Provocative Therapy - Articles

Arnold M Ludwig MD1 and Frank Farrelly ACSW2
Reprinted from American Journal of Psychotherapy
Vol. XXI, No 4 – October 1967

It is becoming fashionable to view mental patients, especially chronic schizophrenics, as poor, helpless, unfortunate creatures made sick by family and society and kept sick by prolonged hospitalisation.  These patients are depicted as hapless victims impotent against the powerful influences which determine their lives and shape their psychopathology.  Such a view dictates a treatment philosophy aimed at reducing all the social and institutional iniquities responsible for the patient’s plight.  However, in the process of levelling the finger of etiologic blame for the production and maintenance of chronic schizophrenia, theoreticians and clinicians have neglected another culprit – the patient himself.  Professionals seem to have overlooked the rather naïve possibility that schizophrenic patients become “chronic” simply because they choose to do so.

Undoubtedly, a myriad of authoritative articles could be quoted to refute such an oversimplified approach to this problem.  We do not deny the complexity of the problem of the multitude of theoretical factors which should be taken into account for the understanding and treatment of chronic schizophrenia.  However, we do claim that all these theoretical considerations have little practical import for the current treatment of these patients.  Since we cannot at this point in time unravel twisted genes, undo the past, reform society, or eliminate mental hospitals, we are left with a more modest, but still formidable task – the treatment of the patient himself.  The major problem is in dealing with what is and not with what should be or might have been.  In our own experience, the problem is not so much modifying factors outside the patient, but rather inc hanging certain patient attitudes and consequent behaviours, as well a complementary, newly traditional attitudes on the part of society and professional staff, which aggravate the basic problem and prevent effective therapeutic intervention.

We have had the opportunity to observe closely and work with a group of 30 male and female chronic schizophrenics, handled with a minimum of medication and housed together on an experimental treatment unit.  In a previous article (1) we outlined a number of characteristic attitudes and behaviours, both on the part of patients and staff, which tended to perpetuate chronicity.  These characteristics comprise what we have called “the Code of Chronicity”.  Implicit in our discussion of the “code” are five important clinical “facts” which, we believe, underlie the behaviours of chronic schizophrenics. 

i. First, these patients can use their insanity to control people land situations. 
ii. Second, they have an indomitable will of their own and are hell bent on getting their own way. 
iii. Third, one of the basic difficulties in rehabilitating these patients is not so much their “lack of motivation” but their intense, negative motivation to remain hospitalised. 
iv. Fourth, insanity and hospitalisation effectively pay off for these patients in a variety of ways. 
v. Fifth, these patients are capable of demonstrating an animal cunning in provoking certain reactions of the part of staff, family, and society at large which guarantee their continued hospitalisation and its consequent rewards.

Related to these characteristics are a number of other important ones, which are typical of these patients and which we want to elaborate on since they are relevant to our basic thesis concerning patient behaviour.  These additional features have gradually come into focus for us during the various phases of our research treatment program; in this article we shall term them the “weapons of insanity”.  It has become increasingly clear to us that patients both have at their disposal and employ effectively an array of counter therapeutic weapons against staff efforts to rehabilitate them.  These weapons not only reach their targets but have the additional bonus of a “fallout” effect in the form of a series of predictable staff reactions.  Since one of the most effective ways to cope with these weapons is

first to recognise them, we have felt the need to describe them and their effects.  Moreover, since we have become convinced that for rehabilitative purposes these weapons of insanity must be jammed, there is a necessity to consider carefully the therapeutic implications and ethical issues involved.  It is our purpose to do precisely this.

The Arsenal of Weapons

Squatter’s Rights

The prevalent conception of mental hospitals as snake pits or horrible asylums from which all patients eagerly long to depart has little trugh when applied to the chronic schizophrenic.  In fact, one of the major problems in rehabilitatin these patients is their adamant refusal to be dispossessed from their adopted hospital homeland.  For many patients, especially those who feel emotionally and financially deprived, the mental hospital represents a “promised land” where the whole range of their needs is met.

The hospital comes to be a model of the idealised childhood home – a cruise on the “good ship Lollipop”.  Every effort is made to help the patient “feel at home”; not only are the basics of food, clothing and shelter provided, but also, as in the good childhood home, his psychosocial needs are met, he is protected from harm and pain, is relieved of any major responsibilities and demands, and has a wide variety of entertainment and recreation provided for him.  His home gives him a ready made group of companions who, because they share similar experience, give him understanding and sense of belonging.  The good parental surrogates never punish him; they attempt to protect him fro failure and frustration, try conscientiously to meet his immediate needs at all levels, and do not expect him, as a child to make decisions for which he is not ready or mature enough.

The hospital thus comes to represent an emotional gold mine where patients stake their claim.  They seem to grasp intuitively the legal dictum that “possession is nine tenths of the law”.  It some claim jumpers, in the guise of therapeutic staff, threaten to dispossess them, especially after their years of homesteading, chronic patients will fight back with animal ferocity to defend their territory.  This general attitude seems best epitomised by the remark of one patient who told the staff “You’ll never railroad me out of here!”

All or Nothing

Ask any patient whether he wants to be rehabilitated and the invariable answer will be “yes”,  try to do anything to effectively bring this about and the invariable behavioural response will indicate “no”.  One reason for this discrepancy between verbalisation and behaviour is that it requires minimal effort to utter the socially appropriate “yes” and maximum effort to do something about it.

There appears to be four basic components to the patients views concerning rehabilitation. 

i. First they sincerely want all the good things, such as status, power, love, material possessions, which can come with discharge.
ii. Second, they want an iron clad guarantee that they will get these good things.  If they are to prepare themselves for leaving the hospital, they want firm assurance that people will accept them, not derogate them for having been mental patients, not hold their behaviour against them, not reject them and treat them with dignity and respect,
iii. Third, they expect the good things to be given to them free.
iv. And forth, they are unwilling to expend any persistent effort or expose themselves to undue frustration to acquire the good things.

Almost any therapeutic staff working with these patients will recognise the “all or nothing” principle in most of their behaviour.  Patients want the whole pie and are often dissatisfied with only one piece of it at a time.  If they have to experience any emotional pain or stress in achieving socially appropriate goals, their most common response is to give up altogether or say “to hell with it”.  This response is reflected in their whimsical work week or their attendance at and participation in any constructive rehabilitation program where they readily throw away all their gains at the slightest frustration or rejection – knowing full well that they can afford to do so since they can always fall back on the good will and beneficence of the hospital.

Most rehabilitation programs for chronic schizophrenics are bound to founder simple because the staff have not come to grips with these patient attitudes and behaviours.  The patients problems may be explained by invoking such scientific terms as low frustration tolerance, infantile omnipotence of the wish, and poor impulse control, but these terms are only substitutional euphemisms for saying that patients want what they want, the way they want it, when they want I, and effortlessly.

Social Push Buttons

It is an interesting phenomenon that “helpless” and “confused” schizophrenics are often much more expert at producing certain reactions on the part of the staff, the family, and society at large than are the latter at evoking desired patient responses.  Because patients have a far better understanding of our social value system with its inherent limitations than we have of theirs, they can employ a repertoire of behaviours which function as push buttons to elicit the desired staff or social response, thereby insuring the attain of their goal.  These patient behaviours and the reactions they trigger off have an “if then” quality to them.  For example, if the patient presents any one of the following behavioural stimuli then it will elicit a specifiable, related staff response with a high degree of probability:

1. Nuisance behaviour evoked irritation and anger;
2. Overt sexual behaviour evokes outrage;
3. Aggressive combative behaviour evokes fear;
4. Self destructive behaviour evokes pity;
5. Stubborn withdrawal evokes frustration; and
6. Crazy bizarre behaviour evokes confusion and helplessness.

When staff, family or society become irritated and angry, outraged, fearful, pitying, frustrated, or confused and helpless, then they are automatically forced to take action in a variety of forms, the end result of which is continued hospitalisation or re-hospitalisation.

