EXPERIENCING HYPNOSIS: THERAPEUTIC APPROACHES TO ALTERED STATES By Milton H. Erickson, M.D. and Ernest L. Rossi, Ph.D. IRVINGTON PUBLISHERS, Inc., New York Copyright © 1981 Ernest L. Rossi All rights reserved. No part of this book may be reproduced in any manner whatever, including information storage or retrieval, in whole or in part (except for brief quotations in critical articles or reviews), without written permission from the publisher. For information, write to: Irvington Publishers, Inc. 740 Broadway, NY NY 10003 ISBN 0-8290-0246-4 PRINTED IN THE UNITED STATES Reprint Edition 1992 EXPERIENCING HYPNOSIS: THERAPEUTIC APPROACHES TO ALTERED STATES Dr. Milton Erickson and Dr. Ernest Rossi We dedicate this volume to Elizabeth Erickson and Margaret Ryan, whose thoughtful editorial work has made it possible. CONTENTS Introduction I. The Indirect Approaches to Hypnosis a. Hypnosis in Psychiatry: The Ocean Monarch Lecture b. Utilization Approaches to Indirect Communication 1. Language and the Art of Suggestion 2. Multiple Levels of Communication in Hypnosis 3. Internal Responses as the Essence of Suggestion 4. Indirect Communication in the Ocean Monarch Lecture II. Catalepsy in Hypnotic Induction and Therapy a. Catalepsy in Historical Perspective b. Recognizing Spontaneous Catalepsy c. Facilitating Catalepsy d. Utilizing Catalepsy e. Summary f. Exercises with Catalepsy Demonstration in the Use of Catalepsy in Hypnotic Induction: Hand Levitation in a Blind Subject III. Ideomotor Signaling in Hypnotic Induction and Therapy a. Ideomotor Movements and Signaling in Historical Perspective b. Recognizing Spontaneous Ideomotor Signaling c. Facilitating Ideomotor Signaling d. Facilitating Ideosensory Signaling e. Utilizing Ideomotor Signaling f. Summary g. Exercises in Ideomotor Signaling An Audio-Visual Demonstration of Ideomotor Movements and Catalepsy: The Reverse Set to Facilitate Hypnotic Induction IV. The Experiential Learning of Trance by the Skeptical Mind Session One: The Experiential Learning of Minimal Manifestations of Trance Session Two: The Experiential Learning of Hypnotic Phenomena 1. Dissociation and the Modern Experiential Approach to Altered States 2. Learning Indirect Communication: Frames of Reference, Metalevels, and Psychotherapy INTRODUCTION This book is a continuation of our earlier work in Hypnotic Realities (Erickson, Rossi, & Rossi, 1976) and Hypnotherapy: An Exploratory Casebook (Erickson & Rossi, 1979), whereby the senior author, Milton H. Erickson, trains the junior author, Ernest L. Rossi, in clinical hypnosis. Taken together, these three volumes present a deepening view of what hypnosis is and the ways in which a creative process of hypnotherapy can be achieved. The material in these volumes touches ultimately on the nature of human consciousness and suggests a variety of open-ended approaches to facilitate its exploration in hypnotherapy as well as in more formal research situations. Indirect communication is the overall concept we use to cover what we have variously described as two-level communication, the naturalistic approach, and the utilization approach. The common denominator of all these approaches is that hypnotherapy involves something more than simple talk on a single, objective level. The readily apparent, overt content of a message is like the tip of an iceberg. The recipient of indirect communication is usually not aware of the extent to which his or her associative processes have been set in motion automatically in many directions. Hypnotic suggestion received in this manner results in the automatic evocation and utilization of the patient's own unique repertory of response potentials to achieve therapeutic goals that might have been otherwise beyond reach. In our previous volumes we outlined the operation of this process as the microdynamics of trance induction and suggestion. Although this is the essence of the senior author's original contribution to modern suggestion theory, we will review in this volume some of the many means and meanings that other authors have used as they struggled to reach an understanding of indirect communication in the long history of hypnosis. The first section of this volume presents an historically important lecture on clinical hypnosis by the senior author wherein we witness his transition from the older authoritarian approach to hypnosis to the new permissive approaches, which he pioneered. Due to the unique nature of this presentation, an audio cassette of it accompanies this volume. We strongly recommend that our professional readers listen to this cassette and savor it a bit before dealing with the lecture as presented in the text. The second and third sections of this volume focus on the phenomena of catalepsy and ideomotor signaling, two of the senior author's basic approaches to trance induction and hypnotherapy. The primary concern is the practical question of how to induce therapeutic trance and how to evoke the patient's repertory of life experiences and involuntary response systems that are utilized in hypnotherapy. As is characteristic of our previous work, the growing edge of our current understanding of the subjective experience of