Posts Tagged ‘case study’
A 28-year-old male physician, who had done well in medical school in Japan, began working on a doctoral thesis at the surgery department of a national university that was not his alma mater. He also was working at the hospital where his father was a staff physician.
He started having difficulties with his doctoral thesis. As a consequence, he began to suffer from severe insomnia. He decided to treat his own insomnia by taking prescription sleeping pills (methaqualone), a type which are no longer manufactured in Japan because of their severe side effects. Soon, the young physician became dependent on these pills as well as tolerant of them. He increased the dosage and finally began taking them during the day as well.
His behavior changed dramatically. He became rude and unreliable; his ability to practice surgery became noticeably and severely compromised. There were even several episodes where he collapsed during surgery. He was relieved from all duties at the hospital. His wife left him and returned to her parents’ home where she thought of divorcing him.
He came to my clinic and decided to use hypnosis as part of therapy. After a deep hypnotic trance was induced, I suggested he recall his happy, confident days before the beginning of his doctoral thesis. The recall and re-experiencing of these good times were confirmed by finger signaling.
Using age progression, he was asked to imagine a scene in the future where he was freed from his addiction and felt happy and confident both mentally and physically. These feelings were tied to the feelings he had as a student before he was addicted. He was asked to see the people close to him, his parents, his wife and the staff of the hospital, being so pleased for him and filled with trust for him as they had been in the past. I suggested that he imagine such scenes as vividly as possible.
As a post-hypnotic suggestion, I told him that the experience he had in the hypnotic trance would be firmly fixed in his unconscious mind. It would positively influence his daily activities without conscious awareness. Then the trance was ended.
The next week, he said he had stopped taking the pills. He said he was feeling some confidence and happiness. There were two more sessions using the same principles of building a productive future on productive behaviors and responses in the past.
It is now 25 years since these three sessions. He has had no further problems with drug dependency. He is working actively at the hospital where he did his doctoral thesis, and has replaced his father, who retired, as director.
The work described here is a successful example of what I have called the “in advance rewarding method.” This technique aims to develop the patient’s inner strengths toward a possible and positive future. I developed treatment in this case without knowing about Erickson’s work in pseudo-orientation in time.Discussion
by Betty Alice Erickson M.S., L.P.C. Dallas, Texas
Dr. Takaishi’s patient did not seem to require the added complexities of a physical detoxification, and he was not initially enthusiastic about treatment. Using the man’s previous experiences as a successful and competent person, Takaishi used trance to guide the man into a realization that his future could have those same components. In 1934, Erickson wrote that the hypnotist “must implant his suggestions in the vast aggregate of mental reactions and patterns accumulated throughout the subject’s lifetime.” Takaishi did just that.
Regression in a hypnotic state helps a patient reestablish patterns of behavior “uninfluenced by subsequently acquired” behaviors (Erickson, 1937). And again, Takaishi did just that.
Good therapy allows the patient to access and build upon personal strengths and resources in productive ways. It is the therapist’s job to structure psychotherapy so the patient is in a position where those currently inaccessible abilities and resources become usable once again.
This patient clearly had the ability to succeed and accomplish his goals. Imagining a future, in a trance state, where goals already have been met and the warm glow of success is felt, can give patients deep-seated feelings of accomplishment and pride. Structuring this future as a post-hypnotic suggestion that didn’t have to enter conscious thinking allowed the patient to reap the benefits of the therapy without having to ascribe the cause to the therapist’s suggestions.
One of the most intriguing aspects of Erickson’s work is its timelessness. Six decades ago, when hypnosis was poorly understood and under-used in the psychotherapeutic world, he was writing about the principles that Takaishi employed in his work 35 years later. These techniques are as applicable and powerful today as they were when Erickson first wrote about them and when Takaishi used them. Takaishi did good therapy, with creativity and intelligence.
The opportunity to reexamine effectiveness after twenty-five years is rare. The absence of a relapse speaks for the effectiveness and the appropriateness of the therapy used. With his discovery that Erickson had written about this same technique years previously, Takaishi can now compare and enhance his own abilities just as students of the “modern” arms of psychotherapy, of brief, cognitive, narrative, and solution-focused, can compare and enhance their own understandings by studying Erickson’s original works.
