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Hypnotherapy with a Psychotic Milton H. Erickson and Ernest L. Rossi

Estimated reading time: 7 minutes, 43 seconds. 

Unpublished manuscript, circa 1940s, edited by E. L. Rossi

Laskarri had been diagnosed on the psychiatric ward as suffering from schizophrenia of the mixed catatonic-hebephrenic type. He was moderately disturbed in his behavior; several times a day he would shout gibberish apparently at hallucinatory figures and race back and forth and around and about the dormitory beds or scramble frantically under and over them. Or in the dayroom comparable behavior might be manifested in relation to the chairs and tables. Otherwise, he merely mumbled and muttered when questioned, despite the fact that he had a college education. Another item of great interest was his alert, intelligent gaze when not disturbed emotionally. He seemed to be intently studying his fellow patients and the interpersonal relationships between patients and the nursing and medical personnel. Yet when approached directly, his interest seemed to vanish and his gaze became veiled.

INDIRECT TRANCE INDUCTION

 Made curious by “this” Laskarri’s behavior, the writer approached a passively obedient, rather stuporous patient and maneuvered him into a chair nearby so that Laskarri would have a full view of him. The writer then took a chair slightly to one side so that his primary view was of the stuporous patient but his secondary, somewhat sidelong glance permitted an adequate view of Laskarri. In effecting this seating arrangement the writer spoke earnestly and intensely to the unresponsive stuporous patient, but was well aware of Laskarri’s intent observations. The writer then gave the stuporous patient a series of suggestions to induce attentiveness, relaxation, a state of restfulness, a state of attentive sleep, restful sleep during which one might hear, understand, wish to respond, to communicate, to tell things of interest, to need to tell one’s thoughts and feelings, to express one’s need to ask for help, to do so comfortably even while asleep and without fear.

Previous experimentation with the mildly stuporous patient, who tended to stand about immobile with a vacuous expression in his eyes, had disclosed that he would, if seated in a chair, loll comfortably and seemingly go to sleep. No interpersonal contact had yet been made with him, but he could be used as a suggestive example for Laskarri.

Peripheral vision and sidelong glances soon disclosed that Laskarri, as is common among normal people, was responding to the suggestions he apparently thought were addressed to the subject. Shortly Laskarri gave every appearance of being in a trance, and he manifested catalepsy upon being tested. Slowly the tempo of the hypnotic “sleep” suggestions was decreased, and there was a gradual replacement of them by increasingly urgent suggestions that sometime, somewhere, somehow, courage be found to tell a little, just a little about what happens when you run, you twist, you turn, you crawl over, crawl under, run, twist, shout, sometime soon, somehow, must some way … will … must … can … must … tell what happens when crawl, run, rush, shout, go over, go under.

These suggestions were repeated many times-softly, gently, insistently, urgently-and they were followed with cautious slowness, “… and head will   nod, nod, nod, yes … yes … yes … yes … slowly nod yes … slowly … will do … will do soon.”

Shortly Laskarri’s head nodded “yes” gently, perseveratively, and further suggestion was offered that he sleep restfully for a while, since he might want to say something that afternoon. The afternoon of that same day the writer slowly made ward rounds, finally seating himself in a chair beside Laskarri and waited patiently. Within 20 minutes Laskarri leaned over slightly and murmured, “Big Joe-you-put Joe asleep-put him asleep-different way.”

What Laskarri meant was readily recognized. Some 10 days previously Big Joe, six feet five inches tall and 275 pounds, had become increasingly restless and had announced finally, in the writer’s presence, his intention of “singing and yelling for about an hour” and then “smashing the ward and everybody in it.” There had been previous such experience with him. Immediately the writer secured a syringe with 15 grains of sterile intravenous solution of sodium amytal and took a seat in front of Big Joe’s chair. Suspiciously Big Joe inquired if an intravenous injection was planned. He was told that none was planned, but that if he were to sing and yell for about an hour, his mouth would get dry, but the writer could squeeze a small stream into his mouth without interrupting his singing and yelling and his mouth would not get dry and sore. Big Joe nodded his head agreeably, tipped his head back, and began his bellowing. Little by little the sodium amytal was squirted into Joe’s mouth. He swallowed it as he sang and soon lapsed into sleep.

Having thus oriented the writer to his needs, Laskarri’s requests now became more personally meaningful. The writer moved his chair closer and Laskarri said, “Sleep-I dream awful dreams-you help.” Suggestions of hypnotic sleep were offered, and soon Laskarri was in a trance. He replied to questions of what he should do by answering, “Just let me sleep here in chair-awful dream-hurt-hurt.” Taking a chance, I told him, “Sit here in chair, don’t move, don’t wake up, just don’t hurt-just dream awful dream and then tell me.”

He seized my wrist, shuddered, perspired, and kept on shuddering and moaning. After some 15 minutes he aroused, stating, “My dream-I had it-I    got to keep dreaming until I find out.” What it was he had to find out he could not tell. But the next day he could tell the content of the dream, and he begged for further help because he must dream until he found an answer. The content of the dream was that he was being forced, shoved, pulled, yanked, twisted, and thrown through an endless, lightless corridor crowded and filled with bramble bushes, thorny bushes, crucifixion thorns, barbed wire, jagged spikes, long, penetrating slivers of glass, swords, daggers, all manner of painful lacerating, cutting things-a journey that would come to a sudden end with the knowledge that again he would have to traverse that painful way until he “found it.” Though approached many times, Laskarri never had revealed anything verbally to any of the hospital personnel. [MHA’s original manuscript was left in an incomplete form at this point. Questioning by Ernest Rossi completed the case history in 1978]

Rossi: What was the next step of your therapy with Laskarri?

Erickson: The next dream was of a similar character. I then told him to dream the same dream again with a different set of characters. In his next dream, instead of bramble bushes, he found himself dealing with a net full of fishhooks.

Rossi: This variation of the dream indicated that his unconscious was receiving your suggestions and that he had enough control within his inner processes to actually modify them in accordance with your suggestions.

Erickson: He repeated that dream with a number of people in it. He did not know who they were or even their sex, but they were fishing. Somehow or other they would snag him in that net full of fishhooks. In the next dream it was the same situation with another cast of characters on a grassy bank of a river with four people there all fishing. Three of them (two women and a man) kept catching him with their fishhooks. The fourth person, a man, caught a fish. He then fried this fish, and it smelled good.

The final dream was of an older brother of his who protected him; he was the one who caught and fried the fish that smelled so good in the previous dream. The other three people who caught Laskarri were his mother, father, and sister. These three were the hurtful people in his earlier life.

Rossi: Did you interpret that dream to him?

Erickson: No, he interpreted it to me! He said he could never get along with his father, mother, or sister, but he could get along with his brother, who always did good things for him. Then we discussed what he ought to do when he left the hospital.

Rossi: Most of his personality was intact; he just needed this insight. The bad dreams of the dark corridor with sharp cutting things were symbolic of the hurt arising from his early family situation. Do you agree that insight was the curative factor in this case? This was a case where the unconscious did have to be made conscious, as Freud believed.

Erickson: Yes. Familiarity breeds contempt. When you go through a painful situation again and again in a dream, changing it a bit each time, it becomes less painful.

Rossi: Yes, that is the desensitization technique of behavior therapy.

Erickson: I got into a lot of trouble over that case. The staff said I had no right to engage in the “unethical and unprofessional act” of sedating Big Joe that way while he was singing.

Rossi: But that act not only protected the ward, it also helped Laskarri gain a positive transference to you as that protective older brother.

Erickson: When he saw the difficulty I got into with the nurses and doctors over my undignified way of sedating Big Joe, that also helped him sympathize and establish rapport with me. The hospital staff did not realize I was actually carrying out Laskarri’s first request to put Big Joe asleep in a “different way.”

Ericksonian Brief Psychotherapy in the New Millennium: Immediate-Early Genes in the Deep Psychobiology of Psychotherapy Ernest Lawrence Rossi

Estimated reading time: 24 minutes, 48 seconds.

