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Strategic systemic approach and hypnosis

      The article addresses strategic dialogue in systemic therapy, showing its role in transformative change for patients. He studies how structured dialogue can lead to corrective emotional experiences, helping to redefine reality and overcome dysfunctional behaviors. The importance of persuasion in therapeutic communication is also explored, highlighting the impact on patients' well-being.

      Construct corrective emotional experiences through dialogue

      We cannot not communicate.
      Watzlawick et al., 1967, p. 56.

      Words arranged differently have different meanings;
      Different arranged meanings have different effects. Pascal, 1995, p. 28.

      Padraic Gibson

      In recent years I have spent a lot of time training psychotherapists and psychologists at an advanced level and have also set up a number of internships with people who are new to our field. Those who are new to our field. I became increasingly (re)fascinated by the work of the pioneers of our field, their lack of excessive introspection and their focus on action. After working in this field for over 25 years, I have noticed a growing obsession with self-reflection, introspection, and academic analysis.  

      This article looks at the ideas of these pioneers and their application to human change. The seemingly inevitable clinical reality that "we cannot not communicate", as the originators of communication theory and systemic therapy (Watzlawick et al., 1967), leaves the therapist in a dilemma . No matter how we would like things to be, we are faced with the choice to persuade, manipulate or convince. None of these methods are inherently wrong, but what makes them ethical or unethical is the result of their use. If a surgeon saves a patient's life through manipulation, if a young anorexic woman is persuaded to eat so that she will live, then how should persuasion be perceived and why might it be clinically significant?

      The pioneering aspect of systemic therapy was that it was action-oriented. This aspect of systemic therapy has been largely eclipsed by interpretation, narrative, and theoretical reflections. The turning point that generated systemic therapy and cybernetic therapy allowed a pragmatic, creative, interactional approach to solving human problems. How can we use dialogue pragmatically and effectively?

      Communication oriented towards change

      Epicurus reminds us that “one must not violate nature but try to persuade it.” The ability to persuade oneself and others is of central importance to human existence. If we want to realize our potential, have our ideas accepted, and if we want to help others achieve their goals, persuasion is necessary. Since communication is the primary social process, our needs, wishes, desires, choice of a sexual partner or access to resources, cannot be realized if we cannot persuade others. We find that a lack of persuasion can lead competent people to fail in many areas.

      Persuasion is considered both a science and an art . If practiced regularly, we can all learn to live fuller, more effective lives. Words and how we use them are very important , and there is no doubt about that (for now!). Despite our best intentions, and even if the patient knows that our therapeutic ideas or conversations can be helpful, many fail to implement the desired changes. Even if they want to follow us, customers do not apply what can help them escape their trap. Although it is beyond the scope of this article, the study of paraconsistent logic, on which interactional reality is based, has been well studied and the work of Newton Da Costa (Da Costa & French, 1989) explains it exceptionally well. .

      Emotional experiences that change us

      There are various situations in which humans find themselves stuck in meaningful emotions and, therefore, cannot, on their own, discover new modes of perception and behavior. In such cases, the only solution is to “experiment” with new ways of feeling about the situation. The experience is transformative, it modifies perception, thought and therefore modifies behavior. Or we could say that their old behavior is no longer sustainable. This is what Alexander and French (1947), in On Psychoanalytical Therapy , called an emotional experience. Emotions arise from sensations in the body that are processed and interpreted in the brain, particularly the limbic system. This area is located in the middle of the brain between the lower center or brainstem and the upper center or cortex. This area controls our alertness and wakefulness, and it sends sensory messages to the cortex, which is responsible for thinking and memory. Emotions arise from our memories and reactions or behaviors to things that have happened and these memories shape our responses to current events. Our emotions influence the way we represent past and present experiences and the meaning we give to them. From a constructivist perspective, we can say that it is not what happens to us, but what we think and feel about what happens to us. The way we perceive events or behaviors and the meaning or value we end up giving them, allows us to construct a representation of our own unique reality.

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      Effective communication for psychotherapeutic change

       The dialogic process

      An effective clinical dialogue, which is structured around the “objectives” sought by the client, should have the effect of improving the quality of care. The client should have the natural feeling of a journey of “joint discovery”. This is what helps patients gain trust, strengthen feelings of empathy, and begin the process of change from the start of treatment. This helps considerably in building the solution. We must keep in mind that these elements are known as the common factors for good and effective therapy (Hubble et al., 1999). By using "circular questions", "questions with the illusion of an alternative", "cognitive reframing", "paraphrase", "metaphor" and "anecdote", we can create a semi- structured that transforms the therapeutic encounter. Aristotle defined the conditions for effective rhetoric: it involves the use of ethos (essentially the credibility of my argument, do I trust you?), pathos (emotions, or even more for the client, do I care what you say to me? (using logic, for the therapist this can be crucial, because the client may wonder if what you are saying is correct and appropriate for their situation (for my given situation?).

