Reframing. Neuro–Linguistic Programming™ and the Transformation of Meaning

Reframing Dissociated States: Alcoholism, Drug Abuse, etc.

There are certain conditions that have to exist in order for six–step reframing to be effective. If you have someone who is severely dissociated, you can't expect reframing to work. Alcoholics, drug addicts, manic–depressives, and multiple personalities are all severely dissociated. Often people who overeat or smoke also fall into the same category. I'm going to talk primarily about alcoholics as an example. But I want you to understand that what I'm saying also applies to all the other examples of extreme dissociation.

If you ask the alcoholic in a sober state about his experiences while he is drunk, he will usually be partly or totally amnesic. Similarly, if you ask him while he is drunk to talk about experiences that he has when he is sober, typically he finds it difficult to offer you any information. That's one of several pieces of evidence you might use to notice that a person is dissociated: the fact that when he is operating out of one model of the world, he does not have access to experiences and resources that he has when he is operating from the other model of the world. He is a multiple personality in the sense that he has two distinct ways of operating in the world which never co–exist in his experience. The two are never in his body or his behavior at the same time.

The thing that really makes reframing work is that you develop a channel to the unconscious. By unconscious I mean the part of the person that is forcing him to do the behavior he consciously wants to change, or preventing him from doing the behavior that he consciously wants to be able to do. Reframing is a two–level communication whereby you talk with whatever part of him is conscious, and use involuntary responses to communicate with the part that is responsible for the behavior that is the focus of the change.

Typically the part of the alcoholic that brings him to your office is the sober part. That's the one who walks in. However, the sober part is already fully committed to being sober, so you don't have to do anything with that part. That's the part that already has lots of appropriate understandings about the disadvantages of drinking, but can't do anything about it. If you work with that part, you can get completely congruent responses about making changes. However, as soon as he goes into a bar, he'll be drinking again. What you need is access to the part of the person that gets him to go on binges, because that's the part of him that is running the show with respect to drinking. Since these two parts of the person are severely dissociated, while he is in one state, you cannot communicate with the other state. So when an alcoholic walks into your office in a sober state, it's extremely difficult to get access to the part that drinks, which is the part you need to change.

Most of the problems people have involve incongruity, or what is often called «conflict.» There is a mismatch, an incongruence, between the part of a person that makes him do something, and the part of the person that wants him to stop. Usually this incongruence is simultaneous: the person behaviorally expresses both parts simultaneously. For example, someone may say «I want to be assertive» in a very soft voice. The two parts are somewhat dissociated, but they express themselves at the same time.

In alcoholism or substance abuse there is a different kind of dissociation in which the incongruence is expressed sequentially over time. The sober part and the drunk part are so separate that they don't express themselves at the same time in the person's experience. They manifest themselves in sequence: first one, and later the other.

The six–step reframing format is designed to deal with simultaneous incongruity. Rather than make up an entirely different approach for sequential incongruity, you can just change a sequential incongruity into a simultaneous one, and use what you already know how to do: six–step reframing.

This kind of maneuver is common in other fields. A good mathematician will always attempt to reduce a complex problem to some other simpler problem that she already knows how to solve. If you take a difficult problem and reduce it to some other simpler problem, then you can solve it more easily.

The easiest way to change a sequential incongruity into a simultaneous one is through the use of anchoring. In the case of alcoholism, first I get access to the drunk part and anchor it. Then I anchor the sober part. Finally I collapse the two anchors in order to force the two states to co–exist.

When someone walks into your office, the sober part is right there, so that's easy to anchor. Getting access to the alcoholic part requires a bit more skill. One way to get that access is essentially to do a hypnotic induction in which you regress him to the last time he was drunk, or to some other good example of the alcoholic state, by gathering detailed sensory–grounded information from him about his experience of being alcoholic. «Go back to the last time. What do you feel like just as you are about to take the first drink? What was it like the last time you binged? Where were you sitting? What did you see? What did you hear? What did you say when you ordered the first drink? What was it? What did it look like? You can smell it now. And what exactly did it taste like? And how do you know when you are really drunk?»

If you ask your client these kinds of questions, you will see a definite shift in his behavior. As he gives you this information, he will begin to re–experience the drunk state. You'll see breathing and body posture shifts, and you'll hear a shift in the client's voice tone, tempo, and timbre qualities. You'll see a difference in facial expressions and in body movements. If you feed back those components of his experience that alter his state the most, you will amplify his experience of being alcoholic. When you see a really definitive shift, you can anchor that state.

Usually thinking of the smell and taste will take the person right back to the alcoholic state. Olfactory access is probably the fastest way to regress. Any time you want someone to re–experience some past state, if you can find an odor associated with that state, just having the person smell that smell will immediately take him back to that past state in all systems. Because of the way smells are processed neurologically, they have a much more direct impact on behavior and responses than other sensory inputs do.

Man: You called this method a hypnotic induction. Are you saying that any time you ask someone to go back, you've induced a hypnotic state or begun an induction?

There might be a question of semantics here about whether you want to call it hypnosis or not. I wouldn't call it that overtly; that might elicit resistance from the client. But, in my perceptions, what I've just described is indistinguishable from an «official» trance induction. The depth may vary a bit, but the actual procedure and the internal strategies a person employs are identical. So one way to get access would be this kind of an induction. What's another way to access the alcoholic part?

