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by Lori Greenleaf, Ph.D., MFT Estimated reading time: 3 minutes, 28 seconds.

Dr. Jim, a sweet-faced, middle-aged man, arrived, referred for treatment of anxiety by a previous hypnosis patient. When I ask him what form the anxiety takes, he says he is a good doctor with a healthy practice, confident in his skills and in his marriage relationship. He describes his wife, Beth, in loving terms. He wants to please her.

His wife had convinced him to take dancing lessons with her so they could enjoy learning together, and he consented. She is a very adept, fluid, and comfortable dancer. He had to work hard at the lessons to be a good partner, and his lessons went well. But, like all beginners, he sometimes stumbled. → Read more

By Steve Andreas, MA Estimated reading time: 4 minutes, 22 seconds.

Implication is one of the most common ways that we unconsciously make meaning out of events in everyday life. A speaker’s statement implies something that the listener infers. Erickson used implication extensively and deliberately, as shown in the following examples (some paraphrased) with the implication in parentheses:

“You don’t want to discuss your problems in that chair. You certainly don’t want to discuss them standing up. But if you move your chair to the other side of the room, that would give you a different view of the situation, wouldn’t it? (From this different position you will want to discuss your problems.)

“I certainly don’t expect that you’ll stop wetting the bed this week, or next week, or this month.” (I certainly expect that you will stop sometime.)

“Your conscious mind will probably be very confused about what I’m saying.” (Your unconscious mind will understand completely.)

Examining these examples, we can begin to generalize about the structure of implication.

There is a presumption of a categorical mental division that is usually an “either/or”–here/there, now/later, conscious/unconscious, This categorical division can exist in space, time, or events (matter and/or process). A statement that is made about one half of the either/or division (often using negation) implies that the opposite will be true of the other.

(Look back to verify that these three elements exist in each example above.) Since implication is often confused with presupposition (which Erickson also used extensively) it is useful to contrast the two. Presuppositions have been well studied by linguists, and 29 different “syntactic environments” for presuppositions in English have been identified. (See the Appendix to Patterns of the Hypnotic Techniques of Milton H. Erickson, M. D. Volume I, [pp. 257-261]. However, implications have not been studied, even though Erickson made extensive use of them, so this is a very useful area to examine in much more detail.

Presuppositions Can be identified unambiguously by examining a statement in written form. The simplest way to identify presuppositions is to negate the entire state- ment, and notice what is still

For example, “I’m glad that you have the ability to change quickly and easily.” Negated, this becomes, “I’m not glad that you have the ability to change quickly and easily.” Only gladness is negated, the rest of the sentence “You have the ability to change quickly and easily” remains true.

Are usually passively accepted Are usually processed and responded to unconsciously, yet can be identified consciously and “You are presupposing that I have the ability to change quickly and easily, and I disagree.” Implications Can’t be identified unambiguously by examining a verbal

For example: “Of course, it’s difficult to change quickly and easily in your everyday life.” (It will be easy to change quickly and easily here in my office.)

Are generated by the listener inferring, using their assumptions and worldview. Are almost always processed and responded to unconsciously. Although they can be identified consciously, they can’t be challenged in the same way that presuppositions can, because they do not exist in the statement. If a client were to say, “Are you saying that I can change quickly and easily here in your office?” it is easy to reply, “No, I only said that it is difficult to change quickly and easily in your everyday life, isn’t that true?”

Summary: Implications are much subtler than presuppositions, they are generated actively by the listener’s process of inference, they are typically processed entirely unconsciously, and they can’t be challenged.

Creating and Delivering Implications (an algorithm) Outcome Identify your outcome for the client, what you want to have happen. (Example: The client will talk freely about their problem.) Opposite Think of the opposite of this outcome (not talking freely; keeping information secret, ) Either/or Category Use space, time, or events (matter/process) as a way to divide the world into two categories (here/there, now/later, conscious/unconscious). Sentence Apply the opposite of your outcome to the contextual category that is not present (there, then, other) and create a sentence that will imply the outcome that you want the client to infer. Space

“In your life outside this office, I’m sure that you would feel uncomfortable talking about private matters.” (Here in the office, you can feel comfortable talking about anything.)

“If you were talking to someone at work, there would be many things that you would not want to discuss at all.” (Here you can talk about anything.)

