Potential Not Pathology

Helping Your Clients Transform Using Ericksonian Psychotherapy

Paul J. Leslie

• Publisher: Routledge
• Year: 2018
• Print ISBN:
  9781782201403
• eBook ISBN:
  9780429917448
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book is designed to assist counsellors who would like to use and understand the psychotherapeutic strategies of Milton Erickson but often find it confusing, intimidating or unrealistic. Using colourful case studies and stories told in everyday language, this work will educate and help professionals in being able to understand how to adapt and apply creative and resourceful therapy interventions based on the concepts of Ericksonian psychotherapy. It will also assist clinicians and therapists in easily implementing the concepts of Ericksonian psychotherapy into their work in order to energise and revitalise their therapy sessions. Subjects explored include client resistance and client potential, the role of imagination and playfulness in the therapeutic work, and the healing possibilities hidden within stories and metaphors.

CHAPTER ONE

Developing the Erickson mindset

There are important beliefs and assumptions when working with clients from an Ericksonian perspective. Adopting these ideas does not mean you have to completely change how you work with clients. In fact, I believe that by adopting these ideas it will help you become more successful in working with clients no matter what your theoretical orientation may be. I recommend playing with this way of viewing therapy for a few weeks and then going back and noting how your sessions felt different. You may already be thinking in this direction. If so, wonderful! Keep it up. If not, then open your mind a little and try out this new mindset.

The mindset we bring to the therapeutic process may be the most important element in working with our clients. If we view performing therapy as something that is old and drab, we tend to get more old and drab clients. On the other hand, if we view therapy as an exciting journey of self-discovery (for both client and therapist) our sessions are often more animated and interactive. The beliefs we have as therapists may determine whether our clients improve.

I believe that therapy should be a life-changing experience. If a client comes to therapy and the therapist does not offer her anything different to what she is currently experiencing, then not only is therapy useless but it is also a waste of money. I encourage you to make your sessions come alive with a sense of curiosity and spontaneity while giving the client the utmost respect and empathy. If it took something out of the ordinary to knock your clients off kilter then they may need something equally out of the ordinary to push them back onto the path of resourceful living.

One of the worst things you can be to your client is boring. I know that many of us are taught to be reserved and centred with no out of the ordinary behaviour while conducting therapy. This is to make our clients feel comfortable and safe. I think we can help our clients feel safe and comfortable while also being alive and interactive. Due to Erickson’s belief that change occurs in psychotherapy not by the amount of information or interpretation given to the client but rather by the unique experience the client receives during his or her therapy session, his goal was to increase a client’s chances for success, not to spend time on a never-ending exploration of where in the client’s life she was inadequate (Haley, 1973).

Every client is unique

I believe the most fundamental characteristic of how Erickson worked with his clients was his respect for the individuality of each person. This meant he never worked with two clients in exactly the same way. Erickson did not feel the need to have clients conform to any specific theoretical model. By approaching therapy in this manner, he was able to create customised strategic methods of assisting clients in obtaining their own goals (Short, Erickson, & Erickson-Klein, 2005).

While we all think we approach each client as unique, the truth is that we often try to fit one client into the same intervention as other clients we have had with what we believe are similar issues. Sometimes this works and sometimes it doesn’t. If we think of every case as unique we may discover more ways to help facilitate change than if we think of our client as more of the same. I have heard many therapists express either exasperation or frustration when they get a client who doesn’t seem to change as quickly as the therapist thinks they should due to their experience with other clients who responded more positively to their standard interventions.

I once explained it this way to a colleague: imagine that you need your child to eat some vegetables. You are trying your best to get the child to eat broccoli because you like broccoli and the child’s three siblings like broccoli. No matter what you do the child will not eat broccoli. You are in total disbelief because the siblings were open to eating broccoli and did not give you any problems with this vegetable. You try ordering the child to eat broccoli. You try to educate the child on how vegetables are good for people. You beg and plead with the child to eat broccoli. All these actions end in failure to get the child to eat this vegetable. Then one day you find out that your child loves turnip greens, mustard greens, cucumbers, and spinach. You now wonder why you have been wearing yourself out trying to get your child to eat a specific vegetable when this particular child was open to other nutritious green vegetables that you were not focused on.