The traditional psychotherapies, ranging from classical psychoanalysis to current cognitive-behavioral schools, usually conceptualize communication in terms of verbal interactions between the therapist and patient. The brain and body in the early behaviorist school, for example, were labeled a “black box” that need not be taken into account in describing human behavior. In contrast to this traditional approach, Milton H. Erickson (1948/1980) emphasized that it was the experiential “reassociation,” “reorganization,” and “resynthesis” of one’s internal life that led to problem solving and healing as follows:

The induction and maintenance of a trance serves to provide a special psychological state in which the patient can reassociate and reorganize his inner psychological complexities and utilize his own capacities in a manner in accord with his own experiential life … Therapy results from an inner resynthesis of the patient’s behavior achieved by the patient himself. It’s true that direct suggestion can effect an alteration in the patient’s behavior and result in a symptomatic cure, at least temporarily. However such a “cure” is simply a response to suggestion and does not entail that reassociation and reorganization of ideas, understandings, and memories so essential for actual cure. It is the experience of reassociating and reorganizing his own experiential life that eventuates in a cure, not the manifestation of responsive behavior which can, at best, satisfy only the observer. (p. 38, italics added)

How are we to understand Erickson’s view of the reassocation and re­synthesis of experiential life? Is it simply a process of change that takes place in a kind of subjective phenomenological space of cognitions, fantasies, and dreams, or does it involve transformations in the organic structure and functioning of the brain and body, as well? This chapter proposes that the current information revolution in psychology and medicine on the cellular-genomic level is creating a new foundation for the understanding of Erickson’s view of “reassociation” and “resynthesis” as the essence of healing leading to lasting impressions in psychotherapy. Prominent researchers, for example, now regard immediate-early response genes (IEGs) as rapidly acting mediators between nature and nurture at the cellular-genomic level. The IEGs act as transducers, allowing brief signals from the external environment to regulate the expression of genes within the nucleus of life itself. It is now known that IEGs can transduce strong but brief signals of pain, trauma, stress, and novelty from the environment into enduring changes in the physical structure of the brain, as well as memory, learning, and behavior. This chapter explores how currently emerging understanding of the pathways of communication between mind and gene may become the psychobiological basis of Ericksonian brief therapy for creating lasting impressions.

IEGs AS THE FIRST RESPONSE TO EMOTIONAL AROUSAL

A generation ago, it was believed that genes were simply the units of physical heredity that were transmitted from one generation to another through sexual reproduction. Today, we know that different classes of genes have a number of other adaptive functions throughout the life cycle. A major class of genes, sometimes called immediate-early genes (or primary response genes or third messengers), that are actively  turned on and off every second of our lives in response to physical and psychosocial stimuli, are important in the continual process of adaptation to our changing environment. Everything from physical trauma and toxins to temperature, psychosocial stress, food, and sexual stimuli in the environment  can be signaled to neurons in the brain, where IEGs are turned on as the first step in the arousal of a creative response system at the molecular-genomic level, as illustrated in Figure 1.

{ADD FIGURE 1}

In step 1, IEGs initiate a series of molecular-genomic transformations that can transduce relatively brief signals from the environment into lasting impressions in the physical structure of the developing nervous system throughout life. When neurons of the brain transmit electrochemical signals to each other, IEGs are activated immediately as the first step in an adaptive response at the cellular-genomic level (Dragunow, 1995; Tolle, Schadrack, & Zieglgansberger, 1995).

Cfos, for example, is an IEG that is stimulated into activity by arousing or stressful environmental stimuli within neurons of the brain, where it leads to the production of a protein called “fos.” Fos can then act as a transcription factor that turns on “target genes.” That is, fos can bind on to the DNA molecule, where it can turn on target genes as illustrated in step 2 of Figure 1. These target genes are transcribed so that the information they contain can be sent to the cell in the form of messenger ribonucleic acid (mRNA). This mRNA then serves as a kind of blueprint for manufacturing the proteins in step 3 that are the bottom line for most processes of adaptation and healing on the material, energetic, and informational levels of life in response to psychosocial, as well as physical, stress and trauma (Rossi, 1986/1993, 1996, 1997a, 2002).

Many researchers now believe that memories, along with new experiences, are encoded in the central nervous system (CNS) by changes in the structure and formation of new proteins within neurons. IEGs function as transcription factors regulating downstream target genes that make the proteins within the neurons. Much current research is concerned with a number of families of IEGs involved with memory and learning, such as the egr family (also know as the zif 268 family, or krox -24 family). More than 100 IEGs have been reported so far. Although many of their functions still remain unknown, neuroscientists are exploring the complex range of interrelated biological and psychological functions that IEGs are already known to serve. It is precisely this simultaneous mediation of both the biological and psychological levels – the psychobiological – that recommends a central role for IEGs in understanding the foundations of mind-body medicine and psychotherapy, as illustrated in Figure 2.

{ADD FIGURE 2}

In the neurons of the CNS, the IEGs are now recognized as general or universal transducers responding to many classes of noxious environmental stimuli by inducing adaptive changes in gene transcription to facilitate the healing of stress and trauma caused by mechanical or physical injury, severed neurons, epilepticus, spreading cortical depression, viral and bacterial infections, drug intoxication, and the like (Merchant, 1996). Studies of the role of cfos are currently changing the face of pain research, for example, in both acute and chronic pain, in phantom limb pain, and in hyperalgesia and allodynia. (Tolle, Schadrack, & Zieglgansberger, 1995). Drugs dealing with pain, as well as related addictive drugs, such as cocaine, amphetamine, and the opiates, are also mediated by IEGs.  The implication is that IEGs are central in the  expression  of  the emotions,  moods, and behavioral addictions that are of prime interest in psychotherapy.

Most arousing environmental stimuli that have been studied can in­duce IEGs within minutes; their concentrations typically peak within 15 to 20 minutes and their effects are usually over within an hour or two (Rossi, 2002; Schlingensiepen, 1995). These rapid changes in gene transcription and new protein formation, however, can lead to enduring transformations in the CNS by converting short-term memory to long­ lasting learning by the process of long term potentiation (Bailey, Bartsch, & Kandel, 1996; Dragunow, 1995; Tully, 1996). Immediate-early genes are now also used as markers or indicators of changes in neuronal activity in psychopathological conditions, such as schizophrenia. Antipsychotic drugs are being designed to modulate the effects of IEGs on pathways leading to the production and utilization of neurotransmitters, such as dopamine, serotonin, and noradrenaline, that are implicated in the “dopamine hypo­thesis” of schizophrenia.

There is as yet no research relating to hypnosis or psychotherapy to the IEG-protein cascade in healing. Recent research on the relation of the IEG c-fos and nerve growth factor-induced A (NGFI-A) in the wake-sleep cycle, however, suggests how they may be related to patterns of arousal and relaxation in hypnotherapy. It has been found “that the expression of c-fos during waking is strictly dependent on the level of activity of the noradrenergic system: “high levels of c-fos during forced and spontaneous waking and low levels during sleep” (Cirelli, Pompeiano, & Tononi, 1998, p. 46). It is tempting to speculate that such stimulation of the noradrenergic system and IEG expression may be the molecular-genetic basis of healing in hypnosis. This leads us to propose that a truly deep psychobiological model of how psychotherapy works at the cellular level to facilitate the lasting impressions of mindbody healing on a physical level as well as on the emotional and mental levels, must involve these moleculargenetic levels.

PATHWAYS OF MIND-GENE COMMUNICATION IN ANXIETY AND DEPRESSION

Much of conventional counseling and psychotherapy consists of talk at an ordinary level of attention and emotional arousal. Genuinely transforming psychological experiences of therapy, however, usually involves some­thing more. Typically, the patient becomes emotionally aroused with highly focused attention when deeply significant psychological experiences are touched upon. Dramatic shifts in posture, mood, and emotional expressions, and tears, flushing, and breathing changes are all common accompaniments of the creative moments of psychological insight that can lead to lasting impressions and transformations of a patient’s life (Rossi & Cheek, 1988, 1990). Such emotional arousal, illustrated as step 1 in Figure 1, has been described in great detail, with varying emphasis and interpretation, in the classical literature of hypnosis and depth psychotherapy as abreaction, catharsis, reliving and reframing of posttraumatic experiences, creative moments of transformation, and so on (Rossi, 1973a, 1973b, 1996, 2002).

