- New Book
I am very excited about my new book, “Potential Not Pathology: Helping Your Clients Transform Using Ericksonian Psychotherapy“, coming out in a couple of weeks. I wrote this book for therapists looking for some interesting ideas to play with in their practices. The work of Dr. Milton Erickson has always been fascinating to me since I first heard about him almost 20 years ago. After writing this book I can honestly tell you that even though I feel I know a little more than I did, Erickson is still a mystery to me in so many ways. Apparently even people who studied directly with him feel the same way.
Erickson was able to create change in a masterfully indirect way. He saw each patient as an individual who only needed certain resources and experiences to be able to live a happier life. He did not view a patient’s condition as a state of pathology. He did not think people were “sick”. He was a master therapist who was committed to doing whatever he needed in order to guide his patients toward a healthier way of being in the world. I agree with Gregory Bateson who called him “the Mozart of psychotherapy”.
It is my greatest wish that this book inspires therapists to move away from limiting disease based models of therapy and instead embrace a resource directed approach to finding the potential in every human being.
- Power of the Wave
This past weekend my family and I were able to sneak away to the quaint little town of Surfside Beach in South Carolina. We had a fun time communing with the ocean and indulging in scrumptious seafood. The weather was great and it was a wonderful experience to share with my wife and kids.
One thing happened while we were at the beach that gave me a little insight into the use of utilization in therapy. Utilization is a creative process of integrating aspects of the behavior and attitudes of a client into a method for developing therapeutic change. Rather than fighting actions clients perform and label them as “resistant”, the resistance is openly acknowledged and encouraged, it can then be directed toward assisting the therapy rather than hindering the therapy. Even the symptoms the client brings to therapy can be utilized toward achieving healing.
The insight came to me as we were all doing some body surfing in the ocean. I noticed that I was getting knocked over by waves when I had my back to them. I couldn’t tell when a wave was about to hit me. My wife, who is very a kinesthetic massage therapist and yoga instructor, explained to me that I needed to really go inside my body and feel the slight little tug the wave gives before it pushes forward. She told me that I needed to just relax and go with the tug and then ride out the wave in the direction I wanted to go. This worked like a charm.
A fun time in Surfside Beach, SC
As I thought about the wave it occurred to me how a therapist’s resistance to the initial offering a client gives us can cause unnecessary problems. It is like getting knocked over by a wave. If we instantly resist the client’s model of the world, we set ourselves up for a more stressful therapy session, a disconnection of rapport and/or ineffective outcomes. In truth, it is not the client who is being resistant but rather the therapist as the client is only supplying us with his or her view of reality. Even if it is flawed view, it is real to the client. Not allowing ourselves as therapists to go with their “tug” sets us up for a crash under their wave. By allowing ourselves to enter their world with that little “tug” we can accept what is given to us and then ride it out in another direction that expands the client’s model of the world.
An example of riding the wave with utilization would be the couple I recently work with who were seeking help due to their arguing. From the moment we started the session I could tell that both of these people were hell bent on being right and continuing to argue. Both told me they had every right to fight to “defend themselves” and would only quit if the other person quit first. I felt the “tug” of their having to be right and argue. I decided to ride the wave by agreeing with them that it is important to defend oneself. I then asked each of them what they thought about having a partner who was brave enough to stand up for him- or herself. Both parties did express some feelings that it was nice to have a brave partner. I then asked them if each of them was brave enough to continue arguing even if the other person was not arguing. With some confusion they said they were brave enough to continue arguing if only one person was arguing. I then asked them to prove who was the bravest by deciding which one of them would be the one who continued to argue and which one would test the other’s bravery by refusing to engage in the argument. They decided to take turns over the course of the week. At the next session both expressed concern that it was getting harder to argue as both of them had found it rather tiring to try and argue with someone who was not interested in arguing. They also noticed less knee jerk reactions that would normally start an argument. I told them they might need to find another way to show how brave each one could be.