Therapy can be a lot like that situation. Sometimes a person responds to your techniques and sometimes she doesn’t. Thinking that the client should be behaving in the same manner as other clients is often unrealistic and will inhibit success in clinical work. Tailoring the session to each client not only helps the level of empathy and rapport but also increases our ability to find the unique manner each person needs in order to heal.

Erickson once worked with a young man who was unable to walk down, or cross, busy, crowded streets. Erickson figured out that his avoidance of public places was due to his fear of interacting with women. Instead of directly interpreting the young man’s avoidance of these streets as a fear of women, or following the usual pattern of treatment based on what worked for other clients with anxiety issues, Erickson treated this client’s case as unique. He focused his attention on helping the young man improve his physique. Erickson’s encouragement in developing strength helped the young man begin to improve his body image. Once the client had more confidence about his physique, he began changing other areas of his life, such as moving out of his dysfunctional mother’s home into his own apartment and being more open to walking down crowded streets. This was all accomplished without Erickson ever telling the young man what he felt was the real reason for his problem (Haley, 1973). If Erickson had treated the young man as just another anxiety or phobia case, in which the treatment was the same for every client, one wonders if such a shift in the young man’s sense of self would have occurred.

When I was working as an intern in a community counselling centre, one of my first clients, Carol, came to therapy due to severe social anxiety. Carol had trouble talking on the phone to anyone she didn’t know and she was panic-stricken when she had to go somewhere she had not previously gone. Interacting with other people made her so nervous that she would become disoriented and nauseous. Halfway through the first session I decided to myself that this was going to be an easy problem to fix. I was going to help Carol spot and change her irrational thoughts about herself and the world around her. I knew this to be effective way to conduct therapy because I had read, researched, and practised this approach in graduate school. I believed that as soon as she understood the logic of what I would teach her about thinking rationally she would instantly begin to change her behaviour and emotions.

Carol was a good client who listened to my interventions and tried really hard to do the things we had discussed. The problem was even though she knew her thoughts might be illogical or unrealistic she just couldn’t seem to change how she felt. She would do her therapy homework and her relaxation exercises but she didn’t seem to be getting better. She perfectly understood why she felt the way she did but seemed trapped in her present emotional prison.

This was a tremendous blow to my initial optimism about the case. I thought this therapy process would be easy. My worries were beginning to overtake me. I was beginning to become frightened that she would not be able to change and that this would be proof to the world that I was not cut out to be any kind of therapist. I wondered to myself if a good client like Carol could not change her thinking then what the heck was I going to do with someone who was in serious trouble or who was resistant? At this point in our work I wondered whose anxiety was worse, the client’s or mine.

After a couple of sessions of this lack of progress, I reluctantly turned to my clinical supervisor, Jerry. He told me not to worry and to just keep doing what I had been doing. From that point Jerry sat in on our sessions and was my co-therapist. In the remaining therapy sessions, I continued to work with Carol on her beliefs about herself and her situation. Jerry, however, mostly teased and joked with Carol and me. He would listen quietly to what was being said and then say something that made us all smile. I couldn’t see much evidence of any effective therapy going on from Jerry’s behaviour.

After three more sessions with Jerry and me, Carol informed us that she had found a job. She further related that she had even struck up a conversation with a new co-worker. Neither of these were things she believed she could have done when she started therapy with me. She proudly announced that she did not think she needed to come back to therapy as she felt she was better. I was happy for Carol but totally confused. Why had she changed if Jerry wasn’t working on her irrational thoughts? To me all he did was tell jokes and playfully tease us.

