Journal (articles & reflections)

To recap, Erickson’s approach emphasises the use of Hypnosis to help clients learn to use their own potential to accomplish therapeutic goals. So he would organise the session around the unique experiences, difficulties and resources of each individual client.

The difference between his approach and classical methods is that the power of the suggestion is derived from the clients associations to it rather than its authority or repetition. He asserted that encouraging clients to explore their natural resources can be much more productive than using the direct style of trying to make them consciously follow repeated instructions and commands.

His style of “Accepting and Utilizing” can be much more challenging than using standardized scripts but has the potential to become more therapeutically significant to the client because it is personally relevant. Building up a therapeutic alliance in this way also creates rapport and expectation. A further consequence of this method is that the transition from “Conversation” to “Induction” to “Deepening” can sometimes become blurred into one process.

He lists his initial objectives as follows:

* Acceptance and Rapport.
* Response Attentiveness and Optimism.
* Assessing abilities and resources (e.g. frames of reference).
* Transforming frames of reference which guide behaviour
* Creating Expectancy.

He uses indirect (the permissive and accommodating style) suggestion to implement the resources he identifies. The difference can be seen in comparing the two styles …

Direct programming: “You are going into trance.”

vs.

Indirect suggestion: “You can comfortably learn how to go into trance.”

He believed that indirect suggestions, help the unconscious mind search for more subjective solutions that are elusive to the conscious mind without challenging the Client directly through a confrontation with the clients critcal faculties (Xref: Part.1.1)

Rossi coined the phrase “Interspersal Approach” to describe the method of presenting words that evoke an exploratory response within each suggestion.

The suggestion below, given to a client who felt her feelings were being repressed illustrates interspersal …

“Notice how good it feels to describe those feelings as freely as you wish”

Repression vs. Freedom is the clients theme, which is echoed indirectly in the suggestion. It becomes the common denominator … the interspersal avoids the habitual responses of the conceptual mind and elicits a subconscious scan of even unlikly possiblities and subsequently comes up with an association of subject and object at a deeper linguistic level .

Another variation is to intersperce the clients situation within a story or a metaphore, such as …

“When I express my feelings so freely I feel so relieved …

… its as if they have escaped, and I’m glad to let them go.”

This is a surface struture metaphore because it relates fairly directly to clients concern.

A deep struture metaphore doen’t have the same obvious relationship, but it does have an association, a relationship or a resonance with, some deeper resourse the Client already has which have the potential to provide insight.

Shaun Brookhouses’ example - The Trucker who felt uncomfortable with the “mean” truckers image - and became a gardener after listening to the Cinderella story, which has the theme of transformation.

Notice that a theme is identified but there is no interpretation going on because Erickson held that interpretation at its best was overly simplistic. He left interpretation to the Clients own subconscious, which can make its own associations because a metaphore is inherently a generalisation rather than a specific experience. As we discovered in eliciting creative visualisations (Xref: Part.1.5) a generalisation is more likely to create homeopathic resonance and less likely to step on our clients toes.

Which brings us back to that familiar old dog … “like cures like”!

Trevor Silvester launches straight into the Wordweaving process. The traditional induction and deepening are dispensed with! It begs the question, “What is trance, then?”

Actually suggestions can be dropped into conversation.   I have tried to weave them into a phone call to an anxious friend … for example, the following suggestion presupposes that she will notice a difference in the near future …
“You may find yourself noticing that the anxitiey in you stomach has been very much relieved in the next day of so”.
It will be interesting to see if they have helped.

Traditional Psychodynamic Psychoanalysts aimed to foster a transference relationship, in which the clients were encouraged to project their feelings onto the therapist who tried to remain impartial and almost anonymous. Negative feelings about past relationships were aired in this manner, sometimes using free association to discharge memories, and the therapist subsequently gave his interpretation.

