Treatment via the “Double Monkey Dialogue”
Ludwig Lowenstein Ph. D.
Southern England Psychological Services

Abstract: The view of the current psychologist is that there is a need for more searching for new creative ways to treat psychological problems. This is especially the case when other procedures have failed. The “double monkey dialogue” involves the engagement of the client's fantasy. The client must take on board the fact that there is both a positive (healthy, constructive psychological aspect) and a negative (unhealthy, destructive psychological aspect) to his/her personality. It is not so unlike the struggle between good and evil in individuals and in society.

Many psychologists, psychiatrists and counsellors as well as others carrying out therapy are turning to their imaginations and fantasy to create new psychotherapeutic techniques. This is because many have turned their backs on orthodox psychotherapy and psycho-analytic approaches. It has been well established that little or nothing can be achieved by concentrating on past events which may have led to present psychological problems. These events can no longer be altered. Drawing attention to the past and what might have caused such illnesses as depression, obsessive compulsive behaviour etc. is unlikely to be of any value since the gaining of insight does not do much to change current and future behaviour and attitudes.

Treatment via the “double monkey dialogue”, has been successfully used with a number of highly resistant cases or individuals who suffer from psychological problems including obsessive-compulsive ruminations, panic attacks, alcoholism, drug addiction etc. This method will shortly be described and its effectiveness delineated following treatment and follow-up one year later, with 21 consecutive cases.

It should be made clear that the sample in which it was used is as yet small and hence replication with a larger number of subjects is necessary. There is also a strong element of what I would deem “creative, rational, emotive manipulation” in order to break through the individual and the obstacles which one confronts when faced with intractable problems which do not respond to normal therapeutic approaches.

This must, however, not be the first and most important objective the creation of a new method for its own sake. As already mentioned, provided individuals respond to more classical and orthodox methods such creative methods about to be proposed are unnecessary. The most important two objectives must be: 1) whether the client truly wishes to make a change in his/her current functioning by being rid of the disturbing or unwanted problems or difficulties; 2) the willingness of the client to abide by the process described by the therapist for achieving the goal of improving the condition of the client. This is also the case for any method that is employed.

Commencing treatment, without these two provisos is likely to be a futile exercise, especially with such serious conditions as addictions to alcohol or other substances, and long standing neuroses. Let us now look at the “double monkey dialogue”.

This approach may appear simplistic in terms as to how we usually view the complex and difficult task of treating individuals with problems. It must be repeated, that from the onset, that this method must ‘hit home', with the client. The instructions to the client go as follow:

“I am going to help you to help yourself. Without your support, and involvement in following instructions, this highly successful procedure will not work even with you. You have suffered for some time from your problems and you obviously want to benefit from the help and guidance being provided. I will give you this now. You must remember that you have not responded to more ordinary methods before used by other people as well as myself. Nothing, however, will be achieved without your working with me. I am sorry to have to tell you that without your involvement the effort I make is doomed from the start. Do you understand? Now I will explain how it works.

“I want you to imagine that you have two monkeys each one sitting on one of your shoulders. The one on your left shoulder is the one causing your particular problems and who is quite satisfied with you continuing to have those problems. The one on the right shoulder is trying to help you be rid of the problem for which you have come to me to treat. I want you to sit there and imagine those two monkeys on your shoulders. Try hard; make them real in your own mind. Those two monkeys do not like one another. You could even say they hate one another. If you can't imaging what I have just said the whole procedure will not work and we will have to deal with things in other ways.”

“So you say you can really imagine those two monkeys on each shoulder…….Good. Now let us take the next step. As you assume, the monkey on the left shoulder is responsible for your problem. You may term it the “bad or evil monkey”. It wants you to go on having the problem. The one on the right shoulder…..you may term it the “good or caring monkey”. That monkey cares about you the way I do and that monkey wants to help you and me to get rid of the damage caused by the monkey on the left shoulder. Do you understand?”

“I want you to concentrate and think about this now, but not only now….. I want you to think about those two monkeys when you are not with me but at home or anywhere else you happen to be. Your treatment is a full time job. It is not only done while you are here. It is continuous, even when you go to bed and fall asleep.”

