Entering Delusions

    Ericksonian Therapy (Zeig)
    • Erickson's view of psychosis by ToddStark@aol.com, 9/5/97

    Entering Delusions
    by Jeffrey Zeig, 9/17/97

    Hello Todd.

    Yes, Erickson "entered" the delusions of psychotic patients. I don't know that the emphasis was to cure them. Rather, it was to help them maximize their potential to enjoy life.

    There are many cases of Erickson working with psychotic patients. A notable case, the case of John, appears in "Experiencing Erickson" (Zeig, 1985: Brunner/Mazel). For a list of cases, you can see O'Hanlon & Hexum, "An Uncommon Casebook" (Norton, 1990).

    Erickson demonstrated that the symptoms of the psychotic patient could be used as a "handle." By helping patients to strategically overcome symptoms, they could make more global progress.

    Here is an example of some of my work with a psychotic patient. It is a excerpt from "The Evolution of Psychotherapy" (J.K. Zeig, Ed., 1987: Brunner/Mazel):

    In working with John, a paranoid schizophrenic, I had a cotherapist, one of my residents, also named John. We worked for a number of weeks and got the patient to the point where he was communicating directly much of the time. One day he can in speaking in garbled, unintellligible schizophreneze. It was as if he had regressed to his chronic state and our previous therapy was for naught.

    I tried a number of ways to influence him to speak directly, but none of these were effective. Then I hit upon an idea. I turned to John- the-patient and said, "Let's have a crazy talking contest. I'll talk crazy with you for five minutes and John-the-resident, will be the judge as to who does the better job."

    John-the-patient, and I talked crazy for five minutes, and then we turned to John-the-resident, who looked up at me and said, "Sorry, Jeff. John won." I indicated that I was a little off that day, but I could accept it graciously.

    Next I turned to John-the-patient, and said, "Let's try it again. I will be the judge and let's have the two Johns talk crazy for five minutes." I signaled when the time was up. They both turned to me. I expressed my regrets to the patient, saying, "Sorry, John. John won." In fact, John-the-resident, did a better job of talking crazy. Then I said, "Fair is fair." I took off my watch and gave it to John-the- patient, and said, "Now John-the-resident, and I will talk crazy, and you be the judge as to who does the better job."

    The patient looked carefully at the watch and parodied being a timekeeper. After the time was up, he looked at me and said his first coherent sentence of the day, "Sorry, Jeff. John won." Subsequently, the patient spoke at a more cogent level and we were able to make better contact.

    So, if a patient speaks "schizophrenic," then why not influence him from within his model by speaking schizophreneze -- playfully? One can utilize what the patient brings. Good psychotherapists influence patients from within the patient's frame of reference.

    Thinking of schizophrenia as a "degenerative brain disease" does not promote interventions. We all have limitations, and we do best to enjoy life in spite of -- even because of -- our limitations.

    Thanks for your inquiry


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