Posts Tagged ‘Innovative Psychotherapy’
Impact Therapy is an approach that is growing in popularity both in the United States and Canada. The founder, Ed Jacobs, Ph.D., professor at West Virginia University, has already written three books on the subject (Jacobs, 1988, 1992, 1995). The creativity and dynamism emerging from this model of therapy were largely inspired by Milton Erickson’s methods.
People learn, grow and change mainly with what they hear, what they see, or through the kinesthetic system which processes all informations coming from the body. Neurophysiologists agree that the kinesthetic system is more important than the visual system which is more important than the auditory system. When we limit therapy to the audio system, simply talking to the clients, we restrict our interventions to a small part of the brain. Dr Jacobs recognized that the more systems involved, the greater the therapeutic impact.
It is said that “a picture can be worth a thousand words.” For example, I can present a sponge to portray how kids absorb everything parents do or say. This visual aid helps make it clear to parents that everything the children’s “sponge” absorbs will eventually leak out. The same visual imagery can be used for couples, especially those who come in saying that they are not getting anything, anymore, from their marriage. Showing them the sponge and asking them what they put on it in the last months often helps bring the focus back on each person instead of each accusing the other. They realize they can’t expect the ‘sponge’ of their couple relationship to remain flexible, nourishing and rich if they don’t give it healthy input.
Concrete tools can help the psychotherapeutic process in at least five ways. First, the difficulty is brought outside the client providing him a chance to look at it as an observer. Second, by using a simple object that already has a meaning in the person’s life, the quality of simpleness dilutes the intensity and the gravity of the more problematic connections. Third, the concrete intervention by the therapist facilitates a more rapid rapport with the client and gives a healthy model with an understandable solution for a piece of the difficulty. Fourth, it offers opportunities to the therapist to explore in a clearer and more detailed way the client’s inner universe. And fifth, the use of visual stimuli helps arouse other relevant material and helps the client focus. These important conditions help to get more done within each session.
Impact Therapy also can be used as an adjunct to other therapeutic modalities, especially with TA and Gestalt. For example, a woman had felt guilt ever since her mom led her to believe she was responsible for being sexually abused by her father and for the disturbances it created in the family. I put a child’s chair in front of her and had her recall how she was as a little girl. Then I added an adult chair and had her describe her dad sitting there. I took the adult chair and turned it upside down on the top of the small one. Looking at the scene she began to cry. We explored her feelings, and the decisions she had made following the abuse. I then took an audiotape, wrote her parent’s name on it, the date of the abuse, and put it on the small chair to represent the messages she had been listening to for years. I then asked her, “Do you think that little girl could have escaped her father no matter how hard she tried?” She realized, as never before that she couldn’t have avoided it. She was simply trapped and the visual stimulus showed her in an inescapable way.
I believe that therapy can and should be fun, for us and for the clients. As Paul Watzlawick, Ph.D., said in one of his workshops, clients are there for a few sessions but we are there for most of our lives, so we better have fun doing what we do if we want our lives to be rich and interesting. Impact Therapy is a framework, that can make therapy more interesting, effective, and enjoyable.
Jacobs, E.E. (1992). Creative counseling: An illustrated guide. Florida: Par.
Jacobs, E.E. (1995). Impact Therapy. Florida: Par.
Jacobs, E.E., Harvill, R.L. & Masson. R.L. (1988). Group counseling: Strategies and skills. Pacific Grove, CA: Brooks/Cole.
Selena is a precocious five-year old girl who could not stop sucking her fingers. Her teeth were beginning to protrude. Because she still believes in Santa Claus and the Tooth Fairy, I was positive that she would be very susceptible to hypnosis.
I asked Selena to “move to the magic chair where kids stop sucking their fingers .” Then , at my request, she named each finger. She responded with, “Bunny Rabbit,” “Robin” and other similar titles. I directed her to ask each finger if it liked being sucked. She said, “No.” Then , I asked her to find out what her fingers would rather do instead. After some conversation with her fingers, she told me they would rather play dolls, jump rope and do puzzles.
l suggested, “Let’s see how we can give those fingers more time to play.” With proper ceremony, I showed Selena my “magic wand.” I then asked her to “… think of a magic word that will keep you from sucking your fingers.” With delight, she squealed , “Poof!”
Next, I asked Selena to put each finger in her mouth. “But,” I cautioned her, “before you put your fingers in your mouth, say ‘Poof!’ And I will wave my magic wand.” We repeated this pleasant little ritual with each finger.
Then, I told her she could do that all by herself after she left my office.
