Understanding and Using Utilization PDF

Hi, this is Bill O\'Hanlon and welcome to There\'s No Such Thing as a Weed, Understanding and Using Utilization. The standard approach to changing problems is to try and get rid of them, fix them. You know, I have a cartoon here on the visuals here of a guy standing on top of a bunch of self-hel...

Hi, this is Bill O\'Hanlon and welcome to There\'s No Such Thing as a Weed, Understanding and Using Utilization. The standard approach to changing problems is to try and get rid of them, fix them. You know, I have a cartoon here on the visuals here of a guy standing on top of a bunch of self-help books which he read to try and fix himself and he\'s using it to prop himself up to hang himself. I think that sometimes there are some problems with this try and fix and get rid of things. Sometimes it backfires and doesn\'t work. The other thing we try and do is medicate away problems and sometimes that works and again sometimes it doesn\'t work. What I want to talk about today in this keynote is a different approach to dealing with problems and to resolving problems. Influenced by Milton Erickson, who\'s picture you see here, and he walked me, I guess, when I started with him, I started learning from him in 1973 and he had a different approach to solving problems and the basis of it was this utilization approach. Some years ago I heard a phrase, it\'s easier to ride the horse in the direction it\'s going and that was certainly the spirit with which Erickson approached people most of the time. When he saw as the title of this presentation that there\'s no system as a weed, that everything is valuable, potentially a resource or an asset that people bring to the therapeutic encounter. So he had a different approach, he wouldn\'t try and get rid of things or wipe things out or fix things or stop things. He really went with him. He one time said is easier to channel the river than to dam it and I think that\'s also part of this utilization approach to figure out where people are already going or what they\'re already doing or what qualities they have or what seems like problems and how they can be turned into change vehicles and assets. Some of you have heard the story of Erickson\'s early intervention when his father was trying to pull a stubborn mule into the barn and the mule kept not only refusing to go into the barn but backing up and Erickson said, Dad, I can get that mule into the barn. His dad said, are you kidding? You\'re smaller than I am, you\'re not as strong as the mule is, how can you do that? Erickson, of course, turned the mule around and started pulling it in the opposite direction and the mule backed into the barn. So the idea is use what the horse is already doing, the mule is already doing and you can get where you want to go. And he used that similar strategy to help people change. He figured out what they were already doing and then he tried to turn it around in the service of change. I learned this lesson early on when I was a student at Arizona State University, it was in the desert but they were always trying to grow grass on the university campus to make it look nicer and those poor landscapers because they would put a sign, please keep off the grass and of course students would just cut across the grass because it was the quickest way to get to classes and they were always late and lazy and wanted to walk fewer steps. So year after year they would make these announcements and say you\'ve got to keep off the grass because it was so desert-like that as soon as you tramp down the grass it would never grow there. It would be really hard to grow, they would have to dig it all up and it would be bad and the students were walking all over the grass, mostly of course they were walking in the most efficient route between one part of the sidewalk and another part of the sidewalk over the grass. Well the third year I was there some brilliant landscaper got this idea, he\'d wait to see where the students may mainly walk where they tamped down a path and then after a few weeks of that he just put in a pathway where the students walked and after that the students walked on the pathway all the time and didn\'t wreck the rest of the grass. So he was just riding the horse in the direction it was going, he saw what people are already doing and he used that and again that\'s in the spirit of utilization, if you can start to think of this generally we\'re going to apply it to clinical work in a moment. The first case that I ever heard of with Milton Erickson using this approach, this utilization approach, was a case in which a woman came in and announced to Erickson that she decided to kill herself that it was pointless to put her in the psychiatric hospital because she would pretend to be normal and that she\'d given up her ambitions for killing herself and then she would get out and do it right away but as it was she decided that she would give him three months to convince her that life is worth living if she didn\'t see things any differently after three months she wanted his agreement he wouldn\'t try and stop her that he would accept her decision because her life truly wasn\'t worth living but she knew it was a momentous decision and she wanted to look at it with another set of eyes and ears and she said so I\'ve decided to give you three months to get me to see things from a different perspective and see if my life is worth living. I don\'t think it is but maybe I\'m wrong and you know there\'s no going back once you make this decision. Erickson agreed to take her as a patient if she agreed to his conditions and his condition was that she do anything she cooperate fully with treatment she show up on time for all the appointments and keep all the appointments and that she do everything he asked her to do as part of treatment as long as it wasn\'t unethical or illegal or harmful and so he asked her if she was a person who kept a word and she said she did and so he said he was going to hold her to that word and she agreed. She proceeded to tell him her story in this first session she was raised by parents who let her know as soon as she was old enough to understand that she was an unwanted child an accidental pregnancy they raised her but just barely they fed her they closed her they sent her to school but they gave her no affection there was no love around the house they were totally into each other and found her to be an intrusion in her life found everybody to be an intrusion in their life they isolated themselves they didn\'t have any close relatives no close friends she didn\'t have any close friends because they didn\'t take her to any social events or encourage her to do anything so so so she grew up very isolated in a very bleak childhood she didn\'t have any hobbies any interests nothing like that and she just went to school did what she did when she was 18 she moved out of the house and she didn\'t see them very often but saw them on occasion but when she was in her 20s they died in a head long car crash so she had no relatives no no people that she was connected with and she just went from job to job every couple years as she got more and more bored right at the moment when she came into the Erickson she was working on a construction firm she was a secretary receptionist she made okay money but she didn\'t need money she had some money saved up and she didn\'t really find it challenging or interesting she thought she was a terrible person she hated the way she looked and she thought she was terrible inside as well and so she had no hopes for having any friends or any relationships or ever getting married because she was such a disgusting person who would want to have anything to do with her and Erickson asked her well what\'s your most you know disgusting aspect and she said well of course you can see it\'s the gap in my two front teeth and he looked and he could barely see it but to her it was you know just like the size of the Grand Canyon a massive gap and she\'d had it worked on by Dennis but she could still see it and she thought it was awful and disfiguring so Erickson could see she didn\'t really take care of herself very well she didn\'t try and brush her hair fix