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Uncommon


UNCOMMON THERAPY,

by Jay Haley, 1973, New York: W. W. Norton & Co., Inc.


Although Erickson commnicates with patients in metaphor, what most sharply distinguishes him from other therapists is his unwillingness to "interpret" to people what their metaphors mean. He does not translate unconscious communication in to consious form. Whatever the patient says in metaphoric form, Erickson responds in kind. By parables, by interpersonal action, and by directives, he works within the metaphor to bring about change. He seems to feel that the depth and swiftness of the change can be prevented if the person suffers a translation of the communication. (pp. 28-29)

Sometimes, when he is interviewing a whole family, a member of the group does not talk even when encouraged.... Erickson handles the problem in the family interview by inhibiting the person from talking. (pp. 31-32)

What appears radical in his therapeutic approach is the absence of interpretations about the supposed causes of behavior. Although Erickson might now put it this strongly, 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. (p. 37)

His style of therapy is not based upon insight into unconsious processes, it does not involve helping people understand their interpersonal difficulties, he makes no transference interpretations, he does not explore a person's motivations, nor does he simply recondition. His theory of change is more complex; it seems to be based upon the interpersonal impact of the therapist outside of the patient's awareness, it includes providing directives that cause changes of behavior, and it emphasizes communicating in metaphor. (p. 39)

There are two ways of "adjusting" a person to his situation without producing growthful change. One is to stabilize the person by the use of medication.... Medication... will prevent trouble, but it will also prevent change and make the situation chronic.... The other method of adjustment is long-term individual therapy focusing on helping the person to understand his childhood development and his misperceptions rather than the reality fo his present life situation.

Many wives, for example, discontented with the narrow pattern of suburban life, have been stabilized for years by intensive analysis. Instead of encouraging them to take action that would lead to a richer and more complex life, the therapy prevents that change by imposing the idea that the problem is within their psyche rather than in their situation.

If one thinks of therapy as the introduction of variety and richness into a person's life, the goal is to free the person from the limitations and restrictions of a social network in difficulty. (pp. 43-44)

Neruosis or psychosis in animals seems only to occur when human beings have intervened-- not in nature. (p. 45)

Among most animals, those who fail to establish a territory of their own... fall to the lowest status in the community and do not mate. They become peripheral animals, wandering about on the edges of the territories of others.... The peripheral animals of most species are undended and uncared for. They are nature's discards, and are offered up to predators as part of the protection of the group. Their life is comparatively short, and they do not breed and reproduce their kind.

In the human species, the peripheral discards are offered up to the helping professions: charity, social work, psychology, and psychiatry are applied to them. The helping professions are, by their nature, benevolent helpers and also agents of social control. In their benevolent aspect, they attempt to help the social deviant to obtain a job and a mate and to become a functioning part of the community. As controllers, they attempt to herd the deviant into an institution, where he is kept from being troublesome to those who have won space and achieved status. Sometimes this is also thought to help him. (p. 46)

One of Erickson's characteristics is his willingness to be flexible in every aspect of his therapy. Not only is he willing to see patients in his office, in his home, or in their place of business, but he is also willing to have short sessions or interviews lasting several hours. He might use hypnosis, or he might not. He will involve all family members at times and not at other times. ...he is also willing to have a session in the form of a social call. Haley, (p. 115)

One of the more interesting aspects of this case is the way Erickson arranged that after six months of treatment the girl requested that she be able to do something about making herself more attractive. She was not then resisting change but piteously seeking it. Haley, (pp. 119-120)

... there must be a framework defining the relationship as one designed to induce change, and within that framework no direct request for a change but an acceptance of the person as he is. Throughout the case, when Erickson requests a change it is defined to the patient as an estension, really quite a minor one, of the way he already is. Haley, (p. 125)

[Therapy is a paradoxical relationship designed to induce change, and the way change is triggered is by accepting the client as he is.]

... within a period of two or three years a manual laborer who considered himself a dumb moron... was shifted from being a peripheral person living on the margin of society to being a participating member of reasonable high status. This goal wa achieved without any exploration 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 relation between his past and present through anything like transference interpretations. No past traumas were revealed to him or explained as "causal" to his difficulties. His presumably miserable childhood was offered as neither excuse nor explanation for his failures or his poor opinion of himself. In fact, instead of bringing ideas about the past inito 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.

