Rodriguez Sanchez, Rodriguez Rodriguez, Santana Mariqo, Piqueras Hernandez, Alvarez Ramirez (1999). Current tendencies and future directions of hypnosis in Cuba. Newsletter of the Erickson Foundation, Vol 2, 6.

Reviews the history of hypnosis in Cuba and the main tendencies and trends. There were no influences from Ericksonian hypnosis till recently when the first group of Ericksonians came to teach for the first time in Manzanillo, Granma Medicine University. The main approach is still the so called traditional hypnosis in which there is a development mainly in surgery and in some medical conditions. There are some strong places: Santiago de Cuba, where HipnoSantiago Hypnosis Workshop is held regularly, Manzanillo, where there is a Hypnosis Research group with publications in the country and abroad and experience in teaching hypnosis. The Hypnosis Society is located in Habana.
The group from Manzanillo is working in a Clinic Project with such themes as hypnoanesthesia in major surgery, models of groups learning under hypnosis, and some other therapies.

List of Manzanillo’s Research group main papers:
Learning under very deep hypnosis. In Neurology Magazine, Spain
Current tendencies of Hypnosis in Cuba. In Newsletter of Erickson Foundation USA
Breaking hypnosis myths. Communication at the University Forum.
Main Philosophical, Physiological and Methodological Problems in Hypnosis Research. In University Forum
States of consciousness and hypnosis. In Multimed Magazine, Cuba.
Memory tests and hypnosis. Psychology Thesis.
Autonomic System and Hypnosis. Psychology Thesis (Master degree)
Hypnosis as the only anaesthetic procedure in major surgery. (Thesis)

Wilson, R. Reid (1999, August). Brief strategic treatment of panic disorder and OCD. [Paper] Presented at the annual meeting of the American Psychological Association, Boston, Massachusetts.

The symptoms, prevalence, and social/economic costs of Panic Disorder, Obsessive-Compulsive Disorder, and other anxiety disorders are reviewed. Cognitive-behavioral therapy (CBT) has demonstrated efficacy for these disorders. Eriksonian and strategic principles of therapy have a number of points of contact with CBT. Taking Panic Disorder and OCD as illustrative models, this paper demonstrates how Ericksonian methods can be fruitfully combined with CBT. Examples include paradoxical interventionis, hypnosis and visual rehearsal, reframing, the fractional approach, and pattern disruption.

Fourie, D. P. (1997). ‘Indirect’ suggestion in hypnosis: Theoretical and experimental issues. Psychological Reports, 80 (3, Pt 2), 1255-1266.

“Indirect” suggestion is conceptualized in two distinct ways in the literature. From an Ericksonian perspective “indirect” suggestions are theoretically approached as suggestions which can circumvent the censorship of consciousness to reach the “unconscious” where they can activate dormant potentials. In contrast, from a research perspective “indirect” suggestion is operationally defined as a technique. Based on Ericksonian theory, it was claimed that “indirect” suggestion was more effective than traditional, “direct” suggestion. However, this claim could not be empirically substantiated. In this paper it is shown that the theoretical claim is based on questionable assumptions about the existence of the “unconscious” as a reified entity and about the direct and lineal influence of certain suggestions on this entity. Also, it is argued that traditional research strategies which emphasize strict controls are unable to verify or unambiguously refute the Ericksonian claim because these strategies are biased toward “direct” suggestion. Finally, the paper provides a different, contextual perspective on “indirect” suggestion, thereby placing the theoretical and experimental issues in a different context of meaning. [PubMed Abstract]

Rosenbaum, Robert & Dyckman, John (1996). No self? No problem! Actualizing empty self in psychotherapy . In Hoyt , Michael F. (Ed.), Constructive therapies (2, pp. 238-274). New York NY: Guilford.

In this book chapter, Rosenbaum and Dyckman (1996) argue that _self has no permanently fixed, defining, _thing-like_ characteristics_ (p. 270). They thus dispute the classical notion–commensurate with the position of _philosophical realism_–that the self is a substance, with fixed qualities and measurable qualities. The authors refer to this classical self as a _full_ self, contained inside the skin and delimited by its participation in linear time. Instead, they propose an _empty self,_ not to be construed as a void, but as a fluid, connected, relational self that overflows the traditional boundaries of the skin and is open to greater possibilities for change. To support their view of an empty self, the authors include several case examples of working with hypnosis and strategic/narrative therapy with clients experiencing a variety of psychological and physical symptoms. The authors further contend that _self is not unitary, but the product of multiple drafts_ (p. 248)[Editor note: See Dennett, 1991, in this database]. In the narrative-constructivist tradition, they argue, _if we speak in terms of multiple contextual selves for us all…[then, people diagnosed with MPD/DID] are not so _different_ from the rest of us_ (p. 249). The chapter draws from western & Buddhist philosophy, strategic/systemic and narrative therapies, Ericksonian hypnosis, and, cognitive science theories regarding memory, consciousness, embodiment, and language, to support their alternative view of, and treatment for, the _self.

Holroyd, Jean (1995). Handbook of clinical hypnosis, by Judith W. Rhue, Steven Jay Lynn, & Irving Kirsch (Eds.) [Review]. International Journal of Clinical and Experimental Hypnosis, 43 (4), 401-403.

This is a book for the thinking clinician” (p. 401). “The editors are to be congratulated for making this volume much more coherent than most edited books” (p. 402). “My impression is that the book is best suited for an intermediate or advanced course on hypnotherapy, or for people who are already using hypnosis in treatment. Although there is some material on the basics of hypnotic inductions and a few introductory sample scripts for inductions, a beginners” course should probably use a different book, or this book could be accompanied by an inductions manual. … I recommend it very highly” (p. 403).

