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By Tom Kennedy, Estimated reading time: 3 minutes, 45 seconds.

When asked about James Braid, Ernest Rossi said, “Braid is the true father of hypnosis (personal communication, Dec. 7, 2001). His work forms the basis of what I’m doing today.” This praise becomes understandable after a quick look at Braid’s contributions. He not only popularized the terms hypnosis and hypnotist; he first explained trance states as the interplay of physiology and  psychology.

Historians credit Braid (1795-1860) as both the first researcher of psychosomatic medicine and the father of modern theories of hypnotherapy.

Braid’s work marked the end of Mesmerism, which held that a hypnotist emanated magnetic fluids to invoke trance. Mesmer believed he could ‘mesmerize’ trees in order to hypnotize passersby, reasoning that the magnetic fluid would pass from the trees to the subjects.

Braid debunked Mesmer’s theory by utilizing a simple ocular fix as an induction technique. He had subjects stare at common, household objects and within minutes, they entered a trance state. His studies proved that hypnosis occurs naturalistically within the subject and wasn’t dependent on the showmanship of the hypnotist. He wrote, “The whole (of the induction) depended on the physical and psychical condition of the patient… and not at all on the volition, or passes of the operator” (Braid, as cited in Tinterow, 1970, p. 283).

Erickson often echoed this theme, “Once you really know…that you don’t do it, your subject does it, you can have unlimited confidence…that your patient is going to go into a trance” (Argast, Landis & Ruelas, 2000, p. 55).

Braid asserted that everyone can be hypnotized, assuring his contemporaries that, “success is almost certain.” (Braid, as cited in Tinterow, 1970, p. 287). Braid described trance as a “universal phenomenon” and “a law of our species” (p.288). Erickson was later to concur, stating, “As long as your subject is alive, you can expect some developed trance state” (Argast et al., 2000, p. 55).

In 1843, Braid conceptualized trance as a, “shift of the nervous system into a new condition,” (Braid, as cited in Tinterow, 1970, p. 271) marked by excitement and the mind’s fascination with a single idea. “It is this very principle, of over-exciting the attention, by keeping it riveted to one subject or idea which is not of itself of an exciting nature… and (a) general repose which excites in the brain and whole nervous system that peculiar state which I call Hypnotism” (p. 301).

Similarly, Braid characterized psychopathology as a mind fascinated with a single, negative idea.

“Abnormal phenomenon are due entirely to this influence of dominant ideas over physical action, and point to the importance of combining the study of psychology with that of physiology, and vice versa” (p. 369). He added that, “all the natural functions may be either excited or depressed… according to the dominant idea existing in the mind of man… whether that has arisen spontaneously, had been the result of previous associations, or the suggestion of others” (p. 369).

Braid regarded hypnotism as a “valuable addition to our curative means,” describing it as “a powerful and extraordinary agent in the healing art,” while cautioning that it wasn’t a “universal remedy” (p. 272). About hypnotherapy, he believed that “the imagination has never been so much under our control or capable of being made to act in the same beneficial and uniform manner by any other mode of management hitherto known” (p. 272).

Braid also detailed the first list of naturally occurring, hypnotic phenomenon: eye movements, pulse and respiratory changes, and catalepsy. He stated that, “All the (hypnotic) phenomena are consecutive” (p. 307). He reported an “extreme acuteness of hearing during the first stage of hypnotism” and advised “allow(ing) the hearing to disappear, by which time all of the other senses will have gone to rest…I allow all of the senses to become dormant and then rouse only the one I wish to exhibit in the state of exalted function, when operating carefully” (p. 312).Braid wrote poetically about how subjects find a somatic balance so they do not topple over. “They acquire (a) center of gravity, as if by instinct, in the most natural and therefore in the most graceful manner ” (p. 305). He added that because of this “faculty of retaining any position with so much ease, I have hazarded the opinion that the Greeks may have been indebted to hypnotism for the perfection of the sculpture” (p. 305)

References:

Argast, T., Landis, R. & Ruelas, G. (2000) Now You Wanted A Trance Demonstrated Today. Laguna Nigel, CA: SCSEPH

Tinterow, Maurice M. (1970) Foundations of Hypnosis: From Mesmer to Freud. Springfield, IL: Charles C. Thomas

Sep 25

Tom

By Dennis L. Doke M.S. Estimated reading time: 6 minutes, 45 seconds.

