Extraordinarily useful on several levels. Highly, highly recommended for anyone curious about their own psychology, curious about psychotherapy, and curious about how to interact with people more effectively.
And there's much more. Over the course of various case histories and therapeutic anecdotes (some surprisingly gripping) the reader learns the elements of persuasion, influence and suggestion, even techniques that, today, we would call NLP. Uncommon Therapy pays an attentive reader a wide range of dividends.
At the same time, there are also certain difficult truths in this book--be ready for them.
For example if someone asks you for help, you'd think you could just say, "here, do this [good thing]. It will really help you." Nope. We give reactance and pushback, we have "not invented here"[1], we view new thoughts or ideas from others to be an egoic threat, etc. We humans have all kinds of difficulties accepting "help," even when we directly ask for it--even when we walk right into a therapist's office explicitly seeking that help! And this is why it's so striking and interesting to see how Erickson takes patient reactance/pushback and uses it to help his patients. It's humbling to see it, but quite often he helps people move in the right direction by, sometimes, pushing them in the opposite direction. Thus the patient's resistance to his "help" that ultimately pushes them in the right direction.
[A quick affiliate link to Amazon for those readers who would like to support my work here: if you purchase your Amazon products via any affiliate link from this site, or from my sister site Casual Kitchen, I will receive a small affiliate commission at no extra cost to you. Thank you!]
This is just one of many counterintuitive and occasionally hard truths here. Here's another: the standard therapeutic method of helping the client learn about all the reasons and root causes behind his behavior does not help anything at all. If you give someone a diagnosis ("You are ADHD, this is why you're having trouble focusing") or if you help a client find a root cause for certain behaviors ("your inability to form attachments comes from the fact that your mother mistreated you") there's a huge risk that the patient will simply ego-attach to these extrinsically approved "reasons," and thus groove their problem rather than solve it. ("I don't really read anymore, the doctors say I'm ADHD.") Author Jay Halley phrases it this way: "Implicit in [Erickson's] work is the idea that a therapist who tries to help people understand 'why' they behave as they do is preventing real therapeutic change." It's an unusual and tremendously useful insight: the "reasons" do not matter, all they do is interfere with your progress. And to Erickson, what matters--the only thing that matters--is solving the problem and helping the patient.
There are even more surprising therapeutic examples: we see Erickson observe a patient improving too rapidly, and in certain cases he may actually encourage a relapse in the old behavior. It sounds ludicrous, but yet there is a clear therapeutic rationale (see Chapter 1: Strategic Therapy). See also the extended case study of "Harold" (see Chapter 4: Character Revision of the Young Adult), which offers examples of nearly every form of Erickson's various reverse psychology techniques, suggestions, hypnosis and other indirect guidance. The Harold case is genuinely fascinating, touching on the entire spectrum of Erickson's "uncommon therapy," and the reader gets to see an absolute wreck of a guy transform himself into a contributing member of society, thanks to Erickson's direct and indirect therapeutic methods.
Erickson's unusual approach can be (and has been) criticized for being manipulative, but sometimes, in order to really help someone, you have to recognize and adapt to the patient's own self-subversive forces. You have to change tack. Erickson uses a river as a metaphor here: it's impossible to reverse the course of a river. You have to work with the force of the river to gradually redirect it. Go indirect; help the patient "be helped" by suggesting the help was their idea all along; use reverse psychology; let the client's automatic reactance lead them in the right direction. Whatever it takes to assist the patient, make it so.
Which takes us to another interesting aspect of Erickson's therapeutic practice. He typically helps patients get results quickly. And even in cases when Erickson helps a patient over a period of years, he will see the patient for a period of time, but then recess after starting in motion certain changes that can continue without his constant involvement. He doesn't turn his patients into revenue generating annuities! This alone might be the reason why nobody knows who Milton Erickson is.
One more idea, a second-order takeaway from the extended "Harold" case study in Chapter 4. Erickson instantly decided he would take on this client, because, as he phrased it, Harold had "therapeutic potential." Invert this idea and you arrive at something striking: if you ever decide to pursue therapy--or for that matter any kind of care from any type of caregiver--be the kind of person who has therapeutic potential. Your doctor, your therapist, anyone who's treating you will then be as invested in your journey as you are. Perhaps we can expand this idea even further to incorporate any form of instruction from any type of teacher: be the kind of person who's teachable, reachable, coachable. You'll find teachers everywhere who want you to learn just as badly as you do.
Finally, a brief discussion of the various hypnosis, suggestion, and sub-communication techniques covered in the book. Admittedly, these techniques could be used for either good or evil, and so it's critical to know about them if and when they are used against you. And they will be: I think we all learned this, crushingly, during the COVID pandemic and its aftermath (during which many suggestion and near-hypnosis techniques were skillfully used against society).
Thus yet another second-order conclusion I arrived at from this book is that I personally have been manipulated far more skillfully over the course of my life than I ever want to be true. Hopefully, this book will help me minimize that manipulation going forward.
Reading Pairings:
If you want to become less foolable and less manipulated, especially in today's era when fooling and manipulating have never been done more skillfully, Uncommon Therapy belongs in the canon of must-know materials, right next to:
2) Daniel Boorstin's The Image, and
Footnote:
[1] "Not invented here" is a bias from the business world where an organization will reject external ideas, innovations or inventions assuming anything they do internally will be superior. In interpersonal dynamics, "not invented here" is a form of self-sealing egoic defense: any idea that comes from outside a person's mind has to be inferior somehow, or he would have known about it already.
[Readers, as always, a friendly warning: the notes and quotes from the text that follow are here to help me order my thinking and better remember what I read. They are almost certainly not worth reading! Feel free to continue, but also feel free to stop right here and return to your lives.]
Notes:
Preface (to the 1986 edition)
9ff On Erickson's death in 1980, having "changed from a controversial figure in the therapy field to a universally admired one." On Erickson's work with Margaret Mead in Bali working on films about trance states and hypnosis; on the author going to one of Erickson's weekend seminars on hypnosis as part of a research project, and then later on his regular visits to Phoenix to meet with Dr. Erickson afterwards. Also on Erickson's very modest private practice, in his home with his eight children running around, the waiting room was the living room. On Dr. Erickson standing out as a unique therapeutic school in himself, "the usual premises of psychiatry and psychology were not adequate to describe him." On comments from the author on his wish to write a book about Erickson's approach but he didn't have an appropriate theoretical framework to present it. [Note that something can work really well, but you never hear about it because there isn't a "framework" to describe it with or structure it with. The something can't just be that something, it has to be fit into something else to be conveyed. To stretch the analogy: you never hear about DMSO or ivermectin because these unpatented, low-cost meds don't fit well into the "framework" of the modern pharmaceutical industry's business model.]
12 "...the point of view generally expressed in this work is not necessarily that of Dr. Erickson. It is my own way of describing his approach to therapy. He read and approved of the manuscript, but his own view of his therapy is expressed in his own writings."
14 "What I liked most about the reception of this book was that Erickson was pleased by it as an expression of his work. He ordered many copies of the book and enjoyed passing them out to colleagues and students." [A nice form of positive reinforcement right there.]
Chapter 1: Strategic Therapy
17 On traditional therapeutic models where the clinician was expected to interpret or reflect back to a patient what he was saying and doing, but not dictate or determine what happens in the therapy session; in most therapy modalities it was seen as manipulative to focus on the problem, to set goals, to deliberately intervene in a person's life. "This passive approach lost for the clinical profession many of the effective therapeutic strategies that were developing before this century."
17-18 "Strategic therapy is not a particular approach or theory but a name for those types of therapy where the therapist takes responsibility for directly influencing people." On hypnosis, which has continuity with past therapies in that "the hypnotist must initiate what is to happen." Also on conditioning therapies that came from Thorndike via Skinner, and with basic premises from Pavlov, "who was immersed in hypnotic theories." [I did not know Pavlov had anything to do with hypnosis!] Also on Joseph Wolpe and his behavioral therapy in the form of reciprocal inhibition, also "Freud's method was rooted in hypnosis." On Erickson who mastered the strategic approach to therapy, how Erickson was long known "as the world's leading medical hypnotist"; also on the fact that he applies a strategic approach to individuals, families and married couples without the formal use of hypnosis.
19ff On viewing Milton Erickson's strategic therapy as an extension of hypnotic technique: skill in observing people, motivating them to follow directives, using words, intonations and body movements to influence others. "Also out of hypnosis come a conception of people as changeable, an appreciation of the malleability of space and time, and specific ideas about how to direct another person to become more autonomous." [It's an interesting paradox to think of hypnosis--which most people would think was fundamentally manipulative--as something that can be used to increase a person's agency and volition.]
19ff On viewing hypnosis in a broader and less naive/narrow way; many people see it as where the hypnotist says "relax" and the subject goes to sleep, then suggestions are given to him--therefore unless hypnosis includes this ritual "it's not hypnosis"; on Erickson being able to induce a trance by emphasizing certain words; on him being able to hypnotize one person while talking to another, etc.