clinical trance and altered states is discussed throughout. A film of Erickson made by Ernest Hilgard and Jay Haley at Stanford University is available from Irvington Publishers for study by serious students who wish to observe the nonverbal aspects of Erickson's I innovative work utilizing the reverse set in hypnotic induction presented in Section III. We believe that further research on and development of this reverse-set approach will greatly expand our understanding of the dynamics of trance and serve as the foundation for a new generation of more effective approaches in hypnotherapy. The fourth section, dealing with the experiential learning of hypnosis, illustrates one of the senior author's favorite occupations in recent years: the training of professionals in the use of clinical hypnosis by allowing them to experience the process themselves. The two sessions presented in this section are illustrative of the problem faced by a modern, rational, scientifically trained mind in learning to experience hypnotic phenomena. Herein are illustrated many of the phenomena and paradoxes of modern consciousness as it seeks to understand more about itself by making an effort to transcend its current limitations. Ernest Rossi Malibu, California SECTION I The Indirect Approach to Hypnosis We begin here by illustrating the indirect approach to hypnotic communication through the transcription of a lecture given by the senior author before a group of his professional colleagues. We then outline our current understanding of this approach and its relevance for facilitating the processes of hypnotic induction and therapeutic trance. A. HYPNOSIS IN PSYCHIATRY: THE OCEAN MONARCH LECTURE This lecture is an unusually clear and succinct presentation of the senior author's approach to hypnotic induction and hypnotherapy. Given at the height of his teaching career, it represents an important shift away from the authoritarian methods of the past to his pioneering work with the more permissive and insightful approaches characteristic of our current era. In the actual words of this presentation we can witness how important concepts are in transition. While Erickson still uses the words technique and control a number of times—and even manipulate and seduce appear once each—it is evident from the broader context that they are outmoded in the traditional authoritarian sense in which they had been used. A paradigmatic shift is taking place in this presentation: It is now recognized that the most significant person in the hypnotherapeutic interaction is the patient, not the therapist. The patient's potentials and proclivities account for most of the variance (what actually happens) in hypnotherapy, not the purported "powers" of the hypnotist. The therapist does not command the patient; rather, as the senior author says, "It is always a matter of offering them [patients] the opportunity of responding to an idea." It is now recognized that the hypnotherapist offers the patient many approaches to hypnotic experience rather than imposing hypnotic techniques. The concept of technique implies the mechanical and repetitious application of a particular procedure in the same way to every patient with the intent of producing a preconceived and predictable response. The concept of approaches implies the profferance of alternatives to help each patient bypass his or her own particular learned limitations so that the various hypnotic phenomena and hypnotherapeutic responses may be experienced. Therapists do not "control" the patients; rather, they help the patients learn to "utilize" their own potentials and repertory of unconscious skills in new ways to facilitate the desired therapeutic outcome. This new orientation requires the development of many observational and performance skills by hypnotherapists. More than ever it is required that they learn to recognize and appreciate each patient as a unique individual. Every hypnotherapeutic interaction is essentially a creative endeavor; certain known principles are being applied, but the infinite possibilities within each patient require an essentially exploratory approach to achieve the therapeutic goals. This lecture is highly characteristic of the senior author's style of presenting his approach to hypnotic induction and hypnotherapy. Listening to it on the cassette accompanying this volume in a relaxed mood may have important values for the reader that are not contained in the edited version presented in this volume. Before reading any further, then, the reader may best listen to the cassette labeled "Hypnosis in Psychiatry: The Ocean Monarch Lecture." Those readers who are familiar with our two previous books in this series will know why we recommend listening to the cassette first. Other readers will understand the reasons after reading the discussion of this tape that follows its edited version on these pages. Please listen now to the lecture. A. HYPNOSIS IN PSYCHIATRY: The Ocean Monarch Lecture The Conscious and the Unconscious Mind I do not necessarily intend to demonstrate hypnosis to you today so much as to discuss its use in psychiatry. However, the use of hypnosis in psychiatry actually applies to the use