Man: Overlap. Have him see himself drunk, and then fit himself into his body in the picture.

OK. What's another way to get access to the alcoholic part? You should have half a dozen choices.

Man: Give him a drink.

Then you would have the problem of getting access to the sober part. Man: Take him to a bar.

Yes. That's using context as an anchor to elicit the state.

Another way you can do it is to pace and lead your client into a drunken state. Mirror your client and then begin to talk, walk, and act like a drunk yourself.

Another possibility is to give him direct instructions. «I want you to pretend to be drunk.» He'll probably say «But that's what I'm trying to avoid!» Then you say «Yes, I understand that, and in order to avoid it, you first need to have the choice of pretending.» There's no actual logic to that statement, but it sounds meaningful, and will get your client to do it.

Once he's begun to pretend, you can increase the quality of the access with feedback. «Ah, come on. Slur your speech a little more. Let's have a little more body sway—a little more tremor here. Are your eyes really blurred yet?» Give him verbal and behavioral feedback to adjust his behavior until you have a good access to his alcoholic part.

It's important to have a variety of ways to get access when you are dealing with people who have severely dissociated sequential incongruities. If you're not satisfied with the access you get using one maneuver, you can always shift to another.

Once you have access, anchor it so that you can get it back. When you have a good anchor for both his sober part and his alcoholic part, then you are ready to «blow his brains out," technically speaking. You collapse anchors for those two states by firing both anchors simultaneously, making both of those states occur at the same time. I generally use kinesthetic anchors for this, because he cannot get away from my touch.

The visible results of collapsing anchors on two states as different as sober and drunk states are remarkable. It definitely induces an altered state. I've seen a client reeling in states of semi–consciousness or unconsciousness for anywhere from three minutes up to an hour and a half. You will see what looks like total confusion; he will literally be unable to organize any coherent response. Sometimes his body movements are out of control, and he has whole–body convulsions. I've actually had a client go into a psychotic break and attempt to do anything he could to get my hands off him, because he knows that his experience is connected with my touch.

What's going on is that I'm jamming together two physiological states that were absolutely dissociated. He has never had those feelings simultaneously in his body. He has never tried to breathe the drunk way and the sober way at the same time, or had the muscle tone or the internal states of consciousness associated with those two states at the same time. In a sense, he was a multiple personality, and you are slamming those two parts together. This really is a sort of shock treatment, and some people have even spontaneously described it that way. The difference is that it's not externally induced, and it will only attain intensities that people can cope with. It's ecological in that sense.

When you have finished collapsing those two anchors, the integration is in no way complete. It simply allows you to have a bridge, so that the alcoholic and the sober person co–exist in the same body at the same time. The two parts are no longer mutually exclusive and completely dissociated. That makes it possible for you to do reframing. This is a precondition for establishing an effective channel of communication through the sober part to the alcoholic part which knows about the drinking problem and what needs it satisfies.

Woman: What do you do while you hold the two anchors and the person is confused for an hour and a half?

I only have to hold the two anchors until the integration is well underway. Then I just make sure he is in a place where he won't hurt himself; that's about all that's necessary. It's also useful to introduce lots of post–hypnotic suggestions while he is in this state of confusion. He will be utterly defenseless at that point. Make sure that your post–hypnotic suggestions are content–free so that you don't impose. You might say «As you continue to thrash around, notice that there's a direct relationship between how intense the feelings are now and how rapidly you'll gain the behavioral choices you want with respect to drinking.»

Since he can't defend against suggestions at that point, you have a tremendous responsibility for the way you frame the suggestions. «You will no longer want to drink» would be the most disastrous way of approaching it. It would be better to keep your mouth shut than to say something like that. You need to talk in positive terms about what will happen in the future, rather than what won't. «You will be able to find alternative ways to satisfy yourself in the way that alcohol used to» is much better. When you talk about the alcohol, you need to speak in the past tense, presupposing that he will no longer use it. All of the hypnotic language patterns described in Patterns I and Trance–formations are appropriate here. If he says «But I don't understand you," you can respond «Of course you don't understand me, and the less you understand me consciously, the more you will be able to reorganize unconsciously in positive ways.»

Man: When you collapse anchors for being drunk and being sober, don't you run the risk of making the person act drunk all the time?

That is a reasonable concern. Giving hypnotic process instructions such as those I've been describing is a way to make sure that the integration you get from collapsing anchors is useful. You say things about how those two states can begin to blend in such a way that the person incorporates all that is useful and valuable in each state, losing nothing, so that the integration can serve as the foundation for more choice, etc.

Let me remind you that this is only a preliminary step. I'm deliberately breaking down barriers between two dissociated states and inducing confusion. I'm literally violating a discrimination, an internal sorting process, that the alcoholic has unconsciously used to make himself effective in life. After doing this, I'm going to have to clean it up with reframing. All I've done is create the precondition for reframing. I now have access to the drunk part and the sober part at the same time. I have reduced a very difficult situation of sequential incongruity to something I can cope with: simultaneous incongruity.

