Metaphor and storytelling in therapy, Part 2

Throughout most of my mental health career I was blessed with good supervision. My first clinical supervisor was a PhD licensed psychologist, Dr. Robert Klein. He taught me a lot, including a procedure for helping enuretic children – bedwetters – to “keep a dry bed” when their families were trying to force them to “stop wetting the bed.” Using this procedure I was able to help several enuretic children to overcome their problem quickly. In one instance, it only took one session for a boy to immediately start keeping a dry bed. The procedure uses storytelling in two different ways, to role-model the desired outcome – as well as a family systems intervention.

This is the sequence I’d learned: After establishing some degree of rapport with the anxious and humiliated child, I’d tell him – in front of his parent(s) – a very brief generic story about “a boy your age” with the same problem, who’d gotten over the problem as quickly as it had started, after seeing a counselor. This provided a ray of hope for a child who desperately wanted to stop wetting his bed, but was clueless as to how to do it.

Then I’d do a family systems intervention, to change the family’s response to the problem, and to get the family to start promoting success, rather than punishing failure. I’d explain that the problem was caused by anxiety ( or “nerves”), and when the boy stopped worrying about bedwetting, it would stop. I’d instruct the parent(s) to stop shaming and punishing the child for “wetting the bed,” and encourage them to talk instead about “keeping a dry bed.” Any siblings should be instructed not to tease their brother. Once I felt confident that the parent(s) understood the plan and that the family would stop blaming and punishing their child, I’d speak to him individually.

By this time, the boy saw me as an ally, one who’d asked his family to stop shaming and punishing him, and who’d predicted quick success. I’d tell him, “There’s a part of your brain that never sleeps” (it’s called the reticular formation), and predicted that when his bladder got full when he was asleep, that part of his brain would wake him up, so he could go pee in the toilet. Then I’d ask him to name his favorite hero, so I could craft a story especially for him. If he said Spider-Man, I’d make up a story on the spot about Spider-Man defeating some supervillain, then going home. There Peter Parker would eat supper, pee, and go to bed. When his bladder got full in the middle of the night, he got up and peed in the toilet, and woke up after sunrise in a dry bed.

Somehow this simple story that models the desired behavior, using a role-model chosen by the child, helps him to be less anxious and to wake up when he needs to pee. In the case of my “one-session enuresis cure,” when I saw the boy’s mother weeks later, I asked her how he was doing and she told me he’d kept a dry bed since the day we met. I asked her how she understood what had worked for him, and she replied, “He said you’d told him that there’s a part of his brain that never sleeps.” Using metaphors and stories that predict success, and give the  client reasons to expect it, can be very effective in therapy.

Therapists who are good at storytelling can craft stories on the spot, or collect teaching stories and select the right one for the right client and situation. The following story, slightly modified, comes from therapist and author Bill O’Hanlon. It’s a good story to tell people whose lives are affected by phobias and irrational fears: The abbot of  a monastery had to go to town for the day, but he hesitated because every time he went away, the monks got into some kind of trouble. The monks urged him to go, promising to stay out of trouble, and not leave the monastery until he returned. So the abbot set out the next morning. Not long after he left, the monks heard a loud knock on the heavy oaken door to the great hall. One of them went and opened the door. He found himself facing a hideous, slimy demon, with a mouthful of fangs and claws like razors. The monk screamed and jumped back, and the demon entered. Other monks heard the screams and ran to the great hall, where they saw the demon menacing their brother and growing larger before their eyes.  They started screaming, too, and the demon grew even faster, towering above their heads.

When the abbot returned, he knew right away that the monks were in trouble again, because the door to the great hall was open, and he heard screaming inside. He entered, closing the door behind him. He saw the huge demon growling and menacing the monks, who cowered in a corner, trembling and screaming. Calmly, the abbot walked over to them, saying “Hi, demon” offhandedly as he passed him.  “Look” he said to the monks, “This demon eats your fear and it makes him grow, but he can’t hurt you. Ignore him.” Comforted by their abbot’s calm presence, the monks stopped screaming and stood up; and the demon started to shrink. Then, to their surprise, the abbot started laughing and telling jokes. Soon all the monks were laughing, and the demon continued to shrink until it was the size of a mouse – its actual size. It couldn’t leave because the door was closed, and the monks decided to keep it as a reminder not to let themselves be ruled by their fears. The abbot told them, “Fear cannot grow where there is heart and humor and laughter.”