In addition to these push buttons there is another more general one which we have termed the “tyranny of the weak”.  It seems to involve a somewhat different kind of process and appears to lead to a “hands off” effect of therapeutic inaction.  When we begin confronting patients and “picking on them” for therapeutic purposes, they portray themselves as helpless and weak, and vulnerable while simultaneously casting the staff in the role of inhumane bullies.  Because they effect this type casting so convincingly, and because we accept these complementary good – bad roles, the consequent shame and guilt aroused in us cause us to withdraw as effectively as does a wolf in response to the exposed jugular vein of another wolf in a fight.  By employing this tactic, patients frequently exploit their “weakness” tyrannically over others by forcing them to make amends for “mistreating” them.

When patients are confronted with or held accountable for these triggering behaviours, they almost always invoke the following ritualistic formulae:

a. I didn’t do it – you did;
b. If I did do it, you made me do it;
c. Even if I did do it, I’m not to blame 0 I’m emotionally and mentally disturbed.

Aside from the apparent reason of assuring continued hospitalisation, it appears that there are three other factors which keep patients pushing these buttons:

1. First, they attain power and recognition.  By pushing any of these buttons, patients can mobilise social agencies, communities, families, and the hospital staff to cope with their behaviour (“I’ll make you pay attention to me”).
2. Second, this affords them a sense of control which reduces their feelings of helplessness and impotence.
3. Third, they continue to push these buttons simply because they are so effective.  People invariably respond to these patient behaviours and unwittingly continue to reinforce them.

The Divine Right of Kings

One of the central problems in treating the chronic schizophrenic centres around the issue of the patients responsibility for his actions.  At the present time, the label of insanity confers diplomatic immunity or sanctuary for all patients deviant behaviours.  Patients can gratify every impulse or whim without fear of serious retaliation.  They have the sanction to indulge any of their feelings because, by definition, they are presumed not to know any better or are unable to control their impulses and, therefore, cannot beheld accountable for what they do.

Not only is the patient immune for retaliation by society, but he can also buy protection form his own conscience for repugnant actions by employing the ultimate excuse of craziness.  Under the sacrosanct banner of insanity, he can avoid guilt and shame for normally shocking or sickening behaviour,.  If he so desires, he can defecate when or where he chooses, masturbate publicly lash out aggressively, expose himself, remain inert and unproductive or violate any social taboo with the assurance that staff are forced to “understand” rather than punish his behaviour.

In many ways, the modern day patient has prerogatives similar to the medieval absolute monarch with the power and sanction to gratify his every whim,  just as the divine right of kings insured that “the king can do no wrong”, so too the mentally ill can do no wrong; they can only engage in “sick” behaviour.

The divine right of the mentally ill confers other advantages.  Like any monarch with his retinue of servants, chronic patients also have a number of helpers or “servants” to wait on them.  In any well staffed mental hospital professional dieticians prepare their meals, and psychiatric aides serve them; should they need some assistance in dressing, shaving or showering some staff person is always available.  Recreational and occupational therapists make details plans to amuse and keep them from becoming bored.  Should they get upset, some doctor or nurse is always nearby to quell their anxiety or relieve their hurts.  Social workers are ready to act as emissaries with their families and diplomatically explain the patients “illness” to elicit understanding and acceptance.  It is not surprising that several patients “delusionally” have referred to us as their servants – that the hospital exists, as in fact it does to take care of them and minister to their needs.

Let the Healer Beware

Even when patients do occasionally apologise or seem remorseful for their actions, they often employ ritualistic confessions with no sustained, firm purpose of making amends.  Their usual behaviour is to do something bad, contritely confess their wrong doing ask for forgiveness, and shortly afterward repeat the same process, sometimes in a different form, which calls into question the credibility of their acts of contrition.  Their behaviour can be summarised in the formula “slap – ‘I’m sorry’ ……. Slap – ‘I’m sorry’ …… slap ………..”  When staff members find these repetitive acts of contrition unbelievable and convey their disbelief to patients, the typical patient response is to become hurt or furious at the staff or not being gullible and naïve enough to accept the magic words “I’m sorry”.

The purpose of the repetitive utilisation of these magic words seems three- fold:

1. First, to be granted a suspended sentence form any guilt or shame they themselves might feel at their behaviour;
2. Second, to placate the staff’s animosity through this show of penance; and
3. Third, to secure the restoration of full privileges.

The Syndrome of “Chronic Staffrenia”

Part of the real difficulty in establishing an effective treatment and rehabilitation program for chronic schizophrenics resides in the reaction of the hospital staff toward working with these patients.  Caught between what they have been taught represents “good” professional treatment and their own personal (often equated with “bad”) reactions provoked by the tactics and behaviours of patients, staff members eventually become incapacitated in their treatment efforts.  The conflict is between how the staff should treat patients and how they spontaneously want to respond.

It is easy to understand the genesis of this bind.  If the staff accept the view that the mentally ill patient is not responsible for his actions, then it follows that the essentials of any humanitarian treatment approach must always be comprised of love, kindness, acceptance and understand; above all, it is professionally inappropriate to criticise strongly, to react angrily or punish patients for their behaviours, since such behaviour has been caused by factors beyond their control.  On the other hand, day to day experience with these patients invariably arouses in the staff reactions which are diametrically opposed to those which they are expected to feel.

If staff attitudes must under all circumstances be those of patience, helpfulness, love and acceptance, what options do staff members have when they frequently find themselves impatient, helpless, angry and revolted by patients behaviours?  Not only is it difficult for the staff to act persistently one way when they feel another but this same hypocritical façade weakens the therapeutic effectiveness of their efforts.  Despite the loud and clear messages from their adrenals and viscera, staff members are permitted only a very limited response repertoire to the behavioural weapons employed by patients.  The staff members tend to resolve the conflicts of this bind by assuming an observable set of attitudes and behaviours which oftentimes complements those of patients.  We have labelled this characteristic staff reaction the syndrome of “chronic staffrenia”.  The components of this syndrome include apathy, weariness, minimal personal involvement, decreased enthusiasm, lack of emotional investment and markedly decreased expectations for patient rehabilitation.  Staff attitudes are depicted by such statements as “let well enough alone”, or “to hell with it – it just isn’t worth it”.  Staff members increasingly withdraw and engage in perfunctory therapeutic activities which, regardless of their name, at best resemble good custodial care, and they become all too happy to settle for patient co-operator in lieu of patient rehabilitation.  Any program that aims at rehabilitating chronic schizophrenics (in contract to one that merely provides good custodial care) must anticipate this syndrome and take measures to prevent or cope with its development.

Implications for Treatment

Any therapeutic program primarily employing psychosocial techniques for the modification of chronic schizophrenic behaviour must make certain operational assumptions as a basis for effective therapeutic action.  The primary and most important assumption is that the patient is responsible for his actions and can muster up the necessary will power to act sanely and decently if he should choose, or be made to choose to do so.  Given this assumption, certain treatment implications follow.

First, the staff must hold patients accountable for their actions, rewarding appropriate behaviour and punishing inappropriate or deviant behaviour.  One of the problems in such a seemingly simple philosophy is that it runs counter to much current clinical thought.  It is our feeling that today’s dynamically oriented theoreticians have placed the onus of responsibility for the patients behaviour on such scapegoat devils as mother, society, or mythical biochemical abnormalities, rather than on the individual patient himself.  With such convenient whipping boys, where everyone is to blame, nobody is to blame.  If the patient cannot be blamed, then, it follows; he cannot take credit for healthy sane behaviour.  We contend that holding patients responsible for both their good and bad behaviour invests them with human dignity and hope; not holding them responsible is tantamount to pronouncing them hopeless.

Our own simplified view of psychotherapy dictates that the assumption of responsibility by the patient represents a prerequisite for any further constructional behavioural change.  If patients are to be receptive to treatment, their attitude must include four successive components or stages which are as follows:

a. I am responsible for my behaviour;
b. I want to change my behaviour since it dissatisfies me;
c. I need help; and
d. I will co-operate with the help you give me.