of hypnosis in any other medical field, whether dental, dermatology, or whatever it might be. The first idea I want to impress upon you is one way of thinking about your patients clinically. It is desirable to use this framework because of the ease of concept formation for the patient. I like to regard my patients as having a conscious mind and an unconscious, or subconscious, mind. I expect the two of them to be together in the same person, and I expect both of them to be in the office with me. When I am talking to a person at the conscious level, I expect him to be listening to me at an unconscious level, as well as consciously. And therefore I am not very greatly concerned about the depth of the trance the patient is in because I find that one can do extensive and deep psychotherapy in the light trance as well as in the deeper medium trance. One merely needs to know how to talk to a patient in order to secure therapeutic results. Learning One's Own Method of Suggestion Following the Patient's Lead Now the next thing I want to stress is the tremendous need for each doctor to work out a method of suggestion for himself. In developing my own technique, I worked out what I felt was a good hypnotic technique. It was about 30 typewritten pages, single-spaced, of the various types of suggestions necessary to induce a deep trance. And then I slowly cut it down from 30 typewritten pages single-spaced to 25, to 20, to 15, to 10, to 5, and so on, so that I could use the whole 30 pages or I could use just one page or one paragraph. But I learned thoroughly how to graduate my suggestions, and how to lead from one suggestion to another. When one does that sort of thing, one learns how to follow the leads given by his patient. Trance Induction: Catalepsy to Heighten Responsiveness In inducing a trance in your psychiatric patient or, for that matter, any patient, it is the fashion in which you present the suggestion to the patient that is important. For example, some of you have seen me demonstrate the proper way to take hold of a patient's wrist. Too often, a doctor will grab hold of a wrist and lift it up forcibly. But when I lift someone's hand, I purposely do so in a very, very gentle fashion so that there is just a suggestion that I am lifting the arm, and just a suggestion that I am trying to move it this way or that way. And the more gentle you can be in the physical touch of the arm, when you are lifting it up in the air to induce catalepsy, the more effective it is. Any forcible seizure of the patient's arm causes difficulty because you want to stimulate the patient to be responsive to you. Hypnosis is primarily a state in which there is increased responsiveness to ideas of all sorts. And one employs that responsiveness not by trying to force, but by trying to elicit an immediate response—and to elicit it by having the patient participate. In exactly the same way, I do not like this matter of telling a patient, "I want you to get tired and sleepy, and to get tired and sleepier." That is an effort to force your wishes upon the patient. That is an effort to dominate the patient. It is much better to suggest that they can get tired, that they can get sleepy, that they can go into a trance. For it is always a matter of offering them the opportunity of responding to an idea. Patient's Freedom to Respond: Positive and Negative Suggestions I have found that patients often have the notion that hypnosis is a powerful tool that can compel them to act according to my wishes. I like to approach my psychiatric patients— whether they are neurotic, emotionally disturbed, prepsychotic, or even psychotic—in a fashion that lets them feel free to respond to whatever degree they wish. I never tell a patient that he has to go into a deep trance, or into a medium trance, or for that matter into a light trance. I suggest also that he never tell me anything more than he really wants to tell me. I usually tell my patient that he can withhold whatever he wishes, and to be sure to withhold whatever he wishes. I am emphasizing this point because I want you to have some understanding of positive and negative suggestions. To tell a patient, "Now, tell me all," is a rather threatening, even dangerous request to make. Rather, you want the patient to be willing to tell you this, willing to tell you that, so that as they begin telling you this and that, they also begin to develop a certain sense of confidence. Rapport: Utilizing Ambivalence and Naturalistic Modes of Functioning Now and again you will meet a patient with whom you have an immediate rapport, and then you can take the dominant attitude. But one really ought to be cautious. In using positive and negative suggestions, one tries to make it possible for the patient to exercise his own ambivalence for your benefit and for his benefit. He is both willing and unwilling to secure help from you, so you try to define the situation for him in such a way that he can get help in one direction and refuse help in another situation. In that way the patient develops a readiness to go along with you. Now in hypnotizing the psychiatric patient I think one of the important things to do first is to establish a