Dr. Cantwell decided to use a combination of desensitization and assertiveness training with Anne. During half of each weekly session with Dr. Cantwell, Anne was asked to relax in a recliner with her eyes closed, and Dr. Cantwell would then describe situations low on her hierarchy. Anne was to try to maintain her sense of relaxation in spite of Dr. Cantwell's description of an imagined situation involving Anne's neighbor. She was to imagine that her neighbor, who was very fastidious about her own yard, knocked at Anne's door to complain about Anne's habit of setting the trash out the night before pickup. Gradually, in a similarly concrete way, Dr. Cantwell had Anne imagine her mother criticizing Anne for using the same sponge for wiping up in the kitchen as for washing the dishes; a boss asking Anne to retype a business letter using another format that he preferred; Anne's mother-in-law "dropping the hint" that her son liked to have his T-shirts ironed; Anne's husband complaining because Anne always overcooked the soft-boiled eggs.
During the second half of each session with Anne, Dr. Cantwell played roles with Anne in which he taught her how to assert herself more in situations involving criticism. In one session, for example, he took the part of Anne's mother and chose a typical remark she might make: "Annie, dear, don't you think it would be smarter to use a different sponge for wiping the kitchen counter? You should use a separate one for the dishes." Dr. Cantwell then asked Anne to think of a way she could reply to her mother's "nice" criticism, without feeling bad about herself, without "getting hooked."
ANNE: Well, one way you've taught me would be to use humor: I could say to her, "Mom, anytime you'd like to come over to do the dishes, it would be fine with me." And then laugh.
DR. C.: That's a good approach. But you don't want to be offensive; you don't want to laugh mockingly. How you do this is important. You want to set a good-natured feeling. Humor can be very useful to offset the sting of criticism. Can you think of a different way to reply to your mother, in addition to humor?
ANNE: Well, let's see.... Yes, well, I could go with her suggestion and not interpret what she says to me as criticism at all. I could say, "Mom, thanks for the idea. Maybe I'll do that."
DR. C.: Sounds very good. That's another way. The more alternatives you can prepare yourself with ahead of time, the less likely she will hook you, leaving you with nothing to say and simply feeling bad. Would you try to think of one more alternative? What other tack could you take?
ANNE: (After a moment of silence.) I can't think of another.
DR. C.: How about telling your mother how you actually feel when she criticizes you? How do you feel?
ANNE: Well, I wish she'd say some positive things instead, at least sometimes. That would be nice.
DR. C.: Great. How could you tell her that?