Journal of Family Therapy (1985) 7: 1-8

The brief therapy of a compulsive gambler

George Walker*

Introduction

Brief therapy is a system of psychotherapeutic procedures designed to resolve specific problems or complaints. Great stress is placed on the necessity of constructing therapy anew for each case in a form com- patiblewith the patient’s understanding of their problem and its genesis. The particular power of this approach derives from placing this emphasis on individuality firmly within the context of an interactional theory of problem maintenance and resolution, wherein problems are understood to occur between rather than within individuals.

The case to be reported illustrates these concerns as it does the notion that a therapist’s primary task is to keep everyone involved in the problem in mind; but not necessarily to have them present in the therapy room. A case of marital therapy, achieved through the medium of individual counselling, is presented.

Presentation of the tenets of brief therapy is beyond the scope of this paper. In this matter it would be difficult to better the clarity of presentation of Herr and Weakland (1979) and Fisch et al. (1982).

Case report

Mrs D. telephoned to request an appointment at the instigation of a friend who had recently completed a placement with us as a family therapy trainee. On the telephone she was tearful and uncertain whether her difficulty might be amenable to therapy. Accordingly she was told that such matters are best discussed face to face and offered an appointment, which she subsequently kept.

Received 12 October 1983; revised version received 30 April 1984. * Southmead General Hospital, Westbury-on-Trym, Bristol BSlO 5NB.

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0163-4445/85/010001+ 08$03.00/0 0 1985 The Association for Family Therapy

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The first interview

Mrs D. gave the following history.

Eighteen months before, she had set up home with a man, to whom she had now been married for some six months. Until recently all had been well. Her family of origin was of modest means and were frugal folk; his family was entirely different, they were affluent and given to extravagance.

She had known all along that he gambled but had not thought it more than an occasional flutter prompted by his family connections with various stables. When her husband lost his job he had taken to passing his time between interviews with a wide circle of acquaintances, most associated with the turf. About six weeks before she had telephoned, Mrs D. had confronted her husband with her inability to understand their bank statement and was shocked to learn the extent of his indebtedness.

Mr D. had maintained that there was no problem. He wasmerely undergoing an unusually protracted run of bad luck, such as might occasionally beset any successful gambler. He argued that her background had not enabled her to understand such matters and cited as examples his many friends. Some days later he asked his wife for a legacy of a thousand pounds she had received. He wanted stake-money and talked seriously of winning enough to clear his debt. Mrs D was now convinced that he was a compulsive gambler and told him so.

Clarification was sought as to how her husband’s gambling was a problem to her. Aside from the immediate financial considerations the main concern was in her view that their plans to begin a family were now compromised. She was sure that she could never feel comfortable in being financially dependent upon him.

Mrs D. was now questioned about how she had tried to handle this problem. She had persisted in trying to talk the matter out. Initially Mr D had seemed quite dismayed that she had taken it all so much to heart. He had begged her not to worry needlessly, assuring her that he would sort it out. Lately he had turned to making excuses or going out to avoid the inevitable rows. He was, by now, edgy and loth to tell her anything. He had mentioned that had she only handed over the legacy when he had asked he would have increased it seven-fold.

Mrs D.’s next move was to enlist the support of her friend, our ex- trainee, in a surprise confrontation of her husband; the outcome being that Mr D. was told by both women that he should stop gambling. Mr D. felt betrayed, in that his wife had taken the matter outside their relation- ship; moreover, his attitude remained unchanged. Unfortunately his

The brief therapy of a compulsive gambler 3

wife’s next efforts confirmed his view that she was getting matters totally out of proportion. Conscious of her failure to persuade Mr D. to her point of view, Mrs D. now tried to persuade various of his friends and acquaintances to talk some sense into him. However, these individuals were of the same mind as Mr D., they told her not to worry and told Mr D. of her attempts at lobbying. Mr D. was, he told her, hurt and embarrassed by her behaviour. His friends meanwhile closed ranks and would no longer tell her anything. Mrs D.’s final attempt to influence her husband before seeking counselling occurred at the height of a particularly unpleasant row when she announced her intention of leaving him if he did not mend his ways. They both knew this to be an empty threat, and when Mr D. called her bluff she dissolved into tears and professed undying love. Thereafter she had decided to seek counsel.

The discussion then turned to what limits Mrs D. might put on what she was prepared to do to change the situation. She replied that she wanted her marriage to last, that she wanted his children and that she would not leave him. Neither did she wish to usurp that ultimate control of their relationship that she regarded as his, stating that they both shared a traditional view of marriage. In short she wanted her husband to choose to change his ways.

