Hope & Resiliency

Understanding the psychotherapeutic strategies of Milton H Erickson MD

Dan Short, Betty Alice Erickson, Roxanna Erickson Klien

• Publisher: Crown House Publishing
• Year: 2005
• ISBN:
  9781845906139
• Topic: Psychology
• Subtopic: Research & Methodology in Psychology
• Index: Psychology

Milton H. Erickson is most commonly examined through the lens of hypnosis. This book takes a much broader approach and defines several key components that made him successful as a therapist. The fundamental strategies described are relevant to all mental health care professionals, regardless of their theoretical orientation.

Part I

Foundations of Healing and Health

Chapter 1

Introduction

What is more important, technique or understanding? If after reading this book the reader is mostly excited about the new techniques that have been discovered, then the book should be read again in order to arrive at the main point.

Most will agree that there is a difference in status between a technician and an expert. A technician is paid less money, has less education, and is assigned to tasks that can be described using step-by-step procedures found in a technical manual. In contrast, an expert is someone who applies reason to problem-solving endeavors and when necessary creates new techniques to address novel circumstances. When considering the diversity and complexity of human problems, it is difficult to imagine how someone functioning at the technician level could make appreciable gains. It is a matter of common sense to recognize that a therapist-technician, a person entirely dependent upon treatment manuals and step-by-step procedures, is not as well prepared to meet the unique needs of each individual patient as the therapist-expert, a person who exercises reason and discovery within the context of a helping relationship.

Expert therapy requires clinical judgment. Clinical judgment is in many ways dependent on the practitioner’s understanding of healing and mental health. Some of this understanding develops over time through experience and exposure. However, the educated professional benefits from having an intellectually informed starting point. Such a start does not come from memorizing excessive jargon or becoming lost in an obscure analysis of minutiae. Instead, it grows forth from an appreciation for the fundamental dynamics of health and healing. So that is where this book begins.

Although it is possible to employ powerful psychotherapeutic techniques without knowledge of the broader understanding from which they were derived, success under these circumstances is more likely to depend on random chance rather than skillful discernment. In order to appreciate fully the clinical strategies described in this book, it is important, first, to develop a conceptual understanding of how mental healing occurs.

Although the following principles may seem academic, they serve the practical purpose of providing the logic behind clinical judgment. In order to individualize treatment in the way that Erickson did, it is necessary to understand the foundational principles that facilitate commonsense reasoning. Therapists who tailor their treatment to the needs of the patient, using an integrated model of therapy, require some means of determining the proper problem-solving principles to apply to each individual case.

When equipped with an underlying philosophy of healing and growth, the practitioner is able to recognize a wide array of therapeutic options and determine which direction is best given a certain set of circumstances. In contrast, to study therapeutic techniques without the benefit of an appropriate philosophical base makes no more sense than a lifeguard learning how to swim but without recognizing how to find the shore. In the following pages, the reader will be exposed to a parsimonious explanation of core objectives. Using a minimum number of theoretical constructs, the text offers a foundational understanding that will act as a guide for navigating occasionally bewildering clinical circumstances.

Once a person knows where to go, the next step is to know how to get there. In the second part of the book, the focus shifts to the intellectual tools used in skillful therapy. Because these tools are used with intention and toward a specific end, they are most appropriately identified as “strategies.”

This book examines core strategies that were woven through and through Erickson’s work. Each strategic principle is then broken down into several techniques that share a common function. To help bring to life these clinical strategies and to provide the experience of witnessing masterful clinical work, this book contains numerous clinical examples from Erickson and others. Those who have systematically studied Erickson’s work will notice that many of these case examples have never before been published. In order to make clearer the core function of any given technique, the overarching concepts have been paired with simple analogies, folk wisdom, and illustrations from other schools of psychotherapy. The reader should not become distracted over which school of thought the book is describing but instead seek to recognize the timelessness and universal nature of these strategic principles. This scaffold framework not only helps the reader better understand the interventions and strategies employed by Erickson, but, more importantly, points beyond the finite limits of Erickson’s achievements to an ever-expanding tradition of exploratory and innovative work by which he was characterized.

Erickson approached his patients with the type of admiration and respect that comes from an appreciation for the complexity and uniqueness of human life. His therapy was not based on a rigid application of step-by-step procedures. Because flexibility is an important hallmark of Erickson’s approach to healing, it is clinical understanding rather than rigid rules that must drive the decision-making process. While reading this book, there is no need to memorize what was said or done by Erickson in response to a particular situation. Rather, the reader will hopefully finish the book feeling better prepared to spontaneously develop novel solutions to complex and diverse clinical circumstances. This is an exploratory humanistic endeavor that helps balance scientific reductionism. As it was with Erickson, the thinking practitioner must be willing to experiment and be prepared to develop new therapeutic approaches for each client.

Through an extensive consideration of his written works, decades of lectures, hundreds of case examples, and his day-to-day behavior at home, the authors have attempted to resurrect Erickson’s voice. The idea that several different techniques can serve the same function and the belief that every intervention should be carried out with careful intention come directly from the teaching of Milton Erickson. After reading Part I of the book, the reader will be able to recognize fundamental dynamics of healing and of the clinical relationship. This philosophical model will then serve as a context for the selection and implementation of clinical strategies. Part II will then provide a description of each strategy. These are introduced in a broad and simplistic manner, followed by a more elaborate and complex examination of the clinical techniques derived from a given strategy. While studying these techniques, it is important to recognize that it is the broad concepts, and not the specific techniques, that are used to facilitate the development of an unlimited number of unique solutions. Although this text is not meant to serve as a summation of the clinical work of Milton Erickson, it does provide a solid basis for recognizing how he learned to approach health-related problem-solving endeavors.

