Erickson is noted for his often unconventional approach to psychotherapy, such as described in the book
Uncommon Therapy, by Jay Haley, and the book
Hypnotherapy: An Exploratory Casebook, by Milton H. Erickson and Ernest L. Rossi (1979, New York: Irvington Publishers, Inc.). He developed an extensive use of therapeutic metaphor and story as well as hypnosis and coined the term
brief therapy for his approach of addressing therapeutic changes in relatively few sessions.
Erickson's use of interventions influenced the strategic therapy and family systems therapy practitioners beginning in the 1950s among them, Virginia Satir and Jay Haley. He was noted for his ability to "utilize" anything about a patient to help them change, including their beliefs, favorite words, cultural background, personal history, or even their neurotic habits.
Through conceptualizing the unconscious as highly separate from the conscious mind, with its own awareness, interests, responses, and learnings, he taught that the unconscious mind was creative, solution-generating, and often positive.
He was an important influence on neuro-linguistic programming (NLP), which was in part based upon his working methods .
Trance and the unconscious mind
Erickson believed that the unconscious mind was always listening, and that, whether or not the patient was in trance, suggestions could be made which would have a hypnotic influence, as long as those suggestions found some resonance at the unconscious level. The patient can be aware of this, or can be completely oblivious that something is happening. Erickson would see if the patient would respond to one or another kind of
indirect suggestion, and allow the unconscious mind to actively participate in the therapeutic process. In this way, what seemed like a normal conversation might induce a hypnotic trance, or a therapeutic change in the subject. It should be noted that "[Erickson's] conception of the
unconscious is definitely not the one held by Freud."
Erickson was an irrepressible practical joker, and it was not uncommon for him to slip indirect suggestions into all kinds of situations, including in his own books, papers, lectures and seminars.
Erickson also believed that it was even appropriate for the therapist to go into trance.
I go into trances so that I will be more sensitive to the intonations and inflections of my patients' speech. And to enable me to hear better, see better.
Erickson maintained that trance is a common, everyday occurrence. For example, when waiting for buses and trains, reading or listening, or even being involved in strenuous physical exercise, it's quite normal to become immersed in the activity and go into a trance state, removed from any other irrelevant stimuli. These states are so common and familiar that most people do not consciously recognise them as hypnotic phenomena.
The same situation is in evidence in everyday life, however, whenever attention is fixated with a question or an experience of the amazing, the unusual, or anything that holds a person's interest. At such moments people experience the common everyday trance; they tend to gaze off to the right or left, depending upon which cerebral hemisphere is most dominant (Baleen, 1969) and get that faraway or blank look. Their eyes may actually close, their bodies tend to become immobile (a form of catalepsy), certain reflexes (e.g., swallowing, respiration, etc.) may be suppressed, and they seem momentarily oblivious to their surroundings until they have completed their inner search on the unconscious level for the new idea, response, or frames of reference that will restabilize their general reality orientation. We hypothesize that in everyday life consciousness is in a continual state of flux between the general reality orientation and the momentary microdynamics of trance...
Because Erickson expected trance states to occur naturally and frequently, he was prepared to exploit them therapeutically, even when the patient was not present with him in the consulting room. He also discovered many techniques for how to increase the likelihood that a trance state would occur. He developed both verbal and non-verbal techniques, and pioneered the idea that the common experiences of wonderment, engrossment and confusion are, in reality, just kinds of trance. (These phenomena are of course central to many spiritual and religious disciplines, and are regularly employed by evangelists, cult leaders and holy men of all kinds).
Clearly there are a great many kinds of trance. Many people are familiar with the idea of a "deep" trance, and earlier in his career Erickson was a pioneer in researching the unique and remarkable phenomena that are associated with that state, spending many hours at a time with individual test subjects, deepening the trance.
That a trance may be "light" or "deep" suggest a one dimensional continuum of trance depth, but Erickson would often work with multiple trances in the same patient, for example suggesting that the hypnotised patient behave "as if awake", blurring the line between the hypnotic and awake state.
