International Handbook of Clinical Hypnosis - E-Lib FK UWKS

90 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
long-suffering victims of exaggerated shortcomings or the insensitivities of others.
Notice the underlying dynamics in this hypothetical exchange:
grandson: Grandma, howare you doing?
grandma: Oh, I'm lonely.
grandson: Why don't you go out and meet some people?
grandma: Oh, my bones ache and it's too far to walk down the stairs.
grandson: Why don't you call some people and have them come over?
grandma: I would, but the house is such a mess and I don't have the energy
to clean it up.
grandson: Why don't you call people and just talk on the phone?
grandma: I would, but I can't hear too well. Why bother?
While Grandma presents herself in a clearly one-down role, she is, however,
controlling and de®ning the relationship in much the same way as a one-up person
might. Bateson described this position as metacomplementary Haley, 1963). A
metacomplementary bind occurs when a person goes one-down in order to get oneup.
It is a bind because these individuals do not experience themselves as one-up.
All symptoms are to some extent metacomplementary binds. In traditional psychiatric
nomenclature, this process is known as `secondary gain.'
As is true in the one-up situation, discussing secondary gain with the patient
does not seem to produce therapeutic change. During a graduate school internship,
I treated a woman who was afraid of venturing into stores. Her fear put her onedown,
but because her condition prevented her from doing the family shopping, a
task her husband had to assume, she gained a measure of control in her marital
relationship, and on this issue at least, she was the de®ning partner. When I
confronted her about secondary gain, she replied, `I don't want control. I just want
to be able to shop.'
The one-up person not only controls and de®nes the relationship, but also
induces roles in the one-down person which can be functional or maladaptive. The
permitted roles for the one-down person could include martyr or helper, being
stupid or ineffective. By assuming the one-up position, the clinician can direct
therapy and elicit effective roles.
SYMMETRIC RELATIONSHIPS
Some people rigidly insist on an equal status in their relationships. Such a
symmetrical relationship can, however, escalate and become problematic. Interaction
can be tenuous and unsteady as the two parties attempt to resolve whether