      So what we can say so far is that communication style and technique are of primary importance, how we pay attention to it and use it is up to us. It must also be recognized that in the presence of another person, all behavior is a form of communication and has communicative value. When we believe we can be non-directive, we turn a blind eye to human "reality." It must be understood that it is the therapist who asks the questions, but who can rarely be asked questions, the therapist sets the time of the appointment and ends it when he considers it necessary, he changes his body language and the tone of his voice when he agrees or disagrees with the client in front of him, he indicates to the patient where to sit and all this is normally done on his "ground". Our indirect influence on the process of human interaction known as therapy is significant. It may also be important to note that the only other time we experience these types of power relationships is probably in childhood and it is perhaps not surprising that people revert to the type of relationships already experienced in certain conditioned situations.

      Effective communication for psychotherapeutic change

      What effective dialogue should do is use a subtle form of communication to induce change from the first meeting. An interactive systemic dialogue can be seen as transforming the nature of any initial clinical encounter from one of investigation and diagnosis to one that helps the clinician assess the "true" nature of the problem and intervene in the process. functional of the problem. It becomes an intervention that changes the problem we are working on, but it also helps us define the problem and therefore distinguish the type of perception/problem. For example, simply ask a patient suffering from an anxiety disorder whether they confront or avoid their problems when confronted with them. When elaborated, this simple question can greatly help us discern phobic and obsessive perception and behavior.

      This dialogic intervention begins the therapeutic change at the initial phase. Here the work seems subtle, but at the same time it is complex. In therapy, we find patients who arrive with too clear a definition of their problem, too rigid and too sure. And in this case, questions help broaden the lens. In other cases, patients may come with too diffuse an idea of ​​their problem and so the questions help us focus their minds on something concrete and achievable. Once the goal is set, the dialogue moves from general to specific and becomes increasingly narrow with the use of discriminating questions that lead the clinician to discover how the person's individual, unique problem works, in their own unique context (Gibson, 2019a; Nardone, 2007; Portelli et al., 2013).

      The phases of the dialogue

      The phases of the dialogue

      Initial stage

      This phase must begin with questions that help define the problem or the objective to be achieved. In this case, it is appropriate to use circular questions, but also linear and simple questions, modifying and gradually elaborating them to begin to include questions with the "illusion of an alternative". Questions with the illusion of an alternative become relevant to both the clinician and the patient and become an effective tool for conducting treatment. Questions with the illusion of an alternative are structured so that they contain two opposing possible answers. The customer will have to choose the one that best suits their situation. They can be open and honest or charged and, used effectively, have a positive effect on the outcome. As the dialogue progresses, the question sequence is structured as a sort of "funnel" that begins with general questions and gradually narrows down to the most relevant features of the person's problem (e.g. with anorexia: "Would you prefer to change slowly and in a controlled manner? Or quickly and in an uncontrolled manner?" The question is an illusion because it seems that there is a choice, yet it oscillates between changing in a way or change in another, either way it is oriented towards change.

      Secondary phase 

      Recapitulating and reframing what the patient has said helps to redefine the problem with them and take stock of the work accomplished so far in the session. Circular cropping and paraphrasing can and usually are used. So, after a sequence of two or three questions to the client, we need to reframe what they said and summarize it in the dialogue: “so far…”. This allows us to confirm whether we have correctly understood their perception of “things”. Acceptance of reframing and paraphrasing is also a subtle form of self-deception and self-conviction. Effective paraphrasing is not limited to verification, it can also allow us to rearrange or repunctuate the sequence of events.

      Tertiary phase and prescription phase 

      Only once we have engaged the customer, defined the problem and qualified their needs from their perspective can we move to the prescription phase. At this stage, the patient must be ready to engage in the interventions proposed by the therapist. The phase of prescribing a good dialogue becomes inevitable and the prescription or intervention proposed by the therapist stands out as a logical conclusion of what has gone before. The use of metaphors, aphorisms, and anecdotes, to evoke the desired sensation towards certain behaviors, such as disgust, fear, anger, pleasure, etc., must directly target the person's dysfunctional perception which maintains the problem from which the patient wants to free himself. Former British Prime Minister Clement Atlee once said that being a politician is "being part butcher and part surgeon": having removed large chunks of irrelevant data through our dialogue, then surgically carried the work down to the redundant interactional script, we should add the final touch which is the prescription. At this point, the patient should receive the correct "dosage" for their problem. Asking too much of the patient will not change the situation, but conversely, asking too much could well block or prevent change and lead to the failure of the therapy.

