Hope & Resiliency E-Book

Dan Short

• Herausgeber: Crown House Publishing
• Kategorie: Geisteswissenschaft
• Sprache: Englisch

Seitenzahl: 494

Veröffentlichungsjahr: 2006

Beschreibung

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

Leseprobe

“The keys to the kingdom! A leading Erickson scholar plus two of the master’s daughters describe the core strategies and techniques that underlie his legacy of healing and therapeutic utilization of clients’ resources. This brilliant book is a ‘must-read’ for anyone interested in understanding and applying Erickson’s work. Highly recommended!”

Michael F. Hoyt, PhD Author of Some Stories are Better than Others, Interviews with Brief Therapy Experts, and The Present is a Gift

“In this engaging book renowned experts, Dan Short, Betty Alice Erickson, and Roxanna Erickson Klein, shed new light on fundamental patterns in the work of Milton H. Erickson, MD. Immerse yourself deeply in this entrancing and timeless wisdom, and realize the power within.”

Jeffrey K. Zeig, PhD Author of Teaching Seminar with Milton H. Erickson, MD andExperiencing Erickson

“As the era of well-meaning, but misguided victimology wanes, psychotherapists are rediscovering the hope and resiliency that permeate the timeless therapeutic strategies of Milton H. Erickson. The authors, family and insiders who know Dr. Erickson best, lucidly and impressively convey new insights into the philosophy of healing that is at the core of his psychotherapeutic genius. By understanding that healing is the activation of inner resources during the process of recovery, making life a continuous process of rehabilitation, psychotherapists can markedly improve their therapeutic effectiveness and bring new hope to their patients.”

Nicholas A. Cummings, PhD, ScD Author of Focused Psychotherapy and The Essence of Psychotherapy

“In this age of standardized and even manualized treatments, Hope & Resiliency provides a refreshing reminder about the importance of honoring each individual’s uniqueness. The authors build on the creative and highly skilled work of Milton Erickson and do a wonderful job of making some aspects of his methods more accessible to the reader. The case examples and family stories bring a folksy charm and gentle wisdom to the authors’ clinically astute considerations of what it takes to do therapy well.”

Michael D. Yapko, PhD Author of Trancework and Treating Depression With Hypnosis

“This is a delightful introduction to the work of Milton Erickson. It is remarkably clear and chalk full of practical examples and applications. It is especially good at emphasizing Erickson’s positive and remarkably creative way of accepting and utilizing all parts of a person’s reality to allow significant change and growth. I look forward to recommending it to my students as essential reading.”

Stephen Gilligan, PhD Author of Therapeutic Trances, The Legacy of Milton Erickson and The Courage to Love

“Hope & Resiliency is a delightful and deeply moving reading experience that facilitated peace and well-being within my own heart and mind. I will keep it by my bedside as a daily refresher in the healing legacy Milton H. Erickson has passed on to all of us.”

Ernest L. Rossi, PhD Author of The Psychobiology of Gene Expression

“A must read for every therapist. The book combines clear, simple instructions with wonderful case studies and an emphasis on Erickson’s belief in the inner strength and the unlimited potential of each individual. The family anecdotes are precious.”

Cloé Madanes Author of Behind The One-Way Mirror, Sex, Love & Violence and Strategic Family Therapy

“Another welcome addition describing the wisdom of Milton H. Erickson, MD by three authors who know his work well. This book makes a connection between his personal and professional life and presents detailed clinical examples for therapists in the field.”

Jay Haley, MA Author of Uncommon Therapy, Art of Strategic Therapy, Ordeal Therapy and Problem Solving Therapy

“Hope & Resiliency: Understanding the Psychotherapeutic Strategies of Milton H. Erickson, MD is a wonderful book. I had the sense while reading it that I was in Erickson’s office and just listening to him talk. This is a consequence of an informal narrative style wherein the book contains many case studies, comments by Erickson, and comments by his daughters and Short. I have not seen some of these studies and commentaries before, and they shed a new and continuingly interesting light on this remarkable man and his works. There are gems like, ‘Let patients know that they are going to be cured and that it will take place within them’ and ‘Often in psychotherapy a change of reference is all that is needed’ and ‘Erickson’s philosophy of healing was characterized by his attention to the goodness of the patient’s mind and body.’

“The heart of the book centers around organizing Erickson’s contributions under the categories of: distraction, partitioning, progression, suggestion, reorientation, and utilization. Although it is next to impossible to characterize or systematize Erickson’s work in simple packets, this organization does lend itself to a useful set of guidelines to the man and his work.

“This book is highly recommended as it provides the reader with some unique perspectives on Erickson’s work, his way of working, and many practical ideas.”

Rubin Battino, MS Author of Metaphoria, Guided Imagery and Other Approaches to Healing and Ericksonian Approaches

Hope & Resiliency

Understanding the Psychotherapeutic Strategies of Milton H. Erickson, MD

Dan Short, PhD Betty Alice Erickson, MS, LPC Roxanna Erickson-Klein, RN, PhD

Foreword by Stephen Lankton, MSW, DAHB

In the desert of Sonora, on thebranch of a tree,

Sat a noble eaglegazing to sea.

Wings forged fromiron, a shadow was sown

Withinwas the hope of dreams not yet known.

Eagle readied for flight looking farand away.

Tree branch grew light,the shadow did stay

A journey ofdiscovery into the sun;

The shadow, the eagle and the tree are one.

By Roxanna Erickson-Klein

The eagle pictured on the cover is from Milton Erickson’s extensive collection of Seri Indian ironwood carvings. Carved from hidden roots that are centuries old, these Indian artifacts allegedly bring good fortune and long life. It seems only appropriate that this unique material—wood that does not float—would serve as an icon for a man who continues to defy static categorization.