After he recovers and is relatively coherent, I would simply proceed with six–step reframing to secure specific alternative behaviors, and to future–pace the new behaviors appropriately. At that point you reframe in the same way that you would reframe anything else.

However, one thing is very important. If you're working with something like drinking, smoking, or over–eating, you have to be sure that the new alternatives not only work better than the old choice, but that the new alternatives are more immediate. You need to be very sensitive to criteria, and «best» in addictions usually has a lot to do with immediacy. If your new choice for relaxing is taking a vacation, that's not nearly as quick and easy as eating a piece of chocolate cake that's already in the refrigerator. It's a lot easier to smoke a cigarette than to meditate or go running on the beach. You can't run on the beach when you're in an elevator, but you can smoke a cigarette.

You can build in immediacy by specifying it at step four. «Go in and find three choices that are more acceptable, more immediate, more available, easier, and faster than the one you are using now.» Often people don't do that when they do reframing. Their clients then come up with long–range alternatives that don't work, because they need something really immediate.

Another thing you can do with any addict is to make his actual feeling of desiring the drug an anchor for something else. The person needs to experience the feeling itself as having a different meaning. Right now he has a certain feeling that he interprets as a craving for a drink, and it pumps him into drinking. You can put him in a trance and make that feeling mean something else. The feeling of «craving» could now lead to intense curiosity about his surroundings, for instance.

I've used this approach of collapsing anchors and reframing effectively with alcoholics and heroin addicts in one session. I have up to two–year follow–ups now, and it's been successful.

After you've done reframing and found new choices for the secondary gain of the alcohol or the drug, you need to test your work. With an alcoholic, my test is to give him a drink and find out if he can stop after just one. I consider that the only valid test of whether I have done a complete and integrated piece of work. With heroin, I'd find out what anchors used to trigger off shooting up, and then I'd send the client out into that context to test his new choices.

Lou: That's really amazing. I've worked with people in AA, and they think that «Once an alcoholic, always an alcoholic.» Are you saying it's possible to cure alcoholics so that they can drink but not get drunk? They can go into a bar and have one drink and then walk away from it?

Definitely. When I work with an alcoholic, three months later I'll go out to some bar with him and have a drink. I watch and listen closely for any of the behavioral shifts that used to be associated with the alcoholic state. That will test whether I've done an integrated piece of work. I want to find out if he can have a drink and have the same response to it that I have; namely, that it's just a drink. I'm going to find out if he can perform the behavior that previously was automatic and compulsive without being compelled to go on and have more. Alcohol is an anchor, and using that old anchor is a good test of my work.

I don't mean to criticize AA, by the way. For decades AA was the only organization around that could assist alcoholics effectively. Historically it was a wonderful thing, and at this point we need to move on to something else. AA has a non–integrative approach, and people in AA are almost always bingers. They believe that «Once an alcoholic, always an alcoholic," and for their people, that's true. If one of them sits down and has one drink, he won't be able to stop; he'll continue on a binge.

The claims I am making would be outrageous to anyone in AA, and also to the belief systems that most therapists have been taught. They are not incredible if you approach addiction from an NLP standpoint. From that standpoint, all you need to do is 1) collapse anchors on the dissociation, 2) get communication with the part that makes him drink, 3) find out what secondary gain—camaraderie, relaxation, or whatever—the alcohol gets for him, and 4) find alternative behaviors that get the secondary outcomes of alcohol but don't produce the damage that alcohol does. A person will always make the best choice available to him. If you offer him better choices than drinking to get all the positive secondary gains of alcohol, he will make good selections.

Lou: How would you deal with someone in AA then? They seem to believe that nothing will work except AA, and they won't listen to anything else.

Yes. AA is a «true believer» system. If you're working with someone who belongs to AA, you just accept that. You say «You're absolutely right.» Then you might add «Since you are so convinced that 'Once an alcoholic, always an alcoholic' it won't be any threat to you if we try something different, because it will fail anyway.» When someone has a strong belief system, I accept it, and then find ways to work within it. Then I can always induce a covert trance and just program directly.

Your question about belief systems reminds me of something a medical doctor in England tried with heroin addicts. He had a clinic with a large methadone program to keep his clients from experiencing withdrawal. Once he had a new group of addicts coming in, so he did a controlled experiment in which he randomly divided the addicts into two groups. The control group just got methadone as usual. He trained all the subjects in the experimental group to be really good trance subjects. The two groups would come in at the same time for their methadone, but the experimental group would go to his office. There this doctor would put them all into a trance and have them hallucinate shooting up. At the end of six weeks, no one in either group had shown any withdrawal symptoms. At that point he told the experimental group what he had done, and all but two of them immediately went into withdrawal! That is an indication to me that the body is capable of handling the chemical imbalances if the person's belief system is consistent with doing so.

After I've tested for ecology, and to make sure the new choices work, I usually give the person something that he can actually get hold of to use as an anchor for his new choices. It might be a coin, or something else that he can put in his pocket and carry around with him. This will help take care of the old motor programs associated with drinking, smoking, or whatever. Part of the choice of drinking, for example, is actually going through the motions of holding onto a glass and moving it up to the mouth. Having some tangible physical anchor gives the person something else to do with his hands.