Erickson rarely claimed credit for “inventing” a technique. He understood that the tenets of human behavior have been known and studied for centuries. Part of his gift to the psychotherapeutic world was his ability to encapsulate commonalties in productive methodologies and to write about and teach them in understandable and replicable ways.
Erickson, M. H. (1934). “A brief survey of hypnotism.” Medical Record, 140, 609-613.
Erickson, M. H. (1937). Development of apparent unconsciousness during hypnotic reliving of a traumatic experience. Archives of Neurology and Psychiatry, 38, 1282-1288.
By Jeffrey K. Zeig, Ph.D.Case One: The Right “Spell”
My son, Robert, asked me when he was attending grade school, “My two best friends can’t spell; [their papers are] marked 10, 15, or 20, and my spelling [lessons are] marked, 85, 90, or 95. Now, will you teach them how to spell?” I said, “I can’t really do that Robert without consulting their parents…I’ll tell you what to do. You make sure you have your spelling lesson with you and your friends have their spelling lessons with them — a marked copy corrected by the teacher. I’ll come over and pick you up and drive you home, and I’ll [also] offer to drive the boys home. And, as we’re riding along, you tell me what mark you got on your spelling lesson. I’ll pull up to the curb and go over your spelling lesson. [When Erickson did this, he said to Robert,] “You got this word right, and this word right, and this, this, and this.” And I graded [his lesson] and it was 98. I turned to one of the boys and said, “Have you got your spelling lesson with you? I’d like to see it.” He didn’t want to show it to me, but I insisted. I looked at it and said, “My goodness…a ‘ck’ in ‘chicken’ is the hardest part of the word to spell — and you got that right.” I looked at the next word and there were three letters correct and [I] said, “[That’s] the hardest part of that word to spell…” Now the second boy handed me his spelling lesson [and] I pointed out the letters he got [right, too.]
A short time later, I asked Robert, “What happened to those little boys after that day?” He said, “They are spelling correctly.”
I merely showed them how to look at their spelling lesson and see the right part of their spelling. [But,] adults will look at the failures, without realizing that failures are always an opportunity to learn.Case Two: Appreciable Curves
Hans (a student asking for help with a case): I had a woman client who came in with her husband. She has scoliosis, which means she has a very rounded back and is much smaller than she would be if she didn’t have it. Other than that, she’s a beautiful woman, but the couple has the same difficulty I told you about before: the man is no longer turned on by his [wife]. He says it does not have to do with her back, but I still think it has something to do with it. He simply tries not to think about it, and the woman gets depressed a lot because she thinks her rounded back is the reason why her husband doesn’t like her anymore — that he no longer accepts her as a woman.
Erickson: Now my [question] to the woman would have been, “Madam, aren’t you aware that all men [think] curves are wonderful?” If the woman has an extra curve, I’d [ask] the man, “What do you want — a flattened board? As a man you are supposed to enjoy [all kinds of] curves.” [This puts] him on the defensive, and when he admits liking some curves, [he’ll] admit to a predilection for [all] curves, [there- fore viewing] his wife’s scoliosis through different eyes.Cases Three and Four: The Body of Knowledge
Erickson speaking to students at a teaching seminar:
I’ll give you two other cases from my [experience working with the WWII] induction board. A handsome young man came through [in] good physical condition, and he had Jayne Mansfield [a buxom actress of the era] beat with his [enormous] breasts. My medical students looked at him in horror, [but were even] more horrified when I wrote a red “A” on the chart, which meant [he was] accepted. I let the medical students wonder for a while, [and] then I said, “The medical students are concerned because I’ve accepted you for the Army. They think that with those great big breasts of yours you’re unfit for the Army. Now, I’ll ask you a question and your answer will reassure [them]: “When you take a shower with the boys and they see your great big breasts, and they start to rib you [and] tease you, what are you going to tell them?” He said, “I’ll tell anybody who stares at my breasts that I brought them along for the homesick boys.” There was no question why [this man would] be accepted. And his composure was excellent.