The first step in mind-gene communication in such emotionally arousing processes of psychotherapy takes place in the limbic-hypothalamic­ pituitary system, which is currently recognized as a major information transducer between the brain and the body. The pioneering physiologist Papez (1937) first traced the anatomical pathways by which emotional experiences of the brain were transduced into the physiological responses of the body in that system. The Scharrers (1940) and Harris (1948) then illustrated how the secretory cells within the hypothalamus could mediate molecular information transduction between brain and body. Cells within the hypothalamus transform the essentially electrochemical neural impulses of the neurons of the cerebral cortex that apparently encoded the phenomenological experience of “mind” and emotions into the hormonal messenger molecules of the endocrine system that are communicated to the body through the bloodstream in a cybernetic loop of information transduction, as described previously (Rossi, 1986/1993, 1996, 2002).

One of the first hormonal messenger molecules to be expressed in the hypothalamus in response to physical, as well as psychosocial, stress is corticotrophin-releasing factor (CRF). Within a minute, CRF signals the pituitary to release ACTH into the bloodstream as a primary messenger molecule, where it travels to the adrenals and signals them to release the next messenger, cortisol, into the bloodstream, where it can turn on cells throughout the entire body to activate their special functions to cope adaptively with stress. This major pathway from mind to molecules in response to stress has been called the hypothalamic-pituitary-adrenal (HPA) axis. During the emergence of stress, cortisol signals muscle cells to absorb fuel to facilitate the “fight or flight response,” while CRF de­ presses appetite and sexuality and sharpens alertness to cope with the environmental stressor.

Several decades of neurobiological research have documented that when there is a chronic stressor, activating the HPA axis to the point where the organism no longer can cope, the conditions are being set for depression. It has been shown that the pituitary and the adrenal gland are actually enlarged because of the hyperactivation of the HPA axis in depressed patients. Microscopic examination of the brain tissues of these patients reveals that there has been a proliferation of CRF-producing neurons in the hypothalamus and an overexpression of the CRF gene, leading to an elevation of CRF in the cerebrospinal fluid and the typical behavior of depression in humans, such as insomnia, decreased appetite and libido, anxiety, and negative cognition.

Although this excessive production of CRF can be reduced by antidepressants and electroconvulsive treatments, there are unwanted side effects. This has led some psychobiologically oriented workers to call for brain-imaging studies with positron emission tomography (PET) to deter­mine whether or not the activity of CRF-producing neurons and the expression of the CRF gene might not be  modified  by  psychotherapy  as well (Nemeroff, 1998). While such workers do not state it as explicitly as here, the direct implication of this research would be that appropriately focused mental activity in psychotherapy could modulate gene expression, as well as the anatomical structure of neurons in the hypothalamus of the human brain. This would clearly document how the mind can modulate molecules as well as how molecules can modulate the mind (Rossi, 1986/ 1993). This mutual modulation between mind and molecules is the essence of what has been called state-dependent memory, learning, and behavior (Rossi, 1990, 1996). This breakthrough in the Cartesian dichotomy between  mind and  body is well  expressed  by Andreasen  (1997, p. 1592) as follows.

A key point … is that the anatomy of melancholy can be modified by both psychological and chemical/ molecular experiences. The depressed state can often be reversed through treatment with drugs that affect the biogenic amine systems of the brain, but it can also be treated with cognitive therapies that attempt to reverse “negative sets,” and combination therapies are perhaps the most effective of all. Depression may be a consequence of the plastic response of mind/brain to experience, and it may also remit because of either pharmacological or psychotherapeutic manipulations of brain plasticity.

The concept of gene-protein dynamics as the final common path to healing integrates traditional physical medicine with mind-body models and becomes an important criterion for evaluating all forms of therapeutic communication and healing – biofeedback, body work, meditation, imagery, active imagination, hypnosis, prayer, ritual, yoga, or whatever – with a common yardstick. Whatever the therapeutic method, we can test whether it has really facilitated healing with relatively simple assays that determine whether appropriate genes are expressed in the form of mRNAs (step 2 of Figure 1) that serve as “blueprints” for the synthesis of proteins. A dramatic example is provided by Schanberg (Pauk, Kuhn, Field, & Schanberg, 1986; Schanberg, personal communication, 1998), who found that “isolated very premature human babies showed marked gains in weight, development and sympathoadrenal maturation” when they were massaged. He reports that in an animal model (pre-weaning rat pups), “The absence of nurturing touch suppresses ODC [ornithine decarboxylase] gene transcription by interfering with a cell’s ability to transduce the hormone receptor-activated signal. This is accomplished by the down regulation of specific immediate early genes essential to the synthesis of this growth regulating enzyme.” Such research literature implies that both touch and verbal suggestion can initiate gene-protein cascades to facilitate growth and healing at the cellular level. Further research may afford a new methodology for differentiating the relative merits of the many approaches to hypnosis and their therapeutic applications.

PSYCHOIMMUNOLOGY, STRESS, CANCER, ANDIEGs

The most comprehensive demonstration of how psychosocial stress can modulate gene transcription was demonstrated by Ronald Glaser (Glaser, et al., 1990; Glaser, Lafuse, Bonneau, Atkinson, & Kiecolt-Glaser, 1993). His research helps us trace the effects of psychological stress (experienced by medical students during academic examinations) on the transcription of the interleukin-2 receptor gene and interleukin-2 production. These re­ searchers, in essence documented the same path of information transduction illustrated in Figure 1 where (1) stress-activated IEGs in the limbic­hypothalamic-pituitary system lead to the release of hormones (primary messengers) that trigger (2) cell receptors to initiate a cascade of secondary messengers (cAMP) that mediate gene transcription of the interleukin-2 Skinnerian, imprinting, sensitization, etc.) involve the four-step cascade of Figure 1. Insofar as these classical forms of learning are initiated with IEGs leading to the formation of messenger molecules, they ipso facto have a “state-dependent component” (Rossi, 1986/1993; Rossi & Cheek, 1988, 1990; Rossi, 1996, 2002).

This four step cascade of information transduction between arousal and stress, immediate-early genes, messenger molecules, and the state-dependent encoding of mind body problems suggest a new research frontier for the psychobiological investigation of many classical psychoanalytic concepts, such as repression, dissociation, and emotional complexes. A new paradigm for such research has been provided by Cahill and associates (Cahill, Prins, Weber, & McGaugh, 1994), who compared the effects of the beta-adrenergic receptor antagonist propranolol hydrochloride on the long-term memory for an emotion-arousing and an emotionally neutral short story. Their results support the neuroscience paradigm of how enhanced memory associated with emotional experiences involves activation of the messenger molecules of the beta-adrenergic system. It would require only a simple extension of their method to document how the arousal phase of a psychobiologically oriented psychotherapy is mediated by the activation of similar messenger molecule-receptor systems.

A NEW PSYCHOBIOLOGICAL APPROACH TO PSYCHOTHERAPY

How long does it take to process one complete cycle of communication between mind and gene in Figure 1? Detailed research on the genetic, neuroendocrinal, and psychosocial levels suggests that the 90-120-minute ultradian rhythm (Lloyd & Rossi, 1992, 1993), originally described as the “basic rest-activity cycle” by K.leitman, is a more fundamental “work cycle of life” than the circadian cycle (the 24-hour rhythm). Ultradian in this context means any rhythm faster than the 24-hour circadian cycle; in this chapter, we focus on the major 90-120-minute ultradian rhythms on the genetic, endocrine, and cognitive-behavioral levels during sleeping and waking that have important implications for a new understanding of how all the systems of traditional psychophysiology are actually coordinated in time.

When the 90-120-minute ultradian cycle of mindbody communication of Figure 1 is unfolded over time we get graphs of the alternating ultradian rhythms of activity and rest on the genetic, endocrine and cognitive behavioral, as illustrated on the lower part of Figure 3 (Rossi, 1996). This coordination of the diverse systems of traditional psychophysiology via their time parameters has been called the “Unification Hypothesis of Chronobiology” (Lloyd & Rossi, 1992; Rossi & Lippincott, 1992; Rossi, 1986/1993). This new understanding of the chronobiology of our natural psychophysiology from the molecular-genetic to the cognitive-behavioral levels may be taken as a new database for understanding the dynamics of mind-body communication and healing in psychotherapy.