her hair she didn\'t put on makeup she didn\'t dress very nicely she clearly just thought she was a terrible looking person so why bother he asked her about her work and she said it was okay but you know anything that was good or bad about it and she said nah nothing that good and there\'s only one sort of irritating thing is that every time she went to the drinking fountain it seemed like this fellow at work would show up and try and talk to her and she would quickly be to retreat to her desk and hide her hideous teeth and Erickson of course got the sense that this guy was interested in her so therein he hatched a plan first thing he told her at the end of the first session was I want you to go home and while you\'re in the shower I want you to practice getting mouths full of water and squirting them through the gap in your teeth until you can hit a target accurately from 10 or 12 feet she thought this was pretty weird psychiatry but he reminded her of her agreement that she said she would do everything he asked her to do as long as it wasn\'t unethical or illegal or harmful so dutifully she reported in subsequent sessions that she was getting very good at squirting through the gap in her teeth now I just want to take a break from describing the case and kind of alert you to he accepted her plans for suicide he didn\'t try and talk her out of it he accepted in a certain way used that\'s this utilization approach the gap in her teeth that she thought was her worst liability he started thinking of it as an asset and we\'ll see how he used it in a moment we\'ll hear how he used it after a couple of sessions of getting to know her and finding out she didn\'t really have much to say she didn\'t have much self-insight she said she had a pretty bleak childhood she couldn\'t remember much of it but it was all bleak what she could remember he found out that she had five thousand dollars that she\'d saved up over the years from working because she didn\'t spend on anything she didn\'t do anything she just came home at night and sat and just bored out of her mind didn\'t see people didn\'t spend money didn\'t go on vacations anything like that so that was a lot of money for those days it was 1950s and he said well it\'s gonna happen with that money when you die you know after you kill yourself and she said I don\'t know I don\'t have a will I don\'t there\'s nobody I want to leave it to no causes I\'m interested in it\'ll probably just go to the state and he said okay as your psychiatrist I want you to treat yourself and spend a little of that money before you die she thought that was useless but again he reminded her of her agreement so she he knew someone who owned a clothing store and he sent her to that clothing store and he called up the woman and said she doesn\'t have a clue she doesn\'t feel very good about herself give her a complete make-over wardrobe or wardrobe wise so the woman did and she came back and she started thinking you know it\'s not bad you know I look a little better but it doesn\'t really make a difference and then he sent her to a beauty salon they taught her how to do her hair gave her make-over taught her how to make up taught her how to do her nails and did it all for her the first times after they showed her and she again subsequently thought yeah look a little better but really it doesn\'t make any difference because inside you know I still feel the same way it doesn\'t really make a difference so then Erickson said to her at the next session well you know tell me about a happy memory event she said I have no happy memories he said well no one should die without at least one happy memory so he said well I\'m not going to have any I\'m going to die without it and he said no we\'re going to make a happy memory and she thought that was ridiculous how could they she was so depressed and you know discouraged there was no way she didn\'t have anything she could think of it would create a happy memory and he said he had a plan and this was his plan the next Monday when she was to go to the to work she was to get dressed up in her nicest new clothes fix her hair do her makeup fix her nails and then she was to go to work and when she went to the drinking file this young man showed up she was and he gave very explicit instructions and he made he made her repeat it back to him she was to get a mouthful of water she was to take one step towards him squirt the water at him through the gap in her teeth and then turn around and run like hell she was appalled no way we should get to do this but he reminded her of her agreement so reluctantly she said she realized she had to do it she showed up on Monday at work she indeed filed the instructions she got a mouthful of water when he showed up at the drink he found took one step toward him and then turned around and we\'re had squirted in the water the gap through the gap in her teeth and turned around and ran like hell he ran after caught her spend her a manner around and gave her a kiss this freaked both of them out they both went back to their work spots and she called up Erickson in a days and said dr. Erickson I don\'t know what\'s just happened I can\'t think I\'m just totally confused will you give me an emergency appointment tonight and Erickson did and when she arrived she said I don\'t know what to think I don\'t know who I am I\'m totally confused I used to think I knew who I was and what was going on in my life now I don\'t know what to think this weird thing has happened this guy kissed me it\'s thrown me into a tizzy can you help me figure out who I am and from there the change started to happen she started to date this guy ultimately she decided he wasn\'t for her but she then went on to date some other people she ultimately got married she had children she gave up her plans for suicide obviously things changed and I was reading this case this is the first case Erickson\'s I read and I was totally hooked I was like I don\'t know what this guy is how he came up with this but this is a different approach to change I\'ve got to learn from this guy and it took me a few years to work up the courage to go and study with him but when I did it was even more profound than I thought from that case he had a such a different way of approaching people that it hooked me and the essence was utilization I\'ll just give you one more case and then we\'ll get into the details of how you can apply this stuff into your practice there was a kid that was brought to see Erickson and and he and his mother were out in the waiting room and his mother walked in the room before the appointment started close the door laid a lot of cash on Erickson\'s desk and said this is for the damage my son will cost your office I brought them to other people and they\'ve ultimately decided they couldn\'t see him because he causes too much damage to the office but I just want you to know I\'m good for it here\'s for the damage and I\'ll also pay you of course for the appointment but he\'s gonna damage your your place and I just want you to know that be prepared for it and know that I\'ll cover you know the repairs so Erickson sends some other out calls the kid in he opens the door he hesitates up the door and Erickson says I want you to go right to that bookcase pick up this clean Xbox and smash it onto the floor kid walks over and smashes it on the floor defiantly Erickson says I want you to take that pillow throw it right in my face takes a pillow off the couch he throws the right in his face said I want you to take all the papers off my desk sweet them off my desk and throw them all over the floor kid does this he gives them a couple of other assignments of how to be destructive but not into bad away kid does those and then ultimately sits now and they have a session and it goes very well now you think okay Erickson just thinking what\'s this kid gonna do how can we use what this kid\'s gonna do and then shift him and give him a chance to express this defiance this destructiveness but while he\'s expressing this he\'s cooperating with Erickson and they develop a cooperative relationship now that is to me a classic Erickson figure out what the person\'s already doing and then riding on that to start