A 28-year-old male physician, who had done well in medical school in Japan, began working on a doctoral thesis at the surgery department of a national university that was not his alma mater. He also was working at the hospital where his father was a staff physician.
He started having difficulties with his doctoral thesis. As a consequence, he began to suffer from severe insomnia. He decided to treat his own insomnia by taking prescription sleeping pills (methaqualone), a type which are no longer manufactured in Japan because of their severe side effects. Soon, the young physician became dependent on these pills as well as tolerant of them. He increased the dosage and finally began taking them during the day as well.
His behavior changed dramatically. He became rude and unreliable; his ability to practice surgery became noticeably and severely compromised. There were even several episodes where he collapsed during surgery. He was relieved from all duties at the hospital. His wife left him and returned to her parents’ home where she thought of divorcing him.
He came to my clinic and decided to use hypnosis as part of therapy. After a deep hypnotic trance was induced, I suggested he recall his happy, confident days before the beginning of his doctoral thesis. The recall and re-experiencing of these good times were confirmed by finger signaling.
Using age progression, he was asked to imagine a scene in the future where he was freed from his addiction and felt happy and confident both mentally and physically. These feelings were tied to the feelings he had as a student before he was addicted. He was asked to see the people close to him, his parents, his wife and the staff of the hospital, being so pleased for him and filled with trust for him as they had been in the past. I suggested that he imagine such scenes as vividly as possible.
As a post-hypnotic suggestion, I told him that the experience he had in the hypnotic trance would be firmly fixed in his unconscious mind. It would positively influence his daily activities without conscious awareness. Then the trance was ended.
The next week, he said he had stopped taking the pills. He said he was feeling some confidence and happiness. There were two more sessions using the same principles of building a productive future on productive behaviors and responses in the past.
It is now 25 years since these three sessions. He has had no further problems with drug dependency. He is working actively at the hospital where he did his doctoral thesis, and has replaced his father, who retired, as director.
The work described here is a successful example of what I have called the “in advance rewarding method.” This technique aims to develop the patient’s inner strengths toward a possible and positive future. I developed treatment in this case without knowing about Erickson’s work in pseudo-orientation in time.Discussion
by Betty Alice Erickson M.S., L.P.C. Dallas, Texas
Dr. Takaishi’s patient did not seem to require the added complexities of a physical detoxification, and he was not initially enthusiastic about treatment. Using the man’s previous experiences as a successful and competent person, Takaishi used trance to guide the man into a realization that his future could have those same components. In 1934, Erickson wrote that the hypnotist “must implant his suggestions in the vast aggregate of mental reactions and patterns accumulated throughout the subject’s lifetime.” Takaishi did just that.
Regression in a hypnotic state helps a patient reestablish patterns of behavior “uninfluenced by subsequently acquired” behaviors (Erickson, 1937). And again, Takaishi did just that.
Good therapy allows the patient to access and build upon personal strengths and resources in productive ways. It is the therapist’s job to structure psychotherapy so the patient is in a position where those currently inaccessible abilities and resources become usable once again.
This patient clearly had the ability to succeed and accomplish his goals. Imagining a future, in a trance state, where goals already have been met and the warm glow of success is felt, can give patients deep-seated feelings of accomplishment and pride. Structuring this future as a post-hypnotic suggestion that didn’t have to enter conscious thinking allowed the patient to reap the benefits of the therapy without having to ascribe the cause to the therapist’s suggestions.
One of the most intriguing aspects of Erickson’s work is its timelessness. Six decades ago, when hypnosis was poorly understood and under-used in the psychotherapeutic world, he was writing about the principles that Takaishi employed in his work 35 years later. These techniques are as applicable and powerful today as they were when Erickson first wrote about them and when Takaishi used them. Takaishi did good therapy, with creativity and intelligence.
The opportunity to reexamine effectiveness after twenty-five years is rare. The absence of a relapse speaks for the effectiveness and the appropriateness of the therapy used. With his discovery that Erickson had written about this same technique years previously, Takaishi can now compare and enhance his own abilities just as students of the “modern” arms of psychotherapy, of brief, cognitive, narrative, and solution-focused, can compare and enhance their own understandings by studying Erickson’s original works.
Erickson rarely claimed credit for “inventing” a technique. He understood that the tenets of human behavior have been known and studied for centuries. Part of his gift to the psychotherapeutic world was his ability to encapsulate commonalties in productive methodologies and to write about and teach them in understandable and replicable ways.
Erickson, M. H. (1934). “A brief survey of hypnotism.” Medical Record, 140, 609-613.
Erickson, M. H. (1937). Development of apparent unconsciousness during hypnotic reliving of a traumatic experience. Archives of Neurology and Psychiatry, 38, 1282-1288.
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.