Posts Tagged ‘Family Therapy’

Clinical Depression Following the Death of a Parent By Ron Soderquist, PhD, MFT

A fellow church member whose husband died 10 years ago called out of concern for her 30-year-old daughter, Amy, who had never gotten over the loss of her father. The woman said, “I think Amy’s depression is affecting her health and her marriage.”

“Haggard” would not be too strong a word to describe Amy when she entered my office. She looked much older than her years. Tears began flowing down her face even before she sat down. The visual evidence of depression was so dramatic, I could understand why her mother reported that it was taking its toll.

As Amy told her sad story, it was obvious that she had told it many times before in the last decade. She began: “I was in training as a student nurse in the local hospital where my father had had heart surgery. One day he came in for a post-surgery check up. I was in the midst of my normal nursing duties when all at once I heard alarms. Staff were rushing around. A nurse said she heard a patient had collapsed and died, and it might have been due to a nursing error. Then, a fellow student nurse came in, put her arms around me and told me it was my father who had died. My first thought was, ‘I should have done something to save him.’ I berated myself for not doing something. Ever since then there has been a voice in my head saying, ‘You could have saved his life.’ I can’t stop thinking about him dying and the funeral and that I could’ve done something.”

I asked her if it was like a movie running in her mind. Amy agreed that a movie of her Dad’s death played over and over in her head. I began by acknowledging her grief. “First, Amy,” I began, “I am so sorry for your loss—a deep tragic loss. And when we have an intense experience like yours, the brain often makes a movie like the one you have been looking at over and over. It’s like the brain gets stuck on that movie.”

“Yes, that’s me,” she replied. “My brain got stuck on that awful moment when I was told my father had died.”

“I wonder if before your tragic loss if you had happy experiences with your father, perhaps family activities or special times with him.”

“Oh yes, I have many beautiful family memories, and also, my father and I used to play tennis together. we had a special warm relationship.”

“I wonder, when you close your eyes, if you could turn on some of those sweet memories, and as you visualize your father, ask him if it would be all right with him now, after 10 years of grieving, for you to switch channels in your brain; if it’s okay if you switch to the Happy Memories channel. And because your father was a Christian, would it be all right to imagine him in heaven smiling when he sees you remembering those happy times? Perhaps you can see him smiling and nodding his head about as you switch to this channel.”

“I can see him saying he wants me to enjoy our happy memories,” Amy said. “And he wants me to enjoy my dear family instead of obsessing about his death.” Then, she added with deep feeling, “I didn’t know I had a choice.”

“Yes, what a relief to discover you have a choice. Just imagine you have a remote control in your hand and you switch to the Happy Memories channel. That’s right, along with a deep relaxing breathing, switch to the memories he would like you to share with your children, his grandchildren.” With a sigh of relief Amy did that easily. We practiced tuning into the Happy Memories channel for a while until she felt relaxed and confident doing it.

The following week, Amy called to report she no longer felt depressed, and, in fact, was now enjoying showing photos of her father and sharing happy memories with her children. It’s been three years now since our session, and the Happy Memories channel is still “on the air.”

Commentary

By Eric Greenleaf, PhD

Ron Soderquist shows us the simple elegance of human relationship – the basis of all psychotherapy, and the heart of Dr Erickson’s hypnotic approaches to helping people. Soderquist listens with compassion to Amy’s story of suffering. Then, thinking like a competent hypnotherapist, he helps her to dissociate – to tune into the Happy Memoirs channel with“sweet memories,” rather than re-experiencing abject grief in a sad movie that plays in a loop.

Utilizing both her love for her father and his heavenly presence in her experience, Soderquist elicits Amy’s realization that she actually has a choice. She can continue to grieve, or she can switch to the Happy Memories channel. The goal of eliciting positive memories over traumatic ones is helping the client recognize that there is a choice. Amy’s grief and torment over her father’s death could be replaced with memories of all the happy times she once shared with him. Soderquist’s ability to transform Amy’s grief was beautiful, brief, direct, and compassionate.

Business as Usual by Carl Hammerschlag, M.D.

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.

When he arrived at my office the first time, his cell phone was clipped to his belt. He explained he was waiting for an important call. When it rang, he interrupted our session to talk at length on the phone. When I asked him if he thought the information that he was going to get from the phone was more important than what he might learn in my office, he replied without hesitation, that it was business and therefore very important.

I told him that if he couldn’t pay attention here in my office, it was clear to me he would not remain married. I asked him to turn the phone off. Reluctantly, he did so.

During the course of therapy, he agreed to follow my directions regarding an important intervention that I told them, could save their marriage. I prescribed what I knew would be an ordeal for him. He agreed to go on vacation with his wife to a place without a telephone or fax machine close by. He also agreed to let me provide all his reading material. I gave him a sealed package which I had already prepared.

His wife later reported that when they arrived at their destination, he opened the package and cursed, threw it against the wall and stormed out of the room. Inside the package was only one book. When he opened it, he discovered there were only blank pages and a pen. On the inside cover, I had written, “Dear John. Fill this book with whatever makes sense to you at the moment. You can choose to write in dialogue or in simple prose but you must write in this book every day. I ask that you to come to this task with openness and truth, and to tell the truth of your experiences at that moment.”