The following week, Selena and her mother reported that Selena did not suck her fingers all week except for one short moment as Selena was leaving my office. The mother then mentioned, almost in passing, that she would ask me to help Selena overcome her bedwetting, but she knew Selena was not yet ready to stop that behavior. I began to talk to Selena, reinforcing the previous week’s process, but it seemed not to have any energy left in it. Then I told Selena, “I don’t want you to stop wetting the bed yet. But you will be ready very soon. So let’s do some things for when you are ready. OK? Can we do the same magic for the part of you that wets the bed?”
Selena agreed. I told her I would wave my magic wand and asked her what she would do. She replied that she “would dive, like this.” She stood and did a full body dive onto the couch. As she hit the couch she said, “POOF!”
Selena did several more dives on the couch and then progressed to crawling all over the floor saying she “was swimming like in the Olympics.” I gave her an “Olympic medal ” (a sticker) and told her that the medal was for “all the dry ‘Pull Ups’ you will have now.” A week later, I phoned the mother for a “follow-up.” She reported Selena had not sucked her fingers since the day of our first session and had not wet the bed since our second.Discussion by William Keydel, M.A.
Magical … and fun. This wonderful case illustrates three principles which are at the heart of Ericksonian psychotherapy. First and foremost is the acceptance and honoring of the client’s way of viewing the world. Dr. Williams begins by utilizing the preschooler’s belief in magic to set the stage for change. She deepens Selena’s natural imagery by asking her to name her fingers and creating the imaginary friends so common to children’s play. It is then these friends of Selena’s unconscious who provide motivation for change with reasons meaningful to the child and not even necessary for Williams to know. Williams also evokes Selena’s natural energy and excitement by allowing her to come up with the magical words and acts that would extinguish unwanted behaviors. In these ways, Williams has entered Selena’s world to stimulate change from within.
The second principle which stands out is the interruption of existing patterns through strategic interventions. The beauty of Erickson’s work stemmed from his ability to see the individual’s patterns and his creative responses to those patterns generating change with a minimal amount of effort. By having Selena say, “Poof!” as she put each finger up to her mouth , Williams introduced a change in the old pattern. Then this became a new pattern, reinforced by practice with each finger, and further reinforced by the excitement of creating magic on her own. In this case, it’s easy to imagine that Selena experienced no effort as the strategic intervention created its own reward. Similarly, Selena’s patterns for approaching bedtime were changed with her full-body dives which naturally utilized the playful energy of a child.
The third principle to be honored in William’s handling of the case, is the willingness to let go of theories and “treatment plans” and respond to the client. As Erickson is quoted by Gindhart, “Too many psychotherapists try to plan what they will do instead of waiting to see what the stimulus they receive is, and then letting their unconscious mind respond to that stimulus” (p. 120). While reinforcement is generally good work, Williams responded to her client’s “energy ” and appropriately moved on. Throughout her work with Selena, Williams demonstrates the elegance of responding to her client and thereby allowing Selena, in a general way, to structure therapy in accordance with her needs.
I could have focused on Williams’ effective use of permissive therapy and embedded commands; or my focus could have fallen on the value of using a naturalistic trance to avoid the awkwardness a formal trance induction is likely to have on a child. But, as Richard Dimond points out in “Trials and Tribulations of Becoming an Ericksonian Psychotherapist,” (Zeig, 1985), Ericksonian psychotherapy requires more than learning Erickson’s techniques. There are fundamental principles about entering in and trusting the unconscious system of the child across from us.
Dimond, R. (1985). “Trials and Tribulations of Becoming an Ericksonian Psychotherapist.” In Zeig (Ed.), Ericksonian Psychotherapy, Vol. 1: Structures. NY: Brunner/Mazel
Gindhart, L. (1985). “Hypnotic Psychotherapy.” In J. Zeig (Ed.), Ericksonian Psychotherapy, Vol. 1: Structures. NY: Brunner/ Mazel
“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 help-less,” 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.
In the EMDR process, something creative happens; with an almost surprising acceleration, images, memories, associations, thoughts, and emotions are often brought forth rapidly into a client’s mind. In reliving events, the client may emote in rage, grief, or fright. After EMDR therapy, he is not simply desensitized or less anxious; his thinking has changed. In the course of one or more sessions, the former memory has lost its power. The EMDR process posits that trauma teaches maladaptive lessons that can be unlearned. The speed of change and the lasting resolution with EMDR are reported to be the most appealing aspects to clinicians of this psychotherapy.
