Posts Tagged ‘Technique’
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.
Milton H. Erickson & Ernest L. RossiEstimated reading time: 4 minutes, 54 seconds.
THERAPEUTIC BINDS AND DOUBLE BINDS
The concept of the double bind has been used in many ways. We use the terms “bind” and “double bind” in a very special and limited sense to describe forms of suggestion that offer patients the possibility of structuring their behavior in a therapeutic direction. A bind offers a free choice of two or more comparable alternatives-that is, whichever choice is made leads behavior in a desired direction. Therapeutic binds are tactful presentations of the possible alternate forms of constructive behavior that are available to the patient in a given situation. The patient is given free, voluntary choice between them; the patient usually feels bound, however, to accept one alternative.
Double binds, by contrast, offer possibilities of behavior that are outside the patient’s usual range of conscious choice and control. Since the original formulation of the double bind (Bateson, Jackson, Haley, and Weakland, 1956) as a hypothesis about the nature and etiology of communication in schizophrenia, a number of authors have sought to utilize the concept of the double bind to understand and facilitate psychotherapy and hypnosis (Haley, 1963; Watzlawick et al., 1967, 1974; Erickson and Rossi, 1975). Since we use the term in a very special and limited sense, we will present only an outline of how we conceptualize the double bind for an understanding of therapeutic trance and hypnotic suggestion.
The double bind arises out of the possibility of communicating on more than one level. We can (1) say something and (2) simultaneously comment on what we are saying. We may describe our primary message (I) as being on an object level of communication while the comment (2) is on a higher level of abstraction, which is usually called a secondary or metalevel of communication (a metacommunication). A peculiar situation arises when what is stated in a primary communication is restructured or cast into another frame of reference in the metacommunication. In requesting an ideomotor response such as hand levitation, for example, we ( 1) ask patients to let their hand lift but (2) to experience it as lifting in an involuntary manner. In requesting an ideosensory response we may (I) ask patients to experience a hallucinatory sensation of warmth, but (2) it is usually understood that such an experience is outside patients’ normal range of self-control. Therefore, patients must allow the warmth to develop on another, more involuntary level. We have many ways of saying or implying to patients that (I) something will happen, but (2) you won’t do it with conscious intent, your unconscious will do it. We call this the conscious-unconscious double bind: since consciousness cannot do it, the unconscious must do it on an involuntary level. Conscious intentionality and one’s usual mental sets are placed in a bind that tends to depotentiate their activity; unconscious potentials now have an opportunity to intrude. The conscious-unconscious double bind is the essential basis of many of the therapeutic double binds discussed in the following sections.
In actual practice the metacommunication that comments on the primary message, may take place without words: one may comment with a doubting tone of voice, a gesture or body movement, subtle social cues and contexts. Hidden implications or unconscious assumptions may also function as a metacommunication binding or qualifying what is said on the ordinary conversational level. Because of this the patient is usually not aware that conflicting messages are being received. The conflict is frequently enough to disrupt the patient’s usual modes of functioning, however, so that more unconscious and involuntary processes are activated.
Ideally, our therapeutic double binds are mild quandaries that provide the patient with an opportunity for growth. These quandries are indirect hypnotic forms insofar as they tend to block or disrupt the patient’s habitual attitudes and frames of reference so that choice is not easily made on a conscious, voluntary level. In this sense a double bind may be operative whenever one’s usual frames of reference cannot cope and one is forced to another level of functioning. Bateson (1975) has commented that this other level can be “a higher level of abstraction which may be more wise, more psychotic, more humorous, more religious, etc.” We simply add that this other level can also be more autonomous or involuntary in its functioning; that is, outside the person’s usual range of self-direction and -control. Thus we find that the therapeutic double bind can lead one to experience those altered states we characterize as trance so that previously unrealized potentials may become manifest.
In actual practice there is an infinite range of situations that may or may not function as binds or double binds. What is or is not a bind or double bind will depend very much on how it is received by the listener. What is a bind or double bind for one person may not be one for another. In the following sections, therefore, we will describe a number of formulations that may or may not lead a particular patient to experience a bind or double bind. These formulations are “approaches” to hypnotic experience; they cannot be regarded as techniques that invariably produce the same response in everyone. Humans are too complex and individual differences are simply too great to expect that the same words or situation will produce the same effect in everyone. Well-trained hypnotherapists have available many possible approaches to hypnotic experience. They offer them one after another to the patient and carefully evaluate which actually lead to the desired result. In clinical practice we can only determine what was or was not a therapeutic bind or double bind in retrospect by studying the patient’s response. The following formulations, therefore, offer only the possibility of therapeutic binds or double binds that may structure desired behavior.[ Note: One may refer to the “following formulations” by reading the rest of the chapter after purchasing the book here — https://catalog.erickson-foundation.org/item/hypnotic-realities ]
Milton H. Erickson was no doubt a master of masters in inducing hypnotic responses for clinical purposes. Dr. Erickson was instrumental in developing a number of indirect hypnotic techniques and strategies, including interpersonal and nonverbal or pantomime tactics (Erickson, 1958, 1964, 1966; Haley, 1967). One fascinating technique that stands out was the “handshake hypnotic induction technique.” The purpose of this article is to outline the key elements and a procedure of the therapeutic hypnotic handshake induction technique.What is a Trance Experience?