He cursed, threw the book against the wall and stormed out. His wife picked up the book and read my note. When he returned, and continued to rail on, she said, “Why not write this down?” She pointed out that writing about how angry he felt might be useful for him and would certainly provide a topic for later sessions. Her words struck a key with him.

Later in the vacation, he found an interesting stone that was covered with lichen. He knew lichen was an organism formed by a combination of fungus and algae growing as a unit on a solid surface. Picking up the stone, he inserted it into a hollow he created in the pages and began to write around it. “Everything grows connected to something other than itself.”

He began to describe himself as the lichen feeding from the impersonal rock of business. He recognized he wanted to find another way to thrive. This moment of insight became the beginning of productive therapeutic expansions and of rebuilding the marriage between two committed people.

I chose this somewhat ambiguous but potentially powerful intervention because of what I learned from Erickson and other medicine men I have known. They taught me that the most important knowledge is that derived from life experience not from theories or equations. If you can help people look again at their present experiences and at themselves with different perspectives, they can create new directions. The process of psychotherapy is to find creative ways through which you make the invisible visible.

Discussion by Ricky Pipkin, Ph.D.

Hammerschlag had a client typically considered difficult–a reluctant participant in therapy wanting a specific outcome without realizing that a generalized change must be made to reach that outcome. Additionally, this man was clearly successful in many areas of his life and accustomed to making fact-based business decisions. It often is easier to factor out emotional content and disregard the importance of feelings and, in business, it often is more efficient. However, this couple was highly motivated to keep their marriage which provided needed leverage.

The problem in the marriage was not a “business” one–it was that the wife felt discounted and unimportant. Hammerschlag’s problem was two­fold. First he had to capture the client’s attention; second, he had to make him understand that feelings and intangibles are important to a well-rounded life. As well as to relationships.

Directly confronting the inappropriate use of John’s cell phone during session and telling him that, what he learned in session could save the marriage was a business-like approach to a multi-level symptom. He used language that John was used to and could understand. John’s willingness to continue participating in therapy without using his phone created an implicit contract.

The sessions before the important intervention of the vacation were preparation for John to expand his own perceptions. Every act of insight, of expansion, is the result of the prepared mind and some serendipitous moment. Finding a rock with lichen, knowing what lichen was, provided John a metaphor of his own making. He recognized that even a lowly lichen is a union of different things, joined together to create a different and more complex organism. The needs of each part must be nurtured.

The simple moment of finding the lichen-covered rock and following, in his own way, Hammerschlag’s instructions, provided ways to understand himself differently. These changes were necessary in order for him to have what he really wanted-­the continuation of his marriage. This would not have occurred had not Hammerschlag first gotten John’s attention by using the techniques and language of business. Then, during the vacation, John was given only one concrete outlet for his thoughts and energies–self-examination in writing “the truth of his experiences of the moment.”

Erickson had a gift for creating and telling stories that patients could hear. He taught us all to look at our own blind spots and how to reach beyond them. Hammerschlag provided that for John by setting the stage for him to tell his own story about his own blind spots and to understand how to reach beyond them by the seemingly simple ambiguous and open assignment of writing on the blank pages , ”with openness and truth.”

Obviously, there was careful preparation so that John would be willing to go on vacation with no phone, fax or business reading materials. Hammerschlag’s success also demonstrates the value of using the client’s own language and world. The implicit contract between Hammerschlag and John insured that the directions would be followed even though, as business, John could implement them in his own way.

Good therapy often appears much simpler than it actually is.

THE MICRODYNAMICS OF SUGGESTION By Milton H. Erickson & Ernest Rossi

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.

Erickson believes that the purpose of clinical induction is to focus attention inward and to alter some of the individual’s habitual patterns of functioning. Because of the limitations of patients’ habitual frames of reference, their usual everyday consciousness cannot cope with certain inner and/or outer realities, and they recognize that they have a “problem.” Depotentiating patients’ usual everyday consciousness is thus a way of depotentiating facets of their personal limitations; it is a way of deautomatizing (Deikman, 1972) an individual’s habitual modes of functioning so that dissociation and many of its attendant classical hypnotic phenomena (e.g., age regression, amnesia, sensory-perceptual distortions, catalepsies, etc.) are frequently manifest in an entirely spontaneous manner (Erickson and Rossi, I 975). Depotentiating the limitations of the individual’s usual patterns of awareness thus opens up the possibility that new combinations of associations and mental skills may be evolved for creative problem solving within that individual.

