The Art of Psychoanalysis ( Jay Haley, 1963)
In a couple of earlier postings (January 19 and 20, 2014, I referenced Jay Haley’s (1963) discussion of symptomatic communication in “The Art of Psychoanalysis,” in his book, Strategies of Psychotherapy. I am going to re-post them here, since they are both enlightening and enlightenment-related.
In his ground-breaking book on psychotherapy from a communication perspective, Haley noted that all human communication attempts both to convey information and to influence or control the relationship within which that communication occurs, and that symptomatic behaviour communicates an attempt by the patient to control the relationship without having to accept responsibility for doing so. It is the job of the therapist, therefore, to interact with the patient in such a way that the patient is not able to control the relationship by behaving symptomatically, thereby not rewarding the patient for symptomatic behaviour, so that it has an opportunity to die out or “extinguish.” [Very similar to what we might do with an ABA-based approach to treating undesirable behaviours in our children with autism – supplemented by modelling and reinforcing “straight talk,” of course. RR] In The Art of Psychoanalysis, Haley comments that the patient begins by offering his symptoms while saying that he cannot help behaving the way he does, that he is not in control of his own behaviour. The therapist doesn’t deny this, nor does he deny the patient’s feeling that he ought to be in control. Instead, he accepts the patient as he presents himself, symptoms and all. But then the therapist suggests that there are unconscious reasons for the patient’s difficulty, placing the locus of responsibility within the patient but not within his conscious control, and defining the task as one of making the unconscious conscious. The idea of the “unconscious” enables the patient to express and talk about himself without owning the responsibility for what he says and does. This pattern of communication is, of course, the same as using one’s symptoms to control the relationship: “It is happening, but I am not responsible for it.” By assuming an unconscious, however, the therapist accepts and encourages the problematic behaviour while, at the same time, preventing the patient from using it to control him.
In due course, the bind that the patient is in becomes critical. He is constrained from getting out of it by quitting the relationship because the therapist has defined that as unconscious resistance to treatment. He cannot force the therapist to make decisions for him, because the relationship is always being defined by the therapist as supportive but nondirective. He cannot break out of the situation by aggression because the therapist simply accepts attacks by questioning their motivation. Haley suggests that, at this point, the patient can only escape from the bind that he is in by either ceasing to try to control the therapist symptomatically or by acknowledging that he is trying to do so, and the easiest solution is frequently for the patient to effect a cure.