Before we ended our session and terminated our therapy, I directly asked Carol what had happened in therapy that had the greatest impact on her and enabled her to change. She thought for a moment and then replied with a smile, “I don’t know. You guys are just funny. I laughed a lot.” I then realised that it was not the information or insight that changed Carol, but rather it was the interaction with two strangers who made her laugh that was the greatest healer.

Her experience interacting with us in the office was what helped her become open to other interactions, not any techniques I had tried to impose on her. Jerry’s playful teasing and jokes indirectly taught her that it was safe in the session and if it is safe in the session, it could be safe outside the session. I do believe that if he had come into the session and sat in quiet empathy Carol would not have learned to be brave. Instead of treating Carol as a unique client, I attempted to impose a technical prescription on her, which almost resulted in failure. From this I learned it is experience and interaction, not solely technique or insight, which creates change.

Becoming flexible

One of Erickson’s unique qualities as a therapist was his ability to be as flexible as possible with each client. As we discussed earlier, if each client is unique then one’s responses to each client will undoubtedly be different. In order to accomplish this, therapists need to be able to work in a seamless manner with what is given to them. Clients often seek therapy due to their perceived limited ability to cope with the inevitable changes that life can bring. Erickson has commented that the client’s lack of flexibility is one of the most common issues one deals with in therapy (Zeig, 1980). I will add that it is also the therapist’s lack of flexibility that is the most common issue one deals with in clinical supervision. If, as therapists, we are inflexible in how we respond to our clients this may make it harder for them to discover their own untapped resources and options.

Being flexible with client behaviour not only aids in maintaining rapport but also helps deal with frustration and burnout on the therapist’s part. I remember a supervision meeting where Jan, a counsellor, was describing herself as “worn down” by one of her clients. The client would attempt to talk over her and he would instantly shut down any difference of opinion she put forth. Jan was attempting to be open and have unconditional positive regard for this client but it just was not working. She felt defeated and angry. All of us in the supervision group could relate to some aspects of Jan’s plight as we had all encountered clients who tried our patience.

The clinical supervisor listened to Jan intently and acknowledged her distress. After thinking for a minute, the supervisor said that Jan might want to try being a little more flexible in how she responded to her client’s behaviour. Jan was told that she had been playing the good therapist and being a polite person to someone who obviously had some communication differences. The supervisor suggested she begin each new idea with the phrase, “I know you aren’t going to agree with any of this, but …” and then give her direction or intervention.

The supervisor’s advice worked like a charm. The client was so used to disagreeing with everyone that the supervisor knew he would disagree with anything Jan said. By beginning every intervention with Jan’s assertion that the client was going to disagree with what she said, the client had to disagree with disagreeing! As a result the client began taking input and direction in a much easier way. If Jan had initially been a little more flexible in how she responded she may have been able to save herself some hassle.

In addition to being flexible with the emotions and behaviour of clients, it is also important for therapists to be flexible with their own emotions and behaviour. Erickson was very skilled at being exactly who he needed to be at any moment in his work. He could be the passive, loving grandfatherly figure that so many experienced. He could also be the tough, directive therapist who would take no crap from his clients. Consider this example of Erickson’s persona in the following case.

A man was brought in by his wife to see Erickson. Due to having had a stroke the man was totally paralysed. He could understand everything being said but he could not move or talk. He had been in a hospital where some of the doctors had said he was a hopeless case. His stroke had kept him from his work, which caused his successful business to close. He was a proud Prussian man who felt angry and helpless at being unable to financially assist his family.

Erickson had been told earlier that this man was someone who wanted to be in control of every situation. The man’s occasional grunts, signalling his exasperation at having to see Erickson and how long it was taking Erickson to write down all the information about the man’s history, made Erickson aware that being in control was indeed hugely significant to the man. Erickson immediately told the man that treatment would not begin that day even if the man wanted the treatment. The man was so angry he refused to leave Erickson’s office but Erickson had his sons carry the man outside. The next time the man came for his appointment Erickson told the man that a patient’s job was to follow his directions without question. If the man refused to do that Erickson would end the session immediately and send the man away. Erickson told the man’s wife that if he tried to communicate with her using any more grunts she was to tell him to shut up. At the end of the session the man was so angry that he ended up attempting to walk with his wife’s assistance to their car.

