Positive Health Online

I'm not usually the one who makes the appointments in our clinic, but a few months ago I found myself talking to the father of a ten-year-old girl (I'll call her Jane), who suffered from what he described as a 'hair pulling problem'. Jane's father explained that Jane had become very embarrassed at the sight of the increasing number of bald patches appearing over her scalp, and that she had recently found it necessary to wear a knitted beanie to cover the damage. He suggested that the problem was exacerbated by two further difficulties. Firstly, Jane had a 'condition' that caused her hair to detach from her scalp very easily, where little more than a slight rub or tug could remove a significant cluster of hair. Secondly, despite the family's best efforts at reminding Jane to desist from pulling or playing with her hair, the problem appeared to be worsening.

According to Jane's very concerned parents, it appeared that the major damage was being done in her sleep, and to a lesser extent during the waking state when Jane was 'not aware' of her problematic activity. They were hopeful that hypnosis might assist as the problem was of an involuntary nature (i.e. its performance was not of 'conscious' origin), and they could see no other way of helping their daughter.

Jane, replete with beanie, presented as a rather small, friendly, effervescent and intelligent young girl. It became obvious, as one might expect, that Jane's major source of distress and frustration arose from her lack of any sense of control over the behaviour. To Jane, it was as if her hand had a mind of its own – as if she would discover her hand in the act of pulling her hair, or discover that the culprit had silently performed the act and fled, undiscovered, like a thief in the night. I asked Jane, to her puzzlement, what she had done in the past when her hand had seemed out of control – when it seemed to have a mind of its own. I continued to wonder with her what had happened to those days when her hand would just decide to pick her nose in public. When did her hand(s) eventually stop inappropriately playing with the food on her plate, or curb themselves from making some indelicate adjustment to her underwear in company? I commented that her hands had needed to learn a lot about behaving more appropriately. Jane soon caught on and delightedly offered her own examples of her hands' 'uneducated, ill-mannered and unhelpful' behaviour. We wondered together how her hands actually learned to stop doing those things.

How did she teach them, and how did they learn to behave differently, in ways that served her better? Within a few minutes, Jane was reporting feeling unusually relaxed, to the point where she was unsure if she could move her body. Jane felt that her hands particularly had become very light and tingly, and she had not noticed at that stage that her left hand had begun to lift from her lap.

With her permission, we continued to explore her experience in this way, and were both curious about what her 'unconscious' was communicating and learning about the sense of disconnection she had been experiencing with her hands. Our work continued in this playful way throughout the session, with Jane having a very real sense of participating in and contributing to the conversation and her experience. When she left, Jane indicated that she felt a much closer relationship with her hands, and was delighted to be able to produce the sense of lightness and tingling in her hands at will – just through attending to them and remembering her experience in my rooms.

She reported a greater sense of co-operation and understanding with her body, as distinct from feelings of frustration, mistrust and the associated need for vigilance.

Erickson's ideas and therapeutic strategies were marked by a characteristic emphasis on the resources, strengths and values of his clientele. He emphasized strategies that empowered the client. In a prelude to a recent publication compiling the letters of Milton Erickson, Zeig and Geary note that: 'simply put, Milton Erickson (1901-1980) was the foremost authority on the use of clinical hypnosis in the twentieth century. And there are many who contend that he was the century's premier hypnotherapist. What Erickson added to the practice of therapy can be compared to Sigmund Freud's contribution to its theory'.[1]

Erickson worked from a background that assumed the theory guiding his interventions was actually sitting in front of him (rather than in a text book). This concept is often referred to as 'utilization' – where the therapist harnesses and utilizes whatever a client might bring into the consulting room, towards a therapeutic outcome.[2] Erickson once wrote that 'each person is a unique individual. Hence, psychotherapy should be formulated to meet the uniqueness of the individual's needs, rather than tailoring the person to fit the Procrustean bed of a Hypothetical theory of human behaviour'. Margaret Mead observed that one of Erickson's distinguishing characteristics was his ability to invent a new therapy for each person.[3]

