I am writing about Erickson's contribution to therapy in terms of epistemology and ontology and run the risk of being mistaken as an article on philosophy. Indeed, I have written an article on philosophy of therapy and change called The 'Changing' Worldview which is the companion and introduction to this current article. Readers are encouraged to read that article before reading the present one. I will refer to it from time to time in this article.
Years ago, I heard Dr. Dan Goleman, editor of Psychology Today magazine, state that Dr. Erickson had made a contribution to psychology parallel to Freud's. Where Freud had made his contribution in terms of theory, Erickson had made an equal impact in terms of intervention. Indeed, many professionals feel that Erickson's significant contribution was the advancement of the use of hypnosis. Others feel it was his use of language in one way or another: indirect suggestion, metaphor, anecdotes, confusion, therapeutic binds, etc. Others would argue that his contribution was the development of concepts known as utilization, indirection, speaking the client's language, and so on.
I suppose that arguing the merits of one of these aspects of intervention over another is a matter of personal and professional judgment. But I would like to express what I believe to be a central underpinning of all of these interventions - his approach to people and problems - or if you like, his epistemological and ontological position.
Finally, to make the matter of bringing home my point a bit harder, I have chosen a topic that concerns the thoughts and perceptions of Dr. Erickson. He is neither present to defend himself from what I am about to say, nor do his written works directly deal with the issues I am presenting. I am basing this content upon my years of training with him and my observations of his work.
An epistemology for change indicates that active therapists have several characteristics which set them apart from traditional therapists of the last century (Lankton, 1997). In summary, modern therapy rests upon an epistemology which operationalizes how people change. It does not attempt to explain truth or causation. It is an active approach to therapy that builds upon resources leading to desired goals. Therapists and clients cooperate in building an awareness of the experiences and an understanding of their meaning.
I can't think of a more obvious way to understand of Erickson's interventions. Consider the following interventions of reframing and retrieving experiential potentials in the following case: When the newlyweds came for counsel due to the lack of sexual intercourse, it was not that the husband did not have love for his bride (which might have seemed true to the observer). Furthermore, it was not formulated that the man had erotic desires for his mother but experienced internal conflicts due to his fear of retribution from his father. Rather, Erickson offered the view that the husband was attempting to express his unique and profound desire for her in a way he had not previously been able to do and he needed to develop some special manner to make his superlative expression now. Erickson's way of viewing the situation is not that of an expert viewing the truth linked to the past in a causal and linear manner. Rather, his way is that of an active participant, helping create a context for change, discovering health as it unfolds, and orienting them toward the current and future goal by retrieving resources.
I want to discuss four aspects of therapy as they reflect the difference between the traditional and emergent epistemologies. I will then demonstrate Erickson's position regarding these issues. The four issues are the purpose and use of suggestion, metaphor as indirect intervention, the meaning of a symptom, and what constitutes a cure.
Some of the distinctive features of therapy and interventions associated
with Erickson's work are important, not for their "uncommon-ness" but
for their function as a vehicle to bind the therapist and client in the process
of co-creating a context for change. Look at indirection and its use as one
example. The traditional epistemology favors the use of direct suggestion which
could be used by experts to tell observed subjects just what they should do to
improve from the problems they bring to the office. Indirect suggestion, on the
other hand, is presented so that a client will apprehend that portion which is
of subjective value and apply it to the process of retrieving and associating
experiences needed to reach the current goals. Indirect suggestion assumes an
active and participating client with a certain innate wisdom. The therapist
learns from the response of the client when to elaborate the presented ambiguity
in even more helpful ways.
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|
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| Use of suggestion | direct, authoritarian | indirect, permissive |
| Indirection, metaphor | if done by client it is an indication of primary process, a sign of client regression | resource retrieval, allowing client to create a unique response, an experiential context which helps build a bridge for learning |
| Meaning of symptom | internal conflict, not well defended | a communication about developmental needs |
| Cure | due to insight, ego strengthening, internal conflict resolution | development of new relational pattern and creative response to environment |
It is easy to see that the conception of a problem or symptom as a sign or communication is another facet of the emerging epistemology. The existence and continuance of the symptom is many things: it is feedback the client can not associate to the needed resources, it is a probe by the client to stimulate the environment, it is a communication and so on. These views are part of the interactive, goal-oriented, future-oriented view. Contrast this to the view that a symptom is a sign of an internal conflict within an individual. People are indeed conflicted when they are not solving problems in an adaptive and creative manner. The decisive feature between the old and new epistemologies may lie in the conception of priority as it pertains to the idea of a symptom. Is this strip of experiences we call a symptom due to the conflict within or is the symptom a sign of the person's attempts to solve a relational problem? It seems reasonable to me to suggest that if we say a symptom is the former, we are of the old tradition. If we say the latter is more accurate, we operate from the emergent view. Refer to item "C" on the above menu for a detailed discussion of the traditional and modern epistemologies.
