On the final morning of the Evolution of Psychotherapy Conference I went to a workshop by Jeffrey Zeig called ‘Evocative Approaches to Change’. This experience went some way to redeeming the conference for me. Zeig is the director of the Milton Erickson Foundation and much of his effort goes into preserving, documenting, understanding and continuing the legacy of the great man. What made this presentation rich for me was that
- here was a therapist whose agenda was constructed directly from what was brought by the client rather than from a pre-established protocol;
- that used the same kinds of amplificatory and metaphoric methods that I use in Zen therapy;
- and who was trying to operationalise these principles in a genuinely experimental way characterised by some humility.
I can’t here give a full exposition of Ericksonian Therapy, but I can list some of the interesting ideas.
A key concept is ‘states’. The therapist is looking to evoke ‘functional states’ in place of dysfunctional ones. Such invoking is called ‘induction’. To illustrate what this means from ordinary life, think of humour. A state of levity is evoked in a person who was previously in a sober state by the telling of a joke. The joke is the induction. This was interesting to me because in ZT we have the idea that people are all the time in one state of trance or another and that these trance states are induced by exposure to significant objects (rupa). This raises many interesting questions about the line between cooperative induction and manipulation. Generally speaking, Erickson is 'bringing something out' from the client rather than 'changing them into' something, but this is a subtle distinction.
ANCHORING & TRIGGERING
Once a person can enter a functional state this state might be anchored by a ‘reference experience’. This might, for instance, be a tiny ritual that helps the person to move into the desired state. A reference experience is a self-induction. This also tallies with ZT in which small personal rituals are used in a similar manner.
A further key concept is ‘utilisation’. This is summed up in the question: “What is the virtue of the fault?” This is very Zen. Milton Erickson used what the client was already presenting as the foundation for his intervention. As a Zen therapist I would say that the virtue in the fault can be understood in more than one way.
The first way is that there is some reason why the person is doing what they are doing. It is not good enough to label a state or behaviour as dysfunctional. Actually it is always functional and it can be very helpful, though not essential, to understand the function. There is generally what is technically called ‘secondary gain’ resulting from even the most seemingly mad , sick or evil behaviour. Buddha himself pointed out that if there was no gain people would not do these things.
The second way is that one can build upon existing behaviours. It is much easier to build upon something the client is already doing than to eliminate it and replace with something else. Erickson was a genius at finding ways to exploit quirks and develop them into benign and useful activities. In ZT this might take the form of amplifying the experiential reality as it presents so that client and therapist together can explore its manifold potential. Thus one is not in the business of getting rid of anything, bot of development and growth.
PLAY & NAUGHTINESS
Related to this, an attitude of playfulness can be releasing and constructive. We saw a film clip of Erickson inducing regression in a young woman, taking her back to childhood with three sequenced inductions 1. imagining going barefoot, 2. dangling her feet in the swimming pool, 3. imagining sucking her favourite sweet while dangling her feet in the pool. The client entered into this as into a game, yet with each step the induction became stronger.
This particular example also illustrates a further dimension. The three actions are all slightly naughty. They each involve a release of social inhibition. These therefore are not just inductions suggesting regression, they also suggest degrees of liberation from social control. In particular, in the third action the client, now in the state of a young girl, implicitly, receives a sweet from Erickson, a stranger. Children are all told never to take sweets from strangers, but here in this imaginary world of the regressed state the client accepts the imaginary sweet from the therapist. We see the client’s sly smile as she accepts this suggestion. At some level she is taking on the complicity. This all serves to establish a close co-operation. It also paves the way for other liberations. This is a principle of rather wide application since many clients are, in one way or another, suffering from socially induced inhibitions.
From the above we can also discern the importance of metaphor. Zeig explained how metaphor is a step on from simile which is a step on from conventional empathy. Thus, for instance: The client says, “I feel overwhelmed.” A literal empathic reflection could be, “You feel unable to cope with all the things you have to do,” or could simply be a direct mirroring, “You feel overwhelmed.” Reflecting back the client’s own words is surprisingly often quite helpful. The introduction of a simile might go, “Overwhelmed… as if a great wave has come and drowned you.” This is the use of a metaphor in an ‘as if’ fashion. But when the therapist is in a fully metaphoric mode the ‘as if’ can be dropped, thus:
Client, “I feel overwhelmed.”
Therapist, “The tidal wave has arrived.”
Then he talked about how the metaphoric style can be developed by repetition with amplification and variation, rather in the way that a composer varies a theme in a piece of classical music, thus:
Client, “I feel overwhelmed.”
Therapist, “The tidal wave is in sight, it’s coming, it’s sweeping you away.”
This developed form is more evocative. It also opens up extra possibilities of dialogue. At a later stage therapist and client can use the whole range of this imagery with expressions such as “So when you see that wave gathering on the horizon…” “When the wave arrives and you lose control…” “And that wave is going to carry you to somewhere new, somewhere you, maybe, never thought you would go, somewhere that the universe has in store for you that you have not even imaged yet,” and so on.
CREATING A FERTILE CONTEXT
In this way we can see another principle that again has exact parallel in ZT, which is to put the client into a context where things can happen. This might be in imagination or it might be literal in the real world. In ZT we know that it is reality that is the real teacher, but to find out what reality has to teach you you have to risk going into a situation where you will be tested in some way. This, however, does not necessarily involve conscious intention on the part of the client. Consent is enough, and the bond established between therapist and client can be sufficient to provide the courage to consent. Erickson was all the time monitoring what the client was willing to buy into.
