Embedding the Message

by Steve Andreas

Presuppositions are messages about the way things are, embedded almost invisibly in a therapist’s language. Because they are not even noticed consciously, these communications have immense power to change a client’s perceptions, expectations and beliefs. Consider this example from the work of Milton Erickson:

In the late 1950s, when Erickson was a guest speaker at the Veterans Administration Hospital in Palo Alto, California, a psychiatrist took one of his toughest clients—a young man who had committed a wide variety of violent offenses—to see Erickson. The young man waited in the hall with his psychiatrist, watching other patients enter and leave Erickson’s office, many of them still clearly in trance. When the two men finally went in, Erickson asked the psychiatrist, “Why have you brought this boy to me?” After the psychiatrist listed the many offenses his client had committed, Erickson said to the psychiatrist, “Go sit down.” Erickson then turned to the client, gazed intently into his eyes, and said, “How surprised will you be when all your behavior changes completely next week?” The young man looked startled and said, “I’ll be very surprised!” Erickson then turned to the psychiatrist and said, “Take this boy away.” The psychiatrist thought that Erickson had decided not to work with him. However, a week later all the client’s destructive behavior did, in fact, change completely.

Erickson had undoubtedly noticed the young man’s heightened receptivity, and decided to deliver the presupposition that all his behavior would change. Erickson didn’t ask him, “Will your behavior change?” Erickson’s question presupposed that the boy’s behavior would change; it was only a question of how surprised the boy would be when it changed.

When the client’s response—verbal and nonverbal—told Erickson that he had completely accepted this presupposition, Erickson knew he had succeeded, so he dismissed him to avoid undoing what he had accomplished. If the client had said, “I would be surprised,” or if he had looked doubtful, Erickson undoubtedly would have gone on to try some other intervention. However, the young man said, “I will be very surprised,” indicating that he had accepted Erickson’s presupposition that the change would occur.

There were other important presuppositions that supported this brilliant intervention. When Erickson asked, “Why have you brought this boy to me?” he presupposed that the patient was immature, had a lot to learn, was dependent and needed guidance. When he commanded the psychiatrist to sit down, Erickson presupposed that the psychiatrist (who had been in a parental role to the “boy” he brought) was in a position to take orders from Erickson.

With these two short utterances, Erickson set himself up as an authority superior to those who had been dealing with the client, all by presupposition and implication. Without these first presuppositions, it is unlikely that his later question would have had such impact.

Most of the presuppositions that are useful in therapy are not as global as Erickson’s. Nevertheless, they can achieve significant shifts in perception and behavior. A number of small presuppositional shifts can work together to affect families powerfully. One of my favorite examples is contained in a videotape of structural family therapist Salvador Minuchin’s first session with a family whose 10·year-old son was sniffing gasoline. Immediately after the introductions, Minuchin turned to the boy and said, “I understand you like to sniff gasoline. What do you think you are, an automobile?” This humorous comment had an immediate impact. Everyone relaxed a little, and the problem became a little less insoluble.

The joke was fairly obvious. Not so obvious was the presupposition that serious matters can be discussed with humor. Even less apparent was Minuchin’s use of the words “you like to.” In contrast, “You sniff;’ or “You have to,” or “You fell driven to” would have presupposed that the behavior was out of the boy’s control, and therefore difficult to change. “You like to” presupposes that the behavior results from the child’s own desire, not some crazy or incomprehensible compulsion.

In his next statement to the boy, Minuchin built on this: “Which do you prefer—unleaded or regular?” Everyone relaxed a bit more as this second joking comment shifted the family’s attention again. Minuchin’s presupposition opened them to the possibility that the problem might not be beyond everyone’s control, but a matter of the boy’s preferences.

Next, Minuchin smelled and then took a sip of the herb tea he had been holding, saying, “I wonder what kind of tea this is.” Then he turned to the boy, offered him his cup, and said, “Since you have a good nose, tell me what kind of tea this is.” This comment built on the previous ones, refocusing attention from the: preference to the learned ability that makes preference possible. Minuchin had presupposed that the boy had “a good nose” and was able to make some discriminations that Minuchin couldn’t. This made the boy superior to Minuchin in this respect, and altered the implicit hierarchy of the superior therapist/needy family.

