#27 – Part 2: Family and Couples Therapist, Author & Teacher Moshe Lang

Podcast: #27 – Part 2: Family and Couples Therapist, Author & Teacher Moshe Lang

Edited and Modified by: Lucianne Grixti (Psychologist) and Lauren Beatty (Psychologist)

Amy Felman: Hi and welcome back to episode 27, part two of We All Wear It Differently. This is the second part of a three-part episode with Australia's most well-known family therapist, Moshe Lang. For more information on Moshe, please see the show notes on the website.

I just wanted to share something with you.  I've been reading Moshe's book, which he co-wrote with his late wife Tesse, ‘Resilience: Timeless stories of a Family Therapist’. It's full of short stories of Moshe's work with children, couples, individuals and holocaust survivors. Not only do I feel like I'm a fly on the wall in the room with Moshe and his clients, but I feel it also reveals the extraordinary element of our work as therapists, that is science combined with art and creativity. As an early career psychologist, I feel that it is this aspect of our work that can only come with experience, true reflection, patience and discovery of our unique qualities.

I get the feeling that Moshe's work is like a dance; it's raw, brave and truly collaborative. Now for part two. Let's see how We All Wear It Differently, with Moshe Lang.

Let's talk about couples. Because you've already started to really tell us that it can be more efficient and powerful if you have two people in the space. You did also mention recently, that working with couples is where a lot of your energy or your passions are at the moment. Is that right?

Moshe Lang: The answer is yes and no.

Amy Felman: Yeah.

Moshe Lang: The reality is that people come to see me initially as either individuals, couples or as families.  However, in my work, I move with ease from one to the other. Often people will call and tell me what the issue is and then ask me whether I think they should come as a couple or come alone. And I would say, “I don't know, I haven't met you yet. I don't know what would be better for you, you decide”, and I’ll leave it at that. Now, let's say a woman comes to see me, and she starts to describe her situation. Together we would think about the pros and cons of one or the other. I may say to her that “If you are considering leaving your husband than you may feel constrained and not able to talk as freely if he were in the room. You may not be able to talk about your anger, resentment and pain or you may not feel able to explore your fantasies and dreams about what you would do afterwards if you were to leave.  If this were the case then perhaps you would be better off coming by yourself.  However, should you want to improve and work on your relationship than maybe it would be better if you come here with him.” I try to tell her as honestly as I can, the pros and cons and ask her what she thinks.  For instance, can she think of any other potential advantages or limitations. Then I ask her “What do you think we should do?”

To me, it is so obvious. It is so clear that clients would benefit greatly from their therapists being more fluid and flexible in their work. Yet I know that I am probably a voice in the wilderness. I think a lot of therapists are thinking at a different dimension with legal thinking taking over.

Amy Felman: Legal thinking?

Moshe Lang: Legal thinking. But let's not go there now.

Amy Felman: But just briefly, what did you mean?

Moshe Lang: For instance, one of the most common issues is, who is your client?

Amy Felman: Yes, which is another thing that I wanted to talk with you about.

Moshe Lang: As far as I'm concerned, there are times when there is a real conflict, and you would be better off working with one or the other. However, in a large number of cases, the client is the relationship and the individual.

Amy Felman: Yeah.

Moshe Lang: There is in my mind, no conflict between the two.

Amy Felman: Can I put a scenario to you? There are two schools of thought, aren’t there?  That if you're working with a couple, you work with the couple and you don't work with them individually as well. Whereas I know for you it's more organic, and you consider what is needed in the moment, et cetera.

Moshe Lang: And I give my clients or patients a greater degree of autonomy.  So, my clients are involved in the decision making with me. I don't decide for them.

Amy Felman: If you're seeing a couple and then you start seeing one person within that couple individually, if that person came to you and they revealed that they're having an affair, how do you then work with the other party and hold that information without it influencing how you are?

