Book Review: Uncommon Therapy

Kirk Honda, M.A., LMFT

May 25, 2012

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In the stimulating and entertaining 1973 book Uncommon Therapy: The Psychiatric Techniques of Milton H. Erickson, M.D., Jay Haley introduced Erickson’s uncommon psychotherapy techniques to the clinical world.  Through numerous case studies with individuals and families, from the young to the old, through various forms of distress, this book attempts to convey how Erickson practiced what would become known as strategic therapy.

As a therapist, teacher, clinical supervisor, and author, Erickson was a legendary and pioneering American psychiatrist.  His ideas were revolutionary in the 1960s and 1970s, and his techniques continue to shock and inspire readers today.  Erickson is recognized as a major contributor to the field of psychotherapy and hypnotherapy.  He was a major influence on Jay Haley who himself was one of the recognized founders of family therapy along with Bateson, Jackson, Weakland, Ackerman, Lidz and Bowen.  Haley credits his mentor, Erickson, as the inventor of the general approach of strategic family therapy. 

Haley entertainingly describes Erickson’s frankness, confidence, flexibility, directness, uniqueness, and creativity.  The book depicts the lives of Erickson’s various clients: pain victims, elderly people, people with terminal illnesses, bedwetting children, couples in conflict, thumb-sucking teens, etc.  Haley describes cases in which Erickson used ingenious techniques to quickly get to the core of a problem and prescribe a course of action that lead to rapid recovery.  Some readers might find his practices manipulative and disrespectful, while others might appreciate his brief techniques as ultimately helpful and respectful.

Strategic Therapy

Erickson’s ideas laid the foundation for many therapies such as strategic family therapy, brief therapy, and solution focused therapy.  These ideas include:

1) Deemphasizing diagnostic labels

2) People have the power to solve their own problems

3) Deemphasizing theory

4) Change is brief

5) Change is carefully planned by the therapist

6) No insight is required

7) The therapist takes responsibility for directly influencing people

8) The therapist must gain the trust of the client

9) Therapists can induce change by indirectly suggesting behavior to break old patterns

10) Each client requires a unique approach

11) The therapist can bypass client resistance by using paradoxical directives

Erickson believed that the smallest intervention can set in motion second-order change.  Erickson’s style emphasizes the need for a holistic assessment and an acceptance of the client’s world without imposing psychological jargon.  As an example of a paradoxical directive, Erickson might tell a client to purposefully be depressed which creates a paradox of control over the symptom and thereby relieving the symptom.  He creatively used the context of the client.  Each seemingly coincidental feature or event in the life of the client could turn out to be part of the solution.

Miraculous Claims and Questionable Practices

The results Erickson achieves seem to border on the miraculous.  In the introduction, Haley acknowledges that some readers may be irritated by the continual emphasis on Erickson’s successes.  Haley very briefly admits that Erickson did fail with cases; however, the entire book is exclusively filled with stories of successful treatment.  This bias puts the entire book into question.  Without a balanced account, wise readers will take Haley’s book with a grain of salt. 

For example, Haley describes Erickson’s therapy with a college-aged woman who was embarrassed about her small breasts.  After several sessions, her breasts became larger.  Erickson then hypothesized that his use of hypnosis was a factor in the enlargement of the woman’s breasts.  Since he thought he was able to enlarge women’s breasts through therapeutic suggestion, it seems possible that other biased and arrogant attributions were also made in Haley’s book.

As with many other writers at that time, Haley writes without reservation or humility.  He is humble regarding his deference for his mentor Erickson, but he does not provide balance to the various claims.  Seen through today’s lens, there are potential ethical violations throughout the book.  The following passages are two such examples:

Page 61: “When working with young women, Erickson makes maximum use of his own masculinity. He assumes that if he persuades a woman that she is attractive to him, she will generalize that idea to an acceptance of herself as attractive to men.”

Page 51: “When the question of sex came up, this shy and inhibited girl developed deafness. She just turned blank and apparently couldn't see or hear. Yet she wanted to get married. I told her the next time she came in for an interview, I wanted her to bring, in her handbag, the shortest pair of short-shorts imaginable. I said she was going to take them out of the bag and show them to me. She did that. Then I gave her a choice. At her next interview with me she would either walk in wearing those short-shorts or she would put them on in my office. She made her preference and chose to walk in wearing them. I wanted to talk about sex with her as part of her preparation for marriage, so I said, Now you're going to listen to me when I discuss sex, or I'll have you take those shorts off and put them on in my presence." She listened to me on the subject of sex and wasn't deaf.”

Among these passages, Haley provides no comment on the ethical considerations of these techniques.  This is evidence that Haley and Erickson did not question their assumptions. 

Also in line with writers of the era, Haley and Erickson have a narrow definition of normality and health.  Haley makes several statements of what is without an allowance for cultural variability and social construction.  For example, Haley identifies children as the marker of a successful early marriage.  However, later in the book, Haley redeems himself by advising therapists to not impose their values on clients.

Conclusion

Even though Haley’s book has problems, some of the case examples inform my work with clients.  Erickson’s creativity is appealing and inspirational.  It was refreshing to be reminded of the underlying philosophy of strategic therapy.  In my practice, I have used Erickson’s techniques, especially when faced with stern resistance.  Just this week I told my students to use profanity as a way of joining with defiant teens, and the next day I coincidentally read Haley’s account of how Erickson used the word “hell” to disarm a resistant client. 

I recommend therapists read at least one of the chapters.  However, I would caution readers to remember that the book is biased toward successes and that some of Erickson’s interventions might be considered unethical by today’s standards (e.g., compromising client confidentiality to achieve a therapeutic goal).  I would also caution therapists to only use hypnosis and strategic techniques under close supervision – given the way Haley describes the cases, it might be tempting for a novice therapist to assume Erickson’s techniques are easily executed and always successful.  In conclusion, I am glad to add this book to my office bookshelf, but I might hide it behind the other books, lest a savvy client associate me with the book’s dark side.