a colleague refers a graduate student for psychotherapy. carlos, he says, has been anxious since some legal difficulties, but he’s bright, articulate, and eager for help. legal difficulties? my friend says he’ll let carlos explain them, but don’t worry; he’s not dangerous.
in my office, i take a broad history, then i ask his main concerns. carlos speaks of his alienation from friends. he hesitates to tell them all of his difficulties. why? he doesn’t want to burden them; he’s not sure how they will react. finally, i check if i'm being asked for something different from (or in addition to) therapy: one more thing, carlos, before we decide whether to work together, i want us to be clear. are you here for therapy or do you need some kind of evaluation from me (some kind of letter for the court or for school) or both? “no, thanks for asking,” he responds, “just therapy. i’ve got the other covered with the deans and the attorneys.”
we meet for about 10 weeks. he is punctual, cordial, and respectful, but very limited in what he will talk about. he starts off abstract: “i think what’s going on is…” often he is also speculative: “i think maybe what’s going on is…” i ask for concrete anecdotes; if i am persistent, he obliges... a bit. every few weeks, i ask if he’ll tell me what happened to get him in trouble with the law. at first he is evasive, “well, that’s a tough question.” when he finally says, “i’m not ready yet for that question,” i’m thankful for small favors.
10 times a session i ask him please to speak up. i move my chair closer. i ask him please not to cover his mouth with his hand. i miss entire sentences. i try talking out the issue with him: carlos, you sure speak softly; i can hardly hear you. “yeah, i do that.” with everyone or just with me? “with almost everyone, i think. not just with you." he tries my patience. i try talking this issue out directly: carlos, are we getting anywhere? i don’t feel like i’m offering you anything. you sure you want to come in? “yes, definitely. it’s getting better. i think it’ll just take some time to trust.”
one day, he notes that the judge needs a letter from me saying that he has been coming to therapy. i am taken aback. hey, i asked you in the first session if you needed something from me for the court and you said no. “yeah, i remember.” what’s up with that?! “i guess, i didn’t think you’d see me if i told you i had an ulterior motive.” maybe, but don’t i get to decide that? “yeah. i’m sorry.” are you done with the court-required therapy? “no, i have to keep seeing someone.” i’ll write you this letter, but if you’re going to continue with me, i don’t want to waste the time. you need to start talking about things you care about, to start being real. think about it til next week. i’ll give you the letter, and then we’ll really go forward or stop; whichever you decide. the next week, he asks to go forward. he is still very soft-spoken, but he starts to talk about troubles with his family, and he gives me permission to talk to his attorney, his parents, and his friends.
to be instrumental is literally to interact with another person for an external purpose. “paper or plastic?” asks the whole foods checker. paper. “on the 540, the franchise tax board has started to ask for state tax on your out of state internet purchases,” advises my accountant. bummer; oh well, thanks for telling me. life is full of these instrumental interactions, which are real and valid. we expect instrumental interactions to be civil, but not personal, and certainly not intimate.
when we call another person’s stance "instrumental," though, we usually mean something else: we mean unexpectedly or excessively instrumental. i am not troubled that carlos needed a letter from the court. i am troubled that he deceived me. further, i am troubled that, as a result, we wasted weeks of meeting time.
we intituitively expect a natural balance of instrumentality and intimacy in relationship. a woman expects that her match.com date will have some interest in sleeping her. she will even likely be disappointed if he’s not at all turned on by her. but we often hear, “all he wanted was sex” if the date was too instrumental. in her 30s, another woman, rather wealthy, is worried that guys are after her money. she lives in a modest apartment, drives an unassuming car. she keeps all investment decisions private. someone could be instrumental (too instrumental) with her. john grisham writes in his thriller, the broker,
an old girlfriend…had written for ten months, until it was reported in the washington post that the fbi had decided it was unlikely that joel backman had looted his firm and his clients of the millions that had first been rumored, who wants to be pen pals with a broke lawyer in prison? a wealthy one, maybe.
a man tells me of his summer visit to his parents. he and his sister brought their spouses and kids. for him the low point of the visit occurred at a party the parents hosted for their friends. rather than celebrating the kids and grandchildren, the grandparents had their son and daughter serve the drinks and hors d’oevres. my patient felt demeaned, disregarded, used. too much instrumentality.
therapists can be instrumental too. patients worry – sometimes correctly – that the therapist is primarily focused on making a living. “the man in the suit has just bought a new car on the profit he’s made on your dreams.” ("the low spark of high-heeled boys" by jim capaldi and steve winwood). my mother once advised me not to give up the psychiatrist's term, "patient," in favor of the psychologist's term, "client": "client is a business term," she asserted. "you're a doctor, not a businessman." either the therapist or the patient can give the appearance of exploring the psyche but covertly be focused on seducing the other. academic therapists can be so focused on demonstrating their latest theory that they squeeze their patients into their pet theoretical box. i check myself often to see that my enthusiasm for this weblog stays in the background. i hope i have been successful, and i welcome my patients' guidance.
any sort of excess or covert instrumentality can get in the way of therapy. is the patient there to placate his wife, to get a disability letter, to keep a large allowance from his folks, to stay out of jail, to meet a grad school requirement? any of these can distract from psychotherapy. the patient can be satisfied just to show up. the resentment of coming under duress can turn into spite towards the process. when possible, i screen out such patients. when i discovered that carlos had deceived me, i chose another tack: could we talk about instrumentality. he was willing. he admitted his ulterior motive and apologized.
small amounts of instrumentality are universal: – a bit of wanting to earn a living, a bit of wanting to be taken care of, a bit of seduction, a bit of ambition, a bit of deception. instrumentality occurs in the therapy session and in the patient's outside relationships; there are parallels to be made. treated with equanimity, instrumentality becomes another interpersonal theme, just as interesting and valuable to examine as disapproval, complaining, excuses. revealing instrumentality is practicing confiding. challenging ulterior motives is practicing constructive assertiveness.
if there is a natural small amount of instrumentality – then there will not only examples of too much instrumentality but also examples of too little: a woman distances her boyfriend when he does not want to commit. she stops being lovers but continues to meet and go places with him. they go to a wedding together. she asks what he liked about it, and he responds, “it was short.” i ask what she said next. “nothing.” i have been encouraging her to be more assertive in many areas of life. here, i offer, (if you still want him and if you’re going to keep going out with him) you invited him to think about weddings; don’t give up so easily. ask what kind of wedding he could imagine that might be fun. transparently instrumental? yes, but, it seems to me, she can use a bit more of that.
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