to him or my hypotheses or judgments about his behavior."

The therapist is on the side of the client. The non-verbal cues of caring are at least as crucial if not more crucial as the verbal cues in this regard.

Humor, of course, is one of the main vehicles of positive regard as well as touching, the twinkle in the therapist's eye, and the high level of activity indicative of involvment (intensity of attention).

Although for a specific client the following may not be central issues in therapy for him, he can derive a number of incidental learnings from the provocative therapist's modeling: verbal, attitudinal, and behavioral sensitization and desensitization, appropriately assertive behavior, impulse control, communicational analysis and decoding nonverbal communication.

To be both comfortable and effective as a client-centered therapist, one has to be a very receptive person, willing to suspect his judgment about the client, enter into his internal frame of reference and become another self for the client.

To be an effective and comfortable provocative therapist, it helps to be a bit of a ham and actor, and to be able both to dish out verbal attacks on the client's self-defeating, deviant behaviors and attitudes, as well as to receive comfortably and with humor the verbal attacks of the client toward him.

The attitude that "I'm not that kind of a person, I couldn't tell clients those things" which we've heard from trainees and colleagues alike provokes the response "Oh yeah? Try it!!!"

In most responses the provocative therapist does everything in "larger than life" style. Voice intensity is louder than normal conversation, and everything is amplified. There is a strong element of drama and hyperbole through therapy.

The therapist will likewise selectively amplify the client's responses in order to become a reality testing device for the client. This may be done by running various future and fantasized scenarios past the client based on the client's present attitudinal and behavior patterns. The client will eventually reject the exaggerations.

This technique may permeate the whole experience. The provocative therapist is often verbally harsh and challenging, not for the sake of being gratuitously harsh on the client, but in order to say in effect "Look, Nutsy, I didn't make up the rules out there in society, but I know how they work, and I'm simply telling you the way it is. There are some hard life lessons that each and every one of us have to learn if we are to function effectively, and the sooner you learn them and begin operating in terms of these, the better off you'll be."

The therapist acts like the client, matching especially his communicational style and burlesquing those aspects of his functionning that are probably causing him trouble. In effect the therapist is saying: "This is how I perceive you (perhaps a little exaggerated). How do you like it? Want to do anything about it?"

The therapist also communicates that he perceives much of the client behavior as acting, i.e., under voluntary control and subject to change.

It is as if the therapist has "beaten them at their own game" or "gotten into the delusion and pushed them out."

As with many techniques endurance is a necessary corollary to confrontation. Implicitly the therapist says "I've got freedom, society, family, peers, and part of you is on my side. It's an unequal fight, and I'm going to win. I'm not going to be driven from my role. So how long do you want to keep this crap up?"

Give the client many different perspectives on his problem. The provocative therapist may operate out of a consistent theoretical framework but is not basically in the business of giving his clients a coherent philosophy (or religion) for life. He does want the client to become aware of certain areas of his functionning, how they are hurting him, and give him the choice of change...

If this communicational pattern (the double-bind) is powerful enough to drive people crazy, perhaps it can be reversed to drive people sane. We strongly encourage the use of contradictory messages in provocative therapy.

Verbal messages can be both true and not true at the same time. That is, it is true about you, the client, if you continue to feel and think, and therefore act, the way you have, and it is possible to be not true about you if you are willing and determined to change, and give concrete, specific behavioral evidence that you are doing so.

Contradictory messages also give the client practice in decoding communications and in dealing with the reality of mixed messages in most interpersonal relationships.

The provocative therapist, in hids contradictory messages to the client, frequently mirrors the world in which the client moves with his highly contradictory messages, pluralistic value systems, agonizing choices, and conflicting lifestyles. The client must choose from among all these, and adopt his own operational value system with its own internal consistency...

The therapist not only forces the client to list reasons and behavioral data to substantiate his self-affirmatory and assertive responses, but the therapist also engages in "listing."

At the risk of being overly simple, a joke can be seen as consisting of two parts: the setting up of a concept and a punch line.Within an established context the punch line has as one of its main effects the reversing of the context very abruptly and bringing new elements into figure. This momentary incongruity shatters and suspends normal perception. Real and not real are incongruously juxtaposed... It is our laughter which signals that this has occured.

At any one time there is an infinite number of levels of abstraction and reality which can be placed together, thus "blowing the mind", increasing awareness, and leading to at least momentary uncertainty in the person experiencing the incongruous juxtaposition or humor in a joke. Uncertainty can be very beneficial when it causes a person to examine his behavior, attitude, or construct of reality more carefully or from a different vantage point. In therapy this occurs functionally as a confrontation when the patient realizes that he is both the listener and butt of a joke that has personal relevance... When the implicit, suggested meanings in the therapist's use of humor have deep personal relevance for the patient, this usage of humor has therapeutic impact.