Acknowledgments

This book draws on the knowledge of other authors and leaders in the field and to each of them we express our gratitude for helping light the way on our journey of discovery. We thank Jeff Zeig and Jay Haley for providing expert feedback during the initial development of the manuscript. Valuable critiques were also provided by Consuelo Casula and Claudia Weinspach who helped prepare the way for international distribution. Dan Short is especially grateful to Teresa Robles who provided the initial encouragement to write the book.

Also, many thanks from each of each of us to the publishing team at Crown House for having enough faith and enthusiasm in the project to make the book be as good as it can be.

Contents

Title Page

Epigraph

Acknowledgments

Foreword by Stephen Lankton, MSW, DAHB

Preface

A Biographical Sketch of Milton H. Erickson

Overview

Family background

Childhood

Late adolescence

Professional beginnings

Post-polio syndrome

The later years

Part I: Foundations of Healing and Health

Chapter 1 Introduction

Chapter 2 The Human Condition

Chapter 3 Mental Health and Healing

Chapter 4 The Role of the Clinician

Chapter 5 A Philosophical Framework

Summary

Part II: Clinical Strategies

Chapter 6 Introduction to the Six Core Strategies

Chapter 7 Distraction

Red herring

Questioning and presupposition

Emphasis on detail

Therapeutic amnesia

The general application of distraction

Chapter 8: Partitioning

Symptom definition

Formal diagnosis

Prognostic splitting

Dividing conscious

Dissection

Partitioning of time and space

The general application of partitioning

Chapter 9 Progression

Geometric progression

Progressive desensitization

Pattern interruption

Cognitive progression

Forward progression

The general application of progression

Chapter 10 Suggestion

Cooperation versus control

Direct suggestion

Indirect suggestion

Permissive suggestion

Interspersal and repetition

The confusion technique

The general application of suggestion

Chapter 11 Reorientation

Insight

Reframing

Externalization

Reorientation in time

The general application of reorientation

Chapter 12 Utilization

Simple bind

Double bind

Utilization of a minor problem

Symptom prescription

General application of utilization

Chapter 13 Conclusion

About the book

Contraindications

Putting the knowledge to use

Appendix A Self-Development Exercises

Distraction

Partitioning

Progression

Suggestion

Reorientation

Utilization

References

Index

Copyright

Foreword

At the time of his death on March 25, 1980, Milton H. Erickson, MD was said to have written over 300 professional papers and hypnotized over 30,000 subjects. Today, there are 118 Institutes established worldwide for the further study and practice of Erickson’s contributions to hypnosis, brief therapy, family therapy and psychotherapy. A search on the Internet today reveals over 78,000 entries under his name. Amazon.com lists 132 books in a search for his name. Even eBay has items for sale pertaining to Dr Erickson! With all this effort to explain the work of Dr Erickson, I still find that Hope & Resiliency is a breath of fresh air.

Erickson’s work has grown from a seed to a forest over the last few decades. This is in large part due to the tireless work of Dr Jeffrey Zeig, Director of the Milton H. Erickson Foundation, Inc. in Phoenix, Arizona as well as the many dedicated faculty members who teach at the Foundation’s training events.

Over the years Erickson’s work became increasingly refined. In fact, early visitors to his office often disagreed about his approach when speaking to those of us who visited him in later years. The reason for this is obvious if we trace the progression of Dr Erickson’s work over the years from Eloise to Phoenix. We can look at the duration of his treatment, the use of suggestion from direct to indirection, at least, during the induction process (if not for treatment also). Also, we could trace the progression in the use of therapeutic metaphors and brief therapy. Additionally, let’s consider some changes in the view of symptoms from a psychoanalytic view to an interactional view. This latter will show a change in viewing people and problems which quite logically goes hand in hand with the above.

Treatment Duration

In the early 1950s we see several cases over which Erickson took several months. The case of the man with a ‘fat lip’ took upwards of 11 months (Erickson and Rossi, 1979) and the case of the “February Man” from Michigan took far longer – up to 2 years (Erickson, 1980). While it is true that Dr Erickson made himself available to clients for an indefinite period of time while he lived in Phoenix, his published cases became shorter in duration. In 1973 we find the case of the 8 year old ‘stomper’ which took 2 hours (Haley, 1973). Various cases of his “shock” technique in 1973 entailed 1 to 2 hour long sessions (Erickson and Rossi, 1980). In general, the movement to brief therapy progressed continually and became prominent in his practice in the late 1970s and beyond.

Hypnotic Suggestion

In a 1957 transcript of induction, we find Dr Erickson’s redundant use of words like “sleep” as in the following quote, “Now I want you to go deeper and deeper asleep” (Haley, 1967). In addition his authoritative approach can be found in this same transcript represented with the statement “I can put you in any level of trance” [italics mine] “ (Haley, 1967). However, by 1976 Erickson believed indirect suggestion to be a “significant factor” in his work (Erickson, Rossi et al., 1976, p. 452). Furthermore, by 1981 Erickson clearly states that he “offers” ideas and suggestions (Erickson and Rossi, 1981, pp. 1–2) and explicitly adds, “I don’t like this matter of telling a patient I want you to get tired and sleepy” (Erickson and Rossi, 1981, p. 4) [italics mine]. With regard to his use of indirect approaches, there is clear evidence that Erickson’s practice evolved to a point in the late 1970s where he had abandoned his earlier techniques of redundancy and authoritarianism during induction.