These stages not only hold for the rehabilitation of the alcoholic, juvenile delinquent, criminal, the patient with a character disorder and the psychoneurotic patient but for the chronic schizophrenic patient as well.  The major problem with the chronic patient is to get him to move form a position where he denies all responsibility for his behaviour or excuses it under the banner of insanity to the first of these states.  Once this id done a major barrier is crossed.

Since staff members have been commissioned to intervene therapeutically with these patients, the second treatment implication is that the staff must have certain rights consonant with their obligations.  In out current and legitimate concern for the rights of patients, we have overlooked or ignored the rights of those working with them.  What currently obtains in most treatment programs is that the staff members have “the right” to being cursed, threatened, or assaulted by ungrateful patients without being able to punish them for their actions or to vent openly their genuine feelings.  However, we insist that the staff should and do have certain rights, the right to expect gratitude form patients and safely from physical harm to interact honestly with patients, to be creative, and to derive a sense of accomplishment from their work.  These are not idealised luxuries but absolute necessities for treatment staff.  Unless their necessary right are encourages, implemented and insured, we are convinced that no intensive, persistent, and concerted staff treatment effort can occur.  Unless the staff can demand responsible behaviour and respect for their rights from patients, the counter therapeutic tactics of patients will surely and inevitably extinguish any remnants of staff rehabilitative efforts of their behalf.

A third treatment implication is that the staff be genuine with patients.  We propose that the staff not be pressured to hide behind pseudo-humanitarian treatment slogans which decree that love and understanding are the only appropriate responses to all patients behaviours and that anger and even occasional hatred are anti-therapeutic.  There is nothing inherently wrong in admiring and liking the good qualities of patients while, at the same time, disliking and rejecting their undesirable qualities.  If staff members are forced to conform to hackneyed platitudes, their response, at best will consist of perfunctory love, phoney acceptance, misguided kindness or biased understanding.  We believe in most appropriate that the staff be allowed to give patients accurate and honest human feedback concerning the impact and social consequences of their behaviour.  For example, it is unreasonable to insist that the staff adopt inappropriate smiles or act kindly toward patients while brimming with anger.  Our contention is that “love and understanding” are not simply insufficient, but at times are actually incongruous and damaging in response to certain patient behaviours.  The staff should be allowed and encouraged to use a whole relationship: both to be positive, warm and loving when patients behave sanely and well, and also to be angry, rebuking, rejecting and punishing when patients are obnoxious or bad.  Them combination of Pollyanna plus Scrooge represents a more whole, integrated, human response, either along is a travesty.

A fourth implication pertains to the so –called rights and prerogatives of the chronic patient.  From our assumptions it follows that patients not be allowed to become too comfortable or settled in the hospital.  It is imperative that the staff feel free to usurp and confiscate the patients “squatters” rights and convey insistently and persistently to patients that they are not only do not have the right to remain in the hospital, but that the only virgin land available for homesteading lies outside the hospital.

Other treatment implications pertain directly to jamming the various weapons which patients employ.  It makes little sense to continue to treat these patients as perpetual convalescents and invalids by waiting on them and thereby encouraging and reinforcing dependency.  As long as patients can continue to gain all the prerogatives and privileges without effort, there is little incentive for them to change.  As long as their craziness continues to pay off without uncomfortable repercussions or sanctions, we encourage the development and perpetuation of chronicity.

Ethical Issues

In evolving a treatment philosophy for chronic schizophrenics, we have had to grapple with a number of ethical issues, posed by ourselves and respected colleagues, concerning staff attitudes and treatment approaches toward these patients.  Since the direction and development of any treatment program is contingent upon how these issues are resolved, their importance cannot be stressed enough.

One of the immediate ethical issues involves the use of punishment for patients.  Without delving into all aspects of this problem, which would require a separate paper to do full justice to it, we will simply say that this issue is largely artificial or moot, for there are no psychosocial techniques for instituting human behavioural change which do not employ the very potent tools of both reward and punishment.  Even those programs which espouse only benevolent approaches make liberal use of such negative reinforcements as withholding privileges, withdrawing love or approval restraints and seclusion, ECT and drugs for the avowed purpose of “controlling” patient behaviour, but eh rationales offered are often only euphemistic or socially condoned excuses for subtle or blatant punishments.  The issue is not whether punishments should be used; they are and will be – this is simple a fact of all clinical and social life.  The real issue is whether punishments will be administered openly, non-apologetically, and in a consistent, systematic,  goal-oriented manner rather than on a disguised, apologetic, whimsical and haphazard basis.

There are those who fear that once the use of punishment is openly acknowledged and condoned, it might well serve as a vehicle for sadism.  We sympathise with and share this concern; however, the essence of the problem is whether the therapist uses punishment solely for his own gratification or for the patient’s welfare.  Our position is simply that if a therapist is sadistic, he will be ingenious enough to find a vehicle for his sadism in any type of therapeutic approach, even in benign non directive therapies.  Or to put it differently, the beatific smile of the therapist does not guarantee that there are not fangs hidden behind it.

A critical ethical question is to what lengths will be go to implement our treatment goals?  Should the goal be to maintain a chronic schizophrenic comfortable in the hospital or to undertake the more ambitious task of helping him become a relatively whole, occasionally uncomfortable person functioning outside the hospital?  If we choose the latter goal (a formidable task), then, it follows, that certain procedures, which might be considered drastic or extreme, will have to be employed.

It cannot be overemphasized how serious and malignant a problem chronic schizophrenia is.  As the situation now stands, these patients represent serious economic, social, political and psychologic debits not only to society by themselves as well.  Many represent the psychologic equivalents of terminal cancer patients devoid of any prospects of a productive existence.  Therefore, we have to make the operational value choice of either preparing them for a comfortable psychologic demise of using, if necessary, radical procedures which measurable increase their chance for responsible meaningful living.

In any radical procedure there must be a willingness for balance the potential risks against the possible gains.  It is our impression that most professionals working in this area have been reluctant to confront the issue of risk and have chosen instead to play it safe.  One way of playing it safe has been to settle for more modest treatment goals for these patients.  Another way (but a valuable one at that) is to concentrate exclusively on the etiologic and preventative aspects of the problem.  It is riskier, but at least equally important, to engage the problem here and now – that is, if we are not going to let patients psychologically rot in the mental hospitals until we engineer social change or determine the presumed biochemical abnormality underlying this disorder.

The bind we are in, whether we like it or not, is that we must deal with these patients.  In doing so, we have to choose between two options.  We can employ palliative procedures with the risk or keeping patients psychologically moribund or of leading to their psychologic death; or we can try radical psychosocial procedures with the possibility of curing the patient, but the risk of his getting worse.  Should this latter possibility occur, the therapist lays himself open to being labelled anti-therapeutic or destructive; we suspect that one reason many therapist have chosen palliative procedures is not to risk censure form colleagues and to void receiving such labels.  Unfortunately for patients, we have been too bound to the principle of primum non nocere (“first do no harm”), and as a result have been employing a variety of gum drop therapies for a very malignant problem.

Long ago Archimedes stated that if he had a lever long enough and a fulcrum on which to rest it, he could move the earth.  It is our contention that we already have at our disposal some therapeutic levers or techniques for dealing with chronic schizophrenics.  If out goal is the ultimate rehabilitation of these patients, we must begin to search for even more potent and effective levers, which may involve to some degree the use of pain, deprivation, and punishment – all socially sensitive areas in the treatment of patients.  It is not enough simply to theorise about these techniques, we must demonstrate a willingness to use and evaluate them.

