Milton H. Erickson Unorthodox psychiatrist, congenial family doctor, ingenious strategic psychotherapist and master hypnotherapist, Milton Erickson's influence has revolutionised Western psychotherapy. Thanks largely to Erickson the subject of hypnosis has shed its shackles of superstition and is now widely recognised as one of the most powerful tools for change.

Within his own life, Milton Erickson had many personal disabilities to contend with, which he often stressed helped him become proficient at practical problem solving for his clients. His 'problems' began early. Born into a poor farming community in Nevada, Erickson didn't speak until he was four. Later, he was found to have severe dyslexia, to be profoundly tone deaf and colour blind. At the age of seventeen, he was paralysed for a year by a bout of polio so bad that his doctor was convinced he would die.

Milton H. Erickson Milton H. Erickson is probably best remembered as the hypnotherapist who revolutionized hypnotherapy not only by developing new therapeutic techniques but also by evolving his own unique epistemology and ontology. Many attempts have been made to present and describe his main principles and practical approach in a coherent form. O'Hanlon has summarized twelve different frameworks for Ericksonian therapy and hypnosis, including one of his own (O'Hanlon, 1987).

Despite his handicaps (or perhaps because of), Milton Erickson went on to qualify as a medical doctor and psychiatrist. In the following years he became the World's greatest practitioner of therapeutic hypnosis and one of the most effective psychotherapists ever.

It was perhaps Erickson's farming background which caused him to approach psychotherapy in such a practical way. Anyone who is interested in relieving human misery and developing human potential will benefit greatly from reading about and learning from this remarkable man.

When Erickson was in his fifties he was struck by a second bout of polio that caused him a great deal of physical pain. Even this he was able to turn into a learning opportunity as he became highly effective at treating other people's pain with hypnosis. He details many of his approaches to sensory alteration and pain control in 'Hypnotic alteration of sensory, perceptual and psychological processes' by Milton Erickson.

Despite severe illness in his old age, Milton Erickson continued to teach, demonstrate and practice his remarkable skills as a therapist, even when eventually confined to a wheelchair. He died at the age of seventy nine.

It was perhaps Erickson's farming background which caused him to approach psychotherapy in such a practical way. Anyone who is interested in relieving human misery and developing human potential will benefit greatly from reading about and learning from this remarkable man.

He is noted for:His often unconventional approach to psychotherapy, such as described in the book Uncommon Therapy, by Jay Haley, and the book Hypnotherapy: An Exploratory Casebook, by Milton H. Erickson and Ernest L. Rossi (1979, New York: Irvington Publishers, Inc.) His extensive use of therapeutic metaphor and story as well as hypnosis coining the term Brief Therapy for his approach of addressing therapeutic changes in relatively few sessions

His use of interventions that influenced the strategic therapy and family systems therapy practitioners beginning in the 1950s including Virginia Satir and Jay Haley His conceptualization of the unconscious as highly separate from the conscious mind, with its own awareness, interests, responses, and learnings. For Erickson, the unconscious mind was creative, solution-generating, and often positive. His ability to "utilize" anything about a patient to help them change, including their beliefs, favorite words, cultural background, personal history, or even their neurotic habits. His influence on Neuro-linguistic Programming (NLP), which was in part based upon his working methods [1].

Milton H. Erickson Milton H. Erickson is probably best remembered as the hypnotherapist who revolutionized hypnotherapy not only by developing new therapeutic techniques but also by evolving his own unique epistemology and ontology. Many attempts have been made to present and describe his main principles and practical approach in a coherent form. O'Hanlon has summarized twelve different frameworks for Ericksonian therapy and hypnosis, including one of his own (O'Hanlon, 1987).

Erickson's practical approach is defined as the techniques and skills he used during therapy while the main principles are defined as the beliefs that he held in relation to doing therapy. {Erickson sometimes said he didn't understand his own work}

Main Principles of Erickson Hypnotherapy

Erickson did not believe it was necessary for himself or his patient to understand the cause of a problem in order to resolve it. In his words "Etiology is a complex matter and not always relevant to getting over a problem" (Hayley, 1973). This belief is a major shift in thinking away from a search for independent cause or truth; a search that permeates our modern culture and one that has perpetuated since the time of Aristotle (1953).

Erickson also believed that "insight" was an unimportant and even unnecessary part of therapy, stating that"Many psychotherapists regard as almost axiomatic that therapy is contingent on making the unconscious conscious. When thought is given to the immeasurable role the unconscious plays in the total experiential life of a person from infancy on, whether awake or asleep, there can be little expectation of doing more than making small parts of it conscious" (Erickson, 1980).

Another important element of Erickson's epistemology was his emphasis on treating each person as an individual, and not according to preconceived theories of personality or by utilizing a rigid approach to therapy. Erickson had no particular theory or hypothesis about problems and had no set method of working and consequently had the flexibility to allow for alternative explanations and to change his behavior to match the needs of the individual client. In addition, he also recognized that "Your patient is one person today, quite another person tomorrow, and still another person next week, next month, next year" (Erickson, 1985[1]).

Erickson also believed in what has been called a naturalist approach to therapy. His belief was that people are not only capable of going into trance and experiencing all possible trance phenomena but also that they have the natural abilities needed to overcome their difficulties.

Similarly, Goldstone reports that "Another important element of Dr. Erickson's work was his deeply held belief that people innately have within themselves the strengths, skills, abilities, talents, resources and knowledge they need to make whatever kinds of changes they wish to make" (1998).

Erickson believed that people not only have all the resources they need but also that "people will make the best choices they have learned how to make" (Lankton, 1998), even if they are not conscious of this or of their process of making these choices.

Erickson believed that the responsibility for change rests entirely with the client and the role of the therapist to create a state of expectation of change and to provide the climate in which change can take place. As Erickson states "In psychotherapy you change no one. People change themselves. You create circumstances under which an individual can respond spontaneously and change. And that's all you do. The rest is up to them" (O'Hanlon, 1987).

Finally, Erickson believed that his work was complete when the presenting problem was resolved. Thus, his premise was that the long-term goal should always be the immediate goal and he did not spend time what was "behind" a symptom.

