Tuesday, June 29, 2010

The Cab Driver Story: Single Session Psychotherapy

Another story came out of the APA conference that Dinah wanted me to blog about.

I was in a cab going to pick up Dinah for dinner. The cab driver found out I was a psychiatrist so he told me about his life-changing experience with therapy. At one time he was having an incredible problem with his life. He was using cocaine, couldn't keep a job and his relationships were going down the tubes. Therapy helped him quit cocaine and change all that. (Which was good, since he was the driver of my cab. I really wanted him not to be high or in distress.) This kind of turn-around story isn't unusual for me; parolees will often come back and tell me about things they've done in free society that they're proud of.

The unusual part of this story is the fact that he made all of these changes after a single one hour session.

OK, that got my attention. What was it about this therapist?? What happened in the session?? I had to ask all the questions.

The cab driver told me that it wasn't so much what the therapist said, but rather who she was. She was a kindly, older woman who was sincere and compassionate. She told him he needed to start taking care of himself, eat better, get enough sleep, etc etc.

And that worked. Geez, I was impressed. It changed his life. The last remaining habit he wanted to fix was his smoking. He wanted to go back and see his therapist again, but she had retired. He was sorry he couldn't go back, and so was I.

That's my cab driver story.


Wait, says Dinah (who added the pic and subtitle): you told it in a more dramatic fashion at the time. He was running 8 miles a day now. There was a religious/spiritual component, something profound about the experience and about the therapist. Oy...we'll never make a novelist of you, Clink.


The Shrink said...

Uncharitable though it may be, my first thought wouldn't be about the therapist being ace. I don't think we're that brilliant, in mental health, that psychological intervention can cure someone in an hour who's got longstanding significant problems.

I think they can be cured in an hour, but I think most of effecting change comes from the patient, not the therapist.

Otherwise, why'd that therapist not cured half a dozen people a day, every day, week after week, and through her career cured the entire town of all woe?

Sadly I think the mechanism for change lies more within the patient than in wondrous therapists, we're simply not that good and it'd be an act of enormous hubris to contend otherwise.

The cycle of change model would suggest he was in the 3rd stage, "Preparation or Determination" and as such was highly motivated to, "intend to take action in the next month."

I'd suggest that the therapist was a valuable, necessary, adept catalyst for this. But the therapist facilitated what the patient had already socialised himself towards the idea of, and advanced his acceptance of change and aspiration to act. So the patient had done most of the work, the therapist helped with the final step.

Which, then unsurprisingly, took but an hour.

moviedoc said...

He changed his life because he quit cocaine. This is not unusual in working in addiction/recovery. Agree with The Shrink, the psychotherapist may have been a catalyst. The light bulb has to want to change.

Anonymous said...

Me, three. I heard the story and said "He was ready to change." Always nice when they attribute it to the shrink, though!

Sunny CA said...

I could be remembering incorrectly, but I think my psychiatrist said he won't see patients while they are using street drugs. I could be wrong about that, though. I think he said it is impossible to do any meaningful work with a drunk or drug-high patient. Perhaps some mental health professionals would comment on that.

I am also curious about the reported comments of the psychiatrist. Is that the normal approach one would take with a drug addict: "You need to take better care of yourself."? In how many cases would it work? Would the obvious caring attitude of the therapist be a factor? She may have been the only person in that man's life who cared enough about him to express that she would want better for him. Hence I also think that the psychiatrist reached him emotionally and was a contributing factor.

Maggie said...

I was thinking along the same lines as Sunny CA's "She may have been the only person in that man's life who cared enough about him to express that she would want better for him" comment. Simple advice that seems obvious can mean a lot to somebody who has never heard it before.

Dinah-- you added that there was a religious component. Did the therapist suggest he start attending religious services? Involvement in a religion can be a very therapeutic experience, especially for somebody who had previously been feeling as though nothing mattered and nobody cared. Religion could be considered ongoing therapy, even if it wasn't with a mental health professional.

Rach said...

I had a shrink like that. It took 3 1/2 months, but I had a revelation like that.
Yet the shrink I have right now has been working 'on me' for 15 years and still hasn't made that much progress.

I wish it was all as easy as an hour in the chair and that's it.

Sarebear said...

I suspect, though, there may have been something about the therapist that might have been similar to an important person earlier in his life, or something that he really identified with . . . she seemed really nurturing, so that whole mother thing, perhaps seems to be a bit of what was at play . . . for someone who desperately seems to have been needing it, there's my armchair analysys, rofl.

Of course he did the work, but I don't think the therapist had NOTHING to do with it, either, or he wouldn't still be remembering it, to this day; he wouldn't still be telling the story, and it wouldn't still be important to him, and it wouldn't have been something he'dve held on to during the hard times of getting clean, which it sounds like the memory of that session WAS something positive he held on to while he got clean thereafter.

So I'd not minimize how important that session and what the therapist did for him, was, since he seems to have regarded her, and the therapy, so highly. (all said after having read just the first comment.)

Dr. Psychobabble said...

Fabulous story. Reminds me of somewhat opposite experience that I had: http://www.islandmedstudent.com/home/2010/03/26/taxi-driver/