Workshop 15 Handouts - The Eleventh International Erickson ...

Workshop WS 15
Expectation: The Essence of
Very Brief Therapy
11th International Congress on
Ericksonian Approaches to
Hypnosis and Psychotherapy
December 9, 2011 1:00 – 3:00 pm
Transforming Ericksonian Methods
Presenter: Rubin Battino, MS, Mental Health
Counseling
Adjunct Professor Department of Human
Resources (counseling), Wright State University
440 Fairfield Pike, Yellow Springs, OH 45387
rubin.battino@wright.edu.
www.rubinbattino.com
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Outline of Talk
• Introduction – brief history of brief therapy
• Central role of expectation
• Theory of Change
• As-If and the Miracle Question
• Ambiguous Function Assignments
• Ordeal Therapy
• Inclusivity Therapy
• Metaphor Basics
Outline continued
• Narrative Therapy
• RB’s Guided Metaphor
• Rossi’s Four-Step Approaches
• NLP Approaches
• When All Else Fails
• Universal Very Brief Therapy Intervention
Experiential Exercises Throughout
(instead of lecturing)
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Educational Objectives
• To understand the central importance of
expectation in doing very brief therapy
• To describe two or three methods that can be
used for very brief therapy that use hypnosis
Brief History of Brief Therapy
• Psychoanalysis. Brief = 50 sessions
• De Shazer et al. study: 5 vs.10 sessions
• Moshe Talmon’s Single Session Therapy
a. 85% satisfaction rate
b. NO correlation between clients and therapists on
what they said helped
c. NO correlation with therapist orientation
RB’s definition of very brief therapy = 1 or 2 sessions
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Central Role of EXPECTATION
• My expectation has a great deal to do with it [success rate].
... I have worked with people who have failed to learn with
other people. They say, “The difference is I know you
believe.” Kay Thompson
• I’m inclined to entertain the notion that the relative efficacy
of most psychotherapeutic methods depends almost
exclusively on how successful the therapist is able to make
the methods fit the clients’ expectation. Jerome Frank
• The effectiveness of placebos results from their ability to
mobilize clients’ expectancies for improvement.
Frank and Frank
Does Expectation = Placebo = Expectation?
Freud (1960) reported
that he cured Gustav
Mahler’s sexual
impotence during a
single long walk
in a park in Vienna!
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“What are you willing to change today?”
Mary Goulding’s opening remark
“When are you able to control the problem
rather than it controlling you?”
David Nylund’s narrative therapy question
“Please do not tell me anything you do not wish to
tell me.”
Milton Erickson’s frequent opening remark.
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When patients come into my office,
I greet them with a blank mind and I
look them over to see who and what
and why they are without taking
anything for granted.
Erickson
“Whenever I have an hypothesis about
what is going on in my client, I lie down
until it goes away.”
Bill O’Hanlon (citing someone else)
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RB’s Model of Therapy
Client is stuck because a stimulus in
environment yields ONE interpretation
which yields ONE response.
Therapist’s job is to help client find other
interpretations and other responses. That
is, help the client to realize CHOICE.
Or go from involuntary to voluntary behavior.
Theory of Change
Watzlawick, Weakland & Fisch (1974)
• First-Order Change: characterized by
dong more of the same. That is, working
within the system.
• Second-Order Change: external to or meta
to or outside the system. Paradoxical,
illogical, unexpected, puzzling, strange.
• Reframing (content or context) is the
approach of choice.
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AS-IF
• Acting “As-If” is magical
• No physiological differences between real and
acted emotions
• On coin-toss have spouse act next day as-if
relationship is improving.
• Act as-if chemotherapy were a gift from God
(rather than a poison).
• Act as-if you were happy, etc.
Miracle Question from Solution-focused
Brief Therapy
“Suppose that tonight while you are asleep
that a miracle occurs, and the miracle is that
what prompted you to come talk with me
today is realistically solved and resolved.
When you wake up tomorrow morning, what
will have changed in your life? What will be
different? How will you and others know
that the miracle has occurred?”
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Ambiguous Function Assignments
• Assign an ambiguous, but specific task.
• Therapist expects that the client will discover
useful solutions, insights, and information.
Assignments must be safe.
• Some Assignments: climb something; walk in
the woods or mall being alert; carry some
(heavy) symbolic object; random reading; visit a
museum, zoo, botanical garden, circus with
expectation.
Ordeal Therapy
• Characteristics: must be more severe than the
problem; generally related to the symptom;
usually involves something beneficial like
exercise; must be do-able by client; does not
harm; link to occurrence of symptom.
• Some Ordeals: exercise in the middle of the
night; catch up on reading or filing or writing;
house-cleaning and other chores.
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Inclusivity Therapy – Bill O’Hanlon
Clients and therapists tend to think EITHER/OR rather
than BOTH/AND. Either a person is depressed or not.
Clients can be released from this restricting bifurcation
by oxymoronic suggestions:
• happily sad or sadly happy
• depressingly energetic or energetically depressed
• calmly tense or tensely calm
• you can feel angry, and you don’t have to feel angry
• you can forgive and not forgive at the same time
• that was either a terrible thing or it wasn’t
Metaphor – Therapist or Client-Generated
• Metaphors need to be sufficiently VAGUE and involve
MANY possibilities. Client picks what he/she needs
from the choices.
• Some Basic Themes: visit to guru or wise person;
hero’s journey; construction of a building; weaving;
baking; sailing; growing plants
• Richard Kopp: client-generated metaphors
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Narrative Therapy – Michael White
and David Epston
• The person is not the problem – the problem is
the problem
• Externalization: the client’s behavior is
controlled by an internal negative thing or spirit
or gremlin. Exorcise this demon.
• Uses family history, life history, social network,
letters, certificates of achievement, etc.
Guided Metaphor: Everyone has and is
a story they tell themselves and others.
Six Steps of Guided Metaphor
• Introduction about life stories
• Elicitation of “old” life story with sentence plus word or
phrase.
• Elicitation of “new” life story with sentence plus word
or phrase.
• Elicit how new life story has changed their future.
• Delivery of personal life metaphors and future.
• Ratification and re-orientation.
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Rossi’s Basic Four-Step Approach
• Establish that client is ready to work.
• Do inner search of all material relevant to
concern.
• Review all possible realistic options to solve or
resolve that concern.
• Ratify with an ideomotor signal (a kinesthetic
anchor) that client will choose option(s).
Rossi’s “Moving Hands”
• Hands out in front move towards each other –
readiness
• One hand and arm drift down – inner search
• Other hand and arm drift down – search for
realistic solutions
• Nod head to indicate willingness to use
solution(s) - ratification
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NLP Approaches
• “Swish” method using submodalities
• Time-Line Therapy
• V-K Dissociation for phobias
• Six-Step Reframing
• Changing Personal History
• Meta-Model of language usage
• Really Listen
• Ask the Client
• Minimalism (Rossi)
• Switch Roles
When All Else Fails
• Look at yourself from …
• Provocative Therapy (Farrelly)
• Crystal Ball and Pseudo-Orientation in Time
• Universal Very Brief Therapy Intervention
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It is the expectation of the therapist
that therapy can be both very brief
and effective that is the essence of
working in the very brief mode.
THANK YOU
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