      Analog communication

      According to White (1989), analogical language can be used to externalize the problem, that is, the problem can become a separate entity and therefore external to the person or relationship that was seen as the problem. In other words, “the problem becomes the problem.” The use of analogical and figurative language helps reduce resistance to change, since patients are not asked to do anything and only their behaviors or opinions. The message is conveyed in a disguised way, as it were. Suggestions may be embedded in a story or communicated through metaphors such that the subject is not directly involved, but the evocative power of the story or image counters the patient's conceptions and behaviors . Analogical language can be used to create aversion to an undesirable behavior or to promote a more functional alternative (Gibson et al., 2016).

      Propose solutions

      The prescription phase should be considered one of the most important stages of therapy because it is both the end and the beginning of therapy. This phase must be kept in mind throughout the dialogue. Begin therapy with the end in mind.  

      Change

      Change-oriented communication must be woven into the very fabric of every element of dialogue, which includes the verbal, non-verbal and para-verbal aspects of communication. By adopting an effective communication approach, we can be more certain that the client will implement the prescribed interventions and desired change (Gibson, 2013a, 2019b, 2019c; Nardone, 2007; Gibson et al., 2016).

      Language and structure

      Adapting our mode of communication to the unique perceptions of the customer, unique and non-repeatable, introduces an important aspect that leads to change. If we don't fertilize the soil, the seeds of change may never take root. By focusing on communication and paying attention to the axioms of communication, (Watzlawick, et al., 1967), we can find ways to quickly help the customer. These modes of communication allow you to bypass the four types of resistance we talked about previously. The use of prosody (or pauses for emphasis and concentration), suggestive and strategic repetition of the prescription and the introduction of redundancy (such as the use of a code word), l The introduction of a redundancy (like the sound of injunctions found in post-hypnotic assonances), combined with the moment of prescription, all this increases the probability that the client will follow us to get out of their mental, relational and emotional traps. behavioral. Once released and in the final therapy session, the client should be told what we have done to achieve change and we should remove any sense of mystery from our work. The client must realize that it is he who brought about his change and that we have only succeeded in helping him get out of his own way, thus increasing the sense of autonomy and faith in his own resources.

      References

      • Alexander, F., French, TM, et al. (1947) On Psychoanalytic Therapy: Principles and Application. New York: Ronald Press.
      • Da Costa, N. & French, S. (1989) On the logic of belief. Philosophical and Phenomenological Research, 49(3):431-446.
      • Gibson, P. (2013a) A pilot study on the effectiveness of brief strategic therapy in the treatment of postnatal depression. Journal of the Family Therapy Association of Ireland, 45.
      • Gibson, P., Portelli, C. & Papantuono, M. (2021) OCD Clinic: A New Approach to Understanding and Treating Obsessive-Compulsive Disorders. Ireland: Strategic Science Books.
      • Gibson, P (2019a) Advances in E! ective Brief Psychotherapy – Strategies, Relationships and Communication. Cork: Lettertec Press.
      • Gibson, P. (2019b) The Coaching Clinic. The Art and Science of Change in Mind, Behavior and Relationships. Cork: Lettertec Books.
      • Gibson, P. (2019c) Escaping the Anxiety Trap. New Solutions for Overcoming Anxiety, Panic, Fear and Obsession. Malta University Press.
      • Hubble, MA, Duncan, BL, & Miller, SD (eds.) (1999) The Heart and Soul of Change: What Works in Therapy. Washington: American Psychological Association.
      • Nardone, G. (2007) Manuale di Sopravvivenza per Psicopazienti. Firenze: Ponte alle Grazie.
      • Pascal B. (1995) Thoughts. Translated by AJ Krailsheimer. New York, NY: Penguin Classics.
      • Portelli, C., Papantuono, M & Gibson, P. (2013) Winning Without Fighting; A Handbook of Effective Solutions for Social, Emotional and Behavioral Problems. Malta University Press.
      • Watzlawick, P., Beavin, J. H., Jackson, & Don, D. (1967) Pragmatics of Human Communication: A study of Interactional Patterns, Pathologies and Paradoxes. New York: Norton.
      • White, M. (1989) Narrative Means to Therapeutic Ends. New York: Norton.

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      The quality certification was issued under
      the following category of actions: Training action

      A team of more than
      50 trainers in France
      and abroad

      of our students satisfied with
      their training year at LACT *

      International partnerships

      The quality certification was issued under
      the following category of actions: Training action

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