Unconscious Role-induction: Implications for Psychotherapy

Abstract

<p>An apparently healthy 34-year-old man with a 2-year-old daughter is suddenly stricken with cardiac symptoms and requires triple bypass surgery. At home, the father has been asked to hold a heart shaped pillow to his chest as part of his recovery. His daughter comes to his room each morning to ask caringly if he is holding his “heart” as he should. She leads him to her room (the hospital), where she “professionally” pretends to take his blood pressure and pulse. For several weeks, as part of the daily routine, she insistently asks, “Daddy, did you take your pills?” He says to himself (and to anyone who would listen) “If I were alone, I would have become depressed. With my daughter, how could I get depressed?”</p> <h4>ABOUT THE AUTHORS</h4> <p>Bernard D. Beitman, MD, is Professor and Chair, Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri. George I. Viamontes, MD, PhD, is Regional Medical Director, United Behavioral Health Inc., St. Louis, MO, and Assistant Clinical Professor, Department of Psychiatry, University of Missouri-Columbia, Columbia, MO.</p> <p>Address correspondence to: Bernard D. Beitman, MD; Department of Psychiatry, University of Missouri-Columbia, Three Hospital Drive, Columbia, MO 65201; fax 573-884-5936; or email <a href="mailto:beitmanb@health.missouri.edu">beitmanb@health.missouri.edu</a>.</p> <p>The authors disclosed no relevant financial relationships.</p> <p>The authors wish to thank the following people for their lucid comments on earlier versions of this paper: Georgian Mustata, Joseph Mazza, Jessica Nittler, Glenn Good, and Angela Soth.</p> <h4>EDUCATIONAL OBJECTIVES</h4> <ol> <li>To demonstrate two ideas about the ways in which people attempt to infl uence the responses of others.</li> <li>To analyze how para- and metacommunication present in clinical practice.</li> <li>To identify three alternative therapeutic responses to paracommunication.</li> </ol>