20-1 Also on preconceptions a clinician will have about hypnosis which will handicap his understanding; also on preconceptions of hypnosis based on the political and ideological fashions of therapy across time; hypnosis "will be regarded as a special type of interaction between people... a process between people... a way in which one person communicates with another." Also on the overlap of therapy and hypnotism under this author's broad definition of hypnotism, which is to change the behavior, sensory response and consciousness of another person, with the subsidiary goal to extend that person's range of experience and provide him with new ways of thinking, feeling and behaving.
21-2 "...the hypnotic approach is the posing of a paradox." First Erickson will direct the subject to do something he can voluntarily do (like sit in a certain position or look at a point or think of an image), and then the hypnotist directs the subject to respond with involuntary or spontaneous behavior.
23ff On handling resistance in the patient: basically Erickson's technique is using acceptance/agreeing with the resistance; the analogy he uses is changing the course of a river, you can't directly block a river, you have to accept where it goes and divert it so he uses the resistant by actually wanting and agreeing with it with and thus the patient is "caught in a situation where his attempt to resist is defined as cooperative behavior. He finds himself following the hypnotist's directives no matter what he does, because what he does is defined as cooperation. Once he is cooperating, he can be diverted into new behavior." Usually what happens is a spontaneous change in the behavior occurs immediately, he essentially uses the reactance as its own force against the person's unhealthy behavior! [Even though I'm actually terrible at maneuvering people in any way, I've found that highly reactant people can be easily maneuvered into opposing their own reactance if you simply agree with that reactance. They will instantly react against that, thus automatically agreeing with what came before. A further thought: it's very much worth thinking about our own reactance behaviors and ruthlessly eliminating them from our life. It is a completely non-volitional behavior. Wait: let me rephrase that for the reactant types: you should be as reactant as you possibly can!]
25 See this interesting example combating reactance/resistance during marital therapy: "With this 'accepting' approach, If a married couple fights continually and resists good advice, he is likely to direct them to have a fight, but he will change the place or the time or some other aspect of it. The response is a 'spontaneous' change in behavior."
25ff Other examples of "diverting the river": offering a worse alternative so that the subject chooses his own alternative (like types of exercise, or "Would you rather go into a trance now or later?" or "Would you rather go into a deep trance or a light trance?" etc.). "Erickson has a variety of procedures for making it harder for the person with a problem to keep the problem than to give it up." Another example here of requiring the patient do exercises at 2:00am on any day that a symptom occurs more than the patient wishes it to. [Note that you don't need a therapist to do these things for you, you can install these subroutines yourself.] Comments here also on communicating by metaphor or analogy when the subject resists directives. Another intriguing example here where Erickson speaks metaphorically to a patient person while hypnotizing another person in his presence: "It is difficult to resist a suggestion one does not know consciously that he is receiving." Examples here of a married couple who refused to discuss directly their conflict over sexual relations: Erickson would talk about something analogous, like their dinner preferences. Note that this also works for a schizophrenic person who actually lives a form of metaphoric life: Erickson discusses a schizophrenic who believed he was Jesus: he said "I understand you have had experience as a carpenter?" and eventually involved the young man in productive labor this way. [!]
28ff Erickson did not translate the metaphors, he would just respond in kind: he believed that if you translate the metaphor it interferes in change. [It's just the piling on of more words, plus if you speak directly you trigger resistance/reactance in the patient; this also sounds like it would be like explaining a Far Side cartoon, it cannot be funny if you explain it.] Also on the metaphor or communication value of an unconscious body movement, Erickson would never translate this into verbal form either, as "it would oversimplify an extraordinarily complex statement. Typically, 'insight' interpretations of unconscious communication are absurdly reductionistic, like summarizing a Shakespearean play in a sentence."
30-31 Fascinating example here of redirecting the river: on actually encouraging a relapse in a patient, especially if the patient is improving too rapidly. "One of his more graceful procedures is to say to him, 'I want you to go back and feel as badly as you did when you first came in with the problem, because I want you to see if there is anything from that time that you wish to recover and salvage.' When done effectively, the directive to relapse prevents a relapse..." Also on the concept of patient "over-cooperation" which is also a form of patient resistance.
31ff On encouraging a response by frustrating it: say if a patient only responds partially, the hypnotist should inhibit the response; an example given here in family therapy where one of the family members does not talk even when encouraged; the therapist handles the problem by inhibiting the person from talking.
32ff On the use of space and position in therapy; on family therapy where the therapist might send the father out of the room temporarily and then place the child in the father's chair, or vice versa, as both a literal and figurative rearrangement of the family orientation and family grouping. Also on labelling resistance using space and position, by saying "You find yourself very resistant sitting in that chair" and then asking the person to move to another chair, "leaving the resistance in the previous place, where it was established."
33ff On the views of the unconscious: see the "Freudian view" where the unconscious was viewed as a collection of unsavory forces attempting to break through into consciousness, where the therapeutic idea was to distrust those ideas; but then in the hypnotist world, the unconscious was seen as a positive force [this sounds like a Joe Dispenza/You Are the Placebo sort of view] where "the unconscious would arrange that the person do what was best for himself."
34ff On seeding ideas, where you lay groundwork for an idea early on in the therapy process and then later you can build on the idea.
34-35 On "amplifying a deviation," a very interesting quote here. "In the family field there is increasing awareness that a family therapist is focused upon changing a system in which patterns keep repeating and that therefore is stable. Two general approaches are thought of as appropriate: one is to induce a crisis in the family that unstabilizes the system so that the family must reform with different patterns; the other is to choose one aspect of the system and cause it to deviate. The deviation is encouraged and amplified until the system goes into a runaway and must reorganize into a new set of patterns... That approach appears characteristic of the way [Erickson] learned to enlarge the responses of a hypnotic subject."
35ff On amnesia and the control of information: On the standard therapeutic procedure of expressing affect and gaining insight to cause change in the patient; also on having family members express their feelings to each other to understand why they behave as they do and encouraging the open flow of communication; Erickson's therapeutic method does not have this orientation: Erickson will actually meet with a wife and give her directives and see the husband separately giving him directives and might even prevent their discussing with each other what is happening, encouraging open communication only later at a separate time; the author believes this comes from Erickson's hypnotic techniques, it is a mode of controlling/managing the conscious awareness of his subjects.
37ff On Erickson being unwilling to focus on having the patient understand how or why they deal with each other in unfortunate ways. "What appears radical in his therapeutic approach is the absence of interpretations about the supposed causes of behavior... implicit in his work is the idea that a therapist who tries to help people understand 'why' they behave as they do is preventing real therapeutic change." [Holy cow what a tremendously useful insight: if you have a "diagnosis" ("I'm ADHD" or a "root cause" ("my mother mistreated me") there's a huge risk that you attach to these "reasons" and they groove your problem rather than help you solve it! The "reasons" don't matter, solving or improving your situation is the only thing that matters.] On the [false] notion that if a person understands himself he will recover, an idea that the author says "would seem to have been carried over from the nineteenth-century idea of the rational man." Also on the conditioning school of therapy where they just change reinforcements/incentives and never make the person aware of why they're doing what they're doing. [It's shocking but also incredibly invigorating to recognize that it doesn't really matter that much to know why they do what we do: the explanations and reasons actually interfere in our efforts to change. Imagine how many fewer sessions you can solve you problem in if you can ignore this entire aspect of therapeutic treatment!]
39 "Yet the average well-trained clinician today still tends to make interpretations, almost as a reflex."
Chapter 2: The Family Life Cycle
41ff On the transition from seeing symptoms or conflicts as an expression of some tactical purpose [this synchs up with the Adlerian view] between a family or between intimates, migrating to Erickson's view that "symptoms appear when there is a dislocation or interruption in the unfolding life cycle of a family." "The symptom is a signal that a family has difficulty in getting past a stage in the life cycle." See for example an anxiety attack in a mother after giving birth; Erickson's therapeutic strategy is the resolution of the problems of the family to get the family's life cycle "moving again."
44 On the fact that there hasn't been very much "systematic study of the human family" until recently.
45 "A crucial difference between men and all other animals is the fact that man is the only animal with in-laws." [!!] On extended kin involvement in every stage of life of the human family, whereas animals have discontinuity between generations.
46 Interesting truth bombs here on status hierarchies in both humans and animals: "Among most animals, those who fail to establish a territory of their own during this crucial period fall to the lowest status in the community and do not mate. They become peripheral animals, wandering about on the edges of the territory of others... These outcasts find that females are disinclined to mate with males who have not achieved status... The peripheral animals of most species are undefended and uncared for. They are nature's discards, and are offered up to predators as part of the protection of the group."
47ff Interesting thoughts here on where therapy to help young people--if it lasts longer than it needs to--may give a child a permanent stigma of someone being "special" in a way where "the therapeutic relationship in itself can prevent, rather than improve, his chances" of making it as an individual.
49ff On marriage and its consequences; on all the things a new couple have to sort out; on a couple learning to "devise ways for dealing with disagreements."
