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. → Read more
When children paint the sun, they often draw a circle with rays coming out. You’ve all seen that; you probably did it yourself when you were young. A year or so later, a child might paint the sun partly behind clouds. Several years later, they might paint rays coming out from the clouds, but the sun is not visible — what a friend of mine calls a “God sunset.” Even subtler is to paint only the scattered reflection of sunlight on water. An accomplished artist doesn’t paint the sun at all but suggests where the sun is by painting a tree with a little more light on one side than the other, and a subtle shadow to indicate the sun’s location. I think that’s a good metaphor for implication: indicating something without ever explicitly stating it. One of my favorite quotes is: “The larger the island of knowledge, the longer the shoreline of wonder.” (Ralph W. Sockman) Knowledge and wonder are stated; the ocean of ignorance is implied.
On the first page of the first volume of Conversations with Milton H. Erickson, (in which the word “implication” appears about every third page) Jay Haley says, “I have a whole week, so I suspect I can learn all about psychotherapy in that time. I wouldn’t expect that anywhere else but here.” Erickson laughs and says, “Well, we can have our dreams.” That’s a polite way of implying, “You are wildly optimistic!” → Read more
“From 0 to 10, with 10 being high, how would you rate your current level of distress?” With his rating, the client is asked to keep the most distressing picture of his presenting event or memory in mind; then, to identify where the feeling lodges in his body; and lastly, to identify his associated negative cognitions that go with the problem–such as “I’m helpless,” or “It’s my fault.” Continuing with his images, feelings, and thoughts, he is kept grounded in the present through the clinician’s interactions with him. The eye movement stimulation (or possibly an alternate form, auditory or tactile, of left-right lateral stimulation) is then introduced. He is intermittently asked for his rating of his distress on a scale of 0-10–the Subjective Unit of Disturbance Scale (SUDS) while he is processing the trauma, until the point when his memories have lost their disturbing power. This recursive procedure is maintained until he has desensitized his difficult memories and until positive self-cognitions have replaced his negative self-cognitions. When his negative images are dissipated, he is asked to rate the believability of his alternative positive cognitions on a scale of 1(completely untrue) to 7(completely true)–the Validity of Cognition Scale (VOC). From having spoken of his negative cognitions initially, he now speaks of what he would rather believe about himself, his positive cognitions. → Read more
A middle-aged man came to see me under pressure from his wife. She had told him she would leave if he didn’t make some life changes. Both husband and wife expressed that their marriage was very important to them, but it was clear to us all that their marriage was near collapse. He told me he did not know what the problem was even though his wife had complained about his commitment to his work for many years. He acknowledged that he was highly committed to his work, but said it was important to them both and that he was very successful. He wasn’t completely aware, nor was he in agreement, that his business interfered on other levels of their lives.
His wife described the man’s work as his mistress and his only interest and hobby. He didn’t even take vacations without sleeping with his telephone by his side. At, and away from, home, where he wasn’t talking business he was reading financial magazines. He was not interested in his wife’s activities and was unwilling to converse about things of interest to her. They had virtually no social life as a couple. → Read more
Once Erickson has fixated and focused a patient’s attention with a question or general context of interest (e.g., ideally, the possibility of dealing with the patient’s problem), he then introduces a number of approaches designed to depotentiate conscious sets. By this we do not mean there is a loss of awareness in the sense of going to sleep; we are not confusing trance with the condition of sleep. In trance there is a reduction of the patient’s foci of attention to a few inner realities; consciousness has been fixated and focused to a relatively narrow frame of attention rather than being diffused over a broad area, as in the more typical general reality orientation (Shor, 1959) of our usual everyday awareness. When fixated and focused in such a narrow frame, consciousness is in a state of unstable equilibrium; it can be “depotentiated” by being shifted, transformed, or bypassed with relative ease. → Read more
My friend Kevin’s 5-year-old granddaughter is known for her dramatic snits, which can be of epic proportions. Once, when he was visiting, she was in the midst of exceptional performance: cringing under a table, clutching her blanket, sobbing with periodic outbursts of saying “NO!” or “GO AWAY!” All efforts by her parents to end the drama were equally futile.
After her parents left for an appointment, Kevin decided to try his hand. He wanted to engage Aurora in a way that did not demand a response. Standing in the doorway to the living room where her older sister was playing, he told a story loud enough for Aurora to hear. → Read more
Milton Erickson was unencumbered by the prevailing orthodoxy of his time. His creativity continues to reverberate profoundly in often unacknowledged ways. Perhaps the most important of Erickson’s principles is utilization. Consider the following vignettes.
Erickson saw Kim, a teacher troubled by nude young men hovering just above her head. She told Erickson not to take her young men away, but rather stop their interference with her everyday life. He suggested that Kim leave the nude young men in a closet in his office where they would be secure and not interfere with her teaching. She checked on the young men at first but gradually stopped. Much later, Kim moved to another city and worried about her “psychotic episodes.” Erickson suggested that she put her psychotic episodes in a manila envelope and mail it to him. Occasionally, she would send Erickson a psychotic episode and meanwhile continued a productive life (Erickson, 1980). → Read more
Judith was a 46-year-old woman who, for the first time in thirty years, was without a job. In the past, when she left a job, it was because someone contacted her with a better offer. Now, for the first time, she had to find a job for herself. She had been sending out resumes by the bushel but received no replies. Judith had been referred to me by someone who said I was practical and knew the ins-and-outs of the business world. The referral source told me that Judith did not want therapy. He identified her as feeling worthless unless she had a job, and that no one would care about her until she was in a position to help others. To match her expectations, I presented myself to Judith more as a coach than as a therapist. However, it was readily apparent that Judith was painfully shy and felt that she had no personal worth. → Read more
A common theme that I remember Erickson discussing during our time together was his fascination with how the unconscious was able to use current events and experiences to conjure past learnings.
I experienced this first hand during my second session with Matt, a ten-year-old boy, and his parents. Matt, an only child was going to have to redo the fourth grade because of poor grades. Matt had felt like an outsider in the fourth grade and had no motivation to do school work. The thought of repeating the fourth grade again after “flunking” made him feel even less motivated. His parents tried “everything.” Unfortunately, each parent felt that his or her strategy-of-choice had been good enough to motivate each of him or her as a child, so it should motivate Matt. Their unyielding assumption was that if their strategy did not work, the problem was in Matt, not the appropriateness of the strategy. → Read more