A PIMPLE ON THE FOREHEAD

For two years a twelve-year-old boy had been picking at a sore, a pimple, on his forehead, and it had become a continuous ulcer. His father and mother had resorted to all manner of punishment to keep him from picking at the sore. His schoolteachers and his schoolmates had tried to reform him. Medical doctors had explained about cancer, had bandaged and taped the sore, and had done what they could to keep him from touching it. The boy would reach up under the adhesive tape and pick at it. He explained.

that he just could not control the impulse.

The boy's mother and father did what they could to stop the

boy from picking at the sore, but they disagreed on the value of punishment. The father had gone to extremes, depriving the boy of any number of toys; he had sold the boy's bicycle and had broken his bow and arrow.

Finally the parents brought the boy to me. 1had an interview with the mother to learn something about the family situation so I could pick out something to work with. I learned about the values and obligations in the home, including the fact that the boy did chores. They had a large lawn, which he cared for, and a large garden. I also learned that the mother tended to be on the boy's

side and that the boy was angry with his father for the various punishments, in particular the breaking of his bow and arrow. I also found out that the boy had a spelling problem; when he wrote he tended to leave out letters in words. I like to check on a child's schoolwork to see what is there.

I had an interview with the boy and his father together, and I focused immediately on how ownership is defined. I picked out the bow and arrow as an issue. Whose was it? The father admitted that the bow and arrow belonged to the boy; they were given to him for his birthday. Then I asked how an ulcer should be treated. W e agreed that it should be treated with bandages and medications of various sorts. I asked how would you use a bow and arrow to treat it? How would breaking a bow and arrow be treating an ulcer? The father was very embarrassed, and the son was eying his father with narrowed eyes. After the father had flushed and squirmed quite a bit in this discussion, I turned to the boy and asked him if he did not think he could at least honestly credit his father with good intentions despite his stupid behavior. Both of them had to accept that statement. In this way the boy could call his father's behavior stupid, but to do so he would also have to credit him with being well-intentioned.

Then I asked how much further we should go in discussing medicines that didn't work. Or could we forget about those? I said, "You've had this for two years. All the medicines from breaking the bow and arrow to selling your bicycle didn't work. What shall we do?" The boy had the idea that I should take charge.

I said to him, "All right, I will. But you won't like the way I take charge. Because I'm going to do something that will clear up the ulcer. You won't like it one bit; all you will like is that the ulcer is healed-that you'll really like." I said I wanted him to devote every weekend to curing the ulcer on his forehead-while his father did his weekend chores for him. The boy gave a triumphant glance at me and at his father.

We went over the chores and discussed the mowing and raking of the lawn, cleaning up the dog messes, weeding the garden, and so on. I asked who inspected the lawn when the boy did it. Father inspected his work. I said, "Well, on Saturday, in between working on curing your ulcer, because you can't work on it steadily, you can go out and inspect how your father is doing on your chores."

By this time the boy was quite curious about what he would be doing on the weekend to cure his ulcer, and I began the procedure of digressing. In a slow, aggravating, dragging out, shaggy-dog sort of way, I offered the therapeutic plan. When you do this, a patient leans forward wishing you'd come to the point of the whole thing- he wants to know what on earth he is to do. He credits you with being thoughtful, deliberate in your presentation. He knows you're not going to rush things over on him. He's waiting for you to come to the point, and when you finally do he is motivated to accept the plan.

I said to the boy, "I found out that your spelling is very poor. Your spelling is poor because when you write a word you very likely leave out letters."

Then I said, "I think you ought to start curing your ulcer on Saturday morning at about six o'clock. You know you'll take things much more seriously if you get up early in the morning to do it, because it is serious business. Of course, if it's only five minutes to six, you might as well start then instead of waiting until six o'clock. Or if it's five minutes after six you can start-what's the difference of five minutes?"

Then I went on, "Now, you can write with a pen, or you can write with a pencil. Some pencil leads are colored, but ordinary pencil lead would be all right. You could use pen and ink, or a ball-point pen would do. I supposed ruled paper would be best. I t could be about so wide, or it could be a little wider, about so wide. I think your father could get you some ruled paper that would be just wide enough."

Finally I broke the news to him. I said, "This is the sentence I think you ought to write: 'I do not think it's a good idea to pick

at that sore on my forehead.' I repeated the sentence slowly and carefully and said, "Now, write it slowly, write it neatly, write it carefully. Count each line when you've got it down. Then write the sentence slowly and carefully again. Always check each line and each word, because you wouldn't want to leave out a single letter. You don't want to leave out any of the little parts of healing that take place in an ulcer like that."

I told him I didn't know how long it would take the ulcer to

heal. I felt that since he had had it continuously for two years, it really ought to take a month. He could examine it in the mirror every three or four days to see how it was progressing. Not day by day. That way he would be able to find out when it was healed. He might want to write an extra weekend after it was healed.

He was to start at six o'clock in the morning and have break- fast later. I told his mother privately to be sure to be very dilatory preparing his breakfast so he would get a rest there. Every two hours he was to take a coffee break-which was essentially a fruit- juice or water break. Then he could inspect his father's work on the chores and go back and write. I explained that he would have an aching hand the first forenoon, and what ought he do aboutthat? I pointed out to him that at his break he should open and shut his hand rapidly to relax the muscles. This would increase the fatigue, but it would keep the muscles limber. I said that I felt that after dinner he should really be free of the day's work. In fact, I really didn't care if he quit at four o'clock. By making the quitting time a matter of indifference to me, it takes away the punitiveness.

The boy wrote all day Saturday and Sunday every weekend. I had the most tremendous stack of sheets of ruled paper containing that sentence-all written with pride and enjoyment. His father didn't have to urge him at all, and mother and father were astonished at his pride in his handwriting. The one-thousandth writing of that long sentence was beautifully done. I made it clear that the inspection of his writing belonged to me. If he wanted to show it to his parents, that was all right, but I was inspector. I examined every page. I told him I could take a quick, hasty look at each page, and were there any pages he could recall that I should give more than passing attention to? In that way he absolved me from doing a minute examination.

The more the boy wrote, the more justification he had for inspecting his father's work. The more he wrote, the more accurately he had to write. All the dice were loaded in favor of progress. With this approach, I took his compulsive picking away at the sore and had him compulsively write accurately, something in which he could take a wholesome pride.

The father said, "I knew what I had to do. I did the most beautiful job you could ever imagine on that lawn." The boy took such pleasure in discovering a leaf on the lawn. Father got the lawn and garden fixed up thoroughly, the garden fence repaired, all the chores done, and the boy wrote his sentence.

In a month's time the ulcer was healed. A year later there had been no recurrence. That chronic, indolent, horrible ulcer, and yet there wasn't even a scar.

I put that stack of the boy's writing in my case record and asked him how long I should keep it. It would fill one file to the full. He said he thought I might like to keep it for quite a number of months. I asked what I should do with it then. He said, "Oh, it's just wastepaper then."

Taken from: Jay Haley. Uncommon Therapies, page 209. W.W. Norton & Company.