In their next session, Erickson said many denigrating things about Prussians and scolded the man for being lazy for the past year. When Erickson told the man that he was going to have to come back to see Erickson and hear more bad things about himself, the man yelled out “No!” Erickson then berated him for not talking for the past year and how pathetic it was that all he could say was “no”. The man kept repeating “no” and walked to the car mostly by himself.

The next time he came to see Erickson the man walked into the office with his wife’s assistance. Erickson told the man that he was free to say “no” or “yes” to whatever was discussed. In addition to more insults, the man also began getting hypnosis work with Erickson. With Erickson’s prodding the man began to start walking more frequently. He later regained most of his functioning and returned to his work. Erickson was flexible enough to use the man’s anger as a motivation to begin healing his body (Haley, 1973).

When reading this example we need to ask ourselves if we can become as flexible and creative as Erickson in how we work. In order to assist a client in changing, the therapist may possibly have to be playful, unemotional, irritated, excited, or calm in the session. I have found that many therapists find a level of comfort in how they approach their clients, and refuse and resist doing anything differently because they have become too comfortable. This level of comfort may often result in a lack of flexibility in how one approaches a client. According to Keeney and Keeney, “practitioners who remain stuck in a particular therapy model or habit of relating to clients risk falling into a rigidity that prevents them from being flexible enough to effectively handle different kinds of clients” (2013, p. 123).

I have often heard absolutes about how one behaves in a therapy session. For example, never get angry in a session, never get sad in a session, or never show emotion in a session. I can understand how these absolutes arose and I believe there is some validity to those ideas but I also reject that one should always be set in emotional cement where all our feelings and behaviour are limited by opinions of certain perceived authorities. As long as we are not violating ethical rules and our actions are not hindering the course of therapy, why not be more flexible in how we respond?

Frequently, clients have gone through some kind of significant event that has knocked them off course with the direction of their lives. As previously stated, if it took a significant event to knock them off course, it may take a significant event to knock them back on course. If the process of therapy is not a unique, life-changing event for the client then one has to wonder why she is going in the first place. If we allow ourselves more flexibility in how we respond to clients we are in a better position to be able to make therapy a significant event.

In some cases therapists may have a fear of showing or experiencing their own emotions during their sessions. I think it is admirable that a therapist wishes to have control over his emotions. To me, being in control of one’s emotions does not mean hiding or avoiding emotions but rather being able to access any particular emotion that is needed to help the client at that moment. If you find that you have problems tapping into and controlling the wide range of emotions you have, I recommend taking a few months of acting lessons. Learn to tap into the wonderful variety of emotions and actions that are available to us. When you are acting you can be anybody. You can be a hero, villain, femme fatale, a king, or a queen. You can play happy, sad, angry, or shy. Who knows, you may even learn to act in a way that helps your clients. They may come to believe you are a free-spirited, creative Ericksonian therapist even if you are not.

A colleague told me that he took close to a year of improvisational comedy courses. He then joined a small, professional improvisational comedy group in order to hone his ability to think quickly and change the frame of whatever happens in the moment. I could relate to what he was doing. Being flexible enough to see the humour in various situations has been something that has benefited me in my work. In many of my sessions with clients, we have been able to look at various aspects of what motivated them to come to therapy in a different way though humour. When I was once asked who my psychotherapy influences were, I included in my list Groucho Marx as his ability to see the abs...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• ACKNOWLEDGEMENTS
• ABOUT THE AUTHOR
• INTRODUCTION
• CHAPTER ONE Developing the Erickson mindset
• CHAPTER TWO Utilisation
• CHAPTER THREE Altering patterns
• CHAPTER FOUR Multilevel communication
• CHAPTER FIVE The Renaissance man
• CHAPTER SIX The possessed boy who belched
• REFERENCES
• INDEX