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“I can use my computer again.” Brief Hypnotherapy with Super Anxiety by Angela Wu, LMFT

Sean was in front of me, looking down at the carpet. “I am afraid that I cannot use my computer anymore. Last night I spent almost four hours downloading all kinds of antivirus software, and when I got up in the morning, I was worried the software could bring more viruses to my computer. I reformatted my computer and worried that I erased my data, which I did not back up.” As an engineer, Sean knew his data was safe, but could not help worrying about it.

As he talked about his worries and fears, I had him describe a typical day, so that I could have a sequence of common events. I also obtained information on his background. He has a loving and academically-oriented Chinese family and he had not experienced major trauma in childhood. Yet, I agreed with him that our world is not a safe one. There are hackers and viruses everywhere. I told him that he was being extremely careful, and that his goal would be to regulate his worry by spending 30 minutes a day worrying about random things.

So he set aside two hours in the morning to worry, two hours in the afternoon, and four hours every night. I asked him if he could find a safe place to visit. He went into trance. His safe place is a quiet lawn with a pond, a bench, and the warmth of the sun. I told him his thoughts would affect his body.

The following week, Sean said he was spending less time worrying about his computer, but more time fretting about his health. He washed his clothes several times a day. The safe place seems to help him calm down. I told him any change is good. I asked him in trance to envision a favorite face; he saw his parents comforting him, assuring him that he is safe. Over the next few sessions he reported that he was sleeping better, no longer washing his clothes repeatedly, and started to go to church to meet people. I encouraged him to walk during his lunch hour. He said that he was talking more to his friends in China and noticed that the worries randomly come and go, about four hours a day. I told him change is good and that things may get worse again before they get better.

By session six, he did not notice the morning worry and used deep breathing and his safe place to handle random worries. I suggested he might want to schedule a time for worry to visit, and to send worry home when the visit is over. I told him that if relapse happens, it is normal, and he said that he invited the worry to come, but his mind was distracted by plans for dinner, taking a walk, and playing video games with friends.

By session eight he happily said, “There is a big improvement.” He traveled with a friend and had a good trip. I initiated a deep trance, just for fun. I asked him to come back every other week and reminded him that a relapse can happen any time. When he reported random worries I said that he was a very responsible per- son and needed his work to be perfect, and that he should take advantage of being perfect and avoid getting caught in too much work.

After 11 sessions, feeling much more relaxed with his life, Sean can handle little worries with deep breathing and a safe place. He decided to discontinue sessions, as he is feeling normal and relaxed, accepting himself as a very detailed and responsible person, and is making travel plans.

Commentary by Eric Greenleaf, PhD

Angela Wu demonstrates the best of brief, strategic, MRI-inspired hypnotic psychotherapy. She preempts relapse by predicting it, and reframes anxiety to its other human meaning of responsibility in living among others. Her hypnotic work is straightforward, and rests on her client’s discovery of the characteristics of a safe place and supportive relationships. That both safety and support can be imagined fully in trance, is an elegant counterpoint to the imagined worries that brought her client to her in the first place.

Angela Zhe Wu, LMFT

Angela Wu is in private practice at MRI, in Palo Alto, CA, where she provides psychotherapy to individuals, couples, and families of diverse, cultural backgrounds. She speaks English and Mandarin, and is skilled in crisis counseling, family therapy, gestalt, EMDR, hypnotherapy, and art therapy.

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Eric Greenleaf, PhD

Eric practices in Albany, CA, and has seen patients for 50 years. He directs the Milton H. Erickson Institute of the Bay Area and teaches internationally. Since 1988, he has studied trance rituals and healing in Bali. Dr. Green- leaf serves on the Board of the New Bridge Foundation, a comprehensive substance abuse treatment center in Berke- ley, CA. Milton H. Erickson, MD, chose Greenleaf to re- ceive the first Milton H. Erickson Award of Scientific Excellence for Writing in Hypnosis from the American Journal of Clinical Hypnosis.