Chapter 2

The Human Condition

This chapter examines the unstated expectations people hold and the insidious problem of perfectionism. A case example as told by Erickson during one of his many seminars has been selected so that the reader can contrast his or her initial conclusions about Erickson’s work with the book’s analysis. The case report in this chapter will be elaborated on in further detail in Chapter 8. The narrative has been divided in this way to help illustrate the multidimensional nature of Erickson’s work. It is important to recognize that there is not just one point to be gleaned from each case example. As intended by Erickson, each story is a metaphor designed to communicate timeless lessons that are difficult to bind up in an explicit construct or theory.

Case report: The man who cursed life

A man was brought to Erickson in a wheelchair, with arms and knees fixed to the chair. He was angry and cursed the fact that he had spent the last eleven years paralyzed by painful arthritis. He could move only his head and had some slight movement in one thumb. He was completely dependent on his wife, who dressed him, put him in his wheelchair every morning, then fed him, and put him to bed at night. All the while, he continued cursing about his unhappy life.

Erickson’s statements were simple and to the point. He reproached the man for his lack of movement: “You have a thumb that will move and you better move it! You better exercise your _________, ________ thumb every day in order to pass the _________ time.” [Blank spaces indicate use of expletives.]

The man responded to Erickson’s medical advice by becoming defiant, wanting to prove to Erickson that he could, “wiggle the damn thumb all day and all night, and all week, and all month,”,” and it would, “not do a damn bit of good!”

The man went home absolutely determined to make his point. But, as he continued to exercise his thumb, he suddenly noticed movement in his index finger, the digit most likely to be affected by movement of the thumb. As the exercising progressed he became able to move more fingers. He became fascinated by this. Each new sign of progress kept him absorbed in finding out how many more little movements he could get out of his fingers. Then he became able to move his wrist, and then finally his arms.

These exercises became the man’s method of passing time. Then, a year after his first appointment, Erickson gave him the task of painting a small cabin. The man responded by swearing as he informed Erickson that if he had any common sense he would not send a man with such limited movement to paint a cabin. Erickson persisted.

The assignment took him about three weeks. By the end of the summer he increased his speed and was able to paint a stucco duplex in a week’s time. Following these accomplishments, he got a job as a truck driver. Next he decided he should join a fraternal order and was soon elected president of that order. During his ongoing work with Erickson, the man decided he needed a college education and went to college.

Some symptoms of the man’s severe arthritis remained. Despite this condition Erickson explains, “He looks forward to the rainy season each year and the three to seven days during which he will be confined to bed with painful arthritis.” The man was able to tolerate the intermittent bedridden condition because it gave him an opportunity to catch up on good books he wanted to read. Rather than being viewed as a relapse, the residual arthritis was identified as producing a “vacation.”

(Erickson, 1957)

Because of the seemingly incredible nature of this case report and most others described in this book, it is very important to pay close attention to what was actually achieved and what was not. It is a mistake to be seduced by the idea that Erickson’s use of hypnosis produced some sort of magical cure. Wonderful as the outcome was for the man with arthritis, it is essential to recognize that he was not cured of arthritis. On the contrary, there remained certain circumscribed moments in which his problem was just as intense as when he first came for therapy. The residual arthritis was so debilitating that he was again temporarily confined to bed. However, the therapy was highly successful in that he was no longer an invalid.

The first major point to recognize is that perfection is not an appropriate therapeutic goal. Although he was often admired for his powers of persuasion, Erickson was careful to avoid misplaced notions of control. He did not try to make people conform to a standard of perfection. In Erickson’s words, “perfection is not a human attribute” (1973/2001b, p. 14). Accordingly, he warned of the complications of striving for a total cure. Instead, Erickson remained focused on the task of promoting the patient’s health, as imperfect as it may be. He felt it important to search for some small good that could be accomplished in relation to the patient’s current situation.

Erickson approached therapy with the premise that all suffering can be reduced. Although pain in life is unavoidable, it does not have to be overwhelming. Painful events can instead be perceived as an inconvenience, a problem, a challenge, something where there can be some sort of improvement (Erickson-Klein, 1990, p. 273).1

As will often occur, one small gain can lead to other unexpected outcomes and even cascade into completely unanticipated benefits. As with the case of the man with arthritis, Erickson admitted that he initially had no idea the patient would make such remarkable progress. The man had been putting most of his energy into making the problem worse. Once that energy was shifted toward identifying unrecognized possibilities, seemingly impossible circumstances were transcended. If Erickson had attempted to cure the man, he would most certainly have failed. Instead he hoped that some amount of good could be accomplished.

The second major point is that living requires effort. This is often overlooked in a culture of modern conveniences. In addition to being imperfect, people need to work hard in order to function well. Healthy muscles require constant exercise. Healthy brains require ongoing stimulation and effortful processing. Healthy families require constant attention and involvement. In most of his clinical work, Erickson rarely used words or phrases that implied a passive role for the patient. He found stimulating ways of encouraging patients to be actively engaged in their own healing processes. Having grown up on a farm, he fully appreciated the meaning of, “You must do your share of the work.” He understood the feeling of satisfaction that comes after a hard day’s toil....