Prior to entering the doctoral program at Rutgers and, after I had earned a Masters Degree in Clinical Psychology at Purdue University, I decided to take a year off from academia and see what the “real world” was like. It was here that I learned one of the most valuable lessons in my professional life. I was working for the Narcotics Addiction Control Commission (NACC), known also as the Rockefeller Drug Program, in the early ‘70’s in Yonkers, New York. This was a residential program that housed young male drug addicts. Although many were guilty of crimes, the law had allowed them to “cop” out to–what was at the time referred to–as The Rehab or glorified incarceration. Such amenities as pool tables and a large swimming pool were available for use by the residents.
During my first few weeks at the rehab center, I agreed to sit in on some of the groups run by counselors who were having difficulty controlling the behavior of the residents. I remember one group session lead by a female counselor with a background in social work. The addicts ate her up alive spewing all sorts of four letter expletives in her direction. At the end of the group she was in tears and, she besieged me for advice of which, at the time, I could offer very little. When I sat in on a group run by a black male therapist, I noticed how he had control of the group and, how he would immediately set limits when the residents asked him to do them favors. He treated the addicts with a firm hand, in contrast to the female social worker, who sucked up to their demands and manipulative requests. I likened her lack of control over the addicts’ behavior to that of a substitute teacher in a classroom where the kids are going wild. Addicts, like adolescents out of control, I learned, needed the structure provided by setting firm limits on their behaviors.
When I first started working with the addicts as a group leader, I was like a fish out of water. I had never socialized with anyone like them and, their language and culture were totally alien to me. Fortune came my way when I befriended a black correction officer who came from the same environment as many of the residents, some of whom he knew. He introduced me to the work of two black psychiatrists named, William H. Grier and Price M. Cobbs, authors of Black Rage and The Jesus Bag. From these two books and my friend’s own life experience, I came to understand the derivation of the “dozens,” and how it can be a harmless game of casual, good-natured jibes or an exchange of malicious insults that can be a prelude to physical violence. Later, the 1981 independent movie, The Dozens, depicted this culture most appropriately.
I suggested to my supervisor that this correction officer work with me as a co-leader when I first began to run my own groups. After watching him continuously cut through the manipulative tactics of the residents, within 6 months, I started to engage the residents in what I considered an effective therapeutic style as a group leader. In the beginning of each new group of residents I worked with, they would test me or my colleague with statements like “you don’t care about us, all you want to do is make money,” etc. Because statements like these became so predictable, I developed a standard reply that sounded something like the following: “You’re right I don’t care and in fact, tonight I’m going to eat the biggest rarest steak at the expense of you guys. Thanks guys.” I would say this with a straight face. I recall receiving the ultimate compliment from one of my group members: “He must be an ex dope fiend.”
Ironically, after my colleague and I would make statements implying we did not care about the residents in our groups, the old timers on the unit would convince the newcomers that, in fact, we really wanted to help them overcome their problems. One may label this approach paradoxical therapy but, in actuality, I was doing what Watzlawick et al. have called “speaking the patient’s language” by virtue of the fact that I had begun to use the idiom of the street known as the “dozens.”
To reiterate, I did not learn this approach in a day or a week. It took about six months and, in the beginning, I was verbally pounded by the addicts in my groups, much like the female social worker I had earlier observed. But I had two things working in my favor: 1) The desire to help these young men and 2) The willingness to adapt to a therapeutic style, at first foreign to me that was much more efficacious than what I had learned in my clinical training. This was my first real understanding of how important it was to think in a flexible manner in tailoring one’s therapeutic stance to the language and culture of a given clinical population.
Dr. Bernard F. Natelson 