Erickson believed there are multiple states that may be utilized. This resonates with Charles Tart's idea (put forward in the book
Waking Up) that all states of consciousness are trances, and that what we call "normal" waking consciousness is just a "consensus trance". NLP also makes central use of the idea of changing state, without it explicitly being a hypnotic phenomenon.
Indirect techniques
Where classical hypnosis is authoritative and direct, and often encounters resistance in the subject, Erickson's approach is permissive, accommodating and indirect. For example, where a classical hypnotist might say "You are going into a trance", an Ericksonian hypnotist would be more likely to say "you can
comfortably learn how to go into a trance". In this way, he provides an opportunity for the subject to accept the suggestions they are most comfortable with, at their own pace, and with an awareness of the benefits. The subject knows they are not being hustled, and takes full ownership of, and participation in their transformation. Because the induction takes place during the course of a normal conversation, Ericksonian hypnosis is often known as Covert or Conversational Hypnosis.
Erickson maintained that it was not possible consciously to instruct the unconscious mind, and that authoritarian suggestions were likely to be met with resistance. The unconscious mind responds to openings, opportunities, metaphors, symbols, and contradictions. Effective hypnotic suggestion, then, should be "artfully vague", leaving space for the subject to fill in the gaps with their own unconscious understandings - even if they do not consciously grasp what is happening. The skilled hypnotherapist constructs these gaps of meaning in a way most suited to the individual subject - in a way which is most likely to produce the desired change.
For example the authoritative "you will stop smoking" is likely to find less leverage on the unconscious level than "you can become a non-smoker". The first is a direct command, to be obeyed or ignored (and notice that it draws attention to the act of smoking), the second is an opening, an invitation to possible lasting change, without pressure, and which is less likely to raise resistance.
Richard Bandler and John Grinder identified this kind of "artful vagueness" as a central characteristic of their 'Milton Model', a systematic attempt to codify Erickson's hypnotic language patterns.
Confusion technique
In all my techniques, almost all, there is a confusion.
A confused person has their conscious mind busy and occupied, and is very much inclined to draw upon unconscious learnings to make sense of things. A confused person is in a trance of their own making - and therefore goes readily into that trance without resistance. Confusion might be created by ambiguous words, complex or endless sentences, pattern interruption or a myriad of other techniques to incite transderivational searches.
Scottish surgeon James Braid, who coined the term "hypnotism", claimed that focused attention was essential for creating hypnotic trances; indeed, his thesis was that hypnosis was in essence a state of extreme focus. But it can be difficult for people racked by pain, angst or suspicion to focus on anything at all. Thus other techniques for inducing trance become important, or as Erickson explained:
... long and frequent use of the confusion technique has many times effected exceedingly rapid hypnotic inductions under unfavourable conditions such as acute pain of terminal malignant disease and in persons interested but hostile, aggressive, and resistant...
Handshake induction
Among Erickson's best-known innovations is the hypnotic handshake induction, which is a type of confusion technique. The induction is done by the hypnotist going to shake hands with the subject, then interrupting the flow of the handshake in some way, such as by grabbing the subject's wrist instead. If the handshake continues to develop in a way which is out-of-keeping with expectations, a simple, non-verbal trance is created, which may then be reinforced or utilized by the hypnotist. All these responses happen naturally and automatically without telling the subject to consciously focus on an idea.
This induction works because shaking hands is one of the actions learned and operate as a single "chunk" of behavior; tying shoelaces is another classic example. If the behavior is diverted or frozen midway, the person literally has no mental space for this - he is stopped in the middle of unconsciously executing a behavior that hasn't got a "middle". The mind responds by suspending itself in trance until either something happens to give a new direction, or it "snaps out". A skilled hypnotist can often use that momentary confusion and suspension of normal processes to induce trance quickly and easily.
The various descriptions of Erickson's hypnotic handshake, including his own very detailed accounts, indicate that a certain amount of improvisation is involved, and that watching and acting upon the subject's responses is key to a successful outcome.
