Discovering the Resources We Possess by Dr Elizabeth McCardell, M. Couns., PhD

 

August 2024.

 

“Every person has more resources than they realise”, as Milton Erickson put it. Erickson was a founder of modern hypnotherapy, an American psychiatrist whose greatest skills were his capacity to observe and listen very closely to his clients and utilize their inherent resources. 

 In such close listening and observing he learned much more about the whole person than his medical diagnostic training may have produced, and he acted on it. His methods were quite eccentric. Sometimes someone would come to his Phoenix, Arizona house with a particular problem but who was so preoccupied with the issue that they didn’t actually listen to what Erickson had to say, so he had them climb a high peak outside the city and then come back for their session. Then, the real work could happen. Another client came to study Erickson’s methods (and he came preoccupied with his own self importance), so Erickson had him work in the garden, which was cacti and stones and not much else. When we are preoccupied, we neglect paying attention to very ordinary things so encouraging the doing of the ordinary is very valuable. Climbing a mountain or talking about ordinary things,  puts clients back in their bodies and makes them attend to the here and now and thereby reconnect with the resources that they’d forgotten about.

 I’m less about extremes, but I will talk about ordinary things – interspersed with the problem that the client came to work out – to reassert a groundedness and to help the person not get stuck in the murkiness of the issue that has preoccupied them.

We all have more resources than we realize, and attending to ordinary everyday stuff is part of that. Erickson used this knowledge to regain muscle strength and mobility after spending a year in an iron lung after contracting polio at age 17. He began to explore autohypnosis and concentrating on the body memories of the muscular activity in his own body. He learned totweak and stretch his muscles and to regain control of parts of his body, to the point where he was eventually able to talk and use his arms. Then he trained his body by embarking and completing a thousand-mile canoe trip. Extraordinary man! On his return he attended the University of Wisconsin-Madison, graduating in both psychology and medicine and then in psychiatry. All these experiences helped in his work with clients and students. Most particularly, though, they focussed attention to the people around him; enabling him to notice not just what they said, but how they said it, and what their bodily expressions had to add to their presence.

 Unfortunately polio comes back to bite you. The virus that affects the nerves and the spinal cord and may affect the breath and can lead to paralysis, doesn’t go away, but returns later on in life. In his late 40s Erickson got post-polio syndrome and became too weak to walk, even with sticks, and so was bound to using a wheelchair.  But this article is less about Erickson and more to do with listening and observing and utilizing all the resources we all have.

 He didn’t just listen to what the clients said they wanted, but observed them to identify what they needed.  This is not to say that Erickson always got it right. There are several cases that he missed the boat entirely, but this is not unusual for any therapist. We are  fallible. Nevertheless, what he taught us about listening, observing and utilizing the resources and strengths each client brings to a session is invaluable. We need to move beyond a self or medical defined diagnosis (eg the person who comes saying they have clinical depression) to understanding how ordinary resources can be drawn upon to grow beyond their problem story. The art, of course, is to say this in an acceptable way to the client, so that they  do not simply reject the therapeutic session. Exploring the subtleties of generally overlooked resources can be the way forward to untangling presenting problems in a safe and acceptable way. Listening, observing and witnessing person is critical and doing good work from that point onwards.

 

 

 

 

 

 

Sound Knowledge Makes for Good Therapy by Dr Elizabeth McCardell, M. Couns., PhD

 

June 2024

 The other evening I did a Mental Health Professionals Network online discussion group event with other hypnotherapists talking about using hypnotherapy for the treatment of chronic pain and phobias. It was nice being in a group of fellow practitioners talking about things I'm passionate about.

 One thing that I couldn't swallow was the uncritical way a couple of the therapists described their use, and training, in Neuro Linguistic Programming (NLP), to the exclusion of other more fundamental studies of human behaviour and, more critically, psychopathologies. You can't treat the habitual use of tobacco or any other substance or behaviour - you can't really understand the psychology behind addictive behaviour at all - just by studying our communication styles (the basis of NLP). You really do have to have made concerted study of the human body-mind beyond what you can achieve in a maximum of 15 days. In 15 days, according to the training websites for NLP, you can get certification as a Master Practitione. And that's all a few of the participants in the MHPN hypnosis group had in the way of other training, apart from hypnotherapy.

 I tear my hair out. I used to teach a unit in Advanced Personality Disorders to Psychology students at Murdoch University, Perth. The human psyche is complex. I also note that I did my Honours dissertation in the area of psycholinguistics prior to researching and writing my PhD in the philosophy of human transactions and interactions.  I know how communication works, and I know much of how the mind works and I am still learning. Why do I mention this? It's to illustrate that the 15 years or so of concerted study in the areas with which we are concerned: treating humans with human problems didn't happen in 15 days.