People sometimes consider AA members obnoxious because they don't want anyone else around them to drink either. Their reason for this, of course, is that seeing someone else drink stimulates that choice in them by identification. Since the old motor programs haven't been integrated into having new choices, this elicits the old drinking behavior in them. When you don't have this kind of sensitivity in an ex–drinker, that's another good indication that you've got full integration.

Woman: I have a question about the anchoring. Would you anchor the sober state first, when the client walks in, and then access the drunk state?

There are lots of ways you can do this. You don't even need to anchor the sober state in order to get integration. After your client has accessed the drunk state, you can say «Hey! Pay attention here. What do you think you are doing, acting like a drunk in my office?» Then you'll get the sober part back. Your client will say «Oh, I'm sorry! I thought that's what you wanted me to do. I was just trying to follow your instructions.» You continue with «What? Pull yourself together here.» You then hit the anchor for the alcoholic state at the same time that you are saying «Stay sober; pay attention here.»

Woman: Is the sober state a powerful enough anchor to be collapsed with the drunk state?

The sober state does need to be as intense as the drunk state. If you collapse anchors and don't get an integration, but rather something which looks like the drunk state, that indicates that you need to get the sober state anchored more intensely. I would stop doing the integration and say «Hey, wake up! Come on! Hey, wake up!» I would bring him back to a sober state completely. I'd stand him up, move him around, give him a cup of coffee, etc. When he's sober again, I'd ask

«Do you know where you are? Do you know what you are doing here? What's your purpose for being here?» I'd get the sober part back fully, and then I'd anchor it.

Man: Couldn't accessing the alcoholic state be dangerous if the client gets violent when he's drunk?

If that's the case you'll need to take extra precautions. You would use visual or auditory anchors instead of kinesthetic anchors. You might keep six feet and a chair between you and him, with the exit behind you. Or you may be well–trained in martial arts and have full confidence in your ability to protect yourself, as I do. You deserve to be sure that your physical and psychological integrity is always preserved. You are a psychotherapist; you are not being paid to put your body or your psyche on the line.

Woman: Would you be able to interrupt such a violent state if you'd anchored the sober state first? You could then use that anchor to bring the client back out of the alcoholic state.

Sure, but don't use a kinesthetic anchor for that. If you're close enough to touch someone who is acting violent, then he is close enough to hit you. An anchor that interrupts a rage state can be a good choice, as long as you can fire it from a distance. You can use auditory or visual anchors for that. A student of ours is teaching foster parents in halfway houses how to use non–tactile anchors to interrupt rage states. Depending upon the clientele you deal with, you may need that. You can anchor from a safe distance by a clap of your hands or some gesture. Another way to do it is to start talking to him using one voice tone, and as he goes into the alcoholic state, you change to another voice tone. Your voice tone then becomes an anchor. Then if he starts to go into a rage state, you say «Hold on a minute» in the tone of voice you used for his normal state.

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.

The fascinating thing is that when I worked with her, no matter which part of her I worked with, or what I changed, or what she learned to do—even tasks like learning to type on a typewriter that had the keys in a different configuration—when the parts flipped over, none of it transferred. She was almost like two people, although she wasn't a complete multiple personality. In each of her states she had some memory of the other state: she remembered where she lived, and most of what had happened in the other state. But learnings and personal changes never transferred back and forth. So, of course, the one that was «up» would go out and make changes and accomplish things, and the one that was «down» would go hide. One of them kept becoming more and more confident and capable, and the other one more and more depressed and incompetent.

When you have people like this, one of the things that you have to do somehow—no matter what else you do—is to integrate those two parts. But in order to integrate them, you've got to get them together in the same time–place coordinates. That's not very easy, because the one that's not in your office can be very hard to get to. You could anchor one, and wait six months and then anchor the other. And if you had really good anchors, you might be able to pull them together.

One approach that has worked really well for me is «pseudo–orientation in time.» That is a hypnotic phenomenon in which you hypnotize the client and you project her into the future in increments. Then you have her arouse from the trance believing, for instance, that this is not her second visit but her sixteenth. It's now three months later, so you can ask her about the past. Pseudo–orientation in time is a neat way to get a client to teach you about therapy. You hypnotize her and tell her you have cured her, and in a moment you are going to arouse her from the trance. It is now August, and she is returning for her last visit, and she has agreed to document some of how all these changes took place.

Then you bring her out of the trance and say «Hi! How have you been?» «Oh, I've been wonderful.» Then you say «I have such a bad memory. Will you recall for me exactly what you consider the most essential thing that I did which changed you?» Your client will then tell you really great things to do! A lot of the techniques that we teach people in workshops have come from doing pseudo–orientation in time.

It takes either a fairly good hypnotic subject or rigorous hypnotic training to be able to do this. It's a complicated trance phenomenon. Of course, once you've become used to doing it, it's not complicated anymore.

Another thing I do is to set up a signal for the different states. I try to detect where the polarities lie. If they are temporal, then I set up signals for the different time zones. Some of them are contextual: some people have sequential polarities depending upon whether they are at work or at home, for example. Some people switch between vacation and everyday life. If it has to do with a drug substance, then of course I set up an anchor that induces the substance state.

