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Marcus
The naturalistic or utilization approach
The naturalistic approach is meant as the acceptance and utilization of the situation
encountered without endeavouring to psychologically restructure it (Erickson,
1958/1980). The presenting behaviour of the client becomes a definite aid rather than
a possible hindrance. The most important consideration is meeting clients’ needs as
individuals and accepting their personalities as an integral part of their psychological
makeup.
In any such utilization, there is a need to accept the psychological states, under-
standings and attitudes that each client brings to the situation. The acceptance and
utilization (Erickson, 1959/1980) of those factors promote the development of the
more ready acceptance of the offered therapeutic intervention.
In the crisis matrix, the clinician should be fully cognizant of the various cognitive
and emotional states already in evidence and utilize them to a therapeutic aim. This is
different from the traditional method of therapy in that what the client presents with
(fear, anger, confusion) is being altered to fit the therapist’s model of what they
believe should be occurring. The major ways in which therapists deal with such highly
affectively charged and uncertain states include labelling them as resistance, demand-
ing that the client act rationally, ignoring or not recognizing them, and trying to cheer
the client up. Gilligan (1987) notes: ‘Another possibility is to recognize it as a self-
induced confusion and utilize with direct suggestion.’ Further directives could be
issued according to the client’s needs and the therapist’s stylistic preference. Such
directives may be social in nature, or may even be hypnotherapeutic.
Crisis interventions with AIDS clients, as with all clients, should not be mere
panaceas. Helping the client adjust to a terminal illness should not be the sole focus of
the intervention. This is a slight shift in the crisis matrix paradigm. Rather than focus-
ing on the pathology, the clinician can concentrate on improving the quality of life.
Clinical examples
Case I: HIV seroconversion and life reframing
In a wellness centre in a southern Texas metropolitan town, a recent seroconversion
HIV-positive male presented with feelings of being overwhelmed, out of control, and
sleeplessness. He was seeking hypnosis, for an unspecified goal. He felt that it would
help, but he just didn’t know what for. He spoke generally of wanting to get some
control back into his life, and to feel less depressed.
He had recently been made aware of his HIV-positive status. He had disclosed his
status to his current significant other. He described a stable, same-sex, monogamous
relationship of relatively short duration. He described his present relationship as being
the ‘best in his life’, with a feeling of shared responsibility for the outcome of their lives.
He was being treated for depression by a psychiatrist and was unsatisfied with the
results. The side-effects of the medication further exacerbated his feelings of being
out of control.
He was able to describe the best time in his life – a recent trip to Montreal, where
he got to see snow for the first time. When he described the event he used both the
primary modalities of auditory and variants of kinaesthetic to describe the situation.
He was encouraged to go into great detail to describe what made this the best time of
his life. He was invited to use as much detail as possible about the various modalities.
The image of dense snowfall was utilized to evoke a trance state (Zeig, 1988).
Using the client’s own words and phrases he was invited to follow a snowflake on its
way down from the sky, watching its intricate, individual pathway as it made its way