 It worries me that practitioners of NLP who have not been trained in anything else, and other inadequately trained therapists are garnering lots of money with such a flimsy understanding of what they're dealing with.  Neuro Linguistic Programming sounds good, to be sure. It sounds scientific, neurological; it’s got “programming” in its title; must be good. This ain’t necessarily so. No studies, apart from lived experience accounts, have shown it’s an evidence based therapeutic strategy. Of course, lived experience accounts matter, but – and we have to caste a critical eye over this – how much positive outcomes are of a placebo effect? After all, paying a substantial amount of money and time encourages us to think a therapy is working. And maybe it does work for some people. The philosophical basis of NLP, though, is debateable, as I shall describe.

 Now, to be perfectly transparent, some aspects of NLP are useful and are used, anyway, in most other therapeutic modalities. What the founders (Grindler, the linguist, and Bandler in the 1970s)) of NLP did was, they believed, at least, to distil and systematize the therapeutic approaches of other client oriented therapies (those of Virgina Satir, Milton Erickson and Fritz Perls). It employs anchoring, belief changing, reframing, visualization and visual-kinesthetic dissociation where the client is asked to relive the trauma in a dissociated state (the latter of which could be dangerous in the wrong hands). They also state as a fundamental, that the map is not the territory (which it is true, it isn't). What Grindler and Bandler and their followers failed and fail to realize that while we can study the therapeutic styles of the masters, we cannot decide that success lies with imitating them. Milton Erickson, whose hypnotherapeutic work was legendary, pointed this out to Grindler and Bandler, but his wisdom fell on deaf ears. Erickson’s work really could not be pinned down and his style differed from person to person. Jung, after all, said decades previously, that there are as many therapies as there are people. We are all different and the therapist must work accordingly.

 That's the beauty of being a therapist - and a well trained one: we understand human processes, we've studied when things go wrong and what do with the person to heal them, and we listen to each person's uniqueness and work with that, work with them.

 It's a beautiful work, a study of which never ends.

 

 

 

 

 

 

 

 

 

 

 

An Uncommon Therapy by Dr Elizabeth McCardell, M. Couns, PhD

November 2018

     Uncommon Therapy, the Psychiatric Techniques of Milton H. Erickson, is the title of a book  by Jay Haley on the strategies and practices of Erickson, the father of modern hypnotherapy.  Fundamental to how Erickson worked was just getting to know how the patient thought and interacted in their world, their potential, the things that mattered to them and then utilizing this knowledge in therapy. For him, the patient was unique, first and foremost. He said that the therapist needs to be flexible conceptually and behaviourally to respect, respond, or redirect the patient’s potential to the full benefit of themselves.

     A lot of therapeutic practices are driven by theory and preconceived classifications and notions of what good therapy should be so the perspectives of the therapist tends to dominate where the therapy goes.  I’m thinking here of certain aspects of psychoanalysis, or the medical model and increasingly the health insurance model that utilizes psychiatric classifications of mood and behavioural problems as set entities, or the idea that mere symptom control is sufficient in every situation, or that therapy needs to be swift and superficial all the times, etc. For some  practitioners of these one-size-fits-all therapies, an alternative model based on the fact that each case, each person, is unique tends to be seen as bizarre.

     Erickson (1901-1980), an American psychiatrist and psychotherapist, went elsewhere. He chose a therapeutic approach particular to the individuality of the person before him and worked that way. Unique people require unique therapeutic approaches that utilize their uniqueness and we are all unique. This took the form of traditional sessions in his consulting room, or he insisted a client climb a particular Arizonian peak or visit a botanic garden, or he invited his patient to watch television at a set time each day with his family (shock, horror), or to work in his garden, or home visits, and so on. This was very much uncommon therapy. It was flexible, it listened to the hang-ups, the foibles, the strengths, the frailties, the needs as well as the non-needs of each person and utilized them.  But before doing therapy of this kind, Erickson needed to be with the person’s experience, to listen, to question, to get a feel for the person.

     It is interesting that, in a desire to practically bottle Erickson’s presence and approach, numerous of his followers tried to pin what he did down to a formulation of his style and personality to be imitated by others, as though this was even possible. Erickson, like you, like me, was unique. He lived according to himself. He could not hear tonality in speech and music was dead to him, he was colour blind (able to see only the colour purple), he had been crippled by polio and post-polio syndrome in his 50s, he was talented, flawed, obstinate, highly intelligent, dogged, frail, methodical, practical, scientific even. What he did was listen to what people said and how they said it, he interacted with them (and the therapeutic relationship is critical to effective work), he supported, he created safety, he held back from getting in the way of good therapy and he did what was required. But not always. He sometimes missed the mark, just like all therapists.

     His was an uncommon therapy. He used a more traditional hypnotic induction techniques in his work, but not always. Sometimes he just did an ordinary act differently in order to get a person out of their conditioned, trancelike way of thinking. Sometimes he just talked of ordinary things a patient loved to do, like growing tomatoes that had the effect of reconnecting the person to other parts of their lives and thus initiating their psychological healing. In other words, Erickson played with the known and the unknown and thus stimulated change.

