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.

 

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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.

 

 

Intuition in the Therapy Room

The role of intuition in therapeutic work has been something that has not been examined as much as it should be in our clinical training. Intuition can be thought of as the unplanned forming of impressions and the drawing of inferences. The noted neuroscientist Antonio Damasio describes intuition as “a non-cognitive way of knowing things.” Most every effective therapist I have met has talked about the importance of following clinical hunches and gut feelings in his or her work.

In the early days of psychotherapy, leading figures such as Sigmund Freud and Carl Jung noted the importance of using intuition in therapy. In the fast paced, emotionally charged work that therapists deal with, there may be great benefit from utilizing the quick nature of intuition. In an article entitled “Intuitive Listening” from the journal Modern Psychoanalysis, Lynne Laub discusses many different ways that intuition can appear in clinical work. She found evidence for using intuition in such areas as metaphors, dreams, symbolism, and non-verbal communication. Other researchers have found that the use of intuition can be very effective, but only if there is ample trust between client and therapist, as well as the clinician’s trust in his or her own gut feelings. Arthur Bohart, in the article “Intuition and Creativity in Psychotherapy” from the Journal of Constructivist Psychology, writes that intuition is really inspiration that just spontaneously occurs to the therapist while he or she is in the flow of the therapeutic interaction. It appears that the topic of intuition might need more exploration as it may aid the needs of our clients within the therapeutic relationship.

 

INTUITION

 

If intuition is so important in clinical work, why is there so little time spent discussing this phenomenon in psychotherapy training?  It may be that many professionals in the fields of psychology and psychotherapy have a desire to have their work strictly rooted in empiricism in order to be seen more as a science than an art. Intuition may be seen as too connected to spirituality and mystical leanings than aligned with “hard science.” Not having a set operational definition and application can make it problematic for researchers who are interested in investigating intuition in order to quantify its operation.

Since the prevalent approach to working in the clinical arena continues to be directed by empiricism and standardization of treatments, there is little space for teaching therapists to begin trusting themselves (and their intuition) more often. The employment of regimented therapeutic techniques often limits a practitioner’s access to his or her own internal wisdom. The “cookie cutter” approach to performing therapy leaves few openings to investigating our clinical hunches. Is there not a middle ground that not only gives therapists a structure in which to work, but also honor the mystery of our unconscious intelligence? I think there is, and most therapists who routinely follow their gut in the therapy room would probably concur.

Using our intuition may involve introducing odd statements and/or actions into the therapy discourse. What may not seem to make sense initially, might connect in ways our conscious minds might not at first comprehend. I have previously written about the importance of introducing the random into a therapy session and it may be that the random is preceded by an intuitive action.

One time I was working with a young woman who was in recovery from Methamphetamine addiction. She was trying to get her life back together and heal the hurts that her addiction had caused. She was not feeling good about herself and was constantly worried about falling back into her dysfunctional patterns. Our topic of the day was her learning to soothe herself when she became distraught instead of automatically turning to unhealthy men or drug use.

As we chatted, a strong image popped into my mind. I saw an image of a large number of birds flying. For some reason I felt compelled to trust this intuitive flash and ask her directly what “birds” meant to her. She stopped talking for a minute and sat with a puzzled look. She then told me that when she was a young girl, she and her grandmother would feed the birds that gathered in her grandmother’s backyard. As she talked about this time period, her eyes began to show tears. She explained that being with her grandmother were the few times in her life when she felt that she was “safe and good”. Upon hearing this information, I decided to see if she would be open to feeding the ducks who gathered at a pond across the street from my office. With a big smile, she quickly agreed to do this task.

In time, she found that she was able to reconnect with the feeling she had with her grandmother when she feed the ducks. She also decided that she would feed the ducks anytime she felt overwhelmed by life and needed to soothe herself.  By following my intuition, with what initially seemed to be an unrelated mental image, my client was able to find a positive resource to use for her healing with which she had previously lost touch.