In the post Freudian, Jungian era the attention was more of a therapeutic alliance, with the therapist expressing empathy. Free association was still the cornerstone of the process. Stack-Sullivan fostered a participant/observer relationship and introduced the idea of sitting at a 45degree angle to the patient, which is slightly less formal and gave each participant the opportunity to turn away and reflect. He paid attention to the way the clients communicated their concerns, not just what was being said but also how it was being said. He was an astute and unprejudiced observer of his own reactions as well as the clients, and like Jung, was interested in the projection and counter-transference of feelings.

The whole process became more open, and therapist and client collaborated. Jung developed the idea of a holding environment or space, so that the client would feel safe to talk freely. This was a move towards the Rogerian style of Client Centred Therapy.

The clients were encouraged to assume responsibility for their own problems and the therapist assumed the role of sympathetic and empathic listener.

Carl Rogers defines Empathy thus …

“… the ability to perceive the internal frame of reference of another with accuaracy … as if one were the other person…

… if this “as if” quality is lost, then one is in the state of identification.”

There was no formal assessment because it was felt the this didn’t help the client sort out their own goals. The responsibility for setting and accomplishing goals is shifted back to the client. A contract of roles and responsibilities is formed between client and therapist which states that, “this is an alliance in which I am facilitating you to help yourself”. The premise is that, “You have all the resources you need within you if you think it through”.

Rogers emphasised the importance of developing the clients trust in their ability to actualise their own potential within a supportive climate. He accomplished this by separating the client from the behaviour and from this attitude developed the concept of “unconditional positive regard”, which means he aimed to be an unprejudiced observer and provide an outgoing positive feeling without reservation or evaluation.

Miltons Erecksons attitude exemplified the Unprejudiced Observer…

“In dealing with people you try not to fit them into your concept … try to discover what their concept of themselves happenes to be.”

There are obvious ethical boundaries to U.P.R. but Rogers asserts that if we build rapport through congruence, empathy and regard the client may adopt these qualities. Autonomy is a wonderful and high minded qualtity to encourage in others, and as Rogers asserts our own insights are indeed more valuable to us than the therapists, but often insight needs a stimulus! One glaring shortcoming of his approach is that various clients need varying degrees of guidance! Most of us learn to walk before we fly, like Rogers, Maslow, Wilber, et al. to the dizzy heights of self-actualisation and autonomy.

Some client centered theorists abandoned the toolbox of therapeutic techniques and relied on the interpersonal encounter. (Fieldler’s research shows that it doesn’t matter which approach is used, either autonomous and humanistic or Psychodynamic, it is the interpersonal relationship that is the most significant element). As a result counselling, as a career, became available to anyone who had the time to do a few evening classes and hand in some minimal dissertation!

Empathy without challenge (Xref: therapeutics.1.2) is not a characteristic of Hypnotherapy today, even though the humanistic principles remain a cornerstone of the ideal therapeutic relationship.

Compare Rogers ideals of Client autonomy with Milton Ericksons “Utilization Approach” (Xref: therapeutics.1.3). He says:

“Suggestion can facilitate the utilization of abilites and potentials that already exist within a person …

… but that remain undeveloped because of a lack of training or understanding …

… we explore what life learnings, experiences and mental skills are available to deal with the problem”.

Erickson has developed a process of therapeutic intervention which still uses the Rogerian thesis that the answer lies within the therapeutic repertory of the patient. N.L.P. and Life Coaching theorists emphasies this even further.

Gerard Egan introduced structure to the counselling agenda by listening to the clients story using a Rogerian approach. He would then clarify the story to identify the blind spots and then focus on these priorities and challenge them in order to provide leverage to help move forward towards the clients goal (Ref: The Skilled Helper).

Along broadly similar lines Family Therapist, Jay Haley a developed a system known as Strategic Therapy in which the therapist takes responsibility for influencing people. He designed a five stage approach for each problem…

* Identify solvable problems

* Set goals

* Design interventions to achieve them

* Examine the responses

* Examine the outcome.

