Posts Tagged ‘LAC’
Milton H. Erickson & Ernest L. RossiEstimated reading time: 4 minutes, 54 seconds.
THERAPEUTIC BINDS AND DOUBLE BINDS
The concept of the double bind has been used in many ways. We use the terms “bind” and “double bind” in a very special and limited sense to describe forms of suggestion that offer patients the possibility of structuring their behavior in a therapeutic direction. A bind offers a free choice of two or more comparable alternatives-that is, whichever choice is made leads behavior in a desired direction. Therapeutic binds are tactful presentations of the possible alternate forms of constructive behavior that are available to the patient in a given situation. The patient is given free, voluntary choice between them; the patient usually feels bound, however, to accept one alternative.
Double binds, by contrast, offer possibilities of behavior that are outside the patient’s usual range of conscious choice and control. Since the original formulation of the double bind (Bateson, Jackson, Haley, and Weakland, 1956) as a hypothesis about the nature and etiology of communication in schizophrenia, a number of authors have sought to utilize the concept of the double bind to understand and facilitate psychotherapy and hypnosis (Haley, 1963; Watzlawick et al., 1967, 1974; Erickson and Rossi, 1975). Since we use the term in a very special and limited sense, we will present only an outline of how we conceptualize the double bind for an understanding of therapeutic trance and hypnotic suggestion.
The double bind arises out of the possibility of communicating on more than one level. We can (1) say something and (2) simultaneously comment on what we are saying. We may describe our primary message (I) as being on an object level of communication while the comment (2) is on a higher level of abstraction, which is usually called a secondary or metalevel of communication (a metacommunication). A peculiar situation arises when what is stated in a primary communication is restructured or cast into another frame of reference in the metacommunication. In requesting an ideomotor response such as hand levitation, for example, we ( 1) ask patients to let their hand lift but (2) to experience it as lifting in an involuntary manner. In requesting an ideosensory response we may (I) ask patients to experience a hallucinatory sensation of warmth, but (2) it is usually understood that such an experience is outside patients’ normal range of self-control. Therefore, patients must allow the warmth to develop on another, more involuntary level. We have many ways of saying or implying to patients that (I) something will happen, but (2) you won’t do it with conscious intent, your unconscious will do it. We call this the conscious-unconscious double bind: since consciousness cannot do it, the unconscious must do it on an involuntary level. Conscious intentionality and one’s usual mental sets are placed in a bind that tends to depotentiate their activity; unconscious potentials now have an opportunity to intrude. The conscious-unconscious double bind is the essential basis of many of the therapeutic double binds discussed in the following sections.
In actual practice the metacommunication that comments on the primary message, may take place without words: one may comment with a doubting tone of voice, a gesture or body movement, subtle social cues and contexts. Hidden implications or unconscious assumptions may also function as a metacommunication binding or qualifying what is said on the ordinary conversational level. Because of this the patient is usually not aware that conflicting messages are being received. The conflict is frequently enough to disrupt the patient’s usual modes of functioning, however, so that more unconscious and involuntary processes are activated.
Ideally, our therapeutic double binds are mild quandaries that provide the patient with an opportunity for growth. These quandries are indirect hypnotic forms insofar as they tend to block or disrupt the patient’s habitual attitudes and frames of reference so that choice is not easily made on a conscious, voluntary level. In this sense a double bind may be operative whenever one’s usual frames of reference cannot cope and one is forced to another level of functioning. Bateson (1975) has commented that this other level can be “a higher level of abstraction which may be more wise, more psychotic, more humorous, more religious, etc.” We simply add that this other level can also be more autonomous or involuntary in its functioning; that is, outside the person’s usual range of self-direction and -control. Thus we find that the therapeutic double bind can lead one to experience those altered states we characterize as trance so that previously unrealized potentials may become manifest.
In actual practice there is an infinite range of situations that may or may not function as binds or double binds. What is or is not a bind or double bind will depend very much on how it is received by the listener. What is a bind or double bind for one person may not be one for another. In the following sections, therefore, we will describe a number of formulations that may or may not lead a particular patient to experience a bind or double bind. These formulations are “approaches” to hypnotic experience; they cannot be regarded as techniques that invariably produce the same response in everyone. Humans are too complex and individual differences are simply too great to expect that the same words or situation will produce the same effect in everyone. Well-trained hypnotherapists have available many possible approaches to hypnotic experience. They offer them one after another to the patient and carefully evaluate which actually lead to the desired result. In clinical practice we can only determine what was or was not a therapeutic bind or double bind in retrospect by studying the patient’s response. The following formulations, therefore, offer only the possibility of therapeutic binds or double binds that may structure desired behavior.[ Note: One may refer to the “following formulations” by reading the rest of the chapter after purchasing the book here — https://catalog.erickson-foundation.org/item/hypnotic-realities ]
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!”
