Sunteți pe pagina 1din 125

Milton H.

Erickson
Unorthodox psychiatrist, congenial
family doctor, ingenious strategic
psychotherapist and master
hypnotherapist, Milton Erickson's
influence has revolutionised
Western psychotherapy. Thanks
largely to Erickson the subject of
hypnosis has shed its shackles of
superstition and is now widely
recognised as one of the most
powerful tools for change.

Within his own life, Milton Erickson


had many personal disabilities to
contend with, which he often
stressed helped him become
proficient at practical problem
solving for his clients.
His 'problems' began early. Born
into a poor farming community in
Nevada, Erickson didn't speak
until he was four. Later, he was
found to have severe dyslexia, to
be profoundly tone deaf and
colour blind. At the age of
seventeen, he was paralysed for a
year by a bout of polio so bad that
his doctor was convinced he
would die.

Milton H. Erickson
Milton H. Erickson is probably best
remembered as the
hypnotherapist who revolutionized
hypnotherapy not only by
developing new therapeutic
techniques but also by evolving
his own unique epistemology and
ontology. Many attempts have
been made to present and
describe his main principles and
practical approach in a coherent
form. O'Hanlon has summarized
twelve different frameworks for
Ericksonian therapy and hypnosis,
including one of his own
(O'Hanlon, 1987).

Despite his handicaps (or


perhaps because of), Milton
Erickson went on to qualify as
a medical doctor and
psychiatrist. In the following
years he became the World's
greatest practitioner of
therapeutic hypnosis and one
of the most effective
psychotherapists ever.

It was perhaps Erickson's


farming background which
caused him to approach
psychotherapy in such a
practical way. Anyone who is
interested in relieving human
misery and developing human
potential will benefit greatly
from reading about and
learning from this remarkable
man.

When Erickson was in his fifties he


was struck by a second bout of
polio that caused him a great deal
of physical pain. Even this he was
able to turn into a learning
opportunity as he became highly
effective at treating other people's
pain with hypnosis. He details
many of his approaches to
sensory alteration and pain
control in 'Hypnotic alteration of
sensory, perceptual and
psychological processes' by Milton
Erickson.

Despite severe illness in his


old age, Milton Erickson
continued to teach,
demonstrate and practice his
remarkable skills as a
therapist, even when
eventually confined to a
wheelchair. He died at the
age of seventy nine.

It was perhaps Erickson's


farming background which
caused him to approach
psychotherapy in such a
practical way. Anyone who is
interested in relieving human
misery and developing human
potential will benefit greatly
from reading about and
learning from this remarkable
man.

He is noted for:
His often unconventional approach
to psychotherapy, such as
described in the book Uncommon
Therapy, by Jay Haley, and the
book Hypnotherapy: An
Exploratory Casebook, by Milton
H. Erickson and Ernest L. Rossi
(1979, New York: Irvington
Publishers, Inc.)
His extensive use of
therapeutic metaphor and story as
well as hypnosis
coining the term Brief Therapy for
his approach of addressing
therapeutic changes in relatively
few sessions

His use of interventions that influenced the


strategic therapy and family systems therapy
practitioners beginning in the 1950s including
Virginia Satir and Jay Haley
His conceptualization of the unconscious as
highly separate from the conscious mind, with
its own awareness, interests, responses, and
learnings. For Erickson, the unconscious mind
was creative, solution-generating, and often
positive.
His ability to "utilize" anything about a patient
to help them change, including their beliefs,
favorite words, cultural background, personal
history, or even their neurotic habits.
His influence on Neuro
-linguistic Programming (NLP), which was in part
based upon his working methods [1].

Milton H. Erickson
Milton H. Erickson is probably best
remembered as the
hypnotherapist who revolutionized
hypnotherapy not only by
developing new therapeutic
techniques but also by evolving
his own unique epistemology and
ontology. Many attempts have
been made to present and
describe his main principles and
practical approach in a coherent
form. O'Hanlon has summarized
twelve different frameworks for
Ericksonian therapy and hypnosis,
including one of his own
(O'Hanlon, 1987).

Erickson's practical
approach is defined as the
techniques and skills he
used during therapy while
the main principles are
defined as the beliefs that
he held in relation to doing
therapy. {Erickson
sometimes said he didn't
understand his own work}

Main Principles of Erickson


Hypnotherapy

Erickson did not believe it was


necessary for himself or his
patient to understand the cause of
a problem in order to resolve it. In
his words "Etiology is a complex
matter and not always relevant to
getting over a problem" (Hayley,
1973). This belief is a major shift
in thinking away from a search for
independent cause or truth; a
search that permeates our modern
culture and one that has
perpetuated since the time of
Aristotle (1953).

Erickson also believed that "insight" was


an unimportant and even unnecessary
part of therapy, stating that
"Many psychotherapists regard as
almost axiomatic that therapy is
contingent on making the unconscious
conscious. When thought is given to the
immeasurable role the unconscious
plays in the total experiential life of a
person from infancy on, whether awake
or asleep, there can be little expectation
of doing more than making small parts
of it conscious" (Erickson, 1980).

Another important element of Erickson's


epistemology was his emphasis on
treating each person as an individual,
and not according to preconceived
theories of personality or by utilizing a
rigid approach to therapy. Erickson had
no particular theory or hypothesis about
problems and had no set method of
working and consequently had the
flexibility to allow for alternative
explanations and to change his behavior
to match the needs of the individual
client. In addition, he also recognized
that "Your patient is one person today,
quite another person tomorrow, and still
another person next week, next month,
next year" (Erickson, 1985[1]).

Erickson also believed in


what has been called a
naturalist approach to
therapy. His belief was that
people are not only capable of
going into trance and
experiencing all possible
trance phenomena but also
that they have the natural
abilities needed to overcome
their difficulties.

Similarly, Goldstone reports


that "Another important
element of Dr. Erickson's work
was his deeply held belief
that people innately have
within themselves the
strengths, skills, abilities,
talents, resources and
knowledge they need to make
whatever kinds of changes
they wish to make" (1998).

Erickson believed that people


not only have all the
resources they need but also
that "people will make the
best choices they have
learned how to make"
(Lankton, 1998), even if they
are not conscious of this or of
their process of making these
choices.

Erickson believed that the


responsibility for change rests
entirely with the client and the
role of the therapist to create a
state of expectation of change
and to provide the climate in
which change can take place. As
Erickson states "In psychotherapy
you change no one. People
change themselves. You create
circumstances under which an
individual can respond
spontaneously and change. And
that's all you do. The rest is up to
them"
(O'Hanlon, 1987).

Finally, Erickson believed


that his work was
complete when the
presenting problem was
resolved. Thus, his
premise was that the longterm goal should always
be the immediate goal and
he did not spend time
what was "behind" a
symptom.