Instead of fighting this couple on their arguing and directed them to both stop, I accepted their desire to continue their behavior and then reframed the positive intention for the arguing. They did the rest. They never felt I was fighting them and I never felt they were resisting me. We all rode the wave away from problem talk and toward resource building. Try letting yourself get pulled a little more into your client’s world and then ride the wave out into a place of new exciting, possibilities. If you are still confused, take some time to go the beach 🙂
- Embracing Meaning and Purpose in Therapy
One of the most overlooked areas in counseling sessions I have witnessed is the importance of purpose and meaning in a client’s life. We as therapists spend so much time trying to help solve problems that we often overlook how crucial it is that our client creates a new meaning for what he or she is going through and align it with a greater purpose than he or she initially perceived. It is rare that the intake questions a client is asked when entering into therapy has anything to do with what the purpose of a client’s life will be. Since the topics of meaning and purpose are rarely discussed in most graduate level counseling courses it is no wonder that the majority of mental health professionals do not venture into this realm. I believe this is a shame because no matter what style of therapy one performs, paying attention to how clients create meaning out of what they are experiencing is the gateway to healing.
If you are a brief therapist I think it is of the most importance to consider working with these topics with your client. It is far too easy to stay focused on the client’s problems and attempted solutions when working in a clinical setting. I think shifting focus to the meaning clients can create for their life can be a more “brief” way to move them toward overcoming their problem from which they seek escape. The great psychiatrist Viktor Frankl believed that the primary concern for humanity is not in obtaining pleasure or dominance, but rather to discover the meaning of our existence. When we have a meaning that empowers us we can do so much more in a therapy session than merely shift our cognitive distortions or process our emotional reactions.
Recently I worked with a man I will call David. David is in his early fifties and has been to jail for several years for a crime he maintains he did not commit. He lost his home and income in a divorce from a woman he deeply loved. When I first began working with him he was living in a homeless shelter he moved to after leaving the hospital after a suicide attempt. To be blunt, David was about as low as he felt he could go. He came to therapy every few weeks with the little bit of money he could afford and took advantage of the sliding scale payments our office offers.
In our first few sessions David detailed the large amount of tragedy he had been through in his life. These tragedies included deaths of parents, sexual abuse, addiction issues, failed marriages and incarceration. I could sense that David was a good person who had been dealt a terrible hand in life. He was a religious person but was having a great deal of trouble accepting his lot in life. He was tired of playing the “Job” role. I couldn’t help feeling sorry for him as it seemed most of his life was filled with despair and trauma.
After learning about David’s life, something inside me pushed me to ask David if his life was near perfect what would he do with his life He told me he wanted to be a preacher who could help others find their way out of addiction, incarceration and poverty through the spiritual path. He was very sincere in his dream but he felt it was out of his reach due to his present life. As soon as I heard this I knew there was a way David could see a different meaning to what he was going through. I asked David if having the experiences he had over the course of his life had given him more credibility in the eyes of others in what he hoped to do. David seemed puzzled by my question. I clarified by asking him if he personally would ever really listen to someone who promised to help guide him down the spiritual path if that person had lived a perfect life with no hardship or pain. David smiled and told me he would probably not relate to that person. I then told David that it may be possible that if his purpose is indeed to help those who have been imprisoned, addicted and forgotten by society, he could not effectively help those people if he himself had not obtained the credibility of living through those very things. I told him, “It is almost as if you had to go through all of those harsh events in order to clearly understand and appreciate the lives of others in similar situations. Think about it, no one can tell you that you don’t understand what they are going though. You have come through hell and are alive and well on the other side. How can people not respect you and look to you for help?” David sat in silence as tears formed in his eyes. He began to laugh and said to me “You know Doc, I have never thought about it that way. Wow. Maybe all of this means more than I realized.”
The rest of our session focused on clarifying the steps he needed to take to begin moving closer to his goal. He told me he wanted to set up a non-profit organization to assist men coming out of prison in obtaining education, job skills and spiritual peace. The first step of his goal was to get out of the shelter and begin educating himself on all the things he would need to do to create his vision. At this point David’s whole outlook on his life changed. Any set back he experienced was now considered just part of the learning process and a way to gain more credibility for his future work instead of further evidence that the world was against him. David was now on purpose and the creator of his own life. He now plans to write a book to help family members of incarcerated individuals in dealing with the pain of losing a loved one to the world of prison. What a change has occurred as he is a man on fire with a purpose! I doubt we could have arrived there if all of the therapy time was spent time focused on his problems and ignoring the greater purpose he had for himself.