The Use of Metaphor as Indirect Intervention

In 1944 Erickson reluctantly published “The Method Employed to Formulate a Complex Story for the Induction of the Experimental Neurosis” (Haley, 1967). His understanding at that point was that a complex story that paralleled a client’s problem could actually heighten the client’s discomfort and bring the neurosis closer to the surface. Within a decade, in 1954, Erickson was using many “fabricated case histories” of fleeting symptomatology (Erickson, 1980). Still, almost two decades later in 1973, we see that Erickson provides several examples of case stories for making a therapeutic point (Haley, 1973) and by 1979 Erickson and Rossi actually use the heading of “Metaphor” as a class of interventions (Erickson and Rossi, 1979). Again, this movement corresponds to his movement from direct and authoritarian therapy to indirect and permissive therapy.

Erickson’s Conceptualization of Symptoms

From his earliest years as a psychiatrist at least up to 1954, Erickson took a traditional analytic view of neurosis and various symptoms. He said the development of neurotic symptoms “constitutes behavior of a defensive, protective character” (Erickson, 1980). By the mid-1960s his view had become much more interactional. Perhaps this was a result of his collaboration with Jay Haley, Gregory Bateson, John Weakland and the Palo Alto Communication Project. In any case Erickson writes, in 1966, “Mental disease is the breaking down of communication between people” (Erickson, 1980). However, by the end of his career he had moved even further from the analytic and the communications/systems theory of disease. He states that, symptoms are “forms of communication” and “cues of developmental problems that are in the process of becoming conscious” (Erickson and Rossi, 1979). In summary, the evolution of thought concerning the nature of problems became less oriented to a pathological explanation until, in the end, symptoms could be seen as communication signals of desired directions of growth. Erickson took such signals to be a request for change, and even unconscious contracts for therapeutic engagement.

Cure Accomplished by Reassociation of Experience not Direct Suggestion

The one area in which Erickson never wavered was his view of “cure.” I suspect this was a result of his personal experience overcoming paralysis. He learned as a young adult that experiential resources created change. As early as 1948 Erickson recognized that cure was not the result of direct suggestion that somehow influenced the client but was due to the reassociation of experiences that were needed in a particular problematic context (Erickson, 1980). In the later years of his career we find this theme repeated again and again (Erickson and Rossi, 1979; Erickson and Rossi, 1980; Erickson and Rossi, 1981).

Dr Erickson’s own explanations were often frustrating to many of us, as he insisted upon sharing wisdom in a rather folksy manner. For instance, asked what the most important thing was in therapy, he would comment, “Speak the client’s own experiential language.” When asked for the next most important thing to do he commented, “Put one foot in the client’s world and leave one foot in your own.” Such comments seemed to side step conventional scientific language and left one wondering if he would eventually come to add more. He never would. The many books that have been written about his work often attempt to rectify this situation. The authors quote Rogers, Bandura, hypnosis research, Berne, Szasz, Perls and many others to connect existing knowledge to Erickson’s folksy wisdom.

Enter Hope & Resiliency. This is a superb book by Dan Short, Betty Alice Erickson, and Roxanna Erickson Klein who have retained Erickson’s own words and yet still manage to paint a powerful, comprehensive, and extremely workable theoretical structure. They have created a well-woven theoretical discussion that is a breath of fresh air for those who are ready for an approach based on principles of engagement and change rather than mechanization. Hope & Resiliency is not a micro-analysis of techniques, nor should it be. A solid text of Erickson’s work needs to highlight the functional principles of how change happens yet still provide comprehensible links to practical interventions. This is exactly what this book does.

Part I introduces Erickson’s philosophical foundations. It presents several cases to clearly illustrate the therapist’s job as a catalyst for change. Above all, the therapist must respect the wisdom of the client’s unconscious and help the client appreciate the same. The best way to accomplish that is through mutual discovery with the client.

Part II presents six key clinical strategies that can provide the foundation for all interventions using an Ericksonian approach. With these six strategies or principles, the authors almost completely circumscribe the vast range of approaches taken by Dr Erickson.

In each situation the authors present strategies in great detail to ensure deep understanding. Specific interventions are not given because the concept of the book is to suggest the strategies from which uncountable creative interventions might be born. As in Part I, each section of the book provides case illustrations and Erickson’s actual words to illustrate the points of concern. The authors discuss the strategies of distraction, partitioning, progression, suggestion, reorientation, and utilization. Here is a brief summary to set the stage for the author’s detailed case discussions and interpretations.

Distraction pertains to the logic of helping the client break the attention given to experiences that lead to failure. Self-fulfilling prophecies and self-defeating behavior are the best examples.

Partitioning is a strategy for re-chunking or re-parsing the client’s problems, goals, resources, attention, and even time and space.

Progression is a matter of building ever increasing gains from small beginnings. The authors give us several new ways to think about progression including geometric, progressive, cognitive, disruptive, and time oriented.

Suggestion is the most significant section for me as I believe suggestion to be foundational to both therapy and socialization. From the authors’ vantage point, the use of suggestion, as exemplified by Erickson, becomes a seminal concept as it underlies not just therapy, but also communication in everyday life. The authors explain the connection between the apparent polarities of therapy and daily living as these relate to suggestion. They help readers understand how therapeutic ideas are conveyed both in and out of formal therapy.

Reorientation is a strategy the authors consider one of the most pervasive in therapy. They describe how each new idea introduced to a client should be formulated for a future success or use and how the job of therapy is to continually create this future associational link. They relate this concept to the work of Victor Frankl and Pat Love, the reframing and externalization carried out in Gestalt therapy, Satir sculpting, and psychodrama. Time distortion is described as a major tool for reorientation.

Utilization is the most distinctive strategy in the book as it was one of the hallmarks of Erickson’s work in his opinion. Utilization is a process of using the client’s energy, point of view, skills, and potentials. The aim is acceptance and motivation of the client to support the distraction, progression, and reorientation. Of course, as clients’ behavior is utilized for their own growth, a sense of hope and confidence is automatically instilled. Finally, Hope & Resiliency provides a wonderful appendix for learning each of the strategies in the reader’s own life and therapy practice.

