TIME, OCTOBER 22, 1973Estimated reading time: 3 minutes, 18 seconds.
A shy, gap-toothed young woman arrives at the simple home of a doctor in Phoenix, Ariz. She says she is embarrassed about her teeth and bashful with men. Then, with sudden force and apparent malice, the doctor commands her to practice spurting water through her teeth until she is sure she can hit the young man who often meets her at the office watercooler. Soon after, the woman carries out her mission. The next day, the young man lies in wait for her with a water pistol. Eventually they marry. Her problem seems to have vanished magically.
This and many other oddly simple cures are credited to the foxy grandpa of American hypnotism, Milton H. Erickson. At 71, Erickson stands in the forefront of a revival of hypnotherapy -in eclipse since Freud rejected it as too superficial and impermanent. “Erickson is the most innovative practitioner of hypnosis since Mesmer,” says Dr. Thomas Hackett, chief of the psychiatric consultation service at Massachusetts General Hospital. Although Erickson sometimes uses deep hypnotic trances to work his will on his psychiatric patients, he often limits himself to straightforward commands. He does not, however, explain the exact cures.
Erickson’s successes have been described in a new and hagiographic book, Uncommon Therapy: the Psychiatric Techniques of Milton H. Erickson, M.D. (Norton; $8.95), written by Jay Haley, his longtime colleague and admirer. Haley shows how, out of hypnosis, Erickson has drawn a whole bag of ploys that persuade the patient to change himself rapidly. For example, a 250-lb. woman says she is “a plain, fat slob.” Erickson takes over: “You are not a plain, fat, disgusting slob. You are the fattest, homeliest, most disgustingly horrible bucket of lard I have ever seen, and it is appalling to have to look at you.” He continues insulting her-agreeing with her self-image and exaggerating it. The woman reduces to 140 lbs., finds work as a fashion artist and becomes engaged.
As a hypnotist, Erickson often reinforces his control over his subject by challenging him to wake up. For example, he might say: “I want you to try to open your eyes and find that you cannot.” Similarly, performing therapy without hypnosis, Erickson will say: “I want you to go back and feel as badly as you did when you first came in with the problem, because I want you to see if there is anything from that time that you wish to recover and salvage.” Thus, his directive to the patient to relapse actually prevents a relapse.
True Grit. Los Angeles Psychiatrist William Kroger credits Erickson with being one of the first to develop behavioral therapy, which tries to alter behavior patterns without dealing with the unconscious mind. But in addition to his hypnotic techniques, Erickson seems to affect patients through sheer force of personality. He is a man of true grit, who pulled himself through two attacks of polio (after the second, he hiked on canes in Arizona’s Kofa Mountains).
He obviously had no trouble dominating the patients in the cases reported by Haley. Says one fellow therapist disapprovingly: “I had an ex-patient of his come to me; he had reduced her ego to nothing. He’s a strong, powerful, charismatic man. The older he’s got, the more authoritarian he’s become.” Psychiatrist Ira Glick of the school of medicine at the University of California in San Francisco says, moreover, that Erickson does not have a high standing among many therapists because “he has only described a few cases, and he never, never describes any failures.”
Even though Erickson’s practices and claims are sometimes called into question, many doctors give him credit for sticking with hypnosis at a time when it was considered merely a showman’s trick. “Some types of disorders need a certain kind of therapist. Hypnosis is fine for those it helps,” says Psychiatrist Jack Ewalt of the Harvard Medical School. In today’s more open-minded approach to therapy, hypnosis-and its sister principle of strong suggestion-is again finding a place.
Estelle is a friend who at age 75 was diagnosed with breast cancer. She knew that I had done volunteer work with people who have life threatening diseases. The first session was devoted to going over the kinds of things I do to help people. For instance, teaching them how to relax and meditate, guided imagery for healing, and asking direct questions about living wills and medical treatment. Considering the information Estelle provided, I prepared two 15- minute guided imagery tapes for her. I used the first session to elicit information about past surgical experiences and any fears Estelle had about the upcoming surgery. I told her about research which indicated that while under anesthesia patients can hear what is said in the operating room. Using the information she gave to me I led her through a hypnotic session centered on preparation for surgery.
