A 24-year old client who had been in therapy almost continually since her mid-teens presented a long history of sexual abuse and incest. Five years previously, she had been hospitalized for major depression and suicidal concerns.
At that time she reported abusive treatment by her psychiatrist. Complaints involved isolation when she refused medication, verbal insults, and suggestions of memories that she did not have. She reported that the psychiatrist subsequently lost his license.
Prior to seeing me, she was in therapy with another psychiatrist for five years. The client reported feelings of resentment and distress toward this psychiatrist. She reported that he insisted that she had engaged in specific sexual acts with her father. These acts were not consistent with her recollections. Therapy had included confrontation of the father.
The client was now married and had not been troubled by suicidal depression or drug abuse over the last three years. However, her history combined with her reported abuse by family, boyfriends, employers and treatment providers contributed to her depression, post-traumatic stress, and “victim” self-image.
Treatment began with the setting of clear boundaries and focusing on the client’s rights and expectations . Her abuse history was gradually disclosed, accompanied by expressions of fear and anger. The client agreed to the use of trance to shift her focus from the perspective of victim to one of curiosity and empowerment. She responded well to conversational inductions. The therapeutic focus was on learning and development as opposed to remediation. As she learned to express her feelings of anger and frustration, she began to express the need to “get away somewhere.” Her fantasy was to take an island vacation, but she believed that she required psychiatric inpatient services to stabilize her thinking.
In our discussion, she expressed that the dollar price of the short hospital stay would be about the same as the desired vacation, however, she was concerned about her husband’s “emotional price tag” that would result if she took a vacation. In therapy, I suggested that some people “prepay” vacations so they can enjoy the entire experience knowing that there would be no legitimate bill waiting on their return. She was challenged to determine all “hidden” costs and experience them affectively and interpersonally, as soon as possible, so she could begin anticipating her trip.
The client accepted this suggestion, and shifted her focus from anticipation of hospitalization to planning for the trip. She took the vacation while her husband stayed home. Upon her return, she reported that she had successfully set boundaries with her husband and did not assume any emotional debt for her trip.
The metaphor of the vacation was used to reinforce her inner strength and independent action. The client reported successful goal planning, boundary setting, calculated risk taking, initiation of interpersonal relationships, and a feeling of inner courage and empowerment. Over the following months, she remained in therapy and reported that the vacation provided a “turning point” for her. The client enrolled in college and performed well. While the change from “victim” to responsibility was rapid, and occasional slips into the former role occurred, the resources for change were integrated within her.
Suggested readings Otani, A. & Koska, M., (1992). “The dialogue technique of hypnotic induction.” American Journal of Clinical Hypnosis, 35, 1, 20-28.
Phillips, M., (1993). “Turning symptoms into allies: utilization approaches with post- traumatic symptoms.” American Journal of Clinical Hypnosis, 35, 3, (179-189).
Rosen, S., (1982). My Voice Will Go With You. New York: W.W. Norton
Discussion by Gene Davita, M.D.Baumgartner focused on presenting issues in the past as well as present boundary violations and abuse from numerous sources including professionals. Establishing a therapeutic relationship with clear expectations, respect for the rights of the patient and opportunity for her to express her emotions was paramount. This established a fluid, process focused therapy in which change could be promoted.
The patient seemed adept at trance since conversational induction worked well. She was able to move from the victim position to one of empowerment rapidly. More traditional therapeutic approaches that encourage hours of exploring victimization experiences can further crystallize that role. Such a shift in the therapeutic paradigm for a patient allows responsibility, self-assertion and creativity that universalizes to all areas of living.
The patient’s concerns with the cost of hospitalization presented Baumgartner with an opportunity to employ an Ericksonian approach and the patient’s fears then could become a useful part of therapy. The vacation metaphor allowed the patient to experience “getting away” and to create an experience that furthered her responsibility, assertion and individuation . This created even more encouragement for further growth and development in living by using the skills developed while turning a dream into a reality. She was further empowered by beginning to create a life of self hood rather than perpetuating the life of a victim.
Baumgartner’s work with this patient, who presented with a multitude of serious problems, demonstrates therapeutic elegance in his work with one aspect of her problems. The assistance of movement from being reactive in her life to being the source of creating her life was important. This resolution can serve as a springboard for future therapeutic advancement.
