Ericksonian hypnotherapy

Dr. Milton Erickson was one of the giants of psychotherapy, as evidenced by the fact that the largest convocation  of psychotherapists in the world, the Evolution of Psychotherapy conferences (held every four years), are organized by the Milton Erickson Foundation. He has been called the father of modern hypnosis. He not only developed a powerful alternative to traditional hypnosis, but introduced a new model of solution-focused brief psychotherapy.

I explained traditional hypnosis in a previous post. Ericksonian hypnotherapy was something new. Whereas traditional hypnotic inductions are characterized by commands and direct suggestions, implying that the therapist wields some kind of power over the “subject,” Ericksonian inductions use indirect suggestion, metaphors, and storytelling to induce trance states, circumventing client resistance to complying with the imperative voice. (You should, you will, etc.) Trance-inducing suggestions like “Your eyelids are getting very heavy and you want to close your eyes” were replaced by indirect suggestions such as “As you relax, you may find that you want to close your eyes.” Instead of hypnotic prescriptions for a person in trance, an Ericksonian hypnotherapist might say such things as “… and as you practice self-hypnosis, you may find that it’s easier for you to ________ .” Erickson also developed non-verbal methods for inducing trances.

Erickson’s life story is remarkable. Long story short, he was stricken with polio at age 17. Told that he would never walk, he taught himself to walk again. Told that he was too disabled to work, he went to medical school  and became a psychiatrist, and later a psychologist. He trained himself to be acutely aware of changes in peoples’ posture, respiration, vocalizations, skin tone (blanching or flushing) and pupillary dilation. He learned to “read people” and their immediate responses to his therapeutic interventions, adjusting his techniques to the unique individual and situation.

Erickson recognized that trances occur naturally every day in all of our lives. (There are many kinds of trance states, including confusion, daydreaming, rumination and jealousy.) He learned to induce them in non-traditional ways and to utilize the power of the subconscious mind to focus on solutions to the presenting problem that brought the person to therapy. He could induce a trance with a handshake or a story. Sometimes he used a confusion technique, framing his words with a deliberate complexity that caused confusion. This put the listener off-guard and receptive to suggestions aimed at the subconscious. The immediate results of some of his interventions would appear miraculous to someone unaware of the techniques being employed.

A well-told story can put listeners in a trance. Erickson was a master storyteller, as well as a master at crafting strategic metaphors that were aimed at the subconscious mind, pointing toward solutions. His verbal presentations – whether in conversation or telling a story – were often layered, talking about one thing on the surface, but using metaphors designed to become embedded at the subconscious level. Sometimes he’d prescribe specific activities related to the metaphors he employed, to amplify the embedding.

An example of this is a case history I remember reading, about a client who was an alcoholic. Erickson first asked questions until he felt he had a good understanding of the client’s life situation and his history of problem drinking. Then he gave a rambling discourse about cacti. “There are many varieties of cacti, but they all have one thing in common. They hardly ever need rain, because they have an amazing capacity to retain all the moisture they need. It’s like they’re never thirsty.” Having planted a strategic metaphor about thirst and resiliency, he then directed his client to take a hike on a specific nearby hiking trail (Erickson lived in Phoenix) the next day and study all of the different kinds of cacti. As I recall the case history, the client got and stayed sober after this strategic intervention. There are many such documented stories of Erickson’s successful brief therapies.

In his later life Erickson suffered from post-polio syndrome and lived with daily, severe pain, which he controlled using self-hypnosis. He knew first-hand how to harness the amazing powers of the subconscious mind, and taught many others how to do this. He frequently taught his clients self-hypnosis, for pain control as well a for anxiety and other psychopathologies. He was the founding president of the American Society for Clinical Hypnosis, and had a major influence on brief therapy, strategic therapy, family systems therapy, and Neuro-Linguistic Programming (NLP).