The next selectee squirmed while I did the psychiatric examination, [but] I didn’t find anything wrong with him. I accepted him and [asked], “Now, why were you so afraid I wouldn’t accept you for the Army?” He said, “Well, I’ve got a problem: I can urinate only when sitting down.” The medical students looked concerned, so I said, “All right. When you’re marching and the sergeant says, ‘At ease, relieve your- selves,’ and you squat down to urinate, what are you going to say to your fellow soldiers?” He said, “If they fault me [for] squatting down, I’ll tell them, ‘Anything good enough for my mother is good enough for me.’”
By Angela Z. Wu, MFTBackground:
Lisa is a 32-year-old single Chinese woman living in Shanghai who has been seeing me for six months via Zoom (online chat like Skype). Two years ago, she discovered that both of her parents were having affairs. Soon after, her periods ceased and she began to get headaches.
Lisa’s parents treated her like a boy, and this angered her, as the little girl inside her yearned to be loved and treated like a girl. In therapy, we did a lot of active imagination so that Lisa could take care of that little girl; love and mother her. She also met a trustworthy man — her acupuncturist – who played a role in her recovery.
Lisa plays the guzheng (classical Chinese string instrument) well, and wants to study violin. During therapy, she cut off contact with her parents. She also ended an uncomfortable romantic relationship, quit her data analyst job, and made plans to study violin in Europe.
Lisa reported that although she was not menstruating, she felt more “woman juice” flowing out of her, and felt her body get warm. However, the headaches remained.Sessions:
Using The Pain Map, (Drs. Eric and Lori Greenleaf, 1997), she drew all of her pain (physical, emotional and spiritual) on one map, and all of her resources on another. Then, in her imagination, she applied a particular resource to a specific pain.
Lisa: My headache became closer, heavier. I see an angry face: a child, but it is my father. Father’s angry face is replacing the headache. [pauses] Now the angry face is getting closer and clearer. I don’t feel much headache.
Angela Wu: What does the child want — to be angry, or not? [pauses],
L: He doesn’t know what to do; he only knows anger.
AW: Suppose the child gets comfort from someone?
L: I feel my acupuncturist is touching the child’s head to calm him. The child is getting quiet and calm. [After a long pause, Lisa begins to cry.] AW: I see the tears; they are real, and my heart gets tender when I see tears. [pauses] Often tears are sacred; they remind us to grieve or to know joy. It is a strong, real emotion. It shows us real life, with all kinds of feelings. When I see your tears, I feel you are so real.
L: I’m crying as I see the angry boy calm down. He said, “I am sorry” to me.
AW: Very nice hearing, “I am sorry.”
L: I see a little girl come out. That was me at 12.
AW: Welcome. How is she?
L: Finally, she can come out. She was so scared by that angry boy.
AW: What does she want? [long pause]
L: She wants to have her period.
AW: That is right. She wants to have her period. Suppose you help her to prepare for her period: read her books, get her sanitary pads, cute underwear, nail polish, or a promise of her favorite ice-cream when the period is over. [Lisa smiles and nods.]
L: The little girl wants to perform music. Her parents always told her that she was not good enough; now she wants to perform. But she is shy, not sure if she can.
AW: Suppose the girl gets dressed in a beautiful Chinese qipao [form-fitting dress]; sets up her guzheng in her room; prepares two seats for her parents. Then she can play and record the saddest melody, and mail it to her parents, as if you are mailing your bad headache to your parents.
L: That is a good idea. I will do that. I am more comfortable playing in my own apartment. And I will mail them my sadness and my bad headache.
AW: One more thing. I do not know about you, but for me, two or three days before my period I often have bad headaches. When I feel that headache, I know I will prepare myself.Two weeks later:
Lisa felt overwhelmed when she played the guzheng, and she stopped. She didn’t record or send the music to her parents. Before our next session, she sent me a link to a classical Chinese violin piece called, “So Long.” She said, “When I hear it, I feel gentleness, unconditional love, separation, and sadness. I may want to hear it during the session. Let’s be prepared.”Session:
L: I don’t feel the headache. I started to feel a mother’s unconditional love, but it is not my mom.
AW: If now you use your body as the map, where do you feel the love?
L: In my feet, and my hands.
AW: What is the sensation when your feet and hands feel love?
L: It is freedom to move around.