Practical Approach of Erickson Hypnotherapy

Erickson defined hypnosis as "a state of special awareness characterized by a receptiveness to ideas" (Erickson, 1985[2]). Essentially this state was elicited using techniques such as suggestion and confusion to focus or distract the client's conscious attention in such a way that Erickson could communicate directly with a client's unconscious mind. The client would then be able to learn new behaviors and new ideas from what was presented. This learning took place in a trance state in which the client was attentive to all the information set out and demonstrated by Erickson; the client could then take on board as much or as little as was appropriate for them.

In order to elicit trance states and to facilitate change, Erickson utilized whatever the client brought into therapy, whether it was beliefs, behaviors, demands or resistance. His advice was never to reject or try to the behavior that the client showed in the office. He advised that "you look at it, you examine it, and you wonder how you use it" (Erickson, 1985[2]). For example, if a child sucks his thumb then which thumb he suck? The left or the right? And shouldn't he suck the other one? And what about sucking the fingers? Which one first? After Erickson repeatedly asked these sort of questions to one little boy, the boy told his grandmother "This is making me want to dislike sucking my thumb!" (Erickson, 1985[2]).

Erickson's acceptance of the patient's ideas and behaviors for what they were, rather than rejecting, contradicting or judging them, contributed to his ability to quickly build rapport with the patient. He also made use of biorapport, which is the rhythmical alignment of some part of his behavior to that of the client's. Examples are breathing in time with the client and making movements at the same time as the client.

Another technique used by Erickson was that of the double bind. This was asking a question that gave the illusion of choice, when in fact whatever choice was made, it would lead to the desired result. To a patient who said Erickson could not hypnotize them, Erickson said "I want you to stay awake, wider and wider awake, wider and wider awake" (Haley, 1963). Whatever this client did he was co-operating with Erickson in the trance induction.

One specific form of double bind was symptom prescription. According to Watzlawick, Bavelas and Jackson (1967) this term was first introduced in the work of the Bateson "Family Therapy in Schizophrenia" project. This involved prescribing the symptom but in an exaggerated, modified or paradoxical way. Erickson once treated a married couple who had both been bed-wetters for many years. He had them set their alarm clock to wake up in the middle of the night and instructed them both to deliberately wet their bed if their bed was dry. Thus, Erickson was modifying the patients' symptoms to make it harder {easier surely} for them to do their problem and also teaching them how to have control over their symptoms.

Erickson would make use of this sort of specific task assignment as well as using generic ones so as to facilitate therapeutic change. The bed-wetting example above is a specific task. However, Erickson would often ask a client to perform a generic task like climbing a local mountain while thinking about their problem and then reporting their thoughts back to him.

The use of Metaphors was used by Erickson to communicate with his clients and he often told anecdotes from his own experience, about other clients or simply made them up. His hope was that the experience of another in overcoming a problem, which is similar to the client's own, would suggest ways in which the client could deal with their situation.

Erickson made use of the processes of framing, deframing and reframing to alter a client's perception about a given situation. A frame being defined as an added meaning given to a sensory experience. Thus, framing is the process of giving a meaning where none already exists, deframing is the process of challenging or casting doubt on the client's current meaning and reframing is the process of providing a new or alternative meaning.

As a hypnotist, Erickson made use of many hypnotic phenomena. Analgesia was used to teach clients that they could control when and where they experienced pain. Amnesia was used to prevent a client's conscious mind from interfering with hypnotherapeutic work (Erickson, 1985[2]) and to overcome learned limitations. According to Erickson "All hypnotic phenomena are made up of normal everyday patterns of behavior, organized to serve intentional purposes for the patient" (Erickson, 1985[2]).

Confusion was another important technique used by Erickson to contend with the client's conscious mind, and thereby bypass it. When solving problems, the person's mind was most frequently concerned with limiting beliefs and ideas about how change was not possible. Hence, Erickson emphasized "that the person's conscious mind has to be contended with in some manner in order to gain access to the person's unconscious abilities" (Erickson, 1985[1]).

In addition, Erickson also developed a state of confusion in his clients' minds from which they were more likely to accept what he suggested as a means of replacing the uncomfortable state of confusion with a more comfortable state of understanding. As pointed out by Lankton "a client will develop a particular receptivity to incoming information at a point in therapy when the normal framework has been disrupted and suspended by an unconditioned stimulus such as a paradoxical prescription" (1998).

Erickson used both direct and indirect suggestions to achieve therapeutic goals. In general, he was very directive when dealing with symptoms and getting people to do things but very indirect in how people would resolve their symptoms and how they would live their lives afterwards. A direct suggestion might have been to tell the client to perform a specific therapeutic task, like buying new clothes or walking a different way to work. An indirect suggestion might have been to say something like "I don't know how quickly you can learn". This statement indirectly suggested that the client will learn, it was just a question of how quickly.

In contrast to many other therapeutic approaches that focus on exploring the past, Erickson worked in both a future oriented and goal oriented manner, eliciting agreed goals with patients and working together with the patient to achieve them. As stated by Erickson "Psychotherapy is sought not primarily for enlightenment about the unchangeable past but because of dissatisfaction with the present and a desire to better the future" (Watzlawick, Weakland and Fisch, 1974).

Conclusion

Erickson once said "I don't try to structure my psychotherapy except in a vague, general way" (O'Hanlon, 1987). Compromises have been made in deciding what to include and what to omit and also in deciding the length of each description, some of which are necessarily brief. In conclusion, Erickson's own advice was to "Develop your own technique. Don't try to use somebody else's technique...Don't try to imitate my voice or my cadence. Just discover your own. Be your own natural self" (O'Hanlon, 1987).

Trance and The Unconscious MindErickson believed that the unconscious mind was always listening, and that, whether or not the patient was in trance, suggestions could be made which would have a hypnotic influence, as long as those suggestions found some resonance at the unconscious level. The patient can be aware of this, or she can be completely oblivious that something is happening. Erickson would see if the patient would respond to one or another kind of indirect suggestion, and allow the unconscious mind to actively participate in the therapeutic process. In this way, what seemed like a normal conversation might induce a hypnotic trance, or a therapeutic change in the subject. It should be noted that "[Erickson's] conception of the unconscious is definitely not the one held by Freud."[5]Erickson was an irrepressible practical joker, and it was not uncommon for him to slip indirect suggestions into all kinds of situations, including in his own books, papers, lectures and seminars.

