On Hypnosis (Part 21/26)

(There are 6 more articles to come on Hypnosis...)

We view hypnotherapy as a process whereby we help people utilize their own mental associations, memories, and life potentials to achieve their own therapeutic goals. Hypnotic suggestions can facilitate the utilization of abilities and potentials that already exist within a person but that remain unused or underdeveloped because of a lack of training or understanding.[1]

In Erickson's terms, trance is a time during which "the limitations of one's usual frames of references and beliefs are temporarily altered so one can be receptive to other patterns of association and modes of mental functioning that are conducive to problem-solving."[2] Hypnotherapy, then, is a "learning process for the patient, a procedure for re-education.[3] [Emphasis added] Erickson's approach deals with the casualties of neurosis (the "learned limitations"). He believed that it was his role to actively change patients -- to use hypnosis and post-hypnotic amnesia to help them restructure their thinking. He viewed hypnotherapy as process for/of restructuring thinking.
Prominent psychotherapist and researcher Jay Haley studied Erickson extensively. The titles of two of his books on Erickson -- Uncommon Therapy: The Psychiatric Techniques of Milton H. Erickson, M.D. (1973), and Ordeal Therapy (1984) -- suggest the idiosyncratic nature of Erickson's techniques. For example, Erickson had a propensity to employ sexist language, verbal assaults, and other bullying approaches when treating women.[4] He was also an authoritarian therapist, as seen in the terms he dictated to a "plump," unhappy, unkempt, and unloved 35-year-old woman who had come to him for treatment:

These terms are absolute, full, and complete obedience in relation to every instruction I give you regardless of what I order or demand...You will be told what to do, and you will do it. That's it. If I tell you to resign your position, you will resign. If I tell you to eat fresh garlic cloves for breakfast, you will eat them...I want action and response -- not words, ideas, theories, concepts...Once you come, you are committed to therapy, and your bank account belongs to me as does the registration certificate for your car...I will tell you what to do and how to do it, and you are to be a most obedient patient.[5]

To "re-educate" this patient, from whom he had demanded complete obedience, Erickson induced a trance and then said to her:

"You are five feet three inches tall, and you weigh about 130 pounds; you have trim ankles, an excellent figure, a beautiful mouth and beautiful eyes..." Then, in a tone of voice of utter intensity, in the manner of conveying a vitally important message, she was asked the following question: "Ann, did you know that you have a pretty patch of fur between your legs?" For some minutes Ann stood staring at the author, blushing deeply and continuously, apparently too cataleptic to close her eyes or to move in any way. "You really have, Ann, and it is definitely darker than the hair on your head. Now at least an hour before bedtime, let us say at nine o'clock tonight, after you take your shower, stand in the nude before the full length mirror in your bedroom. Carefully, systematically, thoroughly examine your body from the waist down...Try to realize how much you would like to have the right man caress your pretty pubic hair and your softly rounded belly. Think of how you would like to have him caress your thighs and hips..."[6] Erickson's idiosyncracies - example {tt203}

Erickson's theories and techniques notwithstanding, a person's self-image does not remain poor, nor do her abilities remain undeveloped, because of limited "frames of reference" or "a lack of training or understanding." Adult neurosis is not the result of cognitive distortions; it is the product of correct cognition which is out of context. Childhood trauma alters one's perceptions to accommodate the Pain. When one's perception is altered, one sees hurt as an adult where none exists. "Can I help you?" becomes, "You think I'm helpless, don't you?" Furthermore, spontaneity and free feeling are not something we "learn"; children simply are spontaneous and free feeling until deprivation and injury intervene. A child whose father is too busy to notice him does not have "learned limitations"; he has the raw feeling of neglect. The child who is physically or sexually abused does not have "learned limitations"; she has the brutal pain of assault and violation. Her underlying fear and therefore distorted perceptions later on reflect an original situation that engendered lifelong fear. To be afraid of airplanes is to have fear from the past placed out of context in the present. ( adult neurosis is the product of correct cognition which is out of context {tt204} )
Learned limitations are the last outcrops of the neurotic process. They represent what Freud called the Superego. They are the acquired inhibitions impressed into the child's brain by parents when at last she has sufficient intellect to register and code inhibition. A stern look by a parent every time the child cries is an example. She "learns" not to cry on an emotional level without any words being spoken. The implicit factor here is fear of loss of love of the parents. If there is no real contact between parent and child, there will be little learned inhibition. Love has already been lost.
To assume that changing one's beliefs about oneself involves reeducation, training, or problem-solving is to assume incorrectly that beliefs, particularly about oneself, are rooted solely in cognition. Beliefs are the product of our experiences, and the source of "limiting beliefs" is a childhood with inculcated prohibitions about everything from how one eats to how one holds one's jaw.

