Posts Tagged ‘Psychologist’
Anxious parents called, each in turn, about their 17 year-old daughter Bev, who for the past six months had obsessively washed her hands three to four hours a day. Both parents reported they had “tried everything.” including counseling and drugs. They were so desperate they were now exploring hypnosis, about which they were skeptical. Somewhat worn down by their forceful skepticism, I said to the anxious mother, “Look, because you are desperate and because you worry that once again you will be throwing money away, I will offer you a complimentary consultation. I will evaluate your daughter’s symptoms and only schedule a therapy session if I believe I can help her.” With this assurance, she made an appointment.
As the family members settled into their chairs at our first meeting, they all appeared relaxed. They communicated with ease, and there were no overtones of hostility. Turning to the girl, I asked about her school and extracurricular activities. She immediately replied, “I have studied piano for many years and enjoy it very much.” I myself play both classical and ragtime piano, so this was a natural opening for building rapport between us.
When I asked about her favorite composer, she quickly said, “Chopin.” Because Chopin is also my favorite, we were now in perfect sync. We agreed we both loved Chopin’s Nocturnes and we both had played most of them. I asked about her favorite and she hummed the melody. I said, “When I practice a nocturne in the evening I often can hear that melody in my head all next day,” and she nodded in agreement. “You can hear that melody right now, can’t you?” I said. She smiled and slipped into a nice little trance. As she did so, I ventured, “Perhaps, when you get the urge to wash your hands, you might enjoy turning on that nocturne instead.” I observed her trance deepen as she considered this, and then she nodded her head and said quietly and confidently, “I can do that.”
After some further rehearsal, and talk about other matters, I concluded the session. I didn’t suggest another session. The mother wondered, “Do we need to make an appointment for Bev?” I looked at Bev as I said, “Perhaps she has already found a solution,” and Bev nodded her head.
A week later the mother called to say Bev was doing fine. I might have held back and scheduled a regular appointment with a fee. But I just couldn’t help myself. It was too much fun just to do it. And while there was no fee, I did get a good story, and the mother soon referred a friend.”Commentary
By Eric Greenleaf, PhD
I immediately liked several aspects of this case and of Ron’s manner with the family and with his young patient. The family’s desperation motivated both Ron to take the case pro bono and the family to agree to let him try therapy with their daughter. Ron bypassed the problem [what Erickson called “drifting rapidly away”] and landed on the keyboard, where his patient could shine as a person and had the resources to address her own solution. Then, as an advanced therapist, he spoke as and of himself: “When I practice a nocturne in the evening I often can hear that melody in my head all next day,” before noting that his patient “can hear that melody right now, can’t you?” Mutual, trance experience can be both more natural and more direct than other hypnotic inductions.
Ron aptly and gently held the mother back from re-establishing the symptom, saying, “Perhaps she has already found a solution,” as indeed, with his help, she had. When the patient is the expert and the therapist is himself, lasting hypnotic therapy can be both brief and effective. I think Dr. Erickson would have been pleased with this case, would he not?”
Perhaps the most useful of Erickson’s remarkable techniques is the concept of utilization. Utilization harnesses the language and experience of the client. It allows clients to use their own knowledge, strengths and skills to explore useful solutions to their own problems. As such it is well suited to working with clients like the adolescent described below, who may not be particularly interested in “therapy” or in “self-examination.”
“John” is a 17-year-old, male high school senior. He is on track to graduate in June and has enlisted in the service, promised that he will be trained as a damage control officer. He already has a year of experience as a volunteer fire fighter.
His mother brings him to the clinic after they have spent an unpleasant night in the emergency room having his stomach pumped after an impulsive suicide attempt. His girlfriend of about a year dumped him for one of his friends. John got furious, got drunk, and overdosed on pills. He is a handsome and athletic young man, but not particularly verbal or very happy to be in my office. He still had not ruled out suicide as a response to the rejection.
After eliciting his history, and a few false starts into being curious about his life, we struck up a conversation about fire fighting. This is something that he knew and cared about, so we conducted the entire rest of the session discussing some principles of Fire Science.”:
First I asked him what he knew about “accelerants.” He named a few of the common ones. I nodded and then offered, “How about alcohol?” He grinned, and we were off to the fire.
I acknowledged his expertise. Then I said that I had some friends who were firefighters and they had shown me that explosions were just very fast fires; were more damaging when they were contained in a small space,; and lost much of their power when they happened in a larger space. I told him that to qualify for the California Department of Forestry’s fire-fighting program, one has to do 50 sit-ups in 60 seconds while holding a 30 pound weight on the chest. I wondered if doing sit-ups, or even taking a run, would be a good way to dissipate potentially explosive energies?
