Strategic therapy; techniques used by Milton Erickson

Whilst looking at my blog stats, it came to light that many people had arrived here whilst searching for information on the therapeutic techniques used by Milton Erickson. I recently had to write about them myself, and became aware that there are not that many online resources for this information; particularly ‘simple’ ones, that aren’t buried deep in the middle of other (wonderful, of course) academic works. It is with this in mind that I have decide to post a small extract from one of my essays about him, in the hope that it will prove useful to any other out there who find themselves in the situation I was in – hope it helps! 

Jay Haley, the popular proponent for this approach, wrote “Strategic therapy isn’t a particular approach or theory, but a name for the types of therapy where the therapist takes responsibility for directly influencing people” It is developed from the work of  Milton H. Erickson MD, one of the world’s leading hypnotists and psychiatrists. Erickson believed that within one’s consciousness, everyone has the power to heal himself or herself, and he used some quite revolutionary techniques to facilitate the client’s acknowledgment of these resources.

His work with hypnosis continued directly from  Freud’s early findings, where the procedure was initially used, but abandoned in favour of other unconscious delving methods such as free-association. Traditional psychoanalytic techniques, although effective, are time consuming, often taking many months for therapeutic progress to be made; psychoanalysis can take years. Erickson wanted a faster moving approach. He believed that the unconscious mind was always alert and listening to the world whether a trance state or waking state;  it was said that he could make suggestions that would lead to a hypnotic state without the client being aware of ‘being put under’ or any such process that could feel unusual or uncomfortable in any way. It must be noted that as the word hypnosis” is used here, it does not apply to a ritual but to a type of communication between people. Milton Erickson explored an almost infinite variety of ways of inducing hypnotic trance and he used this knowledge to engage in what seemed to be perfectly normal conversations with clients however these speech communications would induce a trance.

Acknowledging that both hypnosis and therapy require persuasion, a degree of cooperation and motivation from the client, Erickson recognised that even when motivated, clients would still resist the benefits offered by the practitioner. There are two main types of resistance: not being quite cooperative enough, and being too cooperative. When a subject does not respond quite as he should, the therapist accepts that response, and encourages it so that the client finds himself caught; his attempt to resist is now defined as cooperative behaviour; No matter what he does, he is following the therapist’s suggestion, obliging is unavoidable, and once that is acknowledged it makes the whole process clearer. Once the client and counsellor are truly working together the new desired behaviours can be introduced and accepted.

Reframing would be used to recast a particular conflict or situation in a less threatening light. For instance; a father who constantly pressures his son regarding his grades may be seen as a threatening figure by the son. Reframing this conflict would involve gently steering the conversation into focusing on the father’s concern for his son’s future and helping the son to “hear” his father’s concern instead of constant demands for improvement.

Another technique he used, providing a worse alternative; directing the patient in one direction in such a way that he is provoked to go in another. He might ask for a response the subject does not care for, and the subject will then choose an alternative in which he participates fully. We commonly call that ‘reverse psychology’, and although with our traditional views on therapy it may seem odd for a therapist to practise in this way, Erickson proved that using this technique can sometimes provide the jolt a client needs to stimulate their autonomy kicking into action.

Sometimes when a client is particularly resistant, Erickson tried communicating in metaphor; when A is resisted, the therapist can talk about B, and unconsciously realising that the two are connected, the client can do the processing at a more comfortable level for the client.

He also advocated encouraging relapse in clients that were ‘too receptive’. He was aware of the potential for transference within the client/counsellor relationship providing a situation where the client may want to please the therapist, often through ‘over cooperating’. By encouraging the client to revert to previously discarded behaviours, he created a situation where they have either have to resist (thus breaking that transference, and pushing the client into independence) or comply, whereby he can ascertain that the therapy hadn’t been truly effective and then work with the client to find other ways of achieving the desired result, in a more effectual way.

These techniques lend themselves particularly well to group therapy, and as such Brief Strategic Therapy is commonly used as a family therapy. The therapist can take the directive, creating the right circumstances for clients to really get a feel for the point of view and feelings of the others within the group and challenging the group into working together as a team (or not). The therapist can use his powers of guidance to deal with the issues and perspectives he deems necessary, with his objective perspective.

 

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Journal Post 19; 4th feb 2013

 

Quite a different kind of day today – our tutor is away for a few weeks, so we have another lady standing in temporarily, and although she is basically sticking to the same format that our days have always run to before, her style and approach is so very dissimilar that the entire day felt completely unlike any other. Not in a bad way, though; and illustrating clearly for me how two counsellors can practise from the same theoretical background, yet so many other factors become relevant to the type of therapy that will be created; connection, personality, mood, energy levels, intuition – basically, the qualities that go into making every person an individual, every relationship an individual relationship, and thus, every therapy an individual therapy.

