Inviting patients to take responsibility

“Without contraries is no progression…”,  William Blake

Most therapists, counsellors and coaches will agree with the statement that the patient’s taking responsibility for himself and his own behavior is an important goal in therapy. Most will also believe that they all point to the same thing when they use the word “responsibility.” But in this section, I would like to suggest that, when we use the concept of responsibility, we may refer to a wide range of very different meanings. In fact, although we use the same term, we may often refer to virtually opposite experiences.

In different contexts, responsibility may be understood as punishment, guilt, or burden, as certain positive character traits such as maturity or morality, as a role, an obligation, or as controlling or directing/leading. Responsibility may also refer to an experience that has a completely different connotation: free choice and creation. Irvin Yalom wrote: “I use ‘responsibility’ here in a certain sense – the same sense that Sartre used when he wrote that being responsible means being the uncontested author of an event or thing.’” “Responsibility means copyright.” (Yalom, 1980, p. 218) Werner Erhard, the founder of The Forum seminars, wrote: “Responsibility starts with the willingness to acknowledge that you are cause in the matter. It starts with the willingness to deal with a situation from and with the point of view, whether at the moment realized or not, that you are the source of what you are, what you do and what you have… Ultimately, responsibility is a context  –  a context of Self as source  – for the content, i.e., for what is.”

The experience of responsibility as freedom of choice and creation is, in my opinion, one of the most meaningful experiences a person can have on earth. Helping a person to experience responsibility as freedom and creativity is the highest goal of psychotherapy. Psychotherapy that fails in this goal is nothing but another form of taming.

Nonetheless, most of us are unaware of the differences. We don’t realize that when we use the concept of responsibility in certain ways, we imprison and “tame” our patients, our children, our spouses, our colleagues and ourselves. Take for example the teacher who scolds his/her pupil, “You lack responsibility.”* What will a child learn hearing the word in this context? Following this interaction, will he experience himself as possessing greater options of choice? As being more creative? No and no. The word responsibility in this context will constitute a kind of punishment for the child, and the last thing it will encourage him to do is to take responsibility. On the contrary, what he will want to do, following this interaction, is to avoid responsibility like plague.

What about a sentence such as: “The failure of the project is your responsibility,” addressed by a manager to his worker? In this context, responsibility is experienced as guilt. And guilt may lead to a desire to please, or in the worst case, despair.

More positive experiences may arise in the following contexts:

“Leave it to me, it is my responsibility,” or also: ”We trust you one hundred percent and leave you responsible for the project.” Here responsibility is, actually, a synonym for maturity, obligation and leadership.

A seventeen-year-old boy’s father suffers from a severe illness. The boy is by his father’s bed together with his mother, and she breaks down crying. For the first time in his life, he can see his mother collapse in front of him. He says to her, “Go home. I’ll stay here and see to everything.” Intuitively he feels that he must change roles. From now on, he can no longer be a boy; he has to become the responsible adult. This experience changes his life, for better and for worse. He learns from it that he has the abilities that enable him to organize, direct and calm his surroundings, abilities he had no idea he had. They continue to stay with him all his life, even at those moments when he would already like to get rid of them.

But, following this experience, does he feel himself the author of his life? Not really. Life forced him to take on a role. He did not create it.

What does the experience of responsibility as freedom make possible? What allows people to move from experiencing themselves as victims, helpless, stuck or trapped, to experiencing freedom to choose and create? And how can a therapist assist in such a transition?

Responsibility  as freedom involves a quantum leap. It is a transition from first and second level learning to third level learning or transformation. Gregory Bateson, the famous anthropologist and the founder of the systemic approach in family therapy, started dealing with the different levels of learning in an article which he began writing in 1964, published in 1968, but whose last section he only added in 1971. It was not by accident that completing the article took so many years. Even today, the subject is as complex as ever. Learning theories, he explains in the article, describe different types of learning, but do not take note of the fact that these types of learning are at different levels of abstraction. All learning, claims Bateson, occurs within a certain context. And it is the context, rather than the conditions or the type of learning, that determines what kind of learning will ultimately occur. In order to understand profoundly the possibility of experiencing responsibility as freedom to choose and to create, we will review briefly the different levels of learning.