When Erickson worked with an alcoholic, he would often say, “Bring a full, unopened bottle of alcohol with you to the next session.” The implication was, “Don’t drink,” and the deeper implication was that the client can control his drinking.
In working with couples, Erickson would often say to one of them, “I want to hear your side of the story. One implication is: “I also want to hear the other side of the story.” But, because of the word “story,” the further implication is a distinction between the “story” and real story. Virginia Satir made the same kind of distinction by saying to a family member, “I want you to tell me how you see the problem,” implying that there were other views.
Erickson would frequently say to a client, “I want you to withhold any information that you don’t want to share with me.” “Withhold” is not necessarily permanent; you can withhold for a while, and then you can yield. But the implication is: “Don’t pay attention to all the stuff you’re going to tell me; pay attention to the stuff you want to withhold.” So, clients would tell him many sensitive things, and most likely by the end of the session, would think, “Well, I told him all that other stuff, I may as well tell him this too.”
Erickson was in session with woman right before she was scheduled for risky surgery and she had doubts if she would be okay. He gradually led the discussion around to cooking, and asked about her favorite recipes. When she would mention something, he would say, “Oh, you know, I’ve always wanted a good recipe for that. Would you give it to me?” Of course, she couldn’t give it to him in that session because she was due to have surgery, so he’d say, “Oh, that’s all right, you can bring it in when we have our next session,” implying that the surgery would be successful.
I went to see Erickson in 1979, about a year before he died. In the middle of the day, seemingly out of nowhere, I heard him say, “Marry an ugly woman and she’ll always be grateful.” I thought to myself, ‘What an awful sexist thing to say!’ At the time, I was with a woman who I — and many others — thought was quite beautiful. The implied message is: “Marry a beautiful woman and she won’t always be grateful.” I didn’t understand that consciously until after the woman and I were married.
Erickson once worked with a woman he called, “Inhibited Ann.” Shortly before bedtime, she’d start gasping and choking, which interfered with her having sex with her husband. In order to be physical with him, the woman insisted that the lights be out, so that she could undress in the bathroom, put on a long robe, and then, covered head to toe, she’d come into the bedroom in the dark and get into bed with her husband. After finding out that Ann loved to dance, Erickson said, “You know, you could dance into the bedroom in the nude.” And then said, “We don’t want to give him heart failure,” implying, “We do want to give him something else.” Then, later in the session, Erickson said, “You really could dance into the bedroom in the nude. You’d be in the dark with all the lights out, so your husband can’t see anything, and he’d never know.” So Ann took his suggestion, danced in the nude in the dark, and then crawled into bed feeling like a school girl, giggling about doing something so daring. Giggling implied not gasping, and not gasping implied availability for sex.
On another occasion, Erickson worked with a professor of music who fainted whenever he tried to go onstage to give a piano performance. He told Erickson he was going to be fired from the university if he didn’t perform. So Erickson said, “Okay, ahead of time, put down towels of different colors all the way from the backstage up to the piano. Then, as you walk onstage, decide which one you’re going to faint on.” Involving the professor in a decision process implied that he would not be attending to whatever thoughts made him faint in the past. Since fainting is elicited unconsciously, the implication is he won’t faint at all. And since you have to faint where you are, not somewhere else, thinking about fainting there implies not fainting here.
This same intervention saved Erickson’s life once. When he was working in a mental hospital, he walked into an elevator and per regulation, locked the door behind him before realizing that there was a murderous psychopath in the corner, who said, “I’m going to kill you.” As Erickson always did, he first paced what the psychopath said, and then replied, “Oh, okay, you’re going to kill me…” as he put the key in the elevator door to unlock it, “and the only question is, ‘Where do you think the best place would be for you to slaughter me?’” Erickson opened the elevator door, pointed down the hall and said, “Would over there be best?” The psychopath looked out into the hall as Erickson calmly walked out of the elevator, saying, “Or, maybe over there in that chair would be better. But then again, over there might be best.” Erickson continued walking down the hall toward the nurse’s station, and to safety. Since there is not where he can be slaughtered, he distracted the psychopath from killing him where he stood.
Learning about implication is similar to opening another set of eyes and ears; seeing and hearing in a whole new dimension. It’s spooky the things you can become sensitive to, particularly nonverbal implication. I believe that Erickson’s unparalleled ability to “read” people was largely due to his ability to notice and use implication.
In earlier issues of the Newsletter I have written more extensively about both verbal and nonverbal implication. (Vol. 23, No. 1; Vol. 24, No. 1; Vol. 24, No. 2)
* Edited from a dialogue between Jeff Zeig and Steve Andreas “Experien- tial Approaches: The Power of Impli- cation” at the 2014 Brief Therapy Conference. BT14-D02
“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.