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.

 

 

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.

Creating Ethical and Effective Directives

I received a question the other day about the use of directives in psychotherapy due to my having written other posts about applying absurdity and paradox as effective therapeutic directives. The question I received is “How do you do directives in an ethical manner”? This question caused me to pause as I usually do not think about how I do directives as being unethical at all. Upon further reflection I think the question came about because of the power distribution within the session in which directives arise. In order to give directives, the therapist has to become the “director” of the session and cannot be merely a passive onlooker. This can create concern for those who are uncomfortable with having a larger amount of power and control in their therapy sessions. I completely understand this concern.

 

Ethics

 

To address this concern, first, I must state that if you are a therapist it is crucial that you adhere to the ethical guidelines set forth by the organizations who are involved in your licensing (APA, ACA, NASW, etc.). Thoroughly knowing what is appropriate and what is not in the ethical codes is an important part of being a professional therapist. If there is uncertainty on one’s part about a course of action, I recommend consulting with a colleague or supervisor to bounce ideas off of so that one can have a better perspective on a directive. The allure of power can be seductive so it is imperative that we in the healing profession proceed with caution. At the same time, we need to not be so uptight and worried about what we are doing that we lose our spontaneity and creativity.

Secondly, I think the best way to use directives is to simply ask yourself, “Would I be willing to do what I am asking my clients to do?” If the answer is “yes”, then implement the directives. If the answer is “no”, then do not implement the directive. If we are unwilling to do what we are asking of our clients, then not only are we not congruent with the therapeutic offering, but we are also putting unnecessary burdens and expectations on the people we are trying to help. By approaching directives with this mindset, it creates an opportunity for us to expand our own comfort zones. If we ask our client to do an odd action to change his or her patterns of interaction, then why not implement that same pattern in our own lives? It may help us become less regimented and more creative in how we approach our own problems. I have a rule that I never ask any of my clients to do anything that I would not be willing to do. This helps keep me mindful of the issue of power in the therapeutic relationship and also reminds me that there are areas that I need to work on and expand in myself.

A recent example of this occurred when I had a client who was very anxious about having things in order. She specifically was bothered by the idea of germs in her home. I was able to get her to agree to not wash one of the pans she used in cooking for two days (it was no small feat to get that agreement!). This allowed her mind to observe that not having everything perfectly clean would not automatically lead to excessive germs and sickness. As I gave this directive, I noted that I can be a bit of a neat freak in my own home. I make my bed and wash my dishes daily and do not like things out of order. As a result of giving her the directive to not wash a pan for two days, I decided to implement a similar directive for myself. I did not wash a pan for two days nor make my bed. This may seem like it is not a big deal to some of my readers, but for me it was an annoyance to alter my usual routine. It did pay off as I reminded myself that routines are sometimes made to be broken and it also gave me a level of congruence with my client.

If you direct your client to stand up more for himself in situations where he would previously back down, then make sure you are willing to stand up for yourself in a situation where you usually back down. If you want your client to expand her comfort zone by try something new, then make sure you are willing to try something new outside your comfort zone.  By being willing to do what we ask of people we can defend against potential ethical issues.

 

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 3: Being vs. Doing

sitetitle-youtuber

When therapists view client behaviors as something that can be altered rather than as a part of the client’s “being”, changes in the client can happen in surprising ways.