Albert Ellis

In my post “The Gloria Sessions” I wrote about a three-part video series titled “Three Approaches to Psychotherapy”  in which a brave young single mother named Gloria had brief therapy sessions with three of the twentieth century’s giants of psychotherapy. The three therapists were Dr. Carl Rogers (client centered therapy), Dr. Fritz Perls (gestalt therapy), and Dr. Albert Ellis (rational therapy). Little did I know  when I saw the series in grad school that I would actually meet two of these luminaries. I’ve already described my encounter with Carl Rogers. I’ll conclude this post with an account of my brief exchange with Albert Ellis.

Ellis is best known as the creator of Rational Emotive Behavior Therapy (REBT), and is widely considered one of the most influential psychotherapists since Freud. I first came across his work as a teenager, when I read his 1958 book Sex Without Guilt, which made the case that guilt about responsible sexual behavior is irrational. This was my first introduction to rational thinking, which made a lot of sense to me. However, parts of the book were (in retrospect) just his claptrap notions, like his theory of homosexuality – which was still considered a mental illness back then. He corrected his errors in later editions of the book.

Ellis was a foundational pioneer of what is now known as cognitive behavioral therapy (CBT), and I consider his A New Guide to Rational Living to be his single most important book. (He wrote or co-authored more than eighty books and many academic papers.) When I watched him in “Three Approaches to Psychotherapy,” I didn’t like his therapeutic style. He was the opposite of sensitive, gentle, avuncular Carl Rogers; he was a fast-talking, abrasive New Yorker, who seemed impatient in his dealings with Gloria. But I couldn’t argue with his logic, and Gloria seemed to get something from the session.

Although behavioral therapies weren’t popular in my humanistic Masters program, I started learning and practicing rational thinking in the eighties, and began teaching it in my clinical practice. Being a rational thinker has spared me a lot of unnecessary pain, and I’ve been known to say that if I had a Gospel to preach as a therapist, it was the Gospel of Rational Thinking. REBT focuses on the rational analysis of irrational and self-defeating beliefs and behaviors. Ellis continued to write and lecture and do therapy until shortly before his death in 2007, at the age of 93. He has been charitably described as having a “provocative personality.” I was in the audience for several of his presentations at Evolution of Psychotherapy conferences over the years, and witnessed his provocative style first-hand.

For one thing, his presentations were laced with profanity, and his response to any objections about his language was usually  along the lines of “F _ _ _ you!” If you didn’t like the words he chose, that was your problem. He was still the abrasive stereotypical New Yorker I’d first seen on videotape in grad school; but I’d come to appreciate his personality and his delivery, as well as his contributions to psychotherapy. He made the point in his public speaking that it’s what you say that  matters, not so much how you say it. In his own way he echoed Fritz Perls’ idea, “I am not in this world to live up to your expectations and you are not in this world to live up to mine.”

At an Evolution of Psychotherapy conference I happened to find myself on the same elevator as Dr. Ellis and his small entourage. Seizing on the opportunity, I asked him, “Dr. Ellis, didn’t you write a book titled Sex Without Guilt?” “Yes I did. Did you read it?”  “Yes I did.” “Did it help you?” “I’ve read several of your books and I think I’m a better man for it.” Dr. Ellis grinned at me and said, “I’ll bet you’re a sexier  man for having read Sex Without Guilt, too!”

I don’t know about that, but I do know that Ellis’ influence made me a better therapist. He enhanced my ability to reach some clients, helping them to understand that they didn’t need to feel guilty about being a sexual person, with sexual feelings and needs.

The role/goal model

There are many models of human behavior in the field of psychology, among them the psychoanalytic, behavioral, gestalt, and dialectical models. Most have their utility, but none of them is “the best,” or explains everything. A model is just a description or a map and, as I quoted in a prior post, “the map is not the territory.” I haven’t written about what follows in any formal or comprehensive way yet, but I’ve come up with the bare bones of my own model. I think it’s original, and helpful in explaining certain unconventional or extreme behaviors – as well as many common ones. I call it the role/goal model. It has to do with motivation and it’s rooted in social psychology.