Dr Dan Short did an unprecedented thing in the preparation of this book. After the initial compilation of this material, the framework, or draft, was shown to colleagues in a dozen different countries around the world. Dr Short collaborated with several other well-known practitioners of Dr Erickson’s work so that they might take his basic draft and write adaptations of the work. Thus, he created a cluster of books, each reflecting a differing cultural milieu world-wide. Each version became an adaptation in which the local co-authors modified and tailored the contents of this book to address culturally specific ideas and concepts. Hope & Resiliency has thus been transformed, by the addition of indigenous literature and culturally relevant anecdotes, into a work that is specific to each culture in which it was co-authored. The broad scope of this project to write Hope & Resiliency, is therefore not limited by the personal experiences of the original authors, but rather represents the combined resources of a large number of highly talented multi-national individuals, and reflects the differing circumstances and ideas of people around the world. I believe this is the first time such a project has ever been created in this manner … and it is a brilliant idea. The global scope of the project for Hope & Resiliency may be a unique and original model for the very future of clinical collaboration. If it should turn out to be so, it would be another facet of Dr Erickson’s fundamental principles. It truly allows every to speak in their own language around the world; it co-creates rather than dictates.

In the perennial conflict between researchers and clinicians, the voice of those professionals who repeatedly create change in their clients always leads the way. Now, with the world-wide publication of Hope & Resiliency, that voice becomes a global baseline for a deeper understanding and development of successful methods of change promoted by Dr Erickson.

In conclusion, an important and often overlooked concept in Erickson’s approach is not only not ignored here, but it is part of the very fabric of this project on a global level. There has never been a part of Erickson’s work that was intended to manipulate or trick a client. Of course, all change-agents are capable of influencing others. That aspect of intervention is all too often the subject of modern clinical works. Further, in the case of change like that accomplished by Dr Erickson, it is all too easy to discuss and elaborate the types of manipulations that lead to change rather than get to the heart of the matter of psychotherapy. This book does not attempt to capitalize on that obvious and easily misunderstood and misinterpreted aspect of interpersonal influence. Instead, the principles behind Erickson’s work are shown here to enhance, enrich, and empower each individual in a unique and personal way. Since they are not meant to manipulate or coerce, they are not developed or discussed in that light. Hope & Resiliency shows a deep respect for this potential problem. At all times it is about enriching and empowering clients, and helping therapists establish a framework or two to do the same in a myriad of unique ways that matches the myriad of unique clients. What a delightful book this is for introducing refreshing schemes for therapy taken from Erickson’s own words and cased and delivered by Dr Short, and two of Erickson’s professionally accredited children—psychotherapist Betty Alice Erickson, MBS, LPC and Roxanna Erickson-Klein, RN, PhD.

Stephen Lankton, MSW, DAHB

Editor, American Journal of Clinical Hypnosis, Past-President, Diplomate, American Hypnosis Board for Clinical Social Work

References

Erickson, M. (1980). February Man: Facilitating New Identity in Hypnotherapy. The collected papers of Milton H.: Erickson on hypnosis: Vol. 4. Innovative hypnotherapy. E. L. Rossi. New York, Irvington: 525–542.

Erickson, M. (1980b). Method Employed to Formulate a Complex Story for the Induction of an Experimental Neurosis in a Hypnotic Subject. The collected papers of Milton H. Erickson on hypnosis: Vol. 3. Hypnotic investigation of psychodynamic processes. E. L. Rossi (Ed.). New York, Irvington: 336–355.

Erickson, M. (1980). Hypnotic Psychotherapy. The collected papers of Milton H.: Erickson on hypnosis: Vol. 4. Innovative hypnotherapy. E. L. Rossi. New York, Irvington: 35–48.

Erickson, M. (1980). Hypnosis: It’s Renaissance as a Treatment Modality. The collected papers of Milton H.: Erickson on hypnosis: Vol. 4. Innovative hypnotherapy. E. L. Rossi. New York, Irvington: 3–75.

Erickson, M. (1980). Special Techniques of Brief Hypnotherapy. The collected papers of Milton H.: Erickson on hypnosis: Vol. 4. Innovative hypnotherapy. E. L. Rossi. New York, Irvington: 149–187.

Erickson, M. and E. Rossi (1979). Hypnotherapy: An exploratory casebook. New York, Irvington.

Erickson, M. and E. Rossi (1980). Indirect Forms of Suggestion. The collected papers of Milton H.: Erickson on hypnosis: Vol. 1 The nature of hypnosis and suggestion. E. L. Rossi. New York, Irvington: 452–477.

Erickson, M. and E. L. Rossi (1980). Two Level Communication and the Micro Dynamics of Trance and Suggestion. The collected papers of Milton H. Erickson on hypnosis: Vol. 1 The nature of hypnosis and suggestion. E. L. Rossi. New York, Irvington: 430–451.

Erickson, M. and E. Rossi (1981). Experiencing hypnosis: Therapeutic approaches to altered state. New York, Irvington.

Erickson, M. H., E. L. Rossi, et al. (1976). Hypnotic realities: The induction of clinical hypnosis and forms of indirect suggest. New York, Irvington.

Haley, J. (1967). Advanced techniques of hypnosis and therapy: Selected papers of Milton H. Erickson, M.D. New York, Grune & Stratton.

Haley, J. (1973). Uncommon therapy: The psychiatric techniques of Milton H. Erickson, M.D. New York, Norton.

Preface

Contained within these pages is an account of health-oriented problem-solving that provides a clear, useful guide for responding to those who are seeking help. Such hardships include psychopathology, chronic medical conditions, family dysfunction, addiction, trauma, academic delay, social failure, and other distressing or demoralizing circumstances. The application of these strategies is unusually broad because the underlying concepts provide access to the core of human problem solving.