Lynn, Steven Jay; Neufeld, Victor; Mare, Cornelia (1993). Direct versus indirect suggestions: A conceptual and methodological review. International Journal of Clinical and Experimental Hypnosis, 31, 124-152.

The article reviews the literature on the effects of direct versus indirect hypnotic suggestions. A conceptual and methodological analysis of direct versus indirect suggestions is also provided. Three conclusions follow from the review: (a) Contrary to views of Ericksonian hypnotists, suggestion style has little effect on objective responding to hypnotic test items; (b) studies of clinical- and laboratory-induced pain and other measures of subjective experience have yielded contradictory results–however, the best controlled studies have not indicated that indirect suggestions are superior to direct suggestions; and (c) there is insufficient evidence to conclude that hypnotizability level and suggestion wording interact, such that low hypnotizable subjects are particularly responsive to indirect suggestions. Methodological and conceptual problems in defining and studying hypnotic communications, the lack of rigorous experimental controls, and research issues and directions are highlighted.

Although this article is primarily concerned with the nature of suggestion, the review also mentions several studies comparing hypnosis with other interventions for pain, in passing:
Crowley (1980)
Snow (1979)
Omer, Darnel, Silberman, Shuval, & Palti (1988)
Stern (1982)
Bassman (1983)
“Like the clinical studies using the RIA [Rapid Induction Analgesia], pain studies that did not use the RIA lack appropriate control groups: Neither Bassman’s (1983) nor Stern’s (1982) research explicitly compared direct and indirect suggestions. What our review does suggest is that studies (e.g., Crowley, 1980; Snow, 1979; Van Gorp et al., 1985) that imposed the greatest degree of methodological control yielded the outcomes least favorable to the hypothesis that indirect suggestions are effective and account for the pain relief achieved, above and beyond factors common to placebo treatments” (p. 132).
“Lynn and his colleagues’ studies indicate that whereas indirect suggestions enhance archaic representations of the hypnotist, direct suggestions facilitate involvement in the events of hypnosis, as measured by subjective involvement and involuntariness” (p. 136).

Kirmayer, Laurence J. (1992). Social constructions of hypnosis. International Journal of Clinical and Experimental Hypnosis, 40 (4), 276-300.

Both clinical and experimental views of hypnosis are social constructions that reflect the biases and interests of practitioners and scientists. Each perspective offers useful metaphors for hypnosis. Underlying clinical uses of the term hypnosis are states of mind associated with imaginative reverie and automatic behavior based on procedural knowledge. Social discourse and narratives shape hypnotic experience, but they are themselves influenced by mechanisms of attention and automaticity. Study of hypnosis must proceed on both social and psychological fronts to account for the experience and clinical efficacy of hypnosis.

In accord with Coe, Sarbin, and other social-psychological theorists, I will argue that hypnosis, like all higher mental phenomena, is fundamentally social in nature. To accept this, however, does not obviate the role of distinctive processes of attention, imagery, and imagination. Hypnosis is a socially constructed context and ritual for evoking imaginative enactment and involuntary of “automatic” modes of experience and behavior. Contemporary social-psychological theorists have failed to sufficiently explore the nature of enactment. A satisfactory account of hypnosis must go much deeper into the cognitive and social construction of experience; only then can involuntary behavior be properly distinguished from self-deception and self-authorship from cultural construction” (p. 277).

Brown, Peter (1991). The hypnotic brain: Hypnotherapy and social communication. New Haven, CT: Yale University Press.

Notes are taken from a review of this book: Diamond, Michael (1993). Book review. Bulletin of the Menninger Clinic, 57 (Winter), 120-121.
Brown “posits that because the fundamental matrix of the human brain is metaphoric, hypnosis results from skillful matching of metaphorical communication with the brain’s biological, rhythmic alterations. The most significant feature of trance experience is thereby located in the hypnotist-subject interaction” (p. 120).
“The middle section [of the book is comprised largely of] literature reviews in support of Rossi’s (1986) ultradian rhythm theory of hypnosis and Lakoff and Johnson’s (Johnson, 1987; Lakoff & Johnson, 1980) experientialist theory of conceptual thought” (p. 120). The final section includes “research evidence on medical uses of hypnosis, a theory of dissociation and multiple personality disorders, and an uncritical discussion of Milton Erickson’s naturalistic hypnotherapeutic approach … [and also] a brief discussion of the social-cultural functions of possession states among the Mayotte culture” (p. 120).

Goran, D. K. (1991, February). The effects of hypnosis and hypnotizability testing on chronic pain (Dissertation, Case Western Reserve University). Dissertation Abstracts International, 52 (8), 4466-4467.

This study evaluated the effectiveness of Ericksonian-oriented hypnosis in the treatment of chronic pain and the value of the Stanford Scale of Hypnotic Susceptibility in preselecting pain patients for hypnosis. Chronic pain patients were assigned to one of three treatments: a one-hour session of Ericksonian hypnosis with suggestions for pain control, suggestions with no hypnotic induction, or an interview about their pain condition. It was discovered that during the treatment hour hypnosis was more successful in reducing both pain and emotional distress than was suggestion alone, and both were superior to the interview control treatment. Of particular interest, those patients who were not given the Stanford Scale of Hypnotic Susceptibility until the end of the study improved more than those who were tested with it prior to treatment. Scores on the Stanford Scale did not correlate with improvements in pain or distress. Thus, it is possible that formal hypnotic susceptibility testing may be detrimental to a pain patient’s chances of being successfully treated with hypnosis” (pp. 4466-4467).

