Posts Tagged ‘LISCW’

Sep 18

The Boxer

By Dan Short, Ph.D Dallas, TX Estimated reading time: 4 minutes, 30 seconds. 

The 21-year-old client did not want to be in therapy . Charged with assault on his girlfriend, he had been ordered to counseling as a condition of probation. The intake, conducted by another therapist, noted, “Client is reluctant to focus on violence related issues.” The client, muscular and sullen, entered the first session in silence and sat slouched in his chair with a cap concealing most of his face. He had described himself as “a boxer” and had explained that counseling should not interfere with his “career,” which consisted solely of daily sparring at a local gym.

After preliminaries, I began giving the client an explanation of the negative effects of emotional stress. I told him how “industrial psychologists are paid high wages to insure workers have their lives in order at home.” The role of sports psychologists was also described in detail with some impressive statistics about successful results. The client was then offered psychological training in order to benefit his boxing career. He responded with increased enthusiasm toward treatment.

First, the client was trained in hypnotic time distortion and rapid relaxation. This allowed him  to experience, subjectively, 15 to 20 minutes of rest in a three-minute period. This was important because it allowed him to “gather strength  more  quickly  between boxing rounds.” He also was given training for increased tolerance of frustration “to ensure clearness of thought while in the boxing ring.” The client was told to practice these skills at home with his girlfriend.

During the first few sessions, the client came with specific requests aimed at helping him with his boxing. For example, he said his coach told him he didn’t do as well while sparring with people he liked and that he needed to stop being “so nice.” We explored the concept of respect. Respect for a friend demonstrated by sitting at lunch and asking “how things are going” was differentiated from sparring in the ring “where one wants to show respect by doing one’s very best.”

In the following sessions, our topics changed from specific boxing tactics to more general principles. These included moral strength, responsibility for self and self-respect. The client was given both direct and indirect suggestions about transferring the abilities for the self-discipline required in boxing to the self-discipline required for healthy relationships.

After a few weeks, the client no longer mentioned his boxing career. Instead he began to ask for advice about his relationship with his female partner. He also talked extensively about his current relations with his extended family and his desire to be a son of whom his deceased mother “would be proud.” Toward the end of his counseling , the client was discussing plans to retire early from boxing and become an accountant. After the mandated ten visits, the client was given a letter of completion. Three months later, he returned for a social visit. A six-month follow-up revealed he had enrolled at a local junior college and has had no further reported acts of violence.

Commentary: The Boxer by Tina Foster Jansen, M.S.

Court-ordered clients are typically unmotivated. Faced with this type of client, Short used an opening strategy which would encourage the client to be involved in counseling to the “benefit of his boxing career.” As Cormier and Cormier state, “A productive assumption  in  converting  involuntariness into a  commitment  to be counseled  is that the client’s chief interest is himself.” (p.575) Short’s adroit therapeutic intervention began the changes that eventually alleviated further violence, and also had positive influences in other areas of the client’s life.

The treatment in this case is a study in reframing and utilization . Short used the strengths, weaknesses and temperament of the client to reframe inherent abilities so destructive behaviors could be changed. Haley (Nichols, 1984) maintains reframing is a necessary step in altering problem-maintaining sequences. Proper reframing changes a viewpoint to the meanings of interactions are changed  while  the  facts  of  that inter­action remain the same. Short reframed respect for the client. This new definition allowed the client to change behaviors while keeping and building on the client’s wish for personal  respect. Haley (1971) concludes that, on a general level, the goal of the therapist is to change the maladaptive behavior of the individual. An additional and subsidiary goal  is  to extend  the  client’s personal range of experience . By getting this client to change his violent behavior, Short was able to open the door for further  change  by  the  client.  The man’s personal range of experience could be extended. He could consider ways of obtaining respect other than through violence – he could consider becoming the son his mother “could be proud of.” He then could begin to extend  his  idea of a career and investigate choices.

Utilization is a cornerstone of Erick­sonian psychotherapy. Short demonstrated a superb ability to enter his client’s world and regard that world as having the material for productive change. He took the problem behavior, violence, and gave the client ways in which to reframe that behavior so his needs to be respected and strong were productively met. Short should be congratulated for his insightfulness and creativity in using negative behaviors as material for productive change.

References:

Cormier, W. H. & Cormier, L. S. 1985. Interviewer Strategies for Helpers. Brooks/Cole, Publishing Company. Monterey, CA.