to make a connection and make change that is utilization I\'ll give you one more that\'s not a clinical example but illustrates the idea this was in Germany there was a nursing home that had people with dementia and Alzheimer\'s there and every once in a while the staff would have a problem with one of the residents that is the one of the residents would because they would get confused about who they are and how old they were they would decide they were a child and they had to get out of there because someone had taken them from their home and they had to get back their parents were worried about them now their parents were long dead and if they were able to get out of the nursing home without anybody seeing them once they got this idea and this you know this fixed impulse to leave they would sometimes wander around the city you know sometimes cold they would get you know damaged because they weren\'t wearing the right clothes they would get taken advantage of by somebody or hit by a car something terrible could happen or they\'d make it all the way back to their home and they would show up at the home and try and force their way in and the people were living there then which is no longer their family would be all upset call the police and they would get taken back and they\'d be really upset or if they caught them before they left they would be really you know violent and try and you know hit the staff to because they thought the staff were restraining them from going home and they had to get home to take care of their parents or whatever and so one of the board members who wasn\'t a psychologist wasn\'t a therapist wasn\'t a medical person but just was a businessman one day he came up with a solution he came in to the director of the nursing home and said what about if we build a bus stop to nowhere and the director thought it was really weird and he said look at the first stop when you want to go someplace is in Germany which has a lot of bus and a very good bus system was to go to the bus stop and wait for the bus so this would give these people time to calm down they wouldn\'t go off so far we know where they are we you know we wouldn\'t have to restrain them because sometimes they\'d have to time down with restraints and things like that and at first the director thought it was disrespectful and refused to do it but the more he thought about it you know it can\'t be that much more disrespectful than strapping them down or you know yelling at them because they\'re trying to leave or you know having them hit by a car or something like that arrested by the police so they decided to try the businessman donated the money they built a fake bus stop and at first the neighbors came over and sat there waiting for bus and then the staff had to keep going out and explaining to them no this is an experiment we\'re trying it\'s a fake bus stop don\'t sit here and wait for the bus there\'s no bus is going to come and a couple weeks later one of the residents got really agitated and wanted to leave and so they gave her a coat and her purse and they escorted her out to the bus stop and said why don\'t you just wait here for the bus and then you can go where you need to go and she waited out there for an hour she waited out there for two hours and finally it was getting near dinner and one of the staff members came one of the nurses came out and sat next to her and had a cigarette and said you know it\'s pretty cold i\'d start a chatting and then it\'s this pretty cold out here it\'s about dinner time you want to come back in and eat and the woman said sure now again you think of it one of the things that characterizes dementia and Alzheimer\'s is people forget she forgot why she was out there after a couple of hours once she calmed down she came back in and she was fine since then they\'ve used the bus to nowhere strategy with a lot of the residents when they get upset sometimes they\'ll just or escort them out there and say okay you want to leave sit here for a while and wait for the bus and then of course they come out after a while and get them they keep an eye on them easily because they can see them right from the front desk of the nursing home and that is utilization so let\'s talk about how to use utilization and clinical work and i\'m going to characterize four forms of this there are many forms but i\'m just going to put them into four categories for our purposes for this keynote the first one is symptom transformation next is restraining the next is accepting and shifting and the last one is inclusion there are going to be three varieties of inclusion the first one is symptom transformation and this is the one i wish i understood more of and i wish i could get it in my bones because i think i\'d be a better therapist if i really got this one deeply it\'s so counterintuitive in a certain way what it is is taking the energy or impulse that drives the problem and applying it in a different direction that leads directly to resolution you heard an example that earlier but i think you\'ll recognize this as we go along and i give you a couple of examples the first example is actually from my practice I had a psychologist who was one of my students in a hypnosis workshop where i used to live in Arizona and he came along and he said you know i\'ve got this problem can i consult you about it sure he said i teach a psychology class i\'m a Mormon i have a student who\'s also a Mormon and she knows i\'m Mormon and psychologist and so after class one day she waited until everybody had gone and she told me about a problem she had and she asked for my help and i just don\'t know how to help her she is the patient of a doctor in the community who\'s also Mormon and he\'s a very prominent Mormon very powerful in the community and it\'s a close-knit community everybody knows one another and she told me that he decided at one point convinced her that one of her medical problems needed hypnosis and he did hypnosis he hypnotized her and while she was under trance he sexually molested her and he gave her a suggestion that she would anytime he called her after that he would give her a cue word and she would have to immediately stop what she was doing drive to his office when she would immediately go into trance and he would molest her again sexually now she was married she was Mormon this was very you know against her morals but she felt compiled to follow it because she believed that he was controlling with his hypnotic suggestions so what i suggested to the psychologist who consulted me was to go back because she trusted him and she liked him she\'d been in his class and thought he was an ethical person that she he convinced her to let him hypnotize her and while she was in trance he would give her this suggestion she no longer needed to follow hypnotic suggestions now this freed her from this compulsion she was able to defy this doctor if she\'d gone public it would have been bad for her and people would have doubted her and maybe accused her of being you know trying to destroy this guy so she didn\'t want to go public she just wanted to stop this situation from happening so that worked it was using the pathway she was already using to get her out of the problem she believed that hypnotic suggestions made you do things and if he told her she no longer had to follow hypnotic suggestions while she was in trance he could break this spell the next case is the case of Erickson\'s to illustrate this symptom transformation and that is the case of a premature ejaculator this guy came to see Erickson because he would he was so anxious as soon as he would go to have intercourse he would ejaculate either before he entered his partner or right after he entered his partner it was frustrating for him embarrassing shameful frustrating for his partner and so he came at Erickson Erickson put him in trance and said you\'re going to develop a new anxiety a new worry and the worry is that you\'re not going to be able to ejaculate that you\'ll have a delayed ejaculation and he transferred this anxiety into a new direction and the guy started to you know worry with will I be able to ejaculate and he lasted a lot longer with this this is symptom transformation