1. The Dutiful Daughter

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Provocative Therapist: So what are we going to fix today?

Zara: (pointing a finger to her side) For about 6 months I have had this pain on my right side. It’s nothing serious, but…

Provocative Therapist: How do you know it’s not serious? How do you know it’s not chronic pancreatitis?

Zara: No, no, no it’s not that. I think…

Provocative Therapist: (interrupting again) But can you be sure? Have you had all the necessary tests? Have you seen the best doctors in the world?

Zara: (her voice slightly more assertive) No, I’m sure it’s nothing organic…

Provocative Therapist: Okay then, if it’s not organic it must be psychosomatic. So tell me exactly who or what is tormenting you to put you through the misery of this pain? And that’s if you are sure it’s not pancreatitis…

Zara: No, no it’s not that… well, my mother, my mother needs me. We talk on the phone. (She explains that her mother is a needy person with whom she talks frequently on the telephone and visits nearly every day. Zara is not married and does not have a partner. Her life as a surgeon is incredibly demanding and it is clear that the stress in Zara’s life is relentless. People can survive a stressful job with a fulfilling domestic life or vice versa. To thrive, one needs both, but stress in both arenas may spell depression, physical illness or both.)

Provocative Therapist: Okay, I get it. You are the Dutiful Daughter! You live according to the 5th commandment, to honour your parents. Your days on this earth will indeed be long. Or at least they will feel long. But tell me: Who else is there in the family?

Zara: My father and my brother.

Provocative Therapist: So can’t your brother take part in the ‘Let’s make mother feel better’ programme?

Zara: Well, he lives in Finland.

Provocative Therapist: And I suppose your father does whatever he can, but it’s never enough?

Zara: No, actually he lives in Cologne.

(She explains that her parents, both aeronautical engineers born in East Berlin, work in separate cities. Not because they don’t get on but…In my mind I now see a picture of an unhappy, demanding mother whose needs can never be satisfied. It cannot be discounted that her husband and son have found good reasons to get as far away from her as possible. So I must explore this – in provocative style of course.)

Provocative Therapist: (Smiling happily in the manner of someone who has just finished a crossword puzzle, but I’m also very consciously projecting a lot of genuine warmth and friendliness towards Zara.) Aha! Now I see it! Everyone has run from this needy, demanding woman, your mother. Everyone except you of course. You could never be so cruel. If you left, your mother would be devastated. Who could she complain to every day? Where could she offload all her unhappiness?

(At this point a glazed look comes into my Zara’s eyes and I know I have provoked a reaction in her. There must be some truth in my speculation about the family dynamic.)

Provocative Therapist: Listen, this is nothing to feel guilty about. While everyone has run from your mother, you have stuck it out and done your duty as a daughter. You should feel proud of yourself! You are saving your mother’s life! So what if you don’t have much of a life yourself… So what if the stress of looking after your mother is giving you a pain in the guts? Nobody could ever accuse you of not being a loving daughter to your mother. And that means everything. You…

Zara: Okay, okay that’s true. I couldn’t leave her, she wouldn’t cope.

Provocative Therapist: You are a true altruist. Do you know what an altruist is?

Zara: I know what you mean. I’m not so wonderful though…

Provocative Therapist: Oh, yes you are! It takes someone like me to see the sacrifices you are making to keep your mother, well I wouldn’t say happy, but at least you keep her away from suicidal depression. Which is more than can be said for your father and brother…Your mother gave you life. You owe everything to her. And if you don’t see to all her needs, then who is going to take care of her. Honour you mother and your father, isn’t that what it says in the Bible?

Zara: But what about my life?

Provocative Therapist: You? You are a good-looking woman in the prime of her life and you’re a doctor! What more do you want? Actually you’re very lucky. But the best thing about you is that you are so unselfish. So many children these days are terribly ungrateful to their parents. You know King Lear by Shakespeare? He said of his daughter, “How sharper than a serpent's tooth it is to have a thankless child” Now your mother could never say that of you!


The consultation itself was highly energised and I was keen to follow the case up. A few months later my medical colleague in Berlin telephoned me and congratulated me on a ‘brilliant cure’. The patient’s abdominal pain had completely disappeared. I checked a year later and it had not returned. It is now 4 years since the interview and my colleague who knows the patient assures me that his patient is alive and well and has no pain. I understand that her relationship with her mother has improved as well.