In the new film, LOVE & MERCY, one theme is the  relationship between Brian Wilson, of the Beach Boys, and his abusive, controlling ‘psycho’-therapist. What does this have to do with the title of this blog about conjoint treatment- you ask?  I have been playing a role somewhat similar to that of Melinda Ledbetter’s in the film, coming between a psychiatrist and her over-medicated patient. Conjoint therapy is the term used to describe the phenomenon of the simultaneous treatment of a patient in individual therapy and group therapy with two different clinicians. Ormont and Strean (1978) wrote a book on the subject. Their premise is that conjoint therapy works best when the two therapists have a good working relationship. The converse is also true:–if the two therapists do not have a good working relationship then the treatment is negatively effected, or worse; and that’s the connection between the two apparently disparate themes of this blog. The following is an account of a group member whose individual therapist was abusive and controlling and who pulled the patient out of group therapy with me when I dared to question her treatment decisions about our shared patient.
A psychiatrist found me on the internet and referred a seriously disturbed patient of hers for group therapy. I was immediately alarmed when he (I shall call him Robert. All identifying information has been altered to protect confidentiality) came for a consultation dressed in a tee shirt and shorts in the middle of the winter. He spoke in a flat, modulated, affectless, and almost pressured speech. There was a haunted, frightened and vacant look in his eye. He seemed odd. Robert, a middle-aged, bright but very depressed man, told me about his sad and lonely life. Although he had a professional degree, he was unable to work after a series of breakdowns, leaving him emotionally disabled. His social world was extremely limited. He never had a significant other and except for occasional contact with his immediate family,he spent the rest of the time alone. Robert gave off the emotional vibration that kept people at a distance, he spoke haltingly, with great effort and appeared disheveled. After the consultation, I spoke with his psychiatrist and told her that I would work with him in a supportive group and that we should periodically share reports with each other about his progress. When he started group, Robert seemed anxious and aloof. He only spoke when spoken to and when he did, he didn’t make eye contact. Robert was clearly afraid of social interaction; I wondered if I had misjudged the level of his emotional damage. Had I placed an infant in kindergarten? I asked myself. I decided to wait and see. Slowly, he adjusted to the group. Despite his limited presentation, the group accepted and liked him and over time began to actually believe that he was likeable . He grew attached to the members, although he was very guarded and revealed little of his inner life, choosing mostly to respond to the problems of others. Over time, the group became the most, and sometimes, the only social contact of his week. He looked forward to each group session. One night, he informed the group that his psychiatrist had him on many different psychotropic medications per day. The group was in shock and was critical of the psychiatrist’s judgment. I too was alarmed, and wondered if he had been over-medicated; could that then account, at least in part, for his sluggish, enervated and spooky behavior? However, I thought it unwise to disrupt Robert’s idealized view of her. After all, she had been the only constant in his life for years. I protected their bond and downplayed the group’s alarm. At the same time, Robert was leery of me and was suspicious of my motives. I mirrored his aloofness when speaking to him, neither praising nor criticizing him but I showed great interest in his suspicions of me. I encouraged him to elaborate on what he thought were my motives. I believed that part of his difficulty was his fear of his own aggression. He told of living under the domination of a wealthy, dictatorial and abusive father. The mother was too child-like to protect Robert from the father’s rages. Robert protected his parents from his fury and turned all the aggression back onto himself. He often compared me to his father. My tack with him was to subtly encourage his verbalizing negative feelings toward me. Slowly he showed improvement until one night when he came to group in a panic. His psychiatrist told him that he should join a dating website. I said nothing but the group was incredulous. Robert was light years away from dating. I thought to myself that his psychiatrist’s judgment was way off. After that group session, Robert called me and asked if he could have an individual session. I asked if he had talked to his psychiatrist about seeing me individually. He said yes and that she was okay with it; so we met.