When we try to train a cat not to jump on the dining table, by scolding it, shouting at it or smacking it, we are dealing with what Bateson called “zero learning.” In all probability, the cat will not get on the table when we are there. But when we are not present, it will certainly jump on. The cat does not internalize behavior. This is zero learning. Dogs are capable of more than that.

When a dog, a child or a teenager internalizes the fear of punishment or the desire for a prize, and continues behaving in a “desirable” way from the viewpoint of his owner, parents or teachers, even when they are not around, first level learning or change occurs. Positive and negative enforcement, punishment, conditioning, deterrents, are all tools for first level change and learning. With dogs, this type of learning may last a lifetime. The dog internalizes the rules it was trained to obey, and behaves accordingly from now on, till the end of its life. With children and humans, the story is somewhat different. Although first level change or learning does last slightly longer that zero learning, it does not last forever. As soon as another teacher comes, for example ,or the child gets home to his parents, where there are other rules, the learning or the change ceases.

Now let’s take a child who nags his mother. She says “No”, and apparently refuses to yield to his nagging, but after a while he realizes that if he keeps nagging, in the end she will give in. The child develops a “stubborn” character. He learns that it pays to be insistent. It works. What he has learned becomes his fixed character. It becomes constant. Unchanging. The surrounding conditions do not affect it any more. According to Bateson, this is second level learning.

Here are a few more examples of second degree learning:

– a child who suffers from Attention Deficit Disorder “learns” that he cannot solve certain problems at school because he loses concentration. He “learns” to give up and despair.

–  Louis C.K., in his wonderful comedy Lucky Louie, tries to teach his 4-year-old daughter to apologize for having called him “stupid” by making her take some “time out” in the entrance hall closet.

A few minutes later, when he is ready to let her out of the closet, she refuses to come out. “Okay”, he says, ”you may come out of the closet, if you apologize.” “But I don’t want to come out!” says the little girl. Louis is left helpless. The little girl is in control of the situation now. Not Louis. And what she has learned is to manipulate her parents. From now on, she has a “manipulative” character.

–  Parents complain to me that they never succeed in punishing their child. Every time they try to deny him something he loves, he tells them he doesn’t like that particular thing at all and doesn’t want it anyway. Their punishments have lost their power.

In second level learning or change, the person learns something about the context in which the first level learning takes place. In other words, he learns to observe, consciously or not, the environment, the context in which things happen. He notices signs from the surroundings that his parents, his teachers, or the country in which he lives don’t necessarily want him to learn. In fact, they would rather he did not learn them. What he notices is the discrepancies, the incongruities and the contradictions in the first level learning. He realizes that, in the larger context, whoever wants to teach him something, teaches him, unconsciously, also the opposite. And when he notices the contradiction between the two learnings, the conscious and the unconscious learning, he develops a certain measure of control and ability to manage the situation.

The 17-year-old boy, who began to take responsibility for his father’s illness and his mother’s emotional state, learned something about his context. He understood that while his mother is responsible and grown-up, at the same time she is also broken and desperate. This understanding built in him an aspect of character which was not there before.

Second level learning or change lasts, as mentioned before, much longer than first level learning. With people, second level learning may last their whole lives. In fact, people turn to therapy because they are fed up with their second level learning being so long-lasting, because they are tired of not being able to deactivate it and learn something new.

If in first level learning, there is an understanding of the context, including the contradictions and the discrepancies of zero learning, and in second level learning there is learning of the context, the discrepancies and the contradictions of the first level learning, third level learning demands an understanding of the wider context, the contradictions and the discrepancies in which second level learning occurred or is occurring.

In other words, the importance of third level learning lies in the fact that it frees us from the consistency, the inflexibility, the permanence and the resistance to change characteristic of second level learning.

The experience of third level learning is that of freedom. This is exactly what Sartre is talking about when he says that taking responsibility means understanding that you are the sole creator of your life.

What is it really that can enable a person to experience being the creator of his life?

