Posts Tagged ‘md’
Aug 21
Erickson Archive Case Report
A fellow church member whose husband died 10 years ago called out of concern for her 30-year-old daughter, Amy, who had never gotten over the loss of her father. The woman said, “I think Amy’s depression is affecting her health and her marriage.”
“Haggard” would not be too strong a word to describe Amy when she entered my office. She looked much older than her years. Tears began flowing down her face even before she sat down. The visual evidence of depression was so dramatic, I could understand why her mother reported that it was taking its toll.
As Amy told her sad story, it was obvious that she had told it many times before in the last decade. She began: “I was in training as a student nurse in the local hospital where my father had had heart surgery. One day he came in for a post-surgery check up. I was in the midst of my normal nursing duties when all at once I heard alarms. Staff were rushing around. A nurse said she heard a patient had collapsed and died, and it might have been due to a nursing error. Then, a fellow student nurse came in, put her arms around me and told me it was my father who had died. My first thought was, ‘I should have done something to save him.’ I berated myself for not doing something. Ever since then there has been a voice in my head saying, ‘You could have saved his life.’ I can’t stop thinking about him dying and the funeral and that I could’ve done something.”
I asked her if it was like a movie running in her mind. Amy agreed that a movie of her Dad’s death played over and over in her head. I began by acknowledging her grief. “First, Amy,” I began, “I am so sorry for your loss—a deep tragic loss. And when we have an intense experience like yours, the brain often makes a movie like the one you have been looking at over and over. It’s like the brain gets stuck on that movie.”
“Yes, that’s me,” she replied. “My brain got stuck on that awful moment when I was told my father had died.”
“I wonder if before your tragic loss if you had happy experiences with your father, perhaps family activities or special times with him.”
“Oh yes, I have many beautiful family memories, and also, my father and I used to play tennis together. we had a special warm relationship.”
“I wonder, when you close your eyes, if you could turn on some of those sweet memories, and as you visualize your father, ask him if it would be all right with him now, after 10 years of grieving, for you to switch channels in your brain; if it’s okay if you switch to the Happy Memories channel. And because your father was a Christian, would it be all right to imagine him in heaven smiling when he sees you remembering those happy times? Perhaps you can see him smiling and nodding his head about as you switch to this channel.”
“I can see him saying he wants me to enjoy our happy memories,” Amy said. “And he wants me to enjoy my dear family instead of obsessing about his death.” Then, she added with deep feeling, “I didn’t know I had a choice.”
“Yes, what a relief to discover you have a choice. Just imagine you have a remote control in your hand and you switch to the Happy Memories channel. That’s right, along with a deep relaxing breathing, switch to the memories he would like you to share with your children, his grandchildren.” With a sigh of relief Amy did that easily. We practiced tuning into the Happy Memories channel for a while until she felt relaxed and confident doing it.
The following week, Amy called to report she no longer felt depressed, and, in fact, was now enjoying showing photos of her father and sharing happy memories with her children. It’s been three years now since our session, and the Happy Memories channel is still “on the air.”
CommentaryBy Eric Greenleaf, PhD
Ron Soderquist shows us the simple elegance of human relationship – the basis of all psychotherapy, and the heart of Dr Erickson’s hypnotic approaches to helping people. Soderquist listens with compassion to Amy’s story of suffering. Then, thinking like a competent hypnotherapist, he helps her to dissociate – to tune into the Happy Memoirs channel with“sweet memories,” rather than re-experiencing abject grief in a sad movie that plays in a loop.
Utilizing both her love for her father and his heavenly presence in her experience, Soderquist elicits Amy’s realization that she actually has a choice. She can continue to grieve, or she can switch to the Happy Memories channel. The goal of eliciting positive memories over traumatic ones is helping the client recognize that there is a choice. Amy’s grief and torment over her father’s death could be replaced with memories of all the happy times she once shared with him. Soderquist’s ability to transform Amy’s grief was beautiful, brief, direct, and compassionate.
Milton H. Erickson & Ernest L. Rossi
Estimated 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
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