In concluding this first therapeutic hour Mrs D. was asked to try no new ways of handling her problem, rather she was to consider if it might be worth one last try to get him to see sense. She was advised that during therapy she might well be asked to act differently and that this would be easier if she were sure that her own ways of handling the situation were not going to work. Mrs D. was asked to think over several important issues before she next attended. The questions posed for Mrs D.’s consideration were: ‘Could you ever be sure if he were gambling or not?’ and ‘Do you love him enough that you’d be prepared to take temporary control of the relationship - when it is in his best interest that you do?’. As her husband knew of her attendance she was asked to say nothing of our interview until pressed by him to do so, And then to say nothing beyond the vaguest generalities. Mrs D. was invited to return in a fortnight.

Rationale

The conduct of this first interview was determined by the prime tenet of brief therapy: that a problem’s existence is maintained by precisely those measures intended to solve it. Accordingly a behavioural description of the problem was elicited which was interactional in nature. Enquiry was

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then shifted to a consideration of what had been tried to solve the problem. The pattern of interaction revealed was that of symmetrical escalation. Both Mr and Mrs D. had, in turn, intensified their approach in response to each set-back encountered as they sought to change the other’s mind. In their attempts to solve their problem they employed essentially the same approach - that of trying to get the other to see sense by force of argument. Both of them were responding by becoming more confirmed in their own beliefs.

In the practice of brief therapy, intervention is designed so as to disrupt that central theme of which the sufferer’s attempted solutions may be considered variations. This is done so that different action may follow. In order to gain sufficient influence to achieve this, care and attention are given to the understanding that the complainant has of the problem, and to the language used in its description. These expressed beliefs, or positions, are not challenged but respected and used as the foundations of a therapeutic frame of reference designed to facilitate the complainant into potentially therapeutic action.

Thus, working within Mrs D.’s construction of reality, she was encouraged to test the futility of persisting in her efforts to influence her husband. This might also serve to enhance her compliance with any direction offered by the therapist. Similarly she was sympathetically invited to speculate on the extent to which she might ultimately be deceived, in spite of her continued vigilance, in the hope of decreasing her watchfulness. To balance this focus on her lack of influence she was offered, by implication, other means by which she could secure her goal, means contingent upon her ability to take control temporarily of her marital relationship, in her husband’s best interests. The author thought that the idea of taking charge might appeal to Mrs D. as it was what she had been trying unsuccessfully to do.

T h e second interview

Mrs D. began by reporting how her husband, when confronted with her continuing thoughtful mood, had insisted some days later on an account of our talk. She had told him in outline what she had said and he had become angry, told her that he would sort it out, that she ought not to worry and added that counselling was a waste of time, saying ‘. . . they will not change me by talking to you and I do not need help’. She had not sought to change his mind by further discussion and had concluded that she could never know with absolute certainty what he was doing-she had told Mr D. that she had given up as he could always deceive her if he set his mind to it.

The brief therapy of a compulsive gambler 5

Most importantly she had decided that she was prepared to take control temporarily if she were told how. Reply was made that as a preliminary measure there were some things that she might do differently, merely to gain information from the nature of her husband’s response. She was asked to take up a more powerful stance and said that she would. The rest of the session was given over to careful rehearsal of how this might be done.

Intervention

Mrs D. was asked to act as if she really believed Mr D. could not change. Within this general framework a series of encounters with Mr D. were discussed, so as to provide Mrs D. with material to sustain her improvisa- tion. She was asked what she might say or do if she thought him incurable. In each case her husband’s probable reactions were then anticipated and appropriate neutralizing measures rehearsed. Haley (1963) used the term ‘manoeuvre’ for behaviour which calls into question the prevailing definition or form of a relationship.

Having Mrs D. switch her approach from ‘You must change’ to ‘You cannot change’ was envisaged as such a manoeuvre. Since taking this position required her to reverse the central premise of her attempted solutions it was expected to clarify for Mr D. that only he could act to restore their previous happiness.

Mrs D. ’S manoeuvre

For several days following the session Mrs D. maintained a studied thoughtfulness, as if seeking to hide a great sadness behind a brave smile. She denied having been upset by the interview until her husband finally insisted on hearing what had occurred. Mrs D. then dissolved into tears and told him, in a carefully jumbled fashion, the characteristics of a compulsive gambler. These had been carefully constructed as generali- zations derived from his specific actions and attitudes, as reported by his wife. Mrs D. made no accusations as her husband was well able to recognize himself and thereby comprehend her sadness. By the following day he had recovered sufficiently to be righteously indignant that a stranger had caused his wife exactly the kind of distress he had sought to prevent. This anticipated development was countered by Mrs D.’s tearful report of this stranger’s view of her husband’s prognosis. Essentially he was told that regardless of what he might say he would be absolutely unable to change his nature, that try as he might he would

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always return to gambling, probably hiding this with increased subterfuge. His wife then told how she had been asked if she would leave him and how, when she had said that she would not, she had been counselled not to consider starting a family until she had adjusted to the idea of living with constant debt and its attendant difficulties. Mrs D. took up the position that she was unable as yet to contemplate this and tearfully promised to try to come to terms with how the future was going to be. In short she expressed a resigned acceptance of this prognosis whilst making it clear by her manner how profoundly that acceptance upset her.