If a person really wants to feel liberated from his tenacious habits, his character, he has to be able to observe the gaps and contradictions prevalent in the wide context of his learning. The ability to observe the inconsistencies and the contradictions in our own behavior and thinking is a very advanced one. It is a gift that can free us from unwanted habits. For most of us, however, it is experienced as insulting and hurtful. We are not really interested in seeing how full of contradictions and holes the stories we tell ourselves are.

Gurdjieff, the Armenian master active in Russia and France at the beginning of the last century, spoke about this when he described the mechanism he called “buffers”: “We know what buffers on railway carriages are. They are the contrivances which lessen the shock when carriages or trucks strike one another. If there were no buffers the shock of one carriage against another would be very unpleasant and dangerous. Buffers soften the results of these shocks and render them unnoticeable and imperceptible.

“Exactly the same appliances are to be found within man. They are created, not by nature but by man himself, although involuntarily. The cause of their appearance is the existence in man of many contradictions; contradictions of opinions, feelings, sympathies, words, and actions. If a man throughout the whole of his life were to feel all the contradictions that are within him he could not live and act as calmly as he lives and acts now. He would have constant friction, constant unrest. We fail to see how contradictory and hostile the different I’s of our personality are to one another. If a man were to feel all these contradictions he would feel what he really is. He would feel that he is mad. Moreover, a thought such as this deprives a man of self-confidence, weakens his energy, deprives him of ‘self-respect’.” (In Search of the Miraculous, P.D.Ouspensky, A Harvest Book, Harcourt, Inc., pp.154-155)

Most of us only very rarely get a glimpse of the contradictions in our lives. Some of us never do. Most of us don’t even want to see them. Such a glimpse of our contradictions and flaws inconsistencies is frightening. It may produce dread, disgust, shock. But in fact, without the shock, third level learning cannot take place. Teachers from the East always knew this, and used the tool of shocks to help their pupils to take a leap into a new consciousness. Gurdjieff says, “it is only shocks that can lead man out of the state in which he lives, that is, waken him.” (In Search of the Miraculous, P.D.Ouspensky, A Harvest Book, Harcourt, Inc., p. 155)

It is sometimes life itself that gives us the shock. At times, the shock occurs during a trip to a distant country, at a seminar or workshop in which man can see himself in a completely new light. Sometimes good therapy will do the job. What all these have in common is the sudden realization that arises in a person that he is simultaneously both what he thinks he is and the outright opposite.

A student working on his Master’s degree puts off writing his thesis for a whole year. Every time he sits down to write, he finds twenty thousand other things to do instead, and he is simply unable to make any progress.

The young man has a rich record of procrastination. He has already failed several assignments in his studies, and his belief about himself is, undoubtedly, that something is wrong with him. He believes he is unable to concentrate. And he also believes that this has to do with his relationship with his father and with some ambivalence concerning his wanting and not wanting to please his father with a completed thesis.

He has therapy for a whole year and works on his relationship with his father, his fears, the traumas he experienced, and the failures that accompany him. The therapy does not really help him complete his thesis.

He comes to me and I explore a completely different direction with him. I check his relationship with his wife and children. It turns out that throughout the past year (actually for the two years he has been working toward his degree), his wife has been trying her best to make it possible for him to sit and work on his thesis. She leaves the house with their child so that he would be free to study. She works in two jobs, so that he wouldn’t have to work. For two full years, and especially for the past year, his wife has been busy giving him time to study. He doesn’t do anything with this time. He wastes it.

I ask him a number of questions. It is important to understand that the tone of the questions is one of curiosity and interest. The questions are asked out of real interest. Their role is, as mentioned before, to help the patient to see the contradictions in his life and in his beliefs, but the only way he can see them is by honestly looking at himself and becoming curious about what is happening to him.

“What are you punishing your wife for, when you expect her to make time for you, and you don’t use that time?”

 “What do you think gives you the privilege to use her time?”

“Let’s suppose you are really suffering from traumas, failures and a complicated relationship with your father. Why do you think that your wife, rather than you, has to pay this price?”

“I believe you that you are having a hard time, but I wonder how much motivation you really have to start writing your thesis, when your wife lets you goof off like this without paying any price for it?