Erickson also believed that it was even appropriate for the therapist to go into trance.I go into trances so that I will be more sensitive to the intonations and inflections of my patients' speech. And to enable me to hear better, see better.Erickson maintained that trance is a common, everyday occurrence. For example, when waiting for buses and trains, reading or listening, or even being involved in strenuous physical exercise, it's quite normal to become immersed in the activity and go into a trance state, removed from any other irrelevant stimuli. These states are so common and familiar that most people do not consciously recognise them as hypnotic phenomena.

The same situation is in evidence in everyday life, however, whenever attention is fixated with a question or an experience of the amazing, the unusual, or anything that holds a persons interest. At such moments people experience the common everyday trance; they tend to gaze offto the right or left, depending upon which cerebral hemisphere is most dominant (Baleen, 1969) and get that faraway or blank look. Their eyes may actually close, their bodies tend to become immobile (a form of catalepsy), certain reflexes (e.g., swallowing, respiration, etc.) may be suppressed, and they seem momentarily oblivious to their surroundings until they have completed their inner search on the unconscious level for the new idea, response, or frames of reference that will restabilize their general reality orientation. We hypothesize that in everyday life consciousness is in a continual state of flux between the general reality orientation and the momentary microdynamics of trance...

Indirect TechniquesWhere 'classical' hypnosis is authoritative and direct, and often encounters resistance in the subject, Erickson's approach is permissive, accommodating and indirect. For example, where a classical hypnotist might say "you are going into a trance", an Ericksonian hypnotist would be more likely to say "you can comfortably learn how to go into a trance". In this way, he provides an opportunity for the subject to accept the suggestions they are most comfortable with, at their own pace, and with an awareness of the benefits. The subject knows they are not being hustled, and takes full ownership of, and participation in their transformation.

Erickson maintained that it was not possible to consciously instruct the unconscious mind, and that authoritarian suggestions were likely to be met with resistance. The unconscious mind responds to openings, opportunities, metaphors, symbols, and contradictions. Effective hypnotic suggestion, then, should be 'artfully vague', leaving space for the subject to fill in the gaps with their own unconscious understandings - even if they do not consciously grasp what is happening. The skilled hypnotherapist constructs these gaps of meaning in a way most suited to the individual subject - in a way which is most likely to produce the desired change.

For example the authoritative "you will stop smoking" is likely to find less leverage on the unconscious level than "you can become a non-smoker". The first is a direct command, to be obeyed or ignored (and notice that it draws attention to the act of smoking), the second is an opening, an invitation to possible lasting change, without pressure, and which is less likely to raise resistance.Richard Bandler and John Grinder identified this kind of 'artful vagueness' as a central characteristic of their 'Milton Model', a systematic attempt to codify Erickson's hypnotic language patterns.

Confusion TechniqueIn all my techniques, almost all, there is a confusion.[7]A confused person has their conscious mind busy and occupied, and is very much inclined to draw upon unconscious learnings to make sense of things. A confused person is in a trance of their own making - and therefore goes readily into that trance without resistance. Confusion might be created by ambiguous words, complex or endless sentences, pattern interruption or a myriad other techniques to incite transderivational searches.

James Braid, who coined the term 'hypnosis,' claimed that focused attention ("look into my eyes...") was essential for creating hypnotic trances, indeed, his thesis was that hypnosis was in essence a state of extreme focus. But it can be difficult for people wracked by pain, angst or suspicion to focus on anything at all. Thus other techniques for inducing trance become important, or as Erickson explained:...long and frequent use of the confusion technique has many times effected exceedingly rapid hypnotic inductions under unfavourable conditions such as acute pain of terminal malignant disease and in persons interested but hostile, aggressive, and resistant...

The Handshake InductionConfusion is the basis of Erickson's famous hypnotic handshake. Many actions are learned and operate as a single "chunk" of behavior: shaking hands and tying shoelaces being two classic examples. If the behavior is diverted or frozen midway, the person literally has no mental space for this - he is stopped in the middle of unconsciously executing a behavior that hasn't got a "middle".

The mind responds by suspending itself in trance until either something happens to give a new direction, or it "snaps out". A skilled hypnotist can often use that momentary confusion and suspension of normal processes to induce trance quickly and easily.

By interrupting the pattern of a 'normal' handshake in some way, the hypnotist causes the subject to wonder what is going on. If the handshake continues to develop in a way which is out-of-keeping with expectations, a simple, non-verbal trance is created, which may then be reinforced or utilized by the hypnotist. All these responses happen naturally and automatically without telling the subject to consciously focus on an idea.

The various descriptions of Erickson's hypnotic handshake, including his own very detailed accounts, indicate that a certain amount of improvisation is involved, and that watching and acting upon the subject's responses is key to a successful outcome. The most important thing is that the 'normal' handshake is subverted in such a way to cause puzzlement, which may then be built upon.

Initiation: When I begin by shaking hands, I do so normally. The "hypnotic touch" then begins when I let loose. The letting loose becomes transformed from a firm grip into a gentle touch by the thumb, a lingering drawing away of the little finger, a faint brushing of the subject's hand with the middle finger - just enough vague sensation to attract the attention. As the subject gives attention to the touch of your thumb, you shift to a touch with your little finger. As your subject's attention follows that, you shift to a touch with your middle finger and then again to the thumb.

This arousal of attention is merely an arousal without constituting a stimulus for a response.

The subject's withdrawal from the handshake is arrested by this attention arousal, which establishes a waiting set, and expectancy.

Then almost, but not quite simultaneously (to ensure separate neural recognition), you touch the undersurface of the hand (wrist) so gently that it barely suggests an upward push. This is followed by a similar utterly slight downward touch, and then I sever contact so gently that the subject does not know exactly when - and the subject's hand is left going neither up nor down, but cataleptic.

Termination: If you don't want your subject to know what you are doing, you simply distract their attention, usually by some appropriate remark, and casually terminate. Sometimes they remark, "What did you say? I got absentminded there for a moment and wasn't paying attention to anything." This is slightly distressing to the subjects and indicative of the fact that their attention was so focused and fixated on the peculiar hand stimuli that they were momentarily entranced so they did not hear what was said. strong push or nudge is required, check for anaesthesia.