Tom, a young adult, has had bipolar mental illness with episodes involving complex paranoid delusions. He had been hospitalized four times during the eight year interval since his diagnosis and the time I saw him. Tom’s latest admission followed a trip, with his parents, in December, 1991. Tom’s delusions intensified, on that trip, and he believed the name of a town where they had stopped (Winslow, Arizona) held a special message for him. He walked the streets through the nights, “circling around a U-turn exit and ending back at the hotel.” Tom said he could “…WIN the battle if he went SLOW.”

After his admission, I met with Tom to discuss that experience. He spoke frankly and with a look of fear in his eyes. I remembered an example in which Erickson discussed the choice of not confronting a patient (1) and decided not to confront Tom’s delusions at that time. After his improvement and release, Tom was tapered to monthly sessions. Two years later, he continued to have thoughts about returning to Winslow despite his overall absence of symptoms. I gave him an assignment of writing the Chamber of Commerce of Winslow, utilizing the reality of Winslow to con­front his delusional memory. The following month, he reported he had not done this homework assignment, and that he “had not thought much about Winslow. Reality catches up with you. I guess I’m enjoying reality. Why should I take a trip down  memory lane when I could take a real trip to Key West?” Currently, Tom is stuck in a new dilemma which is more reality-based and more congruent with post-adolescent searching. “I’m living a mundane existence. I’m living in the present and not in the future. However, I have started going out with my friends after work. I have accomplished one of my major goals which was to move out of my parents’ home and live independently.”  I concluded this session by waving my hand towards the end of the couch and asking him if he could imagine a little baby learning to walk, leaning against the arm of  that couch  right  there.

He nodded affirmatively. I carefully helped him visualize that child learning to take his first step. I emphasized that the adult knows what the child will do in the future, but the child doesn’t. At first the child tries to stand, ever so cautiously, staggering and falling on his bottom. Learning occurs through trial and error. I told him, “I know you soon will be able to walk. You try to take a step and falter, but you try over and over again. And then you learn to walk. As you continue growing and changing, more self-confidence is gained.”

The next month, Tom returned to my office saying he needed to return to Winslow in order to go ”full circle and bring closure to that episode.” He added that he always returned to the sites of his psychotic episodes. At this time he held a job as a waiter, but had been thinking about leaving the position stating: “I can’t be a waiter all my life.”

I inquired how long he wanted to be a “wait-er?” He didn’t know so I asked again. “How long are you  going to be a WAIT-er?” Returning the emphasis, he replied “I guess I’ll have to be a WAIT-er until I make the trip and go full circle.” At the conclusion of the session, he reflected “I feel like I was in a tribulation stage for several years. I have now been in a waiting stage for nearly three years. I’m not sure when this waiting period will be over, but the next stage will be a moving-on phase. Maybe I’ll move to another city and settle down. Maybe it’ll be Winslow.”

(1) Erickson,M. (Rossi, E., Ed.). Innovative Hypnotherapy: The Collected Papers of Milton H. Erickson on Hypnosis, Vol. 4 1980. New York. Wiley & Sons. pp 70-74.

Comment on the Case of Tom

by Harriet E. Hollander, Ph.D. The Milton H. Erickson Institute of N.J.

Tom has been diagnosed with a Bipolar Mental Disorder and exhibits its classic features. His illness began in late adolescence, and he has short-term psychotic episodes following psychosocial stress. Trips to strange cities and disrup­tion of significant relationships with family are characteristic symptoms. Delusions may persist in remission  and are seldom treatable by direct confrontation.

