Do patients need to believe?

+ Do patients need to believe? – December 05

This used to happen to me a lot at the sort of
functions we all attend at this time of year.  The
get-together, the dinner party, the bar-be-que,
the partner’s office party.

I’d meet new people, we’d get chatting and the
conversation would inevitably swing around to
occupations.  When it was my turn I’d stumble
through my latest explanation of CST and leave
everyone suitably confused.

Just when I’d think I was off the hook and the
conversation was going to move on, that person
would pipe up.

You know that person, the one who’s in every
fifth or sixth group of new people you meet.  The
one who feels obliged to ask the questions they
think other people are to stupid to think of, let
alone ask.  The one who takes every opportunity to
flex their intellectual muscles at anyone within
earshot.
They’re not really interested!
They’ve no intention of coming to see you!
They’ve no intention of telling anyone else
about what you do!

They’d preface their question by doing
something with their head, either a conceited
wiggle or a questioning head tilt. I don’t know
why they all do this but they do.

‘So, does the person coming for treatment have
to believe in what you do?’

They’d follow this with more head stuff,
usually the slow knowing head nod.

I’d trot out my standard answer. ‘No the person
doesn’t have to believe in it, at all.  It helps
but it’s not required.’  I liked to deliver this
answer almost like a challenge.  I could never
match the head wiggling/nodding/tilting thing
though.

This question used to annoy me, oh you noticed,
and I would get a bit defensive, oh you noticed
that too.

In hindsight I understand why I ended up with
so many difficult patients back then, what with
the challenge and all.

Fast forward to a couple of years ago.

Stay with me here.

I’m talking with one of the therapists I’ve
trained.  They’re telling me about a prospective
patient.

‘This person asked me if I can help them with
their chronic fatigue.’

‘Good.’ They don’t look like it’s good. ‘No?’

‘No.’

‘What’s the problem?’

‘Well I’ve never treated someone with chronic
fatigue before.’

‘So?’

‘So they want to know if I can help them, they
say they’re a bit sceptical and they want me to
reassure them and . . well . .  I don’t know.’

‘Don’t worry about it.  I’ve treated loads of
people for chronic fatigue.  You’ll be fine.’

‘It’s not me I’m worried about, it’s them. It’s
alright for you, I’m sure you’d get results, I
just don’t know if I can.’

‘Oh I see.’

I pondered momentarily and then I had a sort of
epiphany.  All the years of answering the, ‘Does
the patient have to believe?’ question coalesced
into a profound insight.

‘Believe, they may not, believe YOU must.’

‘Pardon?’

‘I said it’s more important that you believe
you can help them than if they believe you can.’

They looked at me dumbstruck as the import of
what I had just said sunk in.

‘Did you just put on a Yoda voice?’

‘No, I just had something in my throat.’

‘You don’t get out much do you?’

‘Look it doesn’t matter how I said it.  It’s
what I said that counts.  If you don’t believe
they can get better with you then they won’t.’

‘That’s what I was afraid of.’

‘Look salesmen have known about his stuff for
years.’

‘Do they use the Yoda voice too?’

‘I’m talking about dominant realities here.’

‘Dominant realities?’

‘Yeah, it’s a well known fact among salesmen
and psychologists that if you get a group of
people together, whomever believes in their
reality the most will dominate the others.’

‘Whomever?’

‘That’s how sales are made.  The salesman
believes his vacuum cleaner is a fantastic product
and these people’s lives will be vastly improved
if they buy it.  He believes it so strongly that
the people start to believe it too and buy the
vacuum cleaner.’

‘Oh I see, you’re talking about kidding
yourself.  If I kid myself into thinking that I
can help this person I stand a much better chance
of kidding them.‘

‘No, I’m not saying you kid yourself.  I’m
saying you need to believe it.’

‘If you tell me to, ‘Feel the force.’ I’m
leaving.’

‘Actually, I don’t really think of it as
believing, I just sort of expect it.  When someone
comes to see me I just expect that they will get
better.  I’m not kidding myself, I just think,
‘They’ve got a body. They’re breathing.  Their
body is designed to fix itself.  All I have to do
is feel what its trying to do and then help it
where its getting stuck.  There’s no good reason
why they shouldn’t get better.’’

‘Fine, but how do I believe, if I don’t really
believe?’

‘Good question.  What you need to do is, you
need to let the spirit of Elvis enter you heart. .
. . No come back . . I’m kidding . . Look, I hear
what you’re saying. . ‘

‘Really?’

‘See, it’s easy for me.’

‘Well finally you admit it.’

‘No, that’s not what I mean.  I have lots of
frames of reference for people getting better.
That’s one of the benefits of experience.  All
those frames of reference support my expectation
that the person will get better.

You, on the other hand don’t have enough frames
of reference yet.  Which leaves you with just one
thing determining the outcome.’

‘What’s that?’

‘The way you think about it.’

‘The way I think about it.’

‘The way you think about it.’

‘Stop saying that and tell me what you mean.’

