Posts Tagged ‘LAMFT’

The Lesser Of Two Evils Richard Landis, Ph.D. Ericksonian Integrative Medical Institute of Orange County

Judith was a 46-year-old woman who, for the first time in thirty years, was without a job. In the past, when she left a job, it was because someone contacted her with a better offer. Now, for the first time, she had to find a job for herself. She had been sending out resumes by the bushel but received no replies. Judith had been referred to me by someone who said I was practical and knew the ins-and- outs of the business world. The referral source told me that Judith did not want therapy. He identified her as feeling worthless unless she had a job, and that no one would care about her until she was in a position to help others. To match her expectations, I presented myself to Judith more as a coach then as a therapist. However, it was readily apparent that Judith was painfully shy and felt that she had no personal worth.

Her job hunting strategies were limited to using the want-ads in the newspapers and on the Internet. When I asked if she asked any friends or acquaintances if they knew of job openings, Judith said that she could not do that. It would be too embarrassing and why would they want to help her? There was nothing in it for them. This presented the opportunity to both open possible job offers and to challenge her underlying assumptions about her personal worth and rights as a person.

During the next session, I said that there were two avenues I would like her to explore in the coming week that would increase her likelihood of getting a job. The first one was to ask a friend or colleague from the old job if he or she knew of something that was available. Judith turned white and I continued. I said that I would like her to do it as a gift to the other person, since Judith knew how good it felt when she could do a favor for someone else. I thought she was being selfish withholding this opportunity for her friends or colleagues to feel good. I spent less than five minutes talking about this alternative.

The second avenue was to make cold calls on companies. She was to research which type of company would most likely be able to afford the salary that she had before and might have a position that she could enjoy. I went into agonizing detail over how to dress and who to ask for when she walked into the office. We rehearsed what she was to say and what her presented attitude should be. I really micro-managed it ad nauseam for 35 minutes. She left knowing what to do but was a bit shaken.

When she returned the next week, she reported that she had done the research for the cold calls, but did not visit any sites. Instead, she decided to ask an old colleague. Judith was pleasantly surprised that her colleague was delighted to be of help and asked everyone else in the office if they knew of any possibilities. From that interaction, Judith got three referrals. Heartened by that outcome, she asked a parent that she met at a PTA meeting during the week. She had never met the parent before, and it just came out in conversation. The parent was a supervisor in a medical office and they were looking for a back-office person.

Judith left therapy at that time, since she was no longer feeling depressed and helpless. She was a bit apologetic about not doing the cold- call homework. I reassured her that I was pleased how she knew which of the assignments fit her best. She did not recognize that by my emphasizing the alternative that generated the greatest anxiety, it made the other alternative more accessible and less scary by comparison. She had a strong need to do something, and the less anxiety producing of the two choices now seemed possible to her. At the same time, she discovered that she was worthy enough that people were willing to be helpful. Her husband later contacted me for some help for himself. At that time, he disclosed that Judith acting on the assignment turned out to have been sufficient for her to become more assertive at work and at home. Once breaking her old assumptions by doing something that challenged them, she continued to assert herself as well as continuing to give to others.

The Wonderfully Terrible Burden By Richard Landis, Ph.D.

A common theme that I remember Erickson discussing during our time together was his fascination with how the unconscious was able to use current events and experiences to conjure past learnings.

I experienced this first hand during my second session with Matt, a ten-year-old boy, and his parents. Matt, an only child was going to have to redo the fourth grade because of poor grades. Matt had felt like an outsider in the fourth grade and had no motivation to do school work. The thought of repeating the fourth grade again after “flunking” made him feel even less motivated. His parent tried “everything.” Unfortunately, each parent felt that his or her strategy-of-choice had been good enough to motivate each of him or her as a child, so it should motivate Matt. Their unyielding assumption was that if their strategy did not work, the problem was in Matt, not the appropriateness of the strategy.

To adapt a key concept from Ellyn Bader’s work with couples: “A lot of times, [parents] are so invested in the other person changing that they don’t want to look at themselves.” I had to take it easy since both parents had a history of taking their son out of therapy if the therapist demanded that the parents change.

It was during the second session that I remembered how Erickson would talk to us as a group when he wanted to avoid triggering a specific person’s self-protections. In that memory, I heard Erickson tell us his classic story about the parents who could not stop their seven-year-old daughter from sucking her thumb.

In that story Erickson told the daughter that she was about to reach a milestone in her life, her eighth birthday. Erickson instructed the daughter to enjoy sucking her thumb and to memorize it because after her eighth birthday, she will have passed the age of thumb-sucking and move onto more interesting things that are more appropriate for an eight year old. By giving the instructions in the presence of the parents, Erickson was indirectly challenging the parents’ assumptions that they had to change the daughter.

Change was a natural part of life. If you let it, the mind moves forward by itself. And at the same time, the communication to the daughter affirmed that the parents were not the targets of change. (For a verbatim account of this story, see Zeig, J., A Teaching Seminar With Milton H. Erickson, Brunner/Mazel, NY, 1980.)

With echoes of Erickson’s words in my head, I addressed Matt, “I am so very glad that your parents brought you in to see me at this time. If they had waited until your eleventh birthday in six weeks, you would have taken care of the problem yourself and I would not have been able to get any of the credit.”

I told Matt about the significant brain changes that naturally occur as we grow. “One of the most significant changes occurs at the age of eleven when the nerve connections between the right and left sides of your brain become insulated. Nerve signals move quicker and more effectively. At that time, we are better able to see old things with new eyes. And along with this wonderful gift comes a terrible burden. [Long dramatic pause].”