In every instance of family, organizational, or cultural progress, the fundamental unit of change is the individual. Hope and resiliency provides a path toward whatever good the future may hold. Without having sufficient hope or resiliency, vast amounts of external resources can be poured into what is essentially a vacuum of despair and surrender. People who are persuaded to believe in themselves put forth greater effort, which increases the probability of success (Bandura, 2003). This focus on hope and resiliency is consistent with the positive psychology movement that has emerged within mainstream psychology and it is a useful way to conceptualize the pioneering work of Milton H. Erickson.

The psychotherapeutic approach of Dr Erickson is considered by many to be the work of a genius, but his methodology is sometimes difficult to understand. Erickson’s most celebrated clinical cases have in common a seemingly insurmountable problem that is elegantly resolved through a surprisingly simple and resourceful solution. Under careful examination, the subtle nuances and complexities of his techniques are daunting. Yet, for Erickson, the interventions were natural behaviors derived from commonsense reasoning. The question we are confronted with is how this type of remarkable clinical intuition can be learned.

Many efforts to learn Erickson’s approach to psychotherapy have focused on identifying and replicating his techniques. Much of the Ericksonian literature provides microdynamic analyses of Erickson’s words and actions so that these behaviors can be imitated. The importance of these works and of studying Erickson’s numerous innovative techniques is not to be underestimated. By studying the artistry of Milton Erickson, a greater appreciation for his skill is developed.

“There is,” as Erickson stated, “a tremendous need to utilize … an awareness of techniques and an awareness of the kinds of techniques that you as an individual can employ” (Erickson, 1959a).

Although a study of techniques is a good starting point, when a practitioner’s education is restricted to learning technical procedures there is a tendency to develop the mistaken assumption that therapy is something that must be “done to” the patient.1 In contrast, there is a great deal of research which suggests that technique accounts for only a minor portion of the measurable positive outcomes in psychotherapy (Duncan, Miller, and Sparks, 2004). While continually adding to one’s repertoire of techniques, it is essential to recognize the broader concepts of transformation that make change possible. As will be discussed later, unless the inner resources of the patient are recognized and engaged, even the best techniques will fail. Only with a broad and well-grounded appreciation of the process of healing and growth will a therapist’s clinical judgment be sound.

Another problem with seeking to replicate Erickson’s work is that the specific interventions he used are not always appropriate in today’s world. Much of the casework used to illustrate the concepts in this text is drawn from Erickson’s work during the 1930s through the 1960s. While looking for timeless lessons, the context of the time, the milieu, and societal resources must also be considered.

The resources and goals of society have changed dramatically from when Erickson practiced. During the first three decades of Erickson’s career, mental hospitals housed a large percentage of individuals who could not adapt to independent living. In contemporary practice there is a focus on the “least invasive” intervention with many new resources such as hot lines, halfway houses, and the vast expansion of Social Security disability payments and Medicaid for people who have physical and psychological disabilities. Furthermore, in Erickson’s time there were few psychotropic drugs available, and most that were available had debilitating and devastating side effects. Recent discoveries in the biochemical realm have created new opportunities for helping individuals with chronic mental illness.

Furthermore, Erickson’s integration of personal life with professional practice is nearly impossible to replicate in today’s urban society. There are new standards of accountability, limitations and boundary definitions that were not present at the time Erickson practiced. Although his emphasis on building alliances will never become outdated, some of his methods are no longer considered to be socially or professionally correct. It is both unrealistic and undesirable for clinicians today to practice exactly as Erickson did.

Students of any field require a certain amount of structured knowledge in order to benefit from the experiences of those who came before them. However, throughout history, human progress has been impeded by the problem of blind repetition and orthodoxy. New innovations are not possible when the specialists of any field confine themselves to step-by-step procedures for conducting their craft. The same is certainly true for psychotherapy. We stand on the shoulders of those who came before us not by working from the mold that they cast but by recognizing the function of their design. It is with this spirit of innovation that we will begin our journey of discovery guided by the psychotherapeutic strategies of Milton H. Erickson, MD.

1 In recent times, the term “patient” has become highly politicized. Some automatically assume that its use implies a superior role for the helper with the helpee stuck in the position of inferior. Others, such as Nicholas Cummings, have argued that the term implies equality among the various branches of healthcare. Because Erickson identified the people he worked with as “patients,” in all of his writings and lectures, we have made similar use of the term. Erickson is quoted frequently in this book so the decision was made to favor continuity and clarity rather than becoming embroiled in an argument over political correctness.

A Biographical Sketch of Milton H. Erickson

Overview

For Milton H. Erickson (1901–80), hope and resiliency were a way of living life and therefore a natural basis for his approach to psychotherapy. Erickson began practicing medicine in the late 1920s, a time characterized by the newly emerging practice of psychotherapy for the treatment of neurosis and when long-term institutional care was the only available solution for psychotic mental illness. By 1940, Erickson had already distinguished himself as someone who had a unique approach to healing. He had published more than 40 papers and would soon come to be known as the world’s leading authority on medical hypnosis. Over a period of five decades he illustrated his method of therapy in 119 published case reports. An additional 200 case examples were described in books published by those who studied his approach (O’Hanlon and Hexum, 1990).

Erickson’s writings and seminars helped inspire a new generation of therapists. He pioneered strategic and brief approaches to psychotherapy at a time when all psychotherapy was psychoanalytical. His unorthodox practice of bringing members of the family into therapy sessions helped inspire the creation of family therapy. He and a few others ushered in the paradigm shift from the long investigative process that formerly characterized psychotherapy to the realization that effective therapy can and should be brief, internally directed, with a focus on the subject’s ability to participate and enjoy life in the present and future. As single-subject research design becomes more common in clinical studies, it is likely that the field will continue to evolve in the direction of individualizing treatment to meet the needs of the patient, a practice that was one of the hallmarks of Erickson’s approach.