‘Check in’ was so much more in depth than it had ever been before – we were questioned not just about where we were, right there and then with our feelings and our mood, but D (the new tutor) wanted to get to know us quickly, so she asked us about our theoretical preferences and leanings – a sure-fire way to get to know what a counsellor is all about. She cut to the nub of me straight away and I got a strong feeling that she felt that vulnerability within me that people so often do, making me feel upset with myself. I had invoked that again – do I need to start recognizing this more clearly when I see it? Is it a warning to me that I am either dipping or flying, and not realising, myself? If I am to be an effective counsellor, employing all the BACP ethics and guidelines regarding self-care, and safety of practice, I must pay close attention to these signals. Yes, I know that I know myself, but my condition can mean that I have a tendency to sometimes ignore myself too – I must make sure that I don’t do this if I am to be safe in my work.

After a visualisation exercise, focussing on grounding ourselves, putting our roots down in this room, in the here and now, making us feel so much more present with ourselves and each other – we began discussing Egan’s ‘Skilled Helper’ theory – a very well used approach throughout the NHS in Britain, and a highly effective strategy used within brief therapy. It is broken down into three simple parts, questions – What is going on? What do I want instead? How do I get to what I want?

Stage I, Current Scenario – What is going on? This is where the counsellor uses their exploring skills to gain an understanding of the story – what has led the client to seek counselling. Skills used by the counsellor would be; open-ended questions, silence, focusing, empathy, paraphrasing & reflecting both meaning and feeling, structuring, summarising. Stage 1 can take five minutes or five years – it may be all someone needs – to get their story out and be heard.

Stage 2, Preferred Scenario– What do I want instead? In this part the counsellor will take a more directive role than in the previous stage, exploring possibilities (akin to the ‘golden question’ from SFBT) – what would the client prefer ideally? Using brainstorming techniques, imaginative thinking, prompting the client into further exploration; ‘what else?’ How might that feel? What would you be doing/thinking/feeling? What will be the benefits when you achieve this? How will it be different when you have done this? Reality check; are there any costs to you achieving this? This part of the approach can be used to regain positivity and really play with ideas – give the client an idea of how their life could be and an idea of what they could strive towards.

Stage 3, Action Strategies – How will I get there?  More brainstorming and creativity initially – ‘Let’s consider as many different ways of achieving this as we can’ leading to an exploration of what action would need to be taken, and eventually formulating a plan. The use of SMART goals is recommended here (Specific, Measurable, Achievable, Realistic and Time-phased), and the strategy is broken down into bite sized chunks of action –‘what will you do first? And then…?’

The key with using this model is that the client’s needs must be kept firmly in the centre of what is going on – the model should be used for the client, not the client for the model. Although, as we found when experimenting with using this in our practical part of the session, it is an extremely easy and effective model to use – such a simple strategy can lend itself to many different situations.

During my (brief) session as the counsellor (our group overran with the timing, so I only ended up with a five minute session – seemingly impossible, but strangely, using the highly focussed approach of Egan, it still worked) we found that stage 1 seemed to contain the bulk of the material; in exploring stage 1 fully, the client’s natural coping strategies were revealed, revealing that she had already pulled herself through to stages 2 and 3 without realising. Upon this being noticed, the client felt much more positive about the situation; a few new strategies were batted about, but her confidence was bolstered by the realisation that actually she had already acted in a positive way intuitively, and she felt encouraged to continue with the approach that she had already embarked on. Bingo!

I felt positive after this session, and the feedback given to me by the tutor on the counselling skills I used was lovely; very, very, encouraging. We spent a little bit of time after that watching a video from ‘Ted Talks’, which was great; very informative, and we had a good old group chat with Donna (our course facilitator) after that, which felt productive, but meant we didn’t get any time for a process group (every cloud has a silver lining! I secretly hate process group, I find it so boring and awkward…)

I was excited to get to the supervision part of the day – having recently started my placement; this was the first college supervision session that I would be able to get involved with properly, and I wanted to tell the group about a particularly troubled client I was seeing, who I felt I needed help with.  When I did though, I felt quite upset though at the reaction I got from the tutor. She seemed to leap at me, barely giving me a chance to explain. An awareness of ‘Safety in my work’ seemed to be her primary feeling that she wanted to communicate to me – she felt that I was possibly taking on too much for a student at my point in my training. But the fact of the matter is that in this placement, all of the clients are in extreme crisis, and it does involve taking on heavy issues. I have had real problems finding a suitable placement, and as long as I don’t feel that this is too much for me, I am very reluctant to let this one go. Yes, I have had an extremely positive response, initially, to this new service that has been set up, but I am well aware that this is probably because it is a new thing for the kids at the hostel, and that once they are used to me being around things will probably settle down and I will be less busy. I think that as long as I am aware of how much I am taking on, and make sure that I don’t bite off more than I can chew, so to speak, I will probably be okay. The overwhelming feeling that I have from this placement is one of positivity, and I do not want to let that get squashed. I have an appointment booked with a new supervisor next week, to discuss my work there fully, and I am excited about that, so I hate to sound so terribly rude, but *blows raspberry* – I will be carrying on with this for the time being, at least! Although, in linking back to the first paragraph of this entry, I am well aware of my own issues, and am keeping a self- critical eye on things, don’t worry…