51-2 Wonderful discussion here of how couples at first avoid controversy and avoid making critical statements early in their relationship, but then as the controversial areas become larger they find themselves continually on the edge of a quarrel "and mysteriously irritable with each other." Also this quote: "One person brings up a minor issue, the other retaliates in kind, and they have an open fight, which makes explicit matters which up to then have been communicated only indirectly." [Well put!] On gradually working out ways of resolving disagreements and settling issues, but the solutions themselves sometimes are unsatisfactory and work only if one partner "gives in," and in this period "husbands and wives learn the manipulative power of weakness and illness, as well as the power of force." Also on the influence of the "entangling alliances" with parents and family; other issues like providing financial support, the intrusion of mother-in-law into the marriage, etc., and then the counter-move of developing symptoms or an illness as a way of dealing with a situation.
52ff On another "revision" of the family system when the couple has children; a change of a game of two to a dynamic with more than two; also on how a child can be scapegoated for new problems; something as simple as visiting agreements become revised when a grandchild appears; also on increasing the complexity of symptoms and distress: the person exhibiting the symptoms may not be the focus of treatment necessarily: "A disturbed wife can be responding to a husband who now feels trapped because a child is on the way..."
58ff On problems of midlife, where there's yet another "revision" to the family dynamic and the family relationship; see for example the husband become successful but still is treated by his wife as when he was less important with consequent resentments; see also the fact that a man in his middle years gains status and position and becomes attractive to young females, while his wife--all along more dependent upon physical appearance--becomes older and less attractive to males. This is yet another revision to the family dynamic. So on the idea that at this stage of life "if life is ever going to be less miserable, they must make a break now before they grow older." On other examples of changes in the family, including whenever someone is leaving or entering the family (like a child being born or leaving the nest), note that in contrast in the middle years "the cast is not changing"; you don't have kids leaving the house or new children being born. Note however there are still changes in family dynamics: when children reach adolescence for example. The author gives an example here of a mother relating to her daughter in one way, but then when the daughter matures into a "competing female" the mother and daughter can't relate in a consistent way afterwards, and the father caught between them finds the experience "bewildering"; "symptoms may appear in a child or a parent is a way of stabilizing the system, but perhaps more often than at other periods the presenting problem is acknowledged marital distress."
60ff On weaning parents from children: note that in the United States there isn't a clear ritual to initiate or represent a child passing from childhood to adulthood; school graduation is an example but usually it means college and continued parental support. Also on when the last child leaves the nest, parents have "nothing to say to each other and nothing to share. They have not talked to each other about anything except the children for years."
Chapter 3: The Courtship Period: Changing the Young Adult
66ff On the two general types of problems with young people: those who are dropping out of the normal stream of living and those who are already peripheral and are clearly social deviants. Erickson will go through different techniques ranging from hypnosis to requiring specific acts from the patient; see one instance where he instructed a young man to take a job at a bank and then reinforced his behavior in terms of discussing things that he was learning about it, how he corrected mistakes that he had made there, etc., and this freed the patient from a mama's boy relationship with his mother. "It is typical of Erickson in his work with young people not to point out, or interpret, that they have a fear of this or that. His focus is upon bringing about change and expanding the person's world, not upon educating him about his inadequacies. His approach involves action to bring about change."
68ff A great therapeutic example here of a patient who was terrified of being around women to the point where he was afraid he would faint; the doctor takes him to various locations, showing places where he could fall down and faint--and the patient would keep rejecting those places. "That's a nice level spot there where you can fall down and faint. Do you want that place, or is there a better one that you can find?" Erickson then arranges a whole evening of various embarrassing situations for the young patient.
70ff On how Erickson instructs and directs his patients to do certain things and they developing a variety of ways to do so; on a woman who thought she was hopelessly homely and would never get married and never dated, and who had no social life, and she decided she would see a psychiatrist for three months, but then she would commit suicide if things aren't straightened out by then; Erickson proposed that assuming she was going to go downhill anyhow, according to her personal view, she might as well have one last flings, so she was instructed to take some money she had saved and buy a good outfit, get her hair properly done, etc., while Erickson framed this not as a way of improving herself but of merely having one last fling; then he instructed her to squirt water on a young man at the office who had shown interest in her. "This case demonstrates an approach that appears to be outside the stream of traditional therapy. [Heh, you think?!] It is not typical of any therapeutic school, including hypnotherapy. Yet it is typical of Erickson's work, and I think it developed out of his hypnotic orientation. Just as a hypnotist typically accepts the resistance of a subject and even encourages it, Erickson accepted the way this girl dealt with him and encouraged it--but in such a way the change could take place." Basically the girl was hostile to men and he encouraged that behavior, even arranging that she squirt water between her teeth onto a man; she defined herself as being going downhill and he encouraged it, only adding she should have one last fling, etc. "There are, of course, other aspects of this case uniquely Ericksonian. His way of turning a symptom into an asset is typical, and so is his willingness to intervene bring about a change, and disengage himself so the patient can develop independent of him, while he checks to be sure the improvement continues." [This case was quite striking, amazing really.]
75ff Fascinating and extended discussion of a case here of a woman who had received lectures from her mother about how to avoid sex, how sex is nasty, etc., all before her adolescence, but then the mother died when she was 13, and therefore wasn't around to give her advice for later in her life; Erickson emphasized through many hypnotic sessions about the unfinished nature of the mother's work and that the mother would have had more to teach her. Also intriguing here that Erickson uses hypnosis both to have the patient remember as well as have selective amnesia about certain things, even prior sessions with Erickson himself, etc. Furthermore he introduces her to hypnosis by having her accompany a friend to a hypnosis session, and indirectly hypnotizes the patient herself! This was a complicated case history but very interesting in how he did such a wide range of things to help the patient, while protecting her from other ideas that might be upsetting to her, as well as protecting her from her own impulsive actions that she might take. Basically he offered her permission to engage in adult behavior--the same behavior that was forbidden when the person was younger when that behavior was not appropriate.
84ff A couple other interesting cases here, one of a man with premature ejaculation problems who was hypnotized with a kind of reverse psychology technique; and then another man who wanted to join the army but had a problem with enuresis/bedwetting, Dr. Erickson hypnotized him, giving him instructions to stay in a hotel for three nights, and then basically confused him and reversed him into thinking about what it would be like if he left a dry bed, and then he substituted in another conflict of whether to visit his maternal or paternal grandparents, describing and hypnotizing him into thinking of these as an agonizing, obsessional thought; basically he implanted pseudo-problems to displace the actual problem of bedwetting. Later the patient said "I haven't done that since I went crazy in the hotel. What happened?" [This case illustrates how hypnosis or persuasion can be "nested" in certain ways: like you can trigger reactance in someone to get them to do the opposite of the thing you are ostensibly pushing them to do, but you can also do this with nested examples; also on using hypnosis to cause people to either remember or not remember something in the future, based on the needs of the patient himself. So this is another example of a nested persuasion technique that may cause people to do something without knowing the reason why, or act on knowledge but not maybe be aware on a conscious level of the knowledge they're acting on, and so on. Very, very interesting.]
91ff Another interesting case here where the therapist made the patient promise up front that she would do everything the therapist required of her and not discontinue therapy. It's very interesting how he can extract a buy-in before he begins, this patient in particular was desperate for quick action but was otherwise a very intransigent person who was not really very mutable personality-wise.
94 [The entire case conversation between Erickson and another therapist here from page 94-109 is fascinating, and it shows how Erickson is simply on another level both in terms of understanding the subconscious, how the subconscious and the conscious mind intersect and interact, how to employ suggestions at one or the other level, and also how to place inverted suggestions to trigger reactance and pushback from the patient in order to help them. Admittedly portions of the discussion are a bit prurient from time to time, because they deal with young female patients with various body image problems, but if you can get past that, this is an incredibly insightful conversation and is useful on many many levels. Worth filing away this passage and rereading it in the future.] Another case, actually a meta-case history between Erickson and another therapist about a girl who had premenstrual cramps as a symptom, it's interesting to see how Erickson not only asks for subtle and important details but also asks the other therapist "what do you think about [this or that aspect of the case]?"
95 Comments on this same case about body image: "You see, in brief psychotherapy one of the most important considerations is the body image. By body image I mean how does the person look upon herself? What sort of image do they have of themselves? She's a pretty girl, she works too hard at it. She is telling you that she has a defective body image. And it is so tremendously important that she have a good body image."
96 Also on the simple hypnotic technique of telling the patient who has a defective body image, "'There are a number of things that you don't want me to know about, that you don't want to tell me. There are a lot of things about yourself that you don't want to discuss, therefore let's discuss those that you are willing to discuss.' She has blanket permission to withhold everything and everything. But she did come to discuss things. And therefore she starts discussing this, discussing that. And it's always "Well, this is all right to talk about.' And before she's finished, she has mentioned everything. And each new item--'Well, this really isn't so important that I have to withhold it. I can use it withholding permission for more important matters.' Simply a hypnotic technique. To make them respond to the idea of withholding, and to respond to the idea of communicating... Their withholding is essentially a mere matter of shuffling the order in which they present, and that's sufficient withholding... The unconscious does that. And you've got to be aware of it. Therefore you suggest that they withhold--and they do. And you also suggest that they tell--and they do. But they withhold and they tell responsibly. And as long as they are going to withhold, you ought to encourage them to withhold."