Of the many revolutionary ideas that Milton Erickson offered, perhaps his most pervasive was that the experience of trance or hypnosis is a natural, everyday experience, what one might call a symptom of being human. Most of us would recall the experience of driving a car and discovering at some point that we were further progressed on our journey than we may have realized. We may have actually gone through a town that 'we had not noticed' at the time, or missed the street that we intended turning into, perhaps on occasion even missed our own street. Sometimes the trip back home can seem to take less or more time than it took to get there, even though we traversed the same geography and the clock showed little or no difference in 'real' time taken. Waiting and watching for that bus can seemingly stretch five ('real time') minutes into what appears to be a much longer period. Effects associated with time distortion and even amnesia are common in our everyday lives.

In our house, a family get-together will often involve looking through a photo album and sharing the memory of long past events. I often notice that the faces and postures of those involved can reflect a 'reliving' and re-experiencing of the event in some way, as if we were bringing a past experience into the present, or transforming (tranceforming?) our present experience into the past. Frequently, conversation around a memory of an event can seem to evoke more of the mood and detail of that occurrence – in a way like an experience of regressing in time or age.

Our concept of pain is another interesting phenomenon. In Western cultures particularly, we appear to experience some confusion or ambivalence around the concept of pain. In one respect we seem to treat pain as something 'to be avoided at all costs', often culminating in the demand for a 'cut it off' or 'blot it out' treatment approach. Yet in another way we see it as quite unavoidable, 'un fait accompli' in the face of injury or the sight of blood. The meeting place of these views presents us with the dilemma of 'having' to experience something that we 'must get rid of' at all costs, whether that be through medication, surgery or some other form of external intervention. However, many a parent will be familiar with the immediate relief that a plaster can bring to the pain and suffering of an injured child – whether the injury be a bruise or abrasion.

In a related way, many of the clients we assist in rehabilitating from a serious injury will report that the experience of pain came long after the actual occurrence of the injury. Additionally, when invited, these clients may also notice the experience of the pain or discomfort fluctuating throughout the day, where periods of the pain may be less bothersome at times, and perhaps even 'unnoticed' at other times (often reported as periods of 'distraction'). These discoveries can often surprise a client who can be 'caught in the thought' that their experience of pain is immutable and all pervasive.

Highlighting a client's noticing of diminished, less frequent or unnoticed pain, can provide very fertile ground for the therapist and client to begin exploring and utilizing. In treating a woman wracked with pain in a hospital bed, Erickson asked her what she might notice about her pain if a lean and hungry tiger greedily looked at her as it walked into her room licking its salivating chops. The woman replied that she would not be noticing much about her pain at all under those circumstances, and was later to ask Erickson if she could take the tiger home with her.[4]

I had a client (we'll call her Susan) some years ago who was referred to me through an insurance company. Susan was referred primarily to learn strategies to assist with the 'management' of her pain, and adjustment to her 'incapacity', so that she could be helped back into the workforce and expand her depleted expectation of quality of life. Susan presented with a quite depressed outlook and a strong sense of resignation about the limitations imposed on her independence by her injury and the associated pain. The accident involved my client crossing the street and at some point discovering that her leg was becoming trapped under a slow-moving vehicle.

As the vehicle slowly moved forwards, her leg became more horribly entwined around the front wheel of the car. When the driver eventually noticed and stopped the car, her leg was wrapped around the wheel with her foot all but severed from her ankle. This incident occurred in a busy street in a shopping centre and attracted quite a large crowd of onlookers, many of whom became hysterical. Susan could recall reassuring those around that she was quite all right, to take it easy and that things would be OK. Who was helping who here? She reported feeling quite 'calm and collected' at the time of the incident, with no experience of pain until much later in hospital.

With hypnotherapy, Susan's recollection of this experience was utilized and seemed to help significantly in reducing her ongoing experience of discomfort in her lower leg. It was a bit like watching the mood and behaviour of my family change when they got in touch with their experiences from the photos. Susan continues actively to run her own very successful business and is on her feet for much of the day.