A final ethical issue concern the question of whether patients should have the right to opt out of living in normal society.  For those who find life and responsibility too stressful should we provide some haven or retreat in the form of mental hospitals, where they can spend the remainder of their days in relative peace and quiet?  Perhaps the ramifications of this issue could be debated endlessly; we have resolved this issue for ourselves by arbitrarily claiming that just as a person does not have the social or legal right to commit suicide, so too the chronic schizophrenic does not have the right to commit psychologic suicide by giving up or opting out through prolonged hospitalisation.  Again just as when a person attempts suicide, every possible technique or treatment, not mater how drastic, is employed by the physician to aid him, so too, we contend that every possible therapeutic technique even those seemingly drastic should be brought to bear psychosocially to revive the chronic schizophrenic.

Summary

In this age of psychologic understanding, modern clinical theoreticians have emphasised the importance of familial, social and institutional iniquities as largely responsible for the production and maintenance of chronic schizophrenia.  Chronic schizophrenics are usually portrayed as hapless, helpless creatures impotent against the powerful forces which shape their pathology.  Unfortunately, such a view completely overlooks the rather “naïve” possibility that patients themselves become chronic simply because they choose to.

From the clinical experience, we have become convinced that chronic patients are anything but fragile, helpless people.  In fact, they are quite ingenious in employing an array or counter therapeutic weapons or tactics which are highly effective in achieving their goal – namely, continued hospitalisation.  We have described many of these weapons within the body of the article.

One of the major problems in establishing and maintaining an intensive, enthusiastic therapeutic program for patients pertains to the reaction of the hospital staff (the syndrome of “chronic staffrenia”) to the tactics of patients.  Unless this staff reaction can be prevented, it is unlikely that any treatment program will prove effective.

Starting with the assumption that patients must be regarded as responsible for their behaviour, we have presented a number of treatment principles which seem crucial for the treatment and rehabilitation of chronic schizophrenics.  The principles outlines raise a number of serious ethical issues which are also discussed within the article.

Reference:
1. The Code of Chronicity.

In 2004, during one of Frank Farrelly’s workshops, to my amazement, I discovered that he had written a second book entitled “Me and God”. This was the good news. The bad news was that unless you understood German, you wouldn’t be able to read it, as it had only been published in Germany! I therefore discussed with Frank the idea of producing an audio book of “Me and God” and was pleasantly surprised by his interest in such a project and we tentatively agreed to explore recording the book in an audio format setting a recording date for May 2005 and I began to make extensive preparations for the session.

As the recording date loomed closer, and I made my preparations, my first call was to my old friend and fellow recording expert Pete Kelly. Pete is a gifted musician and producer in his own right and has an eye for detail that I could only dream of. We had worked together over the years on a number of projects and it was Pete who in less that ten minutes convinced me that the future of recording was in using computers rather than tape.

If you have ever worked or recorded in a studio, you will know that regardless of all the preparations you make, everything is ultimately down to the ability for the artist to perform on any given day. I caught myself wondering how well Frank would at 73 years old be able to cope with the thirty-seven chapters, consisting of 37,000 words. On the first day as Pete called for a take we looked at each other with the exact same thought, hoping that Frank would find his pace and relax into delivering his story. We soon realised that we needn’t have worried. Frank is like the Ernest Shackleton of therapy, in that once he sets his mind on achieving something, there really is no stopping him!

I had allowed a total of eight days for the project and had anticipated that the entire recording would be around six hours once edited. Previous experience had taught me to allow a minimum of one full day for each fully edited hours work. I had also considered best and worst case scenarios from this session. The absolute best-case scenario would be that we completed the entire project including artwork in the allotted time. The worst-case scenario would be that Frank would need to return to the studio in November prior to presenting his workshop in Leeds.

On the first day we completed the first fourteen chapters comprising of some 11,000 words! Pete was not familiar with Frank’s work and could barely contain his laughter as he heard Frank’s stories of his interactions with the nuns. Anyone who has seen Frank in a workshop situation will realise that he has an extraordinary tonal range and an excellent ear. Both of these abilities were ably demonstrated throughout the recording sessions.

Our normal recording day would consist of starting the session at 10.30am and recording until around 2pm. We would then usually break for lunch after which Pete would return to his own studio to edit the morning session. Back at Clara studios Frank and my wife Sue would then listen to the previous day’s edits. In the evening we would usually go out for dinner to mostly Italian restaurants and discuss Provocative therapy, movies and all manner of other subjects. When we returned to the house, we would then watch a movie of choice on our home cinema set-up until around 2pm! Fortunately our taste in movies was very similar and I was pleased to find a few films Frank had not seen and subsequently enjoyed. These included Luc Besson’s “Joan of Arc” and “Open Range” with Robert Duvall and Kevin Costner and Tombstone. One of my fondest recollections of these eight days was hearing the comment “good” during the various westerns we watched as various undesirables were gunned down by Duvall and Costner. For a moment I pondered the concept of a Frank Farrelly audio commentary for a series of westerns, which seemed entirely appropriate! Of course it should be no surprise that such a superb teller of stories would also be an admirer of other people’s excellent tales.

During a break on the third day I recorded an interview with Frank on various aspects of his work including his interactions with Carl Rogers and the history of Provocative Therapy from the early 1960s. Frank commented that Carl’s view was that Frank would “never make a dent on the old guard” but rather would have a better response from new up and coming therapists. Many NLP trainers and practitioners have heard of Frank, but few have been fortunate enough to see him in a workshop situation where you can appreciate just how big an influence he was on the creation of NLP.

On the fifth day we began final editing. What some people forget is that when you record an audio book its important to listen closely to the entire recording, which in this case was close to five hours in length. A good friend of Frank’s, Noni from Germany, who had been involved in the production of the original book, finally located the preface to the book and a copy of a 1937 picture of all the entire Farrelly family, depicted in the book and was kind enough to e-mail a copy to us.

On day 5 we organised the artwork for the project and we contrasted the Farrelly family picture from 1937 with one of Frank and myself in the studio. My good friends Karl and Darren at RRS Music in Leeds worked tirelessly to produce some initial copies of the CD set before Frank departed to Germany. Both of them remarked on how good the audio quality is, which is the highest compliment you can get from sound engineers. We recorded all the speech in 32bit resolution using SE tube microphones, which produce really superb fidelity.

“Me and God” is a fascinating book of stories from Frank’s early life up to the age of sixteen. My view is that the book is an excellent treatise on all human relationships from the personal to the cosmological and divine. The book also gives a good insight into how Frank’s family life was undoubtedly a major influence on the creation of Provocative Therapy. Frank’s unique humour is evident throughout this work and this humour is also reflected in the choice of chapter titles, my favourite being “How I almost lost my immortal soul with a protestant heretic girl one night at a drive-in movie” and “The Crucifixion and the burning at the stake”

(Me and God is available from www.human-alchemy.com as a 5 CD set)

Whether we are aware of them or not, or acknowledge them or not, we all willy-nilly have out assumptive sets.  These function to organise our experiences; they are lenses through which we view out relationships.  Some of them are more general in nature, some are highly specific.  Most of the following statements are derived from my clinical practice, others from clinical colleagues, conversations with friends (both male and female and unguarded moments).

You have your own set of assumptions about the other half of the earth’s population, the opposite sex.  Before you read these, it might be instructive to write down ten perceptions or beliefs or pieces of advice that you were taught about the opposite sex, teachings from your parents, and friends throughout your life.  Write these in simple declarative sentences, preferably using words such as “always” or “never”.