The lower part of Figure 3 summarizes the alternating 90-120-minute ultradian rhythms of the awake and sleep states of an entire day in a simplified schematic manner. The ascending peaks of rapid eye movement (REM) sleep characteristic of nightly dreams every 90-120 minutes or so are illustrated along with the more variable ultradian rhythms of activity, adaptation, and rest in the daytime. Figure 3 also illustrates how many hormonal messenger molecules of the endocrine system such as growth hormone, the activating and stress hormone cortisol, and the sexual hormone testosterone have a typical circadian peak at different times of the 24-hour cycle. Because the nonlinear chronobiological release of many of these hormones (Rossi, 1988) is recognized as having profound state­dependent effects on memory, learning, emotions, and behavior through­out the day, it is important to consider their relevance for new models of psychotherapy.

{INSERT FIGURE 3}

The upper part of Figure 3 illustrates my conjecture (Rossi, 1996) that the natural unit of psychobiologically oriented psychotherapy may be a utilization of one 90-120-minute ultradian cycle of activity and rest. In support of this idea, we may cite much research of the type illustrated by Iranmanesh, Lizarralde, Johnson, and Veldhuis (1989), for example, who documented how the ultradian peaks of cortisol secretion that lead to psychophysiological states of arousal every 90-120 minutes or so throughout the day (that I label as “Ultradian Performance Peaks” in Figure 3) are typically followed after about 20 minutes by ultradian peaks of beta endorphin that lead to rest and relaxation that I label as “Ultradian Healing Responses” (Rossi, 1996; Rossi & Nimmons, 1991). It appears as if nature has built in a natural but flexible and highly adaptive ultradian rhythm of activity, rest, and healing, the “work cycle of life” mentioned above, every 90-120 minutes.

What, exactly, is the “work” that is done in each 90-120-minute ultradian cycle? I propose that the essence of such work is the formation of new proteins for a creative response to changing environmental conditions, stress and healing as described above particularly in the research of Todorov (1990). Twenty-five years ago (Rossi, 1972/1985/2002), I formulated “The Dream-Protein Hypothesis: Recent studies of learning and memory indicate that new experience is encoded by means of protein synthesis in brain tissue … dreaming is a process of psychophysiological growth that involves the synthesis or modification of protein structures in the brain that serve as the organic basis for new developments in the personality” (Rossi, 1973a, p. 1094). While recent research has documented that new proteins are synthesized in some brain structures associated with REM dream sleep, such as the nucleus raphe dorsalis and the locus ceruleus (Sokolova, Taranova, & Kudriavtseva, 1992; Smith, Tenn, & An­nett, 1991), the significance of such protein synthesis for humans during dreaming remains controversial (Flanagan, 1996). As a seminal hypothesis for Ericksonian approaches in the future, however, I would generalize the dream-protein hypothesis to include all states of creativity associated with the peak periods of arousal and insight generation in psychobiologically oriented psychotherapy as illustrated with clinical case histories elsewhere (Rossi, 1996, 2002). It will require extensive cooperation between psycho­therapists and researchers to document this new psychobiological vision of the essence of Erickson’s (1948/1980) synthetic approach as quoted above.

SUMMARY

To summarize, then, this chapter outlines an evolving view of how Milton Erickson’s brief approaches to facilitating lasting impressions in the experience of reassociating, reorganizing, and resynthesizing emotional life “eventuates in a cure” on the molecular-genomic level. Current research on IEGs is providing a new database for understanding the fundamentals of the effects of novelty, pain, and stress on addictions, mood, depression, psychoimmunology, and a variety of issues of central concern to the psychotherapist. The pathways of mind-gene communication and healing that may lead to a new era of psychobiological healing whereby the mind could modulate the transcription and expression of certain classes of genes as the “bottom line” of healing are discussed. A psychobiological approach to hypnosis that is consistent with much of the classical theories of psychoanalysis and psychosomatic medicine, as well as the modern neuroscience of memory and learning at the cellular-genomic level, is proposed. This new integration of theory and research leads to a psychobiological model of how we may utilize the creative process in a manner that may seem visionary to some. Such a visionary ideal, however, may be what we need to develop truly new and inspired approaches to healing in the new millennium.

Note Added in Proof

Castes et al. (1999) reported that a 6-month program of relaxation, guided imagery, and self-esteem workshops with asthmatic children reduced the number of illness episodes and medication. The children had a significant increase in natural killer’s cells and other immune system factors associated with a reduction of psychosocial stress. These children had an increase in gene expression of the T-cell receptor for interleukin-2 as hypothesized (on page 376 of this chapter to text the mind-gene pathway of healing in psychotherapy). Eric Kandel (1998), who received the Noble Prize for Medicine in 2000, describes mind-gene concepts in this way.

Insofar as psychotherapy or counseling is effective and produces long-term changes in behavior, it presumably does so through learning, by producing changes in Gene Expression that alter the strength of synaptic connections and structural changes that alter the anatomical pattern of interconnections between nerve cells  of the brain the regulation of gene expression by social factors makes all bodily functions, including functions of the brain, susceptible to social influences. These social influences will be biologically incorporated in the altered expressions of specific genes in specific nerve cells of specific regions of the brain. (p. 460)

References

Andreasen, N. (1997). Linking mind and brain in the study of mental  illness:  A project for a scientific psychopathology. Science, 275, 1586-1593.

Bailey C.H., Bansch, D., & Kandel, E. R. (1996). Toward a molecular definition of long-term memory storage. Proceedings of the National Academy of Science. USA, 93, 13445-13452.

Brey, D. (1995). Protein molecules as computational elements in living cells. Nature, 376, 307-312.

Cahill, L., Prins, B., Weber, M., & McGaugh, J. (1994). /3-Adrenergic activation and memory for emotional events. Nature, 371(10), 702-704.

Castes, M., Hagel, I., Palenque, M., Canelones, P., Corano, A., & Lynch, N. (1999). Immunological changes associated with clinical improvements of asthmatic chil­ dren subjected to psychosocial intervention. Brain & Behavioral Immunology, 13(1), 1-13.

Cirelli, C., Pompeiano, M., & Tononi, G. (1998). Immediate early genes as a tool to understand the regulation of the sleep-wake cycle: In situ hybridization, and anti­ sense approaches. In R. Lydic (Ed.), Molecular regulation of arousal states. New York: CRC Press.

Davson, H., & Segal, M. (1996). P/rysiology of the CFS and blood-brain barriers. Boca Raton, FL: CRC Press.

Dragunow,  M. (1995). Differential  expression  of immediate-early genes during  syn­aptic plasticity, seizures and brain injury suggests specific functions for these mol­ecules  in  brain  neurons.  In  T.  R. Tolle, J. Schadrack,  and  W. Zieglgansberger {Eds.), Immediate early genes in the CNS. New York: Springer-Verlag.

Erickson, M. (1948/1980). Hypnotic psychotherapy. In E. Rossi (Ed.), 1be collected papers of Milton H. Erickson on /rypnosis. Vol. 4. Innovative lrypnotherapy (pp. 35- 48). New York: Irvington.

Flanagan, 0. (1996). Deconstructing dreams: The spandrels of sleep. In S. Hameroff, Kaszniak, & A. Scott (Eds.), Toward a science of consciousness: The first Tucson discussions and debates (pp. 67-88). Cambridge, MA: MIT Press.

Glaser, R., Kennedy, S., Lafuse, W., Bonneau, R., Speicher, C., Hillhouse, J. & Kiecolt-Glaser, J. (1990}. Psychological stress-induced modulation  of interleukin 2 receptor gene expression and interleukin 2 production in peripheral blood leu­kocytes. Archives of General Psychiatry, 47, 707-712.

Glaser, R., Lafuse, W., Bonneau, R., Atkinson, C., & Kiecolt-Glaser, J. (1993}. Stress­ associated modulation of proto-oncogene expression in human peripheral blood leukocytes. Behavioral Neuroscience, 107, 525-529.

Hadamard, J. (1954}. 7be psychology of invention in the mathematical field. New York: Dover.

Harris, G. (1948). Neural control of the pituitary gland. Physiological Review, 28, 139-179.