Erickson revolutionized how we saw hypnosis. He demonstrated and taught that hypnotic experience and behaviour were a part of the continuum of natural, everyday, human experience and behaviour.

As we saw with Jane in the beginning of this article, the need for a 'formal' induction and direct suggestions are not essential in the delivery of a therapeutic hypnotic intervention. Contrary to more traditional hypnotic methodology, neither Jane nor Susan were required or indeed chose to close their eyes during treatment. In this way, the process of the hypnosis itself becomes a natural and seamless part of the conversation with the client, rather than the hypnotist 'prescribing' an experience to a 'passive' client.

Erickson's work has challenged the notion of 'hypnotizability' (i.e. that some people were able to be hypnotized and some not, whilst the rest were somewhere in between), and points more to the notion that individual differences actually lie in the domain of 'how' someone might experience trance, rather than 'if'. With this in mind, a task of the therapist then becomes more oriented to an exploratory, collaborative and educative role (through discovery with the client), than one of imposing expertise or advice.[5] In working this way, the client and the therapist collaborate in both the process and design of the treatment, where each is seen to bring to the session particular skills and relevant contributions. Emphasis is on empowering clients to become an active part in the design and process of the therapeutic episode, rather than be passively dependent on the expertise and directives of the therapist.

So much has been learned and evolved from the writings of Erickson, from his teaching and from watching him work. He was a master wordsmith, and significantly raised our understanding of the power of language in generating fundamental change in the mood (psychological state), the future(s) and the scope of possibility for our clients. I suspect that we can all identify something indelible – unforgettable, that someone once said to us – something that stuck! Something that was said at a particular time, in a particular mood, in a particular way that made it inescapable. Erickson had that knack.

Health professionals, whether they be psychologists, social workers, nurses, medical practitioners, welfare workers, masseurs or other bodyworkers, rely on language and its delivery to, among other things: educate their clients; build rapport and effective relationships; motivate their clients and help them plan; and help their clients design and implement change. It's all done with language and the delivery of same. For most of us, our clients have come for conversations that are not available to them elsewhere. Hypnosis is a particular kind of conversation with a particular kind of language, and a particular type of languaging, whether delivered in a 'formal' or 'informal' manner.

As health professionals, we are in the languaging business. Improving the quality of our work and enhancing the power of our conversations requires both the learning of distinctions and practice. There is nothing like enhancing the quality of our relationships with our clients, for multiplying the efficacy, efficiency and satisfaction in our work. These are skills that can be learned, and learned further as we learn. Good therapy, as with effective learning, is often only the beginning of a journey rather than an end.[6] Erickson taught us that.

References

1. Zeig JK and Geary B. The Letters of Milton H Erickson. Zeig, Tucker & Theisen Inc. Phoenix. p(ix). 2000.
2. Zeig JK. The virtues of our faults: a key concept of Ericksonian Therapy. in Zeig JK ed. The Evolution of Psychotherapy: The Second Conference. Brunner/Mazel. New York. 1992.
3. Mead M. The originality of Milton Erickson. American Journal of Clinical Hypnosis. 20: 4-5. 1977.
4. O'Hanlon WH and Hexum AL. Uncommon Casebook: The Complete Clinical Work of Milton H Erickson, M.D. Norton. New York. 1990.
5. Johnson DG. Curiosity and ignorance. in Johnson DG & Mc Neilly RB eds. The Proceedings of the Second Annual Clinical Conference of Ampersand Australia. Ampersand Australia. 1999.
6. Johnson Brown E, Johnson D and McNeilly R. Reinventing the art of therapy. Psychotherapy in Australia. 2: 38-41. 1995.

Further Information

David will be running a four-day practical workshop on Ericksonian Hypnosis for Health Professionals at The Abbey Sutton Courtenay, Abingdon OX144AF, Oxford UK on 8-11 June 2001. Bookings and information can be obtained through Mike Nixon-Livy, International Institute of Applied Health Services, 7 Rue du Docteur d'Argelos, 13100 Aix en Provence, France. Tel/Fax: +33 442 935426, email info@nsthealth.com. The Ampersand Australia website address is www.ampersandaus.com.au