Female Tribal Wisdom

1.    All men are animals.  (If they are not animals, a real woman can bring the animal out of a wimp).
2.    Men are little boys in long pants.
3.    The only difference between men and boys is the cost of their toys.
4.    Men are really stupid about women psychologically and sexually (e.g. men are easy to seduce, women can fake orgasms etc).
5.    Men are the romantics, women are realists.  (Example; one study showed by the third date, women begin to view men as possible husbands, judging their pros and cons, assets and liabilities).
6.    Females are more skilled, adroit and clever in their communication and tend to communicate indirectly, implicitly, covertly.  (Example; She:  “Great big you take care – poor little me?”  Now they have reciprocal roles which can hold for one-half a century!).
7.    Men think with two heads; women with one.  (Cf client:  “I make men crawl through bramble bushes to get to me”.  Women play hard to get.  Mother of client “isn’t it funny how nature tricks men into marrying us?”)
8.    Men are turned on by what they see.  (Hence the multi billion dollar cosmetic, fashion and garment industries – including bras and girdles.  Cf  Reay Tannahill’s Sex in History, Stein and Day Publ., N.Y. 1980)
9.    Men have only one thing on their minds.
10.    The greatest source of pain for women is men.  (Female colleague “Frank that’s not a female distorted perception.  It’s a law of physics or something like that!”)  The second greatest is their mothers.
11.    If only men and boys did what their mothers, wives and lovers told them to do, they would keep more regular hours, have better nutrition, wouldn’t smoke or drink alcohol, would eat their salads, live longer and have better bowel movements.  (Summary of female client’s disappointments about her husband, father and sons).
12.    Playing hard to get with men is necessary for women.  (F.F’s father:  “I chased your mother until she caught me.”  Mother to female psychiatrist friend of F.F.  “Don’t be forward!”)
13.    Women are highly competitive and unfair with other women about men.  Female client).
14.    Women are predatory – but the clever woman makes the man pursue and hunt her.  Clever prey choose their own “hunter” and leave “tell-tale-signs” and “tracks” for the hunter to follow.
15.    “Its unfair, we women get older, Frank while you men get distinguished looked”.  (Woman client in tears to F.F.)
16.    “The world is filled with aging women”.  (Australian, beautiful 44 year old female client of F.F.)
17.    All the good men are already married – the rest are like the left-overs from a bad garage sale.  Momma’s boys, perennial bachelors, gays, drunks and drug fiends, other women’s rejects, and wimps.  (Summary of professional woman client of F.F.)
18.    All men are flawed.
19.    Men as they age, become dirty old men.
20.    Men only see women as sex objects.
21.    A really smart woman never tells all she knows (female colleague).
22.    Women can be strong – but never appear stronger than the man you are interested in (German female colleague of F.F.)
23.    A man becomes interested in a woman who is interested in him.  Female colleague of F.F.)
24.    During sex a woman can occupy herself constructively by planning her next grocery list.
25.    “A man doesn’t have to buy the cow if he’s already getting the milk free”.  (Farm wife client of F.F. disapprovingly to her sexually active daughter).
26.    It’s a man’s world (Ann Landers)
27.    Men hold all the trump cards.
28.    There are good girls and then there are bad girls.
29.    Don’t look cute – look stunning!  (Female colleague’s mother to her).
30.    Whenever you go out even to the grocery store, dress up, because you never know whom you’ll meet.  (Female colleague’s mother).
31.    If you don’t like a man, and he asks you for a date, go out with him anyway – he might have some interesting male friends that you can meet that you will like.  (Female colleagues mother).
32.    Men never do what you want them to when they think they are being forced.  (Female colleague of F.F.)
33.    A woman is only one man away from welfare.
34.    There are no jokes about men, there are only truths.  (German female colleague).

Male Tribal Wisdom

1.    There are no free fucks or free lunches.
2.    Bit tits, small brain.
3.    Women’s legs are the gate posts of hell (St. Augustine of Hippo).
4.    Men will cross stormy oceans, hack their way through primeval forests, ford raging torrents and climb perilous mountains to lay their fame, fortune and sacred honour at the feel of their lady fair – just to get a sniff.  (Male colleague to F.F. hypnotized by picture of a beautify woman:  “I’d drag my nuts across an acres of broken glass just to get a sniff.”)
5.    A woman’s major erogenous zone is in her ear.  (Men are turned on by what they see – woman are turned on by what they hear.)
6.    Men are physically stronger than women and usually have more money, which is counter-balanced by women having sexual attractiveness and “moral superiority” over men.
7.    What does every woman want?  Answer: “MMMMMMMMore!”
8.    Verbally flattering a woman makes her wet down there.
9.    Women are not playing with a full deck of cards, are rowing with only one oar in the water, are a day late and a dollar short, have their telephone off the hook; their lights are on but nobody’s home, and their elevator doesn’t go to the top floor.  (Hunting buddy to F.F.)


10.    Women are irrational, that’s all there is to that, their heads are filled with cotton stuff, and rags.  (from My Fair Lady)
11.    There is no bad sex, only good, better and best sex.
12.    Women lie; men are honest.
13.    Women gossip; men exchange informed opinions and rock-solid data about their competitors.
14.    A woman can nag a man to drink and to death.
15.    Some women are prick-teasers; others are ball busters.  (Hurt, angry male client to F.F.)
16.    All women are manipulators!
17.    What does every woman want?  “As much control over her husband as she has over her lover!”  (Chauser).
18.    Women are little girls who want to get married, ride piggy-back on a man financially through life, and “play house2 with their dollies (babies).
19.    All women want to be mommies more than they want to be wives.
20.    Women have a far greater need to be mothers than men have a need to be fathers.  9John Farrelly to F.F., age 16)
21.    The greatest aphrodisiac for women is men’s power (money, status, talent, organisation ((academic business) standing).  Female colleague to F.F.)
22.    Women use men as success objects – a life-support system for a cheque book.  (Female colleague of F.F.)
23.    Hell hath no fury like a woman scorned (Ecclesiasticus) so you better keep your woman happy or she’ll create a living hell for you.
24.    A woman’s ass and a whiskey glass has made many a man a horse’s ass.  (Hunting buddy to F.F.)
25.    Higamous hogamous, women monogamous; hogamous higamous, men are polygamous.  (Ogden Nash)


26.    A man can eat filet mignon every night for a year, and then he’ll want variety – like I wonder what a good juicy hamburger would taste like?  (Male colleague to F.F. 1955 re men’s sexual variety needs.)
27.    A Woman asks you to show her your vulnerability, and the next thing you know, she’s chewing on your soft parts.  (Client to F.F. re his girl friend’s complaint that he was not “emotionally expressive”.)
28.     Every man’s ideal girlfriend is a beautiful, stacked nymphomaniac living in a rent free apartment over her father’s liquor store!  (Hunting buddy to F.F.)
29.    Women are like motor cycles; they’re pretty expensive, a ball to ride – and they require careful handling or they’ll lay some bad hurt on your.  Fast.
30.    For a woman, a man is a doorway to the future (Australian female colleague).
31.    Widows dance and rumba on Caribbean cruise ships on their dead husbands life insurance policies.
32.    The best logic of a man never beats the tricky mind of a woman.  (French female colleague)
33.    every time a woman sounds reasonable, se is using the tricky technique of reframing.  (Dutch male colleague)

Male – Female Dimensions and Continnua

1.    Women’s perennial fear is that of abandonment (by men).
2.    Women give sex in order to get love.  Men give love in order to get sex.  (They both want the same thing – love and sex – but usually in a different order or progression; hence the eternal battle of the sexes).
3.    God or evolution placed women on this planet to elevate, refine and reform men.
4.    Men are voyeurs; women are exhibitionists.  (Male psychiatrist friend of F.F.)
5.    Life is hot, sticky and wet.