When I have good anchors for both parts, I can literally carry on conversations with each one sequentially. With the manic–depressive woman I talked about earlier, I had anchors for a July visit, and for a December visit. I set up anchors not only covertly, but also directly hypnotically: «When I touch you on the knee, it will be July» so that I could literally go back and forth between the two parts and work with both of them. So when I did reframing, I'd induce one state and I'd say «Now, you go and ask the part …» and then I'd induce the other state and do the same thing. It was like doing reframing with two people at the same time.

I used to run groups where I would bring in ten or fifteen people and just start going around the room, using the six–step reframing model. The first week I would always do it with content, and then the next week when they came back, I could do it purely formally. I would have them pick something that they could talk about the first few times to make sure they could tell the difference between an intention and a behavior and that sort of thing, and I would go around the room and troubleshoot as they all went through the steps at the same time.

Man: But the two parts of the manic–depressive woman are in the same person. How do you reframe them to the same conclusion?

If you have sequential incongruity—somebody diets like crazy and then gains weight like crazy—that's actually only an incongruity at the level of content. At the formal level, the two parts are the same. Both are obsessions, and both of them show a loss of control. One is saying «I'll starve myself; the other is saying «I'm going to eat everything in sight.» At the content level, they are opposite, but at the formal level, they are exactly the same. Those people don't diet intelligently. They don't build up to a maintenance program slowly. It's always either crash diets or «pigging out.» If you offered them anorexia, they'd take it! The solution has to take the part that overeats and give it some other way of getting what it wants so that it goes back to eating in moderation. And the part that diets like crazy also has to be reframed, because otherwise when you reframe the eating part, the diet part will go «Ahhhh! Now is my chance!» and go crazy, and then you will get a backlash in the other direction.

After I've worked with the two states in someone with a sequential incongruity, I usually build a part whose job is to integrate these two states, or I set up some kind of unconscious program to lapse together the times when they operate. With the secretary, the times were six months, so I didn't want to do it that way because it would have taken years to get anywhere. I decided to do time distortion: I went into the past and set up a program for integration to begin five years earlier and have the date of integration be the date she was in my office.

It didn't take me long to do this, because anybody who is that dissociated is a great hypnotic subject. She would have to be, or she couldn't be so dissociated in the first place. I did a hypnotic induction and arrived in her past as someone else, some shrink she had seen five years ago. As that shrink I installed the integration program in her unconscious, and then had her create all the necessary alterations in her history so that she could conclude the integration spontaneously in my office, five years later. Sometimes in order to be able to work these things out, you have to create a lot of personal history.

Woman: I have a client who became amnesic for everything preceding an incident in which he «came to» and found himself looking down the barrel of a shotgun, with a stick on the trigger to fire it. Now he's totally amnesic for his whole life prior to that time. As you might expect, he comes from a really awful family situation. He also has a lot of experience at dissociation, having been an alcoholic for a long time. Now he's a sober AA person.

I think you're talking about the same formal situation. What has he requested from therapy?

Woman: Well, his stated goal is to get his memory back.

That kind of goal reminds me of a kind of fairy tale from my childhood. When I was a little kid, my folks used to read me fairy tales at bedtime. I was the oldest of nine kids, and we used to have these big family storytimes that were really fun. It was a nice ritual.

One class of stories that my parents told used to drive me crazy. Some character would be walking along through the forest one day and suddenly he would meet a magical creature whose beard had gotten caught in a fallen tree. I could never figure out what kind of a magical creature would be stupid enough to get his beard caught in a fallen tree! The main character would save the magical creature, and the magical creature would say «You now have three wishes.» The person would always blow it. He'd immediately say «I want to be immensely wealthy.» Then the entire countryside would be destroyed and in ruins, and his family would be wiped out, because everything would be covered with gold.

That kind of story is a good metaphor about the need for the ecological protections we build into reframing. The character doesn't think about the secondary effects of his wish. He doesn't specify context or procedure; he just names a goal. Reaching the goal is much more disastrous than not having reached it at all. Consequently, the character always uses the second wish to reverse the ill effects of the first one. Then he says something like «I wish I had never met this creature.» And that uses up his third wish. So he blows all three wishes and ends up back at zero.

Often people's conscious requests in therapy are a lot like that. People ask for things without any appreciation of their own personal context, or the larger family context in which they are embedded. So one of the ways in which I might proceed in your position, would be to act naive. I might act as if I am taking his request seriously, and arrange for him to go back and recall just a few things.

First I would set up a strong amnesia anchor. Then I would induce a trance in which I was guaranteed that I could create amnesia if I requested it. Then I would have him stay dissociated so he could view things from his past externally, and not be kinesthetically involved. Then I would ask his unconscious to pick three incidents from his personal history; one pleasant, one not so pleasant, and one disastrous, to give him some idea of the range of experiences in his personal history. After he has observed those, I would arouse him, and ask him for his response. If he wanted to continue, then I could. If he didn't want to continue, I would re–induce the trance, create amnesia for those recovered pieces of information, and then proceed to setting new goals.