Typically, the hypnotic session is divided into four parts: (1) relaxation/induction, (2) pre-op suggestions (e.g., knowing when to go to her safe haven within her mind), (3) suggestions that incorporate statements given to the surgeon to say during the operation, and (4) post-op suggestions for comfortable and rapid healing. Each suggestion is designed to function during the post-hypnotic surgery experience. A certain amount of dissociation and time distortion are built into the process (e.g., how surprisingly fast the entire experience will occur).
At the second session she told me her surgical lumpectomy and nodal dissection were scheduled for two weeks hence.
At the third session Estelle was given a 30-minute tape to prepare her for surgery. The same information was recorded on both sides. We talked about the upcoming surgery and related matters. We completed a hypnotic session similar to the one on the tape. I also gave Estelle copies of a letter I had written to her surgeon. Estelle was to decide the most appropriate time to give the letter to her surgeon.
The letter was in two parts. The first part gave information relating to my work with Estelle and additional background about my qualification. The second part follows:
”There is a great deal of evidence that patients, even under the surgical plane of anesthesia, can hear things that are said in the OR. It is felt that if the surgeon (or an assistant known to the patient) makes encouraging and healing comments directly to the patient during the surgery, that this has a beneficial effect on outcomes and recovery. This has been both my personal experience and that of a number of people I have advised. To this end, you will find enclosed a brief set of directions and some simple statements that we hope you will be willing to say to Estelle at appropriate times during the surgery. These statements need to be made only a few times, and should always be prefaced by using Estelle’s name so that she knows the message is directed to her; and ended with a “Thank you,” so that she knows the message is over. Estelle has an audiotape to listen to in advance of the surgery. The statements are: 1) Estelle, please slow down (or stop) the bleeding where I am working. Thank you. 2) Estelle, please relax your muscles in this area. Thank you. 3) Estelle, this is going very well. Thank you. 4) Estelle, you will heal surprisingly quickly. Thank you. 5) Estelle, you will be surprisingly comfortable and at ease after this. Thank you. 6) Estelle, your recovery will be very rapid. Thank you.”
This preparation procedure has worked well for my clients. One friend said that the hysterectomy she dreaded was “almost pleasant.” Estelle’s comments were, “I was sure this works for other people, but not for me. It was after the first meditation you led me through that I became convinced this stuff would work. I found the imagery tapes so wonderful and always fell into the deepest sleep. By the time I got the surgery tape I was ready for it, and listened to it every day for nine days. I was listening to it for the three quarters of an hour when they were injecting the dye into me in the hospital. The tape worked – I was able to relax. I only felt nausea briefly afterwards. The anesthetist read the messages during my surgery. The head nurse was very impressed. I would recommend this highly and have told all of my friends…”Discussion
by Susan A. Adams, M.Ed., NCC Doctoral Student in Counseling Texas A&M University
Stress and fear can be damaging to our bodies under normal circumstances, but when a person is facing a battle with a life-threatening disease or surgery, it can further complicate the individual’s natural ability to heal. Spera and Lanto (1997) note, “stress not only contributes to health problems but is frequently caused by them. This isn’t surprising, of course, if the health problem in question is serious” (p. 31). Although we readily recognize stress and its subsequent effects on daily living, the level of stress may be raised significantly when radical surgery becomes necessary.
Estelle, an older woman diagnosed with breast cancer, sought the assistance of Rubin Battino to prepare for her upcoming surgery. She was familiar with his work and felt it would be a beneficial element for success in her anticipated appointment with the surgeon’s knife. After completing three sessions, Estelle was armed with three tapes and a letter for her doctor containing six statements to be read during surgery.
Each of those sessions served a specific purpose and had a definitive goal. The first concentrated on the methods of relaxation through meditation and using guided imagery to facilitate the healing process. Battino prepared two 15-minute tapes for this purpose.
Sessions Two and Three, which were preparatory for surgery, were focused on different aspects of the surgery process. The second session was used for Battino to discover and explore Estelle’s previous experiences with surgery and any fears she might have about the anticipated breast cancer surgery. This session’s agenda also included a hypnotic element. Hypnosis, according to Woolfolk and Richardson (1978) is defined as an “altered state of consciousness that results from focusing awareness on a set of suggestions and allowing oneself to be receptive to those suggestions – all while allowing free rein to one’s powers of imagination” (p. 157). Battino divided the hypnotic experience into four parts: (1) relaxation induction; (2) pre-op suggestions; (3) operation suggestions; and (4) post-op suggestions to impact the patient’s recovery and healing. Included in this hypnotic session were dissociation and time distortion elements suggesting that the healing experience would be surprisingly rapid.