Medication, along  with psychotherapy,i s the current treatment of Bipolar Disorder. Many of Erickson’s colleagues and students believed that Erickson had little use for medication even in the treat­ment of major mental illness. In her speech to the Ericksonian International Congress, 1994, Mrs. Erickson clarified Erickson’s view on psychopharmacological interventions to mental illness. She  told  the  audience  that Erickson, whose strategic interventions with psychotic patients were deservedly famous, placed little faith in the use of medication, mostly because the medications then available didn’t work. Certainly, she indicated, he would have prescribed medications which were effective and could help the patient.

Many individuals who might benefit from psychopharmacological treatment refuse it for a variety of personal reasons, leaving the therapist to rely on behavioral strategies. This history does not state whether or not Tom was on medication for his disorder. The psychotherapeutic approach taken by the therapist stands on its own as a thoughtful and empathic strategy to stabilize the psychosocial stresses that might have triggered further manic episodes.

The therapist gives his attention to the patient’s age-appropriate effort to individuate and separate from his parents and become an autonomous adult. He makes use of a metaphor with many levels of meaning when he suggests hypnotically to Tom that he imagine a little baby learning to walk, imagine the little  baby  learning  to  fall,  and  succeeding through trial and error. He draws the analogy with Tom’s courage to take the natural steps in his development even if he can’t anticipate where his steps will lead in the future. Tom had the delusion that the town name “Winslow” has a special message for him-“win slow”. Doke did  not deal with this directly. The homework assignment of writing the Chamber of Commerce was designed to allow Tom to understand, on his own, and willingly, that ”Winslow” was merely the name of a town.

Doke kept “win slow” in his mind. When Tom began talking about returning to Winslow, Doke used Tom’s play on words which had created the “special message” as a base for an intervention. As Tom talked about his job and his future, Doke asked, “How long do you want to be a ‘WAITer’?” Meaning was created on both the rational and irrational levels in Tom’s own style of communication. The question, which Doke wisely did not explain furlher, was loaded with a directive for action. The patient’s response testifies to  the  efficacy  of  Doke’s intervention. Erickson’s rationale for not confronting a patient’s delusions directly and aggressively is set out in an article co­authored with Jeffrey Zeig in the Volume referred to by Doke: (pp 34-35).

Man is characterized … by cognition and emotion, and man defends his intellect emotionally. … All people defend their ideas whether they are psychotically based, culturally based, or nationally based or personally based… the first thing in psychotherapy is not to try to compel him to change his ideation; rather, you go along with it and change it in a gradual fashion and create situations wherein he himself willingly changes his thinking.

The case presented above shows a thorough grasp of this principle and is part of the therapist’s respectful approach to his client and his willingness to protect the patient’s personality while also making change inducing treatment interventions. The patient begins to conceptualize his journey through life as stages in which he moves forward.

Editor’s Note: Tom had been under the ongoing care of physicians since his initial hospitalization. He had received a variety of medications, none of which was entirely successful in controlling his symptoms. Following this case report, Mr. Doke reported that Tom drove through Winslow and talked about the event, as if it was unremarkable. Even though Tom remains seriously ill, his psychotic  episodes  have  become less frequent and his social development has continued.

Sep 18

The Boxer

By Dan Short, Ph.D Dallas, TX Estimated reading time: 4 minutes, 30 seconds. 

The 21-year-old client did not want to be in therapy . Charged with assault on his girlfriend, he had been ordered to counseling as a condition of probation. The intake, conducted by another therapist, noted, “Client is reluctant to focus on violence related issues.” The client, muscular and sullen, entered the first session in silence and sat slouched in his chair with a cap concealing most of his face. He had described himself as “a boxer” and had explained that counseling should not interfere with his “career,” which consisted solely of daily sparring at a local gym.