Jun 18
Dogs Will Eat Anything
Several months ago, I found myself in the midst of a terrible conflict. Two people, with whom I had close professional and personal ties, and with whom I shared a common project, fell into a serious dispute — one accusing the other of a crime. Worse than that, each party represented powerful institutions, with which I had important connections.
I attempted to mediate; offering a plausible solution to both sides, but was refused by both. To my dismay and discomfort, the more I tried to solve this dilemma, the more the two parties began to turn their suspicions and mistrust toward me. So I backed away, feeling uneasy, nervous, and despondent. The parties consulted lawyers — positions hardened; empathy dissolved.
For several nights I slept fitfully, thinking about what to do. Any ideas or strategies I settled on would be unwelcome by one party or the other – and lead to a dead-end. I felt awful.
One morning I awoke early, and my wife turned to me and said, “I feel a sense of dread.” I knew the emotion was mine, not hers, and realized I did not want her to feel that way, and that I must do something — but what?
That evening, I decided to give the problem to my unconscious. The next morning I awoke refreshed. Nothing had changed, but I felt happy, and the feeling lasted.
Later that day, out of nowhere, I had a thought: ’Dogs will eat anything. They will eat feces, vomit, dead insects and birds, etc., and then, often just burp and trot away without ill effect.’ Then I had another thought: ‘Lola, our wonderful Standard Poodle, must have eaten the whole mess. It didn’t affect her, and I was free of my troubled state.’
CommentaryWhile teaching Ericksonian approaches, I’ve emphasized the metaphor of the benign unconscious mind as an explanatory concept, and
the utilization of the unconscious mind as a therapeutic means toward healing. I’ve asked many people in workshops and in my practice to: ‘Look at your unconscious mind, and tell me what it looks like.’ People often see marvelous things, from a hacienda to the cosmos, with colors, shapes, sounds, textures, movement, and also distinct emotions.
When I ask people to see their unsolvable problem as though they were in a dream, they often have unique visions. And when I ask them to put the image of their problem into their unconscious mind, they see and feel things that help them to change for the better. I never saw my unconscious as my dog, Lola, but she does provide excellent service with eagerness and good cheer; she is an avatar for my unconscious!
Conceptually, I think of the unconscious as comprised of: the neurophysiology of the body, new learning, and the interpersonal emotions of three or more interrelated people. In trance, we relate to our unconscious, and so invite, in a context of novelty and new learning, the improvement of our bodies and interpersonal relationships. From the earliest times, the small, ex- tended family group has determined our unique sense of self. It is our evolutionary heirloom. This includes generations of stories known and stories never spoken — and secrets, which re- main largely in the unconscious. The selves that interpersonal atmosphere gives rise to, remain unselfconscious and feel (although cloudy) individual, decisive, and self-deter- mined.
Dr. Erickson provided us with many examples from his own life in which he entered the unconscious in order to invite resolution of insoluble problems. He said:
“You go to a doctor and he says, ‘I just don’t know what to do for this. But it does need some care.’ You’ve got a lot more confidence in that doctor than the one that tries to pawn something off on you that obviously won’t work. He says, ‘I don’t know what’s wrong with you but it obviously needs care. Now let’s see what we can do about it.’ And you see yourself in the hands of somebody who will make a penetrating research into an insoluble problem.” Seminars of MHE #1 1962, pp. 47-8. [my emphasis]
Dr. Erickson would often write letters to children about animals, real and invented, to help them, through stories, to learn, grow, and resolve troubles in life. I’m sure he would have loved Lola, as most people do. She is warm, smart, protective, affectionate, and fun, and will, if given the opportunity, eat nearly anything, including my problems!
Please send your unpublished, 800-word Case Reports to: training. MHEIBA@gmail.com
Jun 11
Wake Up and Go To Sleep
Ben was referred to me by a local hospital for treatment of Rapid Eye Movement (REM) behavioral disorder. Due to aging, a part of his brain had degenerated, resulting in loss of muscular control during REM sleep. Both Ben and his wife were fearful that because he had wild body movements while sleeping, he would inadvertently kick or hit her, or that he would injure himself. After nearly 50 years of marriage and sharing a bed, Ben’s wife had resorted to sleeping in the guest room.