Pain Control By Steve Andreas, MA

A year ago, while on vacation on Kauai, I picked up a hitchhiker—a young man in his mid-20s who had a full arm cast (palm to shoulder) on his left arm. As we drove along it seemed natural to ask how he was injured. He explained that he worked in construction, and a couple of week prior, had fallen toward a window. He broke through the glass, and glass shards badly sliced his arm. When he pulled his arm out of the window, the triangles of glass that were still stuck in the frame sliced his arm even more. After telling me this, he glanced down at his arm and said, “It still hurts a lot.”

One of the many things I learned from Milton Erickson was that physical pain can have three components, only one of which is the actual pain in the moment. There can also be components of remembered pain and anticipated pain.

The next time you have pain, try to get a sense of how the past contributes to the present pain by asking yourself, “If I knew this pain started only five seconds ago, how would that change my experience?” You can also get a sense of how anticipated pain contributes to present pain by asking yourself, “If I knew this pain would be gone in five seconds, how would that change my experience?”

Erickson taught that even severe present pain is often ignored in the context of great danger – when all attention is focused on other urgent tasks, such as pulling a loved one from a burning car. Seeing yourself at a distance can also eliminate feelings of pain. As an outside observer, your body will be “over there,” and although you may see grimaces and other expressions of pain, you will not experience pain. This was the basis for Erickson’s “crystal ball technique,” in which he would suggest that a client imagine seeing a “rainbow arc” of images of different times in his/her life in separate crystal balls, to review his/her past life dispassionately, or to envision steps to a better future. Erickson used this method most often in trance, but with sufficient rapport, it can be just as effective without a formal trance induction. “Rainbow arc” implies something beautiful and pleasant, and the crystal balls could be seen at the same distance that you would see a rainbow.

I thought that the hitchhiker’s pain was primarily due to his memory of the accident, and that if he could learn how to distance himself from that memory, his experience of pain would be significantly reduced.

Since he had glanced down at his arm when saying that it still hurt, I was certain that he was remembering the accident from his own perspective…as if it were happening to him again, which is common for people who are still suffering from past horrors, such as in PTSD “flashbacks.” But to be sure about my theory, I asked him, “When you remember falling into that window, what is your point of view?” Again, he glanced down at his arm, and said, “I see my arm going through the window.”

Then, as I gestured beyond the car to his right, I asked: “What would it be like if you viewed that accident from 30 feet away — off to your right?” Besides the overt suggestion, there are covert elements that supported my question. Saying “that accident” (in contrast to “this accident”) implies seeing it at some distance. And, gesturing to his right was a nonverbal instruction to look to his right, which is where most people creatively visualize.

The hitchhiker briefly glanced to his right out the car window, and then, with a surprised look, said, “The pain is gone!”

He was understandably puzzled and curious about what had happened, so I offered my understanding of how it worked, and that it could be used for emotions, as well as for physical pain. I also pointed out that he had discovered he had a skill he hadn’t realized, and that from now on he could choose to use this for other painful memories. Throughout this discussion, his eyes were mostly defocused, indicating that he was actively processing the information internally—what could be described as a spontaneous trance.

When I dropped him off at his destination, he thanked me, and followed up with, “My arm still feels fine,” his face still expressing a bit of puzzled amazement at the change, which for me was better compensation than if he had been a paying client.

Commentary

By Eric Greenleaf, PhD

Milton Erickson once so thoroughly pleased a difficult patient with a rapid solution to a problem that she called the other attending doctors, saying, “People, this man really knows what he’s doing.”

So it’s a pleasure to watch Steve Andreas work, as he crisply observes, succinctly helps, and educates his traveling companion — extending the trance and encouraging the young man to take it further in his own life.

In an introduction to one of the first NLP texts, Erickson wrote that the authors “…have understood some part of what I do.” In integrating the development of NLP with Erickson’s teaching and example, Andreas not only understands all aspects of what the patient needs to heal, but provides a natural, conversational trance in which the patient can learn.

People, this man really knows what he’s doing.