After preliminaries, I began giving the client an explanation of the negative effects of emotional stress. I told him how “industrial psychologists are paid high wages to insure workers have their lives in order at home.” The role of sports psychologists was also described in detail with some impressive statistics about successful results. The client was then offered psychological training in order to benefit his boxing career. He responded with increased enthusiasm toward treatment.

First, the client was trained in hypnotic time distortion and rapid relaxation. This allowed him  to experience, subjectively, 15 to 20 minutes of rest in a three-minute period. This was important because it allowed him to “gather strength  more  quickly  between boxing rounds.” He also was given training for increased tolerance of frustration “to ensure clearness of thought while in the boxing ring.” The client was told to practice these skills at home with his girlfriend.

During the first few sessions, the client came with specific requests aimed at helping him with his boxing. For example, he said his coach told him he didn’t do as well while sparring with people he liked and that he needed to stop being “so nice.” We explored the concept of respect. Respect for a friend demonstrated by sitting at lunch and asking “how things are going” was differentiated from sparring in the ring “where one wants to show respect by doing one’s very best.”

In the following sessions, our topics changed from specific boxing tactics to more general principles. These included moral strength, responsibility for self and self-respect. The client was given both direct and indirect suggestions about transferring the abilities for the self-discipline required in boxing to the self-discipline required for healthy relationships.

After a few weeks, the client no longer mentioned his boxing career. Instead he began to ask for advice about his relationship with his female partner. He also talked extensively about his current relations with his extended family and his desire to be a son of whom his deceased mother “would be proud.” Toward the end of his counseling , the client was discussing plans to retire early from boxing and become an accountant. After the mandated ten visits, the client was given a letter of completion. Three months later, he returned for a social visit. A six-month follow-up revealed he had enrolled at a local junior college and has had no further reported acts of violence.

Commentary: The Boxer by Tina Foster Jansen, M.S.

Court-ordered clients are typically unmotivated. Faced with this type of client, Short used an opening strategy which would encourage the client to be involved in counseling to the “benefit of his boxing career.” As Cormier and Cormier state, “A productive assumption  in  converting  involuntariness into a  commitment  to be counseled  is that the client’s chief interest is himself.” (p.575) Short’s adroit therapeutic intervention began the changes that eventually alleviated further violence, and also had positive influences in other areas of the client’s life.

The treatment in this case is a study in reframing and utilization . Short used the strengths, weaknesses and temperament of the client to reframe inherent abilities so destructive behaviors could be changed. Haley (Nichols, 1984) maintains reframing is a necessary step in altering problem-maintaining sequences. Proper reframing changes a viewpoint to the meanings of interactions are changed  while  the  facts  of  that inter­action remain the same. Short reframed respect for the client. This new definition allowed the client to change behaviors while keeping and building on the client’s wish for personal  respect. Haley (1971) concludes that, on a general level, the goal of the therapist is to change the maladaptive behavior of the individual. An additional and subsidiary goal  is  to extend  the  client’s personal range of experience . By getting this client to change his violent behavior, Short was able to open the door for further  change  by  the  client.  The man’s personal range of experience could be extended. He could consider ways of obtaining respect other than through violence – he could consider becoming the son his mother “could be proud of.” He then could begin to extend  his  idea of a career and investigate choices.

Utilization is a cornerstone of Erick­sonian psychotherapy. Short demonstrated a superb ability to enter his client’s world and regard that world as having the material for productive change. He took the problem behavior, violence, and gave the client ways in which to reframe that behavior so his needs to be respected and strong were productively met. Short should be congratulated for his insightfulness and creativity in using negative behaviors as material for productive change.

References:

Cormier, W. H. & Cormier, L. S. 1985. Interviewer Strategies for Helpers. Brooks/Cole, Publishing Company. Monterey, CA.

Haley, Jay. 1973. Uncommon Therapy: The Psychiatric Techniques of Milton H. Erickson, M.D. W.W. Norton . NY.

Nichols, M. T. 1984. Family Therapy Concepts and Methods. Gardner Press, Inc. NY.