Editor’s Column
How Psychotherapy Works – The Sociopath Who Changed
[Everything written below is absolutely true. I’m not a gifted enough writer to make this up, and Frank (his real name) would be offended if I changed it for “protection”. It has taken me 4 years to be able to publish this story, as readers will understand from the epilogue. I hope each of us has a story of this sort. If you do, write it down and let us put it in the IP. I am amazed at the power of therapy – there is no greater elixir for the strains of practice than success where success is simply impossible.]
This is the story of the sociopath who changed. The patient’s name was Frank. He knew I would tell his story and was very pleased about it; perhaps as you read you will understand why.
Frank came to therapy on referral from his physician who was treating him for a clear Intermittent Explosive Disorder - blowing up nearly every day at family, co-workers, everyone in his life. He had no friends and contact was limited as much as possible with others. Immediately he made it quite clear he trusted no one, except to some small extent his 2 young sons. He’d been married for many years and he and wife had a stormy but dedicated relationship. He had been on Tegretol for mood control, which is the treatment of choice for IED. Psychotherapy, particularly anything exploratory or insight-oriented was clearly not indicated, except to try some basic cognitive behavioral control tactics. On that the professional literature seemed quite clear. But Frank would have none of this crap he made clear in his first session. He had tried it with the input of a prior professional and it had been useless.
Frank’s history was of the worst kind. His parents were both severe alcoholics; father supported the family, but much of the money was put into alcohol. Frank’s clearest memory of childhood was his father coming home drunk and chasing Frank around until Frank took refuge in the cornfield near his house. His father would scream for him, but was too drunk to find him. Often however, Frank could not escape and would be savagely beaten. Mother never aided him, and would at times goad father on.
Frank began to fail early in school. He was probably learning disabled but no one knew it. The nuns at school called him lazy and he was in trouble all the time from the age of 8 on, often being told he was going to grow up and be in jail - he was just no damn good. One person befriended Frank as a teenager. He owned the neighborhood grocery and took Frank under his wing, employing Frank and giving him a refuge from home.
Frank recalled that he felt fondly toward the grocer who was always patient with him. One day, at age 17, Frank got drunk and threw a cinder block through the grocery store’s front window. That was what people got for being nice to Frank.
Sociopathy is unanalyzable. Only fools proceed with it. So, Frank and I pressed on.
Frank joined the Army at 18, and went to Germany, where he found drugs of all kinds in huge quantities. He got along with no one in the Army and was given a General Discharge (for severe discipline problems) after c. 1 year. He was furious and felt abandoned by the Army, so came home and began work as a tree climber/trimmer.
He continued to use drugs copiously and to hate simply everyone. He learned to be a great, sneaky criminal. He was arrested several times for nuisance crimes. In response to his arrests, he firebombed and burned the car of a local city’s mayor. When the police confronted him (they couldn’t prove it but knew it was him), his response was to burn the car of the chief of police!
Frank was a sociopath; that was quite clear when I met him. He was crude, rude, foul-mouthed. A stereotypic lumberjack who hated everyone, found people no damn good, and felt no sense of remorse, except when he got mad at his children or wife. Other people? Well, in Frank’s words, “F--- ‘EM”. He was no longer a criminal when we meet, but he was constantly angry and mistrustful and exploded unpredictably and violently. He threw things, and cursed a blue streak. Frank frightened everyone in his world. The secretary where I worked was acutely aware of people and said, “He scares me”. She got nervous every time he came for appointments.
5 years before therapy, Frank gave up illicit substances cold turkey and was vehemently anti-substance use. He was disgusted with all the people who still used; the only people he had once associated with in his life he now despised. He hated anyone who had more than him or worked less hard than he did (this amounted to 99.5 % of the world). NO ONE was to be trusted!
Either because I was too stupid or too naïve to know better, I began to make interpretations about Frank’s anger at me, and point out that perhaps he was wounded beneath his tough facade. I broke every rule I had read about cases like Frank’s. I dared to try empathy with him, and I didn’t retreat from his attacks. However, the literature was clear. Such patients do not change. Sociopathy is unanalyzable. Only fools proceed with it. So, Frank and I pressed on.