Play, much like psychotherapy, involves three elements:

1- "Foundation behavior" (i.e., the serious struggle or competition that games evolved from e.g. real fighting);

2- Metaphoric behavior (i.e., analoguous but either not as dangerous or in a different modality e.g. fencing, verbal assaults, etc.;

3- Metacommunication (i.e., some nonverbal behavior or the context which changes the usual meaning of the play or verbal message).

Humor is compelling and influential. It has impact. It changes people's minds. It is a powerful interpersonal tool.

We need to strees here again that students have had to be frequently reminded that if their client is not laughing at least some of the time, then they are not doing provocative therapy. The therapist use of humor is highly goal oriented and his purpose is to go beyond the laughter and have the client deal with personal issues, feelings, and behaviors in a direct and honest manner.

The patient can learn to laugh congruently again and model the therapist in what is appropriate to laugh at, including himself.

Operationally, there are many forms of humor used to provoke clients in provocative therapy. These are 1- Exaggeration, 2- mimicry, 3- ridicule, 4- distorsion, 5- sarcasm, 6- irony and 7- jokes.

1- A religious-moral language;

2- Locker room or language of the street;

3- Body or kinesthetic language;

4- Professional jargonese.

Stage 1

The initial interview. The client is precipitously provoked into a series of experiences that tend to leave him astonished, incredulous, uncertain and even at times outraged... His expectations of the therapist's role are not only disconfirmed but are almost reversed. The client is almost invariably intrigued by the therapist's approach to his problem.

Stage 2

After the surprise... of the first stage, the client tipically decreases his protestations regarding the therapist's behavior, begins to recognize that he and not the therapist must change, and starts reorganizing his expectational system toward the therapist.

Stage 3

This stage is characterized by clarification, choosing, and moving on the client's part. The hallmark of this stage is the client's congruent and increasingly firm protestation that the therapist definition of him is a skewed, inaccurate one based on a distorded reading of inadequate samplings... He is increasingly clear about who and what he is and what he is not, and attendant upon this is a beginning confidence in his new crystalizing self.

Stage 4

This final stage is one of consolidation and integration... He is nearing the end of therapy, and has laid a basically secure foundation regarding his identity and self-worth, thereby freeing his psychological energy toward constructing the edifice of his life his life style, relationships, goals and accomplishments.

1- Initial reaction: "My God! That's no way to talk to these poor people in pain!"

2- Secondary reaction: intrigued fascination, which is usually implemented by requests to observe "live" interviews, group sessions, and video tapes of the therapist in action... The degree of the beginner's interest can be roughly measured by the degree to which he immerses himself in the secondary experience of observing and absorbing.

3- The beginner soon wants to attempt engaging clients in provocative therapy and decides to do so with some anxiety that the client will be "scared off" (i.e., that he, the beginning provocative therapist, will fail and be rejected).

4- In this stage the trainee typically tends to experience a sense of release from the relatively constricted role behaviors of the more traditional therapies, and senses this as "an effective antidote to traditional therapies..." The trainee also tends to deeply question his own position on the issues of client fragility and need as well as his view of the therapist's role; it is a time of much self-examination and internal dissonance. The student also becomes hungry to learn the "rules of relationships", begins to sense the lawful processes in interpersonal exchanges, and as a coonsequence experiences a developing sense of control both in his personal and therapeutic relationships.

5- In this stage the beginning provocative therapist experiences the freedom to use more of his total range of responses and whole self as a therapeutic instrument. He becomes more aware of his own ongoing experiencing and receives floods of associations both in and out of therapy.

6- The trainee is becoming more confident and is enjoying therapy more, but at times fails to avoid the two extremes of (1) excessively abrasive confrontation taking the form of unhelpful, indiscriminate sarcasm as well as (2) using his humor to meet his own needs at the expense of the client. He is more adept at reading the client's non verbal communication, and sending his own contradictory provocative messages... He is able to maintain a focus on the client's conflict areas while directing his interventions towards change.

7- This is an open-ended stage, characterized by continual learning, growing, and developing on the part of the beginning therapist. By now he has internalized the supervisory process, is monitoring his own behaviors in therapy, and is no longer dependent on the supervisor, needing only occasional consultation. He is evincing an increasingly wide repertoire of therapeutic behaviors and is able to orchestrate and modulate confrontation, humor, external social reality, and the reasonable expectations of the client's significant others all in response to the range of client's behaviors and problems. He is experimenting with and adapting his skills to new settings and client populations.