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Using Hypnosis in Family Therapy (Jossey-Bass, 1983)
Hope Under
Seige: Terror and Family Support in Chile (Ablex, 1991)
By Michele Ritterman, Ph.D.
In Using Hypnosis in Family Therapy, Michele Ritterman accomplishes several impressive tasks. She synthesizes concepts and clinical practices from the schools of Ericksonian hypnotherapy and structural and strategic family therapy; she presents a detailed theoretical vision of how she formulates her inner map of the problems clients present, as well as how she thinks about her clinical interventions; and she offers extended clinical examples that illustrate her principles clearly.
She describes symptoms as multi-level metaphors referring to at least three aspects of a client's experience: familial, societal, and intra-psychic. She generally regards them as expressive of dysfunctional hierarchies (in the structural family tradition) but often maintained or triggered by "family inductions'-negative trances that limit responsiveness or elicit destructive experiences of self. The list of the ways families can induce symptoms includes cue words, interspersal technique, revivification and regression (especially common when families give history illustrating how the identified patient is the problem), parts-of-self inductions (promoting dissociation), and confusion techniques ("destructively depotentiating conscious ways of thinking").
Familiarity with the specific ways a family weaves its trance informs the therapist in constructing her response: "In observing an inductive moment, the therapist notes contributing hierarchical problems and identifies rigid or trespassed individual boundaries. She then uses her observations to initiate an idiosyncratic counter-inductive process to help family members work in
asymptomatic, nonintrusive concert."
Her understanding of the therapy relationship is based on the "model of gift exchange." Like the analogous process in Senoi
dreamwork, this model promotes the positive connotation of symptoms, and cooperative, collaborative interaction between therapist and client. Consistent with this approach, Ritterman notes that "any of these (family induction) techniques may be transformed into therapeutic counterinductive tools." I like her combination of skillful Ericksonian metaphor with very direct psychoeducational skill- building. One of the strengths of her approach is to incorporate in the interview process "eliciting and working with ... resistances and objections."
An example of the poetic creativity of her interventions is the case example of a young girl with enuresis, successfully treated with Ritterman's focus on the father struggling with a drinking problem as the opening for change in the family. She calls the case "family hydraulics' and describes her conversational induction, a lengthy discussion of "the control of fluids" with suggestions for confidence, action, and motivation,
"while he gazed without blinking into the therapist's eyes."
Clinical examples range from vignettes to full transcripts with commentary. Presenting problems include suicidal teenagers, chronic pain,
somaticization, and claustrophobia. My only discomfort with Ritterman's approach was that, in spite of an exquisite sensitivity to cultural and family context as current symptom-maintainers, there was little discussion of traumatic history as etiologic-neither "incest" nor "sexual abuse' appear in the index.
Ritterman's consciousness of and expertise in trauma become explicit in her second book, Hope Under Siege. In this work, she documents the atrocities committed against the civilian population of Chile by the Pinochet regime. More than an academic study, this is a personal testament of her involvement with therapists who risk harassment and even murder to provide psychological care to political prisoners, and with the prisoners themselves, notably Daniel Rodriguez and his family. Her thesis is that prisoners endure torture because of the deep and present connections they have with their families, and the future that implies.
She describes her own experiences in response to harassment, veiled and overt threats by officials, and various suggestions to be fearful and silent throughout her visits to Chile. This provides a sense of the quality of trauma-based symptoms clinical literature does not provide.
If trauma objectives and torture dehumanizes, then Ritterman's approach is to challenge these processes by championing the details of Daniel's life, personality, and family. If terror breeds in silence, she exposes its intent and methods, and celebrates the international community in support of its victims and their families.
In these two books, Michele Ritterman displays a sensitivity to psychic injury from subtle family-of-origin inductions to overt physical and psychological torture. She offers models of healing ranging from elegant conversational inductions to political activism. These are tools and attitudes of great value: they are invitations to empowerment.