Time

“In the first session with me, there were undoubtedly certain matters that you were not comfortable disclosing.” (In this session, you can feel comfortable disclosing anything.)

“In your previous therapy, you may have been unwilling to talk about certain events that were relevant to your problem.” (Now you are willing to talk about these events.)

Events

“I want you to carefully think about which matters are not relevant to the problem, and that you would like to keep entirely to yourself.” (You can talk freely about anything that is relevant to the problem.)

“In your normal waking state, of course there are topics that you would be very reluctant to discuss with me.” (In trance, you can easily discuss any topic.)

Another way of thinking about this process is that the client’s concern, objection, or reluctance is completely acknowledged, at the same time that it is placed in a different context (place, time, or event) where it won’t interfere with your outcome. Implications can also be delivered nonverbally, which Erickson did extensively, and that is the subject of another paper.

by Hideo Tsugawa Estimated reading time: 7 minutes, 34 seconds.

Editor’s Note: The following is a summary and English translation of an award-winning article published in Japan: Tsuawa. (2000). Play as therapeutic metaphors: Ericksonian play therapy. The Japanese Journal of Brief Psychotherapy, 9, 18-38.

 “Why are children born? They might be born to play. They might be born to romp,” these words are found in Ryojinhisho, an old Japanese song book. Throughout history and across varying cultures, childhood and play have been closely associated. During play, children naturally strive to develop solutions to problems. Play facilitates the expression of emotion and the focusing of attention. Even more importantly, play is a metaphorical device producing rich experiences that add to the life and skill of children.

Play therapy is an approach that incorporates these features of play. Axline (1947), the originator of Child-Centered play therapy, presented eight principles of play therapy, one of which requires the therapist to adopt a non-directive attitude. Many schools of play therapy have adopted this non-directive style of interaction. This approach provides children with the experience of behaving freely. For some, non-directive participation is a useful metaphor that brings changes and solutions. But for others, it is not sufficient. For example, children who have experienced trauma or abuse are not likely to initiate their own healing and instead require the direct participation of the therapist (Gil, 1991). While non-directive play is an important experience, this approach is not useful as a metaphor for all problems and symptoms.

Ericksonian approaches to therapy recognize the metaphorical quality of problems and symptoms. In a like manner, the Ericksonian practitioner provides therapeutic experiences in the form of metaphor. Zeig (1992) calls this process “gift-wrapping.” A gift is presented to the client in which the therapist wraps up the goals and solutions. Symbols, anecdotes, tasks, and hypnosis are generally chosen as the “wrapping.” When working with children, play is used as a gift, a wrapping used to present goals or solutions.

Respect for individuality is another key principal in the Ericksonian approach. Ericksonian therapists tailor their interactions in accord with the unique situation of the client or family. When therapists use tailoring in play therapy, their participation in play becomes more flexible and more effective. An example of an Ericksonian approach to play therapy is illustrated in the following case example.

Naomi, a seven-year-old girl, was brought to therapy by her mother. Her mother explained, “She can not attend school because she is unable t0 separate from me.” Naomi was invited to play and during the following conversation she indicated that she feared arriving to school late and having her class mates stare at her. Whenever Naomi was delayed, she would enter the classroom bent down behind her friends. The initial intervention consisted of an indirect suggestion to her mother to take Naomi to school early. In a follow-up phone conversation, her mother reported, “For the rest of the spring semester, l have taken her to school early in the morning and she goes to school easily.” During the next session, the therapist told Naomi a story about a boy who feared being stared at while riding the bus. As a solution, the boy was instructed by his doctor to walk onto the bus backwards. By presenting this story, the therapist suggested an understanding of her predicament. At the same time, the story implied change is possible. Next the therapist asked, “Naomi, have you had the experience of walking into your classroom backwards?” Naomi was surprised; her expression showed that she noticed something. All the chairs in the playroom were arranged like her classroom with stuffed dolls as her classmates. Her mother and the therapist also sat in the chairs as classmates.

