Posts Tagged ‘psychiatrist’
Ben was referred to me by a local hospital for treatment of Rapid Eye Movement (REM) behavioral disorder. Due to aging, a part of his brain had degenerated, resulting in loss of muscular control during REM sleep. Both Ben and his wife were fearful that because he had wild body movements while sleeping, he would inadvertently kick or hit her, or that he would injure himself. After nearly 50 years of marriage and sharing a bed, Ben’s wife had resorted to sleeping in the guest room.
Ben was a lively and interesting 70-year old, who had recently retired from his job in a factory where he worked as a master toolmaker. He was looking forward to enjoying his retirement. Ben had a keen sense of history and a strong interest in Native American culture, and he read many books on the subject. We enjoyed talking about this because I share the interest. Ben longed to visit ancient Native American sites and national parks and he purchased a Winnebago for this purpose. He said he was ready to go, but the extremely narrow single bed he would have to bring along, and his symptoms of the REM disorder, made him hesitant about traveling.
For his entire life, Ben had used his hands and mind to produce tools, so it was understandable that he was looking for a simple, concrete solution to his problem. The fact that he felt his disorder was beyond his control, upset and embarrassed him. His mechanical engineering training and tactile problem-solving skills that served him well in his professional life, gave him the air of someone reluctant to consider hypnosis as a tool for achieving wellness.
Matching, pacing, and leading are the cornerstones of good hypnosis. Because of my conversations with Ben about Native Americans, in which I spoke of “trance healing ceremonies” and their similarity to modern day hypnosis, he gradually became open to using hypnosis to help with his REM symptoms.
As part of my early hypnotic training with Steven Heller, I learned of Erickson’s technique for creating an unconscious generative suggestion for a patient. Erickson demonstrated this therapeutic intervention in a case he called “The February Man.” In trance, he created a positive male character for his female patient who had an emotionally impoverished childhood. This character who appeared in her dreams, valued her by leaving encouraging notes and bringing gifts on her birthday and holidays, which helped her to developmentally progress. (Interestingly, for the past 44 years, Erickson has appeared in my dreams, sometimes offering me helpful advice.)
I decided that with Ben I could create a post-hypnotic suggestion that would happen during his sleep cycle, which would interrupt the REM pattern and disrupt the threatening behavior. There are many references in experimental hypnosis literature that show the success of this type of suggestion. I also had success, as Ben would wake up briefly before flailing, and then fall peacefully back asleep.
There’s a Three Stooges sketch where Curley, Moe, and Larry are in one bed. Larry begins to snore, and Moe hits him and says, “Wake up and go to sleep.” Larry wakes up briefly, and then falls back to sleep. Then Curley begins to snore and a frustrated Moe hits him and says, “Wake up and go to sleep.” Curley is groggy and falls back to sleep, and Moe just smiles. However, like most Stooge antics, it soon turns chaotic. Curley and Larry begin to snore and Moe goes from one to the other slapping and shouting, “Wake up and go to sleep!” In my next session with Ben, I discussed the idea of a generative suggestion and the Three Stooges episode. He remembered it well, and we were both had a good laugh. I suggested to Ben that we put Moe in his unconscious dream world to wake him up right before any sleep behavioral disorders occurred, and he agreed.
The next week Ben and his wife came to his session together and reported that his violent sleep behavior had not happened the prior week, and then asked me if it would be alright if they attempted to sleep together. I said yes.
I continued to see Ben throughout that summer as he and his wife worked together on getting ready for their road trip. I repeated the induction with Ben each week, and his wife called me several times to say that they were sleeping peacefully together. After the couple left on their adventure out West, I had Ben check in with me every week for five weeks. In his words, “We followed the blueprints, installed the boilerplate, and the new circuitry was working well.”Commentary By Eric Greenleaf, PhD
In a letter, Dr. Erickson once wrote, “Concerning my views about dreams, I can state quite simply that they are the substance that paves the way to the goals of achievement. Such goals are reached more rapidly if a dreamboat is available.” (Seminars of MHE #1, 1962) David Norton’s keen understanding of the blueprints of hypnotic suggestion and his workmanlike installation of the boilerplate, allowed the new circuits to hum, and the dreamboat to sail on. The contrast of the Stooges’ hilarious lack of workmanship with Ben’s own careful and effective craftsmanship was speedily effective, but was only hinted at through laughter. Like all expert craftsmanship, David’s work with this patient might look easy, but it was dreamily inspired.
