Creating Symbolic Tasks

Have you ever worked with someone who remained stuck in the problem he or she brought to therapy despite all the great cognitive oriented applications put into practice? I have found that many times clients’ intellectual insight alone will do very little to change their emotions or behavior.  You may find that, in addition to traditional therapy work, giving your clients a unique experience can often assist them in becoming more flexible in how they deal with a specific problem or situation. I believe this may be due to how the experience is registered in their unconscious minds. We often think that if we consciously “understand” our problem, then we can rationally solve it. This can sometimes work very well, but many times we end up stuck in a loop of rumination with little access to a way out of the loop.

I discovered that designing and implementing unconscious symbolic tasks for clients can assist them in finding a way out of their rumination loop. I believe this type of tasking bypasses the rational mind and goes to the heart of the unconscious mind, which takes in information in symbolic ways. These tasks are created for the purpose of representing clients’ problems (as well as the solutions) to clients’ unconscious minds. The goal in using these tasks is to express the problem and subsequent solution in a metaphoric way. The task is something that can be experienced outside of the therapy room and can allow clients to integrate healing experiences in a way that is unique to them.

 

unconscious symbolism

 

In my exploration of other healing traditions, I have found that it is not uncommon for healing practitioners to request their clients do tasks which are out of the ordinary and represent the inner struggles the clients are going through in their lives. The tasks given are beyond the realm of left brained language and reason, but, instead, operate purely on right brain symbolism. For instance, a Mexican shaman, who worked with a woman suffering from emotional turmoil related to childhood issues with her mother, directed the woman to buy a large watermelon and tape a picture of her mother on it. She was then to carry the watermelon on a long, arduous hike through the mountains. At the end of her hike, she was then directed to look at the picture of her mother for five minutes and then smash the watermelon. She was then to bury the watermelon and write her mother a letter telling her mother how much she appreciated the good things her mother had done. After this act was finished, the woman was no longer upset about her childhood issues. The symbolic task appeared to clear up the old emotional wounds that still persisted.

I view giving clients unconscious symbolic tasks as a way to give them more flexibility and resources in working through the present issue being faced. Once the task has been completed, clients will have experienced an action which may release them from unconscious, automatic patterns of the past and help them realize that they have more options than they may have previously considered. Using strange tasks in therapy may sound a little ridiculous to our regimented, linear thinking, but to our unconscious mind, these tasks can be a gateway to different healing experiences.

 

unconsciou ssymbol 2

 

I often structure the tasks in this way:

  1. Listen closely to the metaphors and words clients use to describe their problem.
  2. Envision how the problem can be solved in a symbolic act. For example, the woman with the watermelon was able to put down the heavy watermelon (burden) after a long, tiring effort and then symbolically “destroy” the burden and reclaim her power.
  3. Have them do something that they have never done previously.  It must be an out of the ordinary action in order to interrupt unconscious patterns.
  4. Make the task something that requires some effort, but is not completely overwhelming to clients. If it is too much or too hard, most of the time clients will not do it.

 

Some examples:

-A woman experienced much apprehension when talking with her mother due to her mother’s past behavior of always verbally shutting the woman down when she was a child. Her mother was argumentative and had to always be right no matter what the topic being discussed.  Talks with the mother were often contentious and anxiety provoking. Now, as an adult, the woman attempted to avoid interactions with her mother due to her anxiety about her mother arguing and shutting her down. I directed the woman to find a doll and tie it tightly with string from its neck to its feet and then hide it in her closet for two days. After that time, she was to use scissors to cut the doll lose. The woman found a doll that her mother had given her many years ago (and strangely enough the doll resembled the woman) and performed the task. After doing so, the woman noticed she no longer was worried and apprehensive about talking to her mother.

 

-A couple were on the verge of divorce due to constant arguments related to the husband’s binge drinking and the wife’s enabling behavior. They were directed to use a cloth to wash their dishes and then to leave the cloth out on the kitchen counter for three days. They were then to take the sour smelling cloth to the back of their property late that night. The husband was to dig a three-foot by three-foot hole while the wife held a flashlight and supervised his digging. They were then to bury the cloth and sit without speaking for ten minutes while they thought about the meaning of the task given (they were not supplied with one when it was assigned). When they reported back to therapy three weeks later, the husband had begun controlling his drinking and the wife decreased her enabling behavior.  They felt their marriage had been saved by this task.

 

-A man who had been severely abused by his step mother as a young child continued to feel intense fear and panic about her, even though he had not seen her in 25 years. He stated that he believed she had spellbound him to live in fear and she wanted to cause evil in people’s lives. He was presented with an Ouija board and given a piece of paper to write down all the bad things his step mother had done to him. He had to tape the paper to the Ouija board and throw it in a fire. He then had to take the ash from the fire and use it as fertilizer for a new plant he was to put in his yard. He noticed a reduction in his fear after his task was completed.

