Posts Tagged ‘psychology’
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?”
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!
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.