Transcript Miltonerickson

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, solutiongenerating, 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 long-term 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 cooperating 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 bedwetters 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 person•s interest. At such
moments people experience the common everyday
trance; they tend to gaze off•to 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 father•s 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,
"Giddy-up." 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]

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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]
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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, 36-54, 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, 36-54, 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/best-
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 1930’s under FDR. These
were very brave ideas at the time and fit a
spirit of entrepreneurship.

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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 1990’s 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.
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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
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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
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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.
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Agency study methodology
Total Quality management processes
Quality circles
Bottom up assessment, customer
sensitivity.
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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, goaloriented 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 men’s 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.
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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.
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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 6’8” and weighs
250 with no neck and his goal alters
to finding a back door to slip out
quietly.
Scientific or classical management
theory:
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Frederick Taylor, an engineer, cir
1895, put forth this model for
organizational management.
Efficiency
Effectiveness
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Science of work
Scientific selection and training of
staff
Management’s work with staff in
implementation
Management’s planning and
development of procedural rules for
staff to follow
Bureaucracy:
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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 1940’s and through the 1950’s in
America there was much more exposure to heavy
industry than ever before for most of American’s.
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 thousand’s 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 1950’s 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 it’s 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.
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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)
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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:
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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-inthe-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 didn’t 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.
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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-employees-owners,
regardless of the particular legal
framework through which it is
achieved. We’re all in this together
approach. All for one, one for all. Where
would this idea work best? Who is in
charge?
Consensus:
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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 organization’s 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:

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
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:
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flexible job descriptions
use of nemawashi information decision
making process
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Nemawashi (根回し) 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 根 (ne, root) and 回す (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.'
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the ring decision making process
promotion of the wa: unity Japanese Wa (
倭? "Japan, Japanese", from Chinese Wō 倭),
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 Wō 倭 "Japan" and
replaced Wa 倭 with Wa 和 "harmony;
peace".
Job reassignment and rotation:
extensive training; job is for life
total quality control or total quality
management or quality circles
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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
1970-intermediate care
facility
 Individual with a developmental disorder
1980alternate 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 person’s
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.