As usual, the things we tell our clients are often things we need to hear ourselves. Writing this post has made me revisit the meanings and purpose I have for myself as a therapist. How about you? What purpose do you have for working with clients? How has focusing on that purpose helped you in your work?
- A Curious Approach to Therapy: An Interview with Richard Hill
I first came across Richard Hill when I was viewing a video about the impact of therapy on the structure of the brain. I found Richard to be an engaging, informative and charismatic presenter who was truly passionate about his subject of interest. He used a good bit of self-effacing humor along with great personal examples to enlighten the audience about the important neurobiological aspects of psychotherapy.
Richard has become one of the leading voices in Interpersonal Neurobiology, a new field which is a hybrid of biology, sociology, psychology and anthropology. Interpersonal Neurobiology presents an integrated view of how human development occurs within a social world in transaction with the functions of the brain that give rise to the mind. This field utilizes recent brain research and emphasizes the view of the brain as a social organ built through experience.
In addition to his work as a speaker and trainer, Richard is also a psychotherapist, author, musician and actor. He is the founder and CEO of MindScience Institute in Australia where Richard offers a variety of services from personal therapy to corporate consulting. Richard is an energetic guy with a playful attitude toward life. He is a learning junkie when it comes to therapy and the brain. As busy as he is Richard was kind enough to allow me to conduct a quick interview with him.
How did you come to the field of psychotherapy?
It was a long and slow journey. My education began before I even knew that I was learning psychotherapy. I was a professional actor for 25 years and this honed so many of the skills that are vital for psychotherapy – listening, responding, improvising, understanding other people from the inside out etc. These translate into our modern skills of utilization, mental mapping, empathy and contributed to the development of a active mirror neuron system. Most importantly it showed me what it was like to actually be another person. I learned first hand about the multiple selves! I went to university when I was 42, in 1996, to do a Bachelor of Arts majoring in linguistics. That took me 7 years, but it had fired up my fascination in learning about the human condition. I followed that with a diploma of counseling in 2004, but then got really serious. I started a Masters of Arts in social ecology in 2006, largely because Jeff Zeig said that I had to have a Masters degree to speak at Erickson conferences. I received my next degree, a Masters in Education in 2011, and then a Masters in Mind and Brain Sciences in 2013. I figured that was enough education, now I am teaching a lot of what I have learned as well as incorporating the knowledge into my psychotherapy practice.
What specifically drew you to the field of interpersonal neurobiology?
I heard Dan Siegel speak with Lou Cozolino in 2005. As I listened I realized that this was the theoretical support for so many of my ideas, including my Winner/Loser World Theory. I went to see Dan speak at the Evolution of Psychotherapy conference in Anaheim USA later that year. He recognized me and we established what is now a delightful friendship, and with Lou Cozolino, too. That was where I met Ernest Rossi which has led to an even more amazing mentorship. It has been quite a ride for the past 9 years!
Richard with Dr. Daniel Siegel
As a therapist, what do you think are the most important components of helping one’s clients?
It’s hard to say this briefly, but in trying to do so, I would say the number one thing is develop an attuned, engaged relationship with the client and, in that relational context, determine to deal with the issue at hand together. I know that sounds like rapport, but it is much more – a relational openness and integration in addition to the rapport of empathy and engagement. Second is to be comfortable in the role as the helper and the helpful contributor. The client is the center of the process. Thirdly, to relieve yourself from being the healer. This allows you to be an element of the relational process to create beneficial change. Lastly is to know a lot about as much as you can, not to be a smarty pants, but to have a reliable and supporting foundation upon which you can trust yourself to utilize and improvise.
You have an approach to therapy you refer to as the “Curiosity Approach”. Could you tell us more about what this is and how you came to use this approach?
