Posts Tagged ‘psychotherapy’

Sep 18

The Boxer

By Dan Short, Ph.D Dallas, TX Estimated reading time: 4 minutes, 30 seconds. 

The 21-year-old client did not want to be in therapy . Charged with assault on his girlfriend, he had been ordered to counseling as a condition of probation. The intake, conducted by another therapist, noted, “Client is reluctant to focus on violence related issues.” The client, muscular and sullen, entered the first session in silence and sat slouched in his chair with a cap concealing most of his face. He had described himself as “a boxer” and had explained that counseling should not interfere with his “career,” which consisted solely of daily sparring at a local gym.

After preliminaries, I began giving the client an explanation of the negative effects of emotional stress. I told him how “industrial psychologists are paid high wages to insure workers have their lives in order at home.” The role of sports psychologists was also described in detail with some impressive statistics about successful results. The client was then offered psychological training in order to benefit his boxing career. He responded with increased enthusiasm toward treatment.

First, the client was trained in hypnotic time distortion and rapid relaxation. This allowed him  to experience, subjectively, 15 to 20 minutes of rest in a three-minute period. This was important because it allowed him to “gather strength  more  quickly  between boxing rounds.” He also was given training for increased tolerance of frustration “to ensure clearness of thought while in the boxing ring.” The client was told to practice these skills at home with his girlfriend.

During the first few sessions, the client came with specific requests aimed at helping him with his boxing. For example, he said his coach told him he didn’t do as well while sparring with people he liked and that he needed to stop being “so nice.” We explored the concept of respect. Respect for a friend demonstrated by sitting at lunch and asking “how things are going” was differentiated from sparring in the ring “where one wants to show respect by doing one’s very best.”

In the following sessions, our topics changed from specific boxing tactics to more general principles. These included moral strength, responsibility for self and self-respect. The client was given both direct and indirect suggestions about transferring the abilities for the self-discipline required in boxing to the self-discipline required for healthy relationships.

After a few weeks, the client no longer mentioned his boxing career. Instead he began to ask for advice about his relationship with his female partner. He also talked extensively about his current relations with his extended family and his desire to be a son of whom his deceased mother “would be proud.” Toward the end of his counseling , the client was discussing plans to retire early from boxing and become an accountant. After the mandated ten visits, the client was given a letter of completion. Three months later, he returned for a social visit. A six-month follow-up revealed he had enrolled at a local junior college and has had no further reported acts of violence.

Commentary: The Boxer by Tina Foster Jansen, M.S.

Court-ordered clients are typically unmotivated. Faced with this type of client, Short used an opening strategy which would encourage the client to be involved in counseling to the “benefit of his boxing career.” As Cormier and Cormier state, “A productive assumption  in  converting  involuntariness into a  commitment  to be counseled  is that the client’s chief interest is himself.” (p.575) Short’s adroit therapeutic intervention began the changes that eventually alleviated further violence, and also had positive influences in other areas of the client’s life.

The treatment in this case is a study in reframing and utilization . Short used the strengths, weaknesses and temperament of the client to reframe inherent abilities so destructive behaviors could be changed. Haley (Nichols, 1984) maintains reframing is a necessary step in altering problem-maintaining sequences. Proper reframing changes a viewpoint to the meanings of interactions are changed  while  the  facts  of  that inter­action remain the same. Short reframed respect for the client. This new definition allowed the client to change behaviors while keeping and building on the client’s wish for personal  respect. Haley (1971) concludes that, on a general level, the goal of the therapist is to change the maladaptive behavior of the individual. An additional and subsidiary goal  is  to extend  the  client’s personal range of experience . By getting this client to change his violent behavior, Short was able to open the door for further  change  by  the  client.  The man’s personal range of experience could be extended. He could consider ways of obtaining respect other than through violence – he could consider becoming the son his mother “could be proud of.” He then could begin to extend  his  idea of a career and investigate choices.

Utilization is a cornerstone of Erick­sonian psychotherapy. Short demonstrated a superb ability to enter his client’s world and regard that world as having the material for productive change. He took the problem behavior, violence, and gave the client ways in which to reframe that behavior so his needs to be respected and strong were productively met. Short should be congratulated for his insightfulness and creativity in using negative behaviors as material for productive change.

References:

Cormier, W. H. & Cormier, L. S. 1985. Interviewer Strategies for Helpers. Brooks/Cole, Publishing Company. Monterey, CA.

Haley, Jay. 1973. Uncommon Therapy: The Psychiatric Techniques of Milton H. Erickson, M.D. W.W. Norton . NY.

Nichols, M. T. 1984. Family Therapy Concepts and Methods. Gardner Press, Inc. NY.

Sep 11

Think Fast

By John M. Dyckman, PhD

Estimated reading time: 3 minutes, 46 seconds.