Edgar, a child of five, is the oldest son of a marriage that has lived with great economic and family pressures. The mother began going to therapy two years ago for her distress because of her pregnancy. She left treatment. A short while later, she asked for an emergency appointment. She told me by phone that she had just gotten Edgar out of the hospital, and he did not want to return home because she was afraid of his father who, in an attack of fury and impatience, had hit him against the wall, fracturing his cranium.
I met with the whole family in therapy because that permitted me to under- stand the family situation, to perceive their emotions and to explore their resources. Once I have an idea of the family structure and the context in which the problem occurred, I can tell a story (or build a story together with the children) that represents the problem and different solutions. In an abuse situation, it is necessary to censure actions, not the persons implicated, trying to see them as parents who make mistakes. In this case I constructed the story because the child was immobile in a chair, not wanting to look at anyone, much less participate.
I told them a story about a lion cub and its family. Mommy lion went out to work and to look for food, while Daddy lion stayed to guard his territory and did- n’t like to be disturbed. The lion cub really wanted to go hunting. He wanted to go out to explore. He saw the older lions roar and fight and he was dying to do it too. He wanted someone to play with him, but when Mommy arrived, she wanted to do anything but play. She was tired and wanted him to eat. The little cub began to think he was not interesting or important enough for his mother to play with him.
One day the little cub decided to do as the older lions did. He ran close by his father growling like the older lions, but Daddy lion did not move. The cub growled louder and louder without success. Finally he decided to bite the Daddy lion’s paws and ears to get his attention. He didn’t know that Daddy’s paws had been hurt many years ago. How surprised he was when he bit his daddy and his daddy gave him a shove, throwing him against a rock.
The poor little lion was hurt very badly. At this precise moment, Mommy came back from hunting. Scared, she ran to her cub and started to lick him. She growled very loudly at Daddy lion, more loudly than in other times. Daddy lion also ran to see what had happened to his little son. He hadn’t wanted to hurt his son and he didn’t know why he had let out such a strong blow and why his claws had come out when normally they only came out for attack and defense.
The story continues telling how the little cub had been healed at a special cave, but his little heart still felt very sad and something still hurt inside. All the family went to consult a Leopard therapist that helped the parents and cub to cure their wounds. Leopard told them, “Now is time to heal your wounds, before they become infected.”
While listening to the story, Edgard had drawn a picture of himself that showed the open wound in his head. He drew merthiolate and band aids over the wound and at the end of the session he felt calm about going home. His father talked about his own past psychiatric diagnoses and agreed to visit the psychiatrist again.
They came to three more sessions. Although the problems of the family environment continued, the father’s aggression disappeared and they became closer and more communicative.
The Ericksonian techniques utilized were: story telling, metaphors and reframing through the story.Reference:
Robles, Teresa (1990) A concert for four brain hemispheres in psychotherapy, Alom Editores, México y (1991) Terapia cortada a la medida. Un seminario con Jeffrrey K. Zeig, Alom Editores, México.
Harold called me because he was concerned about his ten-year-old son, Bob, who was phobic about gravel roads. Bob’s phobia had generalized to the extent that he had become reticent about leaving his home. I told Harold that I would be willing to provide a one-hour consultation, if he would bring his wife, June, and his son.
Bob was the most hyperactive child I have ever seen in my private practice. Based on the phone call, I had no idea that ADHD was part of the constellation. Bob couldn’t stop fidgeting. As he entered my office, he poignantly announced, “I’m the crazy person.” My heart went out to him.
I did not want Bob to assume a negative self-definition. I gave him a difficult wooden puzzle consisting of two pieces that fit together to make a pyramid. Bob struggled but could not solve the puzzle. I told him that I could not solve the puzzle when I first got it. I called the friend who sent me the puzzle and asked, “Where’s the third piece?” There was no third piece.