 

Rock, Paper, Scissors: Learning from Erickson’s Use of Pen and Paper in Therapy by Annette Poizner, MSW, Ed.D., RSW

I’m remembering recess in the schoolyard. We are in the process of deciding who gets to go first and we play the game of Rock-paper-scissors. Each child assumes a hand posture resembling either a rock, piece of paper, or scissors. According to the rules of the game, each of these items “can “defeat” one of the other items and the remaining one is the winner. For example, scissors “beat” paper; rock “beats” scissors. These relationships make perfect sense, given that scissors cut paper and rocks can smash scissors. Yet, one of the relationships spelled out in this childhood game is counter intuitive: paper rules over rock. But doesn’t a heavy rock rule paper? An anonymous comment on the Internet sheds light on this issue: Paper rules rock because paper represents the realm of higher knowledge. We master the world of physicality symbolized by the rock, by using principles of higher knowledge. Ah yes, paper does, in fact, rule rock!

Given the importance of paper, we shouldn’t be surprised that pen and paper are useful in the therapeutic endeavor, despite the fact that most therapists limit its use to process notes. In fact, Erickson frequently brought pen and paper into the therapy process. At times, he would have his patients journal their life story, or he would give homework assignments, having a bed wetter woken up early in order to practice handwriting. Other times, Erickson would utilize automatic writing, wherein hypnotic subjects would respond to hypnotic suggestions to produce meaningful writing or drawings, all outside of conscious awareness. One fascinating case bears reviewing. Erickson and Kubie (1938)1 reported the case of a 24-year-old woman who volunteered to be a hypnosis subject. She explained that in recent months she had been overcome with feelings of agitation, and simultaneously found herself mindlessly drawing pictures and doodling whenever she was studying or sitting in class. She was puzzled by this new habit, and by her agitated state, and she wished to find meaning in her illustrations.

In a subsequent interview, she recounted her history. She was raised as an only child in a happy home with two loving parents. She reflected that the only problems on her mind of late were feelings of resentment about the growing emotional distance between her and her best friend from childhood. Throughout the interview, the woman nervously doodled.

Erickson scheduled a follow-up appointment and gave her specific hypnotic suggestions: that her unconscious mind would organize the material she hoped to access, while her conscious mind would be busy with school and social activities. She would report on her conscious activities when she attended her next appointment. Feeling incredibly well at the next appointment, the woman described the story line of a novel she had been reading. While giving a verbal report of the book, she picked up a pen and doodled, first penning the usual scattering of lines and shapes, but ultimately making a singular, unified drawing that integrated all the elements that she had been randomly drawing. Yet, she was not able to interpret the picture for Erickson. In response to questioning, she gave Erickson a pack of matches from her pocket, then left abruptly. Of note, these matches advertised a local hotel.

Over the next several weeks, the young woman dropped by for a series of visits. Erickson recounts the gradual process by which the woman retrieved awareness of the meaning of the drawing, ultimately leading to a revelation: Her father was having an affair with her girlfriend. Father had been bringing matches home from the hotel where he had frequent encounters with his mistress and all this was ultimately confirmed by the girlfriend, who was eventually brought to a meeting with Erickson!

The case report documents the nuanced way people first hide, then later reclaim knowledge that is difficult to bear. In this particular case, the revelation brought an end to the young woman’s agitation. The case also demonstrates the use of pen and paper in therapy. Clients can spontaneously draw or write material, which can then be analyzed to better access material that has been, for one reason or other, hidden from consciousness.

In the end, we may learn a thing or two from the game of Rock-paper-scissors. It can be a reminder that the seemingly innocuous sheet of paper is more powerful than it looks. It can serve as a proverbial blank slate, and much can be achieved if we will bring it into the clinical context.

Annette Poizner, MSW, Ed.D, RSW serves on the Board of Directors of the Milton H Erickson Institute of Toronto and is the author of “Clinical Graphology: An Interpretive Manual for Mental Health Practitioners” published by Charles C Thomas Publishers.

1 Erickson, Milton & Kubie, Lawrence (1938). Psychoanalytic Quarterly, 7, pp. 443-466.