Man: I appreciate your comment about giving content–free post–hypnotic suggestions to the alcoholic after collapsing anchors. I think that many programs for alcoholics have failed because the therapist or agency has tried to come up with specific alternative behaviors to drinking. They tell the alcoholic «Let's all go bowling» or «Let's all go do leatherwork.» That approach is painfully ineffective.
Absolutely. Bowling and leatherwork are very unlikely to be able to satisfy the secondary gain in drinking.
Man: It seems as if it would be a good idea to have an indefinite amount of time available if you're going to use this approach with alcoholics. This might be difficult to do in hour–long sessions.
Yes, that would be ideal. However, you live in a world of hourly schedules. I'm not a good model for a practicing psychotherapist in this respect. I don't make my living doing psychotherapy anymore. I don't even do psychotherapy anymore. I did for a while to make sure that I tested all the patterns I'm teaching you with a wide range of presenting problems. So when I offer you something, I know it works, and I can demonstrate to you that it works. However, even when I had a private practice, I wouldn't schedule more than two or three clients a day, and I'd leave huge gaps between them so that I could run the session anywhere from ten seconds, which was the shortest time I've ever worked with a client, up to something like six and a half hours, which was the longest.
Man: You've got to tell us about the ten–second client!
You can easily do a content reframe in ten seconds. But I was thinking of a man whose presenting problem was that he couldn't stand up to people who were aggressive. As soon as he told me that, I threw him out of the office! In those days, a group of us had arrangements with each other and with some of the neighbors that they would interact with our clients in certain ways when we offered certain signals. So as soon as I threw him out, I yelled to my wife «Catch him!» So Judith Ann strolled out on the front porch just as this man walked by almost whimpering «He threw me out.» She started talking to him, «Oh, no! Did John do it again? Did he throw you out without any sympathy, without any sensitivity to your needs as a human being?»
At this point, of course, she had perfect rapport. He was saying «Oh, take care of me! Help me!» As a friend who happened to be there, she then told him how to cope with the situation. It took ten seconds for me to access the problem state, and then she picked up the client and programmed him in the next few minutes.
If you work in an agency, you have lots of opportunities to do that kind of thing. You can teach your clients things through role–playing, and the learning will transfer if you future–pace them well. However, it will always work better if you don't announce that the frame is role–playing; you just do it. You can behave in exactly the way that they can't cope with, thereby accessing that limited state fully and purely. They're not just pretending or thinking about it. Then if you have somebody pick them up on the bounce, you can do really amazing things very quickly.
Woman: From what you've said, we can assume that alcoholics and hard drug abusers have very dissociated states, and also be alert that some people who smoke or overeat have these sequential incongruities. Are there other indicators of sequential incongruity?
I don't know of any fail–safe way of detecting sequential incongruity, but there are some things you can watch for. Sometimes I've done what I thought was really great work and it didn't work at all because I didn't detect sequential incongruity. With these «almost multiple personality» cases, sometimes whatever you do seems to work really well. You get all the appropriate responses; you get new choices for the client, you test and future–pace and everything. Then he leaves, and when he comes back the next week he can barely remember what you did last week, and can't even verify whether it worked or not. However, you can tell that your work hasn't been effective at all. If the problem is something like smoking or overweight, it may be very obvious.
When this happens, you can suspect sequential incongruity. The main guideline I use to identify this is to notice that over some period of time you see really radical shifts in a client's behavior. When people who overeat tell you things like «I find myself staring at a pile of chicken bones, and it's as if I just woke up» that's a good indication of sequential incongruity. Sometimes you can suspect it if their behavior sounds very strange, or if your work goes too easily.
When I suspect sequential incongruity, I sometimes use altered states of consciousness to run tests. For example, I had a lady who had a hysterical paralysis of the leg. She came in and we did reframing, and wham! her leg was unparalyzed. I immediately paralyzed it again and she was furious at me. «My leg was fine, and now it's bad again. Why did you do this to me?» I said «That was just too easy. I know there is a part in there that's going to sneak out later on.»
Without actually leaving the time–place coordinates of my office, I had her experience different life contexts internally. Her life was fairly limited. She went to the hospital, to the doctor's office, and spent the rest of her time at home. The part that objected to her leg being fine jumped out at home, and I agreed with the part's motivations. The part wanted her husband to do things around the house. Basically her husband was one of those «old–world» men who say «Women should do all the housework. The man's job is to go to work and earn money.» It was a rather unique situation: she was rich, so he didn't have to go to work, but he still thought that she should do everything around the house. If she didn't, he beat her up. Of course, when her leg was paralyzed, he had to do things for her. Before we cured the paralysis, we had to do something about that. Otherwise, if she went home
without paralysis, she would have to do all the housework. Mary: So then what did you do?
I changed the husband. We engaged him in «assisting with his wife's rehabilitation program.» I arranged for a limited improvement in her paralysis when I took her home. We told the husband «In order for the rehabilitation program to work, it is going to require perseverance on your part. She can do certain things now, but you should definitely not allow her to do other things, because we would run the risk of a relapse. And of course this program may take years.»
To try to get this woman to cope with her husband was too big a piece to do easily. I want you to think of outcomes in terms of chunking. The question I ask is «What's the biggest piece I can do quickly and expediently?» Is that going to be one simple reanchoring, or is it going to be a more complex piece? I start with the smallest piece I can do easily and build on that.
Man: So you make a minimal change in the system, get feedback, and make another minimal change—increasing the chunk size as you go, if you can do that.
Yes. I had one other woman like that who had radical hysterical symptoms. Both were out of the same mold. One had numb feet and the other had a paralyzed leg, and both had Italian husbands. I'm sure not every Italian husband is like that, but these were both Italians from the «old country» and neither was married to an Italian woman. These men both had very strong cultural belief systems which were not congruent with their wives' beliefs, or with American culture.
Let me give you another example of sequential incongruity with which I used a very different approach. I don't always collapse anchors first and then go for a completely integrated outcome. There are other ways to deal with sequential incongruity. A psychiatrist friend of mine had a secretary who was as classic a manic–depressive as you could have. You could even predict the day of the year when she would flip. You got six months of the «up» part where everything was wonderful. She lost weight; she got really attractive and vibrant, and got all the work done. And then, on July 31st, suddenly the other part came out. She gained weight and got depressed and incompetent and so on. This had been going on for twelve years when I met the psychiatrist. He was too fascinated to fire her, even though six months of each year she was totally incompetent. He always knew that at a certain time of year, the whole thing would switch around, and she would take care of all the things that she hadn't done in the previous six months.