Practical Approach of Erickson Hypnotherapy


Erickson defined hypnosis as "a state of
special awareness characterized by a
receptiveness to ideas" (Erickson, 1985[2]).
Essentially this state was elicited using
techniques such as suggestion and confusion to
focus or distract the client's conscious attention
in such a way that Erickson could communicate
directly with a
client's unconscious mind.
The client would then be able to learn new
behaviors and new ideas from what was
presented. This learning took place in a trance
state in which the client was attentive to all the
information set out and demonstrated by
Erickson; the client could then take on board as
much or as little as was appropriate for them.

In order to elicit trance states and to facilitate


change, Erickson utilized whatever the client
brought into
therapy, whether it was beliefs,
behaviors, demands or resistance. His advice
was never to reject or try to the behavior that
the client showed in the office. He advised that
"you look at it, you examine it, and you wonder
how you use it" (Erickson, 1985[2]). For
example, if a child sucks his thumb then which
thumb he suck? The left or the right? And
shouldn't he suck the other one? And what
about sucking the fingers? Which one first? After
Erickson repeatedly asked these sort of
questions to one little boy, the boy told his
grandmother "This is making me want to dislike
sucking my thumb!" (Erickson, 1985[2]).

Erickson's acceptance of the


patient's ideas and behaviors for
what they were, rather than
rejecting,
contradicting or
judging them, contributed to his
ability to quickly build rapport with
the patient. He also made use of
biorapport, which is the
rhythmical alignment of some part
of his behavior to that of the
client's.
Examples are
breathing in time with the client
and making movements at the
same time as the client.

Another technique used by


Erickson was that of the double
bind. This was asking a question
that gave the
illusion of
choice, when in fact whatever
choice was made, it would lead to
the desired result. To a patient
who said Erickson could not
hypnotize them, Erickson said "I
want you to stay awake, wider and
wider awake, wider and wider
awake" (Haley, 1963). Whatever
this client did he was co-operating
with Erickson in the trance
induction.

One specific form of double bind was symptom


prescription. According to Watzlawick, Bavelas
and Jackson (1967) this term was first
introduced in the work of the Bateson "Family
Therapy in Schizophrenia" project. This involved
prescribing the symptom but in an exaggerated,
modified or paradoxical way. Erickson once
treated a married couple who had both been
bed-wetters for many years. He had them set
their alarm clock to wake up in the middle of the
night and instructed them both to deliberately
wet their bed if their bed was dry. Thus,
Erickson was modifying the patients' symptoms
to make it harder {easier surely} for them to do
their
problem and also teaching them how
to have control over their symptoms.

Erickson would make use of this


sort of specific task assignment as
well as using generic ones so as to
facilitate therapeutic change. The
bed-wetting example above is a
specific task. However, Erickson
would often ask a client to
perform a generic task like
climbing a local mountain while
thinking about their problem and
then reporting their thoughts back
to him.

The use of Metaphors was


used by Erickson to
communicate with his clients
and he often told anecdotes
from his own experience,
about other clients or simply
made them up. His hope was
that the experience of
another in overcoming a
problem, which is similar to
the client's own, would
suggest ways in which the
client could deal with their
situation.

Erickson made use of the


processes of framing, deframing
and reframing to alter a client's
perception about a given
situation. A frame being defined
as an added meaning given to a
sensory experience. Thus, framing
is the process of giving a meaning
where none already exists,
deframing is the process of
challenging or casting doubt on
the client's current meaning and
reframing is the process of
providing a new or alternative
meaning.

As a hypnotist, Erickson made use of


many hypnotic phenomena. Analgesia
was used to teach clients that they
could control when and where they
experienced pain. Amnesia was used to
prevent a client's conscious mind from
interfering with hypnotherapeutic work
(Erickson, 1985[2]) and to overcome
learned limitations.
According to Erickson "All hypnotic
phenomena are made up of normal
everyday patterns of behavior,
organized to serve intentional purposes
for the patient" (Erickson, 1985[2]).

Confusion was another important


technique used by Erickson to
contend with the client's
conscious mind, and thereby
bypass it. When solving problems,
the person's mind was most
frequently concerned with limiting
beliefs and ideas about how
change was not possible. Hence,
Erickson emphasized "that the
person's conscious mind has to be
contended with in some manner in
order to gain access to the
person's unconscious abilities"
(Erickson, 1985[1]).

In addition, Erickson also


developed a state of confusion in
his clients' minds from which they
were more likely to accept what
he suggested as a means of
replacing the uncomfortable state
of confusion with a more
comfortable state of
understanding. As pointed out by
Lankton "a client will develop a
particular receptivity to incoming
information at a point in therapy
when the normal framework has
been disrupted and suspended by
an unconditioned stimulus such as
a paradoxical prescription" (1998).

Erickson used both direct and indirect


suggestions to achieve therapeutic
goals. In general, he was very directive
when dealing with symptoms and
getting people to do things but very
indirect in how people would resolve
their symptoms and how they would live
their lives afterwards. A direct
suggestion might have been to tell the
client to perform a specific therapeutic
task, like buying new clothes or walking
a different way to
work. An indirect
suggestion might have been to say
something like "I don't know how
quickly you can learn".
This
statement indirectly suggested that the
client will learn, it was just a question of
how quickly.

In contrast to many other


therapeutic approaches that focus
on exploring the past, Erickson
worked in both a future oriented
and goal oriented manner,
eliciting agreed goals with
patients and working together
with the
patient to achieve
them. As stated by Erickson
"Psychotherapy is sought not
primarily for enlightenment about
the unchangeable past but
because of dissatisfaction with the
present and a desire to better the
future" (Watzlawick, Weakland and
Fisch, 1974).

Conclusion

Erickson once said "I don't try to


structure my psychotherapy
except in a vague, general way"
(O'Hanlon, 1987). Compromises
have been made in deciding what
to include and what to omit and
also in deciding the length of each
description, some of which are
necessarily brief. In conclusion,
Erickson's own advice was to
"Develop your own technique.
Don't try to use somebody else's
technique...Don't try to imitate my
voice or my cadence. Just discover
your own. Be your own natural
self" (O'Hanlon, 1987).

Trance and The Unconscious Mind


Erickson believed that the unconscious mind
was always listening, and that, whether or not
the patient was in trance, suggestions could be
made which would have a hypnotic influence, as
long as those suggestions found some
resonance at the unconscious level. The patient
can be aware of this, or she can be completely
oblivious that something is happening. Erickson
would see if the patient would respond to one or
another kind of indirect suggestion, and allow
the unconscious mind to actively participate in
the therapeutic process. In this way, what
seemed like a normal conversation might induce
a hypnotic trance, or a therapeutic change in
the subject. It should be noted that "[Erickson's]
conception of the unconscious is definitely not
the one held by Freud."[5]
Erickson was an irrepressible practical joker,
and it was not uncommon for him to slip indirect
suggestions into all kinds of situations, including
in his own books, papers, lectures and seminars.