My advice: Trust yourself. If you get a hunch, no matter how odd, follow it. See what opens up

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 24: Rick Miller Interview

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In this episode, psychotherapist and author Rick Miller is interviewed. Rick is a clinical social worker in private practice in Boston, Massachusetts. He has served as faculty for The International Society of Hypnosis, The Society for Clinical and Experimental Hypnosis, The American Society of Clinical Hypnosis, and Harvard Medical School, and was a guest lecturer at The University of Johannesburg Department of Psychology in South Africa. The focus of his recent work is his creation and development of a practical, holistic approach for therapists to help gay clients experience fulfillment and happiness. He is the author of the well-received “Unwrapped: Integrative Therapy with Gay Men and the Gift of Presence”.

In our discussion we explore such topics as the importance of trusting our self in therapy sessions, the use of intuition in creating, maintaining, and deepening therapeutic relationships, Rick’s specialized work with gay men and its related issues of identity, authenticity, and masculinity. Rick also discusses “Gay Sons and Mothers”, his new project which examines the special bond that exists between gay men and their mothers.

For more information about Rick and his work, check out his website: http://rickmiller.biz/

 

New Book Now Available!

My latest book, Unlimited Resources: Simple and Easy Ways to Find, Access, and Utilize Client Strengths and Resources to Facilitate Change, is now available.

Unlimited Resources COVER

I wrote this book for psychotherapists who are interested in directing their therapy sessions toward a focus on client strengths and resources instead of an excessive focus on problem investigation and client pathology. I offer case studies, transcripts, and practical examples to give therapists and coaches simple methods for implementing resource directed ways of working.

To get your copy, go here.

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/

Episode 22: Dana Rideout Inteview

Rideout

Psychotherapist, yoga instructor, corporate consultant and entrepreneur, Dana Rideout, is interviewed in this episode. Dana discusses her path from working in special education to finding her work as a therapist. She also discusses working with trauma and “First Responders.” the use of mindfulness to help others find the missing neurological pieces to facilitate effective interaction, getting past comfort levels in therapy, using yoga for treating anxiety, and balancing “knowing” and “not knowing”.

For more information on Dana and her work, check out her website: danarideoutlpc.com

Episode 21: Steven Hoskinson Interview

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In this episode, Steve Hoskinson is interviewed. Steve is the founder and Chief Compassion Officer of Organic Intelligence, a theory and systemic clinical application of human empowerment, resiliency, and compassion to resolve the devastating effects of Post Traumatic Stress Disorder.  Steve has trained thousands of individuals in the helping professions in North America, Europe, Asia, and the Middle East in the art of the compassionate treatment of trauma.  As a leader in the Somatic Psychology field, Steve was Professional Training Faculty for the Somatic Experiencing® Trauma Institute for 17 years and is currently Adjunct Faculty for JFK University’s Somatic Psychology program. He has graduate degrees in Theology and Psychology and is a founding member of the Northern California Society for Integrative Mental Health and the International Transformational Resilience Coalition.

In this interview we discuss therapy from a systems perspective and the idea that what is wrong with therapy is the focus on what is wrong. He also discusses the crucial aspects of therapeutic context and framing, second order change, the importance of curiosity in therapy, and be able to “act in order to know”.

For more information on Steve Hoskinson and his work, check out his website: https://organicintelligence.org/

Episode 20: Helen Adrienne Interview

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In this episode psychotherapist, trainer and author, Helen Adrienne is interviewed. Helen is a graduate of Rutgers University and Fordham University Graduate School of Social Service, Helen has trained in family therapy, mind/body therapy, cognitive therapy, guided meditation stress reduction techniques, and Ericksonian clinical hypnotherapy. She is an approved consultant for the American Society of Clinical Hypnosis, a Licensed Clinical Social Worker in New York and New Jersey, and a Board Certified Diplomat in Clinical Social Work.

Helen is the best selling author of “On Fertile Ground: Healing Infertility” and a founding member of the New York City chapter of RESOLVE™, a national infertility organization. For many years she has run mind/body support groups and other programs through RESOLVE™ for the infertile patient.

In the interview Helen discusses her work with mind/body stress reduction, fertility issues and teaching clients how to escape from stress and move into themselves, the importance of following therapeutic hunches, and the art of letting things spontaneously unfold in a session.

For more information on Helen Adrienne’s work, check out her website: www.helenadrienne.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.