We all play multiple roles in our lives, some of the more conventional being spouse, parent, employee (or boss), host, and caregiver. Other roles have to do with one’s profession or skill set, and yet others are unconventional and highly specialized. Behaviors appropriate to one role in a person’s life – for instance sexual expression within a marriage – are inappropriate in other roles. If a drill sergeant behaved at home like he did at work, it would be domestic abuse.

Many behaviors are motivated by the desire to feel good about ourselves for fulfilling the expectations of a given role, whether that role is father, wife, breadwinner, merchant, healer, or evangelist. You may not feel like getting up when the alarm goes off at six, but in service to your role as family provider, you get up on time and prepare to go to work, day after day. The goal of such persistent behavior is the feeling of satisfaction you get from providing for your family’s material needs. You know that if you don’t get up and go to work most workdays, you won’t get a check on payday. You’ll fail to meet the goal of the breadwinner role, your family will suffer, and you’ll feel terrible about yourself.

Many times in my life I’ve heard people say things like, “He did that for no reason!” In fact, people don’t do things without a reason, and a more accurate statement would be “He did that for reasons I don’t understand.” We might have a hard time grasping what would motivate a person to torture animals, or purposefully start a forest fire, or shoot schoolchildren, or coax cult followers to drink a fatal dose of poison. I think this model helps to make such behaviors comprehensible.

The role/goal model explains conventional or extreme behaviors by identifying the role that a person perceived herself to be in at the time of the behavior, and the goal of that role-appropriate behavior.  For instance, a mother who has never acted-out violently in her life might inflict severe bodily harm on a stranger, if he was threatening her children with violence. Some roles, like mother, are conferred by circumstance; other roles are self-conferred and may be secret, or unrecognized by others. Self-conferred roles include Rescuer/Hero, Tragic Hero, Devil, Martyr, Outlaw/Rebel, Victim, Player, and “Secret Agent.” Identifying the role and the goal explains almost any behavior that isn’t due to psychotic mental processes.

By Secret Agent I don’t mean a literal spy {although “spy” is an example of a rare and highly specialized role), but someone who acts in secret, or has a perceived “secret identity.” I think that role descriptor helps to explain many aberrant behaviors, such as serial arson or serial rape. Examples: “They think I’m a Nobody, but I burn down forests.” “Women trust me because they think I’m a nice guy.” People like this get off on not only the feeling of power they experience when they commit their crimes, but on their daily feelings, when they think “Nobody knows who I really am” or “She doesn’t know that I want to rape her.”

A less extreme example is the role/goal analysis of an obnoxious, Bible-thumping street preacher who thinks he’s preaching on the street because God wants him to. What motivates him to persistently shout at strangers who don’t want to listen to him? The role/goal model posits that he’s in the evangelical role, and what could be more important than saving souls? The behavior is motivated by the attendant feeling, not the sure knowledge that souls will be saved. People in such a self-appointed role believe that their objective (i.e. saving souls from damnation) is what’s driving their behavior, when in fact their role-appropriate, goal-directed behavior is motivated by the feeling that they’re doing the most important work of all, God’s work.

The goal of the Hero is to be admired for his achievement or strength. The goal of the Tragic Hero is to get sympathy and to justify his helplessness in the face of insurmountable odds. The goal of the Victim is to gain something by being pitied. The goal of the Martyr is to be admired for her sacrifice. The goal of the Player is to get over on people. The goal of the Rebel/Outlaw is to get away with breaking the rules. The goal of the Devil is to raise Hell. The goal of the Rescuer is to feel powerful and to take credit for someone else’s survival or success. None of these roles exists objectively, but in subjective perception and the attainment of consequent, predictable emotional states. The feeling state is often the  goal of the behavior, although it will be rationalized as role-appropriate and goal-directed.

Emotional expression is modulated by both role and goal. An emotion is suppressed if it’s seen as inappropriate to the role or unhelpful in reaching the goal, i.e. never let them see you sweat if you’re in the Hero role. The emotion is exaggerated for effect if it’s seen as role-congruent and/or helpful in reaching a goal, i.e. the Boss’s display of anger, or the Victim’s tears.