Erickson also believed that it was even


appropriate for the therapist to go into
trance.

I go into trances so that I will be more


sensitive to the intonations and inflections of
my patients' speech. And to enable me to
hear better, see better.

Erickson maintained that trance is a


common, everyday occurrence. For
example, when waiting for buses and
trains, reading or listening, or even
being involved in strenuous physical
exercise, it's quite normal to become
immersed in the activity and go into a
trance state, removed from any other
irrelevant stimuli. These states are so
common and familiar that most people
do not consciously recognise them as
hypnotic phenomena.

The same situation is in evidence in everyday


life, however, whenever attention is fixated with
a question or an experience of the amazing, the
unusual, or anything that holds a persons
interest. At such moments people experience
the common everyday trance; they tend to gaze
offto the right or left, depending upon which
cerebral hemisphere is most dominant (Baleen,
1969) and get that faraway or blank look.
Their eyes may actually close, their bodies tend
to become immobile (a form of catalepsy),
certain reflexes (e.g., swallowing, respiration,
etc.) may be suppressed, and they seem
momentarily oblivious to their surroundings
until they have completed their inner search on
the unconscious level for the new idea,
response, or frames of reference that will
restabilize their general reality orientation. We
hypothesize that in everyday life consciousness
is in a continual state of flux between the
general reality orientation and the momentary
microdynamics of trance...

Indirect Techniques
Where 'classical' hypnosis is
authoritative and direct, and often
encounters resistance in the subject,
Erickson's approach is permissive,
accommodating and indirect. For
example, where a classical hypnotist
might say "you are going into a trance",
an Ericksonian hypnotist would be more
likely to say "you can comfortably learn
how to go into a trance". In this way, he
provides an opportunity for the subject
to accept the suggestions they are most
comfortable with, at their own pace,
and with an awareness of the benefits.
The subject knows they are not being
hustled, and takes full ownership of, and
participation in their transformation.

Erickson maintained that it was not


possible to consciously instruct the
unconscious mind, and that
authoritarian suggestions were likely to
be met with resistance. The
unconscious mind responds to
openings, opportunities, metaphors,
symbols, and contradictions. Effective
hypnotic suggestion, then, should be
'artfully vague', leaving space for the
subject to fill in the gaps with their own
unconscious understandings - even if
they do not consciously grasp what is
happening. The skilled hypnotherapist
constructs these gaps of meaning in a
way most suited to the individual
subject - in a way which is most likely to
produce the desired change.

For example the authoritative "you will


stop smoking" is likely to find less
leverage on the unconscious level than
"you can become a non-smoker". The
first is a direct command, to be obeyed
or ignored (and notice that it draws
attention to the act of smoking), the
second is an opening, an invitation to
possible lasting change, without
pressure, and which is less likely to
raise resistance.
Richard Bandler and John Grinder
identified this kind of 'artful vagueness'
as a central characteristic of their '
Milton Model', a systematic attempt to
codify Erickson's hypnotic language
patterns.

Confusion Technique
In all my techniques, almost all, there is a
confusion.[7]

A confused person has their conscious


mind busy and occupied, and is very
much inclined to draw upon
unconscious learnings to make sense of
things. A confused person is in a trance
of their own making - and therefore
goes readily into that trance without
resistance. Confusion might be created
by ambiguous words, complex or
endless sentences, pattern interruption
or a myriad other techniques to incite
transderivational searches.

James Braid, who coined the term


'hypnosis,' claimed that focused
attention ("look into my eyes...") was
essential for creating hypnotic trances,
indeed, his thesis was that hypnosis
was in essence a state of extreme
focus. But it can be difficult for people
wracked by pain, angst or suspicion to
focus on anything at all. Thus other
techniques for inducing trance become
important, or as Erickson explained:
...long and frequent use of the confusion
technique has many times effected
exceedingly rapid hypnotic inductions under
unfavourable conditions such as acute pain
of terminal malignant disease and in persons
interested but hostile, aggressive, and
resistant...

The Handshake Induction


Confusion is the basis of
Erickson's famous hypnotic
handshake. Many actions are
learned and operate as a single
"chunk" of behavior: shaking
hands and tying shoelaces being
two classic examples. If the
behavior is diverted or frozen
midway, the person literally has
no mental space for this - he is
stopped in the middle of
unconsciously executing a
behavior that hasn't got a
"middle".

The mind responds by


suspending itself in trance
until either something
happens to give a new
direction, or it "snaps out". A
skilled hypnotist can often
use that momentary
confusion and suspension of
normal processes to induce
trance quickly and easily.

By interrupting the pattern of a


'normal' handshake in some way,
the hypnotist causes the subject
to wonder what is going on. If the
handshake continues to develop in
a way which is out-of-keeping with
expectations, a simple, non-verbal
trance is created, which may then
be reinforced or utilized by the
hypnotist. All these responses
happen naturally and
automatically without telling the
subject to consciously focus on an
idea.

The various descriptions of


Erickson's hypnotic handshake,
including his own very detailed
accounts, indicate that a certain
amount of improvisation is
involved, and that watching and
acting upon the subject's
responses is key to a successful
outcome. The most important
thing is that the 'normal'
handshake is subverted in such a
way to cause puzzlement, which
may then be built upon.

Initiation: When I begin by shaking hands, I do


so normally. The "hypnotic touch" then begins
when I let loose. The letting loose becomes
transformed from a firm grip into a gentle touch
by the thumb, a lingering drawing away of the
little finger, a faint brushing of the subject's
hand with the middle finger - just enough vague
sensation to attract the attention. As the subject
gives attention to the touch of your thumb, you
shift to a touch with your little finger. As your
subject's attention follows that, you shift to a
touch with your middle finger and then again to
the thumb.
This arousal of attention is merely an arousal
without constituting a stimulus for a response.
The subject's withdrawal from the handshake is
arrested by this attention arousal, which
establishes a waiting set, and expectancy.

Then almost, but not quite


simultaneously (to ensure
separate neural recognition), you
touch the undersurface of the
hand (wrist) so gently that it
barely suggests an upward push.
This is followed by a similar utterly
slight downward touch, and then I
sever contact so gently that the
subject does not know exactly
when - and the subject's hand is
left going neither up nor down, but
cataleptic.