good conscious rapport. Let him know that you are definitely interested in him and his problems, and definitely interested in using hypnosis if in your judgment you think it will help. So often I have had patients come in and demand that they be hypnotized, to which I usually counter with the statement that it is better for the doctor to prescribe than for the patient to prescribe. And surely if they can benefit from hypnosis, I will employ it. But then I will ask their permission to employ it in the way that is most helpful to them. And what have I really suggested? I have suggested that it be employed in a way most helpful to them. Usually I go through the preliminary explanation that they are going to remain conscious. But I point out to them that the fact that they can hear the clock on the wall, that they can see the bookcases in the room, that they can hear any disturbing sounds, is rather unimportant. The essential point is that they pay attention, not necessarily to me, but to their own thoughts—especially the thoughts that flash through their mind, including the manner and the sequence in which those thoughts flash through their mined. [Hypnotic suggestion always utilizes such naturalistic modes of functioning; it never imposes anything alien on the patient.] Now, hypnosis is something that allows you to manipulate [sic—we now prefer utilize!] the personality in its various ways of functioning. One can ask a patient in the trance state to remember something of the past, or to speculate upon the future, or to shift from one gear to another gear. Too often there is an attempt to follow through in a consistent way on one particular problem, long after the patient has become too fatigued or too disturbed emotionally to do that. You must realize that hypnosis allows you to come back to a particular idea, or fear, or anxiety so that it is never necessary to ask a patient to experience too much distress or emotional discomfort at any one time. Questions Facilitating Rapport and Trust What are some of the uses of hypnosis in psychiatry? The first, and I think the primary, use of it should be in establishing a good personal relationship with the patient. Once you have hypnotized patients, they will often feel that they can trust you. And, it is important to give them the opportunity of discovering that they can trust you. Therefore, I usually ask patients in the hypnotic trance some question that I know they should not answer at that time. I ask a question, and before they can possibly hear it, I point out to them that it is a question that should not yet be answered, and that they ought not to answer it until the right time comes along. Then I ask them to think about what I have said. As a result, they realize that they can answer questions freely and easily, but are under no compulsions to answer a question before the right time comes. I make this clear to patients in the waking state as well as in the trance state, because you are dealing with a person that has a conscious mind and an unconscious mind. Integrating Conscious and Unconscious Learning This brings us to another important point regarding the use of hypnosis. Because you are dealing with a person who has both a conscious mind and an unconscious mind, achieving good results with a patient in a deep trance does not mean that the patient will benefit from it in the ordinary waking state. There has to be an integration of unconscious learnings with conscious learnings. This should be foremost in your mind whenever you use hypnosis on psychiatric patients. You can recognize that you can resolve a conflict, a phobia, or an anxiety in the trance state. But unless you do something about it in the waking state, the patient is still likely to have that anxiety or phobia. You can remove a phobia for a certain color in the trance state so that the patient behaves normally. Nevertheless, when he awakens from the trance state, he will still have conscious habit patterns of response to that particular color. And therefore it is essential to integrate the unconscious learnings with the conscious learnings. While a patient of mine was recovering a traumatic experience, she developed a fear of the color blue. She had seen her sister nearly drown, and her sister had looked decidedly blue in appearance. The patient didn't really recover from her fear of blue, although she could handle anything blue and look at anything blue in the trance state, until she had a feeling of conscious comfort while dealing with blue cloth and blue colors of all sorts in the waking state. She did not necessarily need to have a complete knowledge of her sister's near drowning, but she did need to have an awareness that blue used to be associated with very uncomfortable things. Therefore, in dealing with patients it is always necessary to decide how rapidly and how thoroughly they will need to integrate what they learn unconsciously with what they learn consciously. Dissociating Intellect and Emotion in Dealing with Anxiety, Phobia, and Trauma Hypnosis can also allow you to divide up your patient's problems. For example, a patient comes to you with some traumatic experience in the past which has resulted