Shutty, Michael S.; Sheras, Peter (1991). Brief strategic psychotherapy with chronic pain patients: Reframing and problem resolution. Psychotherapy.

There is currently a paucity of literature concerned with the delivery of psychological services to chronic pain patients in an outpatient setting where patient contact is limited to one or two consultations. Yet, the role of psychological consultation to patients with pain problems has expanded greatly in the past decade. This article describes the application of brief strategic interventions that can promote behavior change in patients who have not adhered to medical recommendations for conservative treatment of chronic pain. Strategic interventions embody a here-and-now problem-solving perspective that facilitates integration of medical and psychological treatment goals for pain patients.

Pain is a significant problem for many people–8% of the general population (Von Korff, Dworkin & Le Resche, 1990), accounting for most of the money paid for health care, compensation, and early retirement (Anderson, 1981). Linton (1986) reported that only 35-45% of chronic low back pain patients can work a year after pain treatment, and Gallon (1989) reported that 2/3 of chronic low back pain patients did not show improvement 4-6 years after a pain management program.
In the past, outpatient treatment has included diagnosis and short-term treatment, but now they are providing more physical therapy, vocational retraining, and psychotherapy. Behavioral treatments focus on reducing pain behavior, use of medication, exercise, and stress management. They are labor intensive and the authors state that they are not readily adapted to outpatient settings.
Among psychological treatments would be included ‘brief strategic therapy’ which has a here-an-now problem-solving focus and clearly specified behavioral or attitude change goals. This type of therapy has been associated with Milton Erickson’s hypnotherapy strategies. It has been described by Fisch et al. (1982) and Watzlawick et al. (1974). Erickson and these other therapists stress altering the patient’s frame of reference (reframing) in order to provide an opportunity for change. Brief strategic therapy includes such things as paradoxical intention, negative practice, and symptom prescription.
The authors note that since complete pain relief is not a realistic goal for chronic pain, it is important to focus on teaching patients better coping skills. They note that Rybstein-Blinchik (1979) and Rybstein-Blinchik & Grzesiak (1979) have demonstrated that reformulation of the pain experience (reframing) is beneficial for chronic pain patients. In their research, pain patients were taught to somatize (focus on specific sensations), divert attention (think of important events in their lives) or reframe their experience (reinterpret it in cognitive terms inconsistent with pain complaint, e.g. as numbness or warmth). Those who were taught reframing reported that their pain was less intense, and they exhibited fewer pain behaviors. This is taken as supportive for using cognitive interventions that teach patients to reinterpret pain, rather than focusing on its somatic sensations or diverting attention.

O’Hanlon, W. H.; Hexum, A. L. (1990). An uncommon casebook: The complete clinical work of Milton H. Erickson, M.D.. New York: W. W. Norton & Co.. (Reviewed by Elgan Baker, American Journal of Clinical Hypnosis, 34, 137)

According to the review by Elgan, cases are organized into sections by the presenting problems of the patients treated and include a wide range of psychopathology. Each case is given an identifying number for ease of cross-referencing and is presented in a standard form: case summary, presenting problem, age group, modality of treatment, problem duration, treatment length, result of treatment, follow-up (if available), a summary of techniques used, and sources for the case description.

Sherman, S. J.; Lynn, S. J. (1990). Social-psychological principles in Milton Erickson’s psychotherapy. British Journal of Experimental and Clinical Hypnosis, 7, 37-46.

In this article we will suggest that social-psychological principles may be used to understand M. H. Erickson’s psychotherapeutic approach. In addition to using an array of indirect suggestive approaches, Erickson exploited clients’ reactance, increased their perceptions of control and mastery, altered the accessibility of thoughts and memories, and modified thoughts and behaviours. To accomplish these therapeutic goals, Erickson used the following techniques: seeding, priming, confusion, script enactment, framing, explanation, and perspective modification.

This is the introduction to a special issue of International Journal of Clinical and Experimental Hypnosis, which is devoted to the contributions of Milton Erickson. “The conclusions of these analyses are sometimes surprising. The usual understanding of Erickson’s work and the hallmarks of the Ericksonian tradition emphasize such parameters as indirect suggestion; naturalistic or permissive trance induction; confusional strategies; ‘unconscious learning’; and the focal use of metaphor, analogy, anecdote, and storytelling. These authors suggest, however, that Erickson’s work frequently did not entail the use of hypnotic trance in any conventional sense and attribute many of the crucial variables in his therapeutic work to a variety of nonhypnotic phenomena” (p. 126).
Several consistent themes emerge, which Baker refers to as perhaps the “essence” of Erickson’s contributions: “(a) the charismatic power of Erickson’s personal presentation and style; (b) the marked influence of social variables; (c) consideration of primitive, unconscious relationship variables; (d) the evocative use of language, symbolism, and nuances of communication; (e) the ingenious tailoring of therapeutic interventions to the perceived uniqueness of each patient; and (f) the central influence of nonhypnotic variables rooted in social learning and cognitive-behavioral paradigms” (p. 126).

Diamond, Michael Jay (1988). Accessing archaic involvement: Toward unraveling the mystery of Erickson’s hypnosis. International Journal of Clinical and Experimental Hypnosis, 36, 141-156.