Once a therapist brought in a trainee who wanted me to use hypnosis to discover something about her past. She believed that her older brother and a friend had raped her when she was eleven years old. She wasn't certain this had actually happened, and she wanted to know whether it was true. My response was «What difference would it make to you if you knew?» She had no answer to that question—it had never occurred to her. You might consider asking your client that.

Janet: Well, I have asked him, and he says he wants to remember so that he doesn't have to feel so funny when he runs into somebody that he used to know and doesn't remember. I feel like he's set up a task that is impossible for himself, because he doesn't really want to know.

That would be my first guess, too. He has consciously asked to recover a memory, so that's the goal, but he also has good reasons not to remember.

Janet: He was also in a VA hospital for awhile. He's very proud that they used sodium pentathol on him and got nothing! They also used hypnosis on him and it was unsuccessful in helping him recover the past. All he can remember are very precise details of the day that he woke up looking into the barrel of the shotgun.

I would probably go for his meta–goals then. «You want to recover memory. For what purpose?» «So that when I meet people from my past I would know how to treat them.» «Oh, so what you really want is not to recover memory. You want a way of gracefully dealing with the situation of meeting people who claim to be from your past.» One way to get that outcome for him would be to teach him a little «fluff.» «Gosh, it's been so long! Where was it?» It's quite easy to teach him «fillers» that will gracefully elicit all the information he needs to respond appropriately.

Whenever there is a direct conflict on any level, you just jump up to the next level. You ask for the meta–outcome. «What will you gain from this? What purpose will this achieve for you?» Once you know this, you can offer alternatives that are much more elegant. He will soon give up his original request, because recovering his history will have no function for him anymore.

Janet: As far as I can tell, his family situation continues to be horrendous. I tried saying «Well, you can't remember anything, so why don't I just have your family tell you the good things that happened in your life?» His family couldn't come up with anything!

Another alternative would be to make him a good hypnotic subject, with the goal of creating a new personal history for him. Get him to agree to using hypnosis, not for recovery of his memories, but for building him a new personal history. If you got a bad one the first time around, go back and make yourself a better one. Everybody really ought to have several histories.

Janet: How would you do that?

Directly. You can say «Look, you're a talented guy, but you don't know where you came from. Where would you like to have come

from?»

Janet: This is an unsophisticated farmer.

That makes it easier. The toughest of all clients to deal with are sophisticated psychotherapists, because they think they have to know every step of what you are doing. They have nosy conscious minds.

In the book Uncommon Therapy a case is described in which Milton Erickson built a set of past experiences for a woman. He created a history for her in which he appeared periodically as the «February Man.» That case is an excellent source for studying the structure of creating alternate personal histories.

Fred: Is schizophrenia another example of sequential incongruity and dissociation?

People diagnosed as schizophrenic usually have certain aspects of themselves which are severely dissociated. However, the dissociation is generally simultaneous. For example, a schizophrenic may hear voices and think the voices come from outside of himself. The voices are dissociated, but both «parts» of the person are present at the same time.

Fred: OK. I have been working with schizophrenics for a long time. I have been using some of your techniques, but not as efficiently or precisely as I would like. What particular adjustments would you suggest with so–called schizophrenics?

From the way you phrased your question, I take it you've noticed that some people who are classified schizophrenic don't manifest the symptoms which other people with that label have. There are two ways in which working with a schizophrenic is different from working with any of the people here in this room.

One is that people labeled schizophrenic live in a different reality than the one most of us agree upon. The schizophrenic's reality is different enough that it requires a lot of flexibility on the part of the communicator to enter and pace it. That reality differs rather radically from the one that psychotherapists normally operate out of. So the issue of approach and rapport is the first difference between dealing with the so–called schizophrenic, and someone who doesn't have that label. To gain rapport with a schizophrenic you have to use all the techniques of body mirroring and cross–over mirroring, appreciating the metaphors the schizophrenic offers to explain his situation, and noticing his unique nonverbal behavior. That is a very demanding task for any professional communicator.

The second difference is that schizophrenics—particularly those who are institutionalized—are usually medicated. This is really the most difficult difference to deal with, because it's the same situation as trying to work with an alcoholic when he's drunk. There's a direct contradiction between the needs of psychiatric ward management and the needs of psychotherapy. Medication is typically used as a device for ward management. As a precondition to being effective in reframing, I need access to precisely the parts of the person that are responsible for the behaviors I'm attempting to change. Until I engage those parts' assistance in making alterations in behavior, I'm spinning my wheels— I'm talking to the wrong part of the person. The symptoms express the part of the person that I need to work with. However, the medications considered appropriate in a ward situation are just the medications which remove the symptoms and prevent access to that part of the person.

Working effectively with people who are medicated is a difficult and challenging task. I have done it a half–dozen times, but I don't particularly enjoy it. The medication itself is an extremely powerful anchor that is an obstacle to change.

Let me tell you a little horror story. A young man was wandering down the street of a large city after a party. He was a graduate student at the university there. He'd been smoking some dope and drinking a little bit of booze. He was wandering along, not really drunk, but certainly not sober. At about three o'clock in the morning he was picked up by the police and taken in for being drunk in public. They fingerprinted him and ran a check on him, and it turned out that he had been in the nearby state mental institution several years previously. When he was there, he'd been classified as a schizophrenic, and had the good fortune to run into a psychiatrist who is a really fine communicator. After the psychiatrist worked with this young man, he had altered his behavior, was released, and was doing quite nicely in graduate school. He'd been fine for years.