By her account her husband was by this time beside himself with impotent fury. He took issue with his prognosis and was told that this was apparently a typical reaction; he vowed he would stop immediately and was told that he would not be able to sustain his abstinence. Mrs D. countered each protest until he became speechless and then, with her arms round him, told him that she had thought it through carefully and although it broke her heart she would rather have him this way than not at all.

Mrs D. had maintained her distant and shaken state for about a week when, one evening, her husband discovered a book that had apparently been concealed in haste as he returned home. It was about compulsive gambling and a folded corner marked the page where the characteristics of such individuals were listed. When Mr D. confronted his wife with this find she told him that she wished to understand the nature of his affliction adding that she was awaiting details of a self-help organization for the relatives of gamblers that she intended to join. Some days later Mr D. made arrangements for his wife to monitor all the financial trans- actions. He declared that he had already stopped gambling and she would be able now to be sure that he had; he was adamant that he would never gamble again. Mrs D. said that she would love to believe him and treated him to a sad smile.

Outcome

Mrs D. was next seen some six weeks later, and as far as she then knew her husband had been as good as his word. She reported some difficulty in sustaining her apparent belief in his prognosis. The session was used to rehearse the report which she was to give her husband of the discussion, its essential theme being that it was far too early to tell. The final session some twelve weeks later fell into the same pattern. On this occasion her husband was told that in spite of her report of his achievement she had

The brief therapy of a compulsive gambler 7

been warned that he would definitely relapse and had been told to attend for further counselling when her husband proved the therapist right. Mr D. was told how she had tried but failed to convince her therapist of her husband’s mended .ways, and had finally given him a piece of her mind. By this time Mr D. had obtained employment as a trainee executive for an international company and was throwing himself into his job with all the compulsive zeal that had previously characterized his gambling.

A follow-up interview six months later disclosed the change to have been sustained. This interview occurred at the author’s invitation and Mrs D. reported her husband to be interested to know how her therapist might react to her news. Care was taken to have Mrs D. apparently disappointed by the author’s inflexibility, although she was to tell her husband that to begin with her therapist had looked rather surprised. Mrs D.’s promise to return to therapy, should it prove necessary, was also renewed. Nothing has been heard from her during the year that has since passed.

Discussion

Essentially the practice of brief therapy consists of the formation of hypotheses in relation to maintenance of the presenting problem and the testing of these against the complainant’s reality. Considered from this perspective one’s understanding of a case is manifest only in the attainment of the desired outcome. Accordingly what follows may be regarded as being at best conjectural.

In this case all therapeutic effort was focused on getting Mrs D. to alter radically the nature of her efforts to influence her husband’s behaviour. In taking up the position ‘you cannot change’ all of her previous liabilities became assets. As all his wife’s resistance to his behaviour was removed, Mr D. was left facing the unobscured consequences of his actions. Thus a situation was created whereby Mr D. could choose to stop gambling for his wife’s sake whilst retaining his own beliefs; since altruism requires only the reordering of priorities he was able to set his wife’s happiness above the rights or wrongs of his own conduct. Her change of tactics also allowed Mr D. to maintain his resistance to her understanding and thereby to secure her happiness by ceasing to gamble. Her sustained ‘disbelief allowed his continued ownership of the change he had wrought, against the odds. All of this was possible only because of the regard he bore his wife. In short, stopping the efforts to change his mind allowed him to make the desired change of heart, thereby fulfilling Mrs D.’s criteria for therapy, that he should choose to mend his ways.

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As the issue of Right versus Wrong was removed from the couple’s dispute it was thought best to allow Mr D. to prove the author wrong, firstly to his own satisfaction and eventually to that of his wife. Accordingly a situation was created analogous to that of a wager struck between the author and Mr D. for the stakes of his wife’s happiness. This challenge was understood as respectful of both Mr D.’s personal beliefs and of his ability to change his behaviour if motivated to do so; a challenge to which he might successfully rise. To ensure as lasting an influence as possible the therapist was reported as dogmatically unconvinced to the last.

References

HERR, J. J. and WEAKLAND, J. H. (1979) Counselling Elders and Their Families.

FISCH, R., WEAKLAND, J. H. and SEGAL, L. (1982) The Tactics of Change; Doing

HALEY, J. (1963) Strategies ofPsychotherapy. New York: Grune and Stratton.

New York: Springer.

Therapy Briefly. San Francisco: Jossey-Bass.