Moshe Lang: From my point of view, they come as a couple. How do they then start seeing me by themselves? We discuss it together. I may put it to them, “Tell me, if you come to see me separately, would you like it to be confidential, or would you like information to be shared?” Every couple, in my view, makes their own rules about what is shared and what is not. In other words, what is private and what is not. I am not going to decide for them.

It's their prerogative, it's not for me to tell them when or what to share. They need to negotiate it themselves. Now, as for the practicalities.  If a couple comes to see me, and as a result of negotiation, one of them comes to see me by themselves.  If that person confides in me and tells me that they are having an affair, then I may ask that person what they want to do with that information? The chances are, that if he or she tells me about the affair that person is on the road to telling their partner. If they choose not to, that is their prerogative.

Amy Felman: Have you ever found yourself being pulled towards one party more than the other, and have you had to really stop and take check of that and reflect on what's going on, for you?

Moshe Lang: It happens all the time.

Amy Felman: Yeah.

Moshe Lang: I might see a couple and I will find myself liking her more than him for instance, or I might think she makes better sense than him or the other way around. I might think she's being terribly unfair and that he's so nice to her. It happens all the time.

Amy Felman: I've spoken to people that have been to see people for couple’s therapy, who have had that experience. They've left the room feeling that the therapist was siding with the other party. To the point where they felt that they can't go back, that it's become personal. Whether that's just that person's experience, or perhaps the way that they're perceiving the scenario, I don't know.  I guess that can happen.

Moshe Lang: I take it for granted that it would happen.

Amy Felman: Yeah.

Moshe Lang: Forget being a therapist.

Amy Felman: Yeah.

Moshe Lang: You have couples as friends. Do you like them equally? Do you think equally of both of them? For heaven’s bloody sake. That is just impossible. Parents will often say that they love their children equally but you know that it isn’t true.

Amy Felman: No, really?

Moshe Lang: They might love both of them, but not equally. Both individuals within the couple are different people with different attitudes. I sometimes like both of them, but in different ways, or may have different reactions. I think the problem is if the therapist is not able to acknowledge to themselves or cope with their feelings.  That's the issue. Not that they have different feelings. For example, I might feel closer, I might like one more than the other, or I might understand one better than the other. If I do find myself liking one person more than the other, then I'll spend more time trying to understand the other person. So, I'll try to deal with it, but I won't deny my feelings to myself at least.

Amy Felman: What you're saying is that it's a matter of reflecting on what's going on for you, being aware of it, accepting it, and working with it?

Moshe Lang: That's right.

Amy Felman: You make it sound relatively simple.

Moshe Lang: It's simple in principle but the reality is not. For example, I see a couple, the husband may be aggressive, violent, dismissive, or behaving badly towards his wife. In this case, it’s not simple for me to deal with my feelings, It's very difficult. I don't like the way he behaves.  However, one of my tasks, amongst other things, is to understand why he is behaving in such a bad way towards her. This is not easy for me, it's not pleasant, and it's not nice. I am also conflicted about what's the best way for me to deal with it.

Amy Felman: Do you still have supervision?

Moshe Lang: No.  Well, I consult different people at different times.  If I'm struggling with something, what I find most helpful is sleeping on it. I'll go to bed thinking that I don't know what to do with them. Then I often wake up in the morning knowing what to do.

Amy Felman: Speaking of couples, what are the common issues that people tend to come to you about?

Moshe Lang: Why do couples come to see me? Because they're unhappy with each other; they are angry with each other; the spark that was there is now gone; they may not agree on issues relating to their children or there may be issues around violence.

Amy Felman: Yeah. When you're first sitting in a room with a new couple. What are you holding in your mind, or assessing in that first meeting?

Moshe Lang: I think it's the same regardless of whether it's a couple, an individual or a family. The key questions I ask myself are: Why are they here? What do they want from me? Am I able and willing to provide them with what they want?

Amy Felman: Have you ever been unwilling?

