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 16; Monday 14th january

Today, we began by looking at ‘strategic therapy’ – a model originally developed by Milton Erickson (who is often credited with the founding of several popular NLP techniques that are commonly used) and popularly advocated by Jay Haley, for use in brief courses of therapy. The therapist initiates what happens during therapy and designs a particular, individualistic approach for each problem. “Strategic therapy isn’t a particular approach or theory, but a name for the type of therapy where the therapist takes responsibility for directly influencing people” (Uncommon Therapy: The Psychiatric Techniques Of Milton H. Erickson MD)

We went on to discuss Milton Erickson’s techniques. He was quite a controversial figure in psychology, being largely self-taught, and favouring methods that some considered unorthodox. He regarded the unconscious mind as creative and solution-generating, and used approaches such as hypnosis (although his definition varies from the commonly held image of a client being put to sleep and being made to do things that they would not usually consider doing – his meaning of this word is more to do with achieving a deep state of relaxation and ease with the client, whereby they are more receptive to ideas that the therapist suggests, more aware of intonation, tone of voice, more perceptive of other signals that could be given), working with metaphor (a wonderful example was given of his discussing sex with a couple who he was counselling – he used the simile of a three course meal – did they prefer to slowly savour their food, enjoying a leisurely entrée with a good wine, or was it better for them to rush through to the dessert?) reframing (suggesting it would be more bother to continue presenting symptoms of unease than to give them up)and my favourite – encouraging resistance (whereby the encouragement of the client’s negativity to any suggestions by the therapist, creates a situation where the client, wanting to oppose the suggestion, finds himself unable to resist without cooperating with the very aim of the therapist anyway – often described as ‘reverse psychology’)

In reading about his work, and the lovely anecdotes about his unusual approach to it, a real sense of his quirky personality came across, and the obvious success of his uncommon methods made me warm to them, rather than reject them.  These all seemed to me to be really effective, exciting techniques; but I completely appreciate that a great deal of skill must be acquired in order to practise in this way. Definitely to be used by a confident, experienced and highly intuitive therapist – I have a long way to go yet!

The book by Jay Haley ‘Uncommon Therapy’ (a copy of which I simply had to order, as soon as I got home) describes his technique beautifully here;

One way to view the strategic therapy of Milton Erickson is as a logical extension of

hypnotic technique. Out of hypnotic training comes skill in observing people and

the complex ways they communicate, skill in motivating people to follow directives,

and skill in using one’s own words, intonations, and body movements to influence

other people. Also out of hypnosis come a conception of people as changeable, an

appreciation of the malleability of space and time, and specific ideas about how to

direct another person to become more autonomous. Just as a hypnotist can think

of transforming a severe symptom into a milder one, or one of shorter duration, he

can think of shifting an interpersonal problem into an advantage.

This ‘strategic therapy’ ; where the therapist most definitely takes charge of the treatment, and uses their powers of suggestion, intuition, and at times, plain trickery, into facilitating the client’s change of perception – is commonly used in family therapy situation these days. The therapist will focus on identifying problems, setting goals and helping the clients to examine both the outcome and the effectiveness of them. The British Strategic Therapy Centre advertises this on its website by calling it ” the art of solving complicated human problems with apparently simple solutions” and it strikes me that this quite an accurate summary  -of how I perceive it to be, anyway; assisting the client by breaking the problems down into less complex, more manageable issues, and  in turn, helping them to find solutions – in other words COMMON SENSE (!) – What any helping professional would try to do; be they a social worker, a support worker, nurse, care assistant or counsellor.

The discussion within the group was really interesting that day, but was slightly marred by the anxiety that the weather was bringing – snow was falling, thick and fast, and many of us in the group had concerns about travelling home, and about how our children were being affected by their school’s snow policies (School these days seem to just shut at the first sign of snow. In fact, England just seems to lose the plot as soon as the weather starts to get a little more extreme – you’d think we would be prepared for it by now; after all, it happens almost every winter. Grrrr…) So, after a brief chat about the paradox of failure within counselling (can counselling ever be considered a ‘failure – aren’t all experiences, regardless of the positivity or negativity of their perception at the time, simply lessons to grow from; the very aim of counselling) those of us with children who needed rescuing from their schools took the decision to cut the day short; me included. Such a shame, as the subject matter on today, of all days, was absolutely fascinating – well I thought so, anyway…