By including these suggested activities, the patient is empowered to focus on things she had some control over – her own state of relaxation. It can be difficult to venture into unfamiliar territory and recognize there are so many elements beyond the control of the individual. However, these activities were designed to suggest some degree of control over her impending situation. Two of the suggestions Spera and Lanto (1997) offer to assist individuals in coping effectively with stress are “put your thoughts and feelings into words,” and “use mental rehearsal to pave the way for success” (p. 146). These are methods incorporated in this case.
In addition, Battino indicated that patients can hear what is being said while they are under anesthesia, so he prepared a letter for her doctor. This letter contained six specific statements, which were included in the case report, to be read while the surgery was being performed. The doctor was instructed to begin each of the statements with Estelle’s name and conclude with “thank you.” This was to indicate the statement was addressed to her and now that message was ended.
Estelle admitted skepticism initially, but after experiencing the relaxation from the first imagery tapes, she became convinced of their effectiveness. As preparation for the surgery, she utilized the surgery tape for nine days and then again for three quarters of an hour when the dye was being injected prior to the actual surgery. This was effective in inducing relaxation, and the patient indicated only brief nausea afterward. The statements were read during the surgery by the anesthetist. Estelle felt it was successful and would recommend it to others .
Although Battino did not address the post-op healing process in his case report, be did provide clues throughout the article about the receptiveness of the patient and the impact the various tapes and imagery techniques bad on her mental state prior to and during surgery. These activities provided some degree of participation on Estelle’s part toward her healing, and this empowerment appeared to have a positive mental impact.
Spera, S. & Lanto, S. (1997). Beat stress with Strength a Survival Guide for Work and Life. Indianapolis, Ind.: Park Avenue Productions.
Woolfolk, R. L. & Richardson, F. C. (1978). Stress, Sanity, & Survival. New York: Sovereign Books.
Estimated reading time: 15 minutes, 25 seconds.
Our purpose in this chapter is to describe a hypnotic technique we use to help our clients enhance their performance in almost any enterprise. Our approach remains fairly constant no matter what area of life a person wishes to improve. Whether a client wants to lower his or her golf score, become a better salesperson, develop new interpersonal skills, or simply feel better emotionally, we conduct our sessions in essentially the same manner.
ENHANCING FUTURE PERFORMANCE
After an initial diagnostic interview to determine why the person is there and what he or she wants to accomplish, we use hypnosis to clarify the thoughts, sensations, emotions, and behaviors that individual associates with the desired outcome. During this trance session, the client is instructed to imagine how it will feel to accomplish the desired goal and to examine all of the elements of this imagined situation, including the events that led up to it. This utilization of the individual’s own prior experiential learnings and understandings to establish the treatment outcome ensures that the particular objectives, personality, and background of that person are taken into account and that the prescribed changes truly suit the activity under consideration.
On the other hand, the client’s reservoir of experiential learnings and understandings is not the only possible source of guidance at this point. Relevant information from the professional literature also may be incorporated into the hypnotic suggestion process if necessary. For example, an ever-growing body of research consistently shows that success in virtually every endeavor, including everyday life, depends on an optimistic attitude and a positive sense of self-efficacy (e.g., Taylor, 1989; Maddi & Kosaba, 1984). Accordingly, we routinely include suggestions regarding these attitudes as the person develops the imagined experience of a successful outcome.
We also routinely include suggestions designed to promote a condition of highly focused attention. Obviously, one must focus one’s attention on an activity to perform it with any degree of success. What is less obvious, and less widely known, is that a particular state of highly focused attention is commonly associated with exceptional performances in virtually any area. For example, Gallwey (1974) taught tennis and golf players to enter into a state of “relaxed concentration” to improve their game. Lozanov (1978) found that students could learn a foreign language more efficiently in a similar state that he called “concert pseudopassiveness,” and Gilligan (1987) attributed the “controlled spontaneity” frequently observed in the performances of professional musicians, athletes, and psychotherapists to this condition of absorbed attention. Zeig (1985) described the way in which Milton Erickson reportedly predicted the winners of a track meet. He would choose those who were “concentrating and focusing.” Race car drivers refer to this state as “streaming” and athletes in general talk about being “on” or “in the zone.” Given the similarity of this experience to the absorbed attention typical of a hypnotic state, it is natural and useful to incorporate a description of it as a desirable outcome of therapy for most clients.
