Deciphering Motivation in Psychotherapy

192 Pages·1991·3.918 MB·English

by  David M. Allen M.D. (auth.)

Deciphering
Motivation in
Psychotherapy
CRITICAL ISSUES IN PSYCHIATRY
An Educational Series for Residents and Clinicians
Series Editor: Sherwyn M. Woods, M.D., Ph.D.
University of Southern California School of Medicine
Los Angeles, California
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Deciphering
Motivation in
Psychotherapy
David M. Allen, M.D.
Burbank, California
Plenum Press • New York and London
Llbrary of Congress Cataloglng-ln-Publlcatlon Data
Allen, Davld M., 1949-
Declpherlng motivation in psychotherapy I David M. Allen.
p. cm. -- (Critical issues in psychiatry>
Includes bibliographical references.
Inc I udes index.
ISBN' 13: 978'1'4684'5891'6 e'ISBN'13: 978'1'4684'5889'3
DOl: 10.1007/978'1-4684'5889'3
1. Motivation (Psychology> 2. Psychotherapy patlents--Language.
I. Title. II. Serles.
IDNLM: 1. Communication. 2. Motivatlon. 3. Psychotherapy. HM
460.5.M6 I A425bl
RC489.M655A45 1991
616.89' 14--dc20
DNLM/DLC
for Library of Congress 91-2458
CIP
ISBN'13: 978'1'4684'5891'6
© 1991 Plenum Press, New York
Softcover reprint ofthe hardcover I st edition 1991
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To the memory of Rose Kreitzberg
Foreword
I have often stated to students that I felt that one of the most important
characteristics of a psychotherapist is the ability to tolerate ambiguity. As
Allen so aptly points out in this creative and valuable book, my observa
tion contains an implicit assumption that requires a clear statement in
order for it to be understood. Before ambiguity can be tolerated, it must be
recognized. The psychotherapist who accepts the presentations of the pa
tient at face value is never faced with the difficult problem of tolerating the
ambiguity that is so intrinsic to the circumstances that bring many people
to treatment. In this volume, Allen has undertaken the task of helping the
reader to recognize ambiguity in all of its manifestations, to understand it
better, and, having understood it, to help the patient to grow beyond it.
Ambiguity, in Allen's view, arises from a dialectical conflict, whether
it is between the self and the system, intrapsychic and wholly within the
self, or social, when the individual is tom between competing reference
groups. Psychotherapy is a process by which the dialectic can be brought
to consciousness so that a synthesis can be achieved. The dialectic that
engages the individual, and often is played out between the individual and
the system, parallels the struggle between attachment and individuation.
Every step toward independence threatens to be a step away from en
gagement, and every acceptance of an attachment carries the specter of the
relinquishing of individuality. The synthesis of these two human goals is
captured by a concept such as mature dependency. It is a critical goal of
therapy to help the patient grow in a manner that sacrifices neither attach
ment nor individuation.
Psychodynamically oriented clinicians have recognized that a symp
tom is an amalgamation of a wish and a defense. This recognition allows
us to appreciate the rational function of an irrational appearing symptom,
and also provides the information necessary to intervene effectively. Allen
has extended this principle to the use of language, apparently viewing
language as akin to a symptom in that it often betrays both the true self and
the persona or roles of the speaker. It is this dual expression that leads to
vii
viii FOREWORD
the ambiguity of many communications, an ambiguity that also contains
the seeds of the understanding necessary to resolve the contradiction and
reach a healthy synthesis of competing needs. It is important to recognize
that ambiguous communication does not represent a classic resistance to
change, but rather an ambivalence about change. This reframing then
places the responsibility on the therapist to choose which of the many
meanings contained in the communication to respond to, and by making
this choice, the therapist chooses whether or not to move the treatment
forward. Thus, if treatment founders, the responsibility is not assigned to
the resistant patient, thereby blaming the victim and compounding the
error, but on the professional who has accepted the task of intervening in
a helpful manner and then has failed to do so.
One important contribution of this volume is the focus on language as
the vehicle by which dialectic conflicts are expressed. Allen also con
tributes a critical extension of psychodynamic thought through his recog
nition that the family system provides a model for the roles, conflicts, and
solutions of the patient. This recognition of the etiological and maintaining
function of the family is consistent with an object relations point of view,
but it goes beyond it in its explicit reference to the family in formulating
interventions. In this way, an understanding of family systems can be
employed by the individual therapist in a creative and helpful manner.
Psychotherapy, especially with adults, is a set of verbal transactions
with the explicit goal of helping the patient to resolve the situation that
created the need for treatment. The language of the patient is the primary
road to understanding for the therapist, and the lanquage of the therapist
is the primary means of communicating that understanding in a helpful,
effective, and empathic manner. Ambiguity in the language of either party
will serve as an impediment, and sometimes a total roadblock, to the
success of the treatment.
In Through the Looking Glass, Humpty Dumpty declares, "When I use
a word it means just what I choose it to mean-neither more nor less."
When Alice wonders "whether you can make words mean so many dif
ferent things," Humpty Dumpty replies, "The question is which is to be
master-that's all." In psychotherapy, words mean just what the speaker
chooses them to mean-neither more nor less. It is the task of the therapist
to master the mysteries that surround this meaning. This book is valuable
because it aids the therapist in deciphering the ambiguities and, by doing
so, furthering the success of the treatment.
George Stricker, PhD.
Adelphi University
