Clinical Techniques: #2 - Commands

Clinical Techniques: #2 - Commands

Dr. Hyman Spotnitz (1985, p.255) says that “(t)he preferred intervention when the treatment gets under way is the command.” In spite of this, the use of the command as part of our clinical armamentarium could be said to be even more frequently “overlooked” than the use of our first-mentioned clinical technique, silence.

Why is this?

First, ideally modern psychoanalysis is a patient-centered, patient-driven approach to therapy. (See e.g., Fennessy, 2008). This infers that the therapist does not attempt to direct the patient in the same way as s/he might in other therapies.

Beyond that, it must be mentioned that many of the applicants for candidacy in modern analytic programs start out with personalities that aren’t easily adapted to the idea of giving patients direct orders or commands; quite the contrary. The ability to use or develop divergent clinical techniques (such as commands) may, therefore, depend on the quality of training received in the psychoanalytic institute.

Luckily for some analysts, however, in modern psychoanalysis

“… (c)ommands are not issued to secure obedience;” instead:

“(t)he therapist’s intent … is to find out whether the patient wants to obey or defy and to help him communicate why he wants to do so – in other words, to mobilize resistance and, eventually, to resolve it.” (Spotnitz, 1985, p. 255).

According to Spotnitz, commands may be as simple as ordering the patient to “(l)ie on the couch and talk,” or they may be effectively “formulated in terms of the patient’s resistive attitude…,” for example:

“The patient may say… that he is not going to talk any more. A reminder that he is supposed to talk tends to intensify the resistance of a negatively suggestible person, but if he is told, ‘You’ve talked too much. Keep quiet for the rest of the session,’ he may reply, ‘I will not’ – and continue talking.” (1985, p. 255).

Notice that when we use the term “resistance” in modern psychoanalysis we are normally referring to “anything that interferes with talking.”

Robert J. Marshall refers to commands, such as those used in the last example, as

“… prescribing the resistance in that the therapist literally orders the patient to exercise resistance. Prescribing the resistance may be best used with negatively suggestible persons. These are persons whose characterologic mode of response is ‘No.’” (1982, p. 69).

Marshall (1982, pp. 69-70) then gives the following case involving his patient, Sam, a 10-year old boy:

“He began a series of resistances after announcing that he wasn’t going to say anything more about his life. When he reiterated his unwillingness to talk, I said (in essence), ‘Sam, you’ve really told me a tremendous amount about yourself in a short period of time. I think you deserve a vacation in talking about yourself. So now tell me what kinds of things you can do in order to avoid talking about your life.’ I also indicated to him that I thought he was an ‘expert’ in thinking up ways of avoiding talk. I enjoined him to tell me any conceivable ways of avoiding talk so that I might recognize those ways with other children. He readily revealed all of his ploys… At this point I suggested to him that there probably were good reasons for his not wanting to talk, that he should really talk if he wanted to be helped, but that it was okay if he didn’t talk. Sam then ventured some complaints and feelings about his parents about which he felt guilty.”

This excellent example shows that commands may thus be used as part of joining the patient’s resistance. (“Joining” as a clinical technique will be separately discussed in a later article).

Marshall also used “requests” similar to commands to great effect with a 13-year old boy named Bill, who appeared to be the polar opposite of Sam – Bill was extremely anxious to please his therapist. Over a period of weeks, Marshall confronted Bill “…with a series of unreasonable requests such as bringing me a ham and cheese sandwich for lunch,” until Bill was finally able to object and later “became more comfortable in revealing his rage…” towards his dictatorial therapist. (1982, p. 65).

Spotnitz indicates that commands may be used to help certain patients restore control, to help teach patients to assert themselves, or for patients who cannot tolerate or respond to questions. (1985, pp. 256-57). Likewise,

“Countercommands may be issued. When ordered to do something by a patient, the therapist may say, ‘You do it.’ A patient who commands the therapist to ‘Keep quiet,’ may be told, ‘You keep quiet too.’ ‘Tell me,’ ‘Say it,’ and other brief statements in the imperative mood are often made.” (Spotnitz, 1985, pp. 256).

As with all of our modern psychoanalytic techniques, these interventions are never used haphazardly, but only as part of the treatment plan. Though the technique is simple, the implementation of it is not – it takes a skilled modern analyst to use these techniques in furtherance of “the talking cure.”

References

Fennessy, J. (2008). Narcissism and the Contact Function, in PRACTICE MATTERS, A Journal of Modern Psychoanalytic Treatment Technique (Vol. 2), Philadelphia, PSP.

Marshall, R. (1982). Resistant Interactions: Child, Family, and Psychotherapist, NY, Human Sciences Press.

Spotnitz, H. (1985). Modern Psychoanalysis of the Schizophrenic Patient: Theory of the Technique, Second Edition, NY, Human Sciences Press.


© 2008, James G. Fennessy, M.A., J.D.
Matawan, New Jersey 07747
E-mail: njanalyst@hotmail.com
http://modernpsychoanalysis.org/