The “essence” underlying Milton Erickson’s unique style and uncommon technical maneuvers inheres in his uncommon skill at eliciting patients’ archaic involvement. Archaic involvement, as characterized by perspectiveless overevaluation, is explicated and America’s beloved tale, _The Wonderful Wizard of Oz_, is used to evoke further perspectives. The importance of such regressive object-representations are noted. Erickson’s uncanny ability to access archaic involvement and thereby profoundly influence his client is analyzed in terms of his: (a) relationship style; (b) therapeutic “persona”; (c) theoretical orientation; and (d) specific micro-techniques and interventions. Clinical findings derived from a case transcript and videotaped work are employed throughout to substantiate the argument that Erickson fosters regressive interpersonal shifts. Implications of this skill are discussed, and further avenues for investigation are suggested.

Shor (1959, 1962, 1979) introduced the concepts of archaic involvement, trance (fading of the generalized reality orientation or altered state of consciousness) and nonconscious involvement (or fulfillment of the role of hypnotic subject, dissociated role taking) to account for experienced hypnotic depth. Shor (1979) defined archaic involvement as “‘the extent to which at any given moment in time there are archaic, primitive modes of relating to the hypnotist that echo back to the love relationships of early life [p. 126]’ (p. 143).”
Archaic involvement develops as a hypnotist actively encourages the subject to regard the hypnotist with the role of parent, teacher, guru. Charismatic authority, protector, etc. Erickson fostered these attitudes in his patients, and his apparent magical expertise can be attributed to his ability to tap into these archaic ties, which are ‘ubiquitous.’ “Freud (1919/1955) long ago noted that human beings’ irresolution and craving for authority should never be underestimated. Fenichel (1945) stressed the universal yearning for ‘omnipotent beings whose help, comfort, and protection he could depend on [ p. 491].’ Kaiser (1965) considered the ‘universal psychopathology’ of attempting to create in real life the fantasy of fusion. Still others (Kohut, 1971, 1977; Kriegman & Solomon, 1985; Newman, 1983) suggested that the motivation to yield to or to create such charismatic leaders stems from the desire to lose all boundaries and become lost within a greater whole–an experience elsewhere termed a fusional or symbiotic alliance (Diamond, 1987). This ‘search for oneness’ (cf. Silverman, Lachman, & Milich,, 1982) is engaged by charismatic leaders as we become enticed by our own archaic wishes to avoid uncertainty, ambivalence, and the complexities of maturation, perhaps even creating such leaders to save us from ourselves” (p. 145). There remains the question of how archaic involvement facilitates or impedes psychotherapy.
In addition to archaic involvement, Erickson’s behavior as a hypnotherapist during the later years of his career stressed the evocation of nonconscious role-playing, while underplaying the evocation of the trance dimension. He relied on his reputation and interventional skills, stressing ‘naturally occurring trance’ of everyday life. (In his earlier years he spent more time on developing profoundly altered states of consciousness.)
“Erickson’s _therapeutic ‘persona’_ and style of engaging were consistently parental and authoritative, albeit frequently permissive, supportive, flexible, and benevolent. He always remained in control and typically insisted that his orders be carried out strictly and without question (Hilgard, 1984). … Archaic wishes are further gratified by Erickson’s gentle and soothing parental tone and stance, while control is maintained as he invites his patient to ‘enjoy being irritable with me'” (pp. 147-148). To further psychotherapeutic goals, he sometimes assumed the role of surrogate parent, in hypnosis, to supply the patient with needed (childhood) experiences, as in the famous case referred to as the ‘February Man.’
Erickson’s implicit theory of an autonomous and omnipotent unconscious further encouraged “more primitive modes of perceiving and construing consensual and historical reality” (p. 148). “For example, he tells his patient in the Lustig (1975) videotape that: ‘Your unconscious knows all about it; it will inform the conscious mind when it is ready to know'” (p. 149).
Regarding his technical maneuvers (intonation, wording, nonverbal communication, indirect suggestion, metaphor, and anecdote), “contrary to popular belief, he frequently spent long periods of time thinking about and planning his interventions (Hammond, 1986). In addition to using these patterns to evoke both patient resources and archaic alliances, he adopted an exceptionally confident manner, even when prescribing unusual assignments (McCue, 1984). Thus, patient faith and positive expectation in the efficacy of his interventions were maximized” (p. 149).
Erickson’s pacing of his speech was slow, at the same rate as President Reagan’s speeches. He was tone deaf, which may have contributed to the arrhythmia and unusual intonation observed in his speech. He used the patient’s language, typically, which “undoubtedly provides a narcissistically gratifying identification with a hypnotist felt to be inside one’s own psychic system (Diamond, 1987)” (p. 150). When he would say to patients, “My voice will go with you,” he was inviting a “bodily-level incorporation” (p. 150). When he created mental confusion through his maneuvers, he increased the likelihood that the patient would “respond to subsequent direction in order to bind anxiety” (p. 150). “Thus, an archaic object relationship is recapitulated by an invoked regression to earlier, primary phases of cognitive processing, and in turn, Erickson provides a safe, ‘holding environment’ (cf. Winnicott, 1965) for his now regressed patient” (p. 150).
Erickson used what Watzlawick (1978) has called ‘the language of change’–puns, metaphors, indirect communication, analogies. He finessed the defensive functions of secondary processes (Kalt, 1986) by allying himself with the patient’s secondary processes, as when he used anecdotes and teaching tales in the role of a ‘Dutch uncle’ giving advice. The teaching tales usually affirmed basic American values (common sense, pragmatism, self-sufficiency, resiliency, achievement; Diamond, 1983). However, this kindly grandfather approach “recreates an archaic relational situation wherein adult-level defenses and secondary processes are realigned while Erickson the storyteller permits expression and oftentimes symbolic gratification of instinctual drives. This archaic recapitulation occurs as a result of the relaxing of defenses through metaphorical communication (cf. Schafer, 1983), in addition to the revival of opportunities for mastery within this safe and often enchanting context (cf. Bettelheim, 1977)” (p. 151).
The author concludes by addressing clinical issues pertaining to an Ericksonian approach that relies on archaic involvement. “An essential question for clinicians concerns the long-term effects on the patient of the therapist’s fostering such regressive involvement. There are both pluses and minuses of therapeutic relationships which maximize archaic involvement. Consequently, we need to empirically determine the efficacy of Ericksonian interventions both in offering short-term relief from suffering, and in potentiating developmental maturation in the long run. Not only must we ascertain _how much_ archaic involvement is required for lasting change, but _what is done_ with the regressive involvement (i.e., is it merely evoked, managed, utilized, or ultimately worked through?) is critical in assessing the value of Erickson’s contribution” (p. 152).