I also asked him to tell me something about the different types of fires he had seen, and the different techniques used to fight them. What would happen if you misdiagnosed and used water on an oil fire? What could he remember about how he felt at the moment he discovered his girlfriend’s cruel betrayal? He remembered a flash of sadness before he became furious. I asked what was the best way to extinguish sadness. I invited him to ask his mom how she dealt with similar situations. They had a nice conversation about expressing sadness in the form of tears, and the likelihood that the sadness once expressed would soon “burn out.”
I then asked him about “search and rescue.” We determined that when in a burning or damaged building, it was advisable to keep one hand on the wall, and one on the person ahead of or behind you. I said it sounded to me like his plans for his future were a kind of solid “wall” that he could lean on, but that when “visibility is low” it was crucial for him to keep to his plan, to “keep a hand on the wall.” I suggested he ask himself whether a particular action would help or hinder his plan.
His other hand needed to be on the person in front or behind him. I asked him who would be his “buddy.” He chose his mother, a few named friends, and me. I agreed that it was important to have several different people to trust, so that it was likely that someone would be available in time of need. His mother expressed her relief and gratitude to her son, who received it with more graciousness than I usually expect from 17-year-old males.
They left saying that they felt a lot better, and that they didn’t think that they needed to come back. I followed-up a week later by phone, and John was back at school and apparently back on course.
Impulsive suicide is a real risk in adolescents. John had the advantage of some previous experience of the importance of calm but decisive action in the face of real danger, and so was able to mobilize resources that he had not realized he had. Most everyone has resources of which they are not aware. Our job as therapists is to help them access and utilize these previously dormant resources in the most natural way possible.
Cathy was a 55–year-old single client of a colleague. Her initial complaint was that, although she was very competent in her work, she repeatedly raged at her boss and at co- workers. It soon emerged that she had a history of sexual abuse from her father, and had a very difficult time separating her own experience from others. Hence, it was hard for her to know her own needs, and defend herself from the expectations and intrusions from others. She showed what is often called “co-dependence,” or “enmeshment.” My colleague had done a lot of work with her intermittently over a period of several years, and she had made a lot of progress, but they had reached a plateau.
Cathy’s sense of herself was still wobbly and unclear, and she often felt numb, as if she were “just going through the motions,” and she wanted to feel “solid in my skin.” My colleague knew that one of my specialties was working with self-concept, so she asked me to do a session with Cathy while she observed.
When we first sat down, Cathy was obviously very anxious about what might happen, and her attention was intently on me, rather than on herself, and what she wanted from our session. When I asked her what she was experiencing right now, she said that she was scared. When I asked her what she was scared of, she said, “You’re so big! You’re towering over me.” (Later she said, “At that moment I felt like a child; there I was, this little person with this big giant man towering over me, and all the bad memories of my father’s abuse just rushed in!”)
I immediately got out of my chair, which was a little higher than the couch she was sitting on, and sat down on the floor, at which time her whole body visibly relaxed. (Later, she told me, “If you hadn’t sat down on the floor, I can’t imagine how that session would have gone.”)
As she told me about her outcomes for the session, she repeatedly said, “Wait, I’m getting ahead of myself.” Knowing that what someone says is often literal, rather than metaphoric, I asked her to pause and take a step backward into herself. This was one of those times when I fervently wished that I was recording the session on video, because her transformation was so profound—I wish change was always so easy! We spent some time consolidating this new way of being in her body. But that moment when she stepped back into herself was the key that opened a door. In the absence of video, I offer Cathy’s report a year and a half later:
“When you said to ‘Take a step backward’—WOW, I can still feel it—I literally stepped back into my body, back inside my skin, and I felt so different. At first it kind of scared me – it was unsettling because it was so unfamiliar. I felt ‘connected,’ I felt ‘whole’ in a way I hadn’t known was possible. When I took a walk right after that session, I felt ‘in my body’ so intense-I felt my skin and bones, a tingling sensation all over, even the movement of my blood through my veins, and all my ‘borders,’ my ‘edges’—where my body ends, and everything outside me begins.”
“Before this, the world was kind of a ‘soupy’ place for me. I felt ‘the same as’ others. I thought everyone saw the world the same as I do, and I rarely made distinct choices—I just kind of shuffled along with the crowd. I’ve spent the majority of my life ‘a head of myself,’ in my head and in the future, rather than in my body in the present. I was making life choices based on experiences and beliefs I’d accepted as ‘law’ long ago and far away. I now know in my bones that I can choose, that I make choices every minute, and I no longer live from a place of fear. I know now when it’s appropriate to be afraid, and when it’s not. Since then I have become increasingly aware of who I am, what I want, where I stand in relation to others, and not being swayed by what others around me say or want—and this continues to grow. It’s all still amazing to me. And when I sometimes ‘get ahead of myself’ now, I notice it, and I just take a step backward—back to myself!”
It’s very important to recognize that all of Cathy’s insights were the result (not the cause) of taking the action of stepping back into herself, and her own life.