When the police discovered this history of «mental illness," they decided that his behavior wasn't the result of alcohol or drugs, but rather the result of a psychotic lapse. So they sent him back to the state mental hospital. He was put back on exactly the same ward he'd been on before, and given the same medication he'd been on before. Guess what happened? He became schizophrenic again. He was anchored right back into crazy behavior.

This kind of danger is my reason for insisting that the test for effective work with an alcoholic be exposure to the chemical anchor that used to access the dissociated alcoholic state—to have the client take a drink. Then you need to be able to observe whether taking a drink leads to a radical change in state—whether there is a radical shift in breathing and skin coloring, and all the other nonverbal indications of a change in state. If there is such a shift, then you don't yet have an integrated piece of work; you still have more integration to do.

If you take the challenge of working with institutionalized schizophrenics, you can make your work a lot more comfortable and a lot more effective if you make some arrangement with whomever is in charge of drugs on the ward. Being effective in a reasonable amount of time is going to depend upon your ability to work with people while they are not on drugs, or upon your ability to establish hypnotic dissociated states in which they are essentially independent of chemicals. Those are very difficult tasks; it's a real challenge.

Janet: I have a client who was diagnosed schizophrenic. She was on medication which she's off of now, but she's beginning to hear voices again. That's scaring her. She's very frightened.

Well, first of all, it doesn't frighten her. She has a physiological kinesthetic response to hearing the voices. At the conscious level she has named that response «being frightened.» That may sound like semantics, but it's not. There's a huge difference between the two, and reframing will demonstrate that difference.

My first response to this woman would be to say «Thank God the voices are still there! Otherwise how would you know what to do next? How would you do any planning?» One or two generations earlier, a person who heard voices was characterized as being crazy. That's a statement about how unsophisticated we are in this culture about the organization and processing of the human mind. Voices are one of the three major modes in which we organize our experience to do planning and analysis. That's what distinguishes us from other species. So my first response is «Thank God! And now let's find out what they are trying to communicate to you.» I might say «Good! Let me talk to them, too. Maybe they've got some really good information for us. So go inside and ask the voices what they are trying to tell you.»

Janet: «How I should kill my mother.»

«Good! Now, ask the voices what killing your mother would do for you.» You go to the meta–outcome. If an internal part voices a goal which is morally, ethically, or culturally unacceptable, such as «kill my mother," then you immediately go for a frame in which that is an appropriate behavior. It may sound bizarre as you hear it, but it's quite appropriate given some context. The question is, can you discover the context? «What would killing your mother do for you? Ask the voices what they are trying to get for you by having you kill your mother.»

The person is likely to interrupt you and say, «I don't want to kill my mother!» You can respond «I didn't say to kill your mother. I said to ask the voices.» You need to maintain the dissociation, and then proceed with the standard format of six–step reframing. «Those voices are allies. You don't know that yet, but I'm going to demonstrate that they are. Now, ask them what they are trying to do for you.»

Ben: I'm currently working with a patient who is a chronic schizophrenic. I've discovered that I'm challenging his thirteen–year career as a chronic schizophrenic by working with him. During the last session, he essentially said that he has an investment in maintaining this career. So I applauded his great success at it.

What Ben is saying is really important. He applauds the schizophrenic's thirteen–year–old career. «How well you have done as a schizophrenic for thirteen years.»

Ben: He has the same name as a famous person, and I said that he was as talented at being a career schizophrenic as this person was in his field! He has actually had thirty–two years of treatment, but he has never had adequate family therapy before. In the context of family therapy he told me that he believed his mother would die if he resolved these problems and really became himself.

Was his mother present as he was talking about this belief?

Yes. I explained that she would not die if he got better. In fact, I said she would be pleased. Actually, the mother is somewhat incongruent about wanting him to recover. But I don't know where to go from there. My guess is that I should begin working on the mother.

OK. Ben's been working with a schizophrenic, and now he's going to work on the mother. The next step is the specific way in which he hooks them together. In other words, the mother says to the schizophrenic «I won't die if you get better. Go ahead and get better. In fact, I want you to get better.» (He shakes his head «No.»)

Ben: I didn't read the incongruence that clearly, but I feel that is accurate.

The question is, will the schizophrenic believe that incongruent statement? Definitely not. The schizophrenic is much more sensitive than you and I to those nonverbal signals. He's had a whole lifetime of reading them.

One thing you can do is to get a congruent response from the mother.

You might begin by sorting out the parts of her that do and don't want him to get better. «Ok, pretend that you want him to stay sick. Now tell him all the reasons why it's important that he stay sick.» She says «But I don't," and you say «Well, that will make it easier for you to pretend.» Then later you say «Now pretend you want him to get well.» «Well, I do.» «Of course; that will make it easier to pretend.» The logic of it is flimsy and irrelevant. All that's important is that you make it easy for her to respond. If you want to see something impressive in terms of nonkinesthetic anchors, have the mother alternate between those two behaviors while you watch the schizophrenic. Smoke will come right out of his ears!