I took Bob out of the office into the waiting room. I showed him how to solve the two-piece pyramid puzzle. I then instructed him to give the puzzle to his mother and father. Smiling, he strolled back into the office. Then Bob and I watched as his mother and father struggled to put the puzzle together. They could not easily do something that he knew how to do. Now Bob was one-up.
Building on the situation, I said to Bob and his parents, “I’m an expert at helping families solve puzzles.” I wanted to define the solution as existing within the family.
Harold told me how Bob’s problem began. The family was driving on a gravel road when suddenly a mechanical failure caused the car to spin out of control. A very good driver, Harold brought the car to a safe stop, but Grandmother, who was in the back seat with Bob, completely panicked. Then Bob panicked, and
subsequently refused to get into a car. Eventually he refused to be in any place where there was a gravel road. When Bob went on to say that he was afraid of being out of control, Harold had a new insight. He had not previously understood that aspect of his son’s problem.
I remembered a dictum from Gestalt therapy: “If you’re in terror, play out the terrorizer.” If I can get the fearful person to play the part of the fear monger, it may breed a solution. Continuing my redefinition of their familial problem, I said, “Mr. Fear has attacked this family.” I then asked Bob to show me Mr. Fear. Bob went to the far corner of the office and became Mr. Fear, attacking his family.
I knew from experience that analogies can generate a solution, so I inquired, “Tell me, what is Mr. Fear like?” Bob asked me if I watched Power Rangers, which I knew only vaguely. “Mr. Fear is Drilla Monster,” he continued.”Be Drilla Monster and attack your family.” So Bob pantomimed being Drilla Monster attacking his family.
Next, I thought about the Ericksonian principle of eliciting resources. I knew that there must be a resource in this family to deal with Bob’s fears. Since Bob had offered the metaphor of Power Rangers, I asked him, “What power do you have?” “I know karate,” Bob replied. “Show me how you can use karate to fight off Drilla Monster,” I said. Bob successfully fought back the imaginary Drilla Monster, pushing him out of the consulting room.
Next, I explained the therapy. Whenever Mr. Fear, Drilla Monster, attacked the family, they were to stop and convene a meeting of all the Power Rangers who would decide together how to use their powers to defeat Drilla Monster. I then added, “I have two other therapies that I would like you to practice.” Because June seemed exhausted and overwhelmed, I directed the tasks to the father and son. Harold was bright-eyed and seemed to have a lot of energy to devote to Bob. I explained that each morning for a week, Harold and Bob should practice being out of control. Bob would go into the backyard and play being out of control and Harold would coach him about being better at being out of control. Then Harold would act out of control and Bob would coach him about being out of control. My covert design was to turn a problem component into a game. They agreed to the therapy.
Then I offered, “I have an another therapy for Bob. I want you to write your name in my driveway.” I live in Phoenix, Arizona, in the desert. My driveway is made of gravel. I told him that I did not even allow my daughter to write in the gravel, but that I would like him to leave his mark there showing that he had been at my home office. My technique was a symbolic desensitization. Bob would have to slide on my driveway as he shuffled his shoes around to put his name in the gravel. I would have him violate his phobia about gravel. Adequate psychotherapy with a phobia can be achieved when one gets the patient to violate the phobic pattern, even on a symbolic level.
In the one session therapy, I had a series of heuristics that could generate solutions. In this case, the most important heuristic was faith. There were three components of this faith: One, I had faith in my ability to utilize whatever they brought me. Most of my professional contributions in print during the past ten years have been explications of Milton H. Erickson”s utilization method. I have made utilization a center point of my therapy. The second aspect of faith also came from what I learned from Erickson. I had faith in the family. I had faith that they had a resource in their system that would be adequate for solving the problem. The job of the psychotherapy would be to help them access that resource experientially. Finally the third part of this faith was in myself. I knew that I had surmounted similar problems. I also had used methods to cure myself similar to those I prescribed for them. If I could do it, I knew they could, too.
Jeffrey Zeig, PhD will present at the December 2005 Evolution of Psychotherapy Conference, www.evolutionofpsychotherapy.com