Saturday, October 27, 2012

Therapy is a Zen koan

Threads:                        Not knowing
Relevant recent posts:     12/3/10     What is hypnosis?
                                      6/29/11     In support of not knowing

I think any theoretically based psychotherapy is mistaken because each person is different.
   Milton Erickson (1980)

What is psychotherapy? A process where two people get together to try and figure out what the hell one of them wants.

— One of Erickson’s descriptions of psychotherapy (Gilligan, 1987, p. 82)

This post is certainly for therapists and their clients; but it also for anyone who knows the freedom and depth of connection that comes with shedding old patterns of thinking, behaving, and relating to self, other, and world.

I found a lovely description of the sensibility with which I was taught and mentored to practice therapy. It’s from paper by Hillary and Bradford Keeney published in the Journal of Systemic Therapies. I’ll include an excerpt and two other quotes below, but first, I’d like to provide a bit of context to make clearer what the Keeney’s are pointing at.


The problem with categorizing

We categorize things based on similarities and differences. This process has inherent limitations. For example, the act of recognizing that something is a cat emphasizes what similarities it shares with all other cats while deleting (or at least downplaying) all that make a particular cat different and unique from other cats. Some cats like laps; some cats like their belly rubbed; some cats will scratch if you try to pet them. You can’t treat all cats the same; best to learn about each cat.

Let’s switch from cats to therapy clients.

Fear of flying: I know how to work with that!

Assume I start work with a client who tells me they have fear of flying. My big brain could easily serve up the following: “Fear of flying—I recognize that! I’ve worked with lots of folks with that. Great, I know how to do this… just like I have before. Let’s go!” Three minutes into the exchange and I’ve already generated a diagnosis (fear of flying) and sketched out a treatment plan (what I’ve done before).

Who are you actually with?
I was taught to see this as a problem of my own creation: In categorizing my new client as being like other clients with fear associated with flying, I miss how they are different from the others.

What makes this particular person different from other people?
For example, what exactly are they referring to as fear of flying? Getting on the plane? Being in a cramped space? The doors shutting? Having no escape? Lift off? Turbulence? What are the details of their internal experience? How did they learn to have this fear? Given their unique personal history, what resources do they have which will enable them to solve this problem and be more comfortable—in a way that is both possible and natural for them?

Everyone is different. There is no normal. The most profound fortune cookie I ever got said,

Normal only means you don’t know them well enough.

Best not to treat all people the same
It quickly becomes clear: Any codified approach, method, model, treatment plan, or recipe blinds me to seeing the individual in front of me. How will I drop all that and see who I am with as we both try to learn to collaborate with each other on behalf of clarifying and promoting what this client wants?

In it together: In any relationship we mutually affect each other…

…and so to between therapist and client. But let’s start simply: We could model therapeutic interaction as one in which the therapist is responsible for causing a change in the client (and not the other way around). Systems in which A affects B but not vice-versa are formally called first order cybernetic systems. There are more insightful and useful models.

Systems of mutually affecting parts
Gregory Bateson (1904 - 1980), among other of his far reaching explorations, developed ways of thinking about living systems as consisting of mutually affecting parts, formally called second order cybernetic systems.

The family as a system of mutually affecting parts
For instance, if we take the family as our system of living things, each family member influences every other family member and each family member is influenced by every other family member: Mom affects Dad, Dad affects Mom, kid affects parent, parent affects kid, and kids affect each other.

Lots of complexity

Inviting you a bit further into a second order cybernetic way of thinking, consider just the relationship between Mom and Dad: Mom's behavior affects Dad, and then the reaction of Dad to Mom's behavior affects Mom's behavior, which in turn will affect Dad's behavior, and so on. Add more parts to the system (for instance, kids) and it becomes even more complex.
When you are part of a system you can’t just step outside of it
While enmeshed in the family, no family member can stand outside of the family system. You can’t just suddenly take a break from the family. Your break-taking, your thinking, your perspective on the family is—all of it—still enmeshed within field of the family system.

Nobody in the system has a perspective outside of the system
Consequently, no family member can claim a perspective outside of the family from which they can then objectively comment. Each family member’s story is but a single facet of what’s going on in the family; and no member’s story is more complete or more true than any other member’s.

So to, therapist and client form a system of mutually affecting parts
As therapist and client spend time together they form a system of mutually affecting parts. It is as if they both get in a little boat, cast off from shore, and hope they together figure out how to get back to land. Movement towards what the client wants arises out of the in-the-moment mutually influencing interactions between client and therapist. Together they make use of themselves and each other.

