Strategic interventions
22/02/10 16:59 Filed in: using
language to facilitate change
Last week,
I presented on Strategic Family Therapy in my
Marriage and Family class. My students always love
the stories of Haley's mentor, Milton Erickson,
intervening in such a way as to circumvent client
resistance and facilitate deep change through
hypnotherapy and the sheer power of language. I have
always loved these stories, and I use such methods
from time to time. One of my favorite stories may or
may not be true, but it is of Erickson as a young boy
on his family's farm. He father was trying to get a
cow to go into the barn, and was struggling at the
halter. The cow was firmly uninterested in
cooperating. The young Erickson convinced his father
to let him help after his dad told him there was
nothing he could do. Milton grabbed the cow's tail
and ... pulled it
away from the
barn door. The cow walked through the door with
Milton guiding him from behind. Everyone smiles when
they hear this story. We all know that what Milton
did was much more effective than his father's direct
efforts.
In my opinion, a master therapist uses this philosophy even if he or she doesn't use the terms "strategic," or "paradoxical" to describe them, because fundamentally a seasoned therapist knows that the greatest accelerant to a person's recovery is getting the client's energy harnessed in the service of change. The problem is that our clients are often doing battle with themselves, thinking that if they can defeat a symptom, then they will be better off than before. They declare war on the symptom, and they end up being casualties of internal conflict. Most symptoms, however, express deep and reasonable aspirations, but the person has lost sight of that underlying intent. Think of the symptom (or unwanted behavior) as lying outside the circle of the self -- or in the case of family therapy, outside the family's values. As long as it's a threat, the individual client or family will try to defeat it. But if the symptom is, for example, an individual's own bodily desires, or a 14-year old "acting out" child, then the warfare that ensues is doomed from the outset. A master therapistmust find a way to bring that symptom inside the circle of the client's own self-identity or the family's rules and values. How?
It doesn't take trickery, even though brilliant interventions work like magic. It takes, fundamentally, a great deal of compassion and a commensurate willingness not to get bogged down in thinking of the problem the way that the client(s) do. Let's get practical, and look at an example of a situation that many therapists might have a hard time dealing with constructively: addiction to porn. How do you help a person achieve the goal of avoiding porn sites? A direct approach might call for applying willpower to defeat the problem. But of course, all you're doing as a therapist is trying to pull the cow into the barn when the client has already failed. Not likely that he or she is going to succeed just because you throw your weight behind their efforts, right?
A master therapist is not going to fall for that kind of warfare. But how can one be effective in achieving this very important therapeutic goal? The first step is to bring the symptom into the circle of the self. That is, the therapist has to reach deeply into the client's history and underlying aspirations and understand how this symptom is an attempt to achieve a reasonable, even necessary goal. What would that look like? The therapist, in using reframing in this circumstance has to find a way to reframe the problem as tolerable and even useful, and only then endeavor to redirect the client's focus. The therapist might say, "It appears to me that your desire to view sexually explicit material represents your desire for intimacy in a way that doesn't expose you to being hurt. As long as your fear of being hurt remains high, you will probably want to continue doing this. But if we can work on your fear of being hurt in relationships, I am pretty sure your desire for intimacy will assume other forms."
The therapist has thus succeeded in defining a course of action that does not declare war on the symptom itself. If the client accept this, it's as if the perimeter of the self has expanded, permitting the symptom to be incorporated into a larger circle. Does this mean that the client is going to feel better about viewing porn sites? That scenario is what keeps us from using such interventions. But it's not what happens. Whenever a symptom fits into a larger, more meaningful framework, the client's control of it usually increases, and his or her desire to pursue it decreases, even though that's not the therapist's initial (stated) goal.
If you want to grasp this methodology, think in terms of "normalizing" the client's struggle. I once told a woman who was suicidally depressed, "If you weren't depressed, you'd be crazy." That impressed her, because no one had ever appreciated the full extent of her suffering. We need to find a way to reframe the symptom so that it isn't so bad any more, and thus frees to the client not to do battle with it. It doesn't work, however, to skip reframing and to say, "That's not so bad," because all that does is to minimize your client's struggle. But if you can recast the struggle in a new light, then your efforts to normalize the symptom will probably work. When I honored my client's depression, she was able to see it as a rational response to a terrible set of circumstances, and thereby to accept her symptom.
