Balancing Client Trust and Proactive Interventions

by Tim Brunson, PhD

There is a trend in the healing professions that dogmatically mandates a naturalistic approach. It assumes that a person will always move toward a more healthy state, provided that the causes can be split from the symptoms. In the medical arena, this means that too often physicians focus only on eliminating the symptoms and trusting that their patient will naturally return to health. This sick-care approach – versus a health care approach – fails more often than they would like to admit. On the psychotherapy side of the fence, this same approach has been echoed in various schools of psychology. In fact, within the realm of hypnotherapy I see this as the major methodology preached by those who follow Ericksonian hypnosis and solution-oriented hypnosis, its offshoot. The premise here is that the subconscious mind is perfectly capable of finding a solution on its own, although apparently the subconscious mind is what caused the problem initially.

The homeostatic nature, i.e. the aggregate neuro-physiological entity that we call a person, is designed to survive. That is, a person is a pattern, with structure and encoding, which has as its first priority to preserve itself. This gives one the illusion that there is some sort of mystical entity that has a vested survival interest. This is the superstitious belief in the existence of a semi-autonomous entity called a subconscious mind. How does one reconcile this idealistic faith in the subconscious mind with the fact that it is probably also the miscreant that not only allowed pathology to occur, but most likely caused it?

By using a more scientifically sound and verifiable approach to understanding neuro-physiology, one will quickly understand that both mental and physical pathologies are simply the result of a mal-adaptation. The human entity is both an intrinsic pattern and an inter-network of patterns. As such, each pattern has a structure and encoding that they strive to protect. I call this pattern resistance. However, the story does not end here. Patterns also have a vital secondary instinct, which is to entrain and adapt when connected patterns transform. As patterns are linked, any changes to one pattern –or its components – will result in a cascading series of adaptations as they attempt to re-harmonize. Should one or more patterns lack the requisite flexibility and refuse to adapt to the new harmonic, then they will be out of sync with the superior patterns. This disharmony is a very simple way of understanding pathologies.

Dr. Erickson's approach was essentially two-fold. First, he sought to split the cause from the symptom. When translated into my lingo, this means that he wanted the patient to overcome the maladaptive pattern resistance. In other words, when the patient came to him, they knew that there was a disharmony in their patterns. So, Erickson's splitting technique was intended to intercede with a sufficiently antithetical intervention to overcome this resistance for patient's patterns to adjust to a new structure –or, more importantly, a new encoding. To do this, he either used his elegant techniques to induce a trance and provided minimal suggestive input, or gave the patient challenging homework. From that point, the resulting adaptation (i.e. finding a new organization of pattern structure and encoding) was left up to the patient. Hopefully, the result either provided a cure or at least a more acceptable set of symptoms.

The human entity's homeostatic nature can and will – once the splitting (i.e. overcoming of pattern resistance) occurs – guide the subject to a more functional state. When this happens, the clinician should happily reconcile themselves with the opinion that the mission has been accomplished. However, two problems remain. Sometimes it is necessary and appropriate to suggest to the subject a desired end state. Ironically, in reviewing many of the scripts written by Erickson I found that he often did just that. (Therefore, he regularly violated his avowed naturalistic stance.) Secondly, the urgency of a given situation may dictate a more proactive intervention. Certainly, many medical interventions – such as those used in emergency rooms – are of this ilk. Likewise, there are times when specific end-states must be suggested during psychotherapeutic work. For instance, when a client is likely to be self-destructive or harmful to others, or an abreaction may lead to a maladaptive response such as a catatonic state, a more proactive intervention is most appropriate.

The clinician's choice to use a minimalist intervention and trust the patient/client to be the chief participant in resolving a presenting problem versus using a more proactive, end-state approach must be made with upmost professional wisdom. Unfortunately, there are those who preach the naturalistic approach as universal dogma. This can be extremely dangerous and may lead to more harm than good. While I would be the first to insist that the clinician must be extremely sensitive to signals that are constantly coming from their subjects, and should most definitely be willing to enlist the client's natural tendency toward homeostatic health, they should always be wary when that tendency exhibits a unhealthy adaptation, and be ready to proactively insist on a specific outcome when warranted.

The International Hypnosis Research Institute is a member supported project involving integrative health care specialists from around the world. We provide information and educational resources to clinicians. Dr. Brunson is the author of over 150 self-help and clinical CD's and MP3's.