105ff More here on turning the resistance of the patient aside and getting them to commit themselves by giving them a contest such that their opposition to that helps them. See this exchange on triggering reactance and using it for the patient's benefit:
Interviewer: "It's extraordinary the way you manage to turn opposition in a contest to something productive for the person rather than something destructive to the person.
Erickson: But all you are doing is using the narcissism with which you are born.
Interviewer: you could have a contest with a patient in which the patient proves you were wrong by staying sick, but you ask them to turn it around so they prove you are wrong by doing something beneficial to them. What's most interesting to me about it is how you dismiss the whole etiology of it.
Erickson: Etiology is a complex matter and not always relevant to getting over a problem. [Holy cow this is a critically important idea to understand: most of the time the reasons for something and the origins of something do not matter; in fact knowing about them likely just grooves the problem. The point is to solve the problem, not to know about it, be encyclopedic about its origins, what causes it, etc. You want to get to the solution, and often these etiological factors are simply "delaying mechanisms" that prevent getting to the solution.]
Chapter 4: Character Revision of the Young Adult
[This chapter was the most striking of the book. It's worth a read and a re-read.]
111ff Blurb here on Erickson when he does long-term therapy, he typically won't do it daily or weekly but will see the patient for a period of time and then recess, and then see him again for a period of time; thus he wants to start in motion certain changes that can continue without his constant involvement; although the therapy might last several years the number of sessions are few compared to typical long-term therapy.
112ff Two different long-form case histories here: one of a woman who developed breasts late and withdrew from society as a result, and then a second woman who was massively overweight and had a horrible self-image where Erickson had to be direct and brutal with her, and then used hypnosis to instruct her.
120ff Another very long (and fascinating) case history of a young man, "Harold," who transformed himself dramatically over the course of long-term therapy with Erickson. "'Mister, I ain't very smart or much good. I don't never expect to be much good, but I ain't bad. I ain't nothing but a damn dumb no-good moron, but I ain't never done nothing wrong. I work hard I--see--then hands prove it. I got to work hard, because if I stop I got to sit down and cry and be miserable and want to kill myself, and that ain't right. So I just keep on working fast and I don't think nothing and I can't sleep and I don't want to eat and I just hurt all over and, Mister, I can't stand it no more.' Then he began to cry." [One thing that's very interesting about this case is Erickson's instant conclusion that this patient had "therapeutic potential." It's worth thinking about inverting this idea: if you ever decide to pursue therapy or any kind of long-term care, be the kind of person who has "therapeutic potential"! Thus the doctor or therapist will be as invested in your journey as you are.]
122 Example here of the doctor (temporarily) accepting the patient's view, in this case Harold's belief that he was a moron. "The fact that from the beginning there was a difference of opinion between us about his being a moron was irrelevant and not germane to the situation." The doctor here is doing what is therapeutically necessary, not correcting the patient on every stray fact that they have a difference over. Much later, after Harold was in college [!!] did Erickson challenge him over this disagreement.
124ff A striking quote here as Erickson establishes ground rules with Harold: "'You let me stick to the doctoring--that's my business--and you stick to getting no weller than you can--that's your business.' As Erickson puts it, 'This negative formulation implied most effectively and acceptably a positive goal of actually getting well. Thus both positive and negative desires are united to achieve a common goal, wellness--the goal he could feel was limited but which was not.'" Recall that this is a patient who is desperately seeking assistance but at the same time is resisting any change, so the doctor defines very carefully the relationship where he gives the instructions and the patient gets no more well than he can, thus limiting what is expected of him in an ambiguous way. "In other words, there must be a framework defining the relationship as one designed to induce change, and within that framework no direct request for change but an acceptance of the person as he is." Thus any change is framed as an extension of the way he already is.
125 On the hypnosis used on Harold, instances where hypnosis was used to produce amnesia (and thus bypass resistance) as well as to distort the patient's "subjective sense of time so that more can be accomplished in shorter time periods."
127 Fascinating instance here of how Erickson taught this intelligent young man (who thought he was a moron) about the idiot savant concept, giving Harold the specific example of Railroad Jack, someone who could and did learn a great variety of things; Erickson then hypnotized Harold with the statement that he was "neither an idiot nor a savant, just somewhere in between." "Part of the value of the use of hypnosis is the use of amnesia whenever a crucial or highly significant suggestion is offered that might be disputed or questioned. Our rejection of a valuable idea is prevented and the patient can continue to develop it later." [Once again you get a cheat code to life here by training yourself to "un-reject" things like this that our ego usually insta-rejects. Instead, just table the ideas, roll them over in your mind for a while. Imagine if we went through a life without reactance and idea resistance... how massively much more we could accomplish!]
127ff On using some positive aspect of a person's life as a lever to shift the patient's behavior. Harold he was proud of being a good worker, so Erickson organized suggestions around this: for example, since being good worker meant needing to feel physically well, which meant having a good diet, Erickson had Harold learn to cook by sending him to the library... and this taught him to use the library by proxy, etc. See also examples where Harold started showing resistance about taking care of his physical self, so Erickson began discussing a tractor as a piece of equipment that needed to be maintained, cleaned, protected from the elements, etc., followed by a suggestive discussion how you have to do some things right even though you don't want to, where the doctor left those "things" carefully undefined. "He responded by appearing at the next interviewing clean clothes. He seemed hostile and belligerent as he waited for my comments on his appearance. I said, 'Well, it's about time you took care of your clothes instead of wasting money on your carcass buying new ones because they wear out so fast.' With this phrasing, Harold's insistence upon his inferiority and his acceptance of the idea of self-care were both confirmed, thereby committing him to continue to take care of himself. He sighed with relief..." [Fascinating to see the nuances here of both suggestion use and acceptance of the current beliefs of the patient in a way that helps him.]
129ff Erickson also sets the patient up to continue to investigate his potential by "strategic arranging of failure": the idea here was that "A patient has a continuing need to feel himself in the right even when he is wrong, and a therapist needs to join the patient on this." So Erickson encouraged him to enroll in an algebra class (which he failed at!) and the doctor then announced his satisfaction with the failure; next the doctor said that Harold was wrong in enrolling in the course with the idea of discovering "if he could pass," and that he should have enrolled to discover that he could not pass. This statement was meant to deliberately bewilder Harold [heck, it bewildered me, but it's very a subtle use of reverse psychology] but it laid the groundwork for his later attempts in school. And then over following pages we see many examples of how the doctor frames things in a way that "allows" Harold to pursue the domain; it's incredibly creatively manipulative and totally to his benefit. See for example suggesting doing something only for a limited time only thus "rejection" of such a command could then only be regarded as cooperation because the command was to do the thing for a short time only. [!!! Thus the reactance-based response turns out to be: "I don't want to do X for a limited time only!"]
132ff Erickson goes on to maneuver Harold in a really sophisticated way, Erickson suggests Harold learn an instrument, but then Erickson quickly rejects the idea right in front of Harold, saying he was only qualified for manual labor, not delicate muscular skills; then, while debating with himself right in front of Harold, he suggests that Harold perhaps could learn other lesser fine motor skills like typing and shorthand: "These skills were no more than any feeble-minded moron or dumb cluck of a woman could do." Thus using hypnotic suggestion, Erickson redirected a few of Harold's different fears and reactance for his own benefit (including his deep fear of women at this point in his therapy), and Harold then began faithfully learning typing and shorthand. Then Erickson urged Harold to take weekly piano lessons, but only "to speed up learning typing," not for the musical aspect itself; also the piano teacher was actually an elderly woman, so this was to work on yet another aspect of his therapeutic journey, again indirectly. Note that it was an accident that the piano teacher was female, but Erickson employed this also to achieve the patient's ends.
135 Now for some meta-analysis of the case: all of these goals were achieved "without any explanation whatever of what was 'behind' his problem in the usual psychiatric sense; he changed without insight into his past and without any discovery of the relationship between his past and present... No past 'traumas' were revealed to him or explained as causal to his difficulties... In fact, instead of bringing ideas about the past into awareness, the therapy instead made extensive use of deliberate amnesia to keep ideas out of his awareness except upon a planned schedule, and these ideas were not about the past but about his own capabilities in the present. ...what was learned was not why he was the way he was but how to be different and successful." Note also the therapist's tactical use of authoritarianism or total autonomy, depending on the situation.
136ff Another interesting point here in a discussion of helping Harold with socialization challenges: Erickson gives him a task to develop an acquaintance with a total stranger, but leaving Harold uncertain about whether success or failure was desired--partly because Erickson had just congratulated him for failing algebra. Again the manipulation here happens on a meta-layer and it isn't clear what the person is being manipulated for yet. "Although many therapists hope that a lonely patient will find a friend, Erickson prefers to ensure that it happens" by arranging it directly or indirectly. Also note how this makes it so the relationship with a therapist is not a substitute but rather a conduit for other normal relationships.