Moshe Lang: Yes. Or rather felt that I am not the best person and think they may be better off going elsewhere. At times, it blows my mind. For instance, a woman comes to see me, she says she's married, has two or three kids, and she promised herself that by the time she's 40, she would have an affair. She's getting close to 40 years of age, and she's afraid that she will not be able to keep her promise to herself. How do you deal with that situation?

Amy Felman: How odd.

Moshe Lang: I'm left feeling intrigued and puzzled, so what's the first thing I do? I think to myself, why? So, I ask about her marriage and other areas of her life and then things change. As it happened, she was a teacher and she propositioned one of the other teachers in the school. She comes back to me, ashen-faced because he said to her, you must know that everybody else in the school knows that I'm gay. There was a meaning that needed to be explored and understood behind her promise to herself. But yes, of course, sometimes people may try to enlist you to do things that you may not be willing to provide.

Amy Felman: Did you work with her?

Moshe Lang: Yeah, it was a great success.

Amy Felman: It was a great success. I won't even try to understand what the success looked like.

Moshe Lang: The success was that we unpacked it.

Amy Felman: Yes.

Moshe Lang: I asked her why, and eventually we talked about her, her life and her marriage, and eventually instead of having an affair, she left her husband and her life became better.  If she had sought me ought in the hope that I would be able to assist her in fulfilling her promise to herself, as opposed to being open and willing to exploring the meaning behind her promise than I would not have been the appropriate person.

Amy Felman: This is not a question that I was going to ask you, but what do you think of diagnosis. Do you have that in your mind and use it to influence your work or not?

Moshe Lang: In the workshop that you attended (Moshe Lang: The Affair; APS Study Group), I told a story, I'll repeat it for the listeners.

Amy Felman: Please do.

Moshe Lang: My first ever patient was admitted to the Royal Melbourne Hospital in 1964. He came to casualty carrying sandwiches and claimed that they were poisoned by his landlord.  He said the lady was trying to poison him. He was sent to psychiatry. At the time, I was a psychopathology student.  My wonderful teacher and lecturer in psychopathology, Dr Alan Jeffrey asked me to interview this man. I interviewed him, and there appeared to be no logical basis for why this man assumed that the sandwiches were poisonous.

I went back to my teacher and Dr Jeffrey asked me “So what is your diagnosis?”, I said, “The man is paranoid”. He requested that I go back and get his sandwiches. I went, brought the sandwiches back and Dr Jeffrey said to me, “Would you eat them please?” I refused. Now, I'll answer your question at a different level.

Amy Felman: Thank you.

Moshe Lang: Diagnosis in my view, is a very crude way to classify people. At times, it has utility, but rarely in the work that I do. To give you an example, there could be a debate as to whether somebody is bipolar or not. But there is a level of bipolarity, where clearly the person would benefit from mood stabilizers.  So, there may or may not be a benefit in establishing a diagnosis.

However, in the day to day work that I do, the diagnosis is too crude. Further, in medical practice, there is often a direct relationship between diagnosis and treatment. There is often a treatment of choice relating to a specific diagnosis. This same model does not apply to mental health. We are lying if we think it does. If you say somebody is depressed, there are a choice of treatment options.  In order to know the treatment that a patient would receive, we need to diagnose the therapist. In other words, the type of treatment one would receive depends on the therapist they see.  The CBT therapist would give all of his patients CBT, the family therapist would provide family therapy and so on. That's my cynical view.  However, diagnosis is different from assessment. I think that diagnosis aims to provide a level of precision, which I think is an illusion.  However, it may be useful to describe a person’s experience within a broader context.

Amy Felman: Yeah.

Moshe Lang: But look, I am, amongst other things, a person who, co-authored the Children’s Depressions Scale, so I'm guilty of creating an instrument that leads to a diagnosis. So, I'm a hypocrite.

Amy Felman: Well, that was a long time ago, maybe you've changed.

Moshe Lang: I'm reluctant to diagnose. I think that there are lots of problems with diagnosis, but it has its very limited place.