The founder of EMDR, Francine Shapiro, Ph.D., is the executive director of the EMDR Institute, Inc., and a Senior Research Fellow at the Mental Research Institute, Palo Alto, California. She was awarded the 1993 Distinguished Scientific Achievement in Psychology Award presented by the California Psychological Association. She is the author of three books: Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures (1995), EMDR: The Breakthrough Therapy for Overcoming Anxiety, Stress, and Trauma (1997), and the forthcoming EMDR and the Paradigm Prism (American Psychological Press). Training in the EMDR techniques through the EMDR Institute is mandatory for clinicians. According to Dr. Shapiro, it is a specialized approach and method that requires supervised training for full therapeutic effectiveness and client safety. To date, 30,000 clinicians have been trained throughout the world. Level I EMDR training centers on how to desensitize traumatic memories, anxieties, and phobias, and to install positive belief structures. EMDR has applications to natural disasters, family therapy, Post-traumatic stress disorder (PTSD), children and adult survivors of abuse, adult children of alcoholics and for the personal use for the therapist to process vicarious imagery overflow from traumatized patients. Level II Training has applications for Dissociative identity disorder, Axis II diagnoses and other major disorders.
According to Bessel A. van der Kolk, M. D., “The speed at which change occurs during EMDR contradicts the traditional notion of time as essential for psychological healing. Shapiro has integrated elements from many different schools of psychotherapy into her protocols, making EMDR applicable to a variety of clinical populations and accessible to clinicians from different orientations.” Early inspiration for EMDR was in 1987, when, as a graduate student, Dr. Shapiro discovered the technique as she was walking in a park. She had been troubled by some old memories and disturbing thoughts. Her painful memories seemed to dissolve as she moved her eyes rapidly back and forth. She was amazed by her own discovery, gathered volunteers to experiment with this process, and then, organized formal research to test this discovery.
In 1988, she approached Joseph Wolpe, the originator of systematic desensitization, to teach him her method and to ask him to publish her paper in the journal he edited, The Journal of Behavior Therapy and Experimental Psychology. He experimented with EMDR, and published her article and one of his own case studies using EMDR in the journal. He stated that with EMDR treatment for PTSD “there is often a marked decrease in anxiety after one session, and practically no tendency to relapse.” In 1989, she published her research, “Eye movement desensitization: A new treatment for post-traumatic stress disorder,” which was then followed in adding ‘reprocess-ing’ in the 1991 article, “Eye movement desensitization and reprocessing procedure: From EMD to EMD/R: A new Treatment Model for Anxiety and Related Trauma.” From these original studies, a great deal of other research has followed, until, to date, there have been more controlled treatment outcome studies on EMDR than on any other method used in the treatment of PTSD.
One controlled study by Wilson, Becker, and Tinker (1995), evidenced the effects of three 90-minute EMDR treatment sessions on traumatic memories, working with 80 participants. These subjects revealed decreases in their presenting complaints, and in addition, reported increases in positive cognitions. The general functioning of these participants improved, with less depression, fewer somatic complaints, and improvement in self-esteem. These positive effects were maintained at a 90-day follow-up.
In 1998, a meta analysis of 61 studies compared the efficacy of several treatments of PTSD–drug therapies, behavior therapy, EMDR, relaxation training, hypnotherapy, and dynamic therapy–found that behavior therapy and EMDR were most effective. By self-report assessment, EMDR was the most effective treatment. Treatment effects were maintained at a 15-week follow-up. The meta analysis reviewed the theoretical bases for all treatments and summarized that EMDR maintains these treatment components: “imaginal exposure with concomitant lateralized movements, along with coping statements.” The provisions for how EMDR works is unclear. It is unknown as to “what changes occur in what part of the brain, how oscillatory movements are involved in those changes, how that leads to ‘reprocessing’ of the trauma, and how such reprocessing results in decreased PTSD symptoms. . . . Clarification of the mechanism by which symptoms change and the active ingredients in EMDR is now critical, given its apparent efficacy. Without such clarification, the acceptability of EMDR within the professional community is likely to remain controversial.”
Wilson, S. A., Becker, L. A., and Tinker, R. H. (1995). Eye move-ment desensitization and repro-cessing (EMDR) treatment for psychologically traumatized individuals. Journal of Consulting and ClinicalPsychology; 63, 928-937.
Van Etten, M. L., and Taylor, S. (1998). Comparative efficacy of treatments for Post-traumatic Stress Disorder: A meta analysis. Clinical Psychology and Psychotherapy; 5, 126-144.