A fundamental assumption
You have to be part of a system to affect it; and if you are part of a system, you no longer have a perspective that is outside it.

This is one of the assumptions that underlie my training as a hypnotherapist… and which has become part of the lens through which I see the workings of the world.

Approaching therapy

Here the excerpt from Hillary and Bradford Keeney's paper (2012):

Therapy is a Zen Koan: it has no answer that is right and is no more likely to solve life than theatre, religion, or weather. When we make therapy a game in which theory (or meta-theory) gets to sit in the throne, we all lose. The art of helping bring forth change asks us to go beyond theoretical discourse. It asks for its embodiment in ways that seldom need to be spoken except in those occasions in which it naturally expresses itself without preplanned intent or purpose.

If your therapy of tomorrow is the same as it is today, then your therapy is dying. Its particular form is only true for the moment in which it arose for the client who inspired it. In the changing forms is found the wise process therapist, the practitioner of change who is always changing in order to help others change. Whereas first-order cybernetics asked us to take responsibility for changing the client, second-order cybernetics ups the ethical imperative by asking us to change ourselves in order to foster change in others….

It is time that therapists realize they are in the same domain of interaction as the Zen master and other interlocutors of transformation who mediate in the unknowing of fettered knowing. Let us become emancipated from being fenced in by any architect of an over-schooled approach. All schools of therapy are actually the same: prescriptions to follow someone else’s arbitrary rules rather than being more flexibly responsive to what each session invites…. Here we find an invitation to be more creatively alive in a session and not be attached to any habit of thought that limits other possible ways of serving therapeutic transformation.
In keeping with the sensibility expressed above, here is Milton Erickson's response to one of his students, Steve Gilligan (1987, p. 83), asking, "How do you know what to do?"
I don’t know. I don’t know what I’m going to do. I don’t know what I’m going to say. All I know is that I trust my unconscious to shelve into my conscious what is appropriate. And I don’t know how the clients are going to respond. All I know is that they will respond. I don’t know why. I don’t know when. All I know is that they’ll respond in a way that best suits them as individuals. And I become so intrigued with wondering exactly how their unconscious will choose to respond that I can comfortably wait for their response, knowing that when it occurs I can accept and utilize it. I know that sound ridiculous, but it works.

And finally this from Abu Yazid Al-Bistami (circa 874) , the prince of Sufis in his time:

Nothing is better for a man than to be without anything, having no asceticism, no theory, no practice. When he is without everything, he is with everything.

Gregory Bateson (1904 - 1980) was an English anthropologist, social scientist, linguist, visual anthropologist, semiotician and cyberneticist whose work intersected that of many other fields (see wikipedia). For me, reading him is both rewarding and exhausting: so many new ways of seeing the world, two or three pages and I’m done for a while. Here are three of his books.

Gregory Bateson (1987). “Steps to an Ecology of Mind.” Jason Aronson Inc., Northvale, NJ.

Gregory Bateson (1980). “Mind and Nature: A Necessary Unity.” Bantam Books, Elsevier-Dutton Publishing Co., Inc., Two Park Avenue, New York, NY 10016.

Gregory Bateson (1991). “Sacred Unity: Further Steps to an Ecology of Mind.” Donaldson, R. E., ed., Harper Collins Publishers, 10 East 53rd Street, New York, NY 10022.

Stephen Gilligan (1987). “Therapeutic Trances.” Brunner/Mazel, Inc. 19 Union Square, New York, NY 10003.

Milton Erickson (1980). “A teaching seminar with Milton H. Erickson.” Edited J. K. Zeig. Brunner/Mazel, NY, 1980.

Hillary Keeney & Bradford Keeney (2012). “What is systemic about systemic therapy? Therapy models muddle embodied systemic practice.” Journal of Systemic Therapies, v31:1, p 32-33.

Abu Yazid Al-Bistami from Stephen Mitchell, ed. (1991). “The Enlightened Mind: An anthology of sacred prose.” HarperCollins Publishers, 10 East 53rd Street, New York, NY 10022. p 75.

Friday, March 30, 2012

Hypnosis and weight loss: An example of unconscious learning

With hundreds of diets and programs for weight loss,
in the long-term, why don’t they work for many people?