It takes compassion, an accurate grasp of the client's underlying intentions, and a reframing that brings a symptom into the circle of the self.
Of course, there are several tactics that can accomplish this, including 1) predicting the continuation of the symptom, 2) prescribing the symptom, 3) reframing the symptom, 4) onedownsmanship, and 5) restraining or slowing the process of positive change. But they have little worth, in my opinion, unless they are wedded to a deep compassion for your client, who needs above all else to be respected and to gain self respect in the struggle for healing.
In my opinion, a master therapist uses this philosophy even if he or she doesn't use the terms "strategic," or "paradoxical" to describe them, because fundamentally a seasoned therapist knows that the greatest accelerant to a person's recovery is getting the client's energy harnessed in the service of change. The problem is that our clients are often doing battle with themselves, thinking that if they can defeat a symptom, then they will be better off than before. They declare war on the symptom, and they end up being casualties of internal conflict. Most symptoms, however, express deep and reasonable aspirations, but the person has lost sight of that underlying intent. Think of the symptom (or unwanted behavior) as lying outside the circle of the self -- or in the case of family therapy, outside the family's values. As long as it's a threat, the individual client or family will try to defeat it. But if the symptom is, for example, an individual's own bodily desires, or a 14-year old "acting out" child, then the warfare that ensues is doomed from the outset. A master therapistmust find a way to bring that symptom inside the circle of the client's own self-identity or the family's rules and values. How?
It doesn't take trickery, even though brilliant interventions work like magic. It takes, fundamentally, a great deal of compassion and a commensurate willingness not to get bogged down in thinking of the problem the way that the client(s) do. Let's get practical, and look at an example of a situation that many therapists might have a hard time dealing with constructively: addiction to porn. How do you help a person achieve the goal of avoiding porn sites? A direct approach might call for applying willpower to defeat the problem. But of course, all you're doing as a therapist is trying to pull the cow into the barn when the client has already failed. Not likely that he or she is going to succeed just because you throw your weight behind their efforts, right?
A master therapist is not going to fall for that kind of warfare. But how can one be effective in achieving this very important therapeutic goal? The first step is to bring the symptom into the circle of the self. That is, the therapist has to reach deeply into the client's history and underlying aspirations and understand how this symptom is an attempt to achieve a reasonable, even necessary goal. What would that look like? The therapist, in using reframing in this circumstance has to find a way to reframe the problem as tolerable and even useful, and only then endeavor to redirect the client's focus. The therapist might say, "It appears to me that your desire to view sexually explicit material represents your desire for intimacy in a way that doesn't expose you to being hurt. As long as your fear of being hurt remains high, you will probably want to continue doing this. But if we can work on your fear of being hurt in relationships, I am pretty sure your desire for intimacy will assume other forms."
The therapist has thus succeeded in defining a course of action that does not declare war on the symptom itself. If the client accept this, it's as if the perimeter of the self has expanded, permitting the symptom to be incorporated into a larger circle. Does this mean that the client is going to feel better about viewing porn sites? That scenario is what keeps us from using such interventions. But it's not what happens. Whenever a symptom fits into a larger, more meaningful framework, the client's control of it usually increases, and his or her desire to pursue it decreases, even though that's not the therapist's initial (stated) goal.
If you want to grasp this methodology, think in terms of "normalizing" the client's struggle. I once told a woman who was suicidally depressed, "If you weren't depressed, you'd be crazy." That impressed her, because no one had ever appreciated the full extent of her suffering. We need to find a way to reframe the symptom so that it isn't so bad any more, and thus frees to the client not to do battle with it. It doesn't work, however, to skip reframing and to say, "That's not so bad," because all that does is to minimize your client's struggle. But if you can recast the struggle in a new light, then your efforts to normalize the symptom will probably work. When I honored my client's depression, she was able to see it as a rational response to a terrible set of circumstances, and thereby to accept her symptom.
It takes compassion, an accurate grasp of the client's underlying intentions, and a reframing that brings a symptom into the circle of the self.
Of course, there are several tactics that can accomplish this, including 1) predicting the continuation of the symptom, 2) prescribing the symptom, 3) reframing the symptom, 4) onedownsmanship, and 5) restraining or slowing the process of positive change. But they have little worth, in my opinion, unless they are wedded to a deep compassion for your client, who needs above all else to be respected and to gain self respect in the struggle for healing.