Controversies over the nature and definition of trance phenomena often involve the contextualized experienced “state” vs. nonstate. The present authors consider a trance experience as a contextualized state with multiple levels, expressions, and facets. The central aspect includes an intense focusing and sense of detachment (dissociated response). One particular behavior directly associated with the handshake technique is the dissociative cataleptic response.Dissociative Cataleptic Response
Inducing a cataleptic response is the key to the handshake technique. Edgette & Edgette (1995) categorize the handshake technique as a method of inducing hypnotic catalepsy. Catalepsy is the induced immobility of various limbs and/or entire body. Edgette & Edgette (1995 p. 173) define catalepsy as, “…immobility in one or more parts of the body.” Catalepsy has been defined as an involuntary tonicity of the muscles (Kroger, 1977), and a suspension of voluntary movement and condition of well-balanced tonicity (Erickson & Rossi, 1981). Muscles are felt as being in balance and comfortable, neither too tense nor too limp. The client/subject maintains or sustains a suspended state or immobilized position for a long period of time.Handshake Technique Procedure
Therapy involves communication within a change-oriented context in which the therapist engages the client in conversation, forming interactions, which can start with a simple handshake. This handshake can be utilized to facilitate the hypnotic elements in these therapeutic conversations.
Erickson and Rossi & Rossi (1976) describe the handshake technique by starting with a firm hand grasp, then slightly adjusting the operator’s fingers, creating momentary confusion by refocusing the subject’s attention with the different sensations felt, as the operator withdraws their hand. As the operator withdraws their hand, the subject’s habitual framework is interrupted, thus creating a hypnotic touch.
This procedure can be detailed into the following steps:Engage with client or subject. Gaze into the client’s or subject’s eyes (as part of the initial exchange via eye contact). Slowly reach out to shake or grasp the hand. Grasp the client’s hand in a normal handshake. Slow the handshake down by pacing and leading the client’s hand during the clasp. Shift the touch and pressure, slowly releasing the handshake. Slowly release the hand from the handshake; slide hand away. Meanwhile, if/or when speaking, use a slow, smooth, monotone relaxing voice. Maintain a gaze, looking into the client’s or subject’s eyes, leaving the client’s hand buoyant, as in arm levitation. Direct the client therapeutically, thus utilizing the outcome. If necessary, for reorientation, provide suggestions.
A similar process naturally occurs when taking vitals. Carich and Junge (1990) noticed pantomime hypnotic experiences when taking vitals, particularly pulses. By taking a pulse, for longer than required, the subject’s arm can be suspended in mid-air, forming a cataleptic response. This experience is similar to the handshake technique in developing cataleptic responses.Key Elements
There are several key hypnotic elements involved in the technique:Fixation of attention or refocusing the client’s attention by: Eye gazes. Touch and Pressure. Inducing behavioral suspension or buoyant response (creating a dissociative response). Developing a rhythmic pattern during the process, which includes reduced respiratory rate. Interrupting the subject’s habitual framework, by refocusing one’s attention on different sensations of the handshake.
A key point while engaging the subject/client, is that the individual’s internal focus is fixated on some selected stimuli involving the level of pressure of the grip. Slowing down the movement and touch during the clasp can initiate this. Also, during the initial engagement, eye gazes create another source of client fixation. By slowing down the shaking of the subject’s/client’s hand, an arm levitation response is induced or created, thus leaving the hand/arm buoyant and totally immobilized. In some cases, the subject or client may be totally immobilized. Finally, the process entails a rhythmic pattern or integration between the therapist and client. The depth depends upon several factors or conditions:Context of the interaction. Skill and rhythmic pattern of the operator. Level of receptivity and responsiveness of the client.
This is a form of an informal, indirect technique, in which the hypnotic suggestion or induction is delivered through the interaction manifested in the hand- shake.
The authors further recommend discovering nonverbal touch situations in everyday life, whereby one can utilize and help the subject fix and focus attention inwardly.Conclusion
Milton H. Erickson was a brilliant therapist and hypnotist who provided different ways, including the handshake technique, to induce and create trance-like therapeutic experiences. In his handshake technique, he utilized the client’s responses and behavior to further enhance hypnotic responses and therapeutic experiences. He used his ability to notice minimal cues or define moments of responses and receptivity, and he learned to access these movements to facilitate the hypnotic handshake technique.
There are a number of applications of the handshake technique, ranging from enhancing rapport to inducing calming responses to relaxation. Upon inducing hypnotic responses, several paths can be taken. Therapeutic messages can be interspersed in the moment. Other ways include bypassing “resistant” responses, or client goal inhibitory responses, creating a window of client receptivity.References
Carich, M.S. & Junge (1990). Pulse-Rate Rapid Hypnotic Injection. The American Society of Clinical Hypnosis Newsletter, 31 (2), October, p.2.
Edgette, J.H. & Sasson-Edgette, J. (1995) The handbook of Hypnotic Phenomena in Psychotherapy. New York: W.W. Norton, C.C.
Erickson, M. Naturalistic techniques of hypnosis. American Journal of Clinical Hypnosis, 1958, 1, 3-8.
Erickson, M. Pantomime techniques in hypnosis and the implications. American Journal of Clinical Hypnosis, 1964, 7, 65-70. (a)
Erickson, M. The interspersal hypnotic technique for symptom correction and pain control. American Journal of Clinical Hypnosis, 1966, 8, 198-209. (b)
Erickson, M. H., Rossi, E. L., & Rossi, S. I. (1976). Hypnotic Realities: The Induction of Clinical Hypnosis & Forms of Indirect Suggestions. N.Y.: Irving- ton: New York
Erickson, M. H. & Rossi, E.L. (1981). Experiencing hypnosis. NY: Irvington. Haley, J. (Ed.) (1967). Advanced technique of hypnosis and therapy. NY: Grune & Stratton.
Kroger, W. (1977). Clinical & Experimental Hypnosis. Philadelphia, PA.: Lippincott.
From Newsletter Vol 36. No.1