Termination: If you don't want your


subject to know what you are doing, you
simply distract their attention, usually
by some appropriate remark, and
casually terminate. Sometimes they
remark, "What did you say? I got
absentminded there for a moment and
wasn't paying attention to anything."
This is slightly distressing to the
subjects and indicative of the fact that
their attention was so focused and
fixated on the peculiar hand stimuli that
they were momentarily entranced so
they did not hear what was said.
strong push or nudge is required, check
for anaesthesia.

Utilization: Any utilization leads to increasing


trance depth. All utilization should proceed as a
continuation of extension of the initial
procedure. Much can be done nonverbally; for
example, if any subjects are just looking blankly
at me, I may slowly shift my gaze downward,
causing them to look at their hand, which I
touch and say "look at this spot.". This
intensifies the trance state. Then, whether the
subjects are looking at you or at their hand or
just staring blankly, you can use your left hand
to touch their elevated right hand from above or
the side - so long as you merely give the
suggestion of downward movement.
Occasionally a downward nudge or push is
required. If a

Richard Bandler was a keen proponent of the


handshake induction, and developed his own
variant, which is commonly taught in NLP
workshops.
Any habitual pattern which is interrupted
unexpectedly will cause sudden and light
trance. The handshake is a particularly good
pattern to interrupt because the formality of a
handshake is a widely understood set of social
rules. Since everyone knows that it would be
impolite to comment on the quality of a
handshake, regardless of how strange it may
be, the subject is obliged to embark on an inner
search (known as a transderivational search, a
universal and compelling type of trance) to
identify the meaning or purpose of the
subverted pattern.

Resistance
Erickson recognised that many people
were intimidated by hypnosis and the
therapeutic process, and took care to
respect the special resistances of the
individual patient. In the therapeutic
process he said that "you always give
the patient every opportunity to resist".
Here are some more relevant quotes
pertaining to resistance:

Whatever the behaviour offered by the


subjects, it should be accepted and utilized
to develop further responsive behaviour. Any
attempt to "correct" or alter the subjects'
behaviour, or to force them to do things they
are not interested in, militates against
trance induction and certainly deep trance
experience.

If the patient can be led to accept one


suggestion, they will more readily
accept others. With resistant patients, it
becomes necessary to find a suggestion
that they can accept. Resistance is
always important, and should always be
respected, so if the resistance itself is
encouraged, the patient is made to feel
more comfortable, because they know
that they are allowed to respond
however they wish.

Many times, the apparently active resistance


encountered in subjects is no more than an
unconscious measure of testing the
hypnotist's willingness to meet them
halfway instead of trying to force them to
act entirely in accord with his ideas.

Although the idea of working with


resistance is essentially a hypnotic one,
it goes beyond hypnosis and trance. In a
typical example, a girl that bit her nails
was told that she was cheating herself
of really enjoying the nail biting. He
encouraged her to let some of her nails
grow a little longer before biting them,
so that she really could derive the
fullest pleasure from the activity. She
decided to grow all of her nails long
enough that she might really enjoy
biting them, and then, after some days,
she realised that she didn't want to bite
them anyway.

Ericksonian Therapy
Erickson is most famous as a
hypnotherapist, but his extensive
research into and experience with
hypnosis led him to develop an
effective therapeutic technique.
Many of these techniques are not
explicitly hypnotic, but they are
extensions of hypnotic strategies
and language patterns. Erickson
recognised that resistance to
trance resembles resistance to
change, and developed his
therapeutic approach with that
awareness.

Jay Haley identified several strategies, which


appeared repeatedly in Erickson's therapeutic
approach.
Encouraging Resistance - For Erickson, the classic
therapeutic request to "tell me everything about..."
was both aggressive and disrespectful, instead he
would ask the resistant patient to withhold
information and only to tell what they were really
ready to reveal:

I usually say, "There are a number of things that you


don't want me to know about, that you don't want to tell
me. There are a lot of things about yourself that you
don't want to discuss, therefore let's discuss those that
you are willing to discuss." She has blanket permission
to withhold anything and everything. But she did come
to discuss things. And therefore she starts discussing
this, discussing that. And it's always "Well, this is all
right to talk about." And before she's finished, she has
mentioned everything. And each new item - "Well, this
really isn't so important that I have to withhold it. I can
use the withholding permission for more important
matters." Simply a hypnotic technique. To make them
respond to the idea of withholding, and to respond to
the idea of communicating.

Many people's reaction to a direction is


to think "why should I?" or "You can't
make me", called a polarity response
because it motivates the subject to
consider the polar opposite of the
suggestion. The conscious mind
recognizes negation in speech ("Don't
do X") however the unconscious mind
pays more attention to the "X" than the
injunction "Don't do". Erickson used this
as the basis for suggestions that
deliberately played on negation and
tonally marked the important wording,
to provide that whatever the client did,
it was beneficial: "You don't have to go
into a trance, so you can easily wonder
about what you notice no faster than
you feel ready to become aware that
your hand is slowly rising....."

Providing a Worse Alternative (The 'Double Bind') Example: "Do you want to go into a trance now, or
later?" The 'double bind' is a way of overloading the
subject with two options, the acceptance of either of
which represents acceptance of a therapeutic
suggestion.

My first well-remembered intentional use of the double


bind occurred in early boyhood. One winter day, with
the weather below zero, my father led a calf out of the
barn to the water trough. After the calf had satisfied its
thirst, they turned back to the barn, but at the doorway
the calf stubbornly braced its feet, and despite my
fathers desperate pulling on the halter, he could not
budge the animal. I was outside playing in the snow
and, observing the impasse, began laughing heartily. My
father challenged me to pull the calf into the barn.
Recognizing the situation as one of unreasoning
stubborn resistance on the part of the calf, I decided to
let the calf have full opportunity to resist, since that was
what it apparently wished to do. Accordingly I presented
the calf with a double bind by seizing it by the tail and
pulling it away from the barn, while my father continued
to pull it inward. The calf promptly chose to resist the
weaker of the two forces and dragged me into the barn.
[10]

Communicating by Metaphor - This is explored


extensively in Sydney Rosen's 'My Voice Will Go
With You', but a beautiful example is given in
the first chapter of David Gordon's book
Phoenix:

I was returning from high school one day and a


runaway horse with a bridle on sped past a group
of us into a farmer's yard looking for a drink of
water. The horse was perspiring heavily. And the
farmer didn't recognize it so we cornered it. I
hopped on the horse's back. Since it had a bridle
on, I took hold of the tick rein and said, "Giddyup." Headed for the highway, I knew the horse
would turn in the right direction. I didn't know
what the right direction was. And the horse
trotted and galloped along. Now and then he
would forget he was on the highway and start
into a field. So I would pull on him a bit and call
his attention to the fact the highway was where
he was supposed to be. And finally, about four
miles from where I had boarded him, he turned
into a farm yard and the farmer said, "So that's
how that critter came back. Where did you find
him?" I said, "About four miles from here." "How
did you know you should come here?" I said, "I
didn't know. The horse knew. All I did was keep
his attention on the road."