Edgette, John H. (1988). ‘Dangerous to self and others’: The management of acute psychosis using Ericksonian techniques of hypnosis and hypnotherapy. In Lankton, Stephen R.; Zeig, Jeffrey K. (Ed.), Ericksonian Monographs: No. 3. Treatment of special populations with Ericksonian approaches (pp. 96-103). New York: Brunner/Mazel.

Edgette shows how several agitated psychotics were hypnotized using an Ericksonian approach. His inductions were bold attempts to introduce hypnosis in a setting where drugs and restraints are often the only available tools. He offers some ideas concerning the myth that hypnosis will not work with such a population.

Hammond, D. Corydon (1988). ‘Will the real Milton Erickson please stand up?’. International Journal of Clinical and Experimental Hypnosis, 36, 173-181.

Disciples of Erickson are overaccentuating some aspects of his work and are thereby neglecting others. Current training predominantly focuses on indirection, confusion, esoteric metaphors, paradox, and magical expectations of instant success via superficial trances. Therapists are sometimes encouraged to simply go into trance themselves and “trust the unconscious,” instead of following Erickson’s model of hard work and careful treatment planning. It is time for a new law in the field of hypnosis: the Law of Parsimony. Interviews with numerous long-time associates of Erickson present him as being much more diverse in his approach. Erickson’s true legacy is eclectic hypnotherapy, not a dogmatic and restrictive cultism.

This article appeared in a special issue of the journal devoted to an evaluation of the contributions of Milton H. Erickson, who had died eight years earlier. The author begins with a statement that he has deep respect for Erickson’s work and ideas, but wishes to deal with many myths that have evolved regarding Erickson’s therapy approach. He notes several factors that have contributed to current confusion: 1. Few clinicians are sufficiently skillful to use the panoply of techniques employed by Erickson, so they gravitate to a few with which they feel comfortable. 2. Some of Erickson’s techniques are unique, thereby drawing special attention. 3. The Erickson observed in seminars in his senior years was very different from the man during mid-life, in terms of therapy style.
The author devotes considerable attention to discussing two techniques critically: indirection, and interspersal of suggestions within metaphors (multiple-level communication). These were developed to bypass resistance, but Erickson himself did not use them if the hypnotic Subject was receptive. The author also takes issue with followers’ assumption that Erickson worked spontaneously, without planning his interventions.
(1) Indirect suggestion. Erickson reportedly told a long-time student and associate, Herbert Lustig, “if a person were desirous of changing and accepting of the therapist’s input, then direct suggestions were the most efficient form of treatment” (p. 176). The author indicates that there are numerous examples in his collected works of Erickson giving suggestions “with compelling, progressive, rapid, emphatic, insistent intensity … [Erickson, 1980c, Vol II, p. 281].” Several examples are cited in this article, e.g. “Now listen to me. These are the things you must do. Do them you must, and without fail [Erickson, 1980, Vol. IV, p. 359]” (p. 175). Erickson’s use of direct suggestions was substantiated by another long-term associate, Kay Thompson, who is quoted as saying, “Many of the patients who came to Erickson did not have a need for indirection. They were ready and able to utilize trance. … Sometimes people need the excuse of being ordered to do what they wanted to do, and Erickson complied with that need in a totally intimidating and authoritarian fashion. I would venture to say that his indirect therapy was successful principally because of his extensive work with direct therapy” (p. 176).
(2) Metaphors as suggestions. Regarding the use of metaphors (into which suggestions are imbedded), the author quotes other Erickson colleagues (e.g. Robert Person, Florence Sharp) in support of the position that contemporary followers of Erickson overemphasize his use of them. Many of his stories were not even meant to be metaphors. He seemed to fill in time with stories to allow patients time for deepening or to integrate previous material. “Metaphors were not the core of his therapy and every comment by Erickson did not have three levels of meaning. Pearson said, Erickson ‘told me within the last year before he died that one of the things that disgusted him was that so many people in trying to imitate him with embedded metaphor and parables were hiding behind that obscurity. He was very careful in what he told and why he told them.’
“When Erickson did use metaphors, they were generally not stories constructed on the spot (Erickson, 1983, p. 78), and they usually had obvious relevance rather than being so highly indirect as to be incomprehensible. In fact, most long-term associates recalled Erickson frequently using bridging associations, making _direct_ connections between metaphoric stories and patient problems, rather than refusing to answer patient questions about the possible meanings” (pp. 177-178).
(3) Treatment Planning. Many contemporary followers of Erickson assume that he advocated simply going into a trance themselves and “trusting the unconscious.” However, “Erickson himself said, ‘I have found that I often spend more time analyzing a patient’s resistance–going over and over it, phrasing and rephrasing what I could say in response–than I spend with the patient during the actual interview [Erickson, 1983, p. 245]. Over and over again, after a patient has left your office, you ought to review in detail every item of behavior. You ought to make notations of the types of behavior, and then perhaps even practice out loud to yourself so that you learn how to phrase your remarks [p. 240]. I think you all ought to write out your suggestions and then carefully analyze them to see what they really mean [p. 242]. When a patient comes into my office [for a scheduled appointment], I usually have a rather clear idea of what I want to do’ [p. 125].
“It was this compulsive preparation and writing and rewriting of suggestions for over 40 years that allowed him at the end of his life to have the _appearance_ of spontaneity. He could trust his unconscious after putting something into it” (p. 178). “Late in his life, Erickson instructed Rossi (cited in Erickson & Rossi, 1979): ‘I want you to notice how connected everything is even though it’s all impromptu. It is a language I’ve learned, a careful study. … Because I learned it carefully, I can speak it easily [p. 295].’ His widow and many others emphasized his time consuming, compulsive preparation” (pp. 178-179).
The author notes that Erickson also took a considerable amount of time in training patients to use trance before doing hypnotherapy with them. He quotes Ernest Rossi as writing, “‘Erickson rarely gives therapeutic suggestions until the trance has developed for at least 20 minutes, and this only after hours of previous hypnotic training’ [Erickson, 1980, p. 89, Vol III].”
The references cited in this paper are usually one of the volumes of Erickson, M. H. (E. L. Rossi, Ed.) The collected papers of Milton H. Erickson on hypnosis, published in New York by Irvington Publishers, 1980.

