Integrative Psychotherapy Articles
The Walking Cure
by Joan Adria D’Amico, LCSW, BCD
The following narrative sheds light upon the origins, functions and relational consequences of the obsessive patterns of a man whom I shall call Vincent. His therapy was conducted, on and off, over an 18-year period, beginning when he was 27 years of age. According to the DSM IV-R, his diagnosis would be Obsessive-Compulsive Disorder. The therapy was useful, but largely unremarkable, until the circumstances of the treatment changed...
Vincent was a second generation Italian-American, raised Catholic, second in the birth order of two boys. At the age of 17 he had impregnated his girlfriend and then married her. Economic constraints necessitated his leaving high school and moving into the basement of his parents’ home with his new family. They had a second son three years later.
After treating Vincent on and off for 15 years, I thought that our work had gone as far as it would go. Though his obsessiveness persisted, he had made important changes in his life:
He moved his family out of his parents’ home, into an apartment nearby. Eventually, he managed to buy his own home, an accomplishment of which he was very proud, a considerable driving distance away from his parental home. He completed high school and a year of college. He had started out as a clerk in the mail room of a large corporation, taught himself computer skills, and worked his way into a position teaching other workers those skills. He was able to endure the emotional pain of the sudden deaths of each of his parents...both from heart disease...without serious decompensation.
Though he conquered his premature ejaculation, his wife was still not very interested in his sexual advances. I remember my advice on how to seduce his wife: “Wash the dishes, Vincent; bring dinner home; vacuum! For your wife housework is foreplay.” It worked. Vincent learned foreplay and enjoyed a more willing partner. He was able to stop worrying about whether his wife was more interested in other men than in him.
Nonetheless, Vincent continued more obsessing than the people around him cared to hear. There was no decision that was an easy one, no decision that didn’t require consulting as many people as he could get to listen. When he bought a car, the research seemed endless. You wanted to tell him to BUY ANYTHING...JUST DO IT! Whenever he could, he held people hostage with his review of every possibility, every opportunity, every choice. His preoccupation and distractedness made him largely unavailable for relationship. Anxiety governed his life.
Aside from his engaging sense of humor, one of the main characteristics one noticed about Vincent was the worried look on his face, accompanied by frequent hand-wringing. He was still very much in his own world.
He was a computer addict. When he wasn’t focused on baseball, he was spending his time on the computer. His wife wasn’t happy about that! In occasional marital sessions she brought to my attention all the ways in which the therapy wasn’t successful with Vincent. She wanted him to quit therapy and save the money.
Despite countless attempts at retrieving and working with archaic material, doing productive regression, body work, day-long intensives, group therapy, psychotropic medication (Librium was a staple, sometimes Zoloft), Vincent was....well....Vincent.
He believed that the world was a dangerous and chaotic place. His mother had told him so and had demonstrated it as well. She was a psychotically depressed woman (her diagnosis was verified), as were other members of her family. She would rant and rave, embarrass and scare him. His older brother taunted and humiliated him, with no intervention from his parents.
His father remained passive, silent, uninvolved—ineffectual. To Vincent, father seemed frightened of mother. Vincent needed protection...he needed predictability...he needed contact in relationship. Instead he was being traumatized, and his fear became integral to his way of being in the world.
As a child, Vincent wanted to play baseball, and he had talent. A problem emerged. When he tried to run, his body would not follow his mind’s instructions...it would hesitate. He couldn’t move when he wanted to, an ironic reflection of his young life. At the age of 10 he was diagnosed with Myotonic Dystrophy. Out of shame and the limitations imposed by the muscular disorder, he stopped playing.
He had undiagnosed learning difficulties, and couldn’t read or spell very well...he didn’t get good grades..he thought he was stupid.
He needed refuge. There was none. No way to control the chaos, the fear and dread, the powerlessness. There was no escape, except into his mind.
By the age of 42, Vincent needed quadruple by-pass surgery. He had inherited the family atherosclerosis. Post-surgery, he was afraid to attend the cardiac rehabilitation program recommended by his cardiologist, fearing that he would die while exercising. I watched him gain weight. When he mentioned that he’d had pork roast for dinner, I announced that I was no longer willing to sit in my office with him-------I told him to bring his walking shoes.
For the next 3 years, rain or shine, we walked the neighborhood for our sessions. At first, he would pull out his usual laundry list of obsessional topics. He was afraid to walk near the road, so he’d walk inside and I’d protectively walk on the outside. He feared every dog we passed, even the ones who were fenced in. Vincent had his own dog, but was afraid of strange, unpredictable dogs. He had an intense fear of snakes. Not something that limits your life in suburbia - or so I thought.
I found that I had less tolerance to listen to his anxious recitations in the beautiful outdoors, even though I had long ago developed the habit of limiting the time he was “allowed” to obsess in a session. While we were walking, my attention would drift... I would interrupt him to show him a beautiful flower or tree. He’d quickly look at it and resume talking. And could he talk!
One day, as we walked, he announced: “I haven’t done this since I was a small child.” I asked what he meant. He explained that he hadn’t walked out-of-doors! His wife and sons had tried to get him to walk with them, but he’d always refused...he had so many excuses, so many hidden fears. His way of living had become “normal” to him.