Erickson’s approaches to depotentiating conscious sets are so subtle and pervasive in the manner with which they are interwoven with the actual process of induction and suggestion that they are usually unrecognized even when one studies a written transcript of his words. In order to place them in perspective we have outlined the microdynamics of induction and suggestion in Table I as: (I) the Fixation of Attention; (2) Depotentiating Conscious Sets; (3) Unconscious search; (4) Unconscious Processes; and (5) Hypnotic Response. We have also listed a number of Erickson’s approaches to facilitating each stage. Most of these approaches are illustrated in this volume and are discussed in more detail elsewhere (Erickson and Rossi, 1974; Erickson and Rossi, 1975; Haley, I 967; Rossi, 1973). Although we may outline these processes as stages of a sequence in Table I for the purpose of analysis, they usually function as one simultaneous process. Because of this, and in order to distinguish these processes from the broader dynamics of induction and mediating variables previously outlined (Barber and DeMoor, 1972) we designate ours as “microdynamics.” When we succeed in fixating attention, we automatically narrow the focus of attention to the point where one’s usual frames of reference are vulnerable to being depotentiated. At such moments there is an automatic search on the unconscious level for new associations that can restructure a more stable frame of reference through the summation of unconscious processes. There is thus certain arbitrariness to the order and the headings under which we assign some of the approaches Erickson used in Table 1. He could equally well begin with an interesting story or pun as with a shock, surprise, or a formal induction of trance. Once the conditions in the first three columns have been set in motion by the therapist, however, the patient’s own individual unconscious dynamics automatically carries out the processes of the last two columns.

A number of Erickson’s most interesting approaches to facilitate hypnotic response are the hypnotic forms listed in column 3 of table 1. All these approaches are designed to evoke a search on the unconscious level. Allusions, puns, metaphors, implications, and so on are usually not grasped immediately by consciousness. There is a momentary delay before one “gets” a joke, and in part, that is what is funny about it. In that delay period there obviously is a search and processes on an unconscious level (column 4) that finally summate to present a new datum to consciousness so that it gets the joke. All the approaches listed in column 3 are communication devices that initiate a search for new combinations of associations and mental processes that can present consciousness with useful results in everyday life as well as in hypnosis. The hypnotic forms listed in columns 2 and 3 are also the essence of Erickson’s indirect approach to suggestion. The study of these approaches may be regarded as a contribution to the science of pragmatics: the relation between signs and the users of signs (Watzlawick, Beavin, and Jackson, 1967). Erickson relies upon the skillful utilization of such forms of communication, rather than hyper suggestibility per se, to evoke hypnotic behavior.

As noted in Chapter One, it is important to recognize that while Erickson thinks of therapeutic trance as a special state (of reduced foci of attention), he does not believe hyper suggestibility is a necessary characteristic of such trance (Erickson, 1932). That is, just because patients are experiencing trance, it does not mean they are going to accept and act upon the therapist’s direct suggestions. This is a major misconception that accounts for many of the failures of hypnotherapy; it has frustrated and discouraged many clinical workers in the past and may have impeded the scientific exploration of hypnosis in the laboratory. Therapeutic trance is a special state that intensifies the patient-therapist relationship and focuses the patient’s attention on a few inner realities; trance does not ensure the acceptance of suggestions. Erickson depends upon certain communication devices such as those listed in column 3 to evoke, mobilize, and move a patient’s associative processes and mental skills in certain directions to sometimes achieve certain therapeutic goals. He believes that hypnotic suggestion is actually this process of evoking and utilizing a patient’s own mental processes in ways that are outside his usual range of ego control. This utilization theory of hypnotic suggestion can be validated if it is found that other therapists and researchers can also effect more reliable results by carefully utilizing whatever associations and mental skills a particular patient already has that can be mobilized, extended, displaced, or transformed  to achieve specific “hypnotic” phenomena and therapeutic goals.

In the therapeutic trance situation the successful utilization of unconscious processes leads to an autonomous response; patients are surprised to find themselves confronted with a new datum or behavior (column 5). The same situation is in evidence in everyday life, however, whenever attention is fixated with a question or an experience of the amazing, the unusual, or anything that holds a person’s interest. At such moments people experience the common everyday trance; they tend to gaze off (to the right or left, depending upon which cerebral hemisphere is most dominant, (Baken, 1969; Hilgard and Hilgard, 1975) and get that “faraway” or “blank” look; their eyes may actually close, their body tends to become immobile ( a form of catalepsy), certain reflexes (e.g., swallowing, respiration) may be suppressed, and they seem momentarily oblivious to their surroundings until they have completed their inner search on the unconscious level for the new idea, response, or frames of reference that will restabilize their general reality orientation. We hypothesize that in everyday life consciousness is in a continual state of flux between the general reality orientation and the momentary microdynamics of trance as outlined in Table I. The well-trained hypnotherapist is acutely aware of these dynamics and their behavioral manifestations. Trance experience and hypnotherapy are simply the extension and utilization of these normal psychodynamic processes. Altered states of consciousness-wherein attention is fixated and the resulting narrow frame of reference is shattered, shifted, and/or transformed with the help of drugs, sensory deprivation, meditation, biofeed­back, or whatever-follow essentially the same pattern but with varying emphasis on the different stages. We may thus understand Table I as a general paradigm for understanding the genesis and microdynamics of altered states and their effects upon behavior.

This excerpt has been extracted from Hypnotic Realities by Milton H. Erickson and Ernest Rossi’s Collected Works, Chapter 6: Facilitating Hypnotic Learning.