Hilgard, Ernest R. (1988). Milton Erickson as playwright and director. International Journal of Clinical and Experimental Hypnosis, 36, 128-140.

Milton Erickson in his therapeutic practice can be characterized as a playwright who plans a little play for each patient and then leads that patient to accept and enact the assigned role. This arrangement permits him to be authoritarian as playwright and director by providing the staging and the strategy, while the patient then provides the tactics by carrying out the assignment in his or her own way. Several examples are given from published cases. The first is a case of enuresis in both husband and wife, selected because in this instance no mention is made of hypnosis as Erickson sets the circumstances and gives direct orders for carrying out the instructions. 3 pairs of cases are described to indicate how differently Erickson has treated cases with similar symptoms. Finally, 1 case is discussed more extensively because the treatment extended over a 6-year period. Its interpretation shows how difficult it is to distinguish what belongs to the strategic drama and what to hypnosis. All cases had successful outcomes.

The essence of Erickson’s therapy lay in the unexpectedness of his comments or instructions, the shock element, the surprises, and the tasks that he assigned the patient to carry out in the real space-time world or in fantasy. There was often doubt whether other than light hypnosis was involved” (p. 129).
As an example, Hilgard reports on a published case in which both the husband and wife had enuresis and Erickson treated them in a very authoritarian fashion. Erickson told them that he “would make a bargain with them: If they got well, they would not have to pay; if they did not benefit from the therapy, they would have to take full financial responsibility for the time he gave to them. He obtained their promise that they would do what he told them, and then he proceeded to tell them: ‘This is what you are to do.’ He then laid out the scenario. The most important part was that they were to take fluids frequently, drink a glass of water 2 hours before going to bed, and then lock the bathroom door. At bedtime, they were to get into their pajamas, kneel side by side on the bed and deliberately and jointly wet the bed. Wetting the bed would then be over for the night, and they could sleep through the night in the wet bed. They must do this every night for 2 weeks; on the Sunday night to follow, they may lie down and sleep in a dry bed. If the bed is wet the next morning, they will have to kneel and wet the bed each night for another 3 weeks.
“You have your instructions. There is to be no discussion and no debating between you about this, just silence. There is to be only obedience, and you know _and will know what to do_. I will see you again in five weeks’ time. You will then give me a full and amazing account. Goodbye! [Volume IV, 1954, p. 100, emphasis in original].
“When they reported–cured after the first 2 weeks–they asked whether Erickson had used hypnosis. He dodged their question by saying that they were entitled to full credit for what they accomplished” (p. 130).
Hilgard makes the point that Erickson’s authoritarianism might seem to contradict claims made that he had a high degree of respect for patients, their autonomy, and their responsibility for solving their own problems. “There need be no contradiction, if it is recognized that the planned behavior may not in itself be the cure, but may only be the occasion that leads to patient to reorient and solve the personal problems that led to the seeking of therapy. Another way of putting this is that the _strategy_–that is, the plot of the drama–was entirely Erickson’s, although the _tactics_–that is, beyond the fixed actions required by him, how the part was played–were left to the resources of the patient. This is not the permissiveness of Rogers (1951) with respect to the patient’s responsibility for his or her own life, nor does it have the freedom of expression of Moreno’s (1946) spontaneity theater” (p. 131).

Kirmayer, Laurence J. (1988). Word magic and the rhetoric of common sense: Erickson’s metaphors for mind. International Journal of Clinical and Experimental Hypnosis, 36 (3), 157-172.