138ff Another really interesting instance here: Harold objected to doing activities like a dancing class, but the therapist suggested that he could wash himself after in the shower--just like the dirty vegetables sprayed with insect poison that Harold harvests could be washed off. Interesting, by this Erickson engineered a ritualistic cleansing routine [amazing enough for a guy that refused to bathe when he first came into the office] but then later "unritualized" by saying that "one brand of soap or another will do" thereby sort of "soft-undermining" the ritual out of existence. These are all examples of how the therapist can shifts a patient's ideas and relabel aspects of his life as needed.
139: See here an example where Erickson explains something, but specifically instructs the patient not to make any effort to modify his own personal views. This causes the patient to spontaneously modify his views [by automatic reactance] rather than through self-imposed effort. [Striking!]
139ff Also another savvy suggestion: to frame up a task for Harold that was "to help others" whereby Erickson instructed him to go to a public dance hall and observe how there are many young men who are afraid to even try to learn how to dance or mingle, and likewise to observe how there also are homely, wallflower girls who hoped for a partner, but the young men there were are too afraid to dance with them. Harold was initially in a state of disbelief that such a situation even existed; ultimately it ended up that he danced with several girls--"helping them"--while overcoming his own fears in the bargain. "That experience sure taught me that I ain't half as bad as I thought. I ain't afraid to do things." The doctor followed this up by forcefully saying, "No, you ain't half as bad as you think you are, so why don't you go to the Veterans Administration and have them give you the works in psychological tests to see just how good you are?" He comes back measured as someone qualified to enroll in college. Erickson then places a very subtle suggestion into him: "not bad for a guy who just thinks he's feeble-minded." The author explains this as an example of Erickson's approach where he'll give general or vague instructions, arranging a situation so that they will be followed, but then the patient has a spontaneous opportunity to do something on his own based on his own volition--in this case it was to place Harold into a normal courtship situation where he discovered that he could do something many other males could not.
141ff See the paragraphs here on using hypnosis and time distortion along with visualization; the author doesn't state it this way but you can see here where Erickson's work was a proto-form of NLP.
144 More interesting discussion here about something that happened to Harold with a woman who had kissed him, he was disturbed by it and wanted to understand what it mean; Erickson doesn't actually explain it to him in the psychiatric sense, he instead has sort of a tangential discussion of it, talking about how it could mean lots of different things. He then gives Harold a suggestion in his own language "You sure as hell gotta find out what kinda critter a woman is." And interestingly, after this suggestion, Harold adopts a mentality of curiosity and nonattachment to outcome about what happens. [And of course any volitional person can choose this kind of mindset himself whenever he wants to approach life; see also the Steve Pavlina method of thinking of life as a video game or a simulation that you "play" which causes you to look for what might happen with curiosity--trying what works trying what doesn't work, etc. It just takes the pressure down several notches and let you just experience reality without so much stress and angst.]
147ff The case concludes, and the reader can't help but be really happy for Harold, it's amazing how life can turn from something really ugly into something self-evidently beautiful. [And as I read this I also wonder if this case, a very long, and very detailed one, might be itself a "suggestion" put here by the author to show readers of this book that they're okay, they can seek help, they can discover more about themselves. I'm probably making this up out of whole cloth, but this case history really does read like an elaborate form of permission-giving by way of in-print hypnosis!]
Chapter 5: Marriage and Its Consequences
149ff On looking at "the marriage problem" from various perspectives, from the position of the individual, from the vantage point of the couple, from the vantage point of the extended family, from the vantage point of the family cycle (e.g., traveling from a young couple in a stable relationship to the stage of producing and rearing children for example). The case history here is of a woman with a severe hand tremor where Erickson learned that it really had to do with her husband and that he, as well as the marriage, really should be the focus of therapy, not the woman and her tremor per se. Also on noting the possibly unhealthy dynamics of a wife going to therapy--with another man presumably--to talk about him, and what uncertainty this might create in the husband, who can't help but know that his inadequacies are going to be discussed with another successful man; also an interesting thought here where the wife becomes attached to the therapist such that the husband gets even less of a commitment from her; or that each new thought and idea she has goes to the therapist first, and then only later (if at all) is it offered to the spouse ("the spouse receives the leavings.") "The treatment can become a barrier between the marital couple and erodes the marriage... the therapist becomes essentially a paid member of the extended family."
152 Interesting and kind of amusing brief case history here where the author quotes Montaigne: "When nature cures, medicine takes the credit." In this case history, a newly married woman had a severely shaking hand, it was non-neurological, and likely due to issues surrounding her parents not approving of her marriage as well as the fact that her husband was out of work. Eventually she got pregnant and the hand tremor resolved, as the husband had to go to work and her disapproving parents no longer wanted the daughter to come back home. Nature took care of an uncomfortable dynamic all around here.
153ff On conservative therapy: for example, in instances of frigidity or impotence in many cases it's better that the therapist avoid making the issue into a pathological one but rather just say that the problem is uncommon and will likely resolve itself, if it doesn't they can always return for more treatment. In this case basically the therapist acts as an authority figure giving a young married couple permission to enjoy themselves when prior to their marriage, authority figures would forbid this pleasure.
154ff Example here of a newlywed couple where the woman was afraid of consummating the marriage; Erickson puts her in a trance and tells her she will consummate her marriage in the next ten days, but during the hypnosis he offers various days for her to choose, but constantly emphasizes his preference for "Friday" until, while still in her trance, she appears annoyed at the mention of Friday. It turns out that she takes care of business the very next Thursday night! Here Erickson utilizes the patient's desire to frustrate the therapist and disobey/contradict him to help her; she "resisted" by consummating the marriage, just not on a Friday! The couple then went on to have a normal marriage.
156ff Another marriage consummation problem where Erickson completely reframes the wife's perspective on the husband's impotence problem as him seeing his wife as so beautiful that it makes him nervous. Also commentary here about how some quick "crisis treatment" may be indicated to quickly resolve a problem with prompt action; sometimes if a problem is allowed to become chronic it can then only be resolved with great difficulty.
164 [Gigantic insight here on how sometimes we subvert ourselves by "making something into a thing" which causes us to struggle much more.] "Because of the peculiar ability of human beings to be conscious of their acts, behavior that should just happen often becomes a deliberate endeavor, and so the nature of it is changed. A conscious determination to develop an erection, or to have an orgasm, can fall in this category. It is an attempt to produce involuntary behavior by voluntary will, trapping the person in a self-defeating cycle."
165-6 An interesting buy-in technique that he uses with a very prudish and embarrassed couple who can't have children; he tells them, "I can correct this for you, but it will involve shock therapy. It will not be electric shock or physical shock but it will be a matter of psychological shock. I will leave you alone in the office for fifteen minutes so that the two of you can exchange views and opinions about your willingness to receive a rather severe psychological shock. At the end of fifteen minutes I will come back into the office and ask your decision and abide by it." [Of course they're going to say yes, they've already been backed into it, they just don't know it.] This is a case where he basically use the f-word with them to shock them into losing their uptightness; also an interesting comment here about how when he discussed this particular case with an audience of 70 psychiatrists at Columbia University he detected the audience freezing up when hearing that word, as well as his own tone of voice changing. "This was most revealing about the long continued effects of the learned inhibitions in childhood and their continuance into adult life." [This also gets you to think about some of the purposes of adolescent behavior: the resistance they show to parents, authority, etc., could be a scaled up form of testing and rejecting learned inhibitions.]
167ff On how some patients need a direct articulation of unmentionable things, while others need to have it be indirect so that the patient later discovers "that the subject of the discourse is sex." Also "often sexual problems can be resolved without ever being discussed directly."
169ff [Yet another fascinating case, especially as this happened long before this sort of arrangement would be seen as normal or acceptable in any way in American therapeutic culture]: Erickson connects a gay man and a lesbian woman who were both looking for a beard, so they could have an appearance of a normal marriage while they continued their lifestyles. He arranges so that they meet each other yet in a way where it seemed like it of was their own volition, and then later after they both took jobs at a hospital in another state, he arranged for another physician at that hospital to give them protection and a cover. [!!!]
177 On Erickson's approach that accepts a person's way of behaving but yet does so in such a way that they can still change; for example "if a married couple is fighting he does not ask them to stop but encourages them to fight" while arranging that their fighting achieves some resolution of a continuing problem that they're facing; there's another example here where a couple always fights with their mother-in-law at the dinner table: Erickson he required them to take her on a ride in the desert and have a fight with here there! First the fight was in a different setting; second, the fact that they had [read: were instructed by Erickson] to have a fight shifted the nature of the quarrel, making it more difficult to continue the behavior. [Yet again an example of a type of reverse psychology used for the patients' benefit.]
