A book that takes a great step towards explaining the process of therapeutic change is Dan Short's Hope and Resiliency, recently published by Crown House. Short, in collaboration with two of Erickson's daughters, has extracted some basic principles of the work of Erickson. The subtitle of this book is Understanding the Psychotherapeutic Strategies of Milton H. Erickson, MD.
Milton Erickson (1901-1980) was one of the most innovative therapists of the twentieth century. He was a founding father of clinical hypnosis, and one of the inspirational models of excellence for NLP. Richard Bandler and John Grinder wanted to know what made him so successful, and analysed the language patterns that Erickson used. Dan Short does more. From studying the vast quantity of Erickson's published work, and through personal anecdotes from Betty Alice Erickson and Roxanna Erickson Klein, the authors have devised a simple descriptive model of the kinds of interventions Erickson would make. However, this is not a book about -˜technique.' We are warned in the very first paragraph of Chapter 1 (page 3) that: Modeling
What is more important, technique or understanding? If after reading this book the reader is mostly excited about the new techniques that have been discovered, then the book should be read again in order to arrive at the main point.
We are intensely curious about other people, especially when they do things that we cannot. When someone does something outstanding, we may wonder -œis it magic?- or -œis it something that I could learn to do in time?-
Actually, young children don't bother much with detailed analysis; if they want to do it they pretend that they can. They don't bother to find the reasons why not. That's more an adult thing; getting older and wiser seems to be about telling ourselves that we are no good at doing certain things. In other words, we stop learning from our -˜mistakes' and limit the directions we take in life. We lose the ability to laugh at our own -˜out-takes.' Hence the growing market for self-help and personal development - the aim of which is to reunite us with our abilities and help us achieve our desires. As adults we need to understand the story.
The art of modeling is to find the -˜hidden' key to successful action, and that means seeing beyond appearances and finding the pattern. It is a talent that we all have, and one we could probably improve. We are constantly making sense of our world and of what people are doing; but we are not usually formulating it as a -˜theory' or as a fully worked out story. And therein lies the challenge; putting the essence of what we experience into words, explaining how things happen with abstract generalisations.
Given the huge amount of material created by and written about Milton Erickson, Dan Short has done a great job sorting through it all and describing the basic principles that Erickson was using. It's a relatively short book, but that is to its advantage. A good theory is going to be brief, which means it is going to be more valuable because it is more widely applicable. Accepting what the client brings
The main thing that Erickson did was to take what his clients gave him, and go with it. Rather than deny, distort, or change what they said, he would accept it. That is a rare thing in our culture. Most people want to change other people on their own terms, not on the client's. But accepting what you are offered is a skill that can be learned. You just have to do it. (For more on this, see Keith Johnstone's chapter on Spontaneity.)
Asking questions is an excellent therapeutic technique. You don't need answers. The fact that you ask a question directs the client's attention to some aspect of what they do (or what they say about what they do), and this kind of begins to get them to reflect on it, puts it into doubt, suggests that it could be otherwise ... Once you realise there is an option, you can then seek it. What does the therapist do? He acts congruently, believes that the client has the means to find the alternative they seek. The rest is theatre; it's making the whole experience reinforce the specialness of the encounter. Change becomes a reasonable thing to do. The Emperor thought he was being reasonable, but not wanting to lose status by appearing foolish was bamboozled by the swindlers who had their own agenda.
-œWhen you understand how man really defends his intellectual ideas and how emotional he gets about it, you should realize that the first thing in psychotherapy is not to try to compel him to change his ideation; rather, you go along with it and change it in a gradual fashion and create situations wherein he himself willingly changes his thinking- (p. 186).
-œWhile you respond to people who come to you for help, it feels natural to focus on what you can do for them. Yet when focusing on your abilities and their problems, an implied message of therapist superiority and patient inferiority is communicated. This is why utilization requires a special type of acceptance that sometimes seems counterintuitive- (p. 187)
A good therapist acts ethically, lets the client lead. The therapist starts from a position of ignorance, knows that it is impossible to fully understand the client, why they do what they do. But no matter. If you take what they say, ask questions that enrich the client's understanding of the situation, redirect the client's attention, or do anything that undermines their belief about the original problem, then that's all you need to do.
Short and his coauthors list six core strategies they found Erickson using. They also quote many of Erickson's case studies, some which have not been published before. The 6 Core Strategies Distraction
Distraction is anything that is not part of the client's expected story. In fact, telling stories is a great distraction, because people get absorbed in them. Telling the right story for that client will redirect their thinking to somewhere more useful. Generally, you are shifting the focus of attention by taking the client's mind off what they don't want, and instead give them something they do want. Utilize their need to have a positive outcome. Stop thinking and -œJust do it- (p. 42). Engage the client in something physical. Get them out of the chair, moving about. Lead them along a timeline, or have them look at themselves from different positions. Progression
Change takes time, occurring step-by-step rather than instantly. As a therapist, you need to acknowledges that people have their own preferred timescale for change (p. 105). Therefore, pay attention to small successes, incremental changes. This means you are improving your ability to discriminate and to notice subtle changes. The more you are aware of detail, the richer your world becomes, and the more choices you have. Partitioning
People get stuck when they think in universals, absolutes: -œAll p are q.- Partitioning is an analytical restructuring of experience, that breaks it down into component parts. It is about moving away from all-or-nothing thinking to differentiation, parts, stages, degrees, shades of grey - And as parts have limits or boundaries, the client can then focus on that which can be changed, or realise that: -œThere's more to life than x.- Suggestion
As a therapist, assume the change has already happened, and merely ask the client to consider the finer details: how much, how soon, which part - will change first ... ?
You are accepting the client's desire and intention to change, but questioning the process by which it will occur. Reorientation
This is a familiar change technique: reframing (p. 154). Get someone to think about their experience from another point of view - someone else's or with a different focus of attention. In its simplest form: Stop - Notice what happened. The client reflects on their experience, considers the decisions they made, and then decides to do something different. Utilization
Utilization is the hallmark of Erickson's work. The therapist -˜accepts' whatever the client offers them. This, for many, is an unusual experience. Most people expect others will block (find reasons for not going along with) their suggestions, by arguing, denying, contradicting, ignoring, and so on. If instead you accept what someone says, you put them in a slightly weird position where they then have to reposition themselves, find another way of knowing what to do. Out of that initial confusion, comes regrouping, and change.
You may find when reading the book, that these categories overlap, or that you can think of another way of sorting out these interventions. And that would be worth doing, would it not? That would get you to change the way you think about what to do next.