taking the underlying anxiety in this case and putting in a new direction to lead out of the problem the second method of applying utilization in clinical work is when the therapist notices some resistance some reluctance some defensiveness some holding back some hiding certain things from the client the therapist encourages or insists on the client holding back or not changing Erickson used to say when a patient can we come in for the first session if he had a sense that patient was really holding things back Erickson would tell them don\'t tell me everything I think you have a right to your privacy and you should keep things to yourself until it\'s the right time to tell me and maybe it\'ll never be the right time to tell me so don\'t tell me everything he said people would in a rush then tell him the things they were holding back he had kind of gone with the direction they were already going in and encouraged it and you can think of this as paradox but I don\'t think it is paradox I think of it as a profound respect for where the person is and joining with that resistance if you will and really respecting it and it sometimes has that paradoxical effect but it doesn\'t necessarily it just makes it so the therapy isn\'t a struggle for them or for you the people that the MRI John Wiecklin and Associates by Paul Vosovic they came a dickfish they came up with this idea that when people came in and they noticed you know that they were resistant they would say now don\'t change anything about your problem because there might be some good parts to it and we don\'t want to you know get rid of the good parts and we just don\'t know enough about it yet so don\'t change anything we might be throwing the baby out with the bath people come back and they would apologize and say sorry I changed I hope I didn\'t mess anything up but of course that\'s what they wanted so it was just siding with this don\'t change side of things which sometimes people have they want to change they are afraid to change they want to change they can\'t change and they were siding with this don\'t change part restraining the person from change I heard a story from Steve de Shaser who told me about a case in which he was referred his clinic was referred a couple that had gotten into legal trouble again and again by fighting with their neighbors they would leave things in the hallways you know just some of their junk out in the hallways and their apartment building the neighbors would ask them to clean it up and then they\'d argue with the neighbors and sometimes get in physical altercations with them so finally the judge who\'d seen him about three or four times said look at you got a choice you\'re going to go to jail or you\'re going to go to therapy you\'ve got problems you know so this couple comes in and they see de Shaser and they say well you know the judge sent us here but it\'s really we don\'t have an issue it\'s our neighbors they\'re kind of you know critical and picky and they cause trouble and they pick fights and we don\'t really have a mental health problem so we don\'t know why we\'re here exactly and de Shaser you know thinks about it from many and he says well you know here\'s the problem we\'re publicly funded agency and we you know we see people that have problems and we got a waiting list so we can\'t see you in much of a problem so I\'m gonna have to write a letter to the court and tell them you don\'t have a problem and then we can\'t see you and the couple knew that the next step was jail so they said wait wait wait no no we do have mental health problems we do have emotional problems and de Shaser said now I can\'t tell whether you\'re just trying to pull the wool over my eyes and you know convince me I\'m a problem so you won\'t go to jail I\'m not convinced you do have a problem I mean you said you didn\'t and they said no no we do we do and they started telling them all about their problems and he said you know I still just can\'t you know it sounds okay but it I still can\'t tell whether you\'re trying to con me and they said well how can we convince you and he said well look at if you made these kind of changes I would think okay you had a problem then because only people with these kind of emotional and psychological and relational problems make these kind of changes I can I can tell what\'s a legitimate change so they go out and they make these changes they come back and subsequently report me to so you know that a similar kind of restraining thing just done in a sort of a creative way and of course that\'s an unusual situation because you have the possibility of jail looming over people to motivate them highly but it\'s the similar kind of thing other people would try and convince them they had a mental health problem or that they were part of the problem and to say there didn\'t have any desire to convince them that they had a problem he just accepted their view that they didn\'t have a problem and then went with that and that led to the change Erickson used to say to this guy I remember this famous case where the guy is pacing back and forth in his office and says he\'s been to a lot of therapists often he can\'t sit down he\'s so anxious gets it down and Erickson just accepts it again that utilization is it okay if you pace back and forth in my office and gradually works with him so the guy calms down more and more and he\'s considering sitting down and he almost sits down and Erickson says don\'t sit down yet he restrains him this guy\'s ready to sit down and Erickson restrains him then he\'s anxious to sit down before he was anxious and couldn\'t sit down now he\'s anxious to sit down so you get it\'s like that symptom transformation but done in a different way with restraining now the next category is accepting and shifting and again I don\'t think this was such a technique of Erickson\'s as an attitude that he had and this is the again the power of this utilization is to just profoundly value and accept what the person offers develop a relationship with them where they know you\'re not trying to fix them or change them or you know do anything to them you\'re just there with them and then gradually when you have that relationship and that trust and that relaxation introduce another possibility invite them to shift into a different frame of mind different set of behaviors to make changes but only after they\'re clear you\'re not trying to fix or change them so in order to show you this I\'m going to show you a couple of movie clips and the first one is here let me let me oh sorry let me get back to this before I show you those clips let me give you a couple of clinical examples again from Erickson the first one was the psychiatric patient who claimed he was Jesus was going around preaching to people and pretty obnoxious and was putting people off and you know they always wanted to restrain him because he was so crazy and Erickson comes on staff and here\'s about this guy who\'s one of the most you know difficult to treat patients because he\'s got this delusion he won\'t give it up he says he\'s Jesus Christ and Erickson studies him for a while and here\'s all this stuff about how he\'s alienating everyone and everyone\'s upset with him because he keeps going around preaching righteously to them and he goes up to the guy and he says look it I understand that you have experience as a carpenter you know father was a carpenter and he said yeah and he said well you know there we have a bunch of books that don\'t have a bookshelf and to help the patients and to help the staff it\'d be really great because your person likes to help humanity if you build us a bookcase so the guy goes and builds a bookcase and he stops being so obnoxious and chasing people around trying to preach to them and people\'s in the hospital start to react differently to them they thank him for the wonderful work he did they praised the work the guy starts to talk a little less delusionally he starts to interact a little more normally and Erickson says that was great you know thank you so much you\'ve really made a contribution to the hospital and I know that\'s what you want to do is help people and I noticed when I came here that there was a tennis