Haley, Jay. 1973. Uncommon Therapy: The Psychiatric Techniques of Milton H. Erickson, M.D. W.W. Norton . NY.

Nichols, M. T. 1984. Family Therapy Concepts and Methods. Gardner Press, Inc. NY.

Sep 11

Think Fast

By John M. Dyckman, PhD

Estimated reading time: 3 minutes, 46 seconds.

An athletically built young man in his mid-20s, neatly attired in a business suit, consulted me to deal with “rage issues,” “depression,” and a desire to get to the “root” of his relationship with his mother. He told me that he had been raised by a single mother who was alternately extremely dependent upon him, and then physically and emotionally absent. They had suffered poverty when he was a child, and he was determined to continue to rise financially in the world as an adult.

Recently, his last two therapists, both women, had dismissed him because he had refused to enter a drug rehabilitation program as a condition of therapy. He thought that he might be a “borderline alcoholic” because of his daily use of alcohol, marijuana, and opioid pills, which left him “faded,” but still able to work in a high-pressure, high-stakes business environment.

In our first session, he proudly discussed his history of street brawling, though he had had no run-ins with the police. He was involved in a highly volatile relationship with his girlfriend. They had frequent arguments in which they exchanged hurtful insults and the arguments often rapidly escalated to mutual battery. He was concerned that several months earlier, in the midst of one of these altercations, he had put his hands on his girlfriend’s throat. He was quite right to be concerned, as it does not take much force, even “accidental” pressure, to damage the human wind-pipe.

He was unwilling to consider my suggestion that he attend a male-oriented violence program. Recalling that he had just been fired by his former therapists; I did not make this a condition for continuing treatment with me. Instead, we spent the rest of the session devising a safety plan for both him and his partner.

He came in for a second session, but said he didn’t want to deal with any of “that feelings shit.” I asked him to tell me about his week, and especially about any interchanges he had had with his girlfriend. He described her anger at him and told of her provocative insults questioning his manhood. I asked what he was aware of at the time, and he told me that it was none of my “fucking business.” He then turned bright red, the veins bulging at his neck, clenched his fists and began to rise from his chair.

My conscious mind was aware of a precipitous increase in my own adrenal function, heart rate, and blood pressure. It had been many years since I had retired from martial arts training, but I quickly found myself calculating how close I could let him get to my chair before I would need to launch a kick to his knees.

Happily, my unconscious mind worked faster than either of us. Without any conscious evaluation or plan, I found myself simply pointing at his chair and saying in a calm but intense voice: “I am not afraid of you, but I am afraid for you!” The result surprised us both: He halted in mid-air, began to sob, and then sat back down, crying for several minutes. When he was able to speak, he talked about the pain of being discounted and emotionally extorted, both by his mother and by his girlfriend.

I still do not know what might have happened had I been paralyzed into silence or if I had had to stall him while I devised a creative strategy. I think it helped that I had experience in calming myself before karate competitions — where the other guy really is intent on doing you physical harm, but I don’t think my martial arts training was the deciding factor in my actions. Instead, I believe that years of therapeutic practice has been engrained in my unconscious mind, accompanied with the precept that the worst action comes out of pain. Therefore, my comment emerged spontaneously. I acknowledged him as a man in pain, potentially doing more harm to himself than to anyone else. This I could say with complete authenticity, and in total spontaneity.

We worked together for several more years, and he was able to make substantial and satisfying changes in his career, relationships, self-esteem, and ability to equilibrate his own emotional state. He never directly mentioned the anger incident again, but he also never again attempted to coerce me into the silence that he had himself suffered for so long.

Dr. Dyckman, the author of “Scapegoats at Work,” practices in Albany, CA.

He is an Associate of the Milton H. Erickson Institute of the Bay Area.

Age Progression by Noboru Takaishi, M.D.

A 28-year-old male physician, who had done well in medical school in Japan, began working on a doctoral thesis at the surgery department of a national university that was not his alma mater. He also was working at the hospital where his father was a staff physician.

He started having difficulties with his doctoral thesis. As a consequence, he began to suffer from severe insomnia. He decided to treat his own insomnia by taking prescription sleeping pills (methaqualone), a type which are no longer manufactured in Japan because of their severe side effects. Soon, the young physician became dependent on these pills as well as tolerant of them. He increased the dosage and finally began taking them during the day as well.