Your eventual goal, of course, is to make the schizophrenic independent of whether the mother is congruent or not. In one sense, maturity is reaching a symmetrical relationship that allows a parent to be as incongruent as she wants, and the child can still maintain his own context and momentum in his life.

Whether the schizophrenic believes his mother wants him to stay sick or get well, if you're doing reframing you can say that the purpose the schizophrenic has in staying schizophrenic is to show honor to the mother. His purpose is to demonstrate how much he cares and how concerned he is about her welfare.

This is just standard reframing. I've gone from a piece of behavior, being schizophrenic, to the intent or the purpose of the behavior. I drive a wedge between the behavior «schizophrenia» and the intention or purpose of the behavior, and I validate the outcome. «You're right! Don't you mess around, because you care for your mother and you've got to demonstrate that to her as far as I'm concerned. I care for my mom, too.» Use whatever analogue is appropriate for this particular

guy.

Then you insist that he be schizophrenic until he has tested other ways of showing the respect and caring that his mother deserves and that he wants to give her. You insist that he continue to be schizophrenic until he discovers alternative patterns of behavior that lead to the outcome: showing respect and caring for his mother. «She deserves the best. If schizophrenia is the best, then you need to stay with it. If we can find a better way for you to demonstrate caring and respect for your mother, you'll want to do it that way, because she deserves the best.» By doing this, you operate entirely within his model of the world. At the same time I would also be working with the mother to sort out her behaviors.

Sometimes when someone has come in with aspects of her experience dissociated, we have chosen not to go for an outcome of complete integration. A big Dutch woman who had been in this country for twenty years was brought in by her husband, because she was displaying acute schizophrenic symptoms. She heard voices that were constantly propositioning her sexually, and making lewd and incomprehensible statements. She didn't even understand the meaning of those statements, because she was a «clean woman.»

A number of well–intentioned psychiatrists had attempted to deal with this woman. They explained to her that the voices were really her voices, and were a result of the fact that she was angry with her husband who had been involved with some other woman ten years earlier. This woman was extremely religious, and she had no way of accepting that explanation in her world–model. Her rage was unacceptable to her, so it was projected into auditory hallucinations. If she believed that those voices were hers, it would have shattered her conscious appreciation of herself. The voices were saying things and proposing activities that were abhorrent to her as a good, clean, religious woman. By trying to get the woman to accept this, the well–intentioned psychiatrists were running up against a stone wall.

This woman refused to go to psychiatrists because they were insulting her. So her husband and daughter brought her to us. The problem was getting serious, because she was slugging people who she thought were making indecent proposals to her. She was hitting and slapping waiters in restaurants, and people on the street—and she was a formidable opponent! Consequently, she was about to be locked up. We decided on a fairly limited therapeutic goal. The family was poor, and didn't have any interest in generative change. Mama just wanted to be comfortable, and the rest of the family just wanted Mama to be all right.

She was obviously already very dissociated. In this case it was a representational system dissociation. She had dissociated both the kinesthetics of the rage and the auditory representation of it. We made use of the dissociation, and simply widened it to get an altered state. Then we appealed directly to the part of her that knew what was going on. In the first session we were content with convincing her unconscious of a spurious piece of logic. We told her unconscious that since it had important things to say to her, it should say those things in her language of origin, so that she could completely understand. By doing that, we shifted all the hallucinated voices into Dutch. The consequence of this was that she couldn't beat up anybody here in the U.S., because she was hearing Dutch voices, and she knew that the people around her only spoke English. This was very confusing for her, but it was a good way to prevent her from getting into situations in which she'd actually be arrested or committed.

When she came back, we induced an altered state again, and I had a «revelation» on the spot. God spoke to me, and I reported to her what God said. «God said 'It is right and just and proper that blah, blah, blah.'" This revelation gave her instructions to move all the voices into dreams. So every night this woman would drop off to sleep and have violent dreams about taking revenge on her husband who had stepped out on her. During the day she was perfectly comfortable. We built in safeguards, so that the violent dreams didn't spill over into her behavior during the night, or she might actually have beat up her husband.

That's an example of an extremely limited therapeutic goal. It's been five and a half years now since we worked with her. She's happy and everybody in her family is happy. But that's not an integrated approach. She still has two dissociated parts of herself. Using the metaphor of the alcoholic, she is still capable of bingeing.

Man: In her dreams you mean?

Yes, and there's some possibility that it could spill over into her waking behavior, too. My guess is that if her husband got involved with another woman again, that would break down all the barriers that we set up to sort her behavior. You can always use that kind of dissociation to sort someone's behavior, but you should realize the limitations of not achieving full integration.

You need to be able to select and contextualize behavior, so that you can respond differently in different situations. Overcontextualization results in extreme dissociation, and severely limited and inflexible behavior. Extreme dissociation can work adequately in limited and relatively stable environments, but it quickly becomes maladaptive and ineffective in the face of changing conditions.

The ideal situation is to have full integration, so that any behavior can be available in any context. Our goal for you and your clients is to be able to respond to changing conditions in generative and evolutionary ways. In order to do this, it is useful to integrate dissociations fully, so that you have all your resources available to you anytime and anywhere.