court that people like to play tennis on before but it\'s falling into disrepair it\'s a clay court and needs to be kind of smooth out and because you you know are concerned about humanity and because human bodies are supposed to stay in shape then I wonder if you could make this contribution and he goes out and smooths out to tennis court and again people thank him because now there\'s this tennis court people can use and he starts to shift more and more Erickson gives him more and more of these assignments all based on the premise that he\'s jesus and wants to help humanity and gradually he gives up this delusional idea starts to be more functional and gets out of hospital so that\'s that profound acceptance of don\'t argue with people don\'t try and dam the river but channel the river another case and this one\'s complicated and I\'m going to oversimplify it a bit but a case of a couple that came to Erickson who had married and didn\'t know when they married this is one of those weird errors in cases that they both were bedwetters they came from profoundly religious families they were very inhibited people they were medical students they met in medical school and they were too ashamed to tell the other one that they went to bed and they didn\'t have any sexual contact and a contact before they were married and then when they were married they went to their wedding night and they were too inhibited and shy and embarrassed knowing that the next morning they\'re going to have to confront this problem with their partner of being a bedwett her and so the bed was associated with shame and all this kind of stuff and they didn\'t tell each other instead it didn\'t have sex on their wedding night and slid into bed and fell asleep and the next morning when they woke up to the wet bed they were expecting the you know the big confrontation to happen and the other person got up silently they you know didn\'t say a word they changed the sheets and that was it and they thought oh each of them thought I found such a loving and understanding a non-judgmental person who doesn\'t want to shame me and so they fell more deeply in love with each other little knowing that they both wet the bed and till one day one of them after a few months they both talked about one to have children but still they hadn\'t had sex so one day one of them got up and said you know it\'s too bad that we can\'t blame my wet spot on a little baby you know the baby went to bed the other one said your wet spot and they got into a conversation to discover they were both lifelong bedwetters you know again these cases are weird and hard to believe but that\'s the way it was and so they went to their friends at medical school and said who could we go see we want some help with this and these were psychiatric residents that they were friends of theirs and they referred them to Erickson and when they went to see Erickson they explained to him this situation but they also said they didn\'t have much money they were in medical school they were from working class families and they just didn\'t have much money to pay him so you know they didn\'t know what to do about that and Erickson said I\'ll make it deal I won\'t charge a fee if you agree to what I asked you to do and so they did and he said if you violate what I asked you to do and don\'t follow through on it I\'ll charge you my full fee so they were highly motivated and here\'s what he told them to do want you to go home for the next week before you come and see me again want you to get in bed pull down the sheets have in your pajamas kneel on the bed and deliberately urinate on the sheets on the bed before you go to sleep now this was excruciating for them first of all remember they were both highly religious and inhibited so to urinate in front of their partner something they\'ve tried not to do their whole lives very very difficult also to lie down in that cold wet urine oh that\'s pretty disgusting too and again you think of how religious they already have some kneel down beautiful utilization and they do it the first night but it takes them hours and again they\'re medical school they\'re busy they\'re sleep deprived and it takes them hours to do with the first night just to get the urine to come out second night same thing hours and they\'re exhausted and the third night same thing and it\'s humiliating it\'s exhausting and the fourth night they both look at each other without a word they slide into the bed don\'t say a word to each other and fall asleep without doing the task and the next morning they wake up and for the first morning in their lives is that they can remember there\'s there\'s a dry bed the next night same thing they don\'t do the tasks they get in bed the next morning dry bed they go back and guiltily confess Erickson in the next week that they stop doing it after three or four days and he doesn\'t charge him his fee but he says look it you solve the problem if you ever have another wet bed you owe me four days of kneeling on your bed and urinating before you go to sleep and he said that was motivating enough they never had another wet bed and ultimately they did get over their inhibitions and had sex and had a child and this and that but that to me was a profound example of another way to use utilization accepting and shifting now I want to play you some video clips from some popular movies that illustrate this to in the first one is such a charming movie lars in the real girl some of you have seen it and I\'ll give you the back story and then I\'ll show you a couple of clips from it to illustrate the use of utilization by very compassionate and clever doctor who\'s very Eric Sonja it\'s northern Minnesota this very small community and two brothers live there and one of them their mother has died giving birth to the youngest one and after that their father went into a severe depression it\'s already you know upper Minnesota which is a very stoic place and this guy doesn\'t talk much but then he becomes even less talkative and less relational and the house just becomes this oppressive tough place to live in the older brother who\'s quite a bit older than the younger brother as soon as he\'s of age moves away to get away from this terrible atmosphere and he feels kind of guilty leaving his brother behind with his very depressed and unhappy father in this terrible household that\'s bleak and terrible but he\'s got to get out of there just to survive and he goes away for a while he meets a woman they get married they come back and they move into the house with the younger brother the fathers by now died they move into house with the younger brother and the younger brother feels uncomfortable being there with him because they\'re newlyweds and he just doesn\'t feel comfortable with it so he moves out to the garage and makes the bedroom out of the garage and he becomes more and more isolated and especially when the couple gets pregnant and he starts to get more and more avoid and doesn\'t want to do anything with him the sister-in-law she keeps trying to get him into the house to have a dinner with him or breakfast with him or come over and visit or watch tv with him and he won\'t do it he just isolates more and more he goes to work he comes home and he isolates and she\'s really worried about him and the brother\'s like yeah you know he\'s weird but he\'s okay until one day he lars who\'s the the main character announces to the brother and sister-in-law that he\'s got a girlfriend and they\'re totally stunned and girlfriend how could it be he\'s so isolated he\'s so shy he\'s so inhibited and he doesn\'t go anywhere but they\'re really happy and he says can i bring her over for dinner tomorrow night when he shows up she\'s a sex doll a very realistic looking but sex toy doll that he\'s bought for quite a bit of money on the internet that he one of his co-workers was looking at it online who looks at porn at work and he saw it and bought one and he believes this woman is real that\'s his girlfriend he talks to her as if she\'s real and they\'re really freaked out about this so they decided to bring him to the local doctor who\'s also a therapist psychologist and you\'ll see how she approaches this situation