With three short comments, Minuchin transformed the family’s perceptions, so that they thought of the gasoline sniffing as an expression of the boy’s preferences, and one that demonstrated a positive ability to discriminate. The uncontrollable problem was several significant steps closer to a solution because family members were thinking about it in a very different way. Rather than criticizing, reprimanding or interrogating the boy, Minuchin implicitly complimented him on his skill at discrimination. This provided a positive basis for guiding the boy toward using these skills in ways other than sniffing gasoline.

Of course, more needed to be done. Minuchin gathered information that demonstrated that the boy was a “parental child” with major responsibility for his 4-year-old twin brothers, and he worked toward reorganizing the family so that the l0-year-old could have his own childhood, free of parental responsibility.

As these examples show, presuppositions can subtly alter hierarchies, allow a client to imagine a future that is not hostage to the past, or humorously reframe a worried family’s attitude toward their difficulties. It is impossible not to use presuppositions: Every sentence you utter sends many signals to your clients about what you implicitly assume to be true.

One simple way to identify presuppositions is to negate a sentence and notice what is still true. Take this simple sentence: “It’s good that you’re willing to express yourself”. When we negate this sentence, we get: “It’s not good that you’re willing to express yourself.” Despite the negation, “you’re willing to express yourself” remains as true as it was in the first sentence.

People typically focus on what they can agree or disagree about, while ignoring what is presupposed. When listeners do not notice presuppositions, the ideas unconsciously sink in and the listeners accept them as if they are true, without being consciously aware of the shift that has taken place. If we turn the statement above into a question—”Do you think it’s good or bad that you’re willing to express yourself?”—we focus the listener’s attention more strongly on the choice offered rather than the presupposition behind the choice.

The presuppositions that therapists unwittingly deliver in their first sentence to a new client can set the course for the therapy that follows. Many therapists start by asking, “How can I help you?” This presupposes “I can help you,” a complementary helper/helpee relationship. This is a welcome mat for future dependence and passive behavior.

By contrast, “What changes do you want to achieve today?” presupposes that rapid changes—plural—are possible, and also presupposes that the client is in the active role: the client is the one who both wants and achieves changes, not the therapist “What are the problems in your marriage?” directs the couple to the past in a search for what didn’t work. This is an invitation to endless archaeology, a return to what family therapist pioneer Virginia Satir called “the museum.” However, the question “What kind of relationship do you want to have?”, directs the clients to think of desired outcomes. From there, it is a short step to develop specific ways to reach those outcomes and leave the problem behind. It is amazing how powerfully presuppositions can influence the therapy that follows. Often, if the direction is not useful, the therapist will later complain that the client is resistant or “passive-aggressive,” or realizing that this behavior is a predictable response to the therapist’s own presuppositions about the therapy.

The more therapists know about how they send these messages, the more power and impact every word can have. By sensitizing themselves to their own presuppositions, therapists can recognize ways they may have been holding their clients back unknowingly, and can use this information to change their presuppositions. Listening to clients’ presuppositions points out exactly where their thinking is limited and offers a direction for therapists to take to make it easier for clients to have new perspectives and responses.

Presuppositions about time are particularly useful. The verb tense of every sentence carries a time message that can be a powerful indicator of attitudes toward a problem and the possibility of change. Perhaps a wife says, “We always fight. It is a terrible problem in our relationship.” Her use of the present tense, combined with “always,” indicates that she is thinking of the problem occurring throughout the past, present and future. In contrast, she could have said, “We fought on Saturday,” which would have limited her perception of the problem to a narrow and contextualized past.

My response to the wife might be, “So this has been a terrible problem for you when you have gotten into fights.” By describing the problem in the past tense, I leave it in the past, while acknowledging that I understand what she has said. Then I might begin to direct her attention to what she wants in the” future—”And I’m guessing you both want things to be different.”

The use of verb tense in this exchange is crucial because the language of time carries powerful messages about whether or not change is possible. Most people perceive the past as fixed and unchangeable. But most people can see more alternatives and possibilities in the future, since it hasn’t happened yet. A careful use of presuppositions of time can clear their mind to imagine a more open future.

Notice the difference in your experience if you think of some minor problem of your own, and say to yourself, “It is a problem, isn’t it?”

Now try saying, “That has been a problem, hasn’t it?” and be aware of your sense of the internal spatial location of “the problem” as you do so. If you pay close attention to your internal images, you will find that your image of the problem shifts with each sentence.

The location of images in your internal perceptual field profoundly influences how you will respond to them. You may find that the image of “It is a problem” is close and large, while your image of ”That bas been a problem” is farther away, off to the side, and smaller. Both sentences match your experience, but the second takes the problem out of the future and literally clears a space in your mind for new behavior in a subtle and profound way. If, as a therapist, you use every sentence to communicate that problems are unlikely to continue into the future, and that solutions are part of the future, you make it easier for your clients to develop and consider solutions.