An athletically built young man in his mid-20s, neatly attired in a business suit, consulted me to deal with “rage issues,” “depression,” and a desire to get to the “root” of his relationship with his mother. He told me that he had been raised by a single mother who was alternately extremely dependent upon him, and then physically and emotionally absent. They had suffered poverty when he was a child, and he was determined to continue to rise financially in the world as an adult.

Recently, his last two therapists, both women, had dismissed him because he had refused to enter a drug rehabilitation program as a condition of therapy. He thought that he might be a “borderline alcoholic” because of his daily use of alcohol, marijuana, and opioid pills, which left him “faded,” but still able to work in a high-pressure, high-stakes business environment.

In our first session, he proudly discussed his history of street brawling, though he had had no run-ins with the police. He was involved in a highly volatile relationship with his girlfriend. They had frequent arguments in which they exchanged hurtful insults and the arguments often rapidly escalated to mutual battery. He was concerned that several months earlier, in the midst of one of these altercations, he had put his hands on his girlfriend’s throat. He was quite right to be concerned, as it does not take much force, even “accidental” pressure, to damage the human wind-pipe.

He was unwilling to consider my suggestion that he attend a male-oriented violence program. Recalling that he had just been fired by his former therapists; I did not make this a condition for continuing treatment with me. Instead, we spent the rest of the session devising a safety plan for both him and his partner.

He came in for a second session, but said he didn’t want to deal with any of “that feelings shit.” I asked him to tell me about his week, and especially about any interchanges he had had with his girlfriend. He described her anger at him and told of her provocative insults questioning his manhood. I asked what he was aware of at the time, and he told me that it was none of my “fucking business.” He then turned bright red, the veins bulging at his neck, clenched his fists and began to rise from his chair.

My conscious mind was aware of a precipitous increase in my own adrenal function, heart rate, and blood pressure. It had been many years since I had retired from martial arts training, but I quickly found myself calculating how close I could let him get to my chair before I would need to launch a kick to his knees.

Happily, my unconscious mind worked faster than either of us. Without any conscious evaluation or plan, I found myself simply pointing at his chair and saying in a calm but intense voice: “I am not afraid of you, but I am afraid for you!” The result surprised us both: He halted in mid-air, began to sob, and then sat back down, crying for several minutes. When he was able to speak, he talked about the pain of being discounted and emotionally extorted, both by his mother and by his girlfriend.

I still do not know what might have happened had I been paralyzed into silence or if I had had to stall him while I devised a creative strategy. I think it helped that I had experience in calming myself before karate competitions — where the other guy really is intent on doing you physical harm, but I don’t think my martial arts training was the deciding factor in my actions. Instead, I believe that years of therapeutic practice has been engrained in my unconscious mind, accompanied with the precept that the worst action comes out of pain. Therefore, my comment emerged spontaneously. I acknowledged him as a man in pain, potentially doing more harm to himself than to anyone else. This I could say with complete authenticity, and in total spontaneity.

We worked together for several more years, and he was able to make substantial and satisfying changes in his career, relationships, self-esteem, and ability to equilibrate his own emotional state. He never directly mentioned the anger incident again, but he also never again attempted to coerce me into the silence that he had himself suffered for so long.

Dr. Dyckman, the author of “Scapegoats at Work,” practices in Albany, CA.

He is an Associate of the Milton H. Erickson Institute of the Bay Area.

Milton H. Erickson Unpublished manuscript, 1936. Estimated reading time: 6 minutes, 42 seconds.

An admonition from William Alanson White, M.D., then Superintendent of St. Elizabeth’s Hospital, was given to this writer early in his psychiatric career, and a year or so later he was again given the same admonition by Adolf Meyer,

M.D. Both strongly advised the writer never to refuse to consult with a patient. A single interview graciously granted during which the patient’s story was listened to attentively, while not especially remunerative, had often permitted them to encounter many unusual instances of psychopathology and to achieve, in many cases, astonishingly effective results. These results had sometimes proved to be far better than the doctors had considered possible at the time of the interview, even if long-term therapy could have been instituted. They likened such instances to the processes of behavior wherein “love at first sight” has drastically and positively altered the lives of various individuals. One such historical example was the schoolteacher who thought it wrong for an adult man making his living as a tailor (Andrew Johnson) to be so uneducated. The events that unfolded began with teaching and led to love, marriage, a law degree, a judgeship, and eventually the presidency of the United States.

Adolf Meyer particularly stressed the utility of hypnosis in eliciting the potentialities of these transient patients and urged this writer to see such patients for both the educational values of the experience and the possibility of effecting unexpected results. Throughout the passing years the writer has conducted many “one-shot” interviews and sometimes as much as 20 years later has received an appreciative letter or a personal visit confirming the therapeutic impact of the brief encounter.