in a phobic reaction or an anxiety state. One can put him in a deep trance and suggest that he recover only the emotional aspects of that experience. I have demonstrated this phenomenon in the past by having one of my demonstration subjects recover all the merriment of a joke without knowing what the joke was. And yet that subject laughed and laughed in the merriest fashion over the joke, wondering at the time what the joke was! Later, I let my subject remember the actual joke. In other words, one can split off the intellectual aspects of a problem for a patient and leave only the emotional aspects to be dealt with. One can have a patient cry out very thoroughly over the emotional aspects of a traumatic experience and then later let him recover the actual intellectual content of the traumatic experience. Or, one can do it in a jigsaw fashion—that is, let him recover a little bit of the intellectual content of the traumatic experience of the past, then a little bit of the emotional content—and these different aspects need not necessarily be connected. Thus, you let the young medical student see the pitchfork, then you let him feel the pain he experienced in the gluteal regions, then you let him see the color green, then you let him feel himself stiff and rigid, and then you let him feel the full horror of his stiffness and rigidity. Various bits of the incident recovered in this jigsaw fashion allow you to eventually recover an entire, forgotten traumatic experience of childhood [a gangrenous wound from an accidental stabbing by a pitchfork] that had been governing this person's behavior in medical school and handicapping his life very seriously. [See Erickson & Rossi, 1979, for detailed examples of these approaches.] Facilitating Recovery and Amnesia of Traumatic Events This brings us to the possibility of inducing a complete memory of traumatic experience, and then inducing an amnesia for it. Often patients come to you not knowing why they are unhappy or distressed or disturbed in any way. All they know is that they are unhappy, and they give you a wealth of rationalizations to explain it: Things aren't going right, the mortgage is too much of a burden, their job is too difficult, when actually it may be the lingering, unconscious effects of the father relationship, the mother relationship, of their childhood. One can actually regress the Patient, return him to his childhood, and get him to remember forgotten incidents with remarkable clarity and detail. One can secure all of that information from the patient which gives you complete understanding of many aspects about your patient, and then awaken the patient with a total amnesia of what he has told you. The patient doesn't know what he is talking about, but you know what he is talking about. And therefore, you can guide the patient's thinking and speaking closer and closer to the actual problem. You can detect the significant words that refer to the traumatic experience of which he is consciously unaware and thus understand the deeper implications of what he is talking about. [Eventually, the patient will probably be able to deal consciously with the traumatic experience. But while conscious awareness of it is still too painful, you can help him deal indirectly or metaphorically with the problem.] Learning the Indirect Approach In this regard, you need the practice of repeatedly attempting to get a patient to talk about something in ordinary, everyday life. You need the practice of trying to get normal hypnotic subjects to talk about the lighting, for example, in the corner of the room. Of course, the lighting is not important, but how you guide them to talking about it is important. How can you do this? You merely need to observe their ordinary utterances and casual conversation. Then, emphasize the fact that all of a sudden they said the word corner, and you wonder why. Soon, they will say something is light, and very shortly you can have them talking about the lighting in the corner of the room. It is a matter of directing them. In a similar way, as long as you know some of the traumatic past of the subject, you can guide every one of your remarks in that direction. Psychological Reorientation for Discharging and Displacing Resistance: Facilitating a Yes Set What are some of the obstacles that you will encounter in using hypnosis? Your patients in the psychiatric field are often exceedingly difficult. They are fearful to begin with, they are distressed—they do not know how to handle themselves or they would not be your patient. You can employ all of the various hypnotic phenomena. I can recall one of my patients who came to me and spent the time explaining that he just could not talk to me. There was nothing he had to say, and he felt too miserable to be able to have any thoughts at all. My response was simply this: That he could go into a light trance and experience some interesting and rather helpful phenomena. He agreed that he needed some help, but he didn't know how to get it. And so, in an apparently random fashion, I stated that I could place a chair right there, that it would be just about so far from the bookcase, about so far from the door, about so