There three levels of trance; light, medium and deep, which can be observed or tested by the practitioner. The depth indicators below can be used to ratify the clients experience and build confidence in the process, because it is quite common for a new client to wonder is she/he was really hypnotised or not. Ideomotor signaling is often  used by the client to commuicate the changes she is experiencing.

They are presented in the same order as Aaron’s Scale.

Observations:

• If the position of the head relaxes.
• If the breathing becomes slower and deeper.
• If the limbs become limp and relaxed.

Tests: (The deeper states of trance are required for pain relief.)

• The inability to open the eyes (lid catalepsy).
• Arm catalepsy (arm becomes stiff following suggestion).
  
• Following suggestions (counting test).
• Glove anaesthesia (arm insensitive to pain).
• Positive or negative hallucinations.
• Somnambulism.

 When the client has accomplished the required depth, light or mendium, depending on the circumstances, we can offer post-hypnotic suggestions. These are usually suggestions that install something, such as confidence building, or remove something, such as an unwanted habit (Xref: therapeutics.1.1). These suggestions allow clients to change their feelings and behaviour both during and after the session, if they are reinforced sufficiently.

Engaging Cx in the visualisation of a previous experience of special place or an activity they enjoy can help produce deep relaxation, calmness and serenity. Such visualisations are more powerful if the Cx is encouraged to use all their sense modalities. If the Cx enjoyed horse riding she would be encouraged to ‘fill-in’ such details as the smell of the stables, the sounds made by the horse, especially breathing, the touch of the skin as well as all the sights of the yard.

In this type of visualisation the therapist cannot provide all the details of the content of such a visualisation because these arise from the Cx’s memories and imagination. The therapists instructions can only give an outline and structure to the visualisation. If the instructions on content are made as general as possible we will avoid contradicting the Clients ongoing experience or pushing her in what is perceived to be the wrong direction and breaking rapport.

If we suggest the Cx canters along the road whilst the client knows full well that her horse is nervous of cars the flow of pleasant feelings and sensations will be broken, even if only momentarily. This is a further example of how our suggestions are tested and rejected if inappropriate. It would be quite safe to suggest that the Cx is enjoying the sensation of the fresh air in her face, for example, but if we specify the sensation of the warm air in her face, when she actually take the horse for a run on a daily basis, whatever the weather we are creating unnecessary contradictions.

It’s also important to get the pace right, if we go too slowly the Client may become bored and distracted. Visualisations require quite some practice and skill to do well!

When the Cx is enjoying a comfortable relaxed state through visualisation we can create an anchor to this state so that it can subsequently be triggered. The simplest way is to ask the Cx to touch and press finger and thumb together whilst being aware of all the sensations, feelings, sights and sounds that are present.

Next time the Cx wishes to bring back this state, pehaps later on at home when learning self hypnosis, or when she experiences an unacceptable level or anxiety or stress, she can simply activat the anchored state with the same signal. Each time such an anchor is used the effect is compounded, and it becomes a very useful part of the Cx Hypnotic Toolkit.

This anchoring technique is using the “Law of Dominant Effect”, which is based on the idea that a strong emotion will replace a weaker one. In this case strong emotions are associated with the anchor.

Visualisation can be useful at almost any stage, including some conversational styles of induction, especially in a follow-up session, when an anchor can be used to bring back some of the ideodynamic responses (esp. absorption) that have already been established.

Many Cx, having seen stage hypnotists induce strange or foolish behaviours in volunteers, worry that suggestions could be inserted into their subconscious that would against their will and totally abhorrent. This can produce distrust or a fear of loosing control.

The trance state is produced through the narrowing of consciousness and attention down to the suggestions that are offered.  When the mind strongly focuses on a narrow field impressions can go directly into the subconscious. It is not the nature of the subconsious mind to analyse, but hypnotic suggestions only open the gateway slightly and they are evaluated and tested before being accepted, even in deep trance.