Encouraging a Relapse - To bypass


simple short-lived 'obedience' which
tends to lead to lapses in the absence
of the therapist, Erickson would
occasionally arrange for his patients to
fail in their attempts to improve, for
example by overreaching. Failure is
part of life, and in that fragile time
where the patient is learning to live,
think and behave differently, a random
failure can be catastrophic.
Deliberately causing a relapse allowed
Erickson to control the variables of that
failure, and to cast it in a positive
therapeutic light for the patient.

Encouraging a Response by Frustrating


It - This paradoxical approach acts
directly on the patient's own resistance
to change. Obese patients are asked to
gain weight, or in a family therapy
session, a stubbornly silent family
member is ignored until the frustration
obliges them to blurt out some
desperate truth. Once again, this
approach has its roots in Erickson's
hypnotic language patterns of the form
"I don't want you to go into a trance
yet".

Utilizing Space and Position - Hypnosis and therapy


are experienced subjectively by the patient, and any
part of their total experience can be used to reinforce
an idea. The physical position or even the posture of
the patient can be a significant part of the subjective
experience. Manipulating these factors can contribute
to a therapeutic transformation.
If I send someone out of the room - for example, the
mother and child - I carefully move father from his chair
and put him into mother's chair. Or if I send the child
out, I might put mother in the child's chair, at least
temporarily. Sometimes I comment on this by saying,
'As you sit where your son was sitting, you can think
more clearly about him.' Or, 'If you sit where your
husband sat, maybe it will give you somewhat of his
view about me'. Over a series of interviews with an
entire family, I shuffle them about, so that what was
originally mother's chair is now where father is sitting.
The family grouping remains, and yet that family
grouping is being rearranged, which is what you are
after when changing a family."[11]

Emphasizing the Positive - Erickson claimed that his


sensory 'disabilities' (dyslexia, colour blindness, being
tone-deaf) helped him to focus on aspects of
communication and behavior which most other
people overlooked. This is a typical example of
emphasizing the positive.
Erickson would often compliment the patient for a
symptom, and would even encourage it, in very
specific ways. In one amusing example, a woman
whose parents-in-law caused her nauseous feelings in
the gut every time they visited unexpectedly was
'taught' to puke spectacularly whenever the visits
were especially inconvenient. Naturally the parentsin-law would always sympathetically help her clean
up the vomit. Fairly soon, the annoying relatives
started calling in advance before turning up, to see if
she were 'well enough' to see them.
The subject of dozens of songs, 'emphasizing the
positive' is a well known self-help strategy, and can
be compared with 'positive reformulation' in
Gestalt Therapy.

Prescribing the Symptom and


Amplifying a Deviation - Very
typically, Erickson would instruct
his patients to actively and
consciously perform the symptom
that was bothering them (see the
nailbiting example under
#Resistance), usually with some
minor or trivial deviation from the
original symptom. In many cases,
the deviation could be amplified
and used as a 'wedge' to
transform the whole behaviour.

INTERVIEWER: Suppose someone called you and said


there was a kid, nineteen or twenty years old, who has
been a very good boy, but all of a sudden this week he
started walking around the neighborhood carrying a
large cross. The neighbors are upset and the family's
upset, and would you do something about it. How
would you think about that as a problem? Some kind of
bizarre behavior like that.
ERICKSON: Well, if the kid came in to see me, the first
thing I would do would be to want to examine the
cross. And I would want to improve it in a very minor
way. As soon as I got the slightest minor change in it,
the way would be open for a larger change. And pretty
soon I could deal with the advantages of a different
cross - he ought to have at least two. He ought to have
at least three so be could make a choice each day of
which one. It's pretty hard to express a psychotic
pattern of behavior over an ever increasing number of
crosses.[12]

Seeding Ideas - Erickson would often


ensure that the patients had been
exposed to an idea, often in a
metaphorical form (i.e. hidden from the
conscious mind) in advance of utilizing it
for a therapeutic purpose. He called this
'seeding ideas', and it can be observed to
occur at many levels both coarse and
fine grained, in many of his case
histories. In a simple example, the
question "Have you ever been in a trance
before?" seeds the idea that a trance is
imminent - the presupposition inherent in
the word before is "not now, but later".

Avoiding Self-Exploration - In common with most


brief therapy practitioners, Erickson was entirely
uninterested in analysing the patient's early psychological
development. Occasionally in his case histories, he will
briefly discuss the patient's background, but only as much as
it pertains to the resources available to the patient in the
present.

INTERVIEWER: You don't feel that exploring the past is


particularly relevant? I'm always trying to get clear in my mind
how much of the past I need to consider when doing brief
therapy.
ERICKSON: You know, I had one patient this last July who had
four or five years of psychoanalysis and got nowhere with it. And
someone who knows her said, "How much attention did you give
to the past?" I said, "You know, I completely forgot about that."
That patient is, I think, a reasonably cured person. It was a
severe washing compulsion, as much as twenty hours a day. I
didn't go in to the cause or the etiology; the only searching
question I asked was "When you get in the shower to scrub
yourself for hours, tell me, do you start at the top of your head,
or the soles of your feet, or in the middle? Do you wash from the
neck down, or do you start with your feet and wash up? Or do
you start with your head and wash down?"
INTERVIEWER: Why did you ask that?
ERICKSON: So that she knew I was really interested.
INTERVIEWER: So that you could join her in this?
ERICKSON: No, so that she knew I was really interested.[13]

Shocks and ordeals


Erickson is famous for pioneering
indirect techniques, but his shock
therapy tends to get less attention,
perhaps because it is
uncomfortable for us to hear such
uncharacteristic stories about an
inspirational and gentle healer.
Nonetheless, Erickson was
prepared to use psychological
shocks and ordeals in order to
achieve given results:

When the old gentleman asked if he could


be helped for his fear of riding in an
elevator, I told him I could probably scare
the pants off him in another direction. He
told me that nothing could be worse than his
fear of an elevator.
The elevators in that particular building
were operated by young girls, and I made
special arrangements with one in advance.
She agreed to cooperate and thought it
would be fun. I went with the gentleman to
the elevator. He wasn't afraid of walking into
an elevator, but when it started to move it
became an unbearable experience. So I
chose an unbusy time and I had him walk in
and out of the elevator, back in and out.
Then at a point when we walked in, I told the
girl to close the door and said, "Let's go up."