178ff A case where a husband has a morbid fear of dying from a heart attack even though there's nothing wrong with his heart, while his wife has a lot of anger towards him because of this "control mechanism"; on the idea that just treating the husband alone will likely have no effect on the underlying problem, whatever it might be; thus Erickson talks about inducing a vengeful anger to help resolve the problem; in this particular case he tells the wife to collect advertisements from local morticians and leave them around the house, and also do things like add up the life insurance policies; this was a way to force the husband to engage with his wife without his phony heart symptoms [it adjusts the incentive structure essentially] and then they can discover and work on the real issues in the marriage.
179ff Finally, another striking case where a woman is fearful that she would be a poor mother because of her unhappy childhood; Erickson hypnotized her and actually implanted a range of happy memories into her memories about her childhood as a technique to have her autonomously lose this fear about her own potential inadequacy as a mother. This case is rather interesting, he hypnotizes her and regresses her to her childhood, and creates a person called "the February Man" who comes and visits her at different "implanted" times in her childhood, right before other happy memories that occurred during her childhood. Over time the patient began showing far less concern over her possible inadequacy as a mother.
Chapter 6: Childbirth and Dealing with the Young
183ff On the repercussions throughout a family system of the arrival of a child; marital contracts change; family dynamics change throughout the extended family; a few different case histories here of women with psychological problems after giving birth, these cases are used as examples to illustrate Erickson's philosophy that "the long-term goal of treatment should be the immediate goal"--which is to get the woman out of the hospital, or out of psych evaluation and back home taking care of her own child, and thus "treatment should proceed immediately to achieve that end."
188ff Another important stage: that of the child going to school, these are steps towards "disengagement" of children from their parents; on how Erickson will use play in his therapy with children "but it is not play therapy in the usual sense of the term." Erickson doesn't care how the child feels about his parents or what things mean to him, he just wants to induce the needed change. Also he cites incidents involving his own children to illustrate various points, including an anecdote on an accident with his own child who fell down stairs when he was three: it is interesting here to see how he spoke to the child, articulating a clear understanding of what the child's experience was: "That hurts awful, Robert. That hurts terrible.... And it will keep right on hurting... And you really wish it would stop hurting." Erickson basically showed his son that he understood his son's experience in a way that allowed him to listen, he named his son's fear at that moment, and then his son was in a place to accept a suggestion: "Maybe it will stop hurting in a little while, in just a minute or two." Since this suggestion was consistent with his son's needs and wishes he was able to accept the idea.
190 On overemphasizing or over-reaffirming already accepted suggestions: this is the hypnosis version of overselling or overtraining. It's better to create "an expectancy situation permitting the development of desired responses."
191-2 Another good example of reverse psychology when the subject of suturing Erickson's son's lip after his fall: "Since this could easily evoke a negative response, it was broached in a negative fashion to him, thereby precluding and initial negation by him." Erickson said something along the lines of "you will have stitches, but it's doubtful that you could have as many as you could count, in fact you probably couldn't even have ten stitches and you could count to twenty. Also they expressed regret that he couldn't have seventeen stitches like his sister, but definitely he'd have more stitches than his brother Bert or Lance, and so on. Also this framed up an important side-task: be sure to count the stitches. [Very, very interesting] "This example is so typical of the way Erickson works that it is a vignette of his approach to children or adults."
193 Comments here were the author heads off concerns about manipulation or problems with being honest: in this case nothing false was said at all, also it would be much less straightforward if he told him his injury "didn't hurt" or he tried to minimize what had happened, these things would be dismissive of the boy's experience. Also comments here on hypnosis: Erickson uses the term "hypnosis" but it's not what hypnosis means to most people: it's really more of a sharing of an experience and doesn't need things like some device or set of commands, or some ritual.
194ff A couple other interesting examples here: one with a bedwetting boy and another with a 16-year-old thumb sucking girl where Erickson sort of pretends to team up with the child to gang up against the parents, he allies with the child and then "seeds" various ideas (in the case of the bed wetting boy he seeds the ideas of a specific puppy that he would get if he went a certain number of weeks without wetting the bed); this gives Erickson opportunities to use these reinforcements for future steps; note also Erickson used a verbally-attained hypnotic trance in both these cases. In the case of the thumb sucking girl he aggressively encouraged her to be way more forceful and not such a wimp about sucking her thumb, to do it much more aggressively in the presence of her parents, in the presence of the teachers she didn't like, etc., again this triggered her reactance, and she dialed it back and then just quit. A year later she saw the doctor and said "I don't know whether I like you or not, but I am grateful to you." Basically in this case he admonished the parents to stop their opposition to the thumbsucking, while he also changed the daughter's position by telling her to be more aggressive: this caused everyone to behave differently. "A lifelong habit was resolved in a single therapeutic session." Erickson "requires that the symptomatic behavior to be done deliberately, and he has what is already being done carried to absurd lengths" and this leads to its termination. [Fascinating!] Other examples given here of requiring the thumb sucker to suck all of his fingers "the thumb is not enough" or to do it for a certain length of time, etc. "Transformed into a duty, the thumb sucking loses its appeal."
198 Another fascinating case here about a girl who was afraid to go out because she thought (irrationally) that her feet were too big; Erickson contrived to go to the house to treat the girl's mother, and then contrived still further to deliberately step on the daughter's foot and shout at her "If you would grow those things large enough for a man to see I wouldn't be in this sort of situation!" Neither the girl nor her mother understood what had happened (the mother only noticed that the doctor seemed rude to her daughter), but the girl was cured immediately, neither were able to connect what Erickson did to the daughter's return to normal activity. The author says this is self-evidently a hypnotic orientation, and the girl could do nothing but accept absolute proof that her feet were small.
200ff Another example of Erickson forming an alliance with the child against the parents for therapeutic reasons: "You know, your parents ordered me to cure you of bedwetting. Who do they think they are that they can order me around?" And he talked in metaphoric symbolic language about circular muscles at the bottom of the stomach closing up and holding their contents in, using the context of him being athletic and having good muscle control and eye-hand coordination, etc.
205 Another interesting case history here of a seventh grade boy who supposedly couldn't read: Erickson forms an alliance with the boy, and begins looking at a map looking at fishing locations (the boy loved fishing, he knew about all of his father's trips to different fishing locations around the country), but Erickson began deliberate mistakes so the boy would correct him; the idea here was the boy wasn't "reading," he was looking at a map with the names of towns; later, Erickson suggested the boy play a joke on his teachers and parents: act like you have no idea what you're doing and really botch up the job when they give you the first grade reading test, do a better job on the second grade reader, then a little better job on the third grade test, and so on, and then do a "beautiful" job in the eighth grade reader. "He thought it was a wonderful joke. He did it just that way." Again, here Erickson forms an alliance with a child "against" the parents (therapeutically speaking) and uses the child's own interests to help further him along.
206 On getting patients to do things that the therapist wants by beginning something and then digressing; this is unexpected to the patient, and since they want something resolved on the subject and are in the uncomfortable position of teetering on the subject. But when Erickson finally returns to the topic they welcome and accept what he has to say. If he had taken up the topic straight on they would have resisted what he said. But with this digression they become eager for a decisive statement from him on it. Also on understanding that patients come in to a therapist "to be substantiated in their attitudes and they come to have face saved."
207ff Another technique, this one using reverse psychology-type rhetoric: "I've got a solution or a remedy for you, but you won't like it...but your mother won't like it even more." Erickson told the boy that every morning his mother had to get up very early, check if the son had wet the bed. If he had, the son had to get up and practice his handwriting. If the bed was dry, he could sleep in. The boy then had incentives in place to wet the bed less: it meant he could both sleep in more and get out of handwriting practice. Pretty soon he stopped. Likewise there's a blurb here about how the father said it was his son's intelligence that helped him break the habit, not anything from the psychiatrist!
212ff On handling child behavior problems; Erickson is not permissive in the "permissive parenting" sense, in fact his ideas seem old-fashioned according to the author; also he does not help a child understand the reasons behind his misbehavior, he simply "arranges that he behave more properly." [Once again, the "reasons" don't matter, in fact they will only serve to groove the behavior. Another insight here is that Erickson is thinking of a systems level solution to a problem: what kind of system can I create that will have properly arranged incentives for the child to develop proper behavior, for example.] On child behavior and insecurity often springing from "uncertainty about what limits are set upon him," thus Erickson's therapeutic approach is to enforce limits, and also to have parents enforce limits.