Garden City, New York
Preface
One of the first things I noticed when I began rny training as a psycho
therapist was the presence of certain inconsistencies and arnbiguities in
verbal and nonverbal communications frorn rny patients. At the sarne tirne,
I found that attention to such discrepancies led rne to important clues
about the hidden thoughts and ulterior rnotives that I believed it was rny
duty as a therapist to uncover. It seerned to rne a truisrn that the first step
in changing self-destructive behavior in clients was to understand what
was rnotivating it.
The therne of hidden rnotivation and discrepant cornrnunication is of
course present throughout the writings of the various schools of psycho
therapy, but I believe that a cornprehensive theory that integrates the
observations of these proliferating schools has been lacking. This book was
written in order to provide such a theory. Since the business of psycho
therapy is clinical and not purely academic, however, such a theory would
be pointless if it were not of sorne clinical usefulness. This book is in fact
written primarily for clinicians-psychiatrists, psychologists), social work
ers, rnarriage and family therapists, and other psychotherapists. I have
found the concepts presented in this volurne to be of the utmost utility in
every phase of therapy. The reason for this is that arnbiguity in cornrnun
ication is not confined to therapeutic relationships; indeed, it is an essential
factor in the genesis of rnost disturbed interpersonal relationships.
Many of our goals, and therefore our rnotives, are based on the need
to respond to or control the behavior of the others in our social network.
In order to accornplish this, all of us are faced with the task of hypothe
sizing about the intentions of significant others on a daily basis. Decipher
ing the rnotivations of our fellow hurnan beings is done routinely and often
subconsciously, and rnost of our ideas on the subject are based on their
cornrnunications. When such cornrnunication is arnbiguous, as it often is,
this task becornes rnore difficult. Understanding how our patients respond
to this dilernrna helps us to understand thern, and helps us to devise
alternate, rnore effective, and less destructive strategies for helping thern
to accornplish their goals.
ix
x PREFACE
Despite the fact that ambiguity in communications presents itself in
myriad forms, it is not a random phenomenon. One of the central ideas in
this book is that alternate meanings can be placed in only two general
categories: meanings that reflect idiosyncratic or true-self desires of in
dividuals, and meanings which reflect social roles which mayor may not
conflict with those idiosyncratic desires. The dialectical conflict between
the forces of individuality and the forces of togetherness, to use Michael
Kerr's phrase (Kerr and Bowen, 1988), is part and parcel of human com
munication. In the book, I describe a model of intrapsychic conflict which
I hope will be useful for most therapists, whether they follow an in
tegrated, psychodynamic, cognitive-behavioral or family systems model.
I also hope that the reader will find that a conflict model of psychological
dysfunction is far more advantageous than the various deficit models that
are now in vogue within most schools of thought.
In writing this book, concepts from the field of linguistics were of
necessity included. I have no formal training in the field, and no doubt
linguistic scholars will find some of my notions naive or off-track. I do
believe, however, that the basic thrust of my argument is accurate in its
essentials and request their indulgence. In today's world of exponential
increases in available information, attempts to integrate ideas from differ
ent academic disciplines must always suffer from the impossibility of
receiving training in too many different areas. For science to progress,
however, attempts at integration must be made.
By way of acknowledgment, I would like to thank three individuals
for their assistance in directing me to references which, in my travels
through the literature, I might never have encountered. Michael Braver
guided me to the article by C. W. Mills (1940). My wife Harriet allowed me
to hitch a ride throughout her linguistics course work at California State
University Northridge. The late Rose Kreitzberg introduced me to the
relevant literature in literary criticism, in particular the book by Empson
(1947), and also offered invaluable suggestions for the expansion and
clarification of the manuscript.
David M. Allen, MD.
Burbank, California
Contents
PART I: THE DIALECTICS OF MOTIVATION
Chapter One Language and Intention. . . . . . . . . . . . . . . . . . . . . . 3
The Cooperative Principle ... . . . . . . . . . . . . . . . . . 5
Assessment of the Intentions of Others. . . . . . . . . 6
Behavioral Cues . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
The Search for Behavioral Cues. . . . . . . . . . . . . . . 16
Chapter Two Mixed Motivation and Language............ 19
The Dialectical Perspective. . . . . . . . . . . . . . . . . . . 19
The Dialectics of Motivation . . . . . . . . . . . . . . . . . 24
The Dialectics of Language . . . . . . . . . . . . . . . . . . 25
Universal Grammar. . . . . . . . . . . . . . . . . . . . . . . . . 30
Chapter Three Ambiguity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Types of Ambiguity. . . . . . . . . . . . . . . . . . . . . . . . . 34
Motivational Ambiguity. . . . . . . . . . . . . . . . . . . . . 39
The Semantics of Intrapsychic Conflict. . . . . . . . 43
Responses to Ambiguity. . . . . . . . . . . . . . . . . . . . . 46
The Semantics of the Game without End. . . . . . 53
Chapter Four Selfishness and Altruism . . . . . . . . . . . . . . . . . . . 57
The Paradox of American Individualism . . . . . . 57
Altruism Masquerading as Selfishness. . . ... . . 61
Mortification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Chapter Five Distancing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
The Evolution of Social Roles . . . . . . . . . . . . . . . . 75
Parent-Child Distancing. . . . . . . . . . . . . . . . . . . . . 77
Role Function Support. . . . . . . . . . . . . . . . . . . . . . . 79