Frank continued to blow up. He was sure I was taking his money and trying to cheat him (and told me so often and bluntly); I was just like everyone else in his world, even his family, but he came each week and paid without fail. This work would never succeed, and he would never learn to control his temper, he told me many times. He couldn’t think before he acted. He found my ideas for cognitive delaying ludicrous and stupid. I must be an idiot. I was sure he would quit any time; I feared he was beyond help and unreachable. I wanted to tell him so. I was sure I was a fraud, and he would discover this. But I didn’t say these things. I continued to listen and we explored his pain.
Several months into weekly therapy, Frank came to a session in a horrible mood. On my way to get Frank, the secretary warned me that Frank looked really mad today. His eyes looked like burning coals as I got him from the waiting room. I was afraid, but decided to keep going. It had been a terrible week for him with many blow-ups. He felt angry at the world. He had just had a staring match with a teenager at the local WAWA,ready to hit the kid if the fool dared to speak. The kid walked away silently. He talked in session but was very angry. As the session progressed however, I watched his face change. It was like magic, because I can’t explain how it occurred. His eyes burned less brightly and his face relaxed markedly. After he left, the secretary commented on the marked change - she could see it too! Frank was still too unsure to say it, but he was changing. After many more weeks of work, Frank said he could feel some “small patch of grass growing in the desert”. This was Frank’s own metaphor for his arid, barren and lifeless soul.
Blow-ups did not stop completely, but they became less frequent. Frank got involved with athletic coaching. I was nervous when I first heard this. I feared he would be tyrannical with the kids. BUT, the kids loved him and mobbed Frank every time he was around - parents began to comment on what a great coach Frank was - they wanted their kids on his teams.
Because of his popularity as a coach, Frank was put on the town board that oversaw athletics. Everyone valued his honesty and willingness to speak out. What Frank had always seen as his horrible nastiness was suddenly seen as a real strength. He continued to be very hard on his children, particularly his oldest son, who he feared would become just like Frank if he was not sternly disciplined. He often asked me for input on parenting, carefully listening, but never acknowledging I might be correct. I knew he listened though by his reports in the following weeks about how he handled small problems with the kids. After 2.5 years he began a starter dose of Prozac - he said it made him feel better and his temper was a bit less.
Four stories, all occurring within this later part of our work, define some of the magnitude of Frank’s changes, his character, and our relationship.
- Frank forgot his check for the session one week. He is upset with himself and says he will mail it as soon as he gets home. I assure him I can wait. A few days later the check arrives, and I mail Frank a receipt. At our next session Frank gives me a check for $85.33, to cover the cost of the session and my stamp for mailing his last receipt. Frank rushes out before I can say anything. I quickly grab a penny and rush to his truck - he has over-paid by 1¢, because when I mailed the receipt it was the day before stamps increased a penny in price. I flag him down in his truck and hand him the penny, which he takes with a smile. Our relationship must always be fair we agree.
- In the same session, Frank tells me that he collects broken toys. I notice them in the back of his truck when I give him the penny. He finds these toys during his workday, in garbage piles or by the side of the road or in abandoned woods, takes them and fixes them and keeps them in his truck. His children ask to play with them one day, and Frank says “nope, youse kids (meaning all kids) broke ‘em and threw ‘em away, now you can’t touch ‘em.” I find myself nearly in tears at the meaning of Frank’s broken toy collection - Frank is a broken toy we are fixing, and yet he still can’t let anyone touch him for fear he will break. I choose to keep this one to myself, though my heart nearly breaks for this wounded lumberjack.
- A few months later, Frank leaves a session where we have done good work and we both feel pleased. As he walks out I say to this burly 6 ft + lumberjack “we’ll see you next week, HONEY!” Frank catches what I say, as do I. We are both stunned for a moment. What have I done? I do admire him and my word reflects my tremendous care for him. However, NO ONE calls Frank anything of this sort, not even his wife. I am sure I will never hear the end of this, and Frank will be afraid of me now (I worry he will have a homosexual panic) or will think me so bizarre, losing the respect I have earned. The next session, Frank notes it casualty and moves on. He has not only tolerated this gaffe but taken it in stride - perhaps he even felt the care it conveyed.