 

I believe clients already have what is needed to create a desired change in their lives inside themselves. It may be that they just need an out of the ordinary experiential process for the change to occur.  These unconscious symbolic tasks are not stand alone therapies, but it can aid therapists who have reached the limits of what conscious understanding can do.

 

 

The Psychotherapy Marketplace

Lately I have noticed an increasing trend in the psychotherapy field in which the marketplace of ideas has become more crowded. Every day it appears that someone has invented a new theory, therapy, or technique that is then marketed as the latest and greatest breakthrough. A flocking of therapists to training programs on these new inventions has created thriving businesses for many. The good news is that the more these offerings are marketed, the more these new ideas can be heard and explored. The bad news (at least to me), is that it may create an idea that by learning just the “right” theory, therapy, or technique, we as therapists can increase successful outcomes. Some psychotherapy marketers have gone so far as to draw a line in the sand and declare that what they are offering is the cure to most of the emotional problems for which people come to therapy. Others have been more respectful and inclusive in their offerings.

 

Marketing

 

I think it is important for us all to remember that, in spite of the best marketing efforts, research still shows that any one specific therapy application is not superior to any other when it comes to measuring outcomes. In an article in the journal “Clinical Psychology: Science and Practice”, Stanley Messer and Bruce Wampold found in the results of their research that there is no evidence that that any one therapy application provides the magic bullet for successful clinical work. They write:

Such results cast doubt on the power of the medical model of psychotherapy, which posits specific treatment effects for patients with specific diagnoses. Furthermore, studies of other features of this model—such as component (dismantling) approaches, adherence to a manual, or theoretically relevant interaction effects—have shown little support for it.

In fact, the most recent research on what really works in practice involves each individual client’s perceptions of the overall progress of treatment and the key determinant for success still comes down to the client-therapist relationship. Michael J. Lambert and Dean E. Barley, in an article titled, “Research summary on the therapeutic relationship and psychotherapy outcome” from the journal “Psychotherapy: Theory, Research, Practice, and Training”, found that factors such as warmth, empathy and the therapeutic relationship had a higher correlation with client outcomes than specialized treatment interventions. (For more on the factors which create success in therapy work, I highly recommend the work of Dr. Scott Miller: www.scottdmiller.com )

If it is true that specific theories, therapies, and techniques are not, as Bateson would say, “the difference that makes the difference”, then maybe this can free practitioners from any rigid allegiances in the constant changing psychotherapy marketplace.  I still encourage people to create new models and techniques and expand our field; however, I think we all need to be aware that even the greatest technique may go nowhere if a client does not have trust and a solid connection with the therapist. Unconditional positive regard for clients and having a human connection should never go out of style.

Episode 23: Rob McNeilly Interview

Rob McNeilly

In this episode, Dr. Robert McNeilly is interviewed. Rob is a medical doctor and a psychotherapist in Tasmania who had the privilege of learning directly from Dr. Milton Erickson. Rob was so inspired by Erickson’s human approach to therapy that he created his own interpretation to assist clients in a respectful, dignified way to deal with the human dilemmas that affect individuals, couples and families. Rob founded the Center for Effective Therapy in l988 to introduce Ericksonian Hypnosis and Solution Oriented Counseling to Australia. He has written several well received books on Solution Oriented Therapy and Hypnosis and offers online training in these approaches.

In this interview Rob discusses the importance of having a sense of expectancy on the part of both client and therapist, the importance of creating therapeutic relationships, the power of listening for resources, and therapist genuineness.

For more information about Rob McNeilly go to his website:  robmcneilly.simplero.com/

That is so random….

My present belief system is that clients seek help from a therapist due to their feeling stuck in some way. Their ability to work through what they perceive as a problem is hindered by their attempting to deal with the problem with a pattern of action/reaction which furthers to cement the pattern and, unfortunately, makes it worse. If clients are continuing to perform the same patterns of action, thought, and emotion toward the problem, then the problem will be maintained and clients will feel it insurmountable to overcome. This will lead to them perceiving their problem as a personal reality and their automatic responses to this “reality” further solidifies the pattern.

In order to facilitate a change in these patterns, I believe therapists must be comfortable talking about and doing things that are unexpected and random. Our therapeutic interactions are there to provide clients with new information which can be used to alter the patterns which have previously caused distress. When new and random information enters their present perceived reality, then their reality has to adjust. Sometimes merely giving straightforward logical information in dialogue may not be very effective due to the brain being stuck in a deeply entrenched pattern. Introducing the random into a session can cause the brain to experience different and new realities which can create a shift in how clients respond to their problems. As Gregory Bateson stated in his classic text, Mind and Nature, “Without the random, there can be no new thing.”