Threads:                        Context, Learning
Relevant recent posts:     2/14/2011     Unconscious Learning
                                     5/13/2011     Getting unstuck: Part 1
                                     8/23/2011     Getting unstuck: Part 2

Some people, for whom being overweight is a problem, successfully and sustainably lose weight while others do not. Most people I see for weight loss already have experience adopting a variety of self-imposed regimens, either counting calories, measuring quantities, or adopting a prescribed diet—and regular exercise. Their success has been limited: After a while there is often an internal rebellion, discipline breaks down, and old habits return—sometimes with a vengeance.

What follows is written through the lens of my experience as a hypnotherapist. Here, I will not address medical issues or medications that make maintaining a healthy weight difficult.


What’s missing?

A simple equation
It seems like it should be simple: First, eat healthy foods. Second, a) maintain weight by eating just enough to fuel your activity level; b) gain weight by eating more or being less active—or both; c) lose weight by eating less or being more active—or both.

For many who have tried to lose weight it’s not simple
Overweight people who want to lose weight know it is not that easy. It is often more than a calories-in/calories-out math problem to solve by upping your activity level and changing what and how much you eat. That’s because the old habits that make up our relationship with food and eating are rich with meaning and emotion—and they run far deeper than a calorie count would indicate.

Our underlying relationship with food
My clients who want to lose weight have taught me this: Being unhealthily overweight is the problem and weighing less is the solution. But for some people, the means of accomplishing this sustainably involves changing the underpinnings of one’s relationship with food and physical activity on behalf of health, well-being, and feeling good.

Where do we learn our particular relationship with eating?

We learn most of our habits about eating and food from the environment in which we grow up. Nobody sat us down and taught us about this. We simply absorbed it—like a sponge and mostly unconsciously—from our family of origin.

When old habits become a problem  
As adults, these old learnings, now our habits, function without our conscious awareness. It is fair to say we don’t do them, they do us. If we don’t like the results of our old and habitual relationship with food—for instance, we steadily weight gain—it’s hard to change, precisely because we aren’t aware of our old learnings or the details of their functioning.

As a result, no one—doctor, friend, hypnotist, yourself—can demand that you “eat healthier, eat less, and exercise more” and expect it to work over the long haul. It’s too simple a directive; it fails to address the complexities that go into making changes in our relationship with eating.

Somehow we need to untangle the problematic old learnings in a way that allows us new, less restrictive options. Hypnotherapy is a good tool for that.

Hypnotherapy: Accessing the glue that binds us to habits

Hypnotherapy is great at accessing unconsciously held learnings in a way that allows for some new options of behavior. Specifically, it’s a good tool for breaking up old patterns about food and eating in a way that allows for the emergence of a sustainable, healthier relationship with food and eating.

As with learning anything new, this is an incremental process that takes intentionality, time, and effort… which proceeds in a way that makes use of one’s abilities… and evolves to a sustainable change in a way that is entirely natural for the individual.

Examples of how and what we learn about food

Below are several fictional vignettes that illustrate circumstances in which we might have learned a particular relationship with eating… that subsequently became problematic for us… and that we might untangle in a way that allows us healthier eating habits.

Most people I work with already know the details of what constitutes a healthier relationship with food and exercise for them. If they don’t, our work together starts by focusing on their learning some of the specifics of a healthy diet and activity level. They might need to see a nutritionist or their doctor as part of their research.

Example 1
Old habits of likes and dislikes
A client, in his 50s, grew up in a meat and potatoes household, no salads, no green vegetables, and rarely any other kind of vegetable or fruits… and always a big bowl of cereal or ice cream as a snack before bed. He’s overweight, knows he still eats like he learned to growing up, and can’t get himself to try anything new, but says he wants to.

With encouragement to finally discover for himself what foods he likes and dislikes—rather than go along with whatever he happened to be served as a kid—and with hypnosis to support his accessing his ability to learn something he doesn’t yet know… he began exploring.

Discovering new tastes
We went through some recipes: he was intrigued w/ grilled asparagus with olive oil and roasted pine nuts. He went home and tried it. He liked it! Shortly after that he began to experiment with different kinds of salad greens and his own dressings. He discovered he liked salad. And as he changed and broadened his tastes in food, he gradually carried less weight; and his confidence in his ability to make changes that mattered increased.

Example 2
Old associations of food and rebellion
Growing up we can learn to use food to rebel against—or try to maintain a balance of power with—our parents.