Iranmanesh, A., Lizarralde, G., Johnson, M., & Veldhuis, J. (1989}. Circadian, ultradian, and episodic release of /j-endorphin in men, and its temporal coupling with cortisol. Journal of Clinical Endocrinology and Metabolism, 68, 1019-1026.

Kandel, E. (1998). A new intellectual framework for psychiatry? 7be American Jour­nal of Psychiatry, 155, 457-469.

Kraus, M., & Wolf, B. (1996). Structured biological modeling: A new approach to bio­ physical cell biology. Boca Raton, FL: CRC Press.

Lloyd, 0., & Rossi, E. (1992). Ultradian rhythms in life processes: A fundamental in­quiry into chronobiology and psychobiology. New York: Springer-Verlag.

Lloyd, D., & Rossi, E. (1993}. Biological rhythms as organization and information. Biological Reviews, 68, 563-577.

Merchant, K. (Ed.). (1996). Pharmacological regulation of gene expression in the CNS. Boca Raton, FL: CRC Press.

Nemeroff, C. (1998). The neurobiology of depression. Scientific American, 278, 42-49. Papez, J. (1937). A proposed mechanism of emotion. Archives of Neurology and Psy­chiatry, 38, 725-744.

Pauk, J., Kuhn, C., Field, T., & Schanberg, S. (1986}. Positive effects of tactile versus kinesthetic or vistibular stimulation on neuroendocrine and ODC activity in maternally-deprived rat pups. Life Sciences, 39, 2081-2087.

Rosenberg, S., & Barry, J. (1992). 7be transformed cell: Unlocking the mysteries of can­cer. New York: Putnam/Chapmans.

Rossi, E. (1972/1985/2000). Dreams, consciousness, spirit (3rd edition of Dreams and the growth of personality). Phoenix: Zeig, Tucker, & Theisen.

Rossi, E. (1973a). The dream-protein hypothesis. American Journal of Psychiatry, 130, 1094-1097.

Rossi, E. (1973b}. Psychological shocks and creative moments in psychotherapy. American Journal of Clinical Hypnosis, 16, 9-22.

Rossi, E. (1986/1993). 7be psychobiology of mind-body healing (rev. ed.) New York: Norton.

Rossi, E. (1990). From mind to molecule: More than a metaphor. In J. Zeig & S. Gilligan (Eds.), Brief therapy: Myths, methods and metaphors (pp. 445-472). New York: Brunner/Maze!.

Rossi, E. (1996). 7be symptom path to enlightenment: 1be new dynamics of self organization in hypnotherapeutic work. Pacific Palisades, CA: Palisades Gateway Publishing.

Rossi, E- (1997a). The symptom path to enlightenment: The psychobiology of Jung’s constructive method. Psychological Perspectives, 36, 68-84.

Rossi, E. (1997b). The Feigenbaum scenario in a unified science of life and mind. World Futures, 49, 3-4; part II, 50, 1-4.

Rossi, E. (1998). The Feigenbaum as a model of the limits of conscious information processing. BioSystems, 40, 1-10.

Rossi, E. (2002). 7be psychobiology of gene expression: Neuroscience and neurogenesis in hypnosis and the healing arts. New York: Norton.

Rossi, E., & Cheek, D. (1988). Mind-body therapy: Jdeodynamic healing in hypnosis. New York: Norton.

Rossi, E., & Cheek, D. (1990}. Ideomotor healing of burn injuries. In E. C. Ham­ mond (Ed.), Handbook of hypnotic suggestions and metaphors. New York: Norton.

Rossi, E., & Lippincort, B. (1992). The wave nature of being: Ultradian rhythms and mind-body communication. In D. Lloyd & E. Rossi (Eds.), Ultradian rhythms in life processes: A fundamental inquiry into chronobiology and psychobiology (pp. 371-402). New York: Springer-Verlag.

Rossi, E., & Nimmons, D. (1991). 7be twenty minute break: Using the new science of ultradian rhythms. Phoenix: Zeig, Tucker, & Theisen.

Schacter, D. (1996). Searching for memory: 1be brain, the mind and the past. New York: Basic Books.

Schanberg, S. (1998). Early life experiences and the developing brain: consequences on mind and body. Presented at the Sedona Conference on the Science and Prac­tice of Mindbody Interactions.

Scharrer, E., & Scharrer, B. (1940). Secretory cells within the hypothalamus. In re­search publications of the Association of Nervous and Mental Diseases. New York: Hafner.

Schlingensiepen, K., Kunst, M., Gerdes, W., & Brysch, W. (1995). Complementary expression patterns of c-jun and jun B in rat brain and analysis of their function with antisense oligonucleotides. In T. Tolle, J. Schadrack, W. Zieglgansberger (Eds.), Immediate early genes in the CNS. New York: Springer-Verlag.

Smith, C., Tenn, C., & Annett, R. (1991). Some biochemical and behavioral aspects of the paradoxical sleep window. Canadian Journal of Psychology, 45(2), 115-124. Sokolova, N., Taranova, N., & Kudriavtseva, I. (1992). The normalizing pattern of some behavioral and neurochemical parameters after paradoxical sleep depriva­tion in rats. Fiziologicheskii Zhumal SSSR im L M. Sechenova, 78(5), 9-16.

Todorov, I. (1990). How cells maintain stability. Scientific American, 263, 66-75.

Tolle, T., Schadrack J., & Zieglgansberger, W. (Eds.) (1995). Immediate early genes in the CNS. New York: Springer-Verlag.

Tully, T. (1996). Discovery of genes involved with learning and memory: An experi­mental synthesis of Hirschian and Benzerian perspectives. Proceedings of the Na­tional Academy of Science. USA, 93, 13460-13467.

Ericksonian, Cognitive, Behavioral, Strategic, or All Four? Betty Alice Erickson Estimated reading time: 28 minutes, 8 seconds.

When I read about the different schools of psychotherapy or hear addresses by leaders in various methods of therapy, I often have difficulty sorting out what is Ericksonian and what is better named strategic or brief or cognitive or behavioral therapy. Sometimes, it all seems to be the same. And most of the time, it doesn’t matter what the method is called as long as the client receives the needed help. I do think, however, that understanding the basics of Ericksonian psychotherapy and seeing their connections to the multiplicity of current therapies gives modern therapists clarity to define their own stances and philosophical frameworks. We all want to give our clients what they need in ways that are most palatable and understandable to them. Picking and choosing conceptualizations, approaches, and interventions from the various schools, becoming truly eclectic, is one way to do that.

Before Milton H. Erickson, M.D., there were just a few somewhat rigid theories, sweeping generalizations, and only a few “right” ways to do therapy. Therapy, once began, often became part of a person’s life essentially forever. It was not uncommon for a patient to see a therapist multiple times a week for years and years.

The patient’s personal history and recollection of past events were deemed of paramount importance. They were examined in great detail for reasons and understanding. Insight was a requirement for change. Change without insight was considered superficial and not long lasting; it was not really change at all.

Symptoms were regarded as entities in themselves – a behavior that was “needed” or required for the level of functionality that the patient displayed. “Curing” or altering a symptom was foolhardy. It was thought that the symptom well might reappear in a different, and probably more harmful, manifestation.

Psychotherapy, necessarily, became limited to those people who had the time, money, and energy to spend years examining themselves and their remembered past, and coming to insightful understanding about their present lives. Obviously, great numbers of people who had troubles and who were struggling to make better lives could not get psychotherapeutic help.

Erickson played a very large part in revolutionizing this way of doing therapy. He built a bridge between that kind of psychotherapy, the psychotherapy of his time, and his own conceptualizations and ideas. These ideas, these bridges, have helped create many of the modern schools of therapy.

Erickson believed that theories were too restrictive for the infinite variety and variations of the human race and the infinite creativity of human thinking and behavior. So Ericksonian psychotherapy has remained atheoretical. That may be good for the client, but it is not so good for ease of understanding by students. There is simply no way to fit what is done in Ericksonian psychotherapy into a neat tidy theory.