Utilization: Any utilization leads to increasing trance depth. All utilization should proceed as a continuation of extension of the initial procedure. Much can be done nonverbally; for example, if any subjects are just looking blankly at me, I may slowly shift my gaze downward, causing them to look at their hand, which I touch and say "look at this spot.". This intensifies the trance state. Then, whether the subjects are looking at you or at their hand or just staring blankly, you can use your left hand to touch their elevated right hand from above or the side - so long as you merely give the suggestion of downward movement. Occasionally a downward nudge or push is required. If a

Richard Bandler was a keen proponent of the handshake induction, and developed his own variant, which is commonly taught in NLP workshops.Any habitual pattern which is interrupted unexpectedly will cause sudden and light trance. The handshake is a particularly good pattern to interrupt because the formality of a handshake is a widely understood set of social rules. Since everyone knows that it would be impolite to comment on the quality of a handshake, regardless of how strange it may be, the subject is obliged to embark on an inner search (known as a transderivational search, a universal and compelling type of trance) to identify the meaning or purpose of the subverted pattern.

ResistanceErickson recognised that many people were intimidated by hypnosis and the therapeutic process, and took care to respect the special resistances of the individual patient. In the therapeutic process he said that "you always give the patient every opportunity to resist". Here are some more relevant quotes pertaining to resistance:Whatever the behaviour offered by the subjects, it should be accepted and utilized to develop further responsive behaviour. Any attempt to "correct" or alter the subjects' behaviour, or to force them to do things they are not interested in, militates against trance induction and certainly deep trance experience.

If the patient can be led to accept one suggestion, they will more readily accept others. With resistant patients, it becomes necessary to find a suggestion that they can accept. Resistance is always important, and should always be respected, so if the resistance itself is encouraged, the patient is made to feel more comfortable, because they know that they are allowed to respond however they wish.Many times, the apparently active resistance encountered in subjects is no more than an unconscious measure of testing the hypnotist's willingness to meet them halfway instead of trying to force them to act entirely in accord with his ideas.

Although the idea of working with resistance is essentially a hypnotic one, it goes beyond hypnosis and trance. In a typical example, a girl that bit her nails was told that she was cheating herself of really enjoying the nail biting. He encouraged her to let some of her nails grow a little longer before biting them, so that she really could derive the fullest pleasure from the activity. She decided to grow all of her nails long enough that she might really enjoy biting them, and then, after some days, she realised that she didn't want to bite them anyway.

Ericksonian TherapyErickson is most famous as a hypnotherapist, but his extensive research into and experience with hypnosis led him to develop an effective therapeutic technique. Many of these techniques are not explicitly hypnotic, but they are extensions of hypnotic strategies and language patterns. Erickson recognised that resistance to trance resembles resistance to change, and developed his therapeutic approach with that awareness.

Jay Haley identified several strategies, which appeared repeatedly in Erickson's therapeutic approach.Encouraging Resistance - For Erickson, the classic therapeutic request to "tell me everything about..." was both aggressive and disrespectful, instead he would ask the resistant patient to withhold information and only to tell what they were really ready to reveal: I usually say, "There are a number of things that you don't want me to know about, that you don't want to tell me. There are a lot of things about yourself that you don't want to discuss, therefore let's discuss those that you are willing to discuss." She has blanket permission to withhold anything and everything. But she did come to discuss things. And therefore she starts discussing this, discussing that. And it's always "Well, this is all right to talk about." And before she's finished, she has mentioned everything. And each new item - "Well, this really isn't so important that I have to withhold it. I can use the withholding permission for more important matters." Simply a hypnotic technique. To make them respond to the idea of withholding, and to respond to the idea of communicating.

Many people's reaction to a direction is to think "why should I?" or "You can't make me", called a polarity response because it motivates the subject to consider the polar opposite of the suggestion. The conscious mind recognizes negation in speech ("Don't do X") however the unconscious mind pays more attention to the "X" than the injunction "Don't do". Erickson used this as the basis for suggestions that deliberately played on negation and tonally marked the important wording, to provide that whatever the client did, it was beneficial: "You don't have to go into a trance, so you can easily wonder about what you notice no faster than you feel ready to become aware that your hand is slowly rising....."

Providing a Worse Alternative (The 'Double Bind') - Example: "Do you want to go into a trance now, or later?" The 'double bind' is a way of overloading the subject with two options, the acceptance of either of which represents acceptance of a therapeutic suggestion. My first well-remembered intentional use of the double bind occurred in early boyhood. One winter day, with the weather below zero, my father led a calf out of the barn to the water trough. After the calf had satisfied its thirst, they turned back to the barn, but at the doorway the calf stubbornly braced its feet, and despite my fathers desperate pulling on the halter, he could not budge the animal. I was outside playing in the snow and, observing the impasse, began laughing heartily. My father challenged me to pull the calf into the barn. Recognizing the situation as one of unreasoning stubborn resistance on the part of the calf, I decided to let the calf have full opportunity to resist, since that was what it apparently wished to do. Accordingly I presented the calf with a double bind by seizing it by the tail and pulling it away from the barn, while my father continued to pull it inward. The calf promptly chose to resist the weaker of the two forces and dragged me into the barn.[10]

Communicating by Metaphor - This is explored extensively in Sydney Rosen's 'My Voice Will Go With You', but a beautiful example is given in the first chapter of David Gordon's book Phoenix: I was returning from high school one day and a runaway horse with a bridle on sped past a group of us into a farmer's yard looking for a drink of water. The horse was perspiring heavily. And the farmer didn't recognize it so we cornered it. I hopped on the horse's back. Since it had a bridle on, I took hold of the tick rein and said, "Giddy-up." Headed for the highway, I knew the horse would turn in the right direction. I didn't know what the right direction was. And the horse trotted and galloped along. Now and then he would forget he was on the highway and start into a field. So I would pull on him a bit and call his attention to the fact the highway was where he was supposed to be. And finally, about four miles from where I had boarded him, he turned into a farm yard and the farmer said, "So that's how that critter came back. Where did you find him?" I said, "About four miles from here." "How did you know you should come here?" I said, "I didn't know. The horse knew. All I did was keep his attention on the road."

