Milton Erickson — probably the greatest therapist who ever lived — described an interaction with a woman who had been in therapy with him for some time:

“This woman came in this morning, and she said, “I’ve got a very bad sinus. I know this is correct. My face is aching, and my face is hot. I’ve got a horrible headache. And I don’t think I have been behaving very well. My sexual behavior has been pretty bad. I don’t think I’m improving at all. I think I’m slipping. I think I’m going backwards.”

Imagine for a moment that this woman is your client, and you are wondering what might be the best focus for the session. Would you begin by asking more about her physical symptoms, her sexual or other behaviors, her sense that she is slipping, or going backwards? . . .

Erickson continues: “I don’t know what it was in her tone of voice, (later Erickson wrote, ‘There was that desperate note in her voice when she spoke about her face aches and her sinus. Haven’t you ever heard somebody speak irritably, and you know that this is it, they’ve had all the aggravation that they can take? How do you recognize that?’) but this frank, and open, and ready negative attitude; I said, ‘Well what do you really think?’ She said, ‘I wonder if I’m in pretty serious shape.’ I said “You wonder if you’re in pretty serious shape. Do you want to repeat that question again but change it slightly?’ She said, ‘I’m wondering if I’m going crazy.”

With this additional information, where would you focus your attention? . . .

Erickson continued: “I said, ‘That’s not your question at all, and you know it, and I know it. I think it’s about time you stopped all of that pretense. I’ve been trying for a long time to get you to face the facts. You’ve been afraid. You wouldn’t do it. You’ve gone in every direction. And you know your headaches have been increasing. Your body pains have been increasing. Everything. Now go ahead and ask that question.’ She said, ‘All right, is my husband an alcoholic?’ I said, ‘Would you ask that question if it weren’t true?’ She said, ‘No.’ ‘So what are you going to do about it?’ ” (1)

At this point, you have a specific behavioral outcome that is probably quite different from what you had thought of earlier. How much time could you have wasted trying to achieve one of the earlier possible outcomes? Since Erickson had been seeing this client for some time, he had a lot of background information that gave him the confidence to directly confront her (including her anger at other alcoholics whom she knew) which was probably necessary because of the strength of her denial. Usually a client’s denial won’t be as complete, and there will be no need to confront — an inquiry directed toward the client’s unconscious processing will be adequate.

Clarifying the Meaning of a Significant Word
Often a client says a word that is “marked out,” emphasized by a difference in volume, tonality, facial expression, or gesture, etc., as if it contained an important hidden message beyond its ordinary meaning. A client may be obsessed by a word, and yet be puzzled about its significance. Perhaps a client uses a word that seems strange in the context in which they use it. Sometimes a client uses a very general word, and you would like them to be more specific in order to understand their experience better. Or a client may have an ache or pain and wonder if it has a deeper meaning than the word they use to describe it.

In any such situation where you would like to explore the possibility that there is an additional or different meaning of a word, Erickson recommended offering the following instruction, preferably while the client has turned their attention inward and has their eyes closed, or is in some kind of trance or hypnosis:

“Spell the same word with another set of letters. So that it would read like a different word.”(2)

Take a few minutes to reread this interesting instruction, and then try it yourself. First think of a word you’ve used that has drawn your attention, or that you have been puzzling about, . . . and then close your eyes and follow this instruction, to find out what happens. . . .

If you have a puzzling emotional feeling, physical pain, image or sound (or smell or taste) you can find a word to describe it, and then use that word as a starting point to discover more about its meaning. . . .

Some people will find it easier to do this instruction using visual imagery for a deeper access to unconscious processing and information. For instance, “See the original word printed out in the air in front of you with each letter a different color.” . . . Pause, and then follow with, “Just watch as the word falls apart and the letters all scatter — perhaps like autumn leaves fluttering in the wind, turning over and over as they slowly fall from a tree. Watch as each letter changes color, and some of the letters themselves may separate and fall apart, or join together with other letters as they drift down, and then gradually come back together to spell a new word.” . . .

Instead of autumn leaves fluttering in the wind, you could use any other context that presupposes random movement, such as fish swimming in an aquarium, or birds flying in the sky, people walking in a crowded mall, etc.

You could do the same process in the auditory system. “Notice the sequence of sounds in the original word. Hear each of these sounds separately, one at a time, each coming from a different place in your personal space.” . . . Pause, and then follow with, “Now hear these sounds in reverse order, . . . and then in a different order, . . . and then hear them all at the same time. . . . Now listen as they all move from one location to another around you in your personal space. As the sounds move, some may change how they sound in some way — a sound might change in volume, or tonality, or change the way it is pronounced, one sound might split into two sounds, two sounds might blend into one sound, etc. Continue to listen to these sounds as they move around in space and finally arrange themselves in the same space as the original word to form a new sequence of sounds that creates a new word.” . . .

You could also combine visual and auditory by imagining, “What kind of animal or bird (real or imaginary) is making each of the sounds in the original word? Listen as these creatures move and scurry about, sometimes disappearing into an underground burrow or behind a bush, as other creatures with different sounds emerge, coming together or moving apart, etc.

“Spell the same word” sets a frame of identity. “With another set of letters” gives the client the opportunity (or invitation) to think of how the “same” word could be spelled differently. “So that it would read like a different word,” implies that it is the same word, it just “reads” differently. The implications (processed primarily unconsciously) are that it will have the same or similar meaning as the original word. Of course, logically a word with different letters is actually a different word, but that is conscious-mind thinking, and this is a lovely example of Erickson using language in a way that tends to bypass conscious thinking.

This process is a very gentle roundabout way of asking, “What do you really mean by that word?” or “What else do you mean by that word.” However, if you ask a direct question, you will usually get a very logical conscious mind answer — or no answer — especially with someone who doesn’t have much awareness of their internal processes. The next time someone uses a word in some way that marks it out and draws attention to it, you can try out this intervention, and find out what happens.

Using visual or auditory imagery as outlined above usually makes it easier for unconscious processes to emerge, “take center stage,” and be recognized and acknowledged. If you do this with visual imagery, and nothing interesting emerges, you can try again with auditory imagery using the same word. If you use the process and the new word doesn’t offer a significant new meaning, you can start with that new word and do the process again — as many times as you find useful. Of course it is also possible that there may be no significant additional meaning to discover. “Sometimes a cigar is just a cigar.”

Finding a different word will recategorize the experience described by the original word. This recategorization will provide a different set of reference experiences, connotations, and meanings, and this will often be useful in clarifying or specifying a problem or outcome, and should help indicate what to do next that might be useful.

1. Conversations with Milton H. Erickson, M.D. volume 1, by Jay Haley. NY, W.W Norton Inc. 1985, p. 209.)
2. Ibid, p. 9