Would you want to consult a therapist who can’t keep a straight face for five minutes, who is often annoying, sometimes rude, and who cheerfully encourages you to keep on doing the things you know are bad for you; in fact, to do them more? It doesn’t sound like the behaviour of your standard therapist, who can usually be relied on for empathy. It sounds more like someone determined to unsettle you. And this is precisely the aim of provocative therapy, an obscure but increasingly popular treatment developed in America in 1963 by Frank Farrelly, a psychiatric social worker and therapist, who is now in his seventies. It’s even used at the chocolate-making company Cadbury’s.
Dana Kidson, 40, a graphic designer from London, weighed 18st 7lb (117kg) and says that she was seriously depressed when she had her first session with Farrelly. “He began with the classic opening, ‘So, what’s the problem?’ When I said something about my weight, he said, ‘Well, I can see you aren’t exactly a poster child for anorexia’. Another comment that stuck was: ‘When the fridge sees you coming, does it rear back in horror?’ That was such a funny image. I think of it whenever I’m tempted to snack.”
Farrelly’s approach sounds brutal, but Kidson says that’s not how it felt. “The comments felt very genial because he was so warm. He had this enormous capacity for finding the laughter. During my five sessions with him, I laughed more than I had the whole of the previous year.”
Most important, the therapy worked. It wasn’t a miracle weight-loss cure, but four years later she’s 4st lighter and feels more in control of her life. “Before the therapy I spent up to five hours a day in the bath and had let go of all responsibility for myself. Straight afterwards I began applying for jobs. A month later I was employed. The depression had gone.”
Provocative therapists such as Farrelly combine reverse psychology — saying the opposite of what they mean — with humour, in the hope of changing people’s behaviour, says Brian Kaplan, who, with Phil Jeremiah, a psychiatric social worker, founded the British Institute of Provocative Therapy in 1998. Kaplan, who calls himself a holistic doctor, estimates that there are about 20 provocative therapists in the UK.
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Jeremiah, who has worked as stress consultant at Cadbury’s for 14 years, in addition to his practice, uses a combination of techniques, but regards provocative therapy as an invaluable tool. “I use it with 99.9 per cent of people. I always explain it first so no one is caught unawares.” Dr Paul Kanus, Cadbury’s occupational health adviser, says Jeremiah achieves such remarkable results that he has become an indispensable resource for the company’s 3,000 Birmingham employees.
So how does it work? Kaplan explains that by siding with your “bad” or self-defeating behaviour, the therapist forces you into the position of the one who knows what’s best and is determined to act on it. “He refuses to let you get comfortable with your problem. Because it’s about changing behaviour, not about discovering the underlying feelings, it can produce fast results. Provocative therapy doesn’t replace all other forms of psychotherapy because some people are going to need a long-term relationship with a therapist, but it’s a powerful tool,” he says.
Andrew Sikorski is an East Sussex GP who incorporates provocative therapy into his NHS practice. “I worked with a diabetic patient who hated taking her medication. I suggested that she stand in front of the loo every morning, hold her tablet up high, ritually drop it into the loo and flush it away to demonstrate her contempt for the filthy medical profession and its drugs,” he says. “She did it a couple of times, then thought, ‘I might as well take the thing.’ She’s taken them regularly ever since.”
Dr Sikorski points to the paradox that the provocative-therapy patient often feels warm and cared for while their unwanted behaviour is being addressed, whereas to the onlooker the therapist appears sarcastic. “The secret lies in everything being said from a loving perspective.”
Three years ago, Stephen Miller, a specialist in internal medicine in San Diego, California, began using provocative therapy regularly in his private consulting practice. Since then, he says, “patient compliance” in disease prevention, treatment and rehabilitation has soared from about 30 per cent to about 80 per cent. A patient who can’t be bothered to finish his course of antibiotics might now get a response from Miller along the lines of, “That’s OK.
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When you come back and aren’t better we can put you in the hospital and use intravenous antibiotics, which is much easier. You just lie there and have wonderful food. You don’t have to worry about pills or setting alarms to remind you. We’ll do that for you.”
Miller says: “A positive clinical outcome must always be in the forefront of my mind.” “You never attack the person — that’s an absolute no-no — but you do lampoon their behaviour by reflecting the absurdity of it back to them. In doing so, you force them to take ownership of the problem and then prescribe the solution to you.”
Kaplan uses provocative therapy with the majority of his patients. He has treated a wide range of problems with this combination of reverse psychology and humour, including smoking, alcohol, relationship difficulties, low selfesteem, fear of flying, obsessive cleanliness and even anorexia. He also works with couples. “Your words attack the behaviour, never the patient. Because you work with an open heart and a twinkle in your eye, and surround the patient with love and caring, they ‘re left in no doubt that you have a positive outcome in mind.”
Five years ago Linda Seaton, 56, a PR consultant in Surrey, drank heavily to blot out her feelings and was constantly short of money because she put everybody else’s needs before her own. “If my car broke down, I couldn’t get the motivation to get it fixed; yet if somebody else’s broke down, I’d be on the phone arranging to get it to a garage. I was getting through at least a bottle of wine a day. Sometimes I’d start as early as 12.30pm, if something was upsetting or worrying me,” Seaton says. “My problem was I’d become accustomed to being downtrodden.”
A turning point, she says, was when Kaplan, her doctor, said to her: “I don’t know why you don’t drink more. If I had a life like yours, I’d drink two bottles a day.” She recalls: “I was stung. I thought, ‘My life isn’t that bad’. But then I thought, ‘Well, it needn’t be, if I do something to sort it out’. His words pulled me up sharply. When he said to me, ‘So, you’re proud to be downtrodden ‘, it was another thunderbolt. I felt cross, but then I thought, ‘Well, he’s right. I’m so used to it, it’s true that I am almost proud of it.’ Although these were tough words and I felt provoked by them, there was so much humour, gentleness and caring in his approach that I never felt teased or bullied.”
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Seaton says that her life was transformed by the sheer honesty of this encounter. Now she drinks only socially. “My finances are stable because I put my own needs first, which frees up energy for work. I’m even back at the gym.”
How to be provocative
DOCTORS, nurses, psychologists and social workers can all learn to provoke patients in only six days, at courses run by the British Institute of Provocative Therapy, in Central London. The institute promises to teach practitioners to use laughter and fun to reach patients who previously had been resistant to all other known types of therapy.
www.provocativetherapy.co.uk