If you’re a therapist or are studying to be one, I recommend Bill O’Hanlon’s website <billohanlon.com> as a gateway to a treasure trove of resources. He studied under Dr. Milton Erickson, one of the giants of psychotherapy, whom I’ll be writing about in future posts. Bill has written over 30 published books, and has written about how you can write and publish your book. I got the fear demon story from his CD of stories, “Keep Your Feet Moving: Favorite Teaching and Healing Tales.”

Metaphor and storytelling in therapy, Part 1

Partly because I was an undergraduate English major before I got a psychology graduate degree, I was very language-oriented as a therapist. Carefully listening to my clients’ metaphors and linguistic formulations  (as well as noticing non-verbal cues) was my best key to understanding their unique experiences of being-in-the-world. I tried to use their own language and metaphors in my tailored communications with each client, and often crafted strategic metaphors that I hoped would reach them where they lived. Sometimes I presented the metaphor concisely: “It’s like you always wear a suit of armor around people, and you’ve been wearing it for so long you don’t know when it’s okay to take it off, or even how to do it if you wanted to.” When a strategic metaphor hits the nail on the head, it’s immediately validated by the client, and helps to establish trust in the relationship. (“She understands me!”) If it doesn’t, the client will often use the metaphor as a starting point for clarification: “It’s more like a wall I build around me than a suit of armor.” This provides the therapist with a better understanding of the client’s worldview, and a better metaphor to use with him.

Sometimes I extended my metaphor into a story: Once upon a time there was a knight named Val who survived every battle he fought in, and was a renowned warrior. He was known for his bravery and for his impressive suit of armor, crafted by the best armorer in the kingdom. Sir Val took great care to maintain the steel armor and oil the leather straps, and never went into battle without a careful inspection, to make sure everything was in place. In time, he became known as the most formidable knight in the kingdom. But then there came a time of peace. With no battles to be fought, the king declared an outdoor feast on Midsummer’s Day. It was hot, and the knights and ladies wore their light summer finery. But Sir Val showed up wearing his full suit of armor. He was sweating bullets, it was almost impossible to eat or drink wearing gauntlets and a helmet with a visor, and romancing the ladies with a lute and a song was out of the question; so he left shortly after he arrived. It didn’t hurt his reputation as a brave and formidable knight, but nobody could understand why he thought he needed to wear his armor to a picnic.

Sometimes a story is more effective than an explanation or an interpretation or a speech. I still remember what I learned as a boy from the “Story of the Boy Who Called Wolf” : if you develop a reputation as a liar, people won’t believe you even when you tell the truth. It gave me a practical reason to lie, not a lecture on truthfulness. Teaching stories abound in Buddhism, Sufism, and other religious traditions. Jesus used parables to illustrate religious truths.

One of my favorite Buddhist teaching stories, which I told many times in therapy, is about a Western scholar, an expert on Oriental religions, who was visiting Japan. He had the good fortune to be invited to a Buddhist monastery for a formal tea ceremony with the abbot, or roshi. He was escorted to a serene rock garden, where the roshi awaited him, sitting on a mat. The scholar knew something about tea ceremonies, and sat opposite the roshi, who bowed to him and set about preparing the tea in silence. Impatient, uncomfortable with the silence, the scholar began babbling about Confucianism and Taoism and Buddhism, wishing to impress his host with his broad knowledge. The roshi kept silence until the tea was ready, and nodded to indicate that his guest should hold out his teacup to be filled. The scholar did so, still talking. When the cup was filled, the roshi kept on pouring. The tea overflowed the cup, at which point the scholar shut up, watching the tea drip onto the mat. “Your mind is like that teacup,” the roshi observed. “It’s already so full that it can’t hold anything new. If you want to learn new things, first you have to empty your cup.”

Another Buddhist story I told many times in therapy was about a senior monk and a novice who are journeying on foot through the countryside. They belong to an order that generally observes silence and forbids physical contact with women. One rainy morning they come to a rain-swollen stream. An old woman is weeping, unable to cross and return to her family on the other side. The older monk lifts her up and carries her across the torrent. Then the two monks continue on their journey, in silence. When they set up camp that night, the novice asks for permission to speak. “Our order clearly prohibits physical contact with women, and yet you took this woman in your arms this morning.” “Yes,” the older monk replied. “But I put her down on the far bank of the stream. You’ve been carrying her all day.”

Do you know anyone who might benefit from hearing any of these stories? I’ve collected teaching stories for years, and will share more of my favorites in future posts. An extended metaphor is an analogy, and a story is a kind of extended analogy. A good story can lodge itself in your long-term memory, and affect your behavior.