She went up one story and stopped in between


floors. The gentleman started to yell, "What's
wrong!" I said, "The elevator operator wants to kiss
you." Shocked, the gentleman said, "But I'm a
married man!" The girl said, "I don't mind that." She
walked toward him, and he stepped back and said,
"You start the elevator." So she started it. She went
up to about the fourth floor and stopped it again
between floors. She said, "I just have a craving for a
kiss." He said, "You go about your business." He
wanted that elevator moving, not standing still. She
replied, "Well, let's go down and start all over again,"
and she began to take the elevator down. He said,
"Not down, up!" since he didn't want to go through
that all over again.
She started up and then stopped the elevator
between floors and said, "Do you promise you'll ride
down in my elevator with me when you're through
work?" He said, "I'll promise anything if you promise
not to kiss me." He went up in the elevator, relieved
and without fear - of the elevator - and could ride
one from then on.[14]

References
^ Gorton, Gregg E (2005). Milton Hyland Erickson The American Journal of
Psychiatry. Washington. Vol.162, Iss. 7; pg. 1255, 1 pgs
^ Autohypnotic Experiences of Milton H. Erickson (Milton H. Erickson and
Ernest L. Rossi), The American Journal of Clinical Hypnosis, July. 1977 20, 3654, reprinted in Collected Papers Volume 1.
^ Autohypnotic Experiences of Milton H. Erickson (Milton H. Erickson and
Ernest L. Rossi), The American Journal of Clinical Hypnosis, July. 1977 20, 3654, reprinted in Collected Papers Volume 1.
^ Rosen, S. My Voice Will Go With You
^ Andre M. Weitzenhoffer (1976) Introduction/forward in Hypnotic Realities
Erickson & Rossi
^ Erickson & Rossi: Two-Level Communication and the Microdynamics of
Trance and Suggestion, The American Journal of Clinical Hypnosis, 1976
Reprinted in Collected Papers Vol.1
^ Erickson & Rossi - Hypnotic Realities
^ Erickson & Rossi - Hypnotic Realities
^ Transcription of Interview with Erickson quoted in Uncommon Therapy by
Jay Haley.
^ Varieties of Double Bind Erickson & Rossi, The American Journal of Clinical
Hypnosis, January 1975.
Reprinted in 'Collected Papers' Volume 3.
^ Erickson quoted in Uncommon Therapy by Jay Haley.
^ Erickson quoted in Uncommon Therapy by Jay Haley.
^ Interview with Erickson transcribed in Uncommon Therapy by Jay Haley.
^ Erickson quoted in Uncommon Therapy by Jay Haley.

http://www.hypnosis101.com/bes

t-induction.htm

Despite its detractors, well run


government saved America during the
depression. Though some blame the
democrats for creating the welfare state,
it pulled the country out of a devastating
depression, and is directly responsible for
a good deal of the wealth of today.
Things such a dental care, public health,
public education, public higher
education, good water systems, all came
out of the New Deal, Public Works
Projects and other governmental
programs that began in the 1930s under
FDR. These were very brave ideas at the
time and fit a spirit of entrepreneurship.

Profit, nonprofit and private not for


profit organizations
Business has fundamental differences
with governmental parameters. At the
heart of business is profit while service
is at the heart of government. Business
gets is revenue from profits or sales,
while government gets it from taxes.
The priority for a government work is
to not make a mistake that gets him
noticed. For the business man it is to
make a profit, regardless of how many
mistakes he makes. The concept of risk
is vastly different.

Privatization of human service


organizations

This has been a push for the past several decades.


One thought is that privatization puts money
directly into the local economy through private
providers and that this should always be viewed as
the preferred function of government. The counter
to this is that when private providers are used that
there is a presumption that profit is being made in
the delivery of services to the public and that his
can lead to price gouging or conflict of interest. (ie.
That the private provider would tend to maximize
those services that provided the provider with the
highest profit, further the provision of services by a
provider would more likely tend to meet the bid
specs vs the true need in a dynamic society,
locking the system in place long after the need had
changed or been eliminated.) A counter argument
can be made for government in this area.

For instance we still have an agency who ensures


that we keep national helium reserves dating back to
the days of the dirigibles or blimps incase the
government ever decides to float a fleet of them
again. One argument for privatization is the idea
that private business can alter or retool more quickly
in its provision of services than government and that
their motivation to change can be more readily
affected, that they will tend to be more aware of the
needs of the customer. It is rare private business that
does not take pains to ensure that its product is what
the customer wants. The watch word for the 1990s
was viewing the recipient of services as a customer
and react accordingly. Some compromise is clearly
needed. We want the best of good business operating
with the understanding of good government of the
particular needs of the populace.

Alternatives to standard service delivery:

Traditional functions:
Creating legal rules and sanctions
Regulation or deregulation
Monitoring and investigation
Licensing
Tax policy
Grants
Subsidies
Loans
Loan Guarantees
Contracting

Innovative:

Franchising
Public-private partnerships
Pubic=Public partnerships
Quasi-public corporations
Public enterprise
Procurement
Insurance
Rewards
Changing public investment policy
Technical Assistance
Information
Referral
Volunteers
Vouchers
Impact fees
Catalyzing nongovernmental efforts
Convening nongovernmental leaders
Jawboning or public forums

Avant-Garde:

Seed money
Euity investments
Voluntary associations
Coporductoin or self-help
Quid Pro Quos
Demand management
Sale, exchange, or use of property
Restructuring the market

Is your organization open to new ideas from all levels,


or must ideas come up through the chain. Can one
part of an organization meet with another and share
ideas or enter a joint venture or try out a new idea
together. Vertical organizations have a top down
chart. Information travels down from boss to boss to
boss and information travels up the same way. In a
horizontal organization there is a presumption that
every one knows their respective jobs and is
competent and motivated to do it, so the typical
management structure is much less needed. Much as
a chief of staff at a hospital. Yes the chief manages,
but he does not attempt to tell the doctors under him
what to do, the management is more directed to
coordination of ideas and methods, not enforcing
methods. Some jobs are more open to this sort of
management. The argument is that all jobs would
benefit from more of the horizontal approach as the
vertical arrangements tend to smother creativity.

Agency study methodology

Total Quality management


processes
Quality circles
Bottom up assessment, customer
sensitivity.

Organization:

:social units deliberately constructed and


reconstructed to seek specific goals.
: an organization is a collection of people
engaged in specialized and
interdependent activity to accomplish a
goal or mission.
: as systems of continuous, purposive,
goal-oriented activity involving two or
more people.
Note that any group can be considered
an organization. In this context the key is
together toward a goal, a goal directed
group. This could be a Seal Team from
Rainbow Six, a garden club, a Sunday
School class.