In addition to his direct contributions, numerous influential figures in the social sciences collaborated with Erickson, including Gregory Bateson (a scientist and philosopher who contributed to the fields of cybernetics, education, family therapy, and ecology), Margaret Mead (the world-renowned anthropologist who was the first to conduct psychologically oriented field work), Lewis Wolberg (an innovative psychodynamic theorist and pioneer in medical hypnosis), Lawrence Kubie (an eminent psychoanalyst), John Larson (known for his work in the invention of the polygraph), Ernest Rossi, (a leader in the field of mind–body research), and Jay Haley (one of the founders of family therapy).

Family background

Erickson was the offspring of two highly determined individuals. Erickson’s father, Albert, lost his father at the age of twelve. Three years later, Albert left Chicago to become a farmer. He had nothing but the clothes on his back and a train ticket. After going as far west as his money would take him, Albert began looking for work in the farming community of Lowell, Wisconsin. He hitched a ride to a farmer’s house to seek work as a hired hand. At the house he saw a pretty girl watching him from behind a tree. Albert asked, “Whose girl are you?” She confidently replied, “I’m my daddy’s girl.” He responded, “Well, you are my girl now.” Five years later, Albert and Clara were married. Eventually, they would have nine children and share 73 wedding anniversaries.

Erickson’s mother showed a level of determination no less than his father’s. When she was sixteen years old, she heard her aunt lamenting on how famous their ancestors were and that no descendent would ever merit the name “Hyland,” a much admired relative of the previous generations. Young Clara boldly replied, “When I grow up and get married and have a baby boy, I’m going to name him Hyland!” Milton Hyland Erickson was her second child. He was born in 1901, in a three-sided log cabin with a dirt floor that backed up to a mountain. This was a desolate region of the Nevada Sierras, in a long-since-vanished silver-mining town known as Aurum. As the family grew, Albert and Clara wanted better educational opportunities for the children, so they moved east in a covered wagon.

Childhood

As a child, Erickson was recognized as being different. Although he lived in a rural community with a paucity of printed material, he had an insatiable appetite for reading and amused himself by reading the dictionary for hours at a time. Ironically, he had multiple sensory disorders and apparently had a reading disorder. Erickson later described himself as dyslexic and said that, when he was six, his teacher, Ms Walsh, spent many hours helping him correct his mistranslation of symbols. One such day, Erickson had a sudden burst of insight. His teacher highlighted the most important features of the symbol “3” by turning it on its side. Erickson explains that in a blinding flash of light he suddenly saw the difference between a “3” and an “m.” On many other occasions she would use the same method of instruction. She would take something that was very familiar and then suddenly impose it into an area of confusion. Erickson was grateful for what his teacher had taught him and remembered her method, which later became the inspiration for his use of reorientation and a technique known as therapeutic shock.

In addition to problems interpreting symbols, Erickson was color-blind and tone-deaf. Rather than become discouraged by these multiple handicaps, Erickson dedicated himself to careful observation of the world around him. At the age of fifteen, he wrote an article for the magazine Wisconsin Agriculturists about the problems of young people living on the farm and why they eventually leave this setting. From his earliest childhood, Erickson was looking for a way to make a difference in the world. This is one reason he had so much admiration for the country doctor who brought hope and comfort into the homes of families who were otherwise frightened and isolated.

Late adolescence

In 1919, Erickson contracted one of the most dreaded diseases of the time, poliomyelitis. His prognosis was poor and he overheard the doctor sadly tell his parents that their boy would be dead by morning. Rather than fall into despair, Erickson reacted with intense anger. He did not feel that anyone had the right to tell a mother that her boy would be dead by morning! In defiance of this morose prediction, Erickson used what little voice he still had to instruct his mother to move his dresser to a certain angle near the foot of his bed. She thought he was delirious but did as he asked. This arrangement allowed Erickson to see down the hallway and out the window of the other room, which faced west. Later, Erickson explained, “I was damned if I would die without seeing one more sunset.” After seeing the sunset Erickson lost consciousness for three days.

When Erickson awoke, he could move only his eyes and speak with great difficulty. He was paralyzed in almost every part of his body. All of the independence he had been working to achieve throughout childhood and adolescence suddenly vanished.

Though he was physically trapped by his illness, Erickson still had an unyielding interest in learning. He spent his time as an invalid listening to sounds and interpreting their meaning. For example, he would listen to the sound of footsteps in order to determine who was coming and what sort of mood the person was in. One of his most crucial learning experiences came on a day when Erickson’s family left him in the house alone. His body was bound to a rocking chair so that he could have the advantage of sitting up. Erickson did not have much of a view from his position in the room and wished he could be closer to the window so that he could at least have the pleasure of viewing the outside world. As he sat thinking about what it would be like to be closer to the window, he noticed that his rocking chair slowly began to rock. Erickson believed that this was an extraordinary discovery. By merely having the idea of progress he was able to activate some previously unrecognized muscular potential.

During the following weeks and months, Erickson probed his memories for bodily sensations associated with developing movement. He would try to remember what it felt like in his fingers when he held certain objects.

Progress came slowly, in very small portions. First, he got a twitch in one of his fingers. Then he learned to consciously initiate the movement. Then he learned to move more than one finger. Then he learned to move his fingers in uncoordinated ways. Next he developed special resistance exercises that helped him coordinate his movements.

Erickson also studied the movements of his youngest sister, who was just learning to walk. He dissected her behavior into a series of component skills that he could practice for himself. He later explained, “I learned to stand up by watching baby sister learn to stand up: use two hands for a base, uncross your legs, use the knees for a wide base, and then put more pressure on one arm and hand to get up” (Erickson, 1983, p. 13). His willingness to explore the power of ideas and the connection between thinking and the body proved to be key elements in his recovery.

