NON-PATIENT PATIENTS IRWIN W. KIDORF* Most therapists are convinced...
IRWIN W. KIDORF*
Most therapists are convinced that types, primarily because they do not fit the
among the prime requisites for successful usually accepted role of "patient", and yet
outcome in psychotherapy, are a realiza-
are offered therapeutic hours.
tion of a need for change, and a desire to
The first type consists of parents of
change, on the part of the patient. children referred to the Center. We have,
Obviously, there are patients whose treat-
as have many similarly operated Centers,
ment can be considered "successful", who made parental participation in therapy
do not have the (initial) desire, nor indeed, either with the same or different therapist,
even the realization that change is needed. a requirement for accepting the child into
Consider, for example, children, who are treatment. Actually, the reasoning behind
brought to a Guidance Center by their this is equivocal. On the one hand, we are
parents, either because the parents realize following an established pattern. As far
the Child's emotional development is not back as 1951, Dorfman stated that even
along normally acceptable lines, or because if the parent does not enter treatment,
they, the parents, were themselves made the child who does, changes his perception
aware of the child's problems through, for of his environment, and ultimately will
example, academic failures or court react and interact under this new set of
hearings. There is substantial clinical conditions. ("... the fact remains that many
evidence that psychotherapy "works". That children have benefited from play therapy
is, outside judges, as for instance, the without concurrent parent therapy")
school, the parents etc., agree the child (Dorfman, 1951 : 239). On the other hand,
has "improved". Even test findings can empirical evidence shows that when
indicate "improvement". Yet, it often parents gain insight into their role, vis a
happens that the child is not aware of the vis their child, therapy (of the child) is
reasons he was brought to the Center and, that much easier facilitated.
upon termination of treatment, is unable
to verbalize any real changes in him.
Because of the economics of time, staff,
waiting lists, and other prosaic adminis-
There are other types of patients who trative problems, children, or at least
come to a therapist without a realization of adolescents, are often seen in the group
a need for change. Reference is here made situation. Their parents are also seen in
to those who are referred by the courts, group. And it is here that resistance comes
either directly or through the probation to the fore.
Department. In many instances, therapy is
Parents usually see themselves as
made a "condition" of probation.
"refer-ees." The parent groups customarily
In the years I have been associated with proceed along similar lines. The initial
this Community Mental Health Center, phase is one of a kind of shock that they,
serving an urban-rural population. I have the parents, have to be "seen." ("It is
identified several major types of patients Johnnie who is presenting problems.
who must be considered reluctant, and who Nothing is wrong with me.") After this
have been found to be most resistive to period comes testimonial giving Good or
treatment. I would like to discuss two such bad. ("Johnnie did thus and such; Johnnie's
* Dr: Irwin W. Kidorf, is Chief Psychologist and Director, Outpatient Services, Cum-
berland County Guidance Center, New Jersey 08332.
IRWIN W. KIDORF
teacher said thus and such; Johnnie is not
Our role as therapists after all, does not
as as before". Always the tone consist in placing blame as much as it
is child, rather than parent oriented. consists of clarifying the situation. Patient's
Because the children concerned provide especially "refer-ers" need to recognize this
much to talk about, and because, after all, fact, but unfortunately too often see them-
it was the child who was referred, the selves as placed "under the hammer" of the
therapist often falls into the trap of main-
therapeutic situation. Of course, the thera-
taining the group at this level. Consequent-
pist must consider unconscious motives
ly the "group" remains a collection of on the part of the parent refer-ers who,
individuals who happen to be sharing the almost always perceive themselves as being
same therapeutic hour. There is little somehow responsible for the situation, and
group interaction, the group process suffer guilt, or something akin to this.
becomes stalled, and aside from some Their reliance on professionals for help is,
catharsis allowed the parent, very little it would seem, a tacit admission on their
that is basic is accomplished.
part, unconscious though it may be, that
they have failed in their role of parents.
If the therapist realizes, however, that
Being placed in the role of refer-ee
there is a fundamental attribute common
emphasizes this feeling.
to all members of the group, he can focus
on this to achieve some kind of group
Now, it is one thing to teach a child
awareness. This attribute is, of course, the the mechanics of solving addition pro-
parent-child relationship. Regardless of blems, and it is another to teach him
whether this relationship is positive or better study habits, to attain a healthier
negative, it exists. By constantly bringing school attitude, and so forth. Similarly it
the discussion to this more broad, more is one thing to teach a child to say "yes
encompassing factor, the therapist can sir," and "no ma'am," and it is another,
escape the series of one-to-one relation-
much more important thing to establish
ships that are in danger of becoming a more meaningful two-way relationship
between parent and child. When presented
with this concept, parents seem more
Parents, at least unsophisticated ones,
ready to enter into a group, as such, and
are usually surprised to find that like
the group process flows more efficiently.
Moliere's character who was amazed to
Prognosis for each individual parent-child
learn he had been speaking prose all his life,
relationship becomes that much more
have a relationship with their
child. And, further, that this is a two-way
relationship. The question "How do you
A similar situation exists with respect
suppose your child feels about that?" In to the second type of non-patient patient
reference to something the parent has said I would like to discuss. This group consists
or done, often brings a silence. When of spouses who refer their marital partners
parents in a group setting are forced to for treatment. When the refer-er is told
think about a more abstract concept (e.g., he (or she) should enter into treatment,
relationship) they begin to recognize either co-jointly or conjointly, the refer-er/
communality with fellow patients in the refer-ee conflict arises. This problem was
group. Also, this tends to reduce the initially brought to my attention when a
feeling that the therapist sees something large influx of requests for marital coun-
"wrong" in them, which in turn lowers selling came to a mental hygiene clinic
with which I had been associated. It was
felt that the wives could be treated in a is unfortunately too easy to slough off
group, but at the time there was no other a mother or wife by listening to her
staff member who felt capable of working complaints, rationalizing by saying she is
with the group of husbands. Accordingly, not the primary person we are dealing with.
the husbands were scheduled for individual
It is most important to realize, and to
share the realisation with the patient, that
The immediate reaction in the wives' he is part of the situation. To facilitate
group was "Why me?" The women felt the treatment process, the unconscious
that they made the referral, they perceived motivation, as alluded to above, should be
the husband as the partner responsible for brought to the patient's level of awareness.
the marital disturbance and yet they, the
The above discussion has centered
"refer-ers" were being seen in therapy. around therapy groups, probably because
Again, group sessions became testimonial fledging therapists face more frustration
hours, and the group process (and con-
in this situation than in the one-to-one
sequently therapeutic progress) was situation afforded by individual therapy. In
the latter type treatment, the patient is
Quite often in supervising therapists, I likely to terminate the therapy programme
have run into this complaint about this himself, taking his child or spouse with
type of group. My reaction, based upon my him. The hour is then open for the next
own experience, is to focus away from patient. With groups, a patient leaves, a
specifics to the more abstract; in this new one enters, and the group goes on.
instance, as with the previous type of The therapist is thus constantly confronted
group already discussed, the problem of with his failures. However, by accepting
relationship (in this case, husband-wife) the non-patient patient as one with a
should be stressed.
relationship problem, by delineating this
When faced with the problem of treating problem, and by looking for unconscious
the non-patient, the therapist must be motivation in the referral, the therapist
aware of the refer-er/refer-ee conflict. This can make the therapy hour meaningful,
conflict exists within the patient, and all and thus enhance the prospects of success-
too often exists within the therapist. It ful treatment of the primary patient.
"Play Therapy", in Rogers, C. Client Centered Therapy,
York, Houghton Miffin Company, p. 239.