6.    Life slops over our theoretical paradigms.
7.    Women need a reason to have sex, men just need a place.  (Billy Crystal in the movie The City Slickers).
8.    Women are God’s police (Australian male colleague).
9.    When men marry they expect women to stay the same but they don’t and when women marry they expect men to change but they don’t.  (Australian male colleague)

"This outline of hypnosis and the world of Provocative Therapy is based on the definitive work of Milton Erickson, the father of hypnosis in America, and the conception of trance states by Stephen Wolinsky ("Trances People Live"; c 1991).I quote extensively from that book. In short, I consider that what Wolinsky maintains as the focus of his trance work is also the focus of the extraordinary work of Provocative Therapy. The client presents with the symptom-trance and phenomena intact and functioning! In particular, the concept of (oppositional) hypnotic identities and the pattern interruption of that trance state are integral to outcomes of Provocative Therapy. The symptom -trance is irrevocably altered by Provocative Therapy, and this happens reliably and consistently. You can argue about the "why" of change-hence this outline from one point of view- but not that it does occur as a result of the Provocative Therapy session. Trance
"Stephen Wolinsky postulates that trance phenomena hold symptoms together. He believes that haw we subjectively experience events, interactions, and our own inner self is observer-created-created by us... that we, the knowers of the experience, choose how an experience is experienced. This is the pivotal entry point of Deep Trance Phenomena, the medium in which our creative activity takes place whereby we select how experiences are perceived, interpreted and understood ... each self-created reality is comprised of a specific Deep Trance Phenomenon (or clusters of several) that results in what we typically refer to as symptoms or problems. Acknowledging our observer-created trances - trances created by us - begins a deeper process of assuming responsibility for the part we all play in creating (however unknowingly or unconsciously) our own hypnotic and phenomenological realities … (this understanding) sets the stage for de- hypnosis.
• Trance phenomena are at the core of symptom structure and, thus, at the core of symptom relief. Clients present symptoms and trances together.
• We create the trance process as a coping mechanism, originally in response to
• the content of trauma.
• We enter trance states frequently, in a series of attachments and identifications
• We are not our trances
• We may develop a hypnotic identity, which means we have fused with a set of
• experiences which define how we view ourselves. It is limited, fixated and narrow, compared to our being.
• Changing the trances that hold the symptom structures together will have a cybernetic effect, impacting the deeper "organising principle" (which generates our behavioral, emotional and lifestyle inevitabilities).
Trance has 3 core characteristics:
a) it is characterised by a narrowing, shrinking or fixating of attention.
b) it is most often experienced as happening to the person
c) it is characterised by the spontaneous emergence of various hypnotic phenomena, including age-regression, dissociation, time distortion, pseudo-orientation in time, confusion, post-hypnotic suggestion and amnesia.
According to Milton Erickson, trance can be used therapeutically to evoke unconscious resources, whereas Wolinsky works to expand the focus of attention out of trance, so that resources emerge. Wolinsky refers to the therapeutic process work wherein the person is not trained in experiencing various hypnotic phenomena, but rather brings his/her own trance symptoms into the session. Content is used only as a stimulus to help the client re-create the symptom via its underlying Deep Trance Phenomena ... once the trance phenomena underlying the problem are shifted interrupted re-associated or dissolved(my emphases) the person's resources will automatically float to the surface (since they are no longer so identified)... the mechanism that sustains the symptoms is effectively altered ... the therapist learns to communicate with the creative being, the "self', behind the trance; it is the self that can change the trance and hence the symptom.
By asking clients to describe their symptoms while breathing and looking at me, I interrupt their self-to-self trance of the symptom by placing them (via eye-contact) in a self-to-other trance with me. This changes the context in which the symptom occurs, and adds the therapist as a resource in present time.

Polarity
One's identity is a common psychological concept. What is uncommon is the realisation that many of the identities that people casually own as being representative of who they are, are actually trance identities. Like all Deep Trance Phenomena, a trance identity is created by the child as a means of self-preservation, and to handle various problems and traumas. This identity is comprised of the child's assumptions and beliefs about his interactions with his parents: "This is how I should be... That is how I should not be... This is who I am". These fused / resistant identities continue to function automatically throughout life. Confusion is the transitional state m which a person shifts out of his real self and into the creation of defensive or compensatory identities. Confusion is the primary 'trance-substance' fueling this process. We identify with our role, our profession, our self- image and m oppositional ways as well.
Whenever an identity is negative or uncomfortable there is often an oppositional identity formed too - "I'm a winner, no matter what". If you say "I have a part that wants approval, and I also have a part that just wants to be me", you are experiencing your oppositional identities. A co-dependent person may offer an alcoholic partner a drink, but shortly after, get angry with the partner for drinking. We spend our lives struggling with the tension between what "should be" and "what is"! The task for the therapist is to de-hypnotise the client so that the larger self behind the trance of identification can be experienced.

Paradox
The symptom is the cure. Whatever thought or emotion is completely experienced disappears into something else, and the experiencer enters a deepened state of well-being (The Law of Paradoxical Change Gestalt Therapy Now: Fagan & Shepard). Rossi explains symptom prescription like this: "by asking the patient to experience and worsen the symptom we are presumably turning on right-hemispheric processes that have a readier access to the state-dependent encoding of the problem" This means the therapist is working with the psycho-biological states of the problem rather than the cognitive version.
Intensifying the dynamic that creates the symptom actually helps the person move out of it into an expanded state. The more you shrink your focus of attention in therapeutic trance, the more your perspective spontaneously expands. Gilligan states that trance involves a paradoxical both/and logic, (where) a person identifies with both sides of a complementary distinction of 'this' and 'that', 'subject' and 'object' … the identification with either side does become so reduced that an integration naturally and effortlessly occurs - many times on a non-verbal level. Often, clients experience a deep comprehension of both sides of their issue without identifying with either.

Provocative Therapy
In Provocative Therapy there are numerous strategies which serve as pattern interruption or reframing of symptoms, especially using paradox. These could easily be defined as trance formations or &formations. I think the Provocative session functions as a massive confusion induction and reframe of the "problem" after comprehensive pattern interruption with humour. The therapist sides with the negative, the resistance, the opposite, the symptom! Provocative Therapy gives a difficult lesson about consequences of behavior by excusing or encouraging the opposite. Humour is the essential ingredient of transmission in Provocative Therapy, and is a teaching as well as a balancing. It assaults logic. We laugh when we see the irony of the "yes" and the "no" together (and we use both sides of the brain to do this). We laugh because the problem isn't logical. We laugh because we have to - or else we would cry at our own deadly seriousness. Our problem is never the same after we've laughed at it. We have left our trance when we laugh authentically at ourselves.
Those who have studied the work of Milton Erickson closely have found that when a client is faced with a generalisation, they use cognitively "'transderivational search" for meaning, in a highly personal way. We use the non-dominant hemisphere to associate and seek correlations. Provocative Therapy uses generalisations as an art form; there are enough to use on either side of a polarity of meaning to confuse a client indefinitely. The associative and oppositional shifting of identifications in the client will produce resourceful change, and self-affirming.

Frank Farrelly
Frank Farrelly also functions in person as a highly-skilled utiliser of techniques which any hypnotherapist (or NLP practitioner) would be proud to own. He has developed them naturalistically, and honed their effectiveness over years, without labelling or intellectualising the process. I suspect he uses what "works", and avoids what doesn't! His use of his voice alone would be worthy of a book on the subject (of trance). He is a master of trance management. If his process is hypnotising, it is also de-hypnotising when the trance is in opposition to the symptoms or problem. This is a highly confusing experience, and a hallmark of a session with Frank. He specialises in stimulating (and frustrating) dual oppositional-identities. If you can't find one, he'll create it for you! Thus he represents a "nightmare" for the falsely comfortable and those in denial. Instead of reinforcing our false self with unreal encouragement (as many therapies unfortunately tend to do), the Provocative therapist destroys the falsity by perverse support and bizarre help. The paradoxical opposite to our inner reality does not coexist peacefully in our mind. We flee into reality reluctantly…
Who goes into trance?
Frank ("I go into trance")

The Client
The Audience ("Are you all in trance?")
Anybody ("She was so gorgeous, she was a trance induction on two legs..")
Here are some "interrupting" techniques from his work in sessions:
Naming
"do they think you're the wicked witch of the West? "

Relabelling
tears become "leakage" (content becomes process)

Jumping In
"I see from your expression you've answered that question!"

Incompleting
"It's just so..God.. .well.. .arghh.. ..(muttering and groaning)"

Guffawing, Smirking, Grinning, Joshing, Yukking It Up, Kidding Around.. ..
"you think she understands your needs?? HA HA HA HA !"

Pretending (confusion, embarrassment, being impressed, crying.. ..)
''you what??. .."
"I'm kind of embarrassed for you.. ."
"way to go! ..."
"I was only trying to help.. ."
"I shouldn't be laughing at a guy really trying, but.. ."