When I was a youngster, my parents were occupied with some issues my Dad was having with his job and I wasn’t getting the attention I wanted from my parents. Without consciously plotting it out, I became a fussy eater and refused to eat just about everything except scrambled eggs for dinner. I remember disgust with most other dinner foods. (The fact that meat and vegetables were both cooked until equally grey and tasteless probably contributed to my behavior.) I did this for several months, and then got over the just-eggs thing, but kept my dislike of vegetables and refused to eat them. I gradually rediscovered them for myself—either raw or lightly cooked—in my late twenties.

A variation on rebellion: Eating what is forbidden
Other children learn to sneak away and eat forbidden or strictly regulated foods—candy, desserts, junk foods—behind their parent’s back. For some this can persist into adulthood as a stealth and guilt-ridden overeating of certain foods.

In this case, part of the therapy might involve unraveling an old eating habit—then an act of autonomy and freedom from parental authority—that is now obsolete and unhealthy.

Example 3
Eating for temporary calming and comfort
We can easily learn to use food for comfort when we’re young. As an infant, when we are hungry, we cry, and we get fed. But we can be uncomfortable in a variety of ways, and we also cry. And this crying can be misunderstood as “baby needs food,” so we get fed, and we get Mom or Dad’s attention to boot.

Besides eating because we’re hungry, we learn to associate eating with being comforted. When we’re anxious, lonely, or physically or emotionally uncomfortable, we turn to eating as a means to provide ourselves a temporary sense of well-being. Comfort and well-being are good things to experience; but using food to accomplish good feelings often has the side effect of steady weight gain.

Learning more options (besides eating) for accessing comfort
None of the people with whom I’ve worked who had learned to eat for comfort could get themselves to just give up this strategy—a testimony, I think, to the importance of being able to access comfort. In this case, therapy consists of learning more options for accessing feelings of comfort and well-being that don’t have unhealthy side effects.

This differs for each person. At its simplest, one client learned to use self-hypnosis instead of eating to quell the tensions that arise in the course of their normal work day. Another client addressed and resolved a long-standing family issue rather than eating in order to bear the tension of ignoring it.

Example 4
Eating interwoven with meaning beyond physical nourishment
Food can become imbued with meaning beyond nourishment of body. For instance, some people grow up in a family culture where food is love—the women buy, prepare, and serve food as tangible love for family, and food is received and understood as love. It is an act of love itself as Grandmothers and Mothers teach the young girls about food, to shop for it, to cook it, and how to bring the family together and nurture them with it.

Some individuals in such families can grow large under this diet of love-food.

Keep the love, modify the old eating habits
Here, the therapeutic work consists of separating food-as-love and food-as-physical-nourishment—and in doing so, developing other options for experiencing and expressing love and connection besides food.

Example 5
Being overweight as self-protection
I have worked with women who grew up suffering abuse, or who watched Mother suffer abuse from her partner. They may have unconsciously adopted the strategy of becoming overweight to discourage attention from a potential abuser. One can appreciate this is a brilliant strategy developed under “battlefield” conditions—and it comes with a high cost: It is painful to be overweight, feel unattractive, and have all of one’s efforts to lose weight fail.

Here, the old strategy of self-protection must be separated from the undertaking of losing weight. This involves learning new strategies such as how to set limits and hold boundaries while exploring relationships with others in ways that feel safe and satisfying. As new strategies for self protection are developed, the need to be overweight for protection drops away, and possibilities for sustainable weight loss emerge.


Contrary to a popular myth, hypnosis cannot make someone lose weight or eat differently. Therefore, if you or your doctor think you should lose weight but you really don’t want to, hypnosis won’t help. (Some people want to want to make a change, but that’s different from actually wanting—and being ready—to make a change.) It is a choice: Not everyone wants to make the effort involved in changing old eating habits.

Hypnosis as a useful tool
Although hypnotherapy can’t force you to change, it is an exceptional tool for sifting through old, unconsciously held learnings, and keeping what’s useful and letting go of what is no longer useful—on behalf of health and well-being.

Separating out what’s useful from what’s no longer useful
In each vignette above, what was learned in an old setting persists into later life, becoming a constraint and problem. The therapeutic task is freeing up your relationship with eating from the entanglements of the old and obsolete learnings.

Sustainability: Getting the feedback of feeling good
Your initial motivation to lose weight may be because you don’t like the way you look or how you feel. Losing weight is often about self-imposed discipline and denial—with not a good feeling in sight.

When you actually have the experience that eating well and being active inherently contribute to good feelings—then there is motivation to keep doing what provides you what you like. This is a sustainable feedback loop.