Furthermore, individual activities, such as target shooting, require a narrow internal focus of attention for peak performance (Maxeiner, 1987), whereas team sports demand a more diffuse and external focus (Nettleton, 1986). When such information is available for the pursuit being considered, it is added to the client’s own understandings via the suggestions we offer regarding the goal state.
The specific steps involved in this intervention are as follows:Conduct a trance induction or any other procedure designed to stabilize and redirect the client’s attention inward. Ideally, the person will be in a receptive, passively observant frame of mind before the therapist proceeds to the next Explain to the person that in the same way that it is possible to remember and relive a past experience, it also is possible to use imagination to “remember” an event that has not yet happened. Quickly add that the person can, for example, “remember” what it will feel like when the person realizes that he or she accomplished whatever it was that brought the person to you in the first place. Indicate that the client already knows how it will feel to do so and suggest that they he or she pay attention to those feelings and sensations now. While he or she is locating and becoming familiar with how it feels to succeed, suggestions for different aspects of the experience can be provided, such as a sense of satisfaction, well being, or excitement. After the client begins to identify and experience the emotions and sensations associated with accomplishing the desired goal, the experience is expanded and clarified, one sensory pathway at a time. Details about that future situation are gradually filled in by asking the person to pay attention to physical sensations, sounds, and sights. Eventually the person is asked to take cognizance of where he or she is, who else is there, what the date is, and so on. As the person vividly imagines being in that future situation, happy and satisfied with a successful outcome, he or she is asked to “remember” the actual experience of succeeding. This step can be omitted if the goal is a change in emotional or psychological state, because it is often difficult to identify exactly when such changes occur, but if the objective is enhanced performance of some specific mental or physical activity, then it is a useful part of the process. The client has an opportunity to “experience” (and thus rehearse) how it feels to perform in a successful manner, and the therapist has an opportunity to include suggestions for particular actions or states of mind that are known to enhance performance in that endeavor. For example, this is an appropriate time to suggest that the client “remember” how it felt to be effortlessly focused and undistracted, to be sure of himself or herself and yet amazed by his or her own abilities. This alsois an appropriate time to suggest that the client examine things about the situation that seemed to make it easier to perform so well, that is, to become aware of any changes in attitude or approach that apparently helped to create a positive outcome. The next step is to ask the client to remember, from that future vantage point, some of the significant events that took place along the path leading from now, sitting in your office, to the desired result. These events are mentally “reviewed” to “remind” the person about what led to the hoped-for end product and to set the stage for their eventual occurrence, but there is no need for the events to be reviewed in sequential order, nor is it necessary for the client to understand how those happenings contributed to that conclusion. In fact, it is best if the client views them as a selection of unrelated events that simply pop into the mind. Throughout the entire process, the client is encouraged to wait for different aspects of the experience simply to emerge or appear and not to create them on purpose. Even if what springs to mind does not make sense or seem relevant, as is often the case, the person is asked to observe passively and allow things to unfold in whatever manner they do without interfering or attempting to alter them. Finally, as the trance and the session are brought to a close, the client is told to forget about the things that have occurred and to allow the unconscious mind to assume responsibility for turning these imagined events into Although some clients are able consciously and intentionally to follow their own “unconscious” advice, others tend to alter matters in a way that merely perpetuates previous patterns of action and reaction. Thus, whenever possible, it is desirable to elicit amnesia for these experiences and to offer a posthypnotic suggestion for their eventual accomplishment in a seemingly spontaneous manner. When this suggestion is successful, clients engage in the activities that lead to the desired outcome without realizing that there is a method to it. Looking back on it, they typically report, “One thing just led to another.”Although we would love to take credit for inventing this approach, the basic rationale and structure of the technique presented here were derived directly from the work of Milton Erickson.