     I like Erickson’s thinking and the freedom he has brought to me through his writing and my contact with therapists trained by him to work according to the me-ness of me, and not as a tired imitation of him, or anybody else. This is what drives me: to meet with my patients where they are and where I am in these unchartered waters of an uncommon therapy and work there effectively.

Changing how we listen to noise By Dr Elizabeth McCardell, M. Couns., PhD

If the noise bothers you, listen to it.  (John Cage, 1912-1992)

      We live in a world of confusion: lights, colours, engine sounds, voices, ideas – a multiplicity of ideas, signs, symbols – a rap dance of images, people telling us what to do and what not to do, smoke/don’t smoke, drink/don’t drink, get a job, get an education, be true to yourself/follow the crowd and don’t be too different, stay with an abusive family, because they’re family; noise, so much noise. What to do, how to be?

     In the noise we seek solace and sense. Some seek solace in the arms of someone else, anybody else, and a whole lot of them. Some look to security in substances and food that allow them to bliss out, at least temporarily. Some gamble on the horses and dogs and coins and leaves fluttering to the forest floor.  Some watch television, show after show. Some run and cycle frenetically, till their muscles melt. Some read books, book after book, till their eyes burn. Some meditate for so long they lose touch with the ordinariness of the world. Some play video games, day after day, night after night, and so on. None of these things are wrong in themselves, but when done to extremes, then there is a problem.

      Noise. We humans are really challenged in the face of noise.  We hate it. Confusion is so unsettling that we seek a solution to clear it up, or at least  find something, anything to stop it.  

      Clinical hypnotherapy uses this propensity as an amazingly valuable tool.  We practitioners use confusion to elicit a hypnotic state, to deliberately create a dissociated condition in which the client’s unconscious is able to respond with a greater capacity of autonomy than their usual waking state.  In this state, the unconscious mind is more amenable to hearing alternatives – and hopefully more healthy helpful ones – to the problem choices the client was making previously.  

     Milton Erickson (1901-1980), the father of  modern clinical hypnotherapy, used this technique beautifully. Consider the following, 

[…some family member or friend] … knows pain and knows no pain and so do you wish to know no pain but comfort and you do know comfort and no pain and as comfort increases you know that you cannot say no to ease and comfort but you can say no pain and know no pain but know comfort and ease…

      There is a play on the words, “no” and “know”, as well as on “you cannot say no to ease and comfort,” but “no pain” and “know no pain but know comfort and ease.” Just in these words, focus is shifted from a focus to ambiguity and in this shift, the locus of pain dissipates, for these are not just words, but a physiological perception as well.  

      I recently was asked to do a hypnotic session on a woman about to have surgery on her foot (very damaged in a horse riding accident). She’d had several surgeries under general anaesthetic and the surgeon wasn’t keen on giving her more general anaesthetic if it was possible.  I used a confusional technique and shifted her awareness from her foot to noticing how her hips feel when she is dancing (for she is a dancer), and so she imagined the dance. She got through the whole surgery without needing a general anaesthetic and was, in fact, not aware of her foot at all.

      I use confusional techniques often because they work so brilliantly and quickly. There are several kinds of confusional techniques (humour, surprise, amplifying polarities, double-binds, paradox, etc), and all are designed to shift awareness, and in a long term way. All serve to break the current problem story, and facilitate healing. In fact, clients say to me, after I ask them on a follow up session how they’re getting on, “What problem? I haven’t got a problem.” This is sometimes quite disconcerting for me, but nevertheless I see they’re right, they really do not have a problem any more, and it feels to them that the problem has never been there.

       Re-entering confusion thus loosens and expands a person’s capacity for being present with other ways of being. It is pretty hard to make someone do something they don’t want to do. You can’t say to some smoker, “Give up smoking, or else!” and expect them to follow suit. The old style of hypnosis uses this direct approach, but generally the effects do not last. What prohibition does is set up resistance to the idea of change. What re-introducing confusion does is shift consciousness from the focus on the problem to multiple other ways of seeing, such that the problem is no longer a problem and resistance has been circumvented. It deliberately disrupts clients’ everyday mental set to allow a suggestion in without the client desiring to resist it.

      Noise thus has a purpose. Listen to it, and it will teach you things.

      Some years ago I attended a series of talks, chants and meditations from visiting Tibetan lamas over at the Perth State Library. I’d park my car in the underground car park and then catch the lift to the place the lamas were, sit cross legged, meditate and listen intently. Then I’d get up and go to the lift and down to my car. There in the underground car park was a deafening air conditioning unit. By the 7^th day, I could hear the chanting lamas in the air conditioning unit, in my car engine, and in the wind. I can still hear the chanting these 10 or so years later.  There is no longer noise, but a greater willingness to listen to the layeredness of confusion and seek other ways of understanding things, other than my own story. It’s there in the hum of things, this place of many ways of being. There are many other choices than the one that locks us in.