Many therapists still direct their primary attention toward the past. While it is possible to speak of the past in a way that puts useful presuppositions in place, it is much easier to slip in presuppositions of things being different, better or solved in the present and future. Even a brilliant therapist is operating with both hands tied behind his or her back if limited to changing presuppositions about the past.

Since the future hasn’t happened yet, it is much more malleable. It’s the easiest place to begin to put in presuppositions about change without violating the client’s sense of reality. If a client wants to lose weight, for example, I might ask, “What resources do you think will allow you to lose weight easily?” “What will be your first indication that you have what you need to maintain your desired weight?” “After you reach and maintain your desired weight, do you think you will look back and find it strange that you were ever overweight, or do you think you will have a feeling of understanding and compassion for that former you?” Once the client begins to think of the desired outcome as almost inevitable, it becomes much easier to develop specific interventions to accomplish the desired outcome.

It’s easy to discover how presuppositions work; all it takes is paying close attention to your own internal images. Try the following experiment: First imagine “eating dinner at a restaurant.” Then imagine “discussing a proposal.” Now notice your internal experience of “Let’s eat dinner at a restaurant before discussing a proposal.” Notice how the two representations become smoothly linked together in your mind.

Now try a slightly different sentence: “Before we discuss a proposal, let’s eat dinner at a restaurant” and again pay close attention to the spatial arrangement of the images in your mind. In this case, the first representation you make, “discussing a proposal,” moves aside to your less detailed peripheral visual field in order to make: room for “eating dinner at a restaurant.” In each case, the result is the same: The presupposed representation becomes linked to the other, more conscious one. The process of getting there is slightly different, due to the different order of the two sentences.

“You can go on to experiment with other time words like before, after, during, as, since, when, prior and while. These words all create a presupposed sequence or link between experiences in time and a slightly different internal experience.

You can learn how to generate presuppositions by listening to your own and others’ language and identifying the presuppositions. A detailed analysis of presuppositions can be found in the work of Richard Bandler and John Grindler, the founders of Neuro-Linguistic Programming. In their book The Patterns of the Hypnotic Techniques of Millon H. Erickson, M.D., Vol. 1, they delineate 29 linguistically distinct kinds of presuppositions.

With practice, generating useful presuppositions can become an automatic part of your verbal behavior. Since different clients respond more fully to certain presuppositions better than others, it’s useful to be able to generate a variety of presuppositions at will.

How messages are delivered non-verbally is at least as important, if not more so, than what is said. Tuning, pacing, tone of voice and volume, facial expression, gesture, posture and eye contact all affect how the message is received. For example, questions usually end in a rising pitch, while statements do not. Commands typically end with a sinking pitch. If you ask, “How much do you want to change?” and allow your voice to sink, the apparent question takes on the impact of a command, strengthening the presupposition that “you want to change.” Although most people respond strongly to such tonal communication, very few recognize it consciously, and this increases its impact. Marking out the phrase that is presupposed with a gesture or a shift in voice tone or volume also adds impact. These “embedded commands” were an explicit part of Milton Erickson’s work, and Virginia Satir also used them fully.

You can learn better nonverbal expressiveness by observing animals and infants. Since preverbal children and animals only respond to tone, tempo, volume and other nonverbal expressions, communicating with them will help you develop nonverbal skills that you can then transfer to your interchanges with clients.

After you have learned to craft and deliver a presupposition, it’s important to be able to observe whether it has had the desired effect. Ultimately, what counts is not how artful it is, but how the client responds. Nonverbal responses will usually tell you much more than what is said. With practice, you can learn to notice small shifts in your client’s posture, breathing, muscle tone and facial expression that indicate the effect.

Never underestimate the potential power of a properly supported presupposition on your clients. Years ago, on a television program about kids with cancer, I saw a tape of a 10-year-old child, bald and emaciated. I wouldn’t have bet a nickel on his chances for recovery. The child’s therapist asked him congruently, “How long do you think it will take you to get well?” The child took some time to think carefully, and then answered, “About six months.”

Then a segment shot six months later was shown and the child appeared happy, healthy and fully recovered. I don’t know how much of the child’s recovery was due to the other treatment he was receiving and how much was due to the presupposition that he would get well—but I’m sure it helped.