Milton Erickson did not produce a systematic theory of psychotherapy. His talent was as a storyteller, inventing metaphors and more extended healing fictions for his patients. A great many of Erickson’s cases did not involve hypnosis in any conventional sense of the term. He used a wide range of persuasive rhetorical forms to encourage behavioral change in his patients. Nevertheless, taken together his work represents a significant shift in paradigm from prevailing schools of psychotherapy. Erickson captured the power of word magic in the language of common sense. This coupling of magical power with folk psychology accounts for much of his current popularity. Attempts to experimentally test his techniques are likely to be unsuccessful because these techniques were unique inventions tailored to the individual idiosyncrasies of patient and context. Although regularities in his work can be found, Erickson’s most important contributions are not techniques but changes in the values or ethos under which psychotherapy is conducted.

This paper focuses Erickson’s implicit models of mind and the values they carry. “It is here that Erickson made his most significant contribution to the general practice of psychotherapy . Erickson avoided systematization. His writing is unusually anecdotal, even for psychotherapy (Erickson, 1980; Vol IV, passim). Erickson’s writing format consists of ‘thin’ case descriptions, freely recycled in parable or homiletic form to serve his immediate rhetorical purpose. … For Erickson, flexibility and eclecticism were not signs of a lack of coherence but a spirited rejection of rigid dogma that needlessly limited therapeutic possibilities” (pp. 158-59).
Erickson used language of the common man rather than a technical vocabulary, even when speaking of ‘hypnosis’ or ‘trance’ or ‘the unconscious.’ He called his approach ‘naturalistic’ and viewed hypnotic phenomena as an extension of normal experience and behavior. His common sense descriptions of events and techniques are easily understood in general terms. “Erickson took magic and dressed it in the familiar clothes of common sense. Some of his less critical followers, however, seem intent on taking common sense and dressing it in the cloak of magic” (p. 163).
Erickson used metaphors as a way of actively involving the patient in conceptual, affective, and sensory qualities of experiences, i.e. as a “tool for thought” (p. 164).
In attempting to understand Erickson’s psychotherapy, one must note his “elastic use of the word ‘hypnosis.’ Sometimes Erickson uses the term narrowly with a focus on the elicitation of trance or dissociative phenomena, but more often he uses it broadly to mean any state of absorption” (p. 165). For him, this was “_a state of special awareness characterized by a receptiveness to ideas_” [Erickson, 1985, p. 223, emphasis in original]. By this he does not mean exclusively the classic suggestion effect where motor acts are experienced as involuntary (Evans, 1967). … The hypnotic subject exhibits a “_special willingness to examine ideas for their inherent values_ [p. 224, emphasis in original]. … For Erickson, any move in the direction of increased absorption is an instance of hypnosis. Dissociation accounts for a great deal but not all of hypnotic behavior” (p. 165). That is why he used the word hypnosis to describe heightened attention that might occur when someone is surprised. But in fact, his published cases include many other kinds of interventions, such as reframing, symptom prescription, etc.–forms of influence and persuasion used by many therapists who do not consider themselves working with hypnosis.
Erickson also emphasized that hypnosis enables one to work with ‘the unconscious.’ “Ordinarily, we view our consciousness as the causal agent of doing while our unconscious is the place where things just ‘happen to us.’ Erickson reversed this attribution, emphasizing the unconscious as the agent of active control working for the benefit of the patient while consciousness adopts the attitude of ‘wait and see.’ This leads consciousness into reverie–the state where images and events move of their own accord, animated by emotion, before the ‘passive audience’ of consciousness” (p. 167). So Erickson viewed hypnosis as liberating the unconscious. There was healing potential in helping the ego to relinquish “rigid control over the creative and benevolent processes of the unconscious” (p. 168). From this theoretical position, the patient and therapist are seen as allies and psychotherapy is a collaboration; there is no need for the Freudian concepts of resistance and defense.
“Erickson’s metaphors for hypnotherapy link it with normal processes of learning and imagining. His image of the unconscious as a storehouse of creative potential supports a non-pathologized view of man amid all his troubles and craziness. In contrast to psychiatry’s current preoccupation with nosology, and the emphasis of psychoanalysis on the dimensions of human frailty, Erickson adopted a non-pathologizing attitude. He did not deny his patient’s difficulties but neither was he excessively fascinated by them. He recognized that healing depends not on cataloguing deficiency but on fully mobilizing the person’s intelligence, imagination, and integrity. This message of therapeutic optimism was balanced by his own example of the benefits and limitations of hypnotherapeutic practice” (p. 170).

McCue, Peter A.; McCue, Elspeth C. (1988). Literalness: An unsuggested (spontaneous) item of hypnotic behavior? A brief communication. International Journal of Clinical and Experimental Hypnosis, 36, 192-197.

Milton Erickson claimed that the large majority of hypnotized individuals respond in a peculiarly literal way to questions/requests such as, “Would you mind telling me your name?” and he viewed this behavior as a manifestation of the ‘hypnotic state.’ In the present study, numerous Ss were exposed to hypnotic induction procedures and tested for literalness. Since it is possible that Erickson obtained literal responses by inadvertent cueing, some of these Ss were asked questions in a ‘distorted’ manner that was thought likely to elicit literal responses. A minority of the latter Ss gave literal responses, but with Ss who were asked questions in a normal manner, no clear-cut literal responses of the type described by Erickson were noted.

Omer, H.; Darnel, A.; Silberman, N.; Shuval, D.; Palti, T. (1988). The use of hypnotic-relaxation cassettes in a gynecologic-obstetric ward. In Lankton, S. R.; Zeig, J. K. (Ed.), Research, comparisons and medical applications of Ericksonian techniques (pp. 28-36). New York: Brunner-Mazel.