in a very utilizing sort of way no she is she\'s a psychologist too people think we can\'t worry about that right right there\'s one of my dad used to work our dad that\'s the library i have a card you can go on if you want to well actually i\'ll have to take him out for you but you just tell him i don\'t know actually Gus what was the dad did water and power my job is at the school department i miss everybody but there\'s so much to do in the house i\'ll go back just as soon as the baby\'s old nothing mhm yeah is that right then we\'re sitting or country that\'s what i would say well her blood pressure is low is that serious? could be we\'ll have to wait and say it\'s fine it\'s probably not too i i i want you to bring your end every week for special treatment can you do that yeah are you sure that that\'s is it so? yeah oh that\'s what she says you can set that up with your end with the desk i look forward getting to know you Bianca you Karen i\'m telling you he belongs in a hospital no the local guards went to one of those places and he never came back yeah but he needs more help than you and i are able to get i told you something was wrong and you wouldn\'t listen if i may has worse been functional? does he go to work wash dress himself? so far has he had any violent episodes? oh no no never this is sweetheart he never noises his voice okay we got to fix him can you fix him? i don\'t know good i don\'t believe he\'s psychotic or schizophrenic i don\'t think this is caused by jeans or faulty wiring in the brain so then what the hell is going on then? he appears to have a delusion a delusion? what the hell is he doing with a delusion for christ\'s sake? that\'s what we have to find out chance has always been de-compensating for some time i guess we didn\'t realize but everything changes in the family in the last year or so no everything is pretty much exactly the same except that Karen is pregnant and Lars is nuts you know this isn\'t necessarily a bad thing what we call mental illness isn\'t always just an illness it can be a communication it can be a way to work something out fantastic when we\'ll be over when he doesn\'t need it anymore how can we help go along with it oh no no that\'s oh my no no no no no no i mean pretend that she\'s real i\'m not gonna do it i mean i can\'t i\'m just not gonna do it she is real well she\'s right out there right right i i i get that but i\'m just not gonna you know i\'m just not gonna do it you won\'t be able to change his mind anyway Bianca\'s in town for a reason right but but it\'s not really a choice okay okay all right then we\'ll do it whatever it takes oh yeah yep yep and everyone\'s gonna laugh at him thank you thank you more coffee lars yes please Does Bianco want some? Yeah. There you go. That\'s nice. Okay. You\'re not gonna go to work today, Gus? I don\'t feel okay. I don\'t know. Well Bianco could help you. She has nurses training. She doesn\'t. She doesn\'t have nurses training large because she\'s not a person. She\'s a big plastic fan. That\'s amazing. Did you hear that? Bianco just said that that\'s why God made her to help people. You gonna be late for work? I\'m gonna be late. I don\'t know. I have to go. But I\'m going to check in. Okay, Doug. You have my number at work, right Karen? Yep. I wanted to tell you that you look really pretty today. I hope that you feel better, Gus. Good to you. Thank you so much for breakfast. No. Okay, you gotta go. Bye. Yeah. All right. Another clip from Lars. Gus and I are most very lucky with women. She\'s wonderful. But she\... We don\'t have to talk. Let\'s find you something to read. No, that\'s just between us. Of course. I\'m worried about her. I think she has a little problem. Oh, maybe you shouldn\'t have. No, it\'s okay. It\'s just\... I think it\'s because she\'s insecure. But she\'s just always trying to hug everybody. You know, some people don\'t like that. Some people don\'t like to be hugged. But she doesn\'t realize that she takes it personally and thinks, you know, it hurts her feelings. I don\'t know what to do about that. Do you? That is such a comfort sometimes. Just to have somebody\'s arms on, don\'t you think? No. Come on, it feels good. It does not feel good. It hurts. No. Like a cuddle of a boot. Like a burn. Like when you go outside and your feet freeze and then you come back in and they thaw out, it\'s like that. It\'s almost exactly like that. Same in everybody? Well, not in this piazza. But everyone else. So you don\'t let people touch you? Lars, isn\'t that hard to get away with? Well, I\'m not really here because I have all these players. That helps. Look, we can\'t change Karen. But I can help you. That\'s fine. Pain? Yeah, but I can take it. You okay? Well, that\'s enough for today. All right, last clip from Lars to illustrate this utilization that\'s accepting and gradually shifting. Pain? That\'s okay. Why is that so good? I can take it out. You must be excited about a baby on the way. Mm-hmm. I think you want to be an uncle. Do you want to be a mom? I don\'t know. But I\'m not able to help anyone else. Oh, that\'s fine. I don\'t think I could like that. Yeah, she can\'t have a baby\'s either. It\'s a shame? When she was a baby, her mom died in the middle of things. So, she can be born. Like yours. You have a lot in common. Mm-hmm. Lars, you know, we\'ve learned a lot. Things are better. Yeah, but it could still happen, right? It\'s highly unlikely. It\'s rare. Yeah, but it\'s still good. Lars, just take a breath. It\'s okay. I\'m sorry. I\'m sorry, it\'s just so dangerous. It\'s so dangerous. Lars, sit down. Put your head between your knees. Put your head between your knees. Sit down. Just put your head between your knees. Okay, it\'s okay. I\'m sorry, it\'s okay. Take a breath. Okay, I\'m going to show you one more movie clip from a different movie, Titanic, the famous movie. And this is another example of first trying to oppose and change and then accepting and shifting. So, it\'s a very clever example. Don\'t do it. Stay back. Don\'t come any closer. Come on, just give me your hand. I\'ll pull you back over. No, stay where you are. I mean it. I\'ll let go. No you won\'t. What do you mean no I won\'t? Don\'t presume to tell me what I will and will not do. You don\'t know me. Well, you would have done it already. You\'re distracting me. Go away. I can\'t. I\'m involved now. You let go and I\'m going to have to jump in there after you. Don\'t be absurd. You\'ll be killed. I\'m a good swimmer. Who would kill you? It would hurt. I\'m not saying it wouldn\'t. I\'ll tell you the truth. I\'m a lot more concerned about that water being so cold. How cold? Freezing. Maybe a couple degrees over. You ever, uh, ever been to Wisconsin? What? Well, they have some of the coldest winters around. I grew up there in your Chippewa Falls. I remember when I was a kid. Me and my father. We went ice fishing out on Lake Wessota. Ice fishing is you know where you are? I know what ice fishing is. Sorry. You just seem like, you know, kind of an indoor girl. Anyway, I, uh, I fell through some thin ice. And I\'m telling you, water that cold, like right down there, it hits you like a thousand knives that move all over your body. You can\'t breathe. You can\'t think. At least it\'s not about anything but the pain. Which is why I\'m not looking forward to jumping in there after you. Like I said, I don\'t have a choice. I guess I\'m kind of hoping you\'ll come back over the rail and get me off the hook here. You\'re crazy. That\'s what everybody says, but with all due respectness, I\'m not the one hanging off the back of the ship here. Okay. Accept and shift. First he tried to change it. She wasn\'t changing. Then he accepted it. And he shifted her attention to the pain that she was going to feel. And also to concern about him because he was going to put himself at risk. And he was going to have pain and suffering as well. Beautiful example, I think of utilization. The last method, the fourth method of utilization is inclusion. And that involves inviting in any devalued or dissociated aspects or feelings of the person to dissolve resistance or stuckness. Sometimes people are ashamed of things or they\'ve detached from things