We all talk about curiosity, but I have not been sure that we have really understood the deeper nature of curiosity. Utilizing current developments in neurobiology and many things not so current, I am seeking to raise our confidence in the processes of unregulated engagement, something we might even call play. I regard it more as the creative process of adding new things to what we have now and allowing there to be creative activity that leads to beneficial change. The Curiosity Oriented Approach embraces the principles of Complexity Theory, which requires a much longer answer, but suffice it to say that we range between the edge of rigidity, where we need to creatively stimulate ourselves, to the edge of chaos where we need to creative contain and apply ourselves to the recent innovations and changes. The space between these ‘edges’, and the sensitive awareness of when to creatively change the nature of the flow, is the space we might call Harmony. To achieve this we need an open, engaged and integrated state of the prefrontal cortex. Although many processes encourage curiosity, it is often a cognitive process first to try and stimulate curiosity, or once curiosity is stimulated there is a shift of focus on to cognitive processes. The trick is to get the brain into a curious state before you even start. That can be simply achieved by stimulating interest, wondering and the possibilities of something more – a sense of nascence. This playfulness can create an environment of safety, of engagement and of dissociation from the barriers and disruptions that have put the person into a state of rigidity or chaos. When the mind is in curiosity, there is openness to creative possibility. I believe this is something additional to the state of possibility created by good rapport and empathetic holding. I have developed a number of new processes and techniques that incorporate this Curiosity Approach, such as Arbitrary Mental Mapping, The Open Board, The Dartboard Game and more. I also show how established techniques such as Cognitive Behavioral Therapy and others can be shifted into a more productive, comfortable and comforting process. The Curiosity Approach is just that, an approach, not necessarily a specific therapy. It can be applied to anything. Too much to fully describe here, but that is what I hope to be showing fellow practitioners through workshops and lectures in the future.
I have noticed that over the past few years therapy has moved back to looking at human behavior through the lens of a disease model. How do you blend the biological aspects of how the brain works with the creative, interactive therapeutic aspects of psychotherapy into something that focuses on seeing clients’ potential?
Yes, this is sort of a good thing, but mostly a problematic thing. Evidence-based thinking is being misinterpreted as meaning that if there is no evidence then don’t think about it. Recently I was in a study group doing differential diagnoses. Some of the “whiz kid” younger people were rapidly – and very intelligently and skilfully – ticking DSM IV boxes and determining the condition of the ‘patient’. I listened and then suggested to the group that I understood the evidence, but something just didn’t ‘feel right’ to me. I would need to spend some time with the patient and get inside him some more. The looks of glazed disbelief from the group were not surprising, but disappointing. The point, I suggested to them, was the patient must always be in the center, assisted by the evidence, not the evidence in the center and then make the patient fit into the disease model at hand. In my practice, I use all the wonderful neurobiology and genetic information as I might use a technical musical scale when playing the piano. Rather than my piano playing being restricted by the limitations of the technical knowledge, my capacity to improvise and invent is taken to a new level because I can incorporate this additional information and make my playing even more novel and inspiring. I would like to think that Milton Erickson would agree with that view of information and knowledge. Ernie Rossi would also support the idea that it is expansive to be curious about the disease, not because of how it restricts, but of the path toward enlightenment that the symptoms give. Disease is, in itself, a behavior and almost all behavior is the surface, or explicit, outcome of a set of deeper, implicit and more interesting things.
What new developments are you most excited about in your professional life?
I am probably most excited by curiosity and all the fascinating knowledge that surrounds, supports and expands its potential. I am looking at all the things that emerge from research each day, but I am also going back to wonderful people like Jaak Panksepp and his work on play and fun and Marion Diamond and the ‘thalamic explosion’ that she seeks to engender in her students when she teaches, to Ernest Rossi and psychosocial genomics. Having said that, I think the most important thing to understand, appreciate and utilize at the moment is memory reconsolidation where we are able to permanently change the associative networks of memory that produce PTSD and other trauma based issues. Getting this technique right will help a lot of people a lot more effectively and a lot quicker.
Recently you have been revisiting the work of Milton Erickson. With the experience and knowledge you have obtained about neurobiology over the past few years, what new insights have you gained about his work from these perspectives?
