By Milton H. Erickson, M.D.
Estimated Reading Time: 9 minutes, 4 seconds
Edited by Richard Landis, Ph.D.
Discussion by Betty Alice Erickson, M.S.; Carol Lankton, M.S.W.; Eric Greenleaf, Ph.D.; Goran Carlsson, Psych.; and Steve Lankton, M.S.W.
Editor’s Note: Steve and Carol Lankton, Eric Greenleaf, Goran Carlsson, and Betty Alice Erickson were asked to discuss one of Erickson’s classic cases, “Case of Airplane Phobia.” The following is an excerpt from that discussion.
Steve Lankton (SL): The “Case of Airplane Phobia” or “Two Phobias” is explained at varying lengths in the different literature references (Experiencing Erickson, pp. 122-125; Hypnotherapy Casebook, pp. 314-347; Teaching Seminar, pp. 64-70). This is a case of a woman having anxiety that is related to an earlier mild air travel trauma that was beginning to generalize to situations where she is destined to experience disruptive air turbulence. The first intervention is preceded with a demand that she agrees to a “total commitment” of anything Erickson might ask.
Carol Lankton (CL): The next part is pure and practical and vintage Ericksonian intervention. He has her experience the anxiety of being on an airborne plane, while in trance. Erickson then lets that fear slide off her and remain on the chair as she comes out of trance comfortably and safely. She learns a quick self-induction and leaves with the instruction to enjoy her upcoming airplane trip (not just survive it) using self-hypnosis any time that she might like. Erickson then supplies her with differently developed pictures of the chair as the eternal resting-place of her anxiety. I think it’s nice that even her anxiety is safely resting. And all of her attention has been successfully turned to enjoying the trip!
SL: Erickson’s assessment most assuredly went beyond the few facts we are given in print. He would have assessed her word selection, nonverbal behavior, self-awareness, degree of congruity, cadence, and so on. My understanding of Erickson’s: work leads me to believe that these sort of interpersonal and personal features are essential to proceeding with meaningful personal interventions. So, lacking that knowledge, we are only given his dramatic interventions.
CL: The client asked for hypnosis to cure her airplane phobia. After discovering her anxiety only occurred when the plane was airborne, Erickson concluded that what she was really afraid of was being absolutely committed in closed spaces where there were no visible means of support. This highly specified, operational definition went beyond the more abstract label of “airplane phobia.”
Erickson maintained that “we always translate the other person’s language into our own language,” but in this case his careful attentiveness to exactly when she had anxiety allowed him to translate the client’s experience beyond her own language and into her specific experience.
His deductive thinking then led to the conclusion that she must also be similarly uncomfortable in elevators and on suspension bridges since these two contexts also contained the same common denominator with an airborne plane: absolute commitment, closed space, no visible support.
Betty Alice Erickson (BAE): This case is a wonderful example of Erickson paradoxically expanding rigid sets. Fundamental to the way he worked is his precept that the expansion of mental and emotional sets gives choice. If options and choices exist, people don’t need therapy. Erickson focuses on the patient’s simple definition of her ordinary problem and works metaphorically with the broader-based problem to which she alluded. He is dogmatic even while he works indirectly and symbolically. Interventions are separate yet intricately woven so the thread of each merges with the whole.
Setting the stage
Eric Greenleaf (EG): Erickson uses a paradoxical combination of reasonable goals and unreasonable constraints.
Goran Carlsson (GC): I’m most fascinated about the way Dr. Erickson challenges the patient, both to help her go into a trance and to help her change and take control over her problems: “Well, I don’t know if you are a good hypnotic subject.” She said, “I was in college, it’s been a long time ago.” “The question is, are you a good hypnotic subject now. I’ll have to test you.” How could she not go into a trance right then?
BAE: Fear, which she defined as trembling and shaking and wanting to run away, was given a new emotional frame. Erickson stated obvious facts in a way to elicit anxiety.
GC: That’s when he said, “There’s one more important thing. You’re an attractive young woman, and I’m a man. I’m in a wheelchair. You do not know the extent of my disability. Now listen carefully. I want you to promise me that you will do anything, good or bad I ask of you. I want the promise to be absolute.”
BAE: He was also a respected psychiatrist, in a wheelchair, with his office in his busy home. Clearly there was nothing to fear. Most fear is not the fear of a hungry tiger walking in a room, as Erickson often said. Setting the stage so she would define one fear as invalid, also set the stage to redefine other fears.