Often, therapeutic suggestions become the stimulus for a subconscious search for new associations (therapeutics.1.1).

If they go against the Cx sensitivities suggestions will always be rejected. Such a suggestion would produce a doubtful, questioning response and lighten the trance state. It is not possible to train an honest person to rob an bank!

Cx who are very goal orientated and have high expectations and a strong motivation my well construe the Hypnotherapy Session as yet another opportunity to succeed and out-perform all comers. This may induce a strong desire to comply with the therapist, which can be helpful, but this degree of expectation can easily set up counter-productive intellectual processes which introduce strain and resistance to the induction and deepening of the trance state. This is an example of the “Law of Reversed Effect”, where clients find that the harder they try the less they are able, the corollary of this is that the more passive they remain the more easily they enter a trance (Part.1.1).

It may be helpful to explain that Hypnosis produces a natural state of deep relaxation, and that in the trance state we are simply initiating a non-intellectual awareness of the nature of the subconscious mind.

The idea of the subconscious mind as a potent force for change abounds in modern therapeutic literature and advertising and it needs demystifying. The simplest description I have found is that it is the ‘reservoir’ (metaphors are pretty much unavoidable, and pretty much interchangeable) of all our past experience. It is our storehouse of impressions (Chitta). These impressions become hard and fast over time and with repetition and become habitual.

Suggestions can implant new impressions in the subconscious, which can compound and strengthen the old and this compounding can be a nuisance if they result in patterns of bad habits. The compounding of new impressions can of course be useful, and this is utilised by the therapist who will compound helpful suggestions throughout the session.

I have to admit some hypnotic effects are quite shocking and/or amazing. I’v never been attracted to this side of things - but they do demonstrate depth of trance.

Rapid induction wouldn’t work on me, “I’m a polarity responder, Oh no, you don’t!”
… so far I can’t verify it for myself.

But i’ve witnessed it.

We accomplish a huge number of tasks without any conscious input, from walking to blinking … if we have just learned a new skill (e.g. touch typing) and we are doing well, we might find we “loose it” the moment we focus on the keypad.

The skills we have learned are stored there for us to access at any instant … this of course, includes unhelpful behaviours, such as evauative beliefs like exaggerating and catastrophising. (Xref: therapeutics.1.4)

To help anxious or skeptical Cx to develop trust in the induction process we alternate statements that are observable and verifiable, usually a reference to something in the clients immediate environment or awareness, with more abstract suggestions. This is a skillful way of creating links between the clients present experience and what we would like her to experience. (Pacing statements focus on external stimuli, and Leading statements describe internal responses).

As the induction proceeds we can gradually link in more suggestions and more references to abstract internal states.

Links can easilty be made from an existing state to a desired state using the “implied causative”, using connecting words such as “as”, “while” and “during”.

As you watch your breath you begin to feel more comfortable.

We start off the chain with a series of verifiable statements to put the clients mind at ease, and then introduce a single suggestion, as in this example which chains together the main sensory modalities:

As you sink into the chair,

and notice the gentle illumination,

the sound of my voice,

and the warmth of the room ….

… You will begin to feel more comfortable.

In the next sequence we might use three verifiable statements which chain together an awareness of any physical tension (we all have some tension, even at rest) and introduce two suggestions …

Now, as you become aware of any slight tension in your your body,

any tensions in your neck or shoulders,

or in your arms or in your legs,

You may gradually begin to feel more comfortable,

and relax deeper into the chair

In this way the client gradually begins to rely on the authenticity of our suggestions and begin to flow with the process. The next sequence might only require two verifiable statements and allow three suggestions. Finally we can comfortably make one external reference for each internal reference.

This example method gives the induction a congruent structure which builds up, and corresponds to, the clients confidence in our suggestions. As our observations and mutually supporting contingent suggestions create a credible chain reaction the clients trust and relaxation develop.