I remembered that Matt had said that he had longed for a younger brother so he could “show him how it was done.” With that in mind, I continued, “Matthew, in returning to the fourth grade, you will be going through this change before others in your class do. This means that your classmates will naturally want to look up to you as a role model. It will be as though you are the older brother that leads the way, showing the younger brothers how to do it right. While you will have the advantage of being familiar with what your teacher is presenting, your mind will be different and you will have to learn it ‘brand new’ as an eleven-year-old who has had the brain-change.”

“Before you turn eleven, I want you to memorize how it feels to not want to do homework and to not be particularly interested in learning. You need to remember how this felt so you can let your classmates know that you understand how some of them might feel. You used to feel that way yourself before you had the brain-change.”

I continued for twenty-five minutes, repeating the same message in many different permutations. Within the first ten minutes, Matt and his parents were in a comfortable trance state, hearing future-pictures described of Matt moving forward on his own.

That was the last session I had with Matt. His father called to cancel the next session because Matt “discovered” that he got his “brain-change” early, and started taking an interest in schoolwork. They no longer needed my services.

I met the parents two years later for some couple counseling. They reported that Matt had been successful academically and socially in both the fourth and now in the fifth grade. The parents said that they wished that they had known about the brain-change earlier so they would not have had to work so hard to get him to do his work.

A Shift for Victim to Empowerment by Tim Baumgartner, Ph.D. Houston, TX

A 24-year old client who had been in therapy almost continually since her mid-teens presented a long history of sexual abuse and incest. Five years previously, she had been hospitalized for major depression and suicidal concerns.

At that time she reported abusive treatment by her psychiatrist. Complaints involved isolation when she refused medication, verbal insults, and suggestions of memories that she did not have. She reported that the psychiatrist subsequently lost his license.

Prior to seeing me, she was in therapy with another psychiatrist for five years. The client reported feelings of resentment and distress toward this psychiatrist. She reported that he insisted that she had engaged in specific sexual acts with her father. These acts were not consistent with her recollections. Therapy had included confrontation of the father.

The client was now married and had not been troubled by suicidal depression or drug abuse over the last three years. However, her history combined with her reported abuse by family, boyfriends, employers and treatment providers contributed to her depression, post-traumatic stress, and “victim” self-image.

Treatment began with the setting of clear boundaries and focusing on the client’s rights and expectations . Her abuse history was gradually disclosed, accompanied by expressions of fear and anger. The client agreed to the use of trance to shift her focus from the perspective of victim to one of curiosity and empowerment. She responded well to conversational inductions. The therapeutic focus was on learning and development as opposed to remediation. As she learned to express her feelings of anger and frustration, she began to express the need to “get away somewhere.” Her fantasy was to take an island vacation, but she believed that she required psychiatric inpatient services to stabilize her thinking.

In our discussion, she expressed that the dollar price of the short hospital stay would be about the same as the desired vacation, however, she was concerned about her husband’s “emotional price tag” that would result if she took a vacation. In therapy, I suggested that some people “prepay” vacations so they can enjoy the entire experience knowing that there would be no legitimate bill waiting on their return. She was challenged to determine all “hidden” costs and experience them affectively and inter­personally, as soon as possible, so she could begin anticipating her trip.

The client accepted this suggestion, and shifted her focus from anticipation of hospitalization to planning for the trip. She took the vacation while her husband stayed home. Upon her return, she reported that she had successfully set boundaries with her husband and did not assume any emotional debt for her trip.

The metaphor of the vacation was used to reinforce her inner strength and independent action. The client reported successful goal planning, boundary setting, calculated risk taking, initiation of interpersonal relationships, and a feeling of inner courage and empowerment. Over the following months, she remained in therapy and reported that the vacation provided a “turning point” for her. The client enrolled in college and performed well. While the change from “victim” to responsibility was rapid, and occasional slips into the former role occurred, the resources for change were integrated within her.

Suggested readings Otani, A. & Koska, M., (1992). “The dialogue technique of hypnotic induction.” American Journal of Clinical Hypnosis, 35, 1, 20-28.

Phillips, M., (1993). “Turning symptoms into allies: utilization approaches with post- traumatic symptoms.” American Journal of Clinical Hypnosis, 35, 3, (179-189).

Rosen, S., (1982). My Voice Will Go With You. New York: W.W. Norton

Discussion by Gene Davita, M.D.

Baumgartner  focused on present­ing issues in the past as well as present boundary violations and abuse from numerous sources including professionals. Establishing a therapeutic relationship with clear expectations, respect for the rights of the patient and opportunity for her to express her emotions was paramount. This established a fluid, process focused therapy in which change could be promoted.

The patient seemed adept at trance since conversational induction worked well. She was able to move from the victim position to one of empowerment rapidly. More traditional therapeutic approaches that encourage hours of exploring victimization experiences can further crystallize that role. Such a shift in the therapeutic paradigm for a patient allows responsibility, self-assertion and creativity that universalizes to all areas of living.

The patient’s concerns with the cost of hospitalization presented Baumgartner with an opportunity to employ an Ericksonian approach and the patient’s fears then could  become a useful part of therapy. The vacation metaphor allowed the patient to experience “getting away” and to create an experience that furthered her responsibility, assertion and individuation . This created even more encouragement for further growth and development in living by using the skills developed while turning a dream into a reality. She was further empowered by beginning to create a life of self hood rather than perpetuating the life of a victim.

Baumgartner’s work with this patient, who presented with a multi­tude of serious problems, demonstrates therapeutic elegance in his work with one aspect of her problems. The assistance of movement from being reactive in her life to being the source of creating her life was important. This resolution can serve as a springboard for future therapeutic advancement.