Lucky Dice showing a pair of sixes.

Random information can come from anywhere. Sources such as popular culture, spirituality, childhood hobbies, fine arts, etc. can all introduce new information about different ways to respond to old problems.  Further examination of the problem and trying to solve the problem only continues the process of the problem. Introducing the random or unexpected into the problem alters the problem.

I once had a client who was dealing with social anxiety issues and panic attacks due to a variety of factors. He was very worried about running into people he used to know and their observing how little he had advanced in his life. He stated he knew he was depressed and was not in a good place to talk to former friends as he “did not want to burden them” with his problems. When he did go out he would sometimes have a panic attack which would cause him to immediately return home. He felt stuck and more depressed due to his inability to go out often.

PATTERN: Go out –> worry about seeing someone he knows –> think about the present condition he is in and the shame he has about it  –> have a panic attack –> immediately go home

I heard him state that he didn’t want to “burden others” with his problems. I immediately latched onto how a desire to not burden someone was actually an act of compassion. I told him that his concern for how other people feel was quite remarkable. I complimented him on how compassionate he was to willingly allow himself to suffer so that others would not suffer. I told him it was possible that his unconscious mind could even be creating these panic episodes to help shield others from feeling his pain. He responded favorably to my conjectures. Our conversation on compassion continued as we discussed many other examples of times he was kind to others. Since he was a religious person, we also discussed the spiritual role of compassion and the many saints who had shown great compassion while going through hardships.  The topic of compassion was a “random” entry into the interaction as neither of us expected it to appear. It did not fit the prearranged pattern of the problem.

I then told him that it was not fair for him to waste his compassion being alone at home. We had to come up with some way for him to help others with his strong sense of compassion. I told him he had much to teach all of us about how to become more compassionate in our lives. I reminded him about the hardships that the various saints had to face trying to spread their messages of hope to others. I let him know that he could not fully show compassion by staying at home. He needed to find somewhere to interact with others on a small scale to help them learn to have compassion toward themselves. He agreed that this was important work to do. In time, he found that when he did go out he was not as nervous as before and he found that he could interact with people with fewer panic episodes. The random inclusion of “compassion” into the pattern caused his reality to adjust. His previously self-defeating fear was now a source of compassion to be shared with others.

Random information does not come from a scripted, rehearsed treatment protocol. It can only come from an alive interaction with room for spontaneity. It also does not come from excessive problem investigation. When we allow the random to show up in our therapy room, we can let it flow as we ride the wave of interaction.

Episode 18: Scott Miller Interview

scott-miller

In this enlightening interview, I get to talk with the one and only Dr. Scott Miller. Scott is the founder of the International Center for Clinical Excellence, an international consortium of clinicians, researchers, and educators dedicated to promoting excellence in behavioral health services. Scott conducts workshops and training internationally, helping hundreds of agencies and organizations, both public and private, to achieve superior results. He is one of a handful of “invited faculty” whose work, thinking, and research is featured at the prestigious “Evolution of Psychotherapy Conference.” His humorous and engaging presentation style and command of the research literature consistently inspires practitioners, administrators, and policy makers to make effective changes in service delivery.

In our conversation we discuss such important topics as feedback informed therapy, the misnomer of “evidence based” therapies, what aspects of psychotherapy are consistent in practice, and what can make the most difference in achieving positive outcomes when working with clients. Scott is a wealth of information and you can learn more about his work at his website: www.scottdmiller.com

Episode 17: Bette Freedson Interview

bettejfreedson

In this episode we interview author, psychotherapist, and speaker Bette Freedson. Bette is a clinical social worker, practicing in Southern Maine. Bette is the author of the acclaimed book, “Soul Mothers’ Wisdom: Seven Insights For The Single Mother”. Her work has appeared in The York County Coast Star,“Calgary’s Child Magazine,” “Working Mother Magazine,” and “Women’s Day Magazine,” among others.

In this interview we discuss the role of utilizing intuition in psychotherapy, the overlooked importance of relationship in therapeutic research, circularity in interaction, working with single parents, and Bette’s “S.O.L.V.E.” schema for therapeutic interventions.