Important are the rules that the group


sets for itself and how it elects to make
decisions. In systems theory we have
seen how the system can be greater than
its parts, or a system can develop a life
of its own. The organization theory holds
the same for the organization of group.
There are many instances in human
history that reflect this. The ice age
mastodon hunters were able to bring
down an animal hundreds of times their
size through an organized approach,
doing something a single person could
never do. Imagine for a minute why this
might be possible.

Consider a troup of 100 spear wielding people


attacking a mastodon one at a time with no
organization. 100 flattened corpes left, 1 mildly
bored mastodon. With organization (read clan
of the cave bear), a few brave and quick hunter
can amplify the strength and catch the animal
in areas of vulnerability. How did this occur?
Did a wise iceman suddenly see how it might
be done? Anthropologists suggest that this
behavior came to the ice age people from
viewing the wolf packs. Fossil and cave
paintings reflect the reverence for wolves.
They dressed in their skins and performed
ritualized dances in honor of the wolf. It would
much less of a jump for a poorly organized
troup to learn from observing a wolf pack
bringing down a large bison or elk and from
there make tentative attempts with larger
animals by mimicking the same strategies.

Are we then a modern pack of wolves


and have this in our heritage? The
definition of an organization goal fits
this model: the desired or intended
ends or results to be achieved by an
organization or as a desired state of
affairs which the organization attempts
to realized, can be well viewed through
the eyes of the wolf pack, the ice mens
tribe, the Seal team, the workers in a
unit, the community group, the union
members, Sunday school class, or the
Optimist club. Each form from shared
goals and are the most effective when
they share a vision that contributes to
the overall survival and maintenance of
the organization.

Social care goals are those


directed to changing the
environment in order for people
to improve the quality of their
lives and reach maximum
potential.

Social control relates to control


of other who might interfere
with their own goals or the goals
of others.
Rehabilitation are those directed
toward changing individuals so
they will have improved quality
of life and better opportunity to
reach their fullest potential.

Goal Displacement is when a new


goal contradicts an existing one.
Goal succession is when one goal
is replaced by another, such as
when a drunk challenges someone
to step out side and when the
other stands, reveals that he is
68 and weighs 250 with no neck
and his goal alters to finding a
back door to slip out quietly.

Scientific or classical management


theory:

Frederick Taylor, an engineer, cir


1895, put forth this model for
organizational management.
Efficiency
Effectiveness

Science of work
Scientific selection and training
of staff
Managements work with staff in
implementation
Managements planning and
development of procedural rules
for staff to follow

Bureaucracy:

Classic model of organizations put forth by Max


Weber (1864-1920)
It can be synonymous with organization.
stable and officially stated structure of authority, an
organizational chart.
a hierarchy clearly defines who is over whom
a record of transactions, regulations, and policies
kept over time
specialized training for management
official duties take precedence
follows stable rules
career oriented approach to work
management is apart from owners
management has authority to delegate resources

Why does it now have a negative stereotype?


During the late 1940s and through the 1950s in
America there was much more exposure to
heavy industry than ever before for most of
Americans. During the building of heavy
industry for WWII there was a tremendous
growth in companies. Small machine shops that
had ten to 20 workers suddenly faced staffing
major production lines of hundreds and even
thousands of employees. This required a
tremendous shift in the development of rules
and policies that felt to be necessary in the
maintenance of large production lines and large
numbers of staff. With the downsizing that came
following the end of the war and even more
following the end of the Korean conflict, these
massive bureaucracies were viewed from the
smaller, newer companies that took the place of
the larger more well established company.

Also, the new business climate was much different.


Instead of building more of what was being built,
new ideas resulted in new inventions and new
wealth (the 1950s were a time of great prosperity,
due in part to the energy of men returning from
the war who came back trained, used to a certain
life style, exposed to new ideas, and the GI bill).
With new wealth came demand for goods, both
new and old. People wanted new cars with new
and better options, new refrigerators, newly
designed radios, recording processes, television,
color television, etc. all required a different sort of
company, one that could adjust to a new product,
envision a new product based on its need, get the
new product into production and into the market
quickly. Companies had to be able to completely
retool in a matter of months or even weeks, a task
that used to take years if not end the life of most
companies.

This requires a much more


flexible approach to
management and some of the
regulations became to be seen in
a negative light, as standing in
the way of progress. The Old
guard was often let go as they
had difficulty letting loose of the
tight strands of red tape that
held the old organization (and
their positions in it in place.

This set the stage for human relations


theory of organizational management. The
old operated on the notion of X or Y theory.
The management viewed production staff
as only interested in tangible rewards or
punishments in terms of how they would
respond to management. This was called X
theory of management. At the other end of
the spectrum was the career management
person who was felt to be in his place due
to company loyalty and a shared vision.
This reflected the Y theory, that someone
does something for more intrinsic rewards
instead of extrinsic rewards.

X: inherent dislike for work; must


be forced or threatened directly
with job loss or pay loss; inherent
preference for being directed and
shuns responsibility. Security
critical
(better fits with the classical
approach)

Y: expects to work as a part of life


goals; self directed to objectives to
which they are commited; self
actualization is highest goal;
wants responsibility; untapped
creativity pool; untapped potential
in everyone.
(better fits with the human
relations approach)

Due much to the increase in production


and the critical needs the war effort
placed on management and owners, the
field was hungry for increasing the level
of information about management. The
Hawthorne Studies, by Elton Mayo
showed that any attention provided to
workers increased their output (they
tried various levels of lighting and work
increased under all conditions as long as
the workers were aware that an
experiment was underway) It became
called the Hawthorne Effect. Also noted
was the tendency for the group to set
normative work expectations for the
group, apart from management.

This surprised management


theorist and began a focus more
on some of the more esoteric and
heretofore undiscussed issues
such as the effect of group
dynamics, small group behaviors,
what makes a good leader, how
decisions are made, routes of
communication, and ways of
sharing goals.

As open systems an organization would have the


following characteristics:

importation of energy
throughput: use energy to produce goods or provide
services
output
systems as cycles of events: Self replicating
negative entropy: something to fight chaos
information input, negative feedback and the coding
process: evaluation process
steady state and dynamic homeostasis: a movable
balance established by organizations taking in energy
and information, using it, then exporting it in return for
needed resources in a functional way. A dynamic
movable balance.
differentiation :to greater complexity and greater
specialization of function
equfinality : the attainment of goals via different paths

Contingency theory: that


organization always make decisions
on incomplete information and that
every decision is made in the context
of all other issues. Sounds a good
deal like the person-in-the-situation
theory. Decision making is always
made with incomplete information.
Monday morning quarter backing is
not a decision. It is too late. The
great managers are often viewed in
awe as near fortune tellers. how did
they know this would work?

