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).

Hypnosis

Hypnosis isn’t just one thing, but describes a range of mental states in which one is receptive to suggestions. Stage hypnosis and clinical hypnosis aren’t the same phenomenon. There are a number of popular myths and misconceptions about hypnosis, and several models to explain hypnotic phenomena. I learned the basic techniques of hypnosis in grad school and practiced on friends. But since I never got certified as a hypnotist, I limited the use of hypnotic techniques in my clinical practice. I usually only did one “trance induction” per client, when it seemed appropriate, with the goal of teaching them self-hypnosis while they were “in a trance.” Outside of work, I’ve hypnotized friends at their request, for such things as pain relief.

I put quotation marks around trance because trance induction is only one model – the best known – for hypnosis; but no model is perfect for all occasions. (See my past post on the Model Muddle.) Traditional trance induction involves a verbal induction, which may start with something like “You are getting very sleepy . . . .”, sometimes accompanied by a visual stimulus such as a pendulum, whose motion the subject is told to follow with his eyes. But some verbal inductions suggest that the subject’s eyelids “are getting very heavy” and will soon shut. A technique called guided fantasy can also induce a trance, as can a well-told story.

Stage hypnosis is another thing entirely. The silly on-stage behaviors  of the “hypnotized” volunteers from the audience appear to be best explained by a social role model of hypnosis. This role-playing proceeds from one of the popular myths about hypnosis: that the hypnotist can control his “subject’s” behavior. Anyone who comes forward when the stage hypnotist invites volunteers is a wanna-be performer, predisposed to do whatever he’s told. The hypnotist “auditions” the crowd to see which people are the most suggestable, weeding out the less suggestable. The volunteers he selects to go on stage know they’re absolved of all responsibility for any silly  thing they may do, because they’re seen as being under the hypnotist’s control. He earns his paycheck before his subjects are on stage, because he knows the people he’s selected will act-out the role of hypnotic subject, as it’s popularly understood.

Some people are better hypnotic subjects than others, and clinical hypnotists have ways of assessing “depth of trance” before making therapeutic suggestions. They don’t exert control over the behavior of their clients, but help them harness the power of their imagination and will, to bring about desired changes in behavior. A good hypnotic subject is one who wants to experience a trance state, and expects something good to come from it – if only a feeling of relaxation. It helps if the subject thinks hypnosis can help them achieve a desired goal, such as pain control, quitting smoking, or losing weight.

A good subject can be taught self-hypnosis, and learns that any power she’d thought resided in the hypnotist in fact resides within herself. When a placebo pill works to relieve pain, it’s because the person taking it wants and expects it to – another example of how motivation affects perception. People can learn to use trance to re-direct their mind away from pain,  or from nicotine cravings. Naturally occurring events can  temporarily result in relief from pain. If you were flying in an airliner while you had a splitting headache, and the plane experienced extreme turbulence for two minutes and seemed to be falling out of the sky, it’s likely that you’d lose all awareness of your headache for those two minutes. If panic can re-direct the mind away from pain, so can other things.

Post-hypnotic suggestions can help people to change behavior, but there’s nothing magical about their power. A hypnotist working with a client on smoking cessation will give positive suggestions while he’s in trance, then may give post-hypnotic suggestions that he won’t feel like smoking after the session, and if he does smoke, the cigarette will taste terrible. What the hypnotist can’t supply for the client is willpower. If the client takes a puff after the session and throws the cigarette away because it tastes awful, this experience may help him to fight cravings and stop smoking. But if he resumes smoking despite the initial bad taste, the post-hypnotic suggestion quickly fades.

The only “magical” element of hypnosis is the magic of the human imagination. Hypnotic subjects don’t lose control in trance, and can’t be hypnotically forced to do things they don’t want to do. People can’t get “stuck” in trance. While positive hypnotic suggestions can help people marshal their inner resources to change chosen behaviors, there’s no truth to the notion that it can improve memory or sharpen the recall of details of past events. Indeed,  it can encourage the development of false memories.

In a later post I’ll be writing about Ericksonian hypnotherapy, which revolutionized our understanding – and the practice – of clinical hypnosis in the latter half of the twentieth century. Dr. Milton Erikson was a genius psychotherapist, whose influence on the profession is evidenced by the fact that the Milton Erikson Foundation sponsors the Evolution of Psychotherapy conferences – the world’s largest convocation of psychotherapists.