On Hypnosis (Part 24/26)

Guarding Against Suggestion in Primal Therapy

It has been argued that suggestibility operates in Primal Therapy; that patients come with certain expectations which they self-fulfill. Because a patient thinks he will get well he does; he feels Pain because he expects to feel Pain; he has a Primal because he thinks he will, and so forth. Certainly the potential for suggestibility exists. But if the therapist does not offer suggestions, that possibility is no longer possible. Wherever there is primal need you inevitably encounter suggestibility; because it is ultimately need that you are manipulating. There is no power greater than need to move and motivate human beings. A neurotic is always in search of a suggestion. "Do you think this dress suits me?" "What shall we order for dinner?" "Do you think we should go to the Jones house?" Suggestibility, whatever its form, must hook on to basic unfulfilled need to gather its sources for power. 

We are well aware that people come to us full of hopes and needs, both real and unreal. It is up to us to recognize which are which. We can do this best by first having sorted out our own needs before listening to someone else's. Then we may better trust that our judgment, perception, intuition, and instinct are not being distorted by our own Pain and need. 

In Primal Therapy we recognize the possibilities for suggestion but we take measures to counteract them. For example, we might slow down the defensive maneuverings of the rational-analytical mind so that feelings have a better chance, but we do not attempt to dislocate or hide this level of consciousness. We aim instead to see that feelings pass through it. We want the patient to be fully aware of what he is doing, saying and feeling. He is engaged in a profoundly important experience, so it makes no sense for part of him to be off somewhere else.

The patient-therapist interaction is also an important tool of therapy. The trust of the therapist and a willingness to follow his suggestions in the therapy in order to get to feelings do contribute to success, but there must be a crucial balance. We do not want the therapist to be a pied piper while the patient, in trance, follows passively along to another's tune. It is the patient's life, it is the patient's sickness, and above all, it is the patient's therapy. He is not simply a passive recipient of "suggestions" or insights from a therapist. His unconscious "knows" what happened to him, even if his conscious mind does not. He has the answers. We don't. It is only arrogance that would lead us to believe that we know better what is inside someone's head than he does. His reality sets the scene and determines the course. The patient, then, must lead the way.

Sometimes the neurosis tries to take the lead because it resists the move towards Pain. At this point the therapist intervenes in the role of the agent supporting the expression of Pain. The therapist may see ahead of time where the patient is headed, but, unless a helping hand is clearly needed, he lets the patient arrive there in his own time. Although the "lead" keeps changing hands, the direction is determined by the patient's history and physiologically-imprinted experiences. Healing is not a question of the therapist trying to influence or "change" the patient. Healing does not emanate from outside. It develops from the inside, like all healing processes, from a cut to a burn.

The argument that Primal Therapy operates by virtue of suggestibility is invalidated on several points. One factor is that a person without Pain would not invest the time, money, and inconvenience to come to a therapy, particularly one that offers pain, not pleasure as its immediate goal. Inevitably, the pleasure will follow the Pain. But Pain is primordial and there is no fully enjoying pleasure until Pain and its handmaiden, repression, are removed. Physiology does not permit us to skip steps. We have no need to act out Pain or to expect it unless it is there. At least I have yet to meet a truly healthy person who would choose to spend his time and money acting out a painful childhood and then act as if he had recovered from it. By virtue of such behavior a person would reveal himself to be staging some sort of neurotic scenario.

Secondly, the notion that one can suggest oneself into being well is to seriously mistake the meaning of the word "well" and the state which it describes. Suggested health is shallow and unreal because it is global; it is simply superimposed. This kind of mask of health does not look, sound, or feel right to those who enjoy a more interconnected consciousness, but it can fool others. We never automatically accept a patient's professions of himself as well because to do so would be to take a superficial view of health and human reality. For it would ignore the deeper physiologic processes of brain and body and the disease which permeates them. Someone can think "well," look "well," behave "well," but still not be well. This is why Erickson's claims that one hypnosis session can forever banish violent lifelong somatic headaches or make the adult affects of childhood trauma totally vanish do not ring true to me. 

In Primal Therapy we know that we can use (and have used) objective indices of change to guard against suggested cures as a result of patients reading my books and acting out preconceptions. These objective indices are based on the knowledge that Pain has physiological correlates. Patients who do not truly feel Primal Pain will not register significant short-term (after a single Primal) or long-term (over a period of therapy) changes in their vital sign readings. Even if the patient expects to get better and believes that he is better, we do not consider this valid unless his vital signs so indicate. (This form of assessment is not always necessary because an experienced and sensitive therapist can reliably match the conclusions drawn from vital signs readings by intuitive judgement.) The point is that we, like other therapies, would be as vulnerable to the argument of cure based on suggestion if we were to accept the subjective, third-level reports of patients alone. 

The third important reason for the lessened possibility of suggestibility in Primal Therapy is that generally one suggests someone away from Pain not into it. The classic experiments in hypnosis nearly always involve not feeling pain. It is far more seductive to be offered something that will counteract suffering, that would allow one to conquer it, to surmount it, to rise above it, but never to feel it. People are attracted to hypnotherapy precisely because they want the easy way out; they are already seduced by the notion of a magical therapy where everything happens unconsciously. They already are ready to flee Pain.

As the intellect becomes increasingly overtaken by the rising feeling of need and of Pain, one sees how easy it would be to inject the patient with one's own interpretations and suggestions -- to brainwash. One witnesses the susceptibility and gullibility fostered by years of unmet need. There is the need to trust and believe in someone, the need to follow and be taken care of, the need to be told what to do, the need for explanation and comfort, and so on -- all of the urgent needs that in some cases make a person believe it will be beneficial for her to be seduced by her therapist, as in Erickson's case study.
From a psychotherapeutic standpoint, when one sees all this, one has a choice. Either you suppress the need and Pain with mollification, "education," substitution of ideas, and counter-suggestion, or hand back the need and Pain so that it may be experienced through to its roots and finally resolved. Any therapy which does not deal with Primal Pain as its primary goal can never resolve neurosis or its symptoms. It is ineluctably non-dialectical and reactionary. The same can be said of any political system, as well. Either you fulfill need -- personal or social -- or you suppress it.

The pervasiveness of need explains why someone who can elicit Painful scenes in hypnosis stops short of allowing the patient to experience these traumas consciously. The nerve ends of the therapist's own deepest hurt are too exposed for comfort. When the discoveries of the patient put him disquietingly close to his own unconscious Pain, he may take repressive measures by encouraging the patient to "shove it back down," or by diverting him with suggestions which counter the painful reality. This is what we might call Painwashing .