Fantasies (with a cast of thousands) and Imaginary Comic Dialogues Pithy Comments, Quips, Sayings, Folk Wisdom, Popular Song Lyrics and Frank's Irish Daddy:
"stick with me honey, I'll have you farting through silk!"

"the best indicator of your future behaviour is your past behaviour" ,

male and female 'tribal wisdom'

Exaggerations
"you're probably the worst mother in the world--or at least the state.. ."

Instant Research
"my research shows that Fridays occupy at least a seventh of our life span..."

Lampooning, Cartooning, Playing with the Problem, Consequences
Grimaces, Mirroring and other Expressions (typically the client's chief features)
Voice Tones
Deeply confidential: "now some gals/guys…"
Authoritarian "my research indicates…"
Wheedling "come on, be reasonable!"
Whinging/Whining/Blaming/Meek and Mild

Gestures
nodding emphatically

Non Sequiteurs
"if you see what I mean......

Self-deprecation
"now where was I? … thank you for finishing my sentence"

The session
"So, what's the problem?"

The session is exclusively person to person: the "contract" means no interruption (and no trance interruption except by Frank). The session incorporates a narrowed focus of attention, confusion, laughter, paradox and relaxation, as well as emotional release. It has a rhythm. Initially, the client is surprised by the paradoxical responses. Frank trawls the bottom of their mental harbour and examines the catch; whatever the client responds to, Frank keeps. Soon the tension builds. They find themselves looking deep into the glittering eyes of a person who isn't playing the game of the client's choosing. He laughs, and seems to mock the issue. He encourages, but all in the wrong direction. They are bombarded with double-binding ideas which "worsen" the problem. They struggle with the "oppositional" but empathic therapist, then find that the problem has been completely redefined. Then they begin a search for deeper meaning, with constant re-inductions of the original problem-trance by the therapist! This continues until the end of the "discussion" part of therapy demonstrations (after the "module" part). In hypnotherapy, such re-induction is called "fractionation", and serves to deepen a trance, and provide a tension which only a general "letting go" can relieve.

"So, what's the problem?"

The constant re-inducing occurs with numerous cues from Frank: he uses everything, from the client's presentation and reactions, to his own extensive intuitive resources, on as many communication levels as possible. Particularly, he will choose the client's involuntary reactions and call attention to these, or assume a deeply confidential voice tone, or touch, or use a cute description made up in the session, or generally over-agree with the pathology and dysfunction/symptom until it's "too much". He does all this simultaneously! It's funny-it's silly-it's ? The result is a client who doesn't know what to think any more! Then Frank can step in and teach them how to really make their "show-business" produce results, or teach them how to do the opposite of what they thought was right (and enjoy it), and generally shred their cognitive dysfunction. Frank has more "show business" than the client, and meets their "act" with worse! He is the worst audience a symptom ever had, and takes over the theatre of the client's mind.

"So, what's the problem?"

By this time, the client is so desperate for guidance that they will accept some very simple and direct help-especially if Frank labels it as the secret of solving the problem. As a corollary, Frank will never let the client's label or reframed solution go-he constantly uses it to keep the paradox alive. He is happy to contract you over and over a5 you expand out of that state (until it seems silly…) This stimulates reality-testing intensely. Wolinsky says: "the repetitious shifting in and out (of oppositional hypnotic identities) gives the client the experience of being more than the identities". The triggers and labels developed in the session also function as a new series of bizarre 'post-hypnotic suggestions' for problem behaviour in the future.

"I'm the problem!!" (authentic client response, Sydney 1999)
The last word

Q: Does Frank Farrelly use hypnosis?

A: No, but if he did, he'd be very good at it.

A: No, he only uses humour.

A: No, I read a big book on the subject, and he wasn't mentioned

A: No; it looks like a trance, and sounds like a trance, but it probably isn't a trance.

A: No, but he likes hypnotherapists to explain things to him.

A: What's hypnosis?

David Lake, September 1999.

April 30th 2004

“In provocative therapy you play devil’s advocate with the client. It’s like the affectionate teasing banter between close friends – you side with the negative half of the client’s ambivalence about themselves and their life’s goals”
Frank Farrelly 2004

I first heard about Frank Farrelly while assisting on one of Dr Richard Bandler’s seminars when he famously commented, “If you think I’m wild, you should meet Frank!” From that moment on I was curious about what such a meeting would produce and on April 30th 2004 in Bournemouth, I got the opportunity to find out!


Frank began the first day by introducing himself and commenting that as this was a smaller seminar that usual, each delegate could introduce themselves and their reason for attending the seminar. The delegates came from a variety of backgrounds, including hypnotherapists, sales and marketing directors and other professions with individuals travelling from as far a field as Mexico! Frank began the morning talking about the development of Provocative therapy and explained that he was the ninth of a family of no less than twelve children and that he had learnt much from his family upbringing. Interestingly in the first hour of the seminar, he commented:

“Anyone can be hypnotised, anyone can be gotten to…”
Frank Farrelly

He explained that Provocative Therapy seeks to elicit five types of behaviour

1.    Assertive behaviour
2.    Self affirmatory behaviour
3.    Realistic and appropriate self defensive behaviours
4.    Psycho social reality testing behaviour
5.    Behaviour that denotes communicating positive messages including warmth, affection, friendship, sexual attraction and love.

We were then given the opportunity for “interviews” or 1 on 1 sessions with Frank which were recorded and which we were then able to take home if we wished. Once this opportunity was announced, the group reacted with a mixture of apprehension and excitement.
The individual sessions each lasted 25 minutes and Kerrin Webb one of the Eos seminar organisers, was charged with the responsibility of announcing when 25 minutes were up. The group also collectively agreed not to talk amongst themselves during these sessions, but it was ok to laugh aloud in response to what we heard and saw!
The three interviews addressed a variety of individual questions and Frank skilfully built rapport with each person and wonderfully set up “counterpoints” to each delegate teasing out more of what was at the root of the question, by provoking each delegate into reconsidering their initial perception of the “problem.” Frank speaks in a relaxed tone that often masks some of the more outrageous comments that are carefully constructed and which if taken out of context could be considered quite bewildering. One of the delegate’s wishes was to lose weight and Frank suggested that the delegate could be happy to be seen as being more “Buddha like” commenting
 “Why not relax and let the Buddhist blubber take over?”

Each delegate was given the opportunity to feedback their reactions to Frank and the group. These reactions included feeling “churned up” feeling “spaced out” and in some cases feeling “pissed off” One of the delegates suggested that there were similarities between provocative therapy and homeopathy. Frank was lightening quick in responding to client’s and interestingly commented that he didn’t have predetermined ideas when relaying stories to clients, but it was clear as an observer that he was building rapport with each delegate on numerous levels whilst at the same time offering wonderfully provocative considerations.

During the last half hour of the day, Frank talked about his work in parapsychology and specifically remote viewing as well as being a speaker at psychology conferences.  From having seen Frank up close, its clear to me that he is a real one off like Milton Erickson and Dr Richard Bandler. One of the delegates asked if his stories and questions were random and whether he pre selected his subject material before starting each session. Frank indicated that he simply started talking and let the conversation unfold. As an observer I noticed that he is highly intuitive when working with clients and made each delegate feel totally at ease while at the same time making suggestions that were both outrageous and highly amusing! As he mentioned in the first hour of the day, humour is a key tool in provocative therapy.