Encouraging a Relapse - To bypass simple short-lived 'obedience' which tends to lead to lapses in the absence of the therapist, Erickson would occasionally arrange for his patients to fail in their attempts to improve, for example by overreaching. Failure is part of life, and in that fragile time where the patient is learning to live, think and behave differently, a random failure can be catastrophic. Deliberately causing a relapse allowed Erickson to control the variables of that failure, and to cast it in a positive therapeutic light for the patient.

Encouraging a Response by Frustrating It - This paradoxical approach acts directly on the patient's own resistance to change. Obese patients are asked to gain weight, or in a family therapy session, a stubbornly silent family member is ignored until the frustration obliges them to blurt out some desperate truth. Once again, this approach has its roots in Erickson's hypnotic language patterns of the form "I don't want you to go into a trance yet".

Utilizing Space and Position - Hypnosis and therapy are experienced subjectively by the patient, and any part of their total experience can be used to reinforce an idea. The physical position or even the posture of the patient can be a significant part of the subjective experience. Manipulating these factors can contribute to a therapeutic transformation. If I send someone out of the room - for example, the mother and child - I carefully move father from his chair and put him into mother's chair. Or if I send the child out, I might put mother in the child's chair, at least temporarily. Sometimes I comment on this by saying, 'As you sit where your son was sitting, you can think more clearly about him.' Or, 'If you sit where your husband sat, maybe it will give you somewhat of his view about me'. Over a series of interviews with an entire family, I shuffle them about, so that what was originally mother's chair is now where father is sitting. The family grouping remains, and yet that family grouping is being rearranged, which is what you are after when changing a family."[11]

Emphasizing the Positive - Erickson claimed that his sensory 'disabilities' (dyslexia, colour blindness, being tone-deaf) helped him to focus on aspects of communication and behavior which most other people overlooked. This is a typical example of emphasizing the positive. Erickson would often compliment the patient for a symptom, and would even encourage it, in very specific ways. In one amusing example, a woman whose parents-in-law caused her nauseous feelings in the gut every time they visited unexpectedly was 'taught' to puke spectacularly whenever the visits were especially inconvenient. Naturally the parents-in-law would always sympathetically help her clean up the vomit. Fairly soon, the annoying relatives started calling in advance before turning up, to see if she were 'well enough' to see them. The subject of dozens of songs, 'emphasizing the positive' is a well known self-help strategy, and can be compared with 'positive reformulation' in Gestalt Therapy.

Prescribing the Symptom and Amplifying a Deviation - Very typically, Erickson would instruct his patients to actively and consciously perform the symptom that was bothering them (see the nailbiting example under #Resistance), usually with some minor or trivial deviation from the original symptom. In many cases, the deviation could be amplified and used as a 'wedge' to transform the whole behaviour.

INTERVIEWER: Suppose someone called you and said there was a kid, nineteen or twenty years old, who has been a very good boy, but all of a sudden this week he started walking around the neighborhood carrying a large cross. The neighbors are upset and the family's upset, and would you do something about it. How would you think about that as a problem? Some kind of bizarre behavior like that.ERICKSON: Well, if the kid came in to see me, the first thing I would do would be to want to examine the cross. And I would want to improve it in a very minor way. As soon as I got the slightest minor change in it, the way would be open for a larger change. And pretty soon I could deal with the advantages of a different cross - he ought to have at least two. He ought to have at least three so be could make a choice each day of which one. It's pretty hard to express a psychotic pattern of behavior over an ever increasing number of crosses.[12]

Seeding Ideas - Erickson would often ensure that the patients had been exposed to an idea, often in a metaphorical form (i.e. hidden from the conscious mind) in advance of utilizing it for a therapeutic purpose. He called this 'seeding ideas', and it can be observed to occur at many levels both coarse and fine grained, in many of his case histories. In a simple example, the question "Have you ever been in a trance before?" seeds the idea that a trance is imminent - the presupposition inherent in the word before is "not now, but later".

Avoiding Self-Exploration - In common with most brief therapy practitioners, Erickson was entirely uninterested in analysing the patient's early psychological development. Occasionally in his case histories, he will briefly discuss the patient's background, but only as much as it pertains to the resources available to the patient in the present. INTERVIEWER: You don't feel that exploring the past is particularly relevant? I'm always trying to get clear in my mind how much of the past I need to consider when doing brief therapy.ERICKSON: You know, I had one patient this last July who had four or five years of psychoanalysis and got nowhere with it. And someone who knows her said, "How much attention did you give to the past?" I said, "You know, I completely forgot about that." That patient is, I think, a reasonably cured person. It was a severe washing compulsion, as much as twenty hours a day. I didn't go in to the cause or the etiology; the only searching question I asked was "When you get in the shower to scrub yourself for hours, tell me, do you start at the top of your head, or the soles of your feet, or in the middle? Do you wash from the neck down, or do you start with your feet and wash up? Or do you start with your head and wash down?"INTERVIEWER: Why did you ask that?ERICKSON: So that she knew I was really interested.INTERVIEWER: So that you could join her in this?ERICKSON: No, so that she knew I was really interested.[13]

Shocks and ordealsErickson is famous for pioneering indirect techniques, but his shock therapy tends to get less attention, perhaps because it is uncomfortable for us to hear such uncharacteristic stories about an inspirational and gentle healer. Nonetheless, Erickson was prepared to use psychological shocks and ordeals in order to achieve given results:

When the old gentleman asked if he could be helped for his fear of riding in an elevator, I told him I could probably scare the pants off him in another direction. He told me that nothing could be worse than his fear of an elevator.The elevators in that particular building were operated by young girls, and I made special arrangements with one in advance. She agreed to cooperate and thought it would be fun. I went with the gentleman to the elevator. He wasn't afraid of walking into an elevator, but when it started to move it became an unbearable experience. So I chose an unbusy time and I had him walk in and out of the elevator, back in and out. Then at a point when we walked in, I told the girl to close the door and said, "Let's go up."