They did three studies in which they gave women having gynecologic procedures tapes with a Rapid Induction Analgesia hypnosis experience.
STUDY 1. Women heard tapes before a painful Fallopian tube procedure (salpingography). The patients reported less pain, tension, anxiety, and fear than control patients. (N.B. Physicians’ ratings did not show that difference.)
STUDY 2. Women practiced with the tapes at home before labor and delivery. One day after delivery, there was no difference in pain report or experience report between treated and control patients.
STUDY 3. Women used the tapes during labor. They reported worse pain and labor experiences than the control patients.
The authors conclude that their research does not support the hypothesis that Rapid Induction Analgesia is useful for acute pain.

Spinhoven, Philip; Baak, Diana; Van Dyck, Richard; Vermeulen, Peter (1988). The effectiveness of an authoritative versus permissive style of hypnotic communication. International Journal of Clinical and Experimental Hypnosis, 36, 182-191.

The differential effectiveness of an authoritative versus permissive style of hypnotic communication was investigated, with locus of control as a moderator variable. 44 Ss received in counterbalanced order both the more authoritatively worded Harvard Group Scale of Hypnotic Susceptibility, Form A and the Wexler-Alman Indirect Hypnotic Susceptibility Scale (WAIHS), which is a more permissive scale with the same item content as HGSHS:A. Permissively worded suggestions did not enhance the level of hypnotic responsiveness. Locus of control did not predict the response level on one of the scales. Unexpectedly, significantly more female Ss preferred the WAIHS, and more male Ss preferred HGSHS:A. It is concluded that Ss’ characteristics (i.e., hypnotizability) are more important for hypnotic responsiveness than variations in style of hypnotic communication or scale preference.”

Lynn, Steven Jay; Neufeld, Victor; Matyi, Cindy L. (1987). Inductions versus suggestions: Effects of direct and indirect wording on hypnotic responding and experience. Journal of Abnormal Psychology, 96 (1), 76-79.

This study examined the effects of direct wording (authoritative language, specific responses) versus indirect wording (permissive language, choice of responses) of hypnotic inductions and suggestions in measures of behavioral and subjective responding. Subjects experienced suggestion-related involuntariness and suggested effects to a greater degree in response to direct-word suggestions (Harvard Group Scale of Hypnotic Susceptibility; Form A; Shor & Orne, 1962) than in response to indirect-worded suggestions (Alman-Wexler Indirect Hypnotic Susceptibility Scale; Pratt, Wood, & Alman, 1984). No difference in behavioral responding was observed. Furthermore, induction wording did not have an effect on these measures, nor did the wording of the induction and the wording of the suggestion types interact with each other. Female subjects attributed less of their responsiveness to their own efforts when they received direct suggestions, and male subjects were less likely to attribute their responsivity to the hypnotist’s ability when they received indirect suggestions. Rapport with the hypnotist did not vary as a function of induction or suggestion wording.

Woolson, Donald A. (1986). An experimental comparison of direct and Ericksonian hypnotic induction procedures and the relationship to secondary suggestibility. American Journal of Clinical Hypnosis, 29 (1), 23-28.

Recent studies reporting the disparate effects of direct and indirect suggestion upon hypnotized subjects have indicated that standardized, direct hypnotic susceptibility tests may not accurately predict the suggestibility of subjects exposed to an indirectly worded, albeit similar, test. Historically, primary suggestibility correlates highly with hypnotizability, while secondary suggestibility does not and has been reported to be a subject’s response to indirect suggestion. In this study 56 volunteers for self-hypnosis training were first tested for secondary/indirect suggestibility, then each singly received either a direct standardardized [sic] induction or an Ericksonian (indirect) version. While susceptibility scores between groups were close, a greater number of the Ericksonian group subjects were rated as medium or highly susceptible. This occurred regardless of their type of suggestibility. Also, the Ericksonian group subjects appeared to be less aware of their depth of trance, as judged by a comparison of their susceptibility scores and their self-report depth scores. – Journal Abstract

Yapko, Michael D. (1986). What is Ericksonian hypnosis?. In Zilbergeld, B.; Edelstien, M. G.; Araoz, D. L. (Ed.), Hypnosis – questions & answers (pp. 223-231). New York: Norton.

Author presents the principles of Ericksonian hypnosis (the Utilization Approach) as:
“1. Each person is unique. …
2. The client’s experience is valid for him. …
3. Each person relates to ongoing experience from his own frame of reference. …
4. Join the client at the client’s frame of reference. …
5. The unconscious mind is rich in resources, positive in nature, and patterned from experience. …
6. Trance is naturalistic. …” (pp. 224-225).

Stone, Jennifer A.; Lundy, Richard M. (1985). Behavioral compliance with direct and indirect body movement suggestions. Journal of Abnormal Psychology, 94 (3), 256-263.

Investigated the effectiveness of 2 types of suggestions in eliciting body movement by presenting 96 high-, medium-, and low-susceptible undergraduates, in hypnotic or nonhypnotic conditions, with either of 2 series of body movement suggestions. The indirect suggestions were designed to represent the approach of M. H. Erickson (see PA, vol 60:11116 and 12262) and resulted in greater compliance in the hypnotic condition. Direct suggestions resulted in greater compliance in the nonhypnotic condition. Susceptibility to hypnosis was related to compliance in the hypnosis condition, but no interactions were found between susceptibility and type of suggestion. Sense of volition in responding was unrelated to the major findings. Discussion of the results includes a call for the accurate reporting of the wording of hypnotic suggestions in future research.