Since suggestiblity differs widely from person to person we need to learn to use our own experience and judgement of the clients reactions to decide when to make variations in the sequence and reduce the proportion of pacing statements to more “leading” or abstract suggestions (Xref: Part.1.6.Suggestibility).

YapKo describes this process of building a pattern of responses as a “response set”, it is also described as a “Yes set” (Erickson and Rossi), as it builds an agreeable frame of mind, and there is no obvious reason to reject any part of the sequence of references and suggestions. (Ref: Trancework P. 283).

N.B. Milton Erickson noticed that sometimes resistance can build up simply becuase we tire of being told what to do all the time! The use of a negative can have the effect of acknowledging and discharging it. An example, which takes the pressure off, might be …

“You don’t have to  try to relax any further until you are really ready”.

Sounds complicated? Do not panick! You don’t have to stick to a formula too rigidly. I’v seen Milton Erickson address the camera for minutes at a time, during a session, whilst the client sat there absolutly motionless with a beautific smile on his face!

Its common enough for someone to say I can’t be Hypnotised and it can be daunting for students when this happens. It probably isn’t true at all, but it can become a self-fullfilling prophecy!  It would be a shame if the more autonomous type of person (who values self-control) missed the opportunity to experience deep relaxation and the opportunity to become more familiar with the inner world of the subconscious mind through a fear of relinquishing autonomy.

Pacing and leading are particularly important here to validate the experience,  refer to something external before referring to inner experience.

The pay-off for highly autonomous clients is that they can learn to explore the “shadow side” of consciousness for themselves through Hypnosis.

Introduction - some lessons on dissociation from T.M.

In TM the mantra, a ‘meaningless’ sound is given to fix the attention of the conscious mind, so that the person does not engage with the meaning and create a resistance to the deepening process. Engaging with the meaning and intention are active, left brain processes - the ones we wish to leave behind as we enter trance … it is really the attention of the unconscious mind we wish to utilise therapeutically. In TM relaxation occurs without forcing or trying - the phrase “try to relax” highlights this dilemma!

Relaxation is only achieved by letting go of conscious intellectual processes and switching into a different mode, a parasympathetic mode in which endorphins naturally flow. In this mode (hypnosis!) autonomic behaviour is said to be “dissociated” because it takes place outside of the conscious mind (Erickson). As a result of experiencing this mode the clients grip on their usual associations, limiting beliefs and frame of reference is relaxed, and new constructive suggestions can be evaluated from a different, fresher, and more optimistic angle.

As in the example of the Blackboard script, the intellect is engaged in something which in, and of itself, doesn’t actually appear to contribute to the deepening process; imagining the letters of of the alphabet and then erasing them, in this case.

The visualisation acts as a distraction … keeping the left brain busy whilst the attention is free to listen to the therapist on other cognitive levels, which by nature function simultaneously. This is an example of the operation of the “Law of Concentrated Attention”. The law maintians that as we concentrate on an idea it becomes spontaineously realised.

We can utilise this mode of concentrated attention by making suggestions that are very gentle and require no effort. This type of concentration (contention) would be invoked by a suggestion such as …

“Place your attention on my voice lazily, effortlessly, dreamily.”

If the client difts off and looses track of the therapists voice it is usually a sign of a deep trance.

We can utilise this mode of concentrated attention in a different way by using a sudden distraction or shock, which has the effect of disrupting the previous pattern of thought, the command …

“Go deeper NOW!”

… can suddenly produce a “creative moment” (Rossi, 1972) of dissociation, a much deeper state of relaxation, reflection, and perhaps even a glimpse of the emptiness of sartori (Tart, 1969).

A sudden switch from a gentle persuasive style to a sudden command can create a gap for the client to fall into … programme it in by saying …

“Next time I say Now, you will notice the wonderfull sensations of relaxation your body is already feeling, so you will go much deeper, go NOW!”

… its cuts off the Cx internal dialogue, and creates a bit of a surprise … then the mind focuses inward, on the depth of relaxation (sensations of heaviness, etc) the body has already attained.