She went up one story and stopped in between floors. The gentleman started to yell, "What's wrong!" I said, "The elevator operator wants to kiss you." Shocked, the gentleman said, "But I'm a married man!" The girl said, "I don't mind that." She walked toward him, and he stepped back and said, "You start the elevator." So she started it. She went up to about the fourth floor and stopped it again between floors. She said, "I just have a craving for a kiss." He said, "You go about your business." He wanted that elevator moving, not standing still. She replied, "Well, let's go down and start all over again," and she began to take the elevator down. He said, "Not down, up!" since he didn't want to go through that all over again.She started up and then stopped the elevator between floors and said, "Do you promise you'll ride down in my elevator with me when you're through work?" He said, "I'll promise anything if you promise not to kiss me." He went up in the elevator, relieved and without fear - of the elevator - and could ride one from then on.[14]

References^ Gorton, Gregg E (2005). Milton Hyland Erickson The American Journal of Psychiatry. Washington. Vol.162, Iss. 7; pg. 1255, 1 pgs ^ Autohypnotic Experiences of Milton H. Erickson (Milton H. Erickson and Ernest L. Rossi), The American Journal of Clinical Hypnosis, July. 1977 20, 36-54, reprinted in Collected Papers Volume 1. ^ Autohypnotic Experiences of Milton H. Erickson (Milton H. Erickson and Ernest L. Rossi), The American Journal of Clinical Hypnosis, July. 1977 20, 36-54, reprinted in Collected Papers Volume 1. ^ Rosen, S. My Voice Will Go With You ^ Andre M. Weitzenhoffer (1976) Introduction/forward in Hypnotic Realities Erickson & Rossi ^ Erickson & Rossi: Two-Level Communication and the Microdynamics of Trance and Suggestion, The American Journal of Clinical Hypnosis, 1976 Reprinted in Collected Papers Vol.1 ^ Erickson & Rossi - Hypnotic Realities ^ Erickson & Rossi - Hypnotic Realities ^ Transcription of Interview with Erickson quoted in Uncommon Therapy by Jay Haley. ^ Varieties of Double Bind Erickson & Rossi, The American Journal of Clinical Hypnosis, January 1975. Reprinted in 'Collected Papers' Volume 3. ^ Erickson quoted in Uncommon Therapy by Jay Haley. ^ Erickson quoted in Uncommon Therapy by Jay Haley. ^ Interview with Erickson transcribed in Uncommon Therapy by Jay Haley. ^ Erickson quoted in Uncommon Therapy by Jay Haley.

http://www.hypnosis101.com/best-induction.htm

Despite its detractors, well run government saved America during the depression. Though some blame the democrats for creating the welfare state, it pulled the country out of a devastating depression, and is directly responsible for a good deal of the wealth of today. Things such a dental care, public health, public education, public higher education, good water systems, all came out of the New Deal, Public Works Projects and other governmental programs that began in the 1930s under FDR. These were very brave ideas at the time and fit a spirit of entrepreneurship.

Profit, nonprofit and private not for profit organizationsBusiness has fundamental differences with governmental parameters. At the heart of business is profit while service is at the heart of government. Business gets is revenue from profits or sales, while government gets it from taxes. The priority for a government work is to not make a mistake that gets him noticed. For the business man it is to make a profit, regardless of how many mistakes he makes. The concept of risk is vastly different.

Privatization of human service organizations

This has been a push for the past several decades. One thought is that privatization puts money directly into the local economy through private providers and that this should always be viewed as the preferred function of government. The counter to this is that when private providers are used that there is a presumption that profit is being made in the delivery of services to the public and that his can lead to price gouging or conflict of interest. (ie. That the private provider would tend to maximize those services that provided the provider with the highest profit, further the provision of services by a provider would more likely tend to meet the bid specs vs the true need in a dynamic society, locking the system in place long after the need had changed or been eliminated.) A counter argument can be made for government in this area.

For instance we still have an agency who ensures that we keep national helium reserves dating back to the days of the dirigibles or blimps incase the government ever decides to float a fleet of them again. One argument for privatization is the idea that private business can alter or retool more quickly in its provision of services than government and that their motivation to change can be more readily affected, that they will tend to be more aware of the needs of the customer. It is rare private business that does not take pains to ensure that its product is what the customer wants. The watch word for the 1990s was viewing the recipient of services as a customer and react accordingly. Some compromise is clearly needed. We want the best of good business operating with the understanding of good government of the particular needs of the populace.

Alternatives to standard service delivery:

Traditional functions:Creating legal rules and sanctionsRegulation or deregulationMonitoring and investigationLicensingTax policyGrantsSubsidiesLoansLoan GuaranteesContracting

Innovative:

FranchisingPublic-private partnershipsPubic=Public partnershipsQuasi-public corporationsPublic enterpriseProcurementInsuranceRewardsChanging public investment policyTechnical AssistanceInformationReferralVolunteersVouchersImpact feesCatalyzing nongovernmental effortsConvening nongovernmental leadersJawboning or public forums

Avant-Garde:

Seed moneyEuity investmentsVoluntary associationsCoporductoin or self-helpQuid Pro QuosDemand managementSale, exchange, or use of propertyRestructuring the market

Is your organization open to new ideas from all levels, or must ideas come up through the chain. Can one part of an organization meet with another and share ideas or enter a joint venture or try out a new idea together. Vertical organizations have a top down chart. Information travels down from boss to boss to boss and information travels up the same way. In a horizontal organization there is a presumption that every one knows their respective jobs and is competent and motivated to do it, so the typical management structure is much less needed. Much as a chief of staff at a hospital. Yes the chief manages, but he does not attempt to tell the doctors under him what to do, the management is more directed to coordination of ideas and methods, not enforcing methods. Some jobs are more open to this sort of management. The argument is that all jobs would benefit from more of the horizontal approach as the vertical arrangements tend to smother creativity.

Agency study methodology

Total Quality management processesQuality circlesBottom up assessment, customer sensitivity.

Organization:

:social units deliberately constructed and reconstructed to seek specific goals.: an organization is a collection of people engaged in specialized and interdependent activity to accomplish a goal or mission.: as systems of continuous, purposive, goal-oriented activity involving two or more people.Note that any group can be considered an organization. In this context the key is together toward a goal, a goal directed group. This could be a Seal Team from Rainbow Six, a garden club, a Sunday School class.

