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Ericksonian Family Therapy with a Problem Child Case Report by Jeffrey K. Zeig, Ph.D.

Harold called me because he was concerned about his ten-year-old son, Bob, who was phobic about gravel roads. Bob’s phobia had generalized to the extent that he had become reticent about leaving his home. I told Harold that I would be willing to provide a one-hour consultation, if he would bring his wife, June, and his son.

Bob was the most hyperactive child I have ever seen in my private practice. Based on the phone call, I had no idea that ADHD was part of the constellation. Bob couldn’t stop fidgeting. As he entered my office, he poignantly announced, “I’m the crazy person.” My heart went out to him.

I did not want Bob to assume a negative self-definition. I gave him a difficult wooden puzzle consisting of two pieces that fit together to make a pyramid. Bob struggled but could not solve the puzzle. I told him that I could not solve the puzzle when I first got it. I called the friend who sent me the puzzle and asked, “Where’s the third piece?” There was no third piece.

I took Bob out of the office into the waiting room. I showed him how to solve the two-piece pyramid puzzle. I then instructed him to give the puzzle to his mother and father. Smiling, he strolled back into the office. Then Bob and I watched as his mother and father struggled to put the puzzle together. They could not easily do something that he knew how to do. Now Bob was one-up.

Building on the situation, I said to Bob and his parents, “I’m an expert at helping families solve puzzles.” I wanted to define the solution as existing within the family.

Harold told me how Bob’s problem began. The family was driving on a gravel road when suddenly a mechanical failure caused the car to spin out of control. A very good driver, Harold brought the car to a safe stop, but Grandmother, who was in the back seat with Bob, completely panicked. Then Bob panicked, and

subsequently refused to get into a car. Eventually he refused to be in any place where there was a gravel road. When Bob went on to say that he was afraid of being out of control, Harold had a new insight. He had not previously understood that aspect of his son’s problem.

I remembered a dictum from Gestalt therapy: “If you’re in terror, play out the terrorizer.” If I can get the fearful person to play the part of the fear monger, it may breed a solution. Continuing my redefinition of their familial problem, I said, “Mr. Fear has attacked this family.” I then asked Bob to show me Mr. Fear. Bob went to the far corner of the office and became Mr. Fear, attacking his family.

I knew from experience that analogies can generate a solution, so I inquired, “Tell me, what is Mr. Fear like?” Bob asked me if I watched Power Rangers, which I knew only vaguely. “Mr. Fear is Drilla Monster,” he continued.”Be Drilla Monster and attack your family.” So Bob pantomimed being Drilla Monster attacking his family.

Next, I thought about the Ericksonian principle of eliciting resources. I knew that there must be a resource in this family to deal with Bob’s fears. Since Bob had offered the metaphor of Power Rangers, I asked him, “What power do you have?” “I know karate,” Bob replied. “Show me how you can use karate to fight off Drilla Monster,” I said. Bob successfully fought back the imaginary Drilla Monster, pushing him out of the consulting room.

Next, I explained the therapy. Whenever Mr. Fear, Drilla Monster, attacked the family, they were to stop and convene a meeting of all the Power Rangers who would decide together how to use their powers to defeat Drilla Monster. I then added, “I have two other therapies that I would like you to practice.” Because June seemed exhausted and overwhelmed, I directed the tasks to the father and son. Harold was bright-eyed and seemed to have a lot of energy to devote to Bob. I explained that each morning for a week, Harold and Bob should practice being out of control. Bob would go into the backyard and play being out of control and Harold would coach him about being better at being out of control. Then Harold would act out of control and Bob would coach him about being out of control. My covert design was to turn a problem component into a game. They agreed to the therapy.

Then I offered, “I have an another therapy for Bob. I want you to write your name in my driveway.” I live in Phoenix, Arizona, in the desert. My driveway is made of gravel. I told him that I did not even allow my daughter to write in the gravel, but that I would like him to leave his mark there showing that he had been at my home office. My technique was a symbolic desensitization. Bob would have to slide on my driveway as he shuffled his shoes around to put his name in the gravel. I would have him violate his phobia about gravel. Adequate psychotherapy with a phobia can be achieved when one gets the patient to violate the phobic pattern, even on a symbolic level.

In the one session therapy, I had a series of heuristics that could generate solutions. In this case, the most important heuristic was faith. There were three components of this faith: One, I had faith in my ability to utilize whatever they brought me. Most of my professional contributions in print during the past ten years have been explications of Milton H. Erickson”s utilization method. I have made utilization a center point of my therapy. The second aspect of faith also came from what I learned from Erickson. I had faith in the family. I had faith that they had a resource in their system that would be adequate for solving the problem. The job of the psychotherapy would be to help them access that resource experientially. Finally the third part of this faith was in myself. I knew that I had surmounted similar problems. I also had used methods to cure myself similar to those I prescribed for them. If I could do it, I knew they could, too.

Jeffrey Zeig, PhD will present at the December 2005 Evolution of Psychotherapy Conference, www.evolutionofpsychotherapy.com

“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.