In our book on Hypnotherapy for Health, Harmony, and Peak Performance (Walters & Havens, 1993), we point out that Erickson was less concerned with what people were doing wrong in the present than with getting them to do things right in the future. He encouraged the development of attitudes and behaviors that would eventually result in successful adjustment and emotional well-being. He elicited the positive attitudes, states of mind, and behaviors that he knew would allow his clients to accomplish their goals, whether those goals involved enhanced athletic performance, academic performance, or performance in everyday life. Erickson concentrated on what people could do, and he devised an impressive array of techniques to help them build better futures for themselves. He used direct and indirect hypnotic suggestions, implications, metaphorical anecdotes, and straightforward behavioral assignments to get people to begin thinking and behaving in healthier, more productive ways. The approach outlined here is based on one of these many techniques, a technique Erickson called “pseudo-orientation in time” (Erickson, 1954).
Because Erickson usually devised a unique therapeutic intervention to suit the needs and personality of each unique person, it may seem some what presumptuous to reduce his approach to one specific strategy to be used with a broad range of problems. Nonetheless, we believe that it is appropriate to do so. Few practitioners can emulate Erickson’s creativity or wisdom and, luckily, most of the time it is not necessary to do so. We propose that it is possible, instead, to use his pseudo-orientation-in-time technique with virtually every client because it is the one intervention that captures the underlying essence of Erickson’s seemingly endless list of strategies. By concentrating on one particularly powerful Ericksonian hypnotherapeutic approach, it is possible to condense his insights and genius into a manageable procedure.
Pseudo-orientation in time is one of the few techniques Erickson used with more than one patient, and it is the only one of his techniques that seems to be useful for almost any presenting problem. In his original publication on the topic, Erickson (1954) described his use of this technique with five very different patients, all of whom enjoyed successful outcomes. Each patient eventually engaged in the activity he or she had foreseen in the age-progression visualizations, and each did so with no recognition that he or she was following his or her own self-generated prescription for success.
In another publication (Erickson & Rossi, 1977), Erickson even described using this approach on himself to prepare for the unpleasant situations he realized he would eventually encounter as a physician. He projected himself into an imagined future, figured out how to cope with the unfairness and unpleasantness of the events he was likely to face in his practice, and emerged from his reverie ready to continue with his career. Given the nature of that career, it is safe to conclude that his intervention worked.
Like most of Erickson’s interventions, the pseudo-orientation-in-time approach focuses the client and the therapist fully and solely on the future. In addition, because it is centered around the client’s self-generated imagined experience of accomplishing the desired objective, this technique relies heavily on the client’s own “unconscious” learnings and observations to define both the goal state and the steps required to arrive at that goal. Once the desired future and the steps to that future are identified, then the client is instructed to forget about it and to allow this outcome to unfold automatically or “unconsciously.” No other strategy seems to capture the essence of Erickson’s approach more directly or completely, and no other approach seems to be more consistently successful.
Jason, a 17-year-old member of a local high-school track team, consulted our office to improve his performance in the 1,600-meter race. His coach suggested that he seek professional help because he repeatedly lost races that, theoretically, he should have won. During practices, his lap times were consistently fast. During actual competition, however, he was unable to maintain a fast pace throughout a race. He started and finished fast, but always faded during the middle laps and lost too much ground to catch up and win. As Jason described it, he was always fired up during the first third of the race, discouraged and ready to quit during the middle third, and then would become angry and try to do his best again for the final third of the way.
The intervention in this case was quite simple and brief. Following an induction process, Jason was asked to imagine himself talking to his coach after winning an upcoming race. He was able to do this with little trouble, and he was also able to offer a verbatim account of his conversation with the coach about that race. He was then asked to remember what was different about the way he had thought about the various parts of the race and to tell his unconscious to make sure that these new thoughts arose during the next track meet. Finally, he was told to wake up without remembering much, if any, of the session. He left with a promise to return the following week and report what happened.
Jason later said that he had won his next race, although he did not know why. As he described it, he was really fired up during the first half of the race, and by the second half was getting angry and determined, just as he always did. It was immediately obvious that he had stopped split ting the race into thirds. He had solved the problem of becoming discouraged and tired during the middle third of the race by simply eliminating it from his thoughts. Interestingly, this was exactly what he had said to his coach during his imagined winning experience.