Nothing in Erickson’s life altered his fundamental belief about the inadequacy of a single theory of human function and dysfunction. His work in prisons and mental hospitals, the psychiatric examination of thousands of military inductees during World War II, his work with the courts and the legal system, his private practice, and his work with students all emphasized that people are different. People live functional, productive, and happy lives in an infinite variety of ways, and they think and behave in infinitely creative ways. Creativity and problem-solving abilities are the frameworks of human behavior.

In 1990, at the second Evolution of Psychotherapy Conference, Ar­nold Lazarus, who is clearly identified as a noted cognitive-behavioral therapist, alluded to that thought when he advocated a “flexible personal therapeutic stance that tries to calibrate the goodness-of-fit of the treatment to the client’s basic style.” He continues with the quotation from Erickson that Jeffrey Zeig and Stephen Gilligan use to preface the front of their edited book, Brief Therapy. “Each person is a unique individual. Hence psychotherapy should be formulated to meet the uniqueness of the individual needs, rather than to tailor the person to fit the procrustean bed of a hypothetical theory of human behavior” (1990, p. 103). (Zeig, in a footnote to Lazarus’ comment, explains the history of that quotation. Erickson selected it when asked for a statement for the promotional literature for the first International Congress on Ericksonian Hypnosis and Psychotherapy held in 1980.)

Erickson believed insight was not always important. He focused on productive change, with or without understanding and insight. The future was truly “yet to be” and was rarely ordained by the past. A person’s past was just that – past, even though personal perceptions of that past were highly changeable.

Therapy could often be very brief. There is a story Erickson used to tell. When he was growing up, there was a young man in his small home town who was well known as a troublemaker. That young man’s life was changed completely by just one moment of meaningful interaction. He asked the prettiest girl in town if he could take her to a Friday night dance. According to Erickson, she looked the young man up and down and said, “If you’re a gentleman, you can.” And so he became a gentleman. He turned his dysfunctional behaviors into ways of productive living. Was that really therapy? I am not sure. But I am sure that, without insight, and without examining his past, this young man rebuilt his life in wholesome ways that earned him more pleasure and rewards.

Understanding the concepts of how and why the man was able to change and move forward with his life, as well as concepts of Ericksonian psychotherapy overall, is central to comprehending the wide variety of therapeutic approaches competing for our attention today, including Strategic, Brief, Cognitive, Solution-Focused, and Behavioral therapy, among others. Many of these concepts, Erickson helped to create. Some of these ideas provided a foundation for changes and the current proliferation of a broad range of different orientations. And more important, many of these changes have become standards of modern therapy.

There are all kinds of ways to do therapy, but they include very few “right,” rigidly structured methods. Theories mostly have taken second place to practicalities, and people are recognized for their individualism and differences. Therapy is “supposed” to be quick, brief, goal directed, future focused, and aimed at returning the clients to more productive, and happier lives. Much of the time it is not necessary to understand the reasons for behavior; change is what counts. And all of these ideas were pioneered by Erickson. With the pace of life becoming faster and faster, and the increasing emphasis on immediate gratification, psychotherapy is almost certain to continue to move, in fact, to gallop, in the direction of brief, strategic, practical, reality-based, and future- and goal-focused work. Insight and the understanding of patterns, systems, and theories will probably become less and less important, although they will still be relevant. Managed care certainly approves of this trend, and will do its best to continue and promote it.

Any number of people and events have taken part in the inventing and reinventing of psychotherapy. Any number of dedicated professionals have been working, studying, and experimenting with the human condition for countless years. There has always been available a community warehouse and wealth of knowledge about human psychology. Therapists, known and unknown, have played significant roles in the creation and promotion of very important advances in psychotherapy.

Erickson was fortunate in that his work was studied by some very bright hardworking students who were able to take some of what he taught them and teach it to others. I do not mean to imply that Erickson was the sole originator of some of the ideas and techniques for which he has become so famous. But this chapter is about understanding the underpinnings of Ericksonian psychotherapy. All good and effective therapies have commonalities. Respect for the individual, plans for a productive future, enjoyment of life, the overcoming of obstacles, the promotion of self-responsibility are all hallmarks of a wholesome and responsible life and are all parts of good therapy. Certainly Erickson did not invent this!

His methods of achieving these goals were often very different from other methods. He understood the unconscious to be a storehouse of resources and abilities, he relied on the strengths of the individual, and he used the client’s own world, own resistance, as a tool for change. That, and his careful observation of and attention to details and language, created a framework of therapy so flexible, and yet so individualistic, that it is timeless.

There are inherent limitations in attempting to encapsulate an entire psychotherapeutic theory in a sentence or two. This is certainly true for Erickson’s multi leveled and apparently simplistic, yet complex, work. It is just as unfair to pull a sentence or two from other schools of therapy, and through these sentences show a connection to Erickson’s work. Additionally, much good therapy overlaps. Should a particular approach be identified as Cognitive? Solution-Focused? Behavioral? Strategic? Narrative? The subtleties between the different names are virtually impossible to sort out.

Here is where the one of the real gifts of Erickson’s works lies. His framework for psychotherapy was so flexible that many of his ideas and methods have been incorporated into other schools. Understanding the versatility and applicability of his work as a source for some of these conceptualizations and methods broadens perspectives and allows each of us to become just a little more knowledgeable about psychotherapy. Familiarity with his work, and with the work of those who studied with him, heightens our ability to view other branches of psychotherapy more clearly.

Casework done from an Ericksonian point of view blends with, and supports, other types of more “modern” psychotherapy. This is true even when at the surface the problem and the intervention are strictly Ericksonian. Hypnosis, for example, is inextricably linked with Erickson’s work. The underlying principles of much of the use of hypnosis, however, are the same principles that underlie other schools of therapy. Hypnosis is, after all, a technique for communication and for accessing the client’s own resources. In an article in the Milton H. Erickson Foundation Newsletter (vol. 16, no. 2), I described a client with whom I had worked who had been referred to me for hypnosis to help him learn to swallow pills. He had always found it difficult to take them, and, in childhood, his mother had accommodated him by crushing the pill and mixing it with applesauce. Later, he simply tried to avoid pills. And when he really needed to take one, he would grit his teeth and chew it no matter how bad the taste.

He now has a serious illness and must take up to 30 pills a day. Avoiding pills not only no longer is an option, but some of the tablets must be swallowed intact if they are to work effectively. He knew he was being illogical. He had no trouble eating, and realized that pieces of food he swallowed were often larger than tablets. He also could swallow gum. But he gagged if he tried to swallow pills.

I could have worked with this client about possibly unresolved issues with his mother. Perhaps he had a fear of self-responsible adulthood, and this was a symptom of deeper underlying issues. Perhaps his illness was so frightening that a part of him wanted to avoid medication, and this was one way to do it. Perhaps his habitual behavior precluded open and flexible thinking. I didn’t know, and I didn’t think it was important.

From an Ericksonian standpoint, the therapist works with the world of the client. This client’s world was simply that he wanted to learn to swallow pills – briefly, quickly, and without trying to know the unknowable reasons “why” he couldn’t.

Ericksonian therapists also have a penchant for dealing with the simplest symptoms first. Changing one small part of a person’s thought pattern or behavior often creates an unexpected number of other changes. Also, it is more respectful to the client to address issues from the “top down,” so to speak. Finding pathology from a particular symptom usually isn’t respectful or helpful.

My client wanted to be hypnotized into swallowing pills. I could have helped him achieve that goal by relying strictly on his definition. I could have used my authority as the hypnotist to command – or I could have given a posthypnotic suggestion.

I also could use his world to teach him about his unconscious and underutilized resources. When I teach hypnosis, I talk about how we all have such resources. Most of us do not consciously realize that we can manipulate blood-circulation patterns; he didn’t believe he could. I told him that if I were to say just a few words, he would know he could manipulate part of his circulatory pattern. He would blush. I waited a moment while he thought of the words I might say, and he blushed, just as I did when Erickson used that example with me when I was learning formal hypnosis.

I pointed out that I hadn’t even said those words. He had manipulated the circulatory pattern in his face all by himself, and simply by the power of his unconscious resources.

The next week, he told me had thought a great deal about how he could manipulate his blood flow. He had spent hours thinking about how he did it and blushing again and again until he could blush whenever he wanted. He demonstrated.

