Posts Tagged ‘LISCW’
A private girl’s school nearby my office referred a sophomore named Lana to my practice because of missed classes and academic problems.
Normally when a girl this age comes to a professional for the first time, she pays attention to her appearance. But Lana’s hair was disheveled, her sweat suit looked like it needed a trip to the washing machine, and her sneakers were worn. Her clothing was too big, meant to camouflage her weight. She was definitely not comfortable in her skin. If one looked closer, underneath all this baggage was an attractive, intelligent young lady.
Based on her general appearance I assumed several things: I intuited that Lana was depressed. I asked myself, “Why does she keep her appearance repulsive?” Had someone hurt her in the past; met with abuse or neglect a creative element in her personality? Her repulsive appearance, no doubt, was to keep herself isolated enough to deflect any more harm.
Fortunately, Lana was enthusiastic about hypnosis and wanted to experience it. Hilgard wrote that one of the important components of trance is “original task motivation instruction.” In Ericksonian hypnosis, a key element of therapeutic trance induction is pacing and leading. My procedure was informed by both philosophies.
I began by asking Lana, “What about hypnosis makes you enthusiastic?” Her response was that she had heard wonderful things about hypnosis, and that the experience of trance, in addition to being relaxing, seemed mysterious and exotic. She felt hypnosis helped people to make dramatic changes in short periods of time, like quitting a lifelong habit of smoking in one session. I wholeheartedly agreed. As I mirrored this back to Lana, I repeated the words “relaxing” “mysterious” and “exotic” in pace with each of her exhale breaths. I began to add words suggesting comfort, sleep, and dreamlike feelings.
I also suggested that her unconscious mind probably knew why she was having these current problems. It would be nice if her unconscious gave her a dream during the next few days that would illuminate the source of these problems and offer a solution that would alter the way she looked at this aspect of her past. Her enlightenment would provide a new perspective in how she would see herself in the future. I told her to keep this in the back of her mind.
I finished our trance session by telling Lana a story about how I always made myself go to all of my college classes whether they were interesting or boring, because there might be at least one useful thing from them that I could take away with me.
Two days later, Lana sent me the following email: “During our session, you told me to keep one thing in the back of my mind. Ever since I can remember, I have struggled with my weight. The memory that came to mind during our trance was one of myself at about eight or nine years old at school. A boy I’ve known most of my life was standing next to me and said, “You look like you are pregnant because you are so fat!” Every time I think about my weight struggle, this memory seems to pop into my mind. It was definitely an embarrassing and upsetting moment in my life.
After our session, I felt very sleepy and ended up going to bed quite early. I had a dream that I was standing in my house trying on a prom dress that I had bought with the intention of altering it to fit. I still own the dress, but I never got to wear it to my prom because it didn’t fully zip in the back and the seamstress couldn’t alter it. In the dream, I put the dress on simply to see if it would fit me. At first it would not zip, and then little by little I was showing my mom how it now fit me perfectly! When I woke up this morning, it didn’t immediately occur to me why I had this dream until right before I was leaving my room to go to class.”
A follow-up call to the school’s counseling center a month later revealed that Lana had achieved perfect attendance at her classes and had joined the school swim team. She was finally “fitting in”!
Because Lana had to take a taxi to get to our appointments, I knew I would not see her for more than a few sessions. I would have liked to spend more time discussing relationships, developmental delay issues, and her depression. I decided to use Erickson’s approach of accessing unconscious resources because this has proved successful in my work in the past. Although I anticipated success, receiving Lana’s email was a delight. How’s that for the unconscious as helper!
Implication is one of the most common ways that we unconsciously make meaning out of events in everyday life. A speaker’s statement implies something that the listener infers. Erickson used implication extensively and deliberately, as shown in the following examples (some paraphrased) with the implication in parentheses:
“You don’t want to discuss your problems in that chair. You certainly don’t want to discuss them standing up. But if you move your chair to the other side of the room, that would give you a different view of the situation, wouldn’t it? (From this different position you will want to discuss your problems.)