- Frank’s father is going to get married again. Frank hates the idea – although his mother’s death several years before has caused him no pain (death after all is not something to make a big deal about; each of us, Frank says, could die at any moment). His father remains an alcoholic who Frank sees c. weekly, and can incite Frank’s anger (though Frank has only now begun to see this trigger). Frank doesn’t know what to do because he doesn’t even want to go to the wedding. While working in a rural area one day, he comes upon a sequestered Buddhist monastery. Frank somehow manages to meet the head monk. Frank tells his life story and about his father’s upcoming wedding, and asks the monk what to do. The monk says he must go and honor his father, despite all that has passed between them. 2 weeks later Frank goes to the wedding and enjoys himself.
Some time after these incidents I suggested perhaps Frank was ready to consider terminating. Therapy was costly to him and he had made huge progress. When I mentioned it, Frank asked if I wanted to get rid of him. The next week he said I caused his stomach to get upset and he felt awful. He wanted to stay, just because “you never know”. I assured Frank he could stay as long as wished in therapy, and that it was up to him when to terminate. I vowed to myself I would not mention it again; Frank could make this decision himself and knew he could leave any time. I silently kicked myself for listening with my ears not my head.
Frank continued to see me every other week. He received a promotion at his work after 20 years and supervised several crews of workers. He was one of the most valued employees of the company - the company sent their worst employees to Frank because he could get them to work. He had a cell phone, pager and company truck, and supervised as many as 80 men at one time in the midst of the worst storms. Frank accepted no praise however, and bristled every time someone told him he did a good job.
Frank was a ladies man. Women involved with athletics loved him – he was handsome and not scary any more and he thrived on the attention all the women gave him; 2 years before however women would not look at him because he was so angry looking. The nuns at his sons’ Catholic school considered him one of the nicest men they knew and the school often turned to him for favors he could do with his tree equipment. His children were ‘A’ students and leaders among their many friends. Frank remained hard on them, but had begun to consider every punishment he gave them - he no longer acted without thinking.
Finally, Frank gained his first male friend, ever. The man was much more successful financially than Frank, and a local politician. He was everything Frank hated a few years before. Many men liked Frank because he was honest and hard working. Frank liked none of them beyond the surface and had never done anything with any of them. Now though, Frank accepted male closeness for the first time ever.
The week before (now 5 years ago) I was to give a professional presentation about Frank’s case, I thanked Frank again for letting me speak about his case. He said something poetic about how we might continue to expand on our success and he hoped the story was not at an end. I couldn’t believe this came from Frank. He told me the percentage of rotten people in the world had dropped from 99.5 % to 97 %. He asked me to tell everyone that he hoped they might learn something from his case, noting that if it helped one other person, he would have served his goal of repaying his debt. I told him he had paid back his debt to society in spades. He said that was a job he would never finish.
Epilogue:
Frank contracted terminal cancer 5 years ago, just after I presented his case as I described it above. I worked with him until the end of his life. It was the most painful therapy I have ever done. Frank believed that his cancer was his final punishment for his life of transgressions. I never agreed and was sure that cruel fate was simply too cold this time. By the end, I think he believed he had done all he could do to redress his past, and felt a bit forgiven. I visited him once, a few days before his death in the hospital. I knew he was dying. He knew too, but we never spoke it. When I left, he walked me outside to my car, though he was hooked up to an IV machine and had a tracheotomy and nothing on but a hospital gown. It was just something he had to do. We gave a warm handshake goodbye – I tried to return a few days later but he had died the night before. His calling hours were the most crowded I have ever attended. Estimates were that 500 people filed past him in the very small funeral parlor – I think his wife expected maybe 50.
I still tear up each time I read this story, so I don’t do so very often. I hope I have explained Frank well enough for readers to understand why. He remains one of the most influential people I have ever known. If he were here he would say “thanks” for reading this far, and ask that we, none of us, ever give up on the “broken toys”. For me, when I begin to despair about our work, I can think of him, the sociopath who changed, and feel strengthened.
