Psychotherapy Out of Bounds

PSYCHOTHERAPY Out of Bounds, continued
He trained Patrick in deep muscle relaxation, taking special care to focus on relaxing the hands gently. Then he asked Patrick to picture a variety of scenes in his mind while remaining relaxed. The scenes were presented in pairs, with each pair followed by the request that Patrick raise one of his fingers, one to four, to indicate whether discomfort had decreased, increased, remained the same or been absent across the two items of each pair. At successive sessions, the hand used for this finger-raising signal was alternated to allow both hands to be exercised in this way. The scenes Patrick was asked to picture included the usual sequence of traffic images which have been described in other stories. He was also asked to visualize scenes in which he became impatient, irritated and, finally, angry (to address the usual factor underlying ulcers), and scenes in which he felt mild and then severe pain, became ill and was finally admitted to hospital (to address autonomic function).
Felicity had no choice. He had to watch Patrick’s hands to await his finger signals. That allowed Felicity to examine the arthritic swelling carefully at each session. There were forty sessions. By the twentieth session, there was some reduction in the knuckle swelling and the fingers were twisted to a noticeably smaller angle. By the end of the treatment, no ulcer pain had been reported for a long time, the fingers pointed straight out from the hand, the knuckles looked to be only slightly thicker than ‘normal’ knuckles would be, and Patrick was beginning to use his hands almost normally, even for quite fine finger work.
Felicity saw Patrick on several occasions for non-professional reasons over the next three years. His hands looked normal, and he seemed to be using them in normal ways — and he said they were fine. But, presumably considering the effects on his arthritis to be a result of ‘spontaneous recovery’, Patrick’s physician did not refer any other patients at all to Felicity. Was Patrick the only case of arthritis Felicity has treated? He was not. However, the few others Felicity has seen did not exhibit visible changes except for the fluidity and ease of their movements. But, then, their arthritis was not something Felicity was privileged to examine or treat directly. In Patrick’s case, his hands could be seen.

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