‘You don’t KNOW what the result is going to be
when you treat this person.  It’s in the future.
The only thing you can do with the future is think
about it, which leaves you two options.
You can think the person is NOT going to get
better or you can think they ARE going to get
better.’

‘and that’s going to make a difference?’

‘Yes and no.’

‘Always the yes and no answers with you.’

‘What would you say if I told you that we are
making up our reality as we go and the main thing
that influences it is the way we think.  Things
are the way they are because we expect them to be
that way.’

‘I’d say you’d lost the plot and were a couple
of steps away from the funny farm.’

‘In that case I won’t tell you that and by the
way calling a psychiatric institution the funny
farm is not very politically correct, you know.. ‘

‘Me not politically correct? You’re one of the
least politically correct people I know.  You take
pleasure in being politically incorrect.  I’ve
seen you at parties, remember?’

‘Fair point.
Look, what have you got to loose by being open
to the possibility that the person is going to get
better?’

‘I’ve just never been into that whole positive
thinking thing.’

‘It’s not really positive thinking, it’s more
like . . selfish thinking.  You’re thinking about
the future in the way you’d like it to be.’

‘Does it really make a difference?’

‘It makes a huge difference if you do it in the
right way.’

‘Which is?’

‘The first thing to do is get a very clear
picture of the future you want.  In your case it
would be you supporting this person to move
through chronic fatigue successfully. The clearer
the image the better.
As you think about this outcome you’ll notice
you get an uncomfortable feeling in your gut.
That uncomfortable feeling is what has kept your
current expectations in place.’

I could see I was making progress.

‘You’ve lost me.’

‘Okay, ever thought about winning the lottery?’

‘No . . Yes.’

‘Okay, did you think about all the things you
could do with the money?’

‘Yes.’

‘That’s usually where most people stop.  A sort
of fantasy, up there with being able to fly or
having X-ray vision.  If they thought they were
REALLY going to win the lottery it would be
disturbing for them in ways that they never
suspected.
It would literally rock their world.

The statistics on lottery winners show that a
high percentage of them end up back where they
were financially within a couple of years of
winning.  Which I see as a desperate struggle to
get back to their old version of reality as fast
as possible.’

‘So it’s more than just positive thinking?’

‘If all we had to do was think positively, we’d
have things appearing in their lives all over the
place at a ferocious rate.
It would be like living in a nightmare where
everything you thought about would appear in front
of you as soon as you thought about it.  Things
you wanted and things you didn’t want but couldn’t
stop thinking about.’

‘or the one where you go to a party and
everyone keeps running away from you screaming and
then you catch your reflection in the mirror and
you’ve got the head of a shark. . ‘

‘Focus.’

‘Right.’

‘There are reason’s why we expect things to be
the way they are.  With the lottery winner they
could have a deep belief that money is bad and if
they have lots of it, they’ll be bad too.  Without
them knowing about that belief they will try and
find unconscious ways to get rid of the prize
money as fast as possible.’

‘So that’s what you meant about struggling to
get back to their old version of reality as fast
as possible.’

‘Precisely.’

We were making great progress.

‘Yeah well that’s the thing about unconscious
stuff, it’s unconscious. How do you know about
stuff . . you don’t know about, huh?’

Okay, we were making progress.

‘It’s true, you’ll do your head in thinking
about it like that.  There IS a way of starting to
become aware of it though.  It begins with getting
a clear picture of what you want and then asking
yourself how you would feel about it if it REALLY
happened.
If you can get into how you would feel in that
situation and as you’re doing that you also scan
your body, you’ll find it will be making you
disturbed some where.
When you look into that disturbance you will
get more of an idea of what has been stopping you
having the result you want.’

‘How so?’

‘Like the lottery winner believing that money
was bad.  As soon as they had lots of money that
belief was challenged.  The money made them very
uncomfortable.

If, prior to winning, they had got a clear
picture of how their lives would be with the extra
money and how they would feel in that life, they
would have discovered that it made them
uncomfortable.

If they had looked into what that uncomfortable
feeling was about they would have discovered the
belief about money being bad.  They could then
have started to work through the belief and when
they finally did win, it would have made the
process of coming into money much more enjoyable.’

‘So you reckon I have some unconscious belief
about treating this person with the chronic
fatigue?’

‘I dunno.  I think you’ll find out if you get
clear about the outcome you want and then listen
carefully to how it makes you feel.’

‘Okay I’ll give it a try.’

‘Try you must not, do you must.’

‘Cute.’

Having this chat made me verbalise what had
been brewing in me for a couple of years.  The
question of whether the patient believes in what
we are doing is secondary to what we, as
therapists, believe is possible.

If there is a difference between the results we
would like to be getting and the results we are
getting then the onus is on us to sift through
ourselves and discover why we are getting the
results we are.

It reminds me of a cartoon I saw recently.
Santa Claus is lying on the psychoanalyst’s couch
looking perturbed.  The analyst is saying to him.

‘It doesn’t matter what other people think – the
important thing is that you believe in yourself.’

.

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