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).

Metaphor and storytelling in therapy, Part 2

Throughout most of my mental health career I was blessed with good supervision. My first clinical supervisor was a PhD licensed psychologist, Dr. Robert Klein. He taught me a lot, including a procedure for helping enuretic children – bedwetters – to “keep a dry bed” when their families were trying to force them to “stop wetting the bed.” Using this procedure I was able to help several enuretic children to overcome their problem quickly. In one instance, it only took one session for a boy to immediately start keeping a dry bed. The procedure uses storytelling in two different ways, to role-model the desired outcome – as well as a family systems intervention.

This is the sequence I’d learned: After establishing some degree of rapport with the anxious and humiliated child, I’d tell him – in front of his parent(s) – a very brief generic story about “a boy your age” with the same problem, who’d gotten over the problem as quickly as it had started, after seeing a counselor. This provided a ray of hope for a child who desperately wanted to stop wetting his bed, but was clueless as to how to do it.

Then I’d do a family systems intervention, to change the family’s response to the problem, and to get the family to start promoting success, rather than punishing failure. I’d explain that the problem was caused by anxiety ( or “nerves”), and when the boy stopped worrying about bedwetting, it would stop. I’d instruct the parent(s) to stop shaming and punishing the child for “wetting the bed,” and encourage them to talk instead about “keeping a dry bed.” Any siblings should be instructed not to tease their brother. Once I felt confident that the parent(s) understood the plan and that the family would stop blaming and punishing their child, I’d speak to him individually.

By this time, the boy saw me as an ally, one who’d asked his family to stop shaming and punishing him, and who’d predicted quick success. I’d tell him, “There’s a part of your brain that never sleeps” (it’s called the reticular formation), and predicted that when his bladder got full when he was asleep, that part of his brain would wake him up, so he could go pee in the toilet. Then I’d ask him to name his favorite hero, so I could craft a story especially for him. If he said Spider-Man, I’d make up a story on the spot about Spider-Man defeating some supervillain, then going home. There Peter Parker would eat supper, pee, and go to bed. When his bladder got full in the middle of the night, he got up and peed in the toilet, and woke up after sunrise in a dry bed.

Somehow this simple story that models the desired behavior, using a role-model chosen by the child, helps him to be less anxious and to wake up when he needs to pee. In the case of my “one-session enuresis cure,” when I saw the boy’s mother weeks later, I asked her how he was doing and she told me he’d kept a dry bed since the day we met. I asked her how she understood what had worked for him, and she replied, “He said you’d told him that there’s a part of his brain that never sleeps.” Using metaphors and stories that predict success, and give the  client reasons to expect it, can be very effective in therapy.

Therapists who are good at storytelling can craft stories on the spot, or collect teaching stories and select the right one for the right client and situation. The following story, slightly modified, comes from therapist and author Bill O’Hanlon. It’s a good story to tell people whose lives are affected by phobias and irrational fears: The abbot of  a monastery had to go to town for the day, but he hesitated because every time he went away, the monks got into some kind of trouble. The monks urged him to go, promising to stay out of trouble, and not leave the monastery until he returned. So the abbot set out the next morning. Not long after he left, the monks heard a loud knock on the heavy oaken door to the great hall. One of them went and opened the door. He found himself facing a hideous, slimy demon, with a mouthful of fangs and claws like razors. The monk screamed and jumped back, and the demon entered. Other monks heard the screams and ran to the great hall, where they saw the demon menacing their brother and growing larger before their eyes.  They started screaming, too, and the demon grew even faster, towering above their heads.

When the abbot returned, he knew right away that the monks were in trouble again, because the door to the great hall was open, and he heard screaming inside. He entered, closing the door behind him. He saw the huge demon growling and menacing the monks, who cowered in a corner, trembling and screaming. Calmly, the abbot walked over to them, saying “Hi, demon” offhandedly as he passed him.  “Look” he said to the monks, “This demon eats your fear and it makes him grow, but he can’t hurt you. Ignore him.” Comforted by their abbot’s calm presence, the monks stopped screaming and stood up; and the demon started to shrink. Then, to their surprise, the abbot started laughing and telling jokes. Soon all the monks were laughing, and the demon continued to shrink until it was the size of a mouse – its actual size. It couldn’t leave because the door was closed, and the monks decided to keep it as a reminder not to let themselves be ruled by their fears. The abbot told them, “Fear cannot grow where there is heart and humor and laughter.”

If you’re a therapist or are studying to be one, I recommend Bill O’Hanlon’s website <billohanlon.com> as a gateway to a treasure trove of resources. He studied under Dr. Milton Erickson, one of the giants of psychotherapy, whom I’ll be writing about in future posts. Bill has written over 30 published books, and has written about how you can write and publish your book. I got the fear demon story from his CD of stories, “Keep Your Feet Moving: Favorite Teaching and Healing Tales.”