I think this sort of reference (metaphor) would be very useful adjunct to other methods used in the treatment of subjects who suffer anxiety related to bodily functions, such as appetite difficulties, palpitations, and sleep problems. The subject could be taught to bring down their palpitations, for example by a  suggesting a metaphore for natural blood flow, such as …

… a stream which is pushed through  all the channels and valves of the body by movement and compression to gather in a pool which is emptied at the right moment by the pressure of a pump.  As it flows it brings refreshment to every cell in every part of the body. Just like blinking and breathing the body knows when the time is right for every part of phase of every cycle through the day and through and night … and so on!

On the course a similar behavioural experiment on desensitization was done by visualizing an anxitey dial or thermometer, or some other device appropriate to the parameters being measured (an E.E.G. trace?). You can be as creative as you like! The priciple is to learn to adjust the dial through suggestion and visualisation, to various settings and observe the emotional and physical responses and finally set it at a lower level, so that the level of anxiety becomes more tolerable or normal.

Ouspensky (1949) wrote …
“When I pay attention to the external world, I am like an arrow pointing outward …
When I pay attention to the internal world I am like an arrow pointing inwards”.

With most of us, if we try both at once you either forget the inside and become absorbed in the object, or forget the outside and start daydreaming (i.e. go into a light trance).

Following the induction (Part.2.1) we deepen and intensify the experience of the trance state. This should help the Client when they practice at home, but deep trance is not absolutely necessary because good results can come from a relatively light trance in many cases, where the client has assimilated the practitioners suggestions easily (e.g. non-smoking scripts).

Deepening of trance causes fuller dissociation (Yapko) which may help deeper post-hypnotic suggestions become more effective and  longer lasting; e.g. the Ego Strengthening Script, or interventions based on R.E.B.T. or C.B.T. (if the practitioner is qualified) .

Deepening depends on the clients contiuned attention to the voice of the therapist. Some conversational styles gently build an internal focus using teaching stories and metaphors. These can  have a therapeutic value when they chained to the clients situation. Previous experiences or situations that are similar to Hypnosis, such as daydreaming or reading a good book, can also be used in the conversational style. They act as a reminder of how it feels to become deeply absorbed.  This builds rapport and sets the mood by eliciting the responses associated with that memory in the present (Lankton).  The memory can be chained to the response in a format such as …

“As you experience this memory, you may now experience that same degree of absorption”.

As the cleint becomes more absorbed the conversational style devleops into a more “Hypnotic” style by introducing changes in pace and voice.

There are several  methods which are much more direct. The “Stairs (or elevator)” method is one, (see Part.2.1), where each step down is imagined to be down into a deeper state. 

For example … 

“I wonder if you can imagine yourself standing a the top of the stairs of relaxation, as you take the first step down the stairs of relaxation you can step down into a deeper state of comfort” (Yapko).

Clearly we can avoid the elevator metaphor if the client has a fear of closed spaces.

Chaining and Compounding suggestions are important deepening techniques (See Part.1.3) because they build new responses onto the foundation of the ongoing relaxation response. Repetition deepens the experience and reinforces suggestions. Some therapists introduce a physical experience, such as lowering the clients hand, to reinforce a sinking feeling. 

Sometimes a shift in the Clients attention can produce a deepening experience.  This can happen naturally when we come to the end of a long train of thought. This kind of shift can be induced by interrupting the Client, and shifting from interior to exterior by asking them to open the eyes and then close them again is a very effective way of doing this.  It is almost as if the trance is re-started (Elman, Fractionalisation).

A suggestion that the client enjoys a few precious moments of deeper silence and relaxation can be very effective, since the client has relaxed even from the process of “being hypnotised”. It is a good idea to arrange to give the client a signal which indicates when it is time to proceed.

It is good practice to give the client  a posthypnotic suggestion that the next time they enter trance they will find it much easier to go deeper.  We can also use this suggestion to re-enter a deeper trance later in the same session.