Amy Felman: I think when you talked about assessment in the broader context and how often does that diagnosis come as a result of a thorough assessment…that word, that I can never think of. Is it reifying? Is it? Yes. To put a label to something as if it is a thing.

Moshe Lang: Yeah, yeah. But that's one thing, but the other issue is this. That very often, you need to also think of the consequences of the diagnosis. For instance, I used to do a lot of live supervision with people behind a one-way screen. People who are supervised would be working with an individual or a family, whilst myself and the supervision group would watch them from behind the screen. Now, I remember the day when a family came, and one of the complaints they had was that the son would dominate the shower. I forgot what the diagnosis in this case was. I rang the student who was working with the family and requested that he ask the family and the patient, do you think that because your son has schizophrenia, he should be able to stay in the shower forever? In other words, the diagnosis was the justification for a whole lot of behaviour that had nothing to do with or was independent of his diagnosis.  In other words, sometimes we attribute a person’s behaviour to their diagnosis and we forget to see the person as a person.

Amy Felman: Can you clarify, I didn't quite understand that one?

Moshe Lang: Okay, take another example.

Amy Felman: Yeah.

Moshe Lang: This is a common issue. A child is doing poorly at school. I, the parents, the teacher, the whole world debates, is he not doing well at school because he's depressed or because he's lazy? It's very dangerous to say he's depressed, and therefore he's justified, or lazy. You need to keep both in mind. If you just go one way and forget the other, you could be in difficulties.

Amy Felman: Yeah.

Moshe Lang: Another common issue that comes up in supervision is that somebody would say that this person came to see me and he's been diagnosed with bipolar. My next question would be, who made the diagnosis? The reason being is that there are a number of psychiatrists in Melbourne, that would commonly diagnose patients with bipolar disorder.

Amy Felman: That says a lot in itself, doesn't it?

Moshe Lang: Diagnosis is not an exact science. I could go on, but I won't.

Amy Felman: Yeah, I mean it's a huge issue. The majority of training courses these days are in clinical psychology, as you'd be aware. Which is really very focused on assessment and diagnosis, which is the core of a clinical approach. Whereas counselling specialties and other degrees like that are disappearing.

Moshe Lang: When somebody, a couple or an individual, come to see me, the key question I ask myself is not what is the diagnosis, but rather, given that they have come to me with a request, am I able to meet their request? Are we able to work together? Can I justify inviting them back and them paying me good money? Can we negotiate a meaningful contract? Within that, the diagnosis is something that may be relevant from time to time, but not that often.

Amy Felman: Okay, yeah, yeah. You mentioned contract. Do you actually do a verbal contract with your clients or is it unspoken?

Moshe Lang: You saw my first interview with this couple on the DVD, Behind Closed Doors, and in the end of that first interview, I invited them to come back for another session. What's the contract? There is a contract because the couple indicated that they want to deal with the pain and consequences of the affair. The wife indicated that she also wants to be a better mother. That is the contract. Whether we articulate it or not, I think it's reasonably clear to both parties, that that is the contract. From my point of view, the contract is negotiated at every session.

Amy Felman: Yeah.

Moshe Lang: It's typical of my work for things to change over time.  For instance, a couple may come to see me, but after a while, one or the other may come to see me alone because they would like to talk to me about other things. That is the beauty of me being a private practitioner. I couldn't do it when I worked for the government.

Amy Felman: It’s helpful for us to think about the difference in working in private and public settings and what that enables.

Moshe Lang: That's right. To give you another example. A couple comes to see me, the man drops out of therapy, but the woman continues to come and see me for other issues in her life. She happens to be a writer and would like to continue to come to talk about her writing. She comes, and she talks to me about her writing and how it intersects with her life, you know and et cetera. I continue to say, is it helpful to you? So, I continue for a while, and she talks to me about her writing. To me, it's terribly interesting, I feel privileged.