After having a physician at the university recommend vigorous use of his muscles during rehabilitation, Erickson decided he would strengthen his body by paddling a canoe from the Rock River in Milwaukee to the Mississippi and on to St. Louis. He had planned the trip with a companion, but his friend unexpectedly changed his mind at the last minute. Erickson was extraordinarily determined. Because his parents were already uncomfortable with the excursion, he decided not to tell them that he would be handling the canoe and his crutches alone. In the summer of 1922, Erickson was carried to the river by friends. He had two weeks’ supply of food, cooking gear, a tent, several textbooks, a few dollars in cash, and a tremendous confidence in his ability to make use of whatever situations he encountered. For instance, when stopped by the first of many dams, Erickson pulled himself up on a pier and waited for someone to pass by and ask why he was there. Erickson found that, when he allowed others to approach him, they were more likely to volunteer help. Along the way he was given temporary jobs by local farmers and fishermen. He earned his board for a 250-mile segment of the trip by cooking for two men who were also traveling the river. On many other occasions he earned his supper by telling stories to fishermen.

The depth of his interest as a student of human behavior deepened during his journey. He was able to see many different ways of living. Six weeks later, Erickson had developed tremendous strength in his arms and shoulders and was able to paddle up against the river current as he headed north from St. Louis back to Milwaukee. He had learned to walk again and was able to carry his canoe on his shoulder. In all, Erickson covered 1,200 river miles and returned home after ten weeks with $5 still in his pocket.

From a state of total paralysis and partial loss of speech, Erickson regained the ability to walk with crutches and speak clearly within eleven months. After approximately two years of rehabilitation, in the fall of 1920, Erickson was able to attend his freshman year at the University of Wisconsin. Erickson’s determination to regain the full use of his limbs led him into a journey of discovery beyond what could have initially been hoped.

Professional beginnings

Having participated in research on hypnosis with Clark Hull, Erickson continued to postgraduate medical school in Wisconsin and at the age of 26 qualified for his medical degree and Master of Arts in psychology. He began his career conducting psychological testing and research for the State Board of Control of Wisconsin. Even after earning his medical degree, Erickson would continue to identify himself as both a psychologist and a psychiatrist.

Erickson’s first internship in general medicine was at the Colorado General Hospital. He trained in psychiatry at the nearby Colorado Psychopathic Hospital under the direction of Dr Franklin Ebaugh. During his psychiatric residency, Erickson learned to use his disabilities to his advantage. The fact that he was crippled and had to use a cane made him more approachable by his patients. The fact that he did not see the world in the same way as everyone else enabled him to better understand those who had been institutionalized.

With high recommendations from his internship, Erickson was able to secure a position as assistant physician at the highly reputable Rhode Island State Hospital for Mental Diseases. There Erickson conducted intensive studies in the relationship of mental deficiencies to family and environmental factors and published the results. He then advanced to a new appointment at the State Hospital in Worchester, Massachusetts. From 1930 to 1934 he progressed from junior physician to chief research psychiatrist. Unfortunately, this rapid professional success coincided with the decline of his marriage.

In 1934, Erickson divorced his first wife and was awarded full custody of his three small children. He moved to Michigan, where he became director of psychiatric research and training at Wayne County Hospital, in Eloise, a Detroit suburb. The domestic setback made Erickson even more determined to understand the dynamics of healthy family relationships. A lifelong motto of Erickson’s was that mistakes are best embraced as a valuable learning experience.

In 1936, he married Elizabeth Moore, who was a loving mother for her instant family of three children. Over the years, the Erickson family would grow with the birth of five additional children. She and Erickson had a sense of mutual devotion that filled the rest of his lifetime.1

Erickson valued family life. His future professional dealings encircled the life of the family. Both at Eloise and throughout thirty years of private practice in Phoenix, the Erickson family lived on site. During the fourteen years at the hospital, the family lived in an apartment in the hospital grounds. During his thirty years of private practice, Erickson’s office was in the home, where his children saw him between sessions and interacted with his patients, if his patients wanted that contact. If patients were of an age that Erickson’s children might establish friendships with them, Erickson either encouraged the relationship or made it implicitly clear that a friendship was not appropriate.

In his future travels as a lecturer, Erickson was often accompanied by Elizabeth when he traveled. She and other family members, when available, were often used as demonstration subjects.

Erickson’s growth was linked to the growth of the family. He was constantly searching for ways to expand his thinking and those around him. At home, he enjoyed presenting a puzzle or a riddle that no one could figure out. There were games, contests, and problems presented with great praise for original solutions. This was done in a spirit of fun. It is clear from both his professional legacy and his daily interactions with his family that Erickson truly enjoyed seeking novel and creative solutions to problems. His personal appreciation for the significance of the family translated into pioneering work in the 1940s and 1950s, when Erickson was among the first in the field to use the family to resolve problems and promote individual wellbeing.

In 1947, a minor accident occurred that would eventually alter the direction of Erickson’s career. While riding his bicycle, Erickson was knocked to the ground by a dog. The fall resulted in skin lacerations on his arms and forehead. After receiving a tetanus antitoxin, he developed a life-threatening reaction. Due to his severely weakened condition, along with frequent allergy problems and chronic muscle pain, Erickson was no longer able to tolerate the cold and dampness of the Michigan winter. While still in a state of fragile health, Erickson was placed on a train with two medical interns, who accompanied him to Phoenix.

Erickson had been invited to come to the warmer climate by a friend and college, Dr John Larson. At the time, Larson served as superintendent of the Arizona State Hospital. He would soon have Erickson join his staff. Approximately one year after Erickson’s move to Phoenix, in the spring of 1949, Larson left his position and moved to California. At that time, Erickson also decided to leave the hospital and transition to private practice work.