While we walked Vincent talked about his current life and his childhood, but in a new way. He had a heartfelt connection to his life experiences that even he was surprised by. After a few months of our walking sessions, HE started to interrupt ME to point out beautiful flowers, trees and vistas. One day, to my utter amazement, he agreed to walk out on a narrow low-lying concrete dam into the midst of the serenity of a small river. We had our session in a reflecting pool of autumnal color. We both still remember that day.
Now I felt a mutuality that was only possible because he was coming out of his chrysalis. We were walking and talking WITH each other...there was an IN-BETWEEN space, rather than the alternating talking that was his familiar pattern. (I’d be talking, he’d be thinking of the next thing he was going to say.)
I feel a tender remembrance now as I reflect on our walks. Vincent became a more involved partner to his wife and father to his children. The family moved to Florida, a very out-of-doors state, where his wife had wanted to move for several years. Vincent now spends much of his leisure time riding his bicycle, swimming, walking. He reports a much happier and fuller life, despite major life issues that are out of his control, like the diagnosis of schizophrenia of one of his sons...a major league baseball player.
An ironic addendum to the story. On one of our walks, a 5-foot black river snake crossed our path. I’ve hiked in the wilderness, and never seen a snake of that size outside of a zoo. Vincent grabbed me in panic, looking at me incredulously, searching my eyes (for fear, I assumed). I asked him “Please, don’t scare the snake!”. We then simply moved on, continuing our session.
What was curative about walking as part of the treatment?
- My willingness to leave the comfort of my office and do something different and unconventional with him, in order to help him past his fears of cardiovascular exercise.
- Providing him an opportunity to share a bit of my unafraid experience of the outside world, from the vantage point of relational safety.
- Desensitization of his fears and phobias.
- His brave willingness, based upon the trust we had established, to leave the safety of the holding environment of the office and feel the success of taking that risk.
- Bilateral movement and its effects on his brain structure and chemistry.
- Providing an alternate experience of himself, amidst his experience of the world as a dangerous place, allowing him to go beyond his constraints.
- His body having a chance to "remember"some early life experiences of mobility.
- Providing the missing parental function of safety-making, thereby allowing him to let go of his "self-created parent"—an important function of his rumination.
What impact did walking have upon me and my treatment of him?
- Feeling freer and less of a "hostage" to the control that his obsessive rumination exerted in sessions, and increasing my enjoyment of the treatment.
- Greater awareness of and compassion for his suffering and limitations.
- The effects of bilateral movement on my brain, possibly allowing me more creativity and clarity.
- My greater appreciation of rhythmic attunement, necessitated by our adjusting our pace to one another.
- The satisfaction of making a greater impact upon him and feeling more therapeutically successful.
I used this paper in a group I supervise, in order to stimulate discussion about thetreatment of obsession. I chose the name "Vincent" for this man, as an homage to a friend, Vince, who unexpectedly died in his sleep of heart failure. One of the therapists suggested that I consider the possible deeper meaning of my choice of name for the patient. I came to realize that my feelings for my patient resonated with my love and caring for my friend in an important way. "Vincent" continues to have the opportunity to enjoy his life, unlike Vince, who didn’t have an equivalent luxury of time to enjoy his newly-found happiness. For me, his was a life interrupted...a poignancy I still mourn (among many others). To be able to help "Vincent" open the vistas of his life was profoundly gratifying for me---I made a larger impact than I could’ve imagined for him to live better and longer– what I’d wished possible for Vince.
Another supervisee asked what personal growth I might have experienced in the process of writing about the treatment. It was only in the reflection necessitated by the writing that I realized the scope of what my patient and I had shared and the import of the change in the existential "compass" we co-created. I wondered how often, in a busy work life, I’d failed to appreciate the possibly greater depths of treatment outcomes, successful or not.
Taking the suggestions of my supervisees had a beneficial effect upon them. We were excited by our lively and contactful collegial exchange. As they watched me take notes on their comments, they felt especially honored by my gratitude, making an impact upon my work in such a palpable way....in effect, to supervise me. I was able to surmount my concern that I was taking "their time" for myself..."violating" our contractual boundaries. Retrospectively, silly concerns of mine!
In the earlier years of the treatment I had come to assume that "Vincent’s" obsessive/compulsive style was not one amenable to treatment. I’m usually a perennial optimist, but in this case I had long ago settled for the limitations of our progress. As may be evident in the telling of the story, my "settling" didn’t preclude my frustration with those limitations. The serendipitous turn that the treatment took has been an important reinforcement of what I already believed.....that miracles are the result of a lot of hard work and we never know when or how we’ll achieve one.
This writing has been therapeutic for me in another, very personal, way. About a year after this treatment ended, I experienced a sudden and catastrophic illness...one which few people are lucky enough to survive. My life has been completely changed by that experience...an ironic parallel with that of my patient and his treatment. I lose and regain my optimism, respect my ignorance, continue wandering and wondering, clearing new brush, without knowing what I will find, often reminding myself that openness to serendipity is the foe of paralyzing fear.
I think it apt to end my musings with a quotation which a friend of mine recently shared with me: "We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." - E.M. Forster