Another good example is when a couple came to see me and the man then says to me that he felt seeing me helped improve his relationship with his wife.  He found that he was talking to his wife differently, was more cooperative   et cetera. He asked if he could continue to come and talk to me about his work and his business.  He thought that what I had done for him and his wife, may also help him improve his business life.  So, I continued to see him for so long as it makes good sense to him.

Amy Felman: So, what you're saying is it's dynamic, it's forever changing and you can do that in private work. You're not ticking any boxes, or …

Moshe Lang: I tick all the boxes.

Amy Felman: Well, yeah, you tick all the boxes. Moshe, you talked about being moved by your clients, and the privilege of sitting with so many stories. Have you ever felt that that's taken a toll? That you've been too moved, perhaps?

Moshe Lang: I think not. I've had sleepless nights, because I was worried about whether I was dealing with something adequately, and appropriately. But I don't recall that somebody told me a story that was so overwhelmingly painful or sad, that the result was that I felt diminished. That I suffered as a result. I've been deeply moved, but I like that.

Amy Felman: Yeah, okay.

Moshe Lang: And look, I have sat in this room and I have listened to some of the worst human stories imaginable. But, maybe I also know how to look after myself. I would say, one way or another, maybe it's enough for today, you know? I have had enough.

Amy Felman: Yeah.

Moshe Lang: So, the answer is no I think. But I don't want you to misunderstand it. I've been worried too much, in a way that it has affected my equilibrium in the short term, but nothing to really be too concerned about. You see, I'm also fascinated as the worse somebody’s story is, the more interesting it is for me.

I want to provide you with an example.  I wrote a story about a woman who defines herself as a very boring person.

Amy Felman: How awful, to walk around feeling that way.

Moshe Lang: You know what, her self-diagnosis was correct. She was a very boring person. I became fascinated. How do you help a person, who is so boring?

Amy Felman: It sounds like a kid’s story, ‘The boring person’.

Moshe Lang: It's really a sad and tragic story of a person who has a very low opinion of herself and how you work with it

Amy Felman: Yeah.

Moshe Lang: Here's another example. A man comes to see me because of serious marital difficulties. He complains specifically of suffering from terrible headaches. After a few weeks I realized, that when he comes to see me, I also get a headache, and I get headaches very rarely. It becomes fascinating for me as I try and work out how this man gives me his headaches? It took me weeks to work out the mechanism. How is it that his headaches become mine too? It was a fascinating experience.

Amy Felman: So, what did you figure out?

Moshe Lang: When he came, I monitored my own head and took notice. If you're a yoga practitioner you try to pay attention, so I took notice of when the headache was coming. I then just monitored when it came, how strong it was, et cetera. The next phase was to work out how it got from him to me? It was somehow in the delivery in his voice. There was something about trying to listen to him and his voice, there was a hesitancy, anxiety and tension that gave me headaches. I think by the time I worked it all out, he got better and I got better. It's a story about mindfulness at one level too. But at the same time, if you could frame it appropriately, the difficulty could be an interesting challenge to work through.

Amy Felman: I was immediately thinking about, how he must be with other people in his life as well. It's a great example of how his other relationships might be impacted.

Moshe Lang: Yeah. As I remember it, what happened was, he was in the process of being or not being with his wife. From his point of view, when he was not with her, he didn't have headaches. With her, he had headaches.

Amy Felman: Maybe she's starting it, maybe it's a domino effect.

Moshe Lang: That's right.

Amy Felman: Yeah. You said you've always been very good at taking care of yourself. You also had mentioned mindfulness as well. Tell me about how you have done that?

Moshe Lang: How do I take care of myself, you mean?

Amy Felman: Yeah.

Moshe Lang: I've talked a little bit about it before. Variety is the essence of life. Having enough variety in my work has been one of the key things that has helped me. The variety between teaching, supervising, clinical work and writing. The variety in different ways of working. Working with different types of people. Both in terms of demographics and the issues in their life. I could have got locked in to working with one client group.  For example, years ago I wrote an article that was very influential about the successful treatment of a family, where the daughter suffered from anorexia. I was later inundated with requests to work with people suffering from anorexia. I didn't take it up, because I didn't want to limit myself to the one area.