because of some background that they have probably. And we\'re inviting them in this method to bring those things in. It\'s all part, again, of using what\'s available. But this time dissociated and devalued by bringing it in. And one of the first ways to do this, there are three ways that we\'re going to talk about doing this. The first way to do it is give permission and normalize. Now I learned this from Milton Erickson when I learned hypnosis from him because people would come in and they\'d be distracted and he\'d say it\'s okay to be distracted. Or they\'d hear the sounds outside the office and he\'d say it\'s okay to listen to the sounds outside the office. Or you don\'t have to listen to the sounds outside the office. And if you do, it\'s okay. So also normalizing. You may hear my voice as you\'re going into trance. You may not hear my voice. You may see some images in your mind. You may decide you\'re not going into trance. You may, you know, it\'s okay not to go into trance. You give people permission for what they\'re already doing and you normalize. And so they don\'t feel weird or pathology, pathologized, or as if they\'re wrong for doing. You make them right, if you will. And so I learned this as part of hypnosis, but now then later I learned it as part of general therapy is bringing in the missing piece that\'s gotten devalued and dissociated and thrown out or they\'re shamed about or they think is wrong or bad and just allowing it. And so I\'ll give you an example of this. This is a case of Erickson\'s in which a woman comes to him and she\'s been holed up in her house for quite a while. She dropped out of college because when she was at university and she was writing something on the blackboard, she passed gas and allowed sort of way. You know, she couldn\'t help but but she was so ashamed people kind of tiddered and she ran out of the classroom and never went back. And since then she\'d been hiding in her house ashamed to go out because she was so ashamed of herself and thought her life was over basically. Finally she sought therapy from Erickson because she knew she was in trouble. And Erickson explained to her that gas is a natural phenomenon and she couldn\'t help it and this was part of how God made us and this and that. And he gave her the assignment to go home and cook several pan full of fruit, several pots full of fruit, and eat them and start to in the privacy of her own home experiment with making loud farts and soft farts and small farts and big farts just to get used to this whole process of how natural it was and maybe develop some skill as to when she was going to make noise as well. But that kind of thing she gradually got less ashamed about it and talking with him and doing these experiments and gradually was able to go back to university. So it\'s this sense of giving permission and normalizing that that case illustrates really, really well I think. There are two kinds of permissions that you give to. One is you can or it\'s okay to or you\'re okay if. And the other one is you don\'t have to. So if you\'re doing hypnosis you can listen to sound of my voice and you don\'t have to listen to the sound of my voice. If you\'re doing therapy it\'s okay if you go numb and you don\'t have to be numb. You can start to feel things. You don\'t have to grieve in any particular way. You can grieve in your own way. So giving permission for what they\'re already doing and normalizing it and telling them basically it\'s okay or they don\'t have to do it a certain way. That\'s the essence of this kind of utilization, this first level of inclusion. Now there are three levels of inclusion so we\'re going to get to the rest of them. The second one and it\'s illustrated by the Jian Yang symbol is including opposites. When I was an undergraduate psychology student I was told you can\'t have two opposite feelings at the same time. You know if you\'re happy you can\'t be sad but tell you through that I\'ve been happy and sad at the same moment. I think the human heart and the human soul and the human mind are capable of holding two seemingly opposite feelings or aspects of ourselves at the same time simultaneously and that seems to be the key here without there being a conflict because sometimes people have a conflict between those two aspects and what we\'re doing in this kind of utilization is giving them permission, this kind of more advanced permission to hold these two simultaneously to allow them to be there at the same time. To be happy and sad at the same moment. To love somebody and to hate somebody at the same moment. To not have these be in conflict or jump back and forth between them. I first discovered this when I was an altar boy, a Catholic student. When I was younger I went to Catholic school and we had to learn the Catholic beliefs and one of the beliefs that they told us was God is omnipresent. So I thought about this, I was a pretty thoughtful kid and pretty serious about my religion and I thought about it for a while and went back to the nun a few months later and said, Sister, I\'m thinking about this. If God is omnipresent, God is everywhere, right? Yes. I said, well then God must be in the devil and if God\'s in the devil, God must be the devil because God\'s everything. And she didn\'t hit me with a ruler or say we don\'t ask those questions. She just said, that\'s one of those mysteries we don\'t understand. They don\'t only God understands. And I was a little disappointed with that answer because I thought, you know, they\'ve had thousands of years to work this out and they haven\'t worked that bit out yet. I think that\'s a really important thing. And to me it was a really important thing and that kind of sensibility never went away. And when I studied with Erickson I thought, he does this same thing. He does this inclusion of opposites and I heard him do it a bunch of times. You can find it in the literature about his work. But I think it\'s a profound insight into human beings and how they function and they can hold these if given the container that\'s big enough to hold them. It\'s almost like two parts of them are trying to squeeze through a single door and you make it a double door. So it\'s comfortable for those two parts to go through at the same moment. It\'s the simultaneity that seems really important. It\'s the love and hate at the same moment not bouncing between love and hate. There are several ways that this can be expressed clinically. And one, and Erickson used this and I used it as well as oxymorons. So one time he said a woman came in to his office dressed in an elaborately casual manner. An elaborately casual is a nice oxymoron. This is a phrase that includes two opposites and the same two words. I have clients that have become hyper-vigilant as a result of some trauma and I sometimes will say to them you can have a non-concern hyper-vigilance or unconcerned vigilance. Because something in you is always going to be monitoring your environment to make sure it\'s safe. So you don\'t have to think about it consciously. Something in you can do it non-consciously. And it\'s that unconcerned vigilance that\'s a really weird oxymoron. You\'re validating and valuing both sides of the equation rather than having them jump back and forth or only be stuck on one side of the equation. So oxymoron is one form of it. Another form is at the opposition of opposites which is closely related and Erickson uses. It\'s important to remember to forget certain things you\'d say and to forget to remember other things. Or sometimes he\'d do it in the form of tag questions. You really want to change. Do you not? He said if you can\'t say the no the patient will say the no. If you can\'t validate the no the client will express the no in some way. So Erickson wanted to include it. In this change process he would include not changing. So you know you can remember and not remember. The next one is just straightforward. Permission and encouragement to allow two aspects or feeling simultaneously. You\'re really sad that he\'s gone. You\'re really relieved that he\'s gone. To give them permission to hold both of those at the same time if that\'s true for them. You don\'t impose it on them