By such questions, I am asking the patient to observe himself and his relationships from a completely new angle, in a completely new context. It is a wider context, which is different enough from the previous context to enable the patient to observe himself in a fresh and liberating way. So far, his own, his wife’s and his previous therapist’ assumption was that he is suffering terribly from his procrastination and his inability to sit down and write. I arrived at a completely different assumption: that he is also enjoying his procrastination. That he is also enjoying distressing/tormenting his wife. That he is enjoying not taking responsibility. That he is also enjoying the fact that his wife doesn’t demand anything from him. He is enjoying the situation, rather than just suffering from it. More accurately, he is enjoying it more than he is suffering.

There is a contradiction here. These two realities seem to clash with each other. Is this student suffering from his procrastination and his difficulty sitting down to write, or is he also “enjoying” it?

In order to take responsibility for himself, the student has to be able to observe this contradiction. Only such observation can enable him to choose. As long as he does not see this contradiction, he is chained. From the moment he can see it, he becomes free to choose.

My confrontational questions push him to observe his experiences of the last year from a new viewpoint. In this context, he cannot consider himself as a victim of the situation any more. In this new context he sees himself as the author who created the situation. As someone who does not only put off writing his theses, but also chooses to put off the solution to his problem. Maybe because it also serves him well.

When he suddenly sees himself as responsible, as capable and as a creator of his life reality, he doesn’t feel so comfortable with himself. He is ashamed for what he has seen, and chooses immediately, right at that moment, to stop punishing his wife for it all.

He takes responsibility for his difficulty and decides that he, and he only, will pay the price for his procrastination. If he keeps failing to sit down and write his paper, he decides, he will go back to work and earn money for his family, and will not depend on his wife to do the job. In fact, he is putting himself into a positive “double bind”, into a “win-win” situation. He will either succeed in writing his thesis, or he will restore to himself his self-respect by honoring his wife, their relationship and his ability to choose.

It is also important to understand that I could ask these questions only after I have observed the happenings from a systemic point of view, including the patient’s wife and children. If we had only looked at the student’s emotional upheavals and anxieties without observing his relationship with his wife, we wouldn’t have gained a new perspective. Only observation of the whole system makes discovering the contradictions possible.

These questions were asked during our second session. It was also our last one. I did not hear from the student for three months. And I also chose not to call and ask him. After three months he called me and announced that he had finished writing his thesis.

Here are some more examples for such contradictions that the patients noticed in therapy, following this kind of confrontational questions:

  1. A man who used to believe that pushing his wife to have sex with him demonstrated his masculinity, suddenly discovered, to his deep astonishment, how pathetic, childish and not at all manly he actually was in his dependency on his wife to feel manly.
  2. A woman who felt she was a victim of her husband, and controlled by him, for he left all the household jobs to her, suddenly had the unpleasant realization that she was maintaining the situation in order to feel moral, responsible and much superior to him.
  3. A divorced man who had been fighting a long battle with his ex-wife regarding child support and visitation rights, and was convinced that he was doing it for the sake of the children, so that he could see them more, was suddenly shocked to realize that his behavior only made him see them less often, was a burden for them and hurt them. He understood that his behavior was not an act of love.

How does the discovery of contradictions and discrepancies lead to an experience of responsibility out of a free and creative context?

We live in different realities and we do not see the contradiction between them. A woman may complain that her husband  won’t have intimate conversations with her, but is not aware of the fact that with her body language she is rejecting him. As long as she does not see the contradiction, nothing can happen. She feels stuck and has no idea of her own contribution to her being stuck. As long as she does not see the contradiction, she will feel like a victim of her husband, of her situation, or of her “messed-up” childhood.

But as soon as she is willing to look at the contradiction, she sees that her desire exists along with her rejection. At that moment, freedom is born in her.

When we realize that our weakness exists along with our strength, the possibility of choice is created inside us.

The reality of two opposite pictures, of two contradictory stories, simultaneously, alongside each other, opens the consciousness and liberates it. We take a quantum leap, and are given a golden opportunity for a freer and more liberated observation from a higher vantage point.

All of a sudden, the entire picture becomes clearer, and a whole range of new possibilities opens up before us. This is a very unique moment. But in order to experience it, we must give up our “self-respect”, and look at aspects in ourselves which so far we have not wanted to see.

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