Similarly, the same thing could have happened with childhood depression, et cetera. . I'm repeating myself here but one of the ways of looking after yourself, is being able to be truly collaborative.

Moshe Lang: I'll say a few things that are very controversial.

Amy Felman: Okay.

Moshe Lang: I've always taken psychology with a grain of salt. I think psychology, if it is not taken in moderation and is not taken with other things that I'll mention in a minute, could be very dangerous for your health. My words are carefully chosen. Psychology may be dangerous for your health. I want to explain. What is psychology? Psychology is a science.  At least when I studied psychology. Science means that it has to be evidence based. What does it mean? You pay attention to the outside. Evidence is not inside you, it's out there. So, you stop looking into yourself. You don't monitor your own feelings, your own emotions, you don't use your own imagination. You don't use your own wisdom, you don't allow for creativity. In psychology, you are certainly not allowed to laugh. You will be a terrible psychologist. They'll fail you any day of the week.

Amy Felman: Somehow, I snuck through.

Moshe Lang: I think it was Immanuel Kant who said; “Imagination without rigor is madness, but rigor without imagination is death”. Psychology offers rigor, but it neglects a list of other things.  I've always been aware of what I think are the shortcomings of psychology and I think that helped me a lot. I’ll leave it at that.

Amy Felman: Okay. I know you've said that humour has also probably sustained you over all these years.

Moshe Lang: Humour, play, creativity.

Amy Felman: Did you want to add anything further to that?

Moshe Lang:
I'll make two other comments. The practical advice I would give to therapists in the mental health profession is this, when you are successful and you work with a client, whether it be an individual or a couple, it doesn't matter who, tell important people in your life about your success, and then spend a lot of time trying to understand what made you successful. See, the way I did it was, I videotaped the sessions.  I just spent a whole year with one of my good friends and colleagues, trying to understand what I did with a particular family. I've learned from this experience more than any other.

Last Saturday, you were in one of my supervision groups. I show everyone in the supervision group a video tape of my work, and open it for conversation. There are 20 psychologists, who may tell me, “Stupid, why did you do that?” or “Why did you do something else?”, and in the process, I'm supervising myself. I learn about the things I do and how I do it as well as what I don't do. One of my recommendations to early career psychologists is to record your sessions, and then watch them with care, and to try to understand what you did, how you did it, and what made you effective.

The other, which is the corollary of what I said earlier. Develop and work on your capacity to listen. Listen to the people you work with, but listen also to yourself. Listen to your thoughts, your feelings, your emotions, listen to your gut, listen to your muscles, listen to your humour, and listen to the loud voices, but most importantly listen to the soft voices. At the end, keep a good balance between listening to others and listening to yourself.

Amy Felman: Is there a strategy for people to do that, if they don't find that easy to do? I know we'd like to think that most people in our profession would engage in that anyway. But we know we also have some anxieties and challenges early on that might prevent us from doing that.

Moshe Lang: Try to understand what your difficulties are in doing it, in the first place.

Amy Felman: Yeah.

Moshe Lang: Get a supervisor, a therapist, or some good friends who would help you, or perhaps all of the above.

Amy Felman: Yeah.

Moshe Lang: Probably all of the above.

Amy Felman: Yeah. I think that's good advice.

And that was the end of part two of this interview with Moshe Lang. As always, if you're enjoying this, please leave us a review on iTunes or on the website, to help other early career psychologists find us. Now for the final section of this interview, part three, where we talk more about Moshe's writing and self-care tips. Enjoy.

If you are interested in exploring Moshe Lang’s work further, a comprehensive list of publications, interview transcripts, presentations and workshops are available on his website www.moshelang.com.au.

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