Posts Tagged ‘Family Therapy’

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.

Diplomacy By Henry Close, Th. M.

AURORA

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 an 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.

“Once upon a time, two musicians were hiking in the meadows of upstate New York. Suddenly, they heard a beautiful sound in the distance. It sounded like an animal roaring, and it was rich, melodic, and lovely: ‘ROOOO…A…A…A…AR.’

As the two hikers stepped into a clearing, they saw a magnificent beast — a stunning white dinosaur, holding its head high and filling the air with music! It slowly nodded as the two men approached. One of them spoke quietly: ‘You know, you have a beautiful voice. In fact, I think it is the loveliest roar I have ever heard, even nicer than from animals that have had singing lessons. I think you could have a career as an opera singer, but there is one problem. When you sing opera, you can’t just sing ‘ROAR.’ An opera singer must also sometimes sing ‘AH.’ The dinosaur nodded its head and gave it a try: ‘AH…AH!’ The musicians nodded their heads, ‘Very good. Now try it again.’ ‘AH…ROAR…AH!” “AH…ROAR…. AH!’” By this time, Kevin was singing fortissimo to his granddaughters. He glanced down, and there was Aurora wistfully looking up at him and smiling. He nonchalantly continued: “I never did learn the dinosaur’s name, but I know she sang a couple of times at the opera house. When she was taking her bows, someone in the audience threw her a bouquet of flowers, and she caught them in her mouth. Then she ate them.

TOMMY My friend, Lettie Mohammed, once noticed a young boy in the corner, flailing his arms as his mother tried to corral him. “Come on, Tommy — we’ve got to go! We’re late already.” Tommy showed no interest in going anywhere. Lettie immediately sized up the situation and said, “Tommy just wants to stay in here where all the pretty ladies are!” Tommy glared at her. “If he stays in here long enough, we can all give him a kiss!” With that, Tommy grabbed his mother’s arm. As she was being pulled out the door, she lamented. “He won’t even let me kiss him!” There are at least three principles implicit in these interventions: (1) Nobody loses face when a power struggle is defused rather than crushed; (2) Cooperation is better than obedience, and there are many ways to enlist it; (3) If you don’t mind making a fool of yourself, you can have a lot of fun in life!

Commentary By Eric Greenleaf, PhD

When teaching therapists Ericksonian approaches, remember: If it works with children, it’s likely to work with adults. Similar to the work of Rogers – Carl or Mister – the three principles exemplified by Henry Close, as he brings the power of loving interaction to the world of families, is elegant and effective.

Improving Communication Between Physically and/or Mentally Abusive Parents and Their Children Cecilia Fabre, M.A. Milton H. Erickson Institute of Cuernavaca

Edgar, a child of five, is the oldest son of a marriage that has lived with great economic and family pressures. The mother began going to therapy two years ago for her distress because of her pregnancy. She left treatment. A short while later, she asked for an emergency appointment. She told me by phone that she had just gotten Edgar out of the hospital, and he did not want to return home because she was afraid of his father who, in an attack of fury and impatience, had hit him against the wall, fracturing his cranium.

I met with the whole family in therapy because that permitted me to under- stand the family situation, to perceive their emotions and to explore their resources. Once I have an idea of the family structure and the context in which the problem occurred, I can tell a story (or build a story together with the children) that represents the problem and different solutions. In an abuse situation, it is necessary to censure actions, not the persons implicated, trying to see them as parents who make mistakes. In this case I constructed the story because the child was immobile in a chair, not wanting to look at anyone, much less participate.

I told them a story about a lion cub and its family. Mommy lion went out to work and to look for food, while Daddy lion stayed to guard his territory and did- n’t like to be disturbed. The lion cub really wanted to go hunting. He wanted to go out to explore. He saw the older lions roar and fight and he was dying to do it too. He wanted someone to play with him, but when Mommy arrived, she wanted to do anything but play. She was tired and wanted him to eat. The little cub began to think he was not interesting or important enough for his mother to play with him.

One day the little cub decided to do as the older lions did. He ran close by his father growling like the older lions, but Daddy lion did not move. The cub growled louder and louder without success. Finally he decided to bite the Daddy lion’s paws and ears to get his attention. He didn’t know that Daddy’s paws had been hurt many years ago. How surprised he was when he bit his daddy and his daddy gave him a shove, throwing him against a rock.

The poor little lion was hurt very badly. At this precise moment, Mommy came back from hunting. Scared, she ran to her cub and started to lick him. She growled very loudly at Daddy lion, more loudly than in other times. Daddy lion also ran to see what had happened to his little son. He hadn’t wanted to hurt his son and he didn’t know why he had let out such a strong blow and why his claws had come out when normally they only came out for attack and defense.

The story continues telling how the little cub had been healed at a special cave, but his little heart still felt very sad and something still hurt inside. All the family went to consult a Leopard therapist that helped the parents and cub to cure their wounds. Leopard told them, “Now is time to heal your wounds, before they become infected.”

While listening to the story, Edgard had drawn a picture of himself that showed the open wound in his head. He drew merthiolate and band aids over the wound and at the end of the session he felt calm about going home. His father talked about his own past psychiatric diagnoses and agreed to visit the psychiatrist again.

They came to three more sessions. Although the problems of the family environment continued, the father’s aggression disappeared and they became closer and more communicative.

The Ericksonian techniques utilized were: story telling, metaphors and reframing through the story.

Reference:

Robles, Teresa (1990) A concert for four brain hemispheres in psychotherapy, Alom Editores, México y (1991) Terapia cortada a la medida. Un seminario con Jeffrrey K. Zeig, Alom Editores, México.