His behavior changed dramatically. He became rude and unreliable; his ability to practice surgery became noticeably and severely compromised. There were even several episodes where he collapsed during surgery. He was relieved from all duties at the hospital. His wife left him and returned to her parents’ home where she thought of divorcing him.

He came to my clinic and decided to use hypnosis as part of therapy. After a deep hypnotic trance was induced, I suggested he recall his happy, confident days before the beginning of his doctoral thesis. The recall and re-experiencing of these good times were confirmed by finger signaling.

Using age progression, he was asked to imagine a scene in the future where he was freed from his addiction and felt happy and confident both mentally and physically. These feelings were tied to the feelings he had as a student before he was addicted. He was asked to see the people close to him, his parents, his wife and the staff of the hospital, being so pleased for him and filled with trust for him as they had been in the past. I suggested that he imagine such scenes as vividly as possible.

As a post-hypnotic suggestion, I told him that the experience he had in the hypnotic trance would be firmly fixed in his unconscious mind. It would positively influence his daily activities without conscious awareness. Then the trance was ended.

The next week, he said he had stopped taking the pills. He said he was feeling some confidence and happiness. There were two more sessions using the same principles of building a productive future on productive behaviors and responses in the past.

It is now 25 years since these three sessions. He has had no further problems with drug dependency. He is working actively at the hospital where he did his doctoral thesis, and has replaced his father, who retired, as director.

The work described here is a successful example of what I have called the “in advance rewarding method.” This technique aims to develop the patient’s inner strengths toward a possible and positive future. I developed treatment in this case without knowing about Erickson’s work in pseudo-orientation in time.

Discussion

by Betty Alice Erickson M.S., L.P.C. Dallas, Texas

Dr. Takaishi’s patient did not seem to require the added complexities of a physical detoxification, and he was not initially enthusiastic about treatment. Using the man’s previous experiences as a successful and competent person, Takaishi used trance to guide the man into a realization that his future could have those same components. In 1934, Erickson wrote that the hypnotist “must implant his suggestions in the vast aggregate of mental reactions and patterns accumulated throughout the subject’s lifetime.” Takaishi did just that.

Regression in a hypnotic state helps a patient reestablish patterns of behavior “uninfluenced by subsequently acquired” behaviors (Erickson, 1937). And again, Takaishi did just that.

Good therapy allows the patient to access and build upon personal strengths and resources in productive ways. It is the therapist’s job to structure psychotherapy so the patient is in a position where those currently inaccessible abilities and resources become usable once again.

This patient clearly had the ability to succeed and accomplish his goals. Imagining a future, in a trance state, where goals already have been met and the warm glow of success is felt, can give patients deep-seated feelings of accomplishment and pride. Structuring this future as a post-hypnotic suggestion that didn’t have to enter conscious thinking allowed the patient to reap the benefits of the therapy without having to ascribe the cause to the therapist’s suggestions.

One of the most intriguing aspects of Erickson’s work is its timelessness. Six decades ago, when hypnosis was poorly understood and under-used in the psychotherapeutic world, he was writing about the principles that Takaishi employed in his work 35 years later. These techniques are as applicable and powerful today as they were when Erickson first wrote about them and when Takaishi used them. Takaishi did good therapy, with creativity and intelligence.

The opportunity to reexamine effectiveness after twenty-five years is rare. The absence of a relapse speaks for the effectiveness and the appropriateness of the therapy used. With his discovery that Erickson had written about this same technique years previously, Takaishi can now compare and enhance his own abilities just as students of the “modern” arms of psychotherapy, of brief, cognitive, narrative, and solution-focused, can compare and enhance their own understandings by studying Erickson’s original works.

Erickson rarely claimed credit for “inventing” a technique. He understood that the tenets of human behavior have been known and studied for centuries. Part of his gift to the psychotherapeutic world was his abil­ity to encapsulate commonalties in productive methodologies and to write about and teach them in under­standable and replicable ways.

References:

Erickson, M. H. (1934). “A brief sur­vey of hypnotism.” Medical Record, 140, 609-613.

Erickson, M. H. (1937). Development of apparent unconsciousness dur­ing hypnotic reliving of a trau­matic experience. Archives of Neurology and Psychiatry, 38, 1282-1288.