EG: “You do not know the extent of my disability.” This is intriguing and seems to me paradoxical. It induces fear of the therapist, who “may do anything,” but, while speaking of the therapist, raises two important possibilities for the patient: 1. She may not know the extent of her disability or her abilities. 2. She may be willing to do absolutely anything to recover.
GC: She wanted Dr. Erickson to help her, she trusted him. Her motivation to change was high. He knew that. Of course, she promised.
CL: He chose to hint that it could be an inappropriate sexual thing that could happen between her as a woman and him as a man simply because he believed she would find this most disagreeable in her newly married state.
In making this absolute commitment to whatever might happen, she voluntarily placed herself in the most feared circumstance of having no control over anything. She did this under the impression that it was important to the treatment. And it was important for two reasons: 1) “she found out that she could live through a commitment,” and 2) the actual problem including a bodily threat was present as a reality in the office and could be worked on in the session and then left in the chair.
SL: I felt that Dr. Erickson’s demand that she agree to a “total commitment” of anything he might ask, is useful as it heightens the gravity in the session and forms a basis for the client’s fear. This is admittedly done at some risk. The therapeutic reliving and subsequent post-hypnotic suggestions were an acceptable method of treatment (especially, for a trauma that is not debilitating).
EG: “I want you to promise me that you will do … just anything, good or bad, I ask of you. I want the promise to be absolute.” Having switched the greatest fear from the phobia to the therapist, Erickson then asks that she choose to experience compelling, helpless change for the better. This shifts her from her experience of helpless fear. She replies, ‘”Nothing you could do or ask is going to be as bad as my airplane phobia, so I’ll promise.”
CL: Based on this specified understanding about the scope of this client’s anxiety, Erickson was able to create a parallel anxiety that contained her fears of absolute commitment, closed space and no visible support. · It could be experienced in the present, namely her absolute commitment to accept anything he might do to her, good or bad, in the treatment session.
The Focused Intervention
BAE: Hypnosis was the vehicle for her to experience flying in ways Erickson directed-as she had promised she would do. Hypnosis allowed her to see the fears separate from her, and become very real in the chair. His communication with her about those fears was paradoxical.
SL: The remainder of the transcript provides a wonderful example of how Erickson helps the client dissociate or split effect from the traumatic fear while at the same time blending with the client’s twists and turns of thought.
EG: “All the devils of torture have slipped off your body, into the chair… not on you, but all around you.”. In trance, Erickson induces the fearful flight. Then, when she is shaking, he has the plane descend. “And when you arrive on the ground, you’ll find all your devils appear .. .” He moves the place of fear from the airplane to the ground, then, from the patient’s interior feelings to the space around her. He distances these fears further by taking photos of the chair, labeling them “The eternal resting place of your fears, phobias, anxieties.”
BAE: One message was carried by the phrase “the eternal resting place,” which every adult knows means a final end. The other by giving her the pictures to carry like a child carries a lucky penny. In a trance, this made perfect sense and the convolution of the paradox became impossible to dissect or refuse.
EG: Erickson demonstrated changing places, that identify problems, changes symptoms, meanings, and the status position of patients. He stayed close to the psychological and interpersonal experience of his patients in crafting seemingly eccentric interactions. As he explained, “She was talking about the fear of an enclosed space that had no visible means of support and her life in the hands of some stranger.”
CL: The second part brings the other two problems with the common elements (elevators and bridges) to the client’s conscious attention while at the same time demonstrating to her that she has, in fact, already solved them back in the first session before she had even mentioned them. This was accomplished by having her hallucinate (in trance) in detail a delightful and completely comfortable sightseeing trip across the San Francisco Golden Gate Bridge. This was quite remarkable since she previously went over bridges (even in trance) in great discomfort, cowering and with her eyes closed.
Similarly, he asked her to report on how she had recently been able to comfortably ride 20 floors in a glass elevator instead of getting off at each floor and taking a different elevator one floor at a time as she had previously done.
SL: He ultimately associated her feelings of success with overcoming the bridge trauma, to provide the solution of her previous homework concentration problem.
BAE: Most Ericksonian of all, she didn’t have to understand exactly why she changed.
SL: Again, this shows that it is the process and not the content used by Erickson that must be learned and recreated for successful treatment. It is important to realize the idiosyncratic nature of intervention in these cases. Dr. Erickson would be quick to dissuade a therapist from trying to generalize from this case to any other and quick to discourage the use of an intervention that appears to be decisive in such a case. These interventions were used with a specific person about whom we have insufficient information to be able to generalize and replicate the therapy.
This excerpt has been extracted from Volume 21, Issue No. 2 of The Milton H. Erickson Foundation Newsletter.
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