Important are the rules that the group sets for itself and how it elects to make decisions. In systems theory we have seen how the system can be greater than its parts, or a system can develop a life of its own. The organization theory holds the same for the organization of group. There are many instances in human history that reflect this. The ice age mastodon hunters were able to bring down an animal hundreds of times their size through an organized approach, doing something a single person could never do. Imagine for a minute why this might be possible.

Consider a troup of 100 spear wielding people attacking a mastodon one at a time with no organization. 100 flattened corpes left, 1 mildly bored mastodon. With organization (read clan of the cave bear), a few brave and quick hunter can amplify the strength and catch the animal in areas of vulnerability. How did this occur? Did a wise iceman suddenly see how it might be done? Anthropologists suggest that this behavior came to the ice age people from viewing the wolf packs. Fossil and cave paintings reflect the reverence for wolves. They dressed in their skins and performed ritualized dances in honor of the wolf. It would much less of a jump for a poorly organized troup to learn from observing a wolf pack bringing down a large bison or elk and from there make tentative attempts with larger animals by mimicking the same strategies.

Are we then a modern pack of wolves and have this in our heritage? The definition of an organization goal fits this model: the desired or intended ends or results to be achieved by an organization or as a desired state of affairs which the organization attempts to realized, can be well viewed through the eyes of the wolf pack, the ice mens tribe, the Seal team, the workers in a unit, the community group, the union members, Sunday school class, or the Optimist club. Each form from shared goals and are the most effective when they share a vision that contributes to the overall survival and maintenance of the organization.

Social care goals are those directed to changing the environment in order for people to improve the quality of their lives and reach maximum potential.

Social control relates to control of other who might interfere with their own goals or the goals of others.Rehabilitation are those directed toward changing individuals so they will have improved quality of life and better opportunity to reach their fullest potential.

Goal Displacement is when a new goal contradicts an existing one.Goal succession is when one goal is replaced by another, such as when a drunk challenges someone to step out side and when the other stands, reveals that he is 68 and weighs 250 with no neck and his goal alters to finding a back door to slip out quietly.

Scientific or classical management theory:

Frederick Taylor, an engineer, cir 1895, put forth this model for organizational management.EfficiencyEffectiveness

Science of workScientific selection and training of staffManagements work with staff in implementation Managements planning and development of procedural rules for staff to follow

Bureaucracy:

Classic model of organizations put forth by Max Weber (1864-1920)It can be synonymous with organization.stable and officially stated structure of authority, an organizational chart.a hierarchy clearly defines who is over whoma record of transactions, regulations, and policies kept over timespecialized training for managementofficial duties take precedencefollows stable rulescareer oriented approach to workmanagement is apart from owners management has authority to delegate resources

Why does it now have a negative stereotype? During the late 1940s and through the 1950s in America there was much more exposure to heavy industry than ever before for most of Americans. During the building of heavy industry for WWII there was a tremendous growth in companies. Small machine shops that had ten to 20 workers suddenly faced staffing major production lines of hundreds and even thousands of employees. This required a tremendous shift in the development of rules and policies that felt to be necessary in the maintenance of large production lines and large numbers of staff. With the downsizing that came following the end of the war and even more following the end of the Korean conflict, these massive bureaucracies were viewed from the smaller, newer companies that took the place of the larger more well established company.

Also, the new business climate was much different. Instead of building more of what was being built, new ideas resulted in new inventions and new wealth (the 1950s were a time of great prosperity, due in part to the energy of men returning from the war who came back trained, used to a certain life style, exposed to new ideas, and the GI bill). With new wealth came demand for goods, both new and old. People wanted new cars with new and better options, new refrigerators, newly designed radios, recording processes, television, color television, etc. all required a different sort of company, one that could adjust to a new product, envision a new product based on its need, get the new product into production and into the market quickly. Companies had to be able to completely retool in a matter of months or even weeks, a task that used to take years if not end the life of most companies.

This requires a much more flexible approach to management and some of the regulations became to be seen in a negative light, as standing in the way of progress. The Old guard was often let go as they had difficulty letting loose of the tight strands of red tape that held the old organization (and their positions in it in place.

This set the stage for human relations theory of organizational management. The old operated on the notion of X or Y theory. The management viewed production staff as only interested in tangible rewards or punishments in terms of how they would respond to management. This was called X theory of management. At the other end of the spectrum was the career management person who was felt to be in his place due to company loyalty and a shared vision. This reflected the Y theory, that someone does something for more intrinsic rewards instead of extrinsic rewards.

X: inherent dislike for work; must be forced or threatened directly with job loss or pay loss; inherent preference for being directed and shuns responsibility. Security critical(better fits with the classical approach)

Y: expects to work as a part of life goals; self directed to objectives to which they are commited; self actualization is highest goal; wants responsibility; untapped creativity pool; untapped potential in everyone.(better fits with the human relations approach)

Due much to the increase in production and the critical needs the war effort placed on management and owners, the field was hungry for increasing the level of information about management. The Hawthorne Studies, by Elton Mayo showed that any attention provided to workers increased their output (they tried various levels of lighting and work increased under all conditions as long as the workers were aware that an experiment was underway) It became called the Hawthorne Effect. Also noted was the tendency for the group to set normative work expectations for the group, apart from management.

This surprised management theorist and began a focus more on some of the more esoteric and heretofore undiscussed issues such as the effect of group dynamics, small group behaviors, what makes a good leader, how decisions are made, routes of communication, and ways of sharing goals.

As open systems an organization would have the following characteristics:

importation of energy throughput: use energy to produce goods or provide servicesoutputsystems as cycles of events: Self replicatingnegative entropy: something to fight chaosinformation input, negative feedback and the coding process: evaluation processsteady state and dynamic homeostasis: a movable balance established by organizations taking in energy and information, using it, then exporting it in return for needed resources in a functional way. A dynamic movable balance.differentiation :to greater complexity and greater specialization of functionequfinality : the attainment of goals via different paths

Contingency theory: that organization always make decisions on incomplete information and that every decision is made in the context of all other issues. Sounds a good deal like the person-in-the-situation theory. Decision making is always made with incomplete information. Monday morning quarter backing is not a decision. It is too late. The great managers are often viewed in awe as near fortune tellers. how did they know this would work?