Post-polio syndrome

In 1953, Erickson became severely ill with what is now recognized as post-polio syndrome. During this time his pain was extraordinary. He experienced muscle cramps so severe that some muscles literally tore themselves apart. Even during these moments of great hardship and confinement to bed, he found the energy and concentration necessary to accept phone calls from individuals seeking his aid. His genuine concern for others provided a welcome distraction from his own physical pain.

After recovering from what was believed at the time to be a second attack of polio, Erickson had lost many of the muscles in his arm, back, abdomen, and legs. However, he still managed to maintain a busy lecture schedule, including travel across the country and aboard. Though not as severe as the 1953 attack, Erickson endured further episodes of intense pain and confinement to bed.

The 1950s would be one of the most eventful periods of Erickson’s career. It was at this time that he became a nationally known figure. He was featured in popular news media such as Lifemagazine. He was also consulted as an expert in psychology and human behavior by famous athletes, the US military, the FBI, and the Aerospace Laboratory of Medicine. In 1957, Erickson co-founded the American Society of Clinical Hypnosis (ASCH). Earlier he and four colleagues formed Seminars on Hypnosis which taught medical, dental, and psychological uses of hypnosis throughout the country. He and his colleagues agreed to use $50,000 from that enterprise to fund the educational arm of ASCH. Erickson served as founding president of ASCH for two years and as founding editor of the ASCH journal for ten years.

By 1967, the continued deterioration of muscles forced Erickson to use a wheelchair during his travels. While in Delaware, September 1967, speaking at what was to be one of his final lectures on the road; Erickson remarked that he was learning to find joy in all of the new things he could experience from the vantage point of a wheelchair. By 1969, traveling became too exhausting, so Erickson focused his energy on his activities at his home office, which included writing papers, editing, seeing patients and training therapists. Using the skills that as a youth enabled him to survive polio, Erickson refused to live life as an invalid and, much like the archetypal “wounded healer,” he found the inner resources necessary to continue helping others for as long as possible.

His compelling contributions did not go unnoticed. In 1976, at the Seventh Congress of the International Society of Hypnosis, Erickson became the first recipient of the Benjamin Franklin Gold Medal award for the highest achievement in the theory and practice of hypnotism.

The later years

Despite a lifetime of chronic pain and illness, Erickson embraced a love of the life he had been given. Through his suffering, Erickson learned to value humor and the simple pleasures of life. For instance, having become infirm, he attached a horn to his wheelchair and joked with some of his patients about being an “old codger.” During the teaching seminars conducted from his office, nearly all of the exercises were approached in a humorous manner that brought a sense of playful enjoyment to the learning process (Zeig, 1980).

While training therapists, Erickson taught one of his favorite lessons using what looked like a large granite rock. He kept this prop by him in his office and at the right moment would reach down and begin the arduous task of lifting it to his lap. Watching this was difficult for the students. They had to struggle with whether or not they should risk insulting Erickson by offering assistance or just sit and watch a frail old man struggle to lift a granite rock into his lap. When it was finally resting in his lap, Erickson would look around at each of the students and then slowly lift it again and, without warning, lunge it effortlessly through the air into the lap of a stunned student. What appeared to be a heavy rock was actually an almost weightless piece of foam. Erickson would fix his eyes on the student and say, “Not everything is as it seems!” The shock would soon wear off but the lesson would never be forgotten.

Erickson’s greatest pleasure seemed to be derived from community building. Over the years there were literally hundreds of patients, and students who were also receiving therapy, who developed valued and long-lasting relationships with Erickson family members. Twenty-five years after Erickson’s death, many of those friendships still flourish. This flexibility and creative use of resources added elements of sharing, learning together, social support, and extended family to Erickson’s therapy.

As he aged, Erickson’s physical complications multiplied exponentially. In 1974, he commented to Rossi that the pain had become so intense and pervasive that he felt like a stranger in his own body. Toward the end of his life he had great difficulty lifting his right arm and he had very little strength in his hands. Many of the muscles in his face and mouth were paralyzed. Despite these physical obstacles, Erickson continued to use what strength he had left to provide therapy and training to individuals from around the world.

At the time of his death, Tuesday evening, March 25, 1980, Erickson’s teaching schedule was already filled through the end of the year and there were unconfirmed applications that would have extended his appointments far into the following year. Erickson remained productive up until the very last moments of his life, playing his part to make a difference in the world.

As can be seen in this brief biographical sketch, Erickson’s life was characterized by determination, resiliency, and hope. The ideas that he advocated within his therapy are the same ideas exemplified by how he lived his life. He had a profound appreciation for the strength that comes from a willingness to establish meaningful objectives and then doing something in relation to that goal. For Erickson, progress was not dependent on things going “his way.” He derived intrinsic satisfaction by acquiring some new understanding. By seeking to learn something from his physical disabilities, Erickson understood how to provide hope to those who no longer felt they could help themselves. He fostered resiliency in his patients through the strategic activation of latent abilities. This was an important part of his philosophy of healing. He believed that all people have within them the answer to whatever challenges they face.

As will be seen in the following pages, Erickson knew how to accomplish the “impossible” by finding some small thing that can be done. Building on a framework of small successes, he reinforced resiliency within the individual by engaging immediate successes that reach into the future.

Milton H. Erickson will continue to be remembered for his determination, patient perseverance, humanity, and unending love of learning. From these he benefited personally while at the same time creating a broader spectrum for the field of psychotherapy and benefiting people around the world, decades after his death.

1 For more information on Erickson’s life with Elizabeth Moore Erickson, see Baker, 2004.

Part I

Foundations of Healing and Health

Chapter 1

Introduction

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

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

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

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

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

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

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

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

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