So she tried to go into the playroom/classroom backwards, after which she said, “No problem!” The therapist reinforced her   progress stating, “Great!  But don’t you feel a little fear?” to which she replied, “No, i’m okay.” The therapist then asked solution-focused questions (de Shazcr, 1985) such as, “How were you able t0 do so well? How did you cope with the fear?” She answered, “I watched my feet only.” The playroom was compared to her classroom and a game of entering the classroom was begun. Naomi, her mother and the therapist played going into the classroom using various strange and unique techniques such as coming in with a skip, while spinning, imitating a fashion model, imitating a gorilla, watching only her nose, and while doing a somersault. This produced laughter and suggested to Naomi the possibility of distraction (Erickson & Rossi, 1976). This play provided the opportunity to practice catering the classroom. The purpose of this type of rehearsal is to reduce anxiety and tension in the problem situation. Because it was done as play, it yielded superior results. During a follow-up meeting, Naomi reported, “Now when I go into class room, I laugh unconsciously. Because I remember the games for how to go into the classroom.”

However, three days before the next appointment, her mother called the center in a distressed state of mind. Naomi  had  been  attending school successfully but after being lectured by her grandmother for her previous absences, Naomi developed the hallucination that a bug was crawling into her ear. By the next morning, she felt that insects went inside her body and refused to go to school. The therapist was encouraged by the fact that she had not had any previous episodes of hallucination and that it occurred in response to situational factors (i.e., the interaction with grandmother). Furthermore, Naomi thought her experience was strange, thus indicating that she had the mental facility from which to judge the appropriateness of experience. Because Naomi was ashamed to talk to the therapist about the insects, the therapist chose not to take the problem up directly. Zeig (1980) has suggested the amount of indirection is directly proportional to the perceived amount of resistance. Playing with a large white ball, the therapist told stories of cold  hands and fingers becoming numb. These stories suggested that humans  have the ability to change sensations. A competition was begun to see who could experience the most numbness. The hypnotic induction was accomplished naturally, through play. The hypnotic anesthesia was also introduced using a naturalistic technique (Erickson, 1958). Later, during a phone conversation, her mother told the therapist, “Naomi hasn’t been talking about insects since the last session. She seems to have forgotten about it. I have kept your instruction and have said nothing to make her remember it.” During her fourth and final visit, Naomi confirmed that she no longer had concerns about  going to school. The therapist validated this idea by indicating that there was no longer a problem and the therapy was ended. 

The concept of play is wide and ambiguous. It contains elements such as games, playing with toys, creative activities, and sports. Caillois (1958) systematically classified play using four major principles: competition, chance or luck, imitation and giddi­ness. However, these classifications define play only in terms of external behavior. In contrast, Henriot(1973) views play not as activity but as states of consciousness. From this perspective, it is the experience of play that determines its significance. For example, even when presented with fascinating toys, a child may not want to play. When it is understood that play is determined by the subject’s consciousness, the importance of the therapist’s participation is more apparent. The experiential possibilities for play are not fixed but can be changed by including the child  in play constructed by the therapist.

In the clinical setting, it is important to recognize that the reality of play is derived in part from the interaction between memory and feelings, but equally as important, includes the interaction of therapist and client.

When the therapeutic approach is based on this understanding, play therapy is no longer limited to the use of a playroom or toys. While these can lead to play, it is important to construct therapy as play through human interaction. This allows the child to develop a practical understanding of pertinent situational factors and his or her role in relation to others. While it can be said that play therapy is the approach that utilizes the reality of play for therapy, Ericksonian play therapy is the approach that builds on the reality of the child while permitting the therapist the flexibility to provide assistance when and where it is needed.

References:

Axline, V. M. (1947). Play Therapy: The Inner Dynamics of Childhood. Boston: Houghton Mifflin.

Caillois, R. (1958) Les jeux et les hommes. Paris: Gallimard

de Shazer, S. (1985). Keys to Solution in Brief Therapy. New York: Norton.

Erickson, M. H. (1958) Naturalistic Techniques of hypnosis. The American Journal of Clinical Hypnosis, 1, 3-8.

Erickson, M. H., & Rossi, E. (1976). Two-level communication and the micro-dynamics of trance and suggestion. The American Journal of Clinical Hypnosis, 18, 153-171.

Gil, E. (1991). Healing Power of Play: Working with abused chil­ dren. New York: Guildford.

Henriot, J. (1973) Le jeu. Presses Universitaires de France.

Zeig, J. K. (1980). Teaching Seminar with_ Milton H. Erickson, M.D; New York:.Brunner/Mazel.

Zeig, J. K. (Ed.) (1992). The virtues of our faults: A key concept of Ericksonian psychotherapy.  In pp. 52-269, Evolution of Psychotherapy: The Second Conference. New York: Brunner/MazeI.