Frank also mentioned that he managed once to listen to a whole eleven minutes of Milton Erickson before falling asleep, not due to boredom, but extreme tiredness! When discussing the use of metaphors he lamented at how some therapists would focus on one single metaphor for the duration of an entire session, “wringing the life out of the metaphor”. When one delegate to my amusement asked if Frank’s stories were entirely random, he responded by saying that he was just an old guy who didn’t really know what he was doing. The only other person I have met who is as sharp as Frank is Dr Bandler and I doubt that his approach would be anything like as effective had he not modelled Frank in his early years! Frank is as sharp as they come, working on many levels simultaneously and from what I have seen, nothing slips by him…

Day 2
Day 2 began with Frank asking if anyone had any feedback, questions or observations from the previous day. The subject moved to the application of provocative therapy in specific clinical situations and Frank explained that the number of client sessions could vary immensely from three to as many as ten. He also interestingly commented that when dealing with schizophrenics you have to
“Take your professional dignity and throw it out the window in the service of the client”
Frank called the moment when a client assumes responsibility as “the bingo moment” and suggests getting the client to vocalise this statement three times. He commented that many breakthroughs as statements usually “blurted out!”
We then continued with further interviews with a delegate commenting that he had a problem for many years. Frank’s immediate riposte was “kind of like a pet?” He then enquired exactly how many years the delegate was referring to. The delegate responded that this “problem” had been troubling him for 30 years. Frank’s response was “that’s not a problem, that’s in the marrow of your bones!”
I remembered that Frank had stated on day one that there was no point in attempting to get to a safe vault through the reinforced vault door, far better to get in from another place, such as underneath. This is an excellent metaphor for Frank works, often frustrating the client into revealing to themselves a different perception of what they previously imagined their “problem to be! Frank sits close to each client in interview situations and touches them at specific moments within the conversation. I refrain at this point to describe this as anchoring because when asked specifically about this Frank mentioned that he had met Dr Bandler in Santa Cruz but when previously asked about anchoring commented
“I know nothing about sailing”
The provocative responses from Frank continued with in further interviews and it became clearer and clearer to me how much he uses a combination of razor sharp humour and attitude to change the client’s perceptions. When a client said, “Tell me more”, Frank responded with the most eloquent tonality “fuck you and the horse you rode in on!”

Later in the day an interviewee commented “I really need spirituality” to which Frank responded “Have you ever considered fucking a member of the clergy?” All of these outrageous comments flowed perfectly within the warm and friendly banter that Frank had carefully set up between both parties. The environment of friendly banter meant that the comments still have a powerful impact, but in a safe surrounding.
In the afternoon, I finally got the opportunity to work on an individual basis with Frank and to have a recording of my own session. I found Frank once again to totally defy my expectations and to be working on so many levels that quite quickly my “NLP brain” lost track of what was happening. I realised that I was in the hands of a master communicator and within minutes, he had totally changed my perception of what I had previously considered a problem! Frank quickly established rapport with me and within the first two minutes, and had nailed the heart of the subject with the phrase “Well that is wonderful”. At one point during the interview, I completely lost track of what we were discussing and went into a total state of confusion. My three reactions to Frank and the interview were great humour, confusion and mild annoyance with myself for reacting in such a predictable manner to my situation!
On listening back to the recording later in the evening, I found it to be hysterically funny and noticed how much Frank had already mapped out how I tended to operate and through his method provoked me into viewing my situation in a quite different manner. I also noticed that he had “analogue marked out” all the delegates and addressed each delegate with a specific voice tone and rhythm.
I also realised that “provocative” does not necessarily mean aggressive, rather that through provocation different scenarios are teased out of the interviewee. Provocation literally meaning “to call forth.”
During the final part of the day, we got into threes and started practicing some of the provocative therapy exercises to great effect. I realised that this is a completely different approach to any other therapy I had come across! This view was further confirmed when I read our handouts detailing specific exercises for the provocative therapist. The first two exercises were “don’t help the client” and “blame the client”.  I was in hysterics when a further sheet entitled the “provocative therapy blame list” detailing how the therapist could effortlessly apportion blame for the client’s problem to a whole range of factors. These include destiny, family, history, the mind, nature and society – in short anything but the patient themselves!

Bizarre as this all may seem, I am finding even within two days that Frank’s provocative therapy is extraordinarily effective and is unlike any other approach I have to date encountered. I can already see how this approach is going to be a valuable new skill set in client and business interactions.

 
Day 3
The day began with Frank introducing the metaphor of having the right tools to fix stuff and having the skill to know how to identify and communicate with who would be of most use in fixing something. He talked about the usefulness of assuming an attitude of humility when “going into another’s territory”
The first interview of the day was with a delegate who mentioned that he thought he worried too much. I began to now notice a pattern in Frank’s interactions as within the first minute he set up a strong visual image as a metaphor commenting; “Boy you have a slow dick” He then went on to suggest that the delegate had “timid sperm”. After the interview, the delegate commented that he felt a weight had shifted from him and that he felt genuine warmth for Frank and the time he had allocated to his situation. Frank commented, “One of my main aims in provocative therapy is to move the heart” He also revealed that:
“With guys I buddy buddy them and then walk into their hearts and minds”
I also noticed how Frank would often ask the client about how old they were, what has happened to them and what will happen. In short, he set up timelines of possibilities for each client to consider. Another strategy in provoking the subject was to comment on their level of intelligence!
When one of the delegates asked about working with alcoholics, he commented that many therapists in these sorts of situations feel overwhelmed by their situation and that was actually often the best place to start.
The most fascinating demonstration of the day was when a delegate asked Frank about how to resolve “failure patterns”. Frank then proceeded to give an explanation of how in life there are winners and losers. When she asked if losing could sometimes be useful, he replied;
“Yes for the winners”
Having set up this proposition in such a digital manner Frank continued for 25 minutes to maintain this central theme. When the delegate asked about how people may put up barriers for defence, Frank commented;
“A lot of winners put barriers up against losers”
The next morning some 14 hours later, I still found my mind pondering on this interview…

Day 4
The day began with Frank talking more about his work with schizophrenics and one in particular who claimed that he was from another planet. This patient would only speak in this other planet’s “mother tongue”. After working with the patient for some time and responding in his version of the “alien language” the patient responded with his first few English words, which were “Fuck you Frank”. I was greatly reminded of many of similar Richard Bandler’s stories and couldn’t help noticing that Frank’s work predated NLP and so I wonder what NLP would have been like had Richard not modelled Frank in Santa Cruz all those years ago…

“I approach what the client avoids”
Frank Farrelly

One of the things that continued to impress me about Provocative Therapy is how removed it is from the conventional classical psychological approach. Frank spoke about how he would often start talking to clients about body image, which he viewed as the easiest way into the client’s self-conscious. He also commented; “I tune into the client, but sometimes I don’t address what they say”. I noticed that over a series of interviews Frank would address core issues through masterful use of metaphors. He talked extensively about his 50 years of working with all kinds of patients and commenting; “I never push a highly paying resistant client.”

As I began to track the different interviews in more detail, I saw that recurrent themes would begin to appear. I noticed that in many of the interviews he would present a strong image to the patient in the early part of the interview. He would then begin to provoke the patient into considering a wildly different alternative to their current model of the world usually with tremendous humour, which would result in the patient incapable of not discovering substantial internal changes. A typical response would be one of complete confusion as their maps changed significantly, often within the first minute!

“I feel like a psychological social chameleon”
Frank Farrelly

During the last section of the afternoon, Frank discussed using Provocative Therapy in working with couples. He would seek to elicit each partner’s expectational list. For the women he would ask the men how their husband would rate them in the following way –
•    As a companion
•    As a mother
•    As a partner
•    As a cook
•    As a sex provider

When turning to the men he would ask how the women would rate them –
•    As a provider
•    As a companion
•    As a man around the house
•    As a father
•    As a sex provider

“My interviews are my paintings”
Frank Farrelly

The conversation shifted to discussing the many different systems of psychotherapy and Frank observed that although the systems can help with understandings its “people that help people”.
In describing Provocative Therapy he commented;

“A lot of people can’t tolerate the degree of ambiguity in this stuff”.

The final question of the day posed directly to us was; “Did we get our money’s worth?”
This is was one of the best investments in time and money I can recall and I shall be certainly training with Frank again in the future. Like other, true, innovative genius’s Frank is a real one off. So if you get the chance to see him, grab it with both hands, but prepare for an experience like no other…