One such case is as follows: In 1936 the author lectured to his first class of medical students at the Wayne State University College of Medicine. During one of the last two lectures of the year the subject of hypnosis was discussed. One of the students hostilely and aggressively interrupted the lecture to denounce hypnosis as a hoax and challenged the author to hypnotize him. He proceeded to berate the author; one of his classmates who was well known to the author rushed up and quietly explained that no notice should be given to the student’s misconduct. He was a known sufferer of migraine headaches, which developed unexpectedly; the headaches were always preceded by an outburst, as had just occurred; this behavior was merely the prodomes of a migraine headache, which would last for one to three days; and finally, such outbursts would occur in the most unexpected of situations—on the street, in the classroom, at parties, football games, etc.

After the outburst the student would slowly become flushed of face and neck, followed shortly by projectile vomiting, and culminating in a violent, incapacitating headache of perhaps several days’ duration. He had been examined by many competent physicians and had almost been refused admission to the medical school. So far no medication or treatment had been found for his malady. (Several of the rest of the class members confirmed this account of the student’s history.)

Within 10 minutes the student apologized for his conduct, declared that he was in the process of developing a migraine headache for which nothing could be done, in that about 15 or 20 minutes he would begin vomiting; after that happened, could he and a friend be excused so that he could be taken home. He also explained that his emotional outburst was a part of the aura. He was still getting angrier within himself, but he wanted to stay at the lecture as long as possible, since past experience had taught him how to judge his condition. Consent was given, but a challenge was issued that he might try hypnosis, since nothing else had worked. He bristled at this suggestion, but suddenly said, “Well, I’ve got nothing to lose but my breakfast, so go ahead with your silly hypnosis.”

He was asked to take a seat in front of the class, facing the author and with his back to the audience. Slowly it was explained that he was to rotate his chair (it was a four-legged chair) bit by bit until he had made a complete turn of 360 degrees. His hostile manner and attitude suggested the inadvisability of attempting any routine traditional technique.

Additionally, such a technique as moving his chair in a circle as he sat in it would be utterly incomprehensible to him as well as a difficult task. Yet, by so doing, he would be caught in the situation of actually participating with the author in a joint undertaking.

Thus, he would validate by his own actions the idea that he was going into a trance.

As he gradually rotated his chair, the author explained to the class that the subject would do this task slowly, that each little movement would become slower and more difficult, that there was no hurry, no rush, that the subject could take his time and ought to, that each time he moved his chair a little, he would feel increasing fatigue and sleepiness, that the chair would seem to get more and more difficult to move, that his efforts would increasingly become less and less effective, and that shortly his eyes would close, he would take a deep breath, he would give up trying to move the chair, and simply relax by going into a deep trance.

All of the above was said as if it were no more than an explanation to the rest of the class. Thus, the subject would hear these suggestions as an explanation to the class but not as commands personally addressed to him. He would develop no counterset to the suggestions and would thus tend to respond to them more readily, since he was already cooperating by slowly rotating his chair. Another important factor was the impending threat of a disabling migraine headache and the undoubtedly strong desire to escape from it in some way, even if that “way” appeared silly to him. Indeed, the entire situation favored the development of a trance state—the long history of migraine, the prodromes of hostility, aggressiveness, and belligerency, his own feeling of helplessness, his unwillingness to experience the projectile vomiting, and his dread of the utterly painful incapacitation that awaited him.

By the time he was facing the audience, he had developed a deep trance. He was peremptorily told that the author was now in charge of him and that all instructions were to be carried out. To this he nodded his head affirmatively. He was instructed to awaken, to speak derogatorily about hypnosis and the author, and to declare that such nonsense as hypnosis made him sick to his stomach. He should then try to prove that statement by going to the window, opening it, and trying to vomit projectilely, but that he would fail completely.

He was aroused, appearing surprised to find himself facing his classmates, made several unpleasant remarks as instructed, and then opened a window overlooking a vacant lot. He apparently did his best to vomit but failed, stating, “By this time I should have lost the lining of my stomach, but I’m beginning to feel better. I always vomit when I am about to have a migraine and I sure had all the warning signs this morning. But if I can’t vomit, perhaps I won’t have it [the migraine].”

This utterance was seized upon by the author to expand the idea that maladies, whether psychogenic or organic, followed definite patterns of some sort, particularly in the field of psychogenic disorders; that a disruption of this pattern could be a most therapeutic measure; and that it often mattered little how small the disruption was, if introduced early enough. After some discussion of this for the class (and as disguised suggestions to him) he was challengingly asked if he thought there was such a thing as hypnosis, and did he dare to volunteer to be a subject.

His reply was most informative: “I just told you it was silly nonsense, but I’m beginning to believe in it and I almost feel that you could hypnotize me. But what I don’t understand is that something has happened to my headache. I knew this morning when I woke up that I was going to have one, and when I came into this classroom I was in my usual, helpless, ugly mood. But now I feel fine.”

The answer given was, “It’s all very simple, and as I explain you will go into a trance, a deep trance, remember everything, and then awaken, knowing that you never need to have another migraine headache. So rouse up!” He awakened from the trance that developed as the above remarks were made and had a total recovery of all events.