obviously. And the key seems to be this and this and this rather than this or this or this but this. So that\'s the key for this one. The simultaneity in the and seems to represent that conjunction of and is really important here. The last level of inclusion our fourth method of utilization is finding exceptions. And again that\'s sort of illustrated by this yin yang symbol. There\'s yin in the yang and yang in the yin. And I find that to be true. In psychotherapy we sometimes have an all or nothing view. A person\'s depressed or they\'re not depressed. They\'re anxious or they\'re not anxious. And again I find that a more complete picture says sometimes they\'re depressed, sometimes they\'re not. There are moments within their depression that they\'re joyful even. Sometimes if you\'ll examine those or not depressed let\'s say that feeling okay. A feeling normal or okay. So I\'m searching for those moments of exception to highlight for them and to make a more complete inclusive picture and sense of things for me and for them. And then to utilize use those exceptions that they\'re not using at this moment. So this is actually the basis for solution focus and solutionary therapies. We\'re trying to find exceptions to the problem as one part of both of those therapies. And that therapy came out of that idea. When somebody comes in and they say depression, I\'m thinking when not. I once read a book on Zazan in art and the guy said you know most people try and draw a tree and they draw other leaves in the branches and everything. But people who are really into art they draw the space between the branches and the leaves and the tree shows up. And I thought well that\'s why I\'m not a good artist but I do that thing in therapy. I\'m always curious about when the problem doesn\'t happen. What that teaches us about the person\'s resources, abilities and what they\'re not drawing upon at the moment when they\'re in the midst of their problems sometimes. So I want to search for those exceptions. My friend Steve Gilligan, another student of Erickson\'s has a funny way of saying this. He says sometimes people come in and they basically they\'re already in the problem trance. They\'re already in symptom trance. And they will unwittingly induce you into that trance if you allow it. They\'ll present themselves and sit down in your office and say hello. Glad to meet you. I\'m depression. When you look at me you won\'t see a person. You won\'t see anything else. You won\'t see any resources. You\'ll only see depression. A problem. I\'ve always been depression. I\'ll always be depression. I\'m always depression at this moment. Go deeper and deeper into the depression trance. Deeper, deeper. You\'ll see nothing but depression. You won\'t see anything else. Just depression. Just discouragement. Just hopelessness. Deeper, deeper. And if you get hypnotized by that you start to think yeah you know if I were that person killing yourself sort of makes sense. I mean you get hypnotized into the hopelessness of it and you look at your diary your you know your appointment book and you say oh no they\'re coming in again. That\'s when you know you\'ve been hypnotized by the problem. And one of the ways to get out of that problem is to remember or elicit exceptions to the problem so it\'s not an all or nothing. You start to see a more complex picture of this person. You get to start to get a more complex sense of them. You start to hear exceptions to the problem. So where do we look for these or search for these exceptions? First place is in the present. Just notice when they\'re not depressed or while you\'re talking to them or you can ask them. When are you not depressed? You know and kind of recently. I look in the past too. I searched in the past. When have you not been depressed? When were you not depressed? How were things when you weren\'t depressed? What were you doing differently when you weren\'t depressed? And interestingly I studied when again when I was an undergraduate psychology student the state dependent learning. When people are depressed it tends to color their whole view of the present, the past and the future. When you start to move them out of that depressive sense and they remember other parts of their lives sometimes they get more hopeful or less depressed just because you\'re evoking a different state. And even if I can\'t find it in the present or the past I\'ll search for it in the future. Now you think how do you search for exceptions to the future? You ask them what life will be like when they\'ve recovered from their depression or when they\'re out of their depression or when they\'re through treatment and things are better. So again you get them into a different state of mind that\'s not dominated by or defined by or totally defined by depression. That\'s the third level of inclusion here, this exceptions, this notion of exceptions, searching for exceptions. So we\'ve covered four different approaches to clinically applying this utilization approach. There are many other ways to think about it but I just wanted to fit it in the time that we had and also make it very accessible so you could use these with your clients or patients. And here\'s the idea that draws it all together. The other day I was looking out of my backyard and I have a little planting area and it had gone to seed. And I was talking to my fiance and she said oh those aren\'t flowers, those are weeds. I said yeah those are weeds. And she\'s not from this area and she moved her and she thinks they\'re beautiful and I thought well that\'s it. We only see it as a weed when we devalue it and think it\'s bad and we got to get rid of it. Now again sometimes in the case of kudzu or something which is planted in the United States in the south, it was a non-native plant and it goes wild and takes things over. So you have to manage it but the only way we call things a weed is if we devalue it and don\'t think it\'s right and we want to get rid of it. And I think that kind of attitude pervaded Erickson\'s thinking about clinical stuff is that instead of going in there and trying to get rid of it or you know herb beside it out and try and get rid of it he try and see the value of everything that was available for people. And then find a way to make sure things were a little more imbalanced so one thing didn\'t dominate. But initially he approached everything as something of value or resource and asset and ability rather than a pathology and a deficit and something to be cut out or gotten rid of. And that\'s the shift that\'s so powerful and profound if you can make it in this thinking. And that\'s the influence that Erickson had on me and I hope has on you this whole idea of utilizing rather than getting rid of. So I\'ll send this out here with the entire song that inspired the title to this presentation, the song by the move and it\'s called Fields of People. And the line is Fields of People, there\'s no such thing as a weed, seeds of hatred, plant them and soon they will breed. And that\'s the sensibility that I wanted to leave you with, this sense of loving everything that the client brings and there\'s no such thing as a devalued person and no such thing as a devalued aspect of a person. And we don\'t need to get rid of them, we can embrace them and then work with them. So I\'ll leave you with that and we\'ll fade out to the song by the move, go get it, it\'s a great song. It\'s worth listening to the whole thing and all the lyrics, it\'s a fun song and it has a lively hippie spirit and peace, love and understanding. Thanks for listening, thanks to Rob for having me at his conference, I\'ve enjoyed preparing this for you and I hope you get some out of it. Migrations flow, things will have to change. Good idea madam, it\'s recorded, yes. Strange new ideas, still the air. Some people leave, others grieve, some remember things will change. All concepts go, new ones go up. All it wants the well begins to love again, but that\'s the first, that\'s how to build. And the wild powers grow out of fields. She is a people, there\'s no such thing as a queen. She is a patron, a man and a tooth and a queen. Go do the fun by ya, baby madam. Wildflowers grow everywhere, vibrations flow.