The final area of "cure" can also be seen to reflect the differences in approach. The traditional view of cure, as I have understood it in my academic education, is related to the resolution of an internal conflict, building of ego strength in the individual, removal of resistance, removal of symptoms, and finally the capacity for work and love. The emphasis in this scenario is on an individual in a vacuum who has somehow "worked through" events from the past about which he or she was conflicted, lacked ego strength, and from which he or she developed parataxic distortions. Of course, this often involved insight and sometimes involved corrective emotional experiences. This is a concept of cure based upon a past-orientation. From a future-oriented perspective, a cure would be evaluated on the basis of the loss of the symptom, development of adaptive relationships with those persons in the current social environment, and the acquisition of new skills for handling developmental demands. Let's now look at how Erickson's contribution is expressed in these different areas as a means to evaluate his reliance upon the emerging epistemology.
Many students of Erickson's work have encountered difficulty sorting out the "real" Erickson. Some may have read articles that Erickson was very directive and not indirect as others have claimed. Some contend that he was very authoritarian and others claim he was permissive. One can either check the sources of these comments and sift through them for signs of professional jealousies and alliance, first hand knowledge versus second hand accounts, or perhaps just decide not to over-generalize and conclude that Erickson displayed a wide range of conduct which subsumed both positions., Erickson's views changed and developed over time. One would take a different awareness, seeing his work in 1945 than one would viewing his work in 1975. In order to demonstrate how his view of clients and problems reflected this emerging epistemology, I want to chronicle this change in those areas that have bearing on the discussion: purpose and use of suggestion, use of metaphor as indirection, meaning of symptom, and what is a cure.
Direct suggestions and redundant suggestions
Erickson's early explanations of hypnosis suggest that he moved from the position of an authoritarian expert who "did" something to a client, to a position of co-creator of a context for change. In that context he "offered stimuli" to subjects who put ideas together for themselves. In a 1945 published transcript, he used "sleep" redundantly in the following sentence: "Now I want you to go deeper and deeper asleep." (p. 54). The statement "I can put you in any level of trance" (p. 64) [italics mine] (Erickson, M. With Haley, J. & Weakland, J. 1967).
Interesting, it indicates his directive stance at the time. By 1976 Erickson had fully reversed this method of redundant suggestion and wrote that indirect suggestion was a "significant factor" in his work (Erickson, M. H., Rossi, E. L., & Rossi, S. I, 1976, p. 452). But more interesting still, is the growth evident at the end of his life, published after his death in 1980. Here he took the position, not of authoritative expert who makes someone go into trance, but of someone who will "offer" ideas and suggestions (p. 1-2). Contrary to his early conduct he stated, "I don't like this matter of telling a patient I want you to get tired and sleepy" (p. 4) [italics mine] (Erickson, M., Rossi, E., 1981). This is the exact opposite position and represents a straight departure from the traditional to the emerging epistemology!
Metaphor as indirect intervention
There can be little doubt that Dr. Erickson was comfortable with the role of ambiguity in therapy. In 1944 Erickson used a complex story to help stimulate a client's neurotic mechanisms (Erickson, 1967). So, we see from very early work that he felt that therapy was a matter of offering ambiguity for the client to develop his or her own unique response. Still, in 1954 Erickson was delivering what he called "fabricated case histories" to help a client be relieved of fleeting symptomatology (Erickson, M., 1980, p. 152). And, of course, by the year 1973 there are several examples of case stories used for illustrating points in therapy and normal communication (Haley, J., 1973). Finally, in a 1979 publication, there are section headings on "metaphor" as intervention (Erickson, M., Rossi, E., 1979). It would be most correct to conclude from this evidence that Erickson's use of ambiguity, permissiveness, and indirection in therapy was present from the beginning of his work and progressed with increasing frequency.