They had to have known something we didnt know. Often from a distance managers are viewed highly critically in that their decisions may not be what the production worker would have made in part due to the necessity of the manager to forecast what will be needed a month to a year in advance on a production line or in a decision that might impact the environment in which production or service occurs.

Negatives aspects of Theory X or the classical management approach.Negative aspects of Theory Y or the Human Relations Perspective.Positive?

Organizational Culture: How things are done around here? The real organizational chart. Who has the dirt? Who wields the real power? How are decisions really made? Who is the fair haired who have their ideas listened to more seriously?

Oligarchy: decisions controlled by a few. A failing of organizations is that they almost always eventually see their maintenance as becoming a primary goal vs the original goal that created the organization. Perhaps this is part of human nature. The self interest of the rulers prohibit major change, especially any change that does not benefit or especially change that puts their roles and lines of information at risk. Avoid change or disenstion at all costs, avoid making waves, those that do are not reinforced or rewarded.

Consensus organizations: any enterprise in which control resets ultimately and overwhelmingly with the members-employees-owners, regardless of the particular legal framework through which it is achieved. Were all in this together approach. All for one, one for all. Where would this idea work best? Who is in charge?

Consensus:

I believe that you understand my point of viewI believe that I understand your point of view.Whether or not I prefer this decision, I will support it, because it was arrived at in an open and fair manner.TQMfocus on the consumer of the organizations servicesinvolvement of everyone in the organization in pursuit of qualitya heafvy empasis on temworkencouragement of all employees to think agbou tand pursue quality whtint he organizationmistakes are not to be covered up but ar to be used as learning experiences opportunitiesworkers are encouraged ot work out problems solvable at their level and not to pass them along to the next leveleveryone is on the quality team and everyone is responsible and encouraged to pursue quality

As open systems an organization would have the following characteristics:

importation of energy throughput: use energy to produce goods or provide servicesoutputsystems as cycles of events: Self replicatingnegative entropy: something to fight chaosinformation input, negative feedback and the coding process: evaluation processsteady state and dynamic homeostasis: a movable balance established by organizations taking in energy and information, using it, then exporting it in return for needed resources in a functional way. A dynamic movable balance.differentiation :to greater complexity and greater specialization of functionequfinality : the attainment of goals via different paths

Japanese Social Welfare:

flexible job descriptionsuse of nemawashi information decision making process

Nemawashi () in Japanese culture is an informal process of quietly laying the foundation for some proposed change or project, by talking to the people concerned, gathering support and feedback, and so forth. It is considered an important element in any major change, before any formal steps are taken, and successful nemawashi enables changes to be carried out with the consent of all sides.Nemawashi literally translates as "going around the roots", from (ne, root) and (mawasu, to go around [something]). Its original meaning was literal: digging around the roots of a tree, to prepare it for a transplant.Nemawashi is often cited as an example of a Japanese word which is difficult to translate effectively, because it is tied so closely to Japanese culture itself, although it is often translated as 'laying the groundwork.'

the ring decision making processpromotion of the wa: unity Japanese Wa (? "Japan, Japanese", from Chinese W ), is the oldest recorded name of Japan. Chinese, Korean, and Japanese scribes regularly wrote Wa or Yamato "Japan" with this Chinese character until the 8th century, when the Japanese found fault with the belittling character for W "Japan" and replaced Wa with Wa "harmony; peace".Job reassignment and rotation: extensive training; job is for lifetotal quality control or total quality management or quality circles

Pluralistic work place: Why

Disabilities/obligation or barrier?John:Misfit1720-deviantIdiot1850-boarding school to lessen deviancy, new labelsIdiot1881- farmIdiot1890-asylumRetardate1920-state-run institutionsDevelopmental disability1970-intermediate care facilityIndividual with a developmental disorder1980-alternate placement in group homes/apartmentsConsumer/neighbor/diversity1990-community based supported living, option of choice

Micro organizational issues traditional and alternative paradigms

Issues:MotivationLeadershipPowerCulture/climateDecision-makingCommunicationEmployee evaluation/reward systemsEmployee satisfactionQuality managementConsumer complaintsStaff conflictSexual harassmentDiversity issuesValues and ethicsRural issuesSupervision/staff development

MotivationWhat motivates people to work? Most human services studies in this area place money as third or fourth on the list of things that motivate the most. The most often repeated desired reward is recognition/appreciation of creative effort and recognition of character. Give examples of character recognition. Effective Rewards for workers can include specific comments about their work and their abilities or character. Formal recognition also has its place. In small groups my saying some one is doing a great job, if I do not know the job, falls hallow and shallow. I must know something about the persons job for me to comment on how good it is. How could you praise without knowing how a job is done? You could look at the results or at the comparative work in other areas. Or you could work with the person in having them establish goals and cheer with them when they are met.

LeadershipThis is related to the concept of supervision an motivation. The effective leader must both develop and impart a vision for what the group is about. This vision becomes the kernel of what the unit will view and measure their work against. In a best world the shared vision becomes the very best supervisor in that all staff can begin to self supervise, using self assessment in determining whether or not their work is near the mark. The effective leader shows respect regardless of gender, race, etc. and makes this a critical part of modeling. Care to show that the leader cares for the group collectively and individually. The reason most given for burnout is related to the feeling that one has lost control of his environment and has limited or no input into his situation. This leads to powerlessness and feelings of burnout and impotence.

PowerPersonal power, Ascribed powerAssumed power

Culture/climateOur culture defines to some degree how we feel about our work an our play. What defines the work day? 9-5 / 5 days a week with 2 week Also discuss more about the treatment the comparison group will receive, the number of visits, time spent, etc. as you have done with the experimental groups a year vacation. In Israel a month or more is common. In Europe the feeling is the same. Vacations are considered an important part of life. Timeliness is also considered differently from culture to culture.

Decision makingDemocratic, leaderships, committees, matrix. Stake holders, Delphi concept

CommunicationOpen/closedOne wayEmail/memosCommittee workEmployee evaluation/reward systemsHow often and what shape should it takeMerit systemsEmployee satisfactionWhat generates this the most? Monetary rewards. No. more likely control over ones job environment, and a shared part of te agencies purpose and outcome.Quality managementTQM Quality circles. Feedback. The bowling with curtain concept.