A great deal of Erickson's hypnotherapy centered around the development of indirect suggestions that would "bypass" the conscious mind and lodge squarely and educationally in the unconscious mind. Since intellectual language is the province of the cortical mind, using language to bypass it requires some very clever wording. Erickson's skill at devising these clever linguistic loopholes, termed indirect suggestions, was unparalleled. Moreover, his use of indirect suggestions to bypass consciousness has become a model for much of the hypnotherapeutic community. This is the cognitive approach taken to its limit: there are suggestions called "double dissociation double binds" and those termed "conscious-unconscious double binds" -- not to mention compound, contingent, and associational suggestions. All in all, Rossi organized Erickson's indirect forms of suggestion into some 30 different categories, which he arrived at by simply analyzing the linguistic structure of the suggestion.
Erickson fully believed that suggestions which could not be understood by the conscious mind would be understood and acted upon by the benevolent unconscious mind. Indeed his trust in the unconscious was almost childlike:

You don't have to listen to me because your unconscious is here and can hear what it needs to, to respond in just the right way. And it really doesn't matter what your conscious mind does, because you don't have to listen to me because your unconscious is here and can hear what it needs to, to respond in just the right way. And it really doesn't matter what your conscious mind does, because your unconscious can find the right means of coping with that pain.[7]

Somehow the unconscious would then understand the message of a follow-up suggestion such as, "You can as a person awaken, but you do not need awaken as a body"[8] -- even as the conscious mind puzzled and fretted over its cryptic meaning. For Erickson, indirect suggestion was a cognitive means of bypassing cognition en route to a more beneficent unconscious which could hear, comprehend, decipher, solve, and heal all that consciousness could not. The problem with this viewpoint is that it is contradictory. On one hand, Erickson believed that consciousness could be bypassed by using intricate linguistic devices (ambiguities, metaphors, paradoxes, etc.) in the form of indirect suggestions which the conscious mind could not decipher. On the other hand, he assumed that the unconscious mind would be able to magically sift out the hidden meaning that had so eluded consciousness. The first contradiction is that he attempted to reach the non-verbal levels of the unconscious by using complex verbal techniques. The second contradiction is that in bypassing conscious-awareness, he was bypassing the one level of consciousness that contains the cognitive skills to actually comprehend his suggestions. And in bypassing consciousness he was bypassing exactly the element needed to stimulate the processes of healing and repair
None of this matters much to a person in Pain, and Erickson's viewpoint certainly spoke to the pained child in any adult. However simplistic or contradictory it might have seemed upon close intellectual scrutiny, his notion of the unconscious was comforting and promising. Indeed, it was made even more comforting (and believable) by virtue of Erickson's own personality and history.
In the last three decades of his life, Erickson was a living picture of the wise and comforting grandfather -- white-haired, penetrating, jocular, kindly, and crippled. Of far greater impact was the fact that he had lived out in a very poignant way the archetype of the wounded physician who learns to heal others by first learning to heal himself. At the age of 17, Erickson had almost died from an attack of polio that left his entire body paralyzed. As a teenage farm boy with nothing more than a rural education behind him, who was now still able to speak and see but unable to move any part of his body, he managed to find ways to use his mind to rejuvenate his muscular and motor abilities. Within a year-and-a-half of his attack he was able to walk unaided. Soon thereafter he entered medical school. Then at the age of 52 he experienced the rare medical tragedy of a second attack of polio, which robbed him of his upper-body strength and left him permanently confined to a wheelchair. He lived in constant pain and discomfort in the last decade of his life, but he continued to create ways to deal hypnotically with his disability and the physical pain it caused him. Patients knew this, and few remained untouched or uninfluenced by it.
The great poignancy in Erickson's history and physical presence must be taken into consideration in evaluating both his viewpoints and his impact. It would indeed be unfortunate if the course of psychotherapy as a field veered off into hypnotic realms in the hope of duplicating the often unprecedented results Erickson achieved professionally after coping with his own personal afflictions. His simplistic view of the unconscious has tended to be accepted uncritically, for example, by virtue of the results he achieved (by his own accounts) in applying it clinically. The question remains as to whether patients were responding to an intrinsic principle of consciousness rightly perceived and utilized by Erickson, or were they responding to the influence of an inspiring and seminal personality
{tt210}
Part of the trouble with Erickson's approach to therapy lies in his assuming the role of an omniscient, infallible figure. Jay Haley describes Erickson as "the first major clinician to concentrate on how to change people...influencing people with hypnosis, persuasion, or directives, Erickson...seems to have been the first major therapist to expect clinicians to innovate ways to solve a wide range of problems and to say that the responsibility for therapeutic change lies with the therapist, rather than with the patient."[9] Should a psychotherapist really be so concerned with "influencing" and "changing" his patients? When you combine this attitude with the needs of a patient, you have a formula for continued repression.


[1]Milton H. Erickson and Ernest L. Rossi, Hypnotherapy: An Exploratory Casebook (New York: Irvington), 1979, p. 1.
[2]Ibid., p. 3.
[3]Ibid., p. 9.
[4]See Masson, J., Against Therapy: Emotional Tyranny and the Myth of Psychological Healing. New York: Atheneum, 1988, 224-234.
[5]Innovative Hypnotherapy: The Collected Papers of Milton H. Erickson on Hypnosis, vol. 4, ed. by Ernest L. Rossi (New York: Irvington, 1980), 482-90.
[6]Innovative Hypnotherapy, 482-490.
[7]Erickson and Rossi, Hypnotherapy..., p. 45.
[8]Ibid., p. 47.
[9]Jay Haley, ed. Conversations with Milton H. Erickson, M.D., vol. 1, Changing Individuals (New York: Triangle Press, 1985), vii.