Immersing myself in the words of Milton Erickson has been something I almost cannot describe. Reading transcripts of conversations, therapeutic sessions and commentary by people like Ernest Rossi and Jay Haley and Elizabeth Erickson and more, I find myself not transported to an earlier age, a history, instead I find myself in the midst of the discoveries and the realizations that are only now being widely accepted i.e. there is evidence to support them. Erickson was talking about what we are teaching now in the 1920’s and 30’s. The difficulty in being prescient is that no-one knows you are a genius until the science catches up. Some people have been revered in their day and proved to be completely wrong – phrenology for one, although even phrenology was conceptually prescient i.e. that parts of the brain did particular tasks. So reading the Collected Works of Milton Erickson teaches me, fascinates me, but more importantly has taken me on a journey. I will be working on these volumes for the next 4 or 5 years, reviewing one each semester for the Erickson Foundation. I will let you know where the journey takes me. I have a feeling it will be more than worth the trip!
How has being an actor helped you as a therapist? And most importantly, did you enjoy playing “Hamlet”?
Man that guy was a bit crazy! Or was he? He has been portrayed several ways – crazy, paranoid, pretending he’s crazy so that he can stay close to his uncle in order to kill him, still a bit crazy because he takes 5 acts to get around to actually killing him. Most importantly acting showed me that you have the capacity within yourself to be many different people. We are like a big music recording console with faders attached to elements of our persona. We shift these faders all the time – there is a work me; a social me; a business me; a romantic me – all similar, but not the same. When acting I found that you can radically change those faders, when the conditions require, to become something very unfamiliar and even undesired. I have been a crazy Hamlet, a murderer, a hero, an idiot, morally corrupt, morally exemplary and much more. Many of these ‘characters’ I found undesirable and yet I was able to ‘be’ them for at least the 3 hours of each performance. This was the best training for psychotherapy imaginable. I recommend that everyone do serious acting training for 6 months in preparation for being a therapist. I certainly would love to be leading those workshops. Invitations welcome!
For those interested in finding out more about Richard Hill and his Curiosity Approach to therapy, you can find him at the following websites:
- But….But….they have a Chemical Imbalance!
One of my biggest pet peeves when talking with other therapists is hearing how many people in the mental health field quickly lay down and accept the well-worn line that the root of all mental health issues is a chemical imbalance. As a psychology professor I am well aware of the facts concerning the role of neurotransmitters on our emotional health so I do not deny there can be chemical issues. What I am frustrated with is how many therapists I run into who have convinced themselves there is nothing much they can do to help their clients who have this problem.
Case in point: A few weeks back I was talking to a very nice therapist who was telling me about a case she was working on in which the client was a child diagnosed with a mood disorder. She was complaining to me how she was trying to get the parents to understand they needed to quit emotional pushing the child as the child had a mood disorder. I remarked that if the parents do suddenly shift the way they interact with the child there may be a change in the child’s mood issue. I was immediately informed that was not possible because the child had a “chemical imbalance” and the parents’ behavior would have little change on a medical issue. My reply was something to the extent of “Why bother even seeing the child if you are powerless to do anything?” Her response was silence and a quick change of subject.
If we as therapists all buy into the idea that all mental health issues are only caused and cured by chemicals then we should probably choose another line of work. Why accept this limited view of mental health? Why throw up one’s hands and surrender to a theory that does not tell the whole story? Do people have chemical imbalances? All the time! Can therapy help shift those chemical imbalances? All the time!
I am not anti-medication as I have seen positive aspects to its uses. What I am against is a perspective that does not see value in human interaction as a method for change.
I refuse to believe that every mental health issue that comes in my office is ONLY the result of chemicals and can ONLY be treated with chemicals. It may be good for pharmaceutical company business to preach this limiting model of etiology but we can do better as therapists. Stand up for your clients! Let them know that therapy can create amazing transformations. Make it a goal to see how dramatic a change a person can experience in your therapy room instead of instantly admitting defeat and hiding behind the story of lopsided chemicals.