Mind For Therapy

 
Erickson speaks to this idea of utilization in an example from his own life, in which his son fell down the stairs, split his lip, and knocked his upper tooth back into the maxilla, the fused bones that support the upper teeth.

           " No effort was made to pick him up. Instead, as he paused for breath for fresh screaming, he was told quickly, simply, sympathetically and emphatically, ‘That hurts awful, Robert. That hurts terrible."

"Right then, without any doubt my son knew that I knew what I was talking about. He could agree with me and he knew I was agreeing with him completely. Therefore he could listen respectfully to me, because I had demonstrated that I understood the situation fully" (Erickson, 1967, p.420).

 From this point of mutual acceptance of the situation, Erickson was able to utilize other aspects of this problematic situation with his son. Acceptance and validation of the person’s experience of the problem is the first aspect of being able to move forward with utilization of the resources that are less apparent in the context of the problem.

“At the heart of the Ericksonian utilization approach is a humorous, respectful and loving acceptance of the client’s perceptions and behavior” (Dolan, 1985, p.11). This according to Dolan, includes the problematic behavior. As she goes on to explain that it is crucial that a therapist accept the problematic behavior as legitimate communication and then communicate undeniably back to the client a nonjudgmental stance. This is evident throughout Erickson’s work and is impressively apparent in the case example with his son Robert.

Holding fast to a nonjudgmental and accepting stance the therapist allows himself or herself to then shift to allowing for the possibility that the problem or problematic behavior of the client may be a valuable resource to therapy. “Problems often constitute resources when viewed in a flexible manner” (Dolan, 1985, p.15). Utilization is using whatever it is the person is already doing (Lankton & Lankton, 1986).

Within a context of therapy, the concept of problem is present whether through implication or overt discussion. The question now to ask is what sort of problem is going to be created in therapy. This is not a new idea, but perhaps it is one that has lost focus in a swarm of strengths based approaches. Brian Cade and William O’Hanlon speak to this phenomenon in their book A Brief Guide to Brief Therapy:

Behavior Therapist “discover” behavioral problems; analysts “discover” intrapsychic problems, their origins often in childhood; biologically oriented psychiatrists “discover” evidence of neurological problems and chemical deficits; structural/strategic therapist “discover” hierarchical ambiguities and coalitions; contextual therapists “discover” the effects of intergenerational injustice and exploitation; brief therapist “discover” self-reinforcing patterns of thought and action (1993, p. 50).

Milton Erickson stated in an article published in 1954 that “a proper therapeutic goal is one that aids the patient to function as adequately and constructively as possible under those internal and external handicaps that constitute a part of his life situation and needs” (p.390). The implications of this statement are that the therapist’s goal is not to alleviate the problem all together or attempt to fix the person but to aid them to find constructive ways of function given their life situation. The problem is seen as part of the life situation and is also necessary for the client. Later in the paper Erickson, in discussing a particular set of patients, stated, “apparently both patients desperately needed a neurotic disability in order to face their life situations” (p. 393). Erickson recognized that problems are an element of life that in some cases can not be worked around and should be embraced in an effort to help the client live a more functional life. It is also important to address that this does not mean that the “problem” is a static part of the person or a disease that must be lived with, but a real and important state in which the person finds themselves, at least for the present.  There must be a distinction between the idea of conceptualizing the problem as a necessary part of the given nature of the existential context and pathologizing the problem into a crystallized form within the client.

Erickson states, “Consequently, the therapeutic task becomes a problem of intentionally utilizing neurotic symptomatology to meet the unique needs of the patient” (1954, p. 390).  Erickson utilized hypnotic techniques with these strategies to help to aid change and growth in his patients; however hypnosis is not the necessary element of therapy to bring about such change. Yvonne Dolan elaborates, “Reframing is another aspect of the process in which the therapist utilizes (incorporates) the symptomatic problem behavior as part of the change strategy” (1985, p. 90). As stated earlier, a fundamental aspect of this approach is acceptance of the experience of a problem in an attempt to establish between the therapist and the client a mutual understanding that reduces the likelihood of resistance to change.

What happens when one “accepts” the resistance of a subject and even encourages it? The subject is thereby 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 (Haley, 1986, p.24). 

Erickson utilized a process of substituting a symptom (or problem) that would more easily fit into the lifestyle and frame of reference of the client or clients (Erickson, 1954). An important aspect of this strategy is an adequate understanding of the family and social situation that surrounds the clients in order to successfully frame the intervention in an acceptable manner. The problem that is substituted should be related to the initial complaint, but inherently different. The result of this intervention is a satisfaction of the client’s need for a problem situation and an achievement of therapeutic goals established at the beginning of therapy by the client (Erickson, 1954).

Erickson also used strategies that transformed problem behavior into resources for therapy. In this transformation the purpose of the problem is reframed to serve a useful purpose for the client. This type of technique has been utilized by Jay Haley and others from a strategic tradition but is directly taken from Erickson. Erickson described the technique of symptom transformation that he used in hypnosis as that of a magician’s use of distraction to achieve his purposes (1954). 

The technique of symptom amelioration was used by Erickson when the client has developed an overwhelming symptom complex which is out of proportion to the maladjustment problem (Erickson, 1954) This enhancement of the symptom is distinctly useful when a client has surrendered to the problem and has ingrained himself/herself in, as Erickson called it, the problem complex. In other words the problem has become part of how the person defines self. In such a case avoiding the problem or even trying to transform or substitute another problem will prove to be difficult because any variation from the problem will require the person to redefine self. In such a case an apparently complete acceptance of the problem is necessary to achieve any change in therapy. With a complete acceptance of the problem the therapist and client then seek to improve the client’s application of the problem. 

Many of the elements of Ericksonian utilization can be found in the psychotherapeutic strategies and approaches used in practice today. This long standing use of Erickson’s approaches give credence to the relevance of his ideas in current clinical practice. The following are some examples of utilization of elements of problematic context to seek improvement.