Psychosomatic Pain

One of the important ways in which Provocative Therapy works to disrupt the habitual cognitive patterns which have been generating a problem is by introducing ideas which are surprising or shocking.  Although to a spectator a PT session might appear to be simply a light-heated and not very tasteful conversation, a session adheres to very precise principles and language patterns, which allow powerful imagery to be used to effect powerful change.    Sometimes, this is done by deliberately breaking established taboos or norms.  The following is a case in point.  The session was conducted at very fast pace– leaving Fred with no time to think, or do anything other than respond to increasingly outrageous suggestions.

Fred had been in the psychiatric 'system' for many years.  In his time he had been given a variety of diagnoses, the latest of which was 'personality disorder'.  He was, in the words of the therapist, "One of those heart-sink patients that no-one wants to work with". 

For some months, Fred had been complaining of an excruciating pain in the nose and nasal passages.  He had been referred to the appropriate medical specialists, who had performed a thorough investigation before pronouncing that there was no organic cause.  Fred had also suffered for some years with chronic constipation.  He used to complain about constipation a lot, but for the last few months every visiting worker was regaled instead with a lengthy account of the latest in a long line of Fred's experiences of nasal pain. 

Having introduced the concept of provocative therapy, and secured the client's agreement to it, the therapist immediately began arguing strongly that the pain in the nose wasn't the client's fault– "It's the constipation's fault!"  The therapist carried on with growing enthusiasm to explain that because of the constipation–"The shit's backing up-- all the way up to your nose!  As the session progressed, the metaphor grew ever more graphic–"...so you're genuinely full of shit– mummified, fossilised shit– all the way up to your nose!  In spite of himself, the client was having increasing difficulty keeping a straight face at this grossly scatological language– not what he had come to expect from this normally courteous therapist!

The therapist asked what Fred's sex life had been like when he was married– very good, he said.  The therapist immediately acted as though he had made a great discovery: "Well there you are! - That's the Problem!– a build up of pressure!"  He went on to suggest that Fred should be masturbating regularly to relieve the pressure of enforced celibacy.  After more similar suggestions, the session ended.

At a follow-up meeting some months later, Fred was still under the care of the psychiatric service.  However, he was making progress for the first time in years.  He was no longer complaining of nasal pain, and was no longer constipated.  Now that he was no longer afraid to eat, he was regularly having lunch at the local pub, and had begun socialising with others there.  He reported feeling more relaxed than he had in years, He certainly looked it, and was moving with an easy grace very different from his previous anxious, bird-like jerky movements.The dose of  tranquillisers he had been prescribed for some years had been first reduced, then stopped altogether. 

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