Erickson described the routine as follows:
- *Initiation: When I begin by shaking hands, I do so normally. The "hypnotic touch" then begins when I let loose. The letting loose becomes transformed from a firm grip into a gentle touch by the thumb, a lingering drawing away of the little finger, a faint brushing of the subject's hand with the middle finger - just enough vague sensation to attract the attention. As the subject gives attention to the touch of your thumb, you shift to a touch with your little finger. As your subject's attention follows that, you shift to a touch with your middle finger and then again to the thumb.
- *This arousal of attention is merely an arousal without constituting a stimulus for a response.
- *The subject's withdrawal from the handshake is arrested by this attention arousal, which establishes a waiting set, and expectancy.
- *Then almost, but not quite simultaneously (to ensure separate neural recognition), you touch the undersurface of the hand (wrist) so gently that it barely suggests an upward push. This is followed by a similar utterly slight downward touch, and then I sever contact so gently that the subject does not know exactly when - and the subject's hand is left going neither up nor down, but cataleptic.
- *Termination: If you don't want your subject to know what you are doing, you simply distract their attention, usually by some appropriate remark, and casually terminate. Sometimes they remark, "What did you say? I got absentminded there for a moment and wasn't paying attention to anything." This is slightly distressing to the subjects and indicative of the fact that their attention was so focused and fixated on the peculiar hand stimuli that they were momentarily entranced so they did not hear what was said.
- *Utilisation: Any utilisation leads to increasing trance depth. All utilisation should proceed as a continuation of extension of the initial procedure. Much can be done nonverbally; for example, if any subjects are just looking blankly at me, I may slowly shift my gaze downward, causing them to look at their hand, which I touch and say "look at this spot.". This intensifies the trance state. Then, whether the subjects are looking at you or at their hand or just staring blankly, you can use your left hand to touch their elevated right hand from above or the side - so long as you merely give the suggestion of downward movement. Occasionally a downward nudge or push is required. If a strong push or nudge is required, check for anaesthesia.
Richard Bandler was a keen proponent of the handshake induction, and developed his own variant, which is commonly taught in NLP workshops.
Any habitual pattern which is interrupted unexpectedly will cause sudden and light trance. The handshake is a particularly good pattern to interrupt because the formality of a handshake is a widely understood set of social rules. Since everyone knows that it would be impolite to comment on the quality of a handshake, regardless of how strange it may be, the subject is obliged to embark on an inner search (known as a transderivational search, a universal and compelling type of trance) to identify the meaning or purpose of the subverted pattern.
Resistance
Erickson recognised that many people were intimidated by hypnosis and the therapeutic process, and took care to respect the special resistances of the individual patient. In the therapeutic process he said that "you always give the patient every opportunity to resist". Here are some more relevant quotes pertaining to resistance:
- Whatever the behaviour offered by the subjects, it should be accepted and utilized to develop further responsive behaviour. Any attempt to "correct" or alter the subjects' behaviour, or to force them to do things they are not interested in, militates against trance induction and certainly deep trance experience.
If the patient can be led to accept one suggestion, they will more readily accept others. With resistant patients, it becomes necessary to find a suggestion that they can accept. Resistance is always important, and should always be respected, so if the resistance itself is encouraged, the patient is made to feel more comfortable, because they know that they are allowed to respond however they wish.
- Many times, the apparently active resistance encountered in subjects is no more than an unconscious measure of testing the hypnotist's willingness to meet them halfway instead of trying to force them to act entirely in accord with his ideas.
Although the idea of working with resistance is essentially a hypnotic one, it goes beyond hypnosis and trance. In a typical example, a girl that bit her nails was told that she was cheating herself of really enjoying the nail biting. He encouraged her to let
some of her nails grow a little longer before biting them, so that she really could derive the fullest pleasure from the activity. She decided to grow
all of her nails long enough that she might really enjoy biting them, and then, after some days, she realised that she didn't want to bite them anyway.