He had decided, he then said, that if he could do that seemingly impossible feat, controlling his gag reflex in order to swallow a few pills had to be simple. He had imagined the pills going down his throat smoothly, without triggering his gag reflex, until he could take his pills easily. He proudly demonstrated his newly recognized abilities.

Erickson said, in 1976, that if you really want to prove something to a client, let that proof come from within the client. Cognitive therapy points out that one of its goals is to help the client become his or her own therapist. Therapists do not need to confront or challenge the client’s beliefs head on to produce change. It seems to me that my client proved something to himself – that he became his own therapist (Meich­ enbaum, 1992).

Behavioral therapy, which has a great deal of empirical research substantiating it, recognizes that imagery is a powerful conditioning and reconditioning tool. Calmness of relaxation is often juxtaposed against anxiety as clients learn to overcome their stress with regard to a particular situation (Wolpe, 1997). As that young man imaged pills moving smoothly down his throat, I don’t know if he was in a self-hypnotic trance, or merely imaging comfort and relaxation. But I do know he changed, without having to receive any new information, and without my confronting and dealing with his illogical beliefs. He didn’t need insight or self-under­standing. Perhaps he “desensitized” himself by the imagery, perhaps he corrected his faulty thinking, perhaps he gained flexibility in thinking, perhaps … who knows? I don’t even know if I, an Ericksonian therapist, can declare this a therapeutic success, let alone put it in the column of Ericksonian psychotherapy.

Strategic therapy aims to be quick and dynamic therapy, finding ways to solve problems and recognizing that changing one part of a dynamic system necessarily affects the rest of the system. Erickson called this method of change “the snowball effect,” comparing it to a snowball rolling down a hill, gathering snow and bits of grass and leaves while changing its size and appearance.

In 1964, one of my friends saw Erickson for one lengthy session. She had a three-year-old daughter diagnosed as borderline microcephalic – the child’s brain was going to remain small and poorly developed. The little girl’s abilities and disabilities were oddly scattered. She had never uttered an intelligible sound, but she understood rather complex sentences and sequencing. She lacked certain abilities usually found in children her age, but she was able to perform beyond her years in other areas.

The mother had been advised to institutionalize her. The girl would take time from the family’s other children, she would not develop further mentally, and, as she got older, she would probably become rageful and difficult to control physically. The mother came to see Erickson, tearful and frightened. Afterwards, she told me only that Erickson had asked her questions that made her think. Over the ensuing years, we both moved several times and lost track of each other. When Erickson died, almost 15 years after her only visit with him, she called me. She said she wanted to tell me what had happened in that session. She said she had cried very hard as she told Erickson about her fears for the future and the dismal outcomes the other doctors had predicted. When her tears finally ceased, Erickson told her one thing that changed her life. “No one knows the future,” he said. “No one. But you can prepare for a future that may be possible.”

She said he then began asking questions. What did my friend really want for her child? How could she use her daughter’s attributes as a foundation for her life? By the time the session was over, my friend felt hopeful. She knew her daughter’s life would be difficult, but she knew she could prepare for a possible future. She had gone from “problem talk” to “solution talk” my friend said, using the language of Solution-Focused Therapy even though she knew nothing about that psychotherapeutic orientation (deShazer, 1988). My friend told me that her daughter, now a young woman, was happy and busily raising show rabbits that had won numerous prizes throughout the country. She even earned a modest income through the sale of her animals. The daughter needed help in keeping records, her mother acknowledged, but she did all the other work. “You don’t need words to communicate with rabbits,” my friend told me. “You don’t even need words to communicate to other rabbit fanciers – the animal speaks for itself.” I know Erickson didn’t plan this life for my friend’s daughter. After all, no one knows the future. But his statement opened new doors in her mother’s thinking.

The constructivist narrative perspective of Cognitive Therapy, as described by Don Meichenbaum (1997) at the third Evolution of Psychotherapy Conference, conceptualizes this dynamic way of working with patients. Patients are viewed as “meaning-making agents who proactively create their own personal realities” (p. 100). This type of therapy, he says, is both exploratory and discovery oriented, with the therapists helping the clients to see how their personal realities are created and the consequences, both good and bad, that are a result of those created realities. Sounds exactly like what Erickson did with my friend. Almost all formal definitions of psychotherapy include mention of some sort of client education. Cognitive therapist Aaron Beck (1997) defines it as “modification of dysfunctional thinking” (p. 56). Multimodal therapist Arnold Lazarus (1997) says education in therapy deals with missing information.

Erickson’s (1980) view of education fits well within his definition of therapy – that is, helping the “patient achieve a legitimate personal goal as advantageously as is possible” (p. 382). His way of teaching included two often overlooked, but vitally important, parts of Ericksonian psychotherapy – utilization and seeding.

Utilization is using whatever the client presents, whenever the opportunity presents itself, to reach the goal of therapy. “Whatever the patient presents to you … you really ought to use” (Erickson & Rossi, 1981, p. 16). Because the therapist is using what is brought by the client, the client’s world, it ensures that the therapy, the information, is given in ways meaningful to the client. Erickson would frequently use a necessary part of life to teach people to expand their lives, as well as to provide them with a way of thinking that would help them learn the enjoyment-seeking alternatives and options. In that way, the learner, be that learner a patient or a student or Erickson’s own child, would become more flexible and creative in the personal search for betterment. At the 1990 Evolution of Psychotherapy Conference, Albert Ellis (1992) talked about the importance of flexible, open-ended thinking. At that same event, Meichenbaum (1992) discussed schemata, the cognitive representations of past experiences that assist and influence the construction of current experiences and the organization of new information, or how people create data that confirm views. Sounds like what Erickson was doing.

Erickson used virtually everything as a teaching tool. He appreciated hard work; most of those associated with him learned to value work on many levels. When he assigned tasks to us children, which he never hesitated to do, he often used that work to help us learn to think creatively. I don’t think that mowing the lawn in Phoenix, Arizona, in the summer could ever be classified as real fun. However, even as we were complainingly lugging out the lawn mower, Erickson would ask, in an interested way, if we thought we could get the job done faster if we mowed in circles, or maybe in diagonal lines. Perhaps if we mowed a strip on the part close to the end and then “forgot to remember” that strip, the welcome, almost surprise, sight of that already mowed part would make it seem as though the job were moving faster. In other words, he was teaching us to approach life with creativeness and curiosity, to utilize what was in our life as a way of enhancing it. To this day, if I have a repetitive task, I figure out different ways to do it and how to do parts in the middle so I can have a pleasant “surprise” as I come upon a completed bit.

My brother, Lance, in the keynote panel address for the 1983 International Congress on Ericksonian Psychotherapy, talked about sweeping the basement when he was a youngster in the 1940s. Lance was interested in the Civil War, and Erickson discussed with him how the cracks and lines on the concrete floor could be seen as boundaries between countries. The dust and debris could be seen as armies. Then Erickson asked Lance if he thought that if the armies fought battles over and through the boundaries, the results would be the same each time. With that careful setup and the curious question, Erickson invited his young son to construct the reality of sweeping the basement floor in a more pleasurable way (Erickson, 1985).

The same framework for thinking was provided in many different ways. All of the Erickson children walked at least a mile to and from their various schools. We don’t remember those daily walks as drudgery. We remember some of the things we learned from what I now realize was Erickson’s carefully constructed paradigm. Did the flowers on the north side of the street bloom before those on the south side? How many short­ cuts could we find, and how much shorter were they really? Did some longer ways actually take less time because the environment was different? How much of our homework could we get done in our heads on the way home? Erickson obviously was not doing therapy on us. However, the concept is the same. He was helping us to create a flexible view of the realities of life that, in turn, would create a flexible way of constructing data for the rest of our lives. Our personal schemata of our tasks just as easily could have been created so that there was no creative pleasure or intellectual curiosity in the drudgery. But Erickson carefully structured and seeded a way of constructing reality, using natural curiosity and the inclination to find “easier” ways of doing work. He utilized what we brought in to seed more productive ways to achieve goals.