They had to have known something


we didnt know. Often from a
distance managers are viewed highly
critically in that their decisions may
not be what the production worker
would have made in part due to the
necessity of the manager to forecast
what will be needed a month to a
year in advance on a production line
or in a decision that might impact
the environment in which production
or service occurs.

Negatives aspects of Theory X or


the classical management
approach.
Negative aspects of Theory Y or
the Human Relations Perspective.
Positive?

Organizational Culture: How things


are done around here? The real
organizational chart. Who has the
dirt? Who wields the real power?
How are decisions really made?
Who is the fair haired who have
their ideas listened to more
seriously?

Oligarchy: decisions controlled by a few.


A failing of organizations is that they
almost always eventually see their
maintenance as becoming a primary goal
vs the original goal that created the
organization. Perhaps this is part of
human nature. The self interest of the
rulers prohibit major change, especially
any change that does not benefit or
especially change that puts their roles
and lines of information at risk. Avoid
change or disenstion at all costs, avoid
making waves, those that do are not
reinforced or rewarded.

Consensus organizations: any


enterprise in which control resets
ultimately and overwhelmingly
with the members-employeesowners, regardless of the
particular legal framework through
which it is achieved. Were all in
this together approach. All for one,
one for all. Where would this idea
work best? Who is in charge?

Consensus:

I believe that you understand my point of view


I believe that I understand your point of view.
Whether or not I prefer this decision, I will support it,
because it was arrived at in an open and fair manner.
TQM
focus on the consumer of the organizations services
involvement of everyone in the organization in pursuit
of quality
a heafvy empasis on temwork
encouragement of all employees to think agbou tand
pursue quality whtint he organization
mistakes are not to be covered up but ar to be used as
learning experiences opportunities
workers are encouraged ot work out problems solvable
at their level and not to pass them along to the next
level
everyone is on the quality team and everyone is
responsible and encouraged to pursue quality

As open systems an organization would have the following


characteristics:

importation of energy
throughput: use energy to produce goods or provide
services
output
systems as cycles of events: Self replicating
negative entropy: something to fight chaos
information input, negative feedback and the coding
process: evaluation process
steady state and dynamic homeostasis: a movable
balance established by organizations taking in energy
and information, using it, then exporting it in return for
needed resources in a functional way. A dynamic
movable balance.
differentiation :to greater complexity and greater
specialization of function
equfinality : the attainment of goals via different paths

Japanese Social Welfare:

flexible job descriptions


use of nemawashi information
decision making process

Nemawashi ( ) in Japanese culture is an


informal process of quietly laying the foundation
for some proposed change or project, by talking
to the people concerned, gathering support and
feedback, and so forth. It is considered an
important element in any major change, before
any formal steps are taken, and successful
nemawashi enables changes to be carried out
with the consent of all sides.
Nemawashi literally translates as "going around
the roots", from (ne, root) and (mawasu,
to go around [something]). Its original meaning
was literal: digging around the roots of a tree, to
prepare it for a transplant.
Nemawashi is often cited as an example of a
Japanese word which is difficult to translate
effectively, because it is tied so closely to
Japanese culture itself, although it is often
translated as 'laying the groundwork.'

the ring decision making process


promotion of the wa: unity Japanese Wa
( ? "Japan, Japanese", from Chinese
W ), is the oldest recorded
name of Japan . Chinese, Korean, and
Japanese scribes regularly wrote Wa or
Yamato "Japan" with this
Chinese character until the 8th century,
when the Japanese found fault with the
belittling character for W "Japan"
and replaced Wa with Wa
"harmony; peace".
Job reassignment and rotation:
extensive training; job is for life
total quality control or total quality
management or quality circles

Pluralistic work place: Why

Disabilities/obligation or barrier?
John:
Misfit
1720-deviant
Idiot
1850-boarding school to lessen
deviancy, new labels
Idiot
1881- farm
Idiot
1890-asylum
Retardate
1920-state-run institutions
Developmental disability
1970intermediate care facility
Individual with a developmental disorder
1980-alternate placement in group
homes/apartments
Consumer/neighbor/diversity 1990-community
based supported living, option of choice

Micro organizational issues traditional and alternative


paradigms
Issues:
Motivation
Leadership
Power
Culture/climate
Decision-making
Communication
Employee evaluation/reward systems
Employee satisfaction
Quality management
Consumer complaints
Staff conflict
Sexual harassment
Diversity issues
Values and ethics
Rural issues
Supervision/staff development

Motivation
What motivates people to work? Most human
services studies in this area place money as third
or fourth on the list of things that motivate the
most. The most often repeated desired reward is
recognition/appreciation of creative effort and
recognition of character. Give examples of
character recognition. Effective Rewards for
workers can include specific comments about
their work and their abilities or character. Formal
recognition also has its place. In small groups my
saying some one is doing a great job, if I do not
know the job, falls hallow and shallow. I must
know something about the persons job for me to
comment on how good it is. How could you praise
without knowing how a job is done? You could
look at the results or at the comparative work in
other areas. Or you could work with the person in
having them establish goals and cheer with them
when they are met.

Leadership
This is related to the concept of supervision an
motivation. The effective leader must both
develop and impart a vision for what the group is
about. This vision becomes the kernel of what the
unit will view and measure their work against. In
a best world the shared vision becomes the very
best supervisor in that all staff can begin to self
supervise, using self assessment in determining
whether or not their work is near the mark. The
effective leader shows respect regardless of
gender, race, etc. and makes this a critical part of
modeling. Care to show that the leader cares for
the group collectively and individually. The
reason most given for burnout is related to the
feeling that one has lost control of his
environment and has limited or no input into his
situation. This leads to powerlessness and
feelings of burnout and impotence.

Power
Personal power,
Ascribed power
Assumed power

Culture/climate
Our culture defines to some degree how
we feel about our work an our play. What
defines the work day? 9-5 / 5 days a week
with 2 week Also discuss more about the
treatment the comparison group will
receive, the number of visits, time spent,
etc. as you have done with the
experimental groups a year vacation. In
Israel a month or more is common. In
Europe the feeling is the same. Vacations
are considered an important part of life.
Timeliness is also considered differently
from culture to culture.

Decision making
Democratic, leaderships,
committees, matrix. Stake holders,
Delphi concept

Communication
Open/closed
One way
Email/memos
Committee work
Employee evaluation/reward systems
How often and what shape should it take
Merit systems
Employee satisfaction
What generates this the most? Monetary
rewards. No. more likely control over ones job
environment, and a shared part of te agencies
purpose and outcome.
Quality management
TQM Quality circles. Feedback. The bowling
with curtain concept.