This means, therefore, that although good therapy is minutely in tune with the material being presented and the current state of the client it is also provocative and destabilising. Again, like good music, it is exactly at the point where a theme has become established and predictable that the composer introduces an element of surprise. This was very much Erickson’s style and it is, in this respect, exactly in parallel with Zen method. Timing is of the essence here. If the timing is off there will not b e consent and the induction will fail.
The skill of the therapist in this kind of work is like that of the expert dancer. The good dancer is always in movement and senses exactly the moment to make a new turn. The inexperienced therapist easily falls into a rut. You do something that works and so you go on doing it. However, the second time is not as fresh as the first and the fourth time is actually counter productive.
There is a deep question here about what is really client-centred. Being deeply client-centred is not a matter of following a little behind the client, it is a matter of being so in tune with the movement of the client’s soul that a playful dance emerges. Neither client nor therapist know in advance what will come out of the co-creative activity, but the whole thing is non-cognitive. It flows from a resonance between the functional states of the client and therapist. This requires profound respect.
MASTER OF ZEN
Clearly Milton Erickson was, without knowing it, a Zen master. His terminology is not identical to that of Buddhist psychology, but there is a sufficient similarity for the two languages to be mutually comprehensible. I find this exciting. It was the one workshop in the whole conference that really gave me hope.
After some disappointment, you finally found a great hope. Good for you and for us!
You have made me go back to Erickson for a while. Yes, you are right! He is a Zen Master. I agree with you. Paradoxical, brief and system-oriented, metacommunicative, hypnotic, spiritual and here and now worker! Perhaps, more than a Zen teacher!
Some years ago I bought some books by Erickson and one by Zeig. I was trying desperately to "grasp" something of that therapeutic approach, the method. I did not find the way, of course...I thought : "this man (thinking about Erickson) seemed to do magic"...It was fascinating for me but I could not understand anything about his method.
Really there was nothing to be grasped, there was no method to follow...It was only about the spontaneity and creativity that arises when flowing with a particular and unique reality...After having studied some Buddhist psychology It is easier for me to understand a bit better what all of this means. So maybe, it is a good time for me for rereading those fascinating books.
Thank you very much for your great exposition and for motivating me again to read those books again :)
What a clear exposition, David. Thank you so much. I am struck by much of what you have written about working with people in distressed states. So much feels so true. One point...the timing you mention as vitally important seems somehow inextricably wound with trust. Thoughts? Anyone? how does trust between client and therapist/teacher work to provide a flexible tension?
Thank you Minsung, Nati and Charlene. Erickson is not easy but certainly repays study. On the point about timing and trust, I think it is akin to music. In order to be held and moved by a piece of music the timing in the sequence of notes and chords has to be just right with just enough consistency to draw you in and just enough variation to keep you interested. Then you resonate with the music. To resonate with another human being probably requires something similar.
Great article. I really enjoyed reading about the similarities between ZT and ET.
Trust is an interesting point...I used to run guided meditation for patients in a psychiatric hospital and it was very clear that they quite enjoyed being guided into a loving and non-judgemental environment. I would leave the actual details up to them but would offer some examples and when we finished it was always interesting to hear some of them talk about where they had gone. I would always invite them to create a new place if they didn’t have a natural loving place to go to, but it seemed that most of them had one. It was always bitter sweet, often a place from their childhood, or with a pet, or companion from their past. I think for me, as a visitor to the hospital offering this sort of group, I felt like they knew I wasn’t there to judge them, or label them. We were all invited to create a place and I think this sort of invitation (or induction) is valuable because it doesn’t matter if it is based on reality. The whole exercise was to fill them with love wherever they imagined themselves to be and this I felt made them more willing to trust.
So maybe trust and love need to be felt by both the client and therapist?Maybe, if one feels loved then there is less fear, and if there is less fear then we can let go of some of our social conditioning and be more likely to dance naturally to the music. But one can’t really contrive love, one must feel it from a source outside of oneself and that is probably the hardest thing to do.
This is all very good to read, and chimes with my own experience as a therapist. Much of it also fits with the embodied work I have been training in - the amplification, the playfulness, the idea of moving to creative states from dysfunctional ones.
Much of my experience in working in an embodied way is that it really allows me to get into the clients shoes (or the clients other's shoes (of which I am one!)) and speak or move spontaneously from that place. The analogy of a dancer is a good one, sometimes I feel like am taking on the clients steps, if they are wary of stepping too much into the dance, sometimes I dance the counterpoint role, sometimes I am outside the dance encouraging them to step-in, or out, as appropriate.
Ericksonian approach teaches therapist to trust the wisdom inside client, to trust that everything is already there, therapist is facilitating, utilizing, fertilizing the ground in order the plant could keep growing accordingly to its own nature. I love Milton Erickson work and how it is blossoming through his students. I am thrilled to read and catch the enthusiasm in the text, it is good to find more people who understand this way of thinking.
Susthama Kim to your point about the exercise not mattering if it's based on reality is coherent with neuroscience which demonstrates that imagination alone convinces our brains the event is occuring in real time/space. Imagining one is loved then, is quite as powerful as being in the presence of being loved. The secret to prayer and some meditations?
Yes, absolutely, fake it until you make it as I have heard it said.