Ben was a lively and interesting 70-year old, who had recently retired from his job in a factory where he worked as a master toolmaker. He was looking forward to enjoying his retirement. Ben had a keen sense of history and a strong interest in Native American culture, and he read many books on the subject. We enjoyed talking about this because I share the interest. Ben longed to visit ancient Native American sites and national parks and he purchased a Winnebago for this purpose. He said he was ready to go, but the extremely narrow single bed he would have to bring along, and his symptoms of the REM disorder, made him hesitant about traveling.
For his entire life, Ben had used his hands and mind to produce tools, so it was understandable that he was looking for a simple, concrete solution to his problem. The fact that he felt his disorder was beyond his control, upset and embarrassed him. His mechanical engineering training and tactile problem-solving skills that served him well in his professional life, gave him the air of someone reluctant to consider hypnosis as a tool for achieving wellness.
Matching, pacing, and leading are the cornerstones of good hypnosis. Because of my conversations with Ben about Native Americans, in which I spoke of “trance healing ceremonies” and their similarity to modern day hypnosis, he gradually became open to using hypnosis to help with his REM symptoms.
As part of my early hypnotic training with Steven Heller, I learned of Erickson’s technique for creating an unconscious generative suggestion for a patient. Erickson demonstrated this therapeutic intervention in a case he called “The February Man.” In trance, he created a positive male character for his female patient who had an emotionally impoverished childhood. This character who appeared in her dreams, valued her by leaving encouraging notes and bringing gifts on her birthday and holidays, which helped her to developmentally progress. (Interestingly, for the past 44 years, Erickson has appeared in my dreams, sometimes offering me helpful advice.)
I decided that with Ben I could create a post-hypnotic suggestion that would happen during his sleep cycle, which would interrupt the REM pattern and disrupt the threatening behavior. There are many references in experimental hypnosis literature that show the success of this type of suggestion. I also had success, as Ben would wake up briefly before flailing, and then fall peacefully back asleep.
There’s a Three Stooges sketch where Curley, Moe, and Larry are in one bed. Larry begins to snore, and Moe hits him and says, “Wake up and go to sleep.” Larry wakes up briefly, and then falls back to sleep. Then Curley begins to snore and a frustrated Moe hits him and says, “Wake up and go to sleep.” Curley is groggy and falls back to sleep, and Moe just smiles. However, like most Stooge antics, it soon turns chaotic. Curley and Larry begin to snore and Moe goes from one to the other slapping and shouting, “Wake up and go to sleep!” In my next session with Ben, I discussed the idea of a generative suggestion and the Three Stooges episode. He remembered it well, and we were both had a good laugh. I suggested to Ben that we put Moe in his unconscious dream world to wake him up right before any sleep behavioral disorders occurred, and he agreed.
The next week Ben and his wife came to his session together and reported that his violent sleep behavior had not happened the prior week, and then asked me if it would be alright if they attempted to sleep together. I said yes.
I continued to see Ben throughout that summer as he and his wife worked together on getting ready for their road trip. I repeated the induction with Ben each week, and his wife called me several times to say that they were sleeping peacefully together. After the couple left on their adventure out West, I had Ben check in with me every week for five weeks. In his words, “We followed the blueprints, installed the boilerplate, and the new circuitry was working well.”
Commentary By Eric Greenleaf, PhDIn a letter, Dr. Erickson once wrote, “Concerning my views about dreams, I can state quite simply that they are the substance that paves the way to the goals of achievement. Such goals are reached more rapidly if a dreamboat is available.” (Seminars of MHE #1, 1962) David Norton’s keen understanding of the blueprints of hypnotic suggestion and his workmanlike installation of the boilerplate, allowed the new circuits to hum, and the dreamboat to sail on. The contrast of the Stooges’ hilarious lack of workmanship with Ben’s own careful and effective craftsmanship was speedily effective, but was only hinted at through laughter. Like all expert craftsmanship, David’s work with this patient might look easy, but it was dreamily inspired.
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