“One of these two monkeys has to win. Which one do you want it to be?......I thought so, you want the one on your right shoulder to win, of course you do. Now let's get started. You and I know what your main problems are. The one on your left shoulder wants you to continue suffering from that problem. The one on the right wants you to be free of this problem. You must help that monkey on your right shoulder to control the other one on your left shoulder. He needs your help and only you can help him to help you; just as I can only help you if you support that monkey on your right shoulder. Will you promise to do this now and when you leave and until you come back next time to see me?”

One might well ask is this all there is to helping another human being with his/her problems? Of course not. What does it do? It removes the dependence the client feels on the therapist and to coin an old phrase: “Places the responsibility on his/her own shoulders”. It helps, the client, in essence to do more to help him/herself. In addition, the therapist now has an assistant, this being the monkey on the right shoulder. Other good advice follows and this is to give the client and the monkey on his right shoulder the chance to change the attitude of the client without the therapist being always present.

This includes what is likely to be specifically helpful to the client such as thoughts and activities that directly oppose the problem from which they are suffering. It is difficult to be specific here because different problems require different solutions. The condition or habit which causes the individuals to feel unhappy or suffering must be counteracted with habits that are in direct opposition. Let me illustrate this by examples:

The depressed, dependent on alcohol, drugs and anger individual who is consumed with gloom and does not wish to do anything but to withdraw from the company of others should do as follows with the help of the monkey on his right shoulder.

1. Thinking positive thoughts. These again are specific to the individual concerned.

2. Be active in some activity, which again is an individual preference, such as running, walking, swimming, art activities, hobbies etc.

3. Avoid sleeping during the day but be with other people and interact with them if one is depressed especially.

4. Work with some task which promotes activities whether paid or unpaid, perhaps charitable in nature.

5. Develop a meaningful routine or programme for the day, week, month or year and not deviate from this except under very special circumstances.

Such a programme needs to be based on the individual needs, likes and values. While the left shouldered monkey will always be there threatening to return and sometimes will return indeed to the old ways of self-destructive or joyless lifestyle. The monkey on the right shoulder will continue to try to control and guide the client to continue not merely to avoid the unpalatable attitude and behaviour but to change the direction of how the individual thinks, acts and lives.

It is hoped that other therapists may also think of newer more novel ways, or creative ways of reaching and treating clients who do not respond to more orthodox approaches. This will both make therapists more creative and help those clients who require less orthodox treatment approaches.

Now follows a case illustration of how treatment by the “double monkey dialogue” can be most effective when other procedures have failed.

Mrs X was the wife of a public house owner in Hampshire. She came from a gypsy background and had tried for years to get rid of the panic attacks and obsessive-compulsive ruminations concerned with terrible things that were likely to happen to her. She had never been on a holiday and was eager to travel abroad with her husband but could not face the situation of getting on a plane.

She was constantly worried about a great number of things such as something happening to her children, or that her husband would be unable to control his temper. Her husband did have a considerable temper and would become aggressive at times. He had for some time been smoking marihuana in order to help him control his anger and this had been helpful, but now Mrs X began to worry about the fact that marihuana could be dangerous. She visited the psychologist on three occasions. She revealed that she had been taking medication and had seen counsellors and other psychologists but none had been able to help her with her obsessive-compulsive ruminations and panic attacks. The psychologist (myself) decided to try something which had been most effective with a number of cases of obsessive-compulsive ruminations and extreme worriers. The “double monkey dialogue” was used with the left shoulder carrying the pathological side of her nature (the bad monkey), and the right shoulder carrying the monkey (good monkey) with the positive methods that can be used to counteract the effects of the bad monkey. Mrs X was also provided with a desensitisation method such as a yoga breathing exercise which was used to relax her in combination with the “double monkey” approach.

Mrs X used this at home as well as when with the psychologist and in due course she felt great relief. She was advised to reduce her medication for obsessive-compulsive ruminations and anxiety and this she did. There were no further signs of panic attacks or obsessive-compulsive ruminations but she was warned that it was likely to return when she was under stress and that she should keep in mind the two monkeys sitting ready for action on her shoulders.