For more information on Bette Freedson’s books, articles, training, and therapy services, check out her website: bettefreedson.com

Episode 13: Clifton Mitchell Interview

Clift_Mitchell

In this information packed episode, Dr. Clifton Mitchell is interviewed about how to effectively and creatively deal with difficult and resistant clients. Clift is a licensed psychologist and an international clinical trainer and keynote speaker. He is currently a professor of counseling at East Tennessee State University in Johnson City, Tennessee, where he received the Teacher of the Year award in 2002. He has taught hundreds of mental health organizations, businesses, leadership and civic organizations effective techniques for improving communications and for creating change through the precise use of language. He is the author of the book, Effective Techniques for Dealing with Highly Resistant Clients, in which he presents cutting-edge approaches for managing psychological resistance in creative ways. He has published in numerous professional journals and his ideas and writings have also been published in “Men’s Health Today” and “Barron’s Financial Weekly.” His website is http://www.cliftonmitchell.com/

That’s Absurd!: Using Absurdity to Create Change

Performing odd, unexpected and absurd actions in psychotherapy is not something one usually learns in graduate school. In fact, in my many years in training, giving absurd directives was never covered. There were examples of various leaders in the field doing strange things to create change but this was never followed up with explanations or encouragement on how to perform such actions. In really examining the use of absurdity and paradox in therapy we find that it is the unexpected that creates a sense of confusion in clients which opens the space for new possibilities to emerge.

Even though great therapists such as Whitaker, Haley, Erickson, Palazzoli, etc. have used absurdity and paradox in their work, as of late there does not appear to be much information in the literature about how or why to perform such maneuvers. I personally believe that being open to absurdity not only makes you a better therapist, but also allows you to have a happier life. The nature of life itself is absurd, so why not embrace this fact? Absurdity can be utilized for shaking up interactions in a way that forces clients to find a different way of relating to the situation which originally brought them to therapy.

 

absurd

In order to create absurdity in the therapy room, clinicians must be one hundred percent willing to abandon any rigid ways of interacting with clients. They should be prepared to act in a spontaneous and creative manner. To be absurd we need to not make any sense. This statement will clash with the prevailing paradigm of logical, left brained therapy which appears to engulf much of the evidence based research. We are often taught that we need to teach our clients to think and act rationally in order for them to change. Certainly these are good objectives, but I will raise the point that it is in learning to deal with the absurdity of life where we really learn to be happy. When we become confused by things we naturally search for understanding. While we are trying to make sense of certain absurd actions, we automatically are being stretched out of our habitual ways of relating to our world. With this stretching process we become open to new resources in how to respond to the absurdity of the moment and of life in general.

 

Some examples of using absurdity to create change:

1. I once saw a couple who were having issues due to the wife’s unwillingness to let her husband have any power in the relationship. She was very controlling but at the same time wanted her husband to “step up” and take some control in the household. The husband wanted to do this but every time he attempted to “step up” she would create a fight because it triggered her control issues and he would back down. He was stuck in a “double bind” situation (which was absurd to begin with). Even though both the husband and the wife logically knew what the situation was, nothing was changing. When they came to their first session, I got their approval for them to do anything I asked them to do as long as it did not violate any safety, security or ethical boundaries. I then told them to go home and on the next day that they were home alone with nowhere to go (which was the upcoming Saturday), they were to wear each others’ clothing for the whole day. The husband was to wear one of his wife’s dresses and she was to wear one of his suits. They were instructed to do whatever they wanted to do that day but they were not allowed to talk about how they felt about the change of clothing. They reluctantly agreed. On the next session, three weeks later, it was revealed that the wife had begun to allow the husband to take on more responsibility in the home.

2. A man in his late 50s came to therapy stating that he was emotionally wounded from the constant “destructive” criticism he received growing up. He stated that he was in a wonderful marriage and his wife rarely ever criticized him. He said the problem was anytime she would offer anything that was “constructive” criticism; he would emotionally withdraw because it would activate his old fears and emotional pain from his past history of “destructive” criticism. He was open to trying anything to get past this problem. His wife was called during the session and put on speaker phone. I directed her to constantly criticize her husband for the next three days about everything. I told her to let him know that he was breathing incorrectly eating incorrectly, sleeping incorrectly or anything else he naturally did. Clearly confused, both parties agreed to do it. When the husband returned in a week he told me not only had he not been upset at any criticism, but both his wife and daughter began to open up more to him to let him know how they felt about certain private things. The dialogue in the home was more emotional in a positive way and he felt closer to his family. He was clearly confused how getting criticism from loved ones for three days created the ability for a family to become closer and more loving toward each other.

