Page 23

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.

Utilization — the Virtues of Faults Excerpts from the Erickson Foundation Archives

By Jeffrey K. Zeig, Ph.D.

Case One: The Right “Spell”

My son, Robert, asked me when he was attending grade school, “My two best friends can’t spell; [their papers are] marked 10, 15, or 20, and my spelling [lessons are] marked, 85, 90, or 95. Now, will you teach them how to spell?” I said, “I can’t really do that Robert without consulting their parents…I’ll tell you what to do. You make sure you have your spelling lesson with you and your friends have their spelling lessons with them — a marked copy corrected by the teacher. I’ll come over and pick you up and drive you home, and I’ll [also] offer to drive the boys home. And, as we’re riding along, you tell me what mark you got on your spelling lesson. I’ll pull up to the curb and go over your spelling lesson. [When Erickson did this, he said to Robert,] “You got this word right, and this word right, and this, this, and this.” And I graded [his lesson] and it was 98. I turned to one of the boys and said, “Have you got your spelling lesson with you? I’d like to see it.” He didn’t want to show it to me, but I insisted. I looked at it and said, “My goodness…a ‘ck’ in ‘chicken’ is the hardest part of the word to spell — and you got that right.” I looked at the next word and there were three letters correct and [I] said, “[That’s] the hardest part of that word to spell…” Now the second boy handed me his spelling lesson [and] I pointed out the letters he got [right, too.]

A short time later, I asked Robert, “What happened to those little boys after that day?” He said, “They are spelling correctly.”

I merely showed them how to look at their spelling lesson and see the right part of their spelling. [But,] adults will look at the failures, without realizing that failures are always an opportunity to learn.

Case Two: Appreciable Curves

Hans (a student asking for help with a case): I had a woman client who came in with her husband. She has scoliosis, which means she has a very rounded back and is much smaller than she would be if she didn’t have it. Other than that, she’s a beautiful woman, but the couple has the same difficulty I told you about before: the man is no longer turned on by his [wife]. He says it does not have to do with her back, but I still think it has something to do with it. He simply tries not to think about it, and the woman gets depressed a lot because she thinks her rounded back is the reason why her husband doesn’t like her anymore — that he no longer accepts her as a woman.

Erickson: Now my [question] to the woman would have been, “Madam, aren’t you aware that all men [think] curves are wonderful?” If the woman has an extra curve, I’d [ask] the man, “What do you want — a flattened board? As a man you are supposed to enjoy [all kinds of] curves.” [This puts] him on the defensive, and when he admits liking some curves, [he’ll] admit to a predilection for [all] curves, [there- fore viewing] his wife’s scoliosis through different eyes.

Cases Three and Four: The Body of Knowledge

Erickson speaking to students at a teaching seminar:

I’ll give you two other cases from my [experience working with the WWII] induction board. A handsome young man came through [in] good physical condition, and he had Jayne Mansfield [a buxom actress of the era] beat with his [enormous] breasts. My medical students looked at him in horror, [but were even] more horrified when I wrote a red “A” on the chart, which meant [he was] accepted. I let the medical students wonder for a while, [and] then I said, “The medical students are concerned because I’ve accepted you for the Army. They think that with those great big breasts of yours you’re unfit for the Army. Now, I’ll ask you a question and your answer will reassure [them]: “When you take a shower with the boys and they see your great big breasts, and they start to rib you [and] tease you, what are you going to tell them?” He said, “I’ll tell anybody who stares at my breasts that I brought them along for the homesick boys.” There was no question why [this man would] be accepted. And his composure was excellent.

The next selectee squirmed while I did the psychiatric examination, [but] I didn’t find anything wrong with him. I accepted him and [asked], “Now, why were you so afraid I wouldn’t accept you for the Army?” He said, “Well, I’ve got a problem: I can urinate only when sitting down.” The medical students looked concerned, so I said, “All right. When you’re marching and the sergeant says, ‘At ease, relieve your- selves,’ and you squat down to urinate, what are you going to say to your fellow soldiers?” He said, “If they fault me [for] squatting down, I’ll tell them, ‘Anything good enough for my mother is good enough for me.’”