The meaning of symptoms
Regarding the meaning that Dr. Erickson attributed to symptoms, there is a pattern of change from the traditional, analytic view in his early career to that of the systemic and interpersonal view by his death. His medical degree was obtained in 1928 and he then went to Colorado General Hospital for his internship and was there until 1938 or 39. But as late as 1954, he wrote, "The development of neurotic symptoms constitutes behavior of a defensive, protective character" (Erickson, M., 1980, p. 149). This strikes me as a traditional analytic view with concepts like "defense and attack."
But, again, we see movement to the modern epistemology by 1966, when he wrote, "Mental disease is the breaking down of communication between people" (Erickson, M., 1980, p.75). And, finally, in 1979, he had arrived at the fully formed idea state in "Symptoms are forms of communication" and "cues of developmental problems that are in the process of becoming conscious" (Erickson, M., Rossi, E., 1979, p. 143). This view is much more in keeping with the ideas expressed verbally by Erickson on repeated occasions, that he did not have a theory of personality and invented a new theory with each unique client.
Cure seen as reassociation of experience not direct suggestion
Erickson's ideas of cure remained essentially the same from 1948 to the end of his work. In 1948 he recognized that cure was not the result of suggestion but rather, developed from reassociation of experience (Erickson, M., 1980, vol. 4, p. 38). (In this citation we also can see that Erickson did not wish to use direct suggestion in treatment but preferred to use indirect suggestion for treatment and, in the earlier 1954 quote, he still used direct suggestion for induction.) We see essentially the same quote in Erickson's writing at the end of his career (Erickson, 1979; Erickson, M. & Rossi, E., 1980, p. 464; and Erickson, M. & Rossi, E., 1981).
While his use of suggestion and redundancy changed over the course of his career from the traditional to more permissive, his use of permissive ambiguity, what constituted a symptom, and what facilitated a cure was consistent from his earliest records until his latest works. We also see that reliance upon this emergent epistemology increased in frequency over time. Clearly, in these important and revealing ways, Erickson's work evolved from a modification of the traditional approach to a full representation of the emergent epistemology. And, this happened increasingly from the period of 1944 until the end of his career.
Even though I have focused on Erickson's interventions to illustrate my points, his work was often a prime example of the psychology's paradigm shift to the modern epistemology. The ramifications of this paradigm shift are tremendously widespread and important. It is curious that Erickson's interventions can be in the spirit of either the traditional or the modern epistemologies. If a therapist were to so choose, he or she could use an intervention such as metaphor and deliver it in a manner similar to giving a patient Valium. Indeed, there are books written which prescribe telling this or that metaphor to a patient with a particular diagnostic label. His interventions, delivered by therapists who are still dominated by the antiquated epistemology, will find they get success now and again (defined in whatever manner they define success). Those therapists will not find much of interest about Erickson's approach – at least not for long. Soon enough, many of them will be searching for some new techniques that promise to deliver terrific therapeutic results.
But I do not believe Erickson's greatest contribution was his remarkable interventions. In fact, therapists bound in the traditional epistemology can use his interventions and they will "work" so to speak - but they will be no more useful, exciting, or dramatic than the conventional interventions on most occasions. Furthermore, it will be a chore to conceive of them from that framework.
On the contrary, Erickson's approach to clients and problems nearly predicts novel interventions with no effort. Assuming the epistemology written about in these two articles will result in an abundance of new interventions for each patient. That is, the use of Ericksonian interventions will not create an awareness of the new epistemology but the modern goal-oriented epistemology will generate interventions. Interventions seem to flow from the posture created with the emerging epistemology.
The combination of Ericksonian interventions and the posture of the modern epistemology creates a total package for powerful change even, at times, in a brief number of sessions. There is little wonder why Bateson and the MRI team studied Erickson's work for the first eight years of their organization - it was for Erickson's worldview. I have to conclude then, that interventions are not the greatest contribution made by Erickson's life work but rather it is his epistemology, and from that, the interventions Dan Goleman spoke of are secondary and almost unimportant.
This article serves as an introduction and explication about Erickson's contribution as it pertains to the territory for the shifting paradigm in psychology. More information can be found in Practical Magic, The Answer Within, Enchantment and Intervention in Family Therapy, and The 'Changing' Worldview.
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