far from my desk, and it would be really very nice to sit in that chair and be able to talk when sitting in that chair. My patient tended to agree with me that if there were a chair over there, it would be so far from the bookcase, it would be so far from my desk, it would be so far from the door. At this point I had elicited three excellent agreements from my patient which brought us to the statement that if he were sitting in the chair in such-and-such a relationship, he might find it helpful to him in talking about himself. Of course he risked nothing in saying that he might find it helpful if he sat there in that chair—since there was no chair! I had not had him hallucinate one. I simply had him imagine it just as all of you can. But what is the subject really doing? He is agreeing with me without knowing it that he would find it easier to speak more freely if he were sitting in a different position in the office. Then I suggested that it was impossible, really, to talk in this chair—the one that he was actually sitting in—but all that would be necessary for him to do would be to take the chair, put it over there, sit down, and begin talking. I've had a patient more than once pick up his chair, move it to another side of the room, and immediately begin discussing his problems and giving me the information he needed to give. In effect, he has left all of his resistances in the room orientation that he had when sitting in this chair. But by sitting in that chair, which had just been moved over there, he saw the room in a different way entirely. I have found that whatever you can do to alter the orientation of your patients in the office aids them tremendously in communicating with you and examining their problems. [Reorienting a patient physically and spatially often helps to reorient him psychologically. The chair in its old position represents the patient's old patterns of thinking and behaving. Moving the chair to a new position represents the patient's willingness to look at himself in a different way and gives him, literally and psychologically, a different perspective.] Hypnotically, of course, it is very easy to induce a deep trance and reorient patients completely, even to depersonalize them. That is why I emphasize the importance to all of you, no matter what field of medicine you are in, to work with normal subjects. Spending a little time with normal subjects will enable you to discover all the various hypnotic phenomena. Harvey, the Sad Sack: Depersonalization and Projection to Free the Intellect for Therapeutic Change Depersonalization and the projection of the self are other very helpful hypnotic phenomena. You can teach a subject to hallucinate a movie screen and to see his "self" up there on the screen. You can then have him forget his name, his identity, to forget everything about himself—the way all of us do normally in the theater when observing a suspense movie or anything that completely absorbs our attention. Then have your patient look at the screen and tell him that he is going to see a continuous series of events—you can have them in the form of moving pictures, or you can have them in the form of stills. I can think of one person, a sad sack, who came to me, and the question was, could one ever make a man out of that sad sack? I was challenged to do that, and I had to conduct psychotherapy on that man using hypnosis and having an audience of antagonistic psychoanalysts and residents in psychiatry—some of whom were undergoing psychoanalysis. The simple procedure I used with the sad sack was this: Harvey had every known ache and pain, every known sense of inferiority. But he was intelligent, even though he didn't manifest much intelligence. He was fearful, and that was all I really needed to know about the man, because knowing that he was intelligent, I also knew that he could have a rather rich fantasy life. And so I suggested to him that he see a series of movie screens or crystal balls in which he would see still-life pictures of tremendous importance. I had Harvey forget his name, his identity, his age, the fact that Harvey as a person really existed. All he was was an intelligence that was looking at all those things that I had scattered around the room for him to look at. He saw the little boy on his way to school as a moving picture—most of them were moving pictures. He followed the little boy to school. He saw the little boy getting his hands racked by the school teacher. He saw the schoolteacher forcing the little boy to change from the left hand to the right hand in writing. He saw the little boy getting punished rather brutally by the teacher. One particular day, he saw that boy walking home very sadly. And Harvey looked and commented on the paltriness of the scene. He saw that little boy walking home, reaching home, and looking into the yard over the gate. And there he saw the sheriffs deputy with a gun in his hand. The deputy had just finished shooting the little boy's dog. And then he saw the little boy crying. And then I told him to start there and see another picture several years later when that same emotion would come forth. And he saw that same boy at the age of 10 out in the