 

In order to be effective at performing absurd actions in therapy we need to be sure that we have our clients’ best interests at heart and that we are asking them to do things which we would be willing to do ourselves. We are creating an alive” Zen Koan” in our therapy room when we allow absurdity in. By being open to absurdity and paradox we also free ourselves to become more creative in our interventions. There is not fixed pattern when we utilize absurdity. To do this we are jumping off into the unknown. This may be frightening to some practitioners who cling to standardized regimentation. To me, that is absurd!

 

For a case study of the absurd I offer the following clip from the Marx Brothers. Get out your notebooks and watch how literally everything within this clip is absurd, yet it creates a wider perspective of what could happen.

Episode 9: Courtney Armstrong Interview

Armstrong

Courtney Armstrong is a licensed professional counselor and the best selling author of The Therapeutic “Aha!” and Transforming Traumatic Grief. In her twenty years of practice as a grief and trauma specialist, she has helped thousands of clients recover from trauma and experience deep personal transformation. In this interview we discuss Courtney’s background, how to access client resources, and the importance of creating an experiential session for clients.  She is also kind enough to give out some crucial pieces of the puzzle in helping those who have been through trauma make rapid changes.

Courtney offers training to mental health professionals, showing them how to use creativity, care, and humor to elicit transformation for their clients and make trauma recovery less painful. She is a regular contributor to magazines like the Psychotherapy Networker and The Neuropsychotherapist and has appeared on CBS Radio News, NPR affiliates, and networks in Europe, Asia and Australia. Her website is www.courtneyarmstronglpc.com/

 

How to Become an Irreverent Therapist

I recently came across an old article while doing some research that really got me thinking in a different direction. The article was written by Cecchin, Lane and Ray and published in the Journal of Marital and Family Therapy in 1993. It is entitled “From Strategizing to Nonintervention: Toward Irreverence in Systemic Practice”. The article discusses the shifting of focus in systemic therapy away from cybernetics and directive interventions and towards nonintervention and a focus on narrative (this shift was a huge mistake in my opinion). In the article, the authors suggest that in order to avoid the trap of being constricted in any way, therapists may want to embrace irreverence in their clinical work. This will enable them to avoid any potential limitations. It is a fantastic article that still has applications today. I was so inspired by the authors’ ideas that I wanted to share them, along with my own thoughts about how to become an “irreverent therapist.”

How to become an Irreverent Therapist

To be able to act without any restrictions on effectiveness, irreverent therapists need to take 100 percent responsibility for the actions they take and the directives they give. They must be willing to do anything within ethical guidelines to create the conditions for change to occur. If a therapist needs to be silent for the whole session in order to create change, she will. If a therapist needs to be confrontational in order to create change, she will. If a therapist needs to jump up and down on the couch singing songs from the 1960s to create change, she will. An irreverent therapist has an incredible amount of flexibility because her client is the focus of the session, not her theory.

 

Jester-_Joker_Card001

 

This will mean that the therapist will have to abandon any concepts, ideas, theories, or beliefs which could hamper the successful outcome of treatment. To quote Cecchin, Lane, and Ray, “therapists should maintain a healthy disrespect for any idea which restricts therapeutic maneuverability and creativity.” If you want to be an irreverent therapist, it is crucial that you successfully overcome any desire to stick to predetermined theory or technique that is regarded as the gospel truth. Any allegiance to a dogma is to quickly be rejected in order to flow with the moment as you and your client interact.  Practice laughing maniacally when you hear that a specific theory or technique is labeled “the best”.

An irreverent therapist will go out of his way to undermine and create havoc in the rigid beliefs and patterns of his clients. The order of the day is to embrace playfulness and see what happens when an inspired, uninhibited shrink gets to have fun. The irreverent therapist is also expected to poke holes in his own beliefs and patterns as he weaves a web of possibilities in his interactions with his clients. Uncertainty is not only embraced but encouraged in the therapy room. Any viewpoint the therapist or client takes as an absolute certainty in the session must be disregarded and discarded in favor of pure spontaneity and aliveness. Any certainty that the problem the client brings is unsolvable needs to be immediately dismantled in the therapy session. Spend time observing mastery of the absurd by watching a Marx Brothers movie or a Samuel Beckett play (these are much more enjoyable and teachable than most therapy textbooks).

An irreverent therapist pays little attention to how problems got started. He or she will be mostly focused on how things can shift and change. Investigation into past history and narrative explanations are kept to a minimum as the therapist redirects focus away from problem investigation and towards an exploration of client strengths and resources. Diagnostic labels are regarded with much suspicion and even disdain (maniacal laughter can be used here as well).

Try on the mantle of “Irreverent Therapist” for a week. Put it on your business cards. For this title there are no expensive, long term trainings to attend in order to obtain some silly certification. All that is needed is an openness to absurdity, an embracing of compassion, and a sense of humor.

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