SUMMARY AND CONCLUSIONS
Peak performance in any field is a function of multiple variables, including attitudes, emotions, innate talents, and practice. People who succeed have a clear idea of an attainable goal. They also know what they must do to accomplish that goal, and they have the willingness or desire to do it. Finally, they have optimistic expectations that they can and will reach their objective; they trust themselves and know how to get out of their own way. The techniques presented here are designed to provide these ingredients of peak performance to those who want and/or need them.
Hypnotic trance allows people to establish attainable goals. During trance conscious concerns, inhibitions, misunderstandings, fantasies, or wishful thinking do not interfere with the construction of a viable outcome. People are able to review the potential disadvantages or advantages of various goals and actions in a detached and careful fashion. The end product springs into awareness before it can be censored or modified by ordinary conscious considerations. Consequently, the imagined future is almost invariably compatible with the person’s needs and capacities.
This also is the case when trance is used to envision a series of actions or events that will lead to that imagined outcome. When conscious biases are bypassed, the end product is a set of activities, insights, or decisions that are quite appropriate for that individual and that lead almost inexorably to the desired outcome. Hypnotherapists merely help people discover what they already knew about their own abilities and potentials but were unable or unwilling to acknowledge.
People seek help from professionals because they want something different, something better, to occur. They want to change their thoughts, their feelings, their actions, and their lives, but those changes will take place only after they can envision them as happening in the future. Our vision of the future is a road map, a program, a guiding principle that modifies our present actions in ways that lead us toward that envisioned outcome. To explain his technique of pseudo-orientation in time, Erickson (1954) said, “Deeds are the offspring of hope and expectancy” (p. 261). When we expect more of the same, that is what our deeds create. But when we can imagine a better future so clearly that it actually seems possible, then we begin to think and behave in ways that lead us there.
Many different techniques can be used to attain enhanced performance, but few are as straightforward or as likely to meet the unique needs and capacities of each individual as the approach presented here. If you want to help others respond in ways that promote a better future, why not follow Erickson’s lead? Imagine the changes your clients will experience, first in their imaginations, then in their lives. Once you have envisioned such outcomes, you will find this approach hard to resist.
Points to RememberFocus on what will make things go right in the future. Not on what made things go wrong in the past. Remember that people need to know where they are going in order to get there. Help them develop a clear picture of a successful outcome. Always assume that the client knows at some level what goals and strategies are most appropriate and useful, but also remember to mention relevant information from the research. Encourage the client to enter imagined future situations by thinking about how it will feel to succeed rather than about what to do. After the client has a clear picture of a successful outcome and re views the events that led to to it, suggest that the unconscious mind can now accomplish these things and that the conscious mind can forget all about them.
Erickson, M. H. (1954). Pseudo-orientation in time as a hypnotherapeutic procedure. journal of Clinical and Experimental Hypnosis, 2, 261-283.
Erickson, M. H., & Rossi, E. (1977). Autohypnotic experiences of Milton H. Erick son. American Journal of Clinical Hypnosis, 20, 36-54.
Gallwey, W. T. (1974). 1beginner game of tennis. New York: Random House.
Gilligan, S. (1987). Therapeutic trances: The cooperation principle in Ericksonian hypnotherapy. New York: Brunner/Mazel.
Lozanov, G. (1978). Suggestology and outlines of suggestability. New York: Gordon & Breach.
Maddi, S., & Kosaba, S. (1984). The hardy executive: Health under stress. Homewood, IL: Dow Jones-Erwin.
Maxeiner, J. (1987). Concentration and distribution of attention in sport. International Journal of Sports Psychology, 18, 247-255.
Nettleton, B. (1986). Flexibility of attention and elite athletes’ performance in “fast ball games.” Perceptual and Motor Skills, 63, 991-994.
Taylor, S. E. (1989). Positive illusions. New York: Basic Books.
Walters, C., & Havens, R. A. (1993). Hypnotherapy for health, harmony, and peak performance: Expanding the goals of psychotherapy. New York: Brunner/Mazel.
Zeig, J. (1985). Experiencing Erickson: An introduction to the man and his work. New York: Brunner/Mazel.