David Gordon - Phoenix: Therapeutic Patterns of Milton H. Erickson

The first consideration in dealing with patients, clients, or subjects is to realize that each of them is an individual. There are no two people alike. No two people understand the same sentence the same way. And so in dealing with people you try not to fit them into your concept of what they should be... you try to discover what their concept of themselves happens to be.

Now Betty thinks in a straight line, and I think all over the place. Now, I purchased the boys their bicycles. I warned them that they should keep the pressure up in their tires, I gave them a pressure gauge and told them that they should keep it on the intercom. Our kitchen was in the basement, we lived on the second floor. Got an intercom so Betty could hear the babies crying. One evening I came home from the office, there on the kitchen table was the pressure gauge. I said, "Oh oh, the boys got careless. I'll have to punish them for that. I'll hide the pressure gauge." I said, "I know, I'll drop it in the garbage pail." Betty said, "That'll be the FIRST place that Bert looks." I said, "That's probably right. I'll hide it in that quart measure up on that shelf." She says, "That will be the second place he looks!" I said, "All right, I'll hide it the way YOU would hide it." The boys came in the kitchen. I said, "How's the air pressure in your tires?" They said, "UH OHpressure gauge!" I said, "That's right. I hid it." Bert said, "Oh, it'll be in the garbage pail." Betty said, "I told Dad that's the first place you would look." Bert said, "Oh, how about the quart measure?" "I told Dad that was the second place you would look. So he hid it the way I would hide it." Bert said, "Oh", and leaned against the doorway, and said, "I'll let Lance find it." Lance wandered from the kitchen to the breakfast room, back and forth. He always paused by the radio on the opposite side of the room by the intercom. He looked under it, on top of it, behind it. Didn't find it. He went back and forth, looking everywhere, always pausing at the radio. About the third time, Bert said, "The tire gauge is in the radio." Walked over and picked up the radio, reached inside, and hauled it out. The radio and intercom are forms of communication and Betty thinks in a straight line. And I think every therapist ought to become acquainted with straight line thinking, and, oh... what do you call it? ... scattered thinking!!

A basic requirement for successful therapy is trust. Most individuals do not enter into therapy lightly. Rather it is usually an important and momentous step accompanied by frets about appearing a failure, foolish, awful, or "naked" before another person. Professional confidentiality is, of course, an obvious and necessary first step in providing an atmosphere in which people can feel free to speak of their problems, but in and of itself it is not sufficient to ensure access to an effective therapeutic relationship. Before an individual seeking help feels safe in revealing necessary information and becomes receptive to new ideas he must first discover his therapist to be a trustworthy person who is capable of both understanding and accepting the client and his problem situation. This ability of a therapist and client to trustingly and comprehensively communicate with one another is what we refer to as "rapport". As we shall see in the sections to follow, rapport is neither the ability to be sympathetic nor does it mean being liked by one's client (although sympathy and pleasant interactions are often erroneously taken as evidence of being in rapport), but is the ability to symmetrically respond to another person's model of the world. Rapport is often cited as an essential ingredient to a successful therapeutic relationship, but how to go about establishing rapport is rarely described.

Now how DOES one create that seemingly intangible experience of trust? In general the attitude has been, "either it's there or it isn't." Consequently many therapists turn clients away, believing their paralyzing lack of rapport with that particular client to be an inherent function of a clash of characters. Because so little has been done to explicate and utilize those interactional elements which create rapport within the therapeutic relationship, much valuable time has been wasted by clients trying one therapist after another, resisting each in turn, until he or she comes upon one that that individual experiences as being trustworthy and perceptive. It is no doubt true that the experience of rapport between a client and therapist can result from the fortuitous conjunction of many subtle personality characteristics, but it is also true that there are some specific patterns of communication which create and foster rapport, and which can be effectively used by any therapist to secure a therapeutic relationship with any client.

One of the most powerful of these rapport-building patterns with which we are familiar is that of matching the client's characteristic use of predicates (words that specify action and relationshipsverbs and their modifiers). Most individuals tend to depend upon one or another of their sensory systems (visual, auditory or kinaesthetic) for most of their conscious representations of ongoing experience. This specialization will be reflected in an individual's choice of predicates such that people who are highly visual (in terms of the sensory modality most often utilized for consciousness) will be heard to use words like "I see" "new perspective", and "that's clear" as their way of painting for you a picture of the particular experience they are focusing on at that moment. Correspondingly, those who are highly kinaesthetic will be heard to use words such as "I grasped the idea", "it's a stumbling block", and "let's smooth things out", when handing you descriptions of the many warm and chilling experiences they have wrenched from memory. And for still others an experience may "ring a bell", be "screaming for attention" or "in harmony with one's needs" when intoned by an auditory person giving voice to discordant passages in their lives. If the therapist matches his or her own predicates (visual, auditory, kinaesthetic) to those the client uses most often, the consistent result is that the client experiences the therapist as someone who (literally) speaks his or her language, understands and is understandable, and is therefore trustworthy. Familiar to many will be Virginia Satir as an example of a therapist who intuitively and exquisitely uses the matching of predicates in her work to quickly establish close rapport with each member of a family.

Another means of establishing rapport (of which Erickson is a master) is that of mirroring the client's analogical behavior. By "analogue" we are referring to an individual's breathing rate, pulse, temperature, body posture, muscle tonus, facial expression, gross body movements, voice tonality, and intonation patterns (that is, everything other than the words being used). The effect of mirroring is that your behavior becomes so closely identified with that of the client's that you become for him an unconscious and accurate source of feedback as to what he is doing. At the most fundamental level mirroring involves directly copying some or all of the analogical behavior of the person before you. So, if your client talks with a high pitched voice and is fidgety, you match the behavior by raising your own tonality and by squirming in your chair. A more sophisticated level of mirroring is called "cross-over mirroring", and is the level at which Erickson usually operates. In cross-over mirroring you copy the analogical behavior you wish to mirror using a part of the body or an output system that is different from that being used by your client. For example, you could mirror the nervous bobbing of your client's foot by bobbing your head at the same tempo or by causing the pitch or loudness of your voice to rhythmically raise and lower to the tempo of the client's foot. Using his tremendous ability to notice breathing patterns, pulse rates, skin color changes, minute muscle tone changes, and so on, Erickson uses cross-over mirroring to quickly adapt his own tonality and body movements to those of his clients. Accordingly, Erickson may time the tempo of his voice to match his client's pulse rate, while the movements of his body correspond to changes in the client's breathing rate. The possibilities for the utilization of analogical mirroring to create rapport are limitless, and such utilization is one of the most important skills we teach participants in our training seminars.