The therapeutic approach was distinctly Ericksonian and included many tactics appropriate to a learning experience; however, what was learned was not why he was the way he was but how to be different and successful. Haley, (p. 135)

It does not seem accidental that people most frequently go crazy-- become schizophrenic-- in the late teens and early twenties, the age when children are expected to leave home and the family is in turmoil. Adolescent schizophrenia and other severe disturbances can be seen as an extreme way of attempting to solve what happens to a family at this stage of life. When child and parents cannot tolerate becoming separated, the threatened separation can be aborted if something goes wrong with the child. By developing a problem that incapacitates him socially, the child remains within the family system. The parents can continue to share the child as a source of concern and disagreement, and they find it unnecessary to deal with each other without him. The child can continue to participate in a triangular struggle with his parents, while offering himself and them his "mental illness" as an excuse for all difficulties. (p. 61)

Erickson puts a primary emphasis on shifting [people] toward success in work and love. He does not usually review their past with them, nor does he help them to understand why they have problems. His general apporach is to accept the ... person's way of behaving while simultaneously introducing ideas and acts that lead to change. What he does with a particular patient will vary, and therefore he approaches each new ... person with an open mind as to possible interventions. In one case he might work with hypnosis to provide an elaborate shifting of ideas, in another he might focus on reducing a problem to absurdity, and in another he might require quite specific acts. (p. 66)

Whether Erickson uses hypnosis or not, he typically directs people to behave in particular ways. Although many therapists are reluctant to tell people what to do, partly because they fear the people will not do it, Erickson has developed a variety of ways to persuade people to do what he says. Commenting on this once in a conversation, he said, "Patients usually do what I tell them, largely because I expect them to. A patient said to me, 'You never make an issue of my doing what you say, you just expect it in such a way that I have to do it. When I balked and tried to avoid it, I always wanted you to try to force me, and you'd always stop short. Then I'd try a little harder to made you force me to do it.' In that way she would come closer to me in the performane of what I wanted.

"But you see, that's the way human beings are. Whenever you start depriving anyone of anything, they are going to insist that you give it to them. When I instruct a patient to do something, that patient feels I'm ordering him. They want me to be in the unfortunate position of failing at that. Therefore they've got to keep me in the active task of ordering them. When I stop ordering them at the right moment, then they substitute for me and do things for themselves. But they don't recognize that they are substituting for me." (p. 70)

The more modern view is that symptoms develop as ways of adapting to intolerable situations, and when the situation is resolved, the symptom will haved lost it's function and disappear. (p. 170)

It is characteristic of Erickson that his range of responses to problem situations is as wide as the kinds of problems that appear. He can be firm and require certain behavior from a young couple, or he can be amiable and influence them in indirect ways. Most typically, he prefers an approach that "accepts" a person's way of behaving, but in such a way that it can change. If a married couple is fighting, he does not ask them to stop but encourages them to fight. However, he arranges that the fight achieve a resolution of the continuing problem. For example, a couple who always fought with a mother-in-law at the dinner table were required to take her for a ride in the desert and have a fight. To fight in a different setting, and because they have to, shifts the nature of the quarrel and makes it more difficult to continue. (p. 177)

In Erickson's approach, there is always an emphasis on the presenting problem that brings someone into therapy. When a symptom is what the person seeks to recover from, Erickson works directly on the symptom, and through it he makes whatever changes in relationships are necessary. He argues that the symptomatic area is the most important and intense to the person with a problem, and therefore it is in this area that the therapist has the greatest leverage for change. (p. 179)

.... treatment can go surprisingly quickly if one adopts Erickson's premise that the long-term goal of treatment should be the immediate goal. (p. 188)

He first accept completely the patient's position, in this case by saying, "That hurts awful, Robert. That hurts terrible." Next he makes a statement that is the opposite of reassurance. He says, "And it will keep right on hurting." ...Once he has done this, he can offer a move for change by saying, "Maybe it will stop hurting in a little while, in just a minute or two." (pp. 192-193)

When a child is misbehaving, Erickson does not help him understand the reasons; he arranges that he behaves more properly. Often his ideas sound old-fashioned. For example, if a child will not eat his breakfast and the mother is upset, Erickson will provide her with a procedure to resolve this. He will have her cook the child a good breakfast, and if the child does not eat it, then the mother is to place the breafast in the refrigerator. At lunchtime she is to bring out the breakfast and offer it. If the child does not eat it, at suppertime she will again offer the same meal, and continues with this until the child eats it. (p. 212)

"I know some schools of therapy would recommend that a couple with these buried resentments should express them to each other and work through them. My own view is that it is best to bypass the issue when one can. If the house is uncleanable, don't try to clean it; move out into a new one." (p. 233)

Paraphrase: A young woman came to Milton Erickson because she was alarmed about her possessive parents. What was most upsetting to her was that they'd built rooms onto their house so that when she married she could live there. Erickson say the parents together, and they had a series of pleasant talks. He praised them for their solicitude, for being available as babysitters. He asked if they'd soundproofed the walls so the babies crying in the night wouldn't bother them. It happens they hadn't. He congratulated them on being willing to put up with toddlers, the way toddlers get into everything and everything breakable has to be put away.

The parents decided they really didn't want their daughter living with them. They decided to rent the rooms to a quiet person and bank the money for their granchildrens' future education. Erickson commented, "Is it essential to feel guilt? I don't believe in salvation only through pain and suffering." (pp. 280-282)

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