Engage the enemy in therapy.

I have talked before about certain treatment strategies that I do with things like panic attacks and eating disorders.

If a person presents with panic attacks I will at some point ask them to have a panic attack there in the session with me. Some look at me in disbelief, state that they came here to stop having panic attacks and refuse but most will go through with it and produce the panic to varying degrees.

Others who may be bulimic I will get them to make a homework contract to throw up at least once this week. If their purging is not a physically harmful levels that is.

In the past I have tried to explain the theory behind this and never really felt that I have explained it adequately. I have not been satisfied with my explanation. The other day I was relaxing in front of the TV, surfing the channels with my remote and I happened on an interview with Mel Brooks.

He talked about a number of things including the parody that he does of Adolf Hitler in one of his comic sketches called the Hitler Rap.

This has caused quite a controversy as some argue that making fun of Hitler trivialises what he did to the Jews in the second world war. As he explained why he did such a parody I realized he was explaining exactly why I ask the panic attack sufferer to have a panic attack. There he was saying precisely why I do what I do.

If one gets to know thy enemy and engage thy foe then it disempowers them. If one only ever addresses the topic of Hitler in very sombre and serious ways then that is making him to be more important. To engage Hitler in a funny way reduces his impact and importance was the basis of Mel Brooks’ argument.

When a client comes to therapy the first thing they do with the therapist is spend a great deal of time and energy defining the problem, discussing its causes, seeking to stop it, remove it, side step it and so forth. All this focus on the problem in one way empowers it. It makes it even more important in the person’s mind.

Hence I suggest the client at times engage the foe and produce a panic attack, or for the bulimic to go and purge. Panic attacks come and panic attacks go, nobody has ever gone crazy or died from a panic attack, throwing up is throwing up, not the end of the world. It disempowers the enemy (the symptom). It is not something of great awe and immensity.

The other point that is different from Mel’s parodies is that it also defines the therapeutic relationship. If I as the therapist also hold the problem in great awe and dread, such that it must be avoided at all costs, then the client has the therapist and the therapeutic relationship confirming the belief in the power of thy enemy. If I suggest to the client they go and do purging homework they see that I am not overawed by it.

I certainly understand that it is a painful problem for the individual and empathise with that but it does not fill me with fear and dread. This will also have a disempowering effect of the problem in the client’s mind. Hence my rule of thumb about treating eating disorders, never spend more than 50% of any session discussing food, weight, eating and so forth. Talk about other non food related matters.

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