“I certainly don’t expect that you’ll stop wetting the bed this week, or next week, or this month.” (I certainly expect that you will stop sometime.)
“Your conscious mind will probably be very confused about what I’m saying.” (Your unconscious mind will understand completely.)
Examining these examples, we can begin to generalize about the structure of implication.There is a presumption of a categorical mental division that is usually an “either/or”–here/there, now/later, conscious/unconscious, This categorical division can exist in space, time, or events (matter and/or process). A statement that is made about one half of the either/or division (often using negation) implies that the opposite will be true of the other.
(Look back to verify that these three elements exist in each example above.) Since implication is often confused with presupposition (which Erickson also used extensively) it is useful to contrast the two. Presuppositions have been well studied by linguists, and 29 different “syntactic environments” for presuppositions in English have been identified. (See the Appendix to Patterns of the Hypnotic Techniques of Milton H. Erickson, M. D. Volume I, [pp. 257-261]. However, implications have not been studied, even though Erickson made extensive use of them, so this is a very useful area to examine in much more detail.Presuppositions Can be identified unambiguously by examining a statement in written form. The simplest way to identify presuppositions is to negate the entire state- ment, and notice what is still
For example, “I’m glad that you have the ability to change quickly and easily.” Negated, this becomes, “I’m not glad that you have the ability to change quickly and easily.” Only gladness is negated, the rest of the sentence “You have the ability to change quickly and easily” remains true.Are usually passively accepted Are usually processed and responded to unconsciously, yet can be identified consciously and “You are presupposing that I have the ability to change quickly and easily, and I disagree.” Implications Can’t be identified unambiguously by examining a verbal
For example: “Of course, it’s difficult to change quickly and easily in your everyday life.” (It will be easy to change quickly and easily here in my office.)Are generated by the listener inferring, using their assumptions and worldview. Are almost always processed and responded to unconsciously. Although they can be identified consciously, they can’t be challenged in the same way that presuppositions can, because they do not exist in the statement. If a client were to say, “Are you saying that I can change quickly and easily here in your office?” it is easy to reply, “No, I only said that it is difficult to change quickly and easily in your everyday life, isn’t that true?”
Summary: Implications are much subtler than presuppositions, they are generated actively by the listener’s process of inference, they are typically processed entirely unconsciously, and they can’t be challenged.Creating and Delivering Implications (an algorithm) Outcome Identify your outcome for the client, what you want to have happen. (Example: The client will talk freely about their problem.) Opposite Think of the opposite of this outcome (not talking freely; keeping information secret, ) Either/or Category Use space, time, or events (matter/process) as a way to divide the world into two categories (here/there, now/later, conscious/unconscious). Sentence Apply the opposite of your outcome to the contextual category that is not present (there, then, other) and create a sentence that will imply the outcome that you want the client to infer. Space
“In your life outside this office, I’m sure that you would feel uncomfortable talking about private matters.” (Here in the office, you can feel comfortable talking about anything.)
“If you were talking to someone at work, there would be many things that you would not want to discuss at all.” (Here you can talk about anything.)Time
“In the first session with me, there were undoubtedly certain matters that you were not comfortable disclosing.” (In this session, you can feel comfortable disclosing anything.)
“In your previous therapy, you may have been unwilling to talk about certain events that were relevant to your problem.” (Now you are willing to talk about these events.)Events
“I want you to carefully think about which matters are not relevant to the problem, and that you would like to keep entirely to yourself.” (You can talk freely about anything that is relevant to the problem.)
“In your normal waking state, of course there are topics that you would be very reluctant to discuss with me.” (In trance, you can easily discuss any topic.)
Another way of thinking about this process is that the client’s concern, objection, or reluctance is completely acknowledged, at the same time that it is placed in a different context (place, time, or event) where it won’t interfere with your outcome. Implications can also be delivered nonverbally, which Erickson did extensively, and that is the subject of another paper.
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.