Erickson looked at this type of seeding as a farmer looks at seeding crops. If you sow enough seeds, some of them will take root and grow – especially if you are wise enough not to keep going back and pulling them up to see if they have sprouted. Even in the autographing of books, Erickson sought to seed information. My son, at age 10, was noted for his carefree, nonchalant attitude. Erickson’s inscription in one of his books to Michael referred to a time when Michael had thoughtfully planned for the future of his pet birds, which had to be left behind when our family moved back to the United States from overseas. My son cherished what was written; he quoted it many times during his growing up, usually when he was being chastised for some impulsive behavior. As an adult, he still credits Erickson for being the first to recognize his “foresight in planning for the future.”

I don’t know for certain that the inscription helped him mature. I do know he thinks it influenced him. His personal reality, his schema for life, began to incorporate planning for the future as a counterpoint to his inclination to impulsivity. Deliberately creating interventions that invited a client to provide his or her own meaning, to become his or her own therapist, was a strong point in Erickson’s methods and is a goal of Cognitive Behavioral Therapy (Meichenbaum, 1997). Resistance is side-stepped as the clients truly become the experts on themselves, and independence is fostered. I don’t have to go too far to find ways in which Erickson did that. He advised hundreds of people to climb Squaw Peak, but rarely told them what he expected them to get out of the hike. Because people could create their own meanings, the hike meant whatever the person needed it to mean. Sometimes he structured the event for a positive interpretation, knowing that this would help the client’s overall sense of self. He knew, as the late Viktor Frankl espoused so poignantly and meaningfully, that people always search for meaning. He believed that if a positive meaning is implied, people are likely to adopt that positive definition. I recently talked with a patient who had seen Erickson in the mid- 1950s. While working with him, she had learned Origami – the Japanese art of creating objects by folding paper in specific and careful ways. Right there, I could see the opportunity for a multiplicity of meanings. At her last session, she said, she gave Erickson a small Origami box she hand made. He examined it carefully and admiringly, then handed it back to her, and told her that she could keep it as a reverse Pandora’s box. “Bad­ness” would be safely locked in the closed box. She could continue to feel control and self-determination in life. She showed me the little blue-and-white paper box. She has kept it for more than 40 years, through countless moves and upheavals in her life. The box she had made so long ago has continued to be a symbol to her of empowerment in her life. The sole purpose of her visit to me was to show me how her cherished reverse Pandora’s box was still working for her. She was still managing her life well, she said. When I reflected that to her, she smiled. She already knew. She wanted to be sure that I, as Erick­son’s representative, knew it too. Erickson’s ability to incorporate a vision of the future in the present is one part of his framework that is difficult to quantify and teach. It does not seem to have yet become a regular component of other theoretical positions. The future was very real in a great deal of his therapeutic work, and even in casual conversation. People were given permission and the empowerment they felt they needed to do things in the present so that, in the future, they would be able to look back at their accomplishments. It might be hard work now, he would indicate, but it will be so fulfilling in the future to look back at it. In this chapter, I have barely addressed the use of hypnosis, which was an important and integral part of his work. I do not believe Erickson’s therapeutic methods can be well understood without a basic understanding of hypnosis. I have also barely addressed his use of metaphors and his storytelling, about which entire books have been written. This method of teaching, of providing options, of creating new and flexible thinking, is so strongly identified with Erickson that some think it constitutes the major part of his psychotherapeutic orientation. But Erickson knew that a story is just another way of helping a client to rely on internal resources and to learn how to think flexibly and creatively. It was a small part of his repertoire, but part of his lasting legacy. We all need to learn to tell stories – what a delightful way to evoke curiosity and concentration, to teach, to normalize, to give humor, and to promote independence. If Erickson were reading this, I know he would be shaking his head at me. I have not even mentioned two integral parts of his orientation that he emphasized to others over and over. One is observation. “Observe,observe, observe,” he would say. The therapist must learn to set aside personal perspectives and really see and hear from the client’s point of view. The other is the careful choice of words. Words have multiple meanings, not only to different individuals, but within the context of the moment. Pop psyche says it all – men are from Mars, women are from Venus. We are all unique with different experiences upon which we build meanings. But words are a primary pathway to thoughts, as well as to manipulating and changing personal thoughts and schemata. I almost always ask clients, at the end of therapy, to tell me what was most valuable to them. One, a young man I’ll call Tommy, answered immediately. “That’s easy,” he said. “You told me, ‘Be fearless, Tommy. Write it on your hand if you have to, but be fearless.’ So I did. Every time I had to do something that was scary, I’d take a deep breath, read the imaginary writing on my hand – be fearless – and go for it.” I told that story to a little girl named Beatrice. She listened intently and said she was going to do that too. But she was going to write ‘Be scaredless.” I smiled, thinking she was misusing a word, as children do. “No,” she explained. “You don’t understand. I am writing ‘Be scaredless’ because my name is Bea, and every time I do something hard, I will be scared less.” Bea reorganized her understanding of her world by using words to help create new internal experiences. She manipulated her thoughts by words. She created her own scheme for her future. She also re-reminded me of the importance of remembering that the meanings of words are created, in part, by the uniqueness of the individual’s perspective.

In this chapter, I have focused primarily on some of Erickson’s methods that have become part of the larger therapeutic world. Sometimes his ideas and thoughts have been incorporated into other therapies, sometimes they overlap the good therapeutic methods developed from different roots, and sometimes they have been altered to fit the culture of today. So where are we going now? What is the future of Ericksonian psychotherapeutic methodology? I don’t know for sure. No one knows the future. But I would bet that the foundation of Erickson’s work will still enrich and be part of therapy as it continues to develop. As therapists search for the best, most efficient, most respectful ways of doing therapy, the work that Erickson did and taught will remain a part of their base.

Perhaps refusing to define a theory was one of Erickson’s greatest gifts to modern therapies. As humans, we all are unique, and so individualistic that each of us should choose wisely from the vast buffet of psychotherapeutic methods available according to our tastes. To benefit the most, each of us should come to that plethora with an appetite to learn and an understanding of the ingredients of each offering.

Studying the original work of Erickson, along with the work of those who studied with him directly does that. It gives today’s therapists a deeper understanding of the ingredients, of the complexities and nuances, of many therapeutic stances. This, in turn, allows all of us to become even more effective. We can pick and choose among the ways of doing therapy or of giving information those that are best for a particular client on a particular day. We can help to create a possible future. And we fulfill the real goal of therapy – to help our clients achieve legitimate personal goals as advantageously as possible.

References

Beck, A. T. (1997). Cognitive therapy reflections. In J. K. Zeig (Ed.), The evolution of psychotherapy: The third conference. New York: Norton .

De Shazer, S. (1988). Keys to solutions in brief therapy. New York: Norton. Erickson, L., et al. (1985). Keynote address: Special (family) panel on Milton Erick­son. In J. K. Zeig (Ed.), Ericksonian psychotherapy, Volume l • Structures. New York: Brunner/Maze!.

Erickson, M. H. (1980). The collected papers of Milton H Erickson on lrypnosis. Vol IV. E. L. Rossi, (Ed.) New York: Irvington.

Erickson, M. H., & Rossi, E. (1981). Experiencing lrypnosis. New York: Irvington. Erickson, M. H., Rossi, E. L., & Rossi, S. I. (1976). Hypnotic realities. New York: Irvington.

Lazarus, A. (1992). Clinical/therapeutic effectiveness. In J. K. Zeig (Ed.), The evolution of psychotherapy: The second conference. New York: Brunner/Maze!.

Lazarus, A. (1997). Can psychotherapy be brief, focused, solution-focused and yet comprehensive? In J. K. Zeig (Ed.), The evolution of psychotherapy: The third conference. New York: Brunner/Maze!.

Meichenbaum, D. (1992). Evolution of cognitive behavior therapy. In J. K. Zeig (Ed.), The evolution of psychotherapy: The second conference. New York: Brunner/ Maze!.

Meichenbaum, D. (1997). The evolution of a cognitive-behavior therapist. In J. K. Zeig (Ed.), The evolution of psychotherapy: The third conference. New York: Brunner/Maze!.

Wolpe, J. (1997). From psychoanalytic to behavioral methods in anxiety disorders. In J. K. Zeig (Ed.), The evolution of psychotherapy: The third conference. New York: Brunner/Maze!.

Zeig, J. K., & Gilligan, S. G. (Eds.). (1990). Brief therapy: Myths, methods, and meta­phors. New York: Brunner/Maze!.