Book Review: Milton H. Erickson

This brief book in the 'Key figures in counselling and psychotherapy' series aims to articulate the therapeutic approach of Milton Erickson, as well as some commonly held concerns about his approach.

Attempting to summarise Erickson's work, which intentionally eschewed theory in place of rude pragmatism, gives Zeig and Munion both difficulties and opportunities. The difficulty is one of conveying the nature of Erickson's work without over reliance on simple description. Although the book does make extensive use of case stories, these are used in order to elucidate particular elements of Erickson's work. Even the word 'technique' conveys an improper impression of what Erickson was up to. As a psychiatrist with a longstanding interest in hypnosis, both applied and researched, Erickson followed a relatively conventional, although highly successful, academic and medical career before ill health forced him to withdraw from the safety of the institution into private practice. Thus, for a period of about thirty years, many of the latter confined to a wheelchair, Erickson saw clients in the home that he shared with his wife and children. Without an overriding theory, what best describes the work that Erickson undertook? Three principles stand out. The first is that in contradistinction to other approaches of the time, the focus was not on the insight of the patient, but on changing the negative pattern of behaviour or negative emotional state. Thus, it was what brought the client to Erickson's house that mattered, not what had happened to them in the past, nor to any previous diagnostic labels. This did not mean that Erickson eschewed the existence of the unconscious, rather the opposite. In fact he saw the unconscious as extremely powerful but directly accessible without the need for conscious awareness. Thus, Erickson believed that one could communicate directly with the unconscious through hypnotic techniques, metaphor and other indirect techniques. Indeed a number of cases are reported where the only insight the client has is of their cure and not of how they have been cured. This does raise an interesting ethical question which Zeig and Munion discuss in chapter four, concerning informed consent. Put simply, how can informed consent be given if the work being undertaken is with the unconscious mind, given that it is the conscious mind that gives consent. Their answer is that consent is given for treatment and that therapy is by its nature manipulative. This is a profound conclusion, only briefly touched upon here and raises important questions for all therapists who accept this conclusion.

Erickson's second principle is that of utilization. As he is not restricted to a narrow model or theory about what should be done when confronted with a particular disorder, he is able to make use of everything that an individual brings to the consultation. Eminently pragmatic, the utilization principle recognises the uniqueness and individuality of every client and indeed the uniqueness of every therapeutic encounter. Thus, the therapist cannot impose any pre-determined intervention on the client as this simply reduces them to a fact to be manipulated, an error of positivism, where a phenomenology focused on the strengths and abilities is called for.

For those concerned about the influence of Erickson's ideas, then chapter 4 of this book is essential reading. Exploring four main areas of concern: theoretical, ethical criticisms, personal criticisms and approach criticisms, the authors explore many of the common concerns about Erickson's approach and provide reasoned responses to such concerns. To take one example, Erickson saw theory in relation to psychotherapy practice as limiting and confining. How then, it can be asked, can anyone else but Erickson undertake such work? Zeig and Munion note that Erickson would probably say first of all that no one could do the work just like Erickson, as they are not him. Yet, they can still work with clients in a meaningful and effective manner. How is this achieved? Firstly, even though there is no guiding theory, there are guiding principles (utilization, a focus on symptoms and not pathology, the healing role of the unconscious, active therapist direction and so forth). Secondly, even though Erickson was not a theoretician he still carefully described what he did and conducted hundreds of teaching and therapy sessions for those interested in his work. Students who were interested in his approaches were confronted with the need to experience it in order to begin to understand it. Finally, Zeig and Munion raise the question of whether it is the theoretical understanding of the a therapy or the years of practice that are the essential element in successful working with clients.

Erickson's work has given rise to an array of other approaches, such as solution-focused work, Rossi's mind-body work, neuro-linguistic programming and, of course, Zeig's own work, and for that reason alone, some knowledge of what Erickson himself actually said is extremely important. This book can be read in about three hours and should excite those of us who are also interested in existential approaches. Interestingly, while it is one of the core principles, namely utilization of the client's individuality, that fits relatively easily into existential therapy, its partial location within the patient's unconscious makes such accommodation with Erickson difficult. Yet, despite that, there is a real sense of authenticity in the world-view of Erickson, and the fact that he refused to codify the individual into the artificial grammar of illness and diagnosis is something to be welcomed.

Dr R.G. Hill