213ff Extremely interesting case here of an eight-year-old boy with tremendous discipline problems and how Erickson had to reverse engineer the mother into a specific plan to achieve a sort of surrender of the boy to her authority. This case is told in a very compelling way, Erickson had to work with the mother to really get her to see the damage the boy had done and the gravity of the situation, this was in order to get her on board with his instructions; also, post hoc, there's kind of a Monday morning quarterbacking of the case on how the boy's mother described her experience during the final conflict before the boy's surrender. "I knew I had a real job to do." Note also the "floor stomping" part of this case where the boy had a relapse, but then Erickson dismissed the mother and then encouraged him to stomp on his floor (basically saying: "You're only eight years old. No matter how angry you are you can't stomp that many times. When you get all tired out like a little boy you may rest by standing still, until you find out you won't be able to stand still without wiggling and wanting to sit down.") This scene is quite interesting because a surrender occurs, but it occurs in the context of an alliance between the boy and the doctor, where they don't share any details about this surrender with the mother. Joe, don't tell your mother a single thing about what happened in this office. You and I both know, and that's enough. O.K.?" The doctor enabled the boy to keep his misbehavior and his surrender as a private thing just with the doctor. And then from then on the boy both looked up to Erickson and the boy's behavior was totally normal from then on. [The various scenes in this entire case are all fascinating on a bunch of levels. It's worth rereading and contemplating.]
Chapter 7: Marriage and Family Dilemmas
223ff On the middle years of marriage when there is discontent in the hierarchy of the partnership; also examples here of where spouses make paradoxical demands on the other, or use behavior and symptoms as ammunition, and then these conflicts become "embedded as habitual, cyclical behavior." [Perhaps one major clue to having a successful marriage is do not do these kinds of things.]
224ff Interesting case here about a wife that kept quizzing and grilling her husband about how he ran a restaurant--this was the manifestation of the power struggle--and Erickson assigned her the task of continuing to do this ["go with the direction of the river"], but to write down the questions she asked him, and then also ask herself (and answer herself) the same number of questions to herself about how she was running the household. She quickly tired of this, and this extinguished the original grilling/quizzing behavior with the husband too. Also interesting that "the husband is used in the treatment without ever being involved." See another case about a couple owning a restaurant [the reader has the interesting experience here of thinking that there's some sort of continuity error in the book but it turns out to be a totally separate case, and deliberately coincidental]; Erickson changes one tiny thing: he has the husband arrive to the restaurant half an hour before the woman. The reason this solution worked wasn't even clear to the audience that he explained this case to: Erickson had to explain that when the husband arrives half an hour earlier, he carries the keys, he opens the doors, he unlocks everything, he sets things up for the day, etc., and so the wife is way behind and not able to grill or micromanage or do any of these things for him; and in the long run she realized it didn't matter whether she was a half an hour late, or an hour late, or more, and gradually she figured out that he was going to run the restaurant without her. Thus yielding just half an hour in the morning turned into yielding time in the evening and then eventually leaving everything in the restaurant to him totally, while she managed the house. But yet she was still available if a position needed to be filled for that day if an employee was sick. "I couldn't feel I would get anywhere by telling the husband he was inviting his wife to manage him into mopping the floor, and so on. He wouldn't have understood that. But he did begin to understand that he was in charge of the place for a whole half hour. And he was perfectly comfortable being in charge." [Incredibly interesting. He does nothing to explain the various motivations or give any kind of psychological explanation, he just makes this one tweak, this one minor change in dynamic, then lets it play out, and the people participating don't even need to know anything about why it works. It worked. That's all that matters.]
227 On dealing with a therapy situation where the wife determines whatever is to be said during the session, or she interjects and talks for the husband; Erickson sometimes can simply ask the woman to be silent, but also has used his "unusual" approach: he asks, "Do you happen to have a lipstick? Now this will seem ridiculous to you, but hold the lipstick just gently touching your lips keep it right there... I'm going to ask your husband some questions, and I want you to notice how your lips want to move. I think you'll find it very interesting."
227-8 Note this technique of dealing with a woman who excludes her husband from raising the children, Erickson will complement her on her competence but then raise a small doubt how "a woman of her intelligence could neglect using the competency of her husband." [This basically uses the ego and narcissism of the woman to benefit the partnership--and children.]
235ff Other techniques to manipulate/manage marriage counseling patients: bringing the husband in against his will by telling through the wife things that Erickson knew that he would disagree with, thus that he finally came in to therapy in order to "straighten things out"; also an interesting example here where Erickson tells a husband and wife that they cannot look at each other, and by not being able to sneak looks at each other they communicate more things that carry a burden of guilt; thus they can communicate their guilts to each other because they feel guilty for breaking the rule of looking at each other [this was a very interesting case];
237ff Also on some of the absurd things Erickson would have patients do in order to assist them: there's a case given here where a passive husband let his wife have the lead in every domain; weirdly he would follow her around the house watching her do housework, Erickson instructed her after she cleaned the house to go back into each room and take the dust bag out of the vacuum cleaner and put a pile of dust on each floor and then say well that's that until next Saturday refuse to discuss it with her husband, at this point Erickson predicted the couple would fight during that week over an important marital issue which surfaced as a result of this; Another example of absurdity where the two partners are too nice and too polite and gentle with each other: Erickson would say, "If you were a less tolerant woman, and if you were a less tolerant man, what do you suppose would be the things you would disagree with your spouse about?" This caused them to develop the skill of expressing disagreements.
238ff On encouraging a couple to fight under duress or fight in a way where the nature of their fight has been changed: again this grows out of Erickson's technique of encouraging resistant behavior. See for example of the couple on page 238-239 where the wife, an alcoholic, would hide her bottle, and the husband would rage at her searching for it; Erickson instructed the woman to do exactly that: hide the bottle and if the husband found it he could pour it out. If he couldn't find it she could drink it. Thus Erickson basically encouraged them to continue to fight but with a nuance that because it was purposeful it took away all the twisted pleasure she got out of it. It robbed her of the privilege of hiding the bottle.
240ff More interesting nuances here: Erickson anticipates the ideas of codependency and how alcoholism when it is conquered changes the ecological dynamic of a family; thus for example he'll put a suggestion in the mind of the spouse: "What will you do with all the energy you've been spending on nagging him about his drinking?" and then frame a similar question for the alcoholic husband: "Think of all the energy that she can use towards other things if you were to stop your drinking." Erickson ties the two things together without telling the couple this; also interesting thoughts here on psych meds: in Erickson's day tranquilizers were used frequently by psychiatrists, and Erickson saw this as inappropriate, often his therapeutic problem was to get someone off tranquilizers [clearly this started a loonnnnng time ago]; also Erickson makes an interesting comment here about if a patient asks for a prescription for tranquilizers if he refuses he knows they'll just go to some other doctor to get them. "Therefore I don't refuse them, but somehow I don't provide them." [Very interesting, again don't try to redirect the river aggressively just deflect it a little.]
243ff On family therapy as a therapeutic conception which began in the early 1950s: Erickson, among many other therapists, begin practicing family therapy in those years.
243ff Various techniques to stop one family member from dominating the conversation: there's an example here where Erickson has a dominating mother hold her hands in her lap and keep looking at her thumbs while she held them precisely one quarter inch apart, and then he promised that she could have the last word at the end if she remains silent. [!!] Another example where he would purposely frustrate the speech of certain members of the family who aren't speaking at all in order to encourage them to talk: he would say something like "There are undoubtedly some things that you feel really need restating," but before the person could actually answer, Erickson would frustrate him by turning away and talking to someone else in the family, this would lead to drawing that person out; also Erickson uses a reverse suggestion by saying "You tell me the things you want to talk about but I think there are some things you'd rather not tell me, so just tell me the things that you can tell me with the least amount of pain and be sure to hold back the things you can't bear to tell me." By the end of the discussion they end up telling the doctor all of the difficult things too, because he's giving him the freedom to withhold the information but they feel they can tell him anyways; Also a good example here with couples: Erickson will say: "I want to hear both your stories. But there certainly are things that you're going to withhold. You're going to withhold them because you'd rather let your wife tell me than tell me yourself." This is really a suggestion saying, "Would you rather tell me, or do you want someone else to tell me?" and the person will usually open up to it right away.
246 Once again the critical idea underlying Erickson's therapy: "Helping a patient understand himself, become more aware of himself, has nothing to do with changing him. Most psychiatrists make people more self-aware but never get the patient to become aware of what he can do. It is irrelevant to know why a person does what he does. If you look over the lives of happy, well adjusted people, they have never bothered to analyze their childhood or their parental relationships. They haven't bothered and they aren't going to."
249ff Extended case where a patient has certain physiological symptoms due to a sex hangup, and Erickson addresses these sexual issues extremely subtly and indirectly without mentioning anything having to do with sex: for example he has her explain where she hangs up her clothes in the bedroom (on the back of a chair, or on the arm of a chair?); he then walks through a whole range of scenarios and contrives to give her permission to both articulate and carry out a fantasy, but then he uses reverse psychology yet again, saying she shouldn't do it "too soon," "not tonight or tomorrow night or even next week." [Really really interesting.]
257 "How many patients resent your taking their difficulty away from them? How many bottled chronic appendices are there in the family treasures? Have you ever listened to someone tell you, 'This is the appendix the doctor took out. Do you know how many attacks I had of appendicitis?' They treasure their problem, but they want to treasure it safely."
258 "This [previous] case illustrates the elaborate care with which Erickson will sometimes protect patients from facing issues before they are ready to do so. He will carefully manage the interviews so that the person is not confronted with an idea that cannot be tolerated." [Yet another difficult takeaway from this book is that we all have to accept that we don't really know what we want; we simply do not understand ourselves; we don't really know what we're doing most of the time. Nobody wants this to be true about themselves and yet it is.]