AW: Good. Focus on that freedom — your feet and hands. Does that feeling stay still or move around?
L: It is moving up, coming to my hands. I feel very gentle and warm, like a baby’s skin. Now it’s moving to my belly button. [pauses] AW: What is happening there?
L: The little belly button wants to say something.
AW: Before a baby’s born, she is connected with mother through the cord. The baby gets food; feels mother’s heartbeat. In this way baby communicates with mom, so of course the belly button wants to say something. [pauses]
L: The belly button feels mom’s love. She was held in big hands; warm and gentle. The little belly button feels mom’s gentle touch, gentle kisses. [Lisa nods, and begins to cry; long pause.] Then, the little belly button grew up. Mom starts to say she is not good enough, and is very harsh to her. She didn’t want to talk. She is so scared all the time; scared, sad, and hurt. She is afraid of talking; felt something stuck in her throat.
AW: Let’s start with a long, deep breath; breathing out first. Really clear out all the fear, all the worries and sadness inside of her. Then breathe in all the fresh air and oxygen that she needs. That’s right; just breathe, breath by breath. She is growing up, she is still good. The little belly is still good.
Now she is an adult, and she can open a new file for her life. She is going to put the people she likes and loves; the loving memories, in her new file. She knows she has unconditional love with her; right on her feet, right on her hands. She just needs to feel it. [pauses]
L: The little belly walked to a door. It is oval; a glass door. She is nervous, scared.
AW: Where does the door take her to? [pauses]
L: The other side of the door is the womb.
AW: Does little belly want to go there?
L: She is nervous and scared…even with unconditional love. It is dark over there.
AW: Can little belly put a flashlight in her pocket?
L: Yes, a flashlight will be useful.
AW: If you like, you can take me with you. You can hold my hand.
L: Yes, let’s do that. I am shining the flashlight and holding your hand. I’m walking in. [tears; long pause] I saw an old friend.
AW: What does the old friend look and feel like?
L: It is round, soft, sticky. It is red.
AW: Very good. Say, “Hi” to this old friend. Tell her, “I missed you, and I’m so happy to see you. I know you’re here, so today I came. We are old friends. I know I’ll always see you.”
L: I started to feel warm. I started to feel the blood running through my body. Now it’s time to play the music.
AW: [I push the button and music plays.] Yes, you are saying good-bye to the fear, to the worries. Now feel the blood and the freedom. Feel and enjoy the love. [pauses]
Ten days later, Lisa sent me a message saying that her periods resumed.The session after her period:
Before the session, Lisa sent me another violin solo called, “Raise Me Up,” to play as background music for the session. She still gets a headache from time to time, but isn’t bothered by it. She remembered that she often had a headache around her period. She began to remember her grandfather, who loved her very much.
L: I feel that I need to walk home and become a mature woman. I feel lonely. I am scared to be with the old friend; to be a normal woman.
AW: Now you’re telling me, so you’re not lonely anymore. You’re walking towards your home; not a little girl going to her parents’ home.
L: I feel the love was buried by hate for so long. Now I have to go through the pain to find it. [crying] I haven’t been crying like this.
AW: This is good. When the love is opening up and meeting the pain, two strong energies meet, and it can be overwhelming.
L: I see so many things: I see grandfather; I see me on the stage as a grown, beautiful woman playing violin; I see a man that I want to love — only his back, not his face yet.
AW: These are beautiful things. They are somewhere — awaiting. And now I know you can go there. You have met your old friend, and you will meet many new friends.
L: [still crying] I know. I am walking home. My home.
We decided to do a monthly checkup, and eventually terminate the therapy. Lisa is now looking into studying music in Europe and has started to date men.Commentary
Eric Greenleaf, PhD
Relationships shape therapy, and the language used represents human experience. The patient often speaks in symptom language: a headache, amenorrhea, or anxiety. Ericksonian therapists speak in image, metaphor, and a common language: “the little girl,” “an oval door,” “the old friend.” Angela Wu’s gentle, healing touch and patient inquiry formed a relationship that drew healing from the patient’s inner life resources. And, hand-in-hand, both therapist and client shone a light together into the frightening darkness — and they created beautiful music.