Intervention with a metaphor

Solving the problem of enuresis, a therapeutic intervention by Milton Erickson (Erickson, M

This is one of Ericson’s therapeutic stories that illustrates the therapeutic concepts of brief-therapy, solution-oriented approach. The story is presented here as described by Rosen (1982. Pp. 113-117) in his “book and is called by him “dry beds
“As in tales Sufi  or Zen stories, the recipient of the knowledge of the healer must be in state of readiness to receive.  In many of those stories the supplicant comes to the master but is refused entry until “the vehicle is ready to receive the riches of the teaching 

“Erickson often accomplishes this preparation by causing the listener or the patient to wait a long time before he delivers his “punch line.” For example, when he presented the next tale to a group of students, he spent about one- half hour in building up to the final prescription. Some of this time was spent in outlining the background history. Some was spent in asking the listeners how they would treat such a patient. Some time was spent in telling other stories, not directly related to the problem. He repeated such  phrases as: ” There is something that you know, but don’t know that you know. When you know what it is that you don’t know you know, then you will be able to have a dry bed”. “This type of puzzling and yet intriguing statement  causes the listener to do what Ernest Rossi has called” an “inner search.” “The listener is thus already beginning to search inside himself for resources that may help in the healing process. When we consider  one of Ericson’s induction technique,” the same principle applies.  The patient literally is left begging for more. Then he is ready to receive

A mother brought her eleven-year-old daughter to see Erikson.  After he heard that the daughter wets the bed he sent the mother out of the room with the believe that the girl can tell the story by herself. The girl told that she had a bladder infection when she was very small, that she was treated by a urologist but infection lasted six or seven years or more. She was cystoscoped hundreds of times and finally the focus of the infection was  found in one kidney.  The kidney had been removed and she was free of infection for about four years. She was cystoscoped again hundreds of times and her bladder and sphincter were so stretched that she wet the bed every night, as soon as her bladder relaxed in her sleep. During the day she controlled her bladder except in situations where she laughed. Relaxation accompanying laugh caused her to wet her pants.
Her parents thought that since the kidney was removed and she was free of infection,  she ought to learn to control herself. She had three younger sisters who mocked her. All the mothers, and all the schoolchildren knew she wet her bed and that she wet her pants when she laughed. So she was the butt of much ridicule.
She was very handsome, blond, with long hair that reached to her waist. She was a really lovely girl. However, she was ridiculed; more was demanded on her  than she could do. She had to endure the pity of neighbors, the derision of her sisters and the schoolchildren. She did not go to parties or sleepovers or stayed with relatives  because of bed-wetting. Erickson asked her if she had seen other doctors. She said she had seen a lot of them, swallowed a barrel full of pills and medicine, and nothing helped

Erickson told her he is like other doctors, and that he can not help her either. Then he continued and said: “But you already know something but you don’t know that you know it. As soon as you find out what is that you already know and don’t know you know, you can begin having a dry bed

Then he told her, that he will ask her a very simple question and that he wants a very simple answer. Then he posed the question:  “If you were sitting in the bathroom, urinating, and a strange man poked his head in the doorway, what would you do?” 
“I’d freeze!”, the girl answered.
“That’s right.” Ericson continued, and said: “You’d freeze-and stop urinating. Now you know what you already knew, but did not know that you already knew it. Namely, that you can stop urinating at any time for any stimulus you choose. You really do not need a strange man poking his head in the bathroom. Just the idea of it is enough. You will stop. You will freeze. And when he goes away you will start urinating.”
“Now, having a dry bed is very difficult job. You might have your first dry bed in two weeks. And there has to be a lot of practice, starting and stopping.  Some days you may forget to practice starting and stopping. That’s all right. Your body will be good to you. It will always give you further opportunities. And some days you may be too busy to practice starting and stopping, but that’s all right. the wetting. Your body will always give you opportunities to start and stop. It would surprise me very much if you have a permanently dry bed within three months. It will also surprise me if you did not have a permanently dry bed within six months. And the first dry bed will be much easier than the two dry beds in succession. And three dry beds in succession is much harder.  And four dry beds in succession is still harder. After that it gets easier. You can have five, six, seven, a whole week of dry beds. And then you know that you can have one week of dry beds and another week, of dry beds”

Erickson tells that he didn’t have nothing else to do with her. He just spent with her another hour and half and dismissed her.  Two weeks later she brought him a gift – the first gift she ever gave with the knowledge that she had a dry bed (it was a knitted purple cow). Six months later she spent the night at the home of friends, relatives, and a hotel. Here Erickson  makes a very important comment, he says: “Because it is the patient who does the therapy, I didn’t think it was the family that needed therapy…my feeling was that her parents would not have too adjust too her dry beds.”  Erickson told her what she really knew but did not know she knows.

Then he says something important to all of us, that we all have been interrupted and shutting off a stream of urine very suddenly. Everybody has that experience – and she had forgotten it. “All I did” says Erickson ” was to remind her of something she already knew but did not know she knows”.
According to Erickson. In doing therapy we have see our patient as an individual and no matter how much of a problem  her bedwetting was a problem to her parents, her sisters, neighbors and school – children. It was primarily her problem. All she needed  to know was something she already knew – and the therapy for the others would allow them to adapt themselves

Psychotherapy, as Ericson thinks, should be an orientation to the patient and an orientation to the primary problem itself. We have to remember that each of us has his own individual language, and when we listen to a customer we should listen knowing that he is speaking an alien language and that we should not try to understand in terms of our language. We have to understand the customer in his  language.
This intervention process had also an indirect effect on Rosen, (1982) as he describes it later: This is one of my favorite Erickson’s tales, perhaps because it always Erickson would almost always introduce it with a comment such as ” You’ll be especially interested in this story, Sid.” I puzzled for a long time before I could find his message to me and finally was able to extract two main ones. The first is that I can learn control of thoughts, of working energies and of symptoms such as anxiety. I must do this, however, not by willpower, but by discovering which stimuli are necessary to induce me to “start and stop.” Then I must take the opportunities to practice “starting and stopping

“The second message is that  “all of you have you grown up with the idea that when you  empty your bladder you empty it all the way.”  In the version of this tale published in “A Teaching Seminar with Milton H. Erickson ” edited by Jeffrey 
Zeig, Erickson added some extra sentences that make this second point even clearer. “All she needed to know was that she could stop her urination at any time with the right stimulus.” And, “We grow up thinking that we have got to finish. That is  not true that we must continue until we are finished.” I have found this attitude to be a great help in accomplishing such tasks as writing. The coercive feeling that we must finish can easily block spontaneity and creativity. A far more effective way of getting something done is by “starting and stopping” according to one’s inner rhythm. I have found this story to be effective in helping patients overcome blockages, such as writer’s block

Use of metaphors, as was done by Erickson, affects everyone who delves into the structure of the intervention to understand how it works on those involved in directly and indirectly