258ff Finally here an extended case where Erickson uses a sledgehammer and just tells people directly what's wrong with them right to their face.
Chapter 8: Weaning Parents from Children
[This is one of the weaker chapters of the book, the cases don't seem to have coherence to them and it is less clear what the reader can generalize in terms of therapeutic techniques here; there doesn't seem to be the same good organization of this chapter's cases like there are in the other chapters.]
265ff Interesting passage here quoting Anton Mesmer from the 18th century, working on a patient blind since the age of four; then fast-forwarding a hundred years to Sigmund Freud, treating a patient with agoraphobia; Mesmer and Freud both viewed the patient as the "unit of observation," implicitly viewing the family as peripheral to the problem. [Obviously what we've seen so far is that this can be a huge mistake: the parents or family could be integral to the problem, or even the source of the problem, and in some instances therapy shouldn't even take place on the patient who has "the problem."]
268 [Comments on how therapeutic improvement can produce a second-order "ecological shift" in dynamic in the family] It is typical to have a negative response from parents to the improvement of an adolescent with a severe problem, there's a "general factor operating here" and the therapist is not dealing with an individual, but rather "with a phase of family life where difficulties can take a variety of forms."
269 "Not only is the human being the only animal with in-laws, but he is the only one who must go through the extraordinary shift from taking care of his children to dealing with his children as peers."
269 "What Mesmer and Freud lacked was the idea that 'symptoms' are contracts between people that serve many functions."
269ff A series of cases here that don't really all seem to deal with "weaning parents from children" not do they seem to have a consistent logical thread: first, a case of a schizophrenic daughter who Erickson helped grow up basically; second, a case that went to completion very quickly after just a few minutes as a family of a husband wife and daughter heard the daughter tell the parents that nobody listens to anybody, they all laughed and went home and were cured more or less; third, a case of a son who was an absolute shitshow where Erickson failed to achieve any therapeutic success.
280ff A case here [and this one actually has to do with weaning parents from children] where parents built an addition on their house and were pressuring their daughter to continue to get married, have a child, and live in the addition; Erickson sat the parents down and complemented them on all of these sacrifices they would be making--and he then described the noise of the new baby, the crying, the idea of a toddler getting into everything, etc., etc. Eventually he backended the parents into realizing that this wasn't such a good idea after all! They ended up renting the addition to the house to a quiet adult person and saved the rent payments for their grandson's education, while the daughter went to live in another city with her husband and child. [Note the really interesting closing comment here as Erickson said about the case that he could have used guilt on the parents by showing them what an awful thing it was to think they could control their daughter's future in such a way: "Is it essential to feel guilt? I don't believe in salvation only through pain and suffering." Once again, the reasons, the underlying motivations, etc., don't matter: all that matters is using a tool (suggestion, with rich imagery in this case) to get the family to a better place. Erickson chose the least painful tool!]
282ff Another fascinating example of suggestion: here Erickson helps parents think through their overprotective or inappropriate behavior by having them think in the future about them being grandparents; the patient wouldn't see this coming, but by considering the conflict from the "grandparent level" this gets them to accept the idea of a change in themselves. The subtlety here is that in order to even become grandparents, they have to have their son (who they're overprotecting) actually produce a grandchild. "Since Erickson doesn't believe that merely pointing out to people that they shouldn't behave as they do is often helpful, he usually doesn't advise parents to behave differently, but arranges that they do so." He'll do this sometimes "by shifting the ground on which the battle takes place." Thus here he shifts the ground of conflict from the question of whether people have been good parents to whether they will be good grandparents. "When a mother is overinvolved with a child and cannot release him, Erickson does not assume that this is a rational matter that can be dealt with rationally by the mother." Further examples here, where Erickson will "disorient the [overprotective] parents so that when the child tries to get away they push him away."
285ff A fascinating example here where an overprotective mother would keep saying "But you don't understand" to Erickson, he would immediately mention "that as long as her son lived at home she would have an opportunity to understand him. I did that over and over again--when she said I didn't understand her, I mentioned something about her son living at home. When she did I did understand her in some regard, I would say, 'This idea of your son living with his brother. I haven't made up my mind about it.' So when I did understand her, I was talking about the son moving out. It was finally the mother who insisted that her son should move out and live with his brother. She's glad she thought of that." [She's glad she thought of that!! A beautiful combined use here of suggestion as well as employing the patient's reactance to her own benefit.]
286ff The author kind of gets sidetracked here dealing with totally unusual cases in a mental hospital that--once again--have nothing to do with weaning parents from children. Perhaps the author feels like he has to set groundwork on Erickson's techniques with genuinely psychotic people in a mental hospital before going back to family therapy situations?
290ff On Erickson accepting peculiar behavior in such a way that it changed. An example here of a schizophrenic child carrying a large cross: Erickson says he wants to examine this cross, and he then encourages the child to have more than one--at least two, maybe three. [Heh, this is the psychiatrist's version of "agree and amplify."]
293 Another example here of finding for someone a "class" of activity (like exercise) that you want them to do, but the therapist finds a type of exercise which they're not happy to do, and the person responds by spontaneously find another item in that same class--in this case, a form of exercise which they enjoy and will therefore succeed at. [Again the therapist sort of backs the patient into behavior that is good for him.]
Chapter 9: The Pain of Old Age
297ff This chapter begins with a discussion of how old age is something that has to be accepted, it's inevitable; often problems that happen to people grow to become more severe as they get older; the author then does a little side trip, describing a case history in which Erickson helped an older man conquer his fear of riding in an elevator; as the man's health and fitness deteriorated, he could no longer take the stairs, so Erickson recruited one of the elevator girls to "threaten" to kiss the man (he was actually prudish and very earnestly married); she kept stopping the elevator, saying "I want to kiss you," "I'm craving to kiss you" etc., and this distracted him enough to relieve his fear of the elevator; he was actually able to ride one from then on.
299ff On Erickson's subspecialty of using hypnosis on patients with pain; he teaches the subject how to develop numbness in the body; he also adds to this a suggestion that the patient feel detached and dissociated from the body. Also on teaching "hypnotic time distortion" to separate the pain from the anticipation of the pain. [Sadly the author doesn't reveal mechanics of how to do this in the book, this absolutely would be a subject to read up on if I can find some other resource]. Also on teaching amnesia for a pain so that he would not look back or forward to the last period of pain (or the next one) with dread and fear. [Interesting examples of handling the constellation of feelings that surround pain here: basically indicating that the pain isn't a problem per se, it's the fear and dread of it that is the problem. Insightful.]
301ff Another fascinating example here with a patient who didn't believe in hypnosis: Erickson calls it "the interspersal technique. It is a way of talking as if in a casual conversation, but certain words and phrases are given special emphasis so they will be effective suggestions." In this case he used phrases like "that isn't what you want"; "comfortably"; "listen to me comfortably"; "not very much difficulty"; "bring peace and comfort"; also on the central metaphor Erickson uses with this patient here: he starts talking about a tomato plant and describes how it soaks up water, it has the joy of growing, the little seed swells and sends out a rootlet, and as he is describing this he inserts little comments like "You can listen to me, Joe," "You can keep on listening"; the patient quickly went into a trance. More details here about how he emerged from the trance a couple of times, likely due to barbiturate toxicity, and how Erickson re-inducted the trance with two quick phrases: "Think, Joe, think" and "Sleep so restfully, so comfortably" both embedded in another meaningless sequence of ideas. "This tomato-plant induction by Erickson is characteristic of his way of working indirectly with people who might resist more direct suggestions."
306ff This next case is a wild one: a woman with very painful terminal cancer who doesn't think hypnosis can help her is persuaded as Erickson hypnotizes the daughter right in front of her! And then he hypnotizes her a second time showing a sort of proto-NLP technique of taking a feeling out of your body and putting it on the other side of a room. The NLP mental image here was to put the painful feelings "into her body" which she left in her bed, while she would get into her wheelchair but only mentally move her head, shoulders and neck. This way she could leave her bed and then go into the living room and watch a TV program, without pain.
310ff Finally one more shockingly unusual therapeutic strategy (the author says it "seems appropriate to end this work" with it), about a proud German man who had a severe stroke, was totally paralyzed, and couldn't even talk. Erickson lets loose on him, mocking him for being a Nazi, saying how pathetic he was, playing on his German pride, saying he wasn't "even the equal of a mentally retarded criminal Jew!" He angered the man so severely that the man first shouted no (after allegedly not being able to talk) and then somehow the man managed to get to his feet. "Here was a man who had been insulted beyond endurance for a whole year in the hospital--then I showed him what insults could really be like and he reacted."
To Read:
Jay Haley: Strategies of Psychotherapy
Jay Haley: Advanced Techniques of Hypnosis and Therapy: The Selected Papers of Milton H. Erickson
J. Ehrenwald: From Medicine Man to Freud