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CH: One of the most pleasing aspects of the organization of your book Hypnotic Phenomena in Psychotherapy was the inclusion of contraindications for the use of each of the hypnotic phenomena discussed. That information could be very reassuring for clinicians who might be avoiding using a hypnotic approach because they fear using it in the wrong place. Have you gotten feedback from clinicians that this was freeing to them in clarifying how to think about appropriate contexts for specific kinds of hypnotic work?
JE: I have gotten feedback to that effect. I think early on in the latest phase of the history of hypnosis, people went hog wild, especially using some of the innovative things that Milton Erickson was doing. There was a sense of a calling to carry the banner of hypnosis forward, and some folks became absolute zealots. That had the unintended side effect of scaring the living daylights out of some very responsible clinical people with regard to using hypnosis. It's important for people to think in a very
professional way clinically rather than seeing hypnosis as the be-all and end-all or as a panacea. So establishing boundaries in terms of contraindications helps people become more comfortable with the tool of hypnosis.
CH: Other professionals we work with are going to be turned off if they experience us as zealots of that sort, too. They'll notice a professional approach and reasonable expectations about outcomes.
JE: Exactly - other professionals are more impressed with a sober approach to this tool of hypnosis. It's an extremely valuable tool, a necessary and sometimes vital part of therapy, but isn't some outrageous panacea.
CH: Every technique contains the danger that the clinician will retreat into the technique, numbing himself from authentic contact with the client. It seems to me that hypnosis offers the possibility of deepening that contact, the way a rapport trance enhances awareness of the variations of energy, attention and connection. Have you used hypnosis as a way to guard against that kind of retreat?
JE: Absolutely. One of the things I've gotten from studying the work of Milton Erickson is the emphasis on the interpersonal connection. I consider that a hallmark of my work, as does my wife (Sally Edgette, co-author of Hypnotic Phenomena in Psychotherapy). Our development of Ericksonian technique underscores and highlights the connection between client and therapist. We consider it to be an existential Ericksonian hypnotherapy. The sacredness of the connection, the relationship, the I-Thou aspect is more easily accessed and developed. This stands in contradistinction to folks who use hypnosis primarily as a technique, as a way of taking something and putting it into a patient. This is not an outside-in approach but an inside-out approach. The hypnotherapist is helping the patient to access and bring forth inner resources. It creates a certain sacredness around the connection. I think when any psychotherapy or school of psychotherapy is successful, they manage to create those poignant moments of existential connection, and the therapy takes place in that holding atmosphere. One of the beauties of hypnotic work is that you can create that moment, orchestrate that moment more easily.
CH: Although it's describable in language, it's not primarily a cognitive connection. You're bringing - or inviting - the non-verbal and non-linguistic aspects of consciousness into the room.
JE: Right. And too many people conceptualize hypnosis with patients as having something done to them, as opposed to having it be a way of relating.
CH: I wonder if some of the early focus on Erickson, in NLP, for example, was seduced by the technical brilliance of Erickson's language away from his profound sense of connection. There's that wonderful passage in Uncommon Therapy where a young Jay Haley keeps asking Erickson about his strategic reason for asking the OCD patient whether she washes from the top down or the bottom up, and Erickson keeps answering unwaveringly, "I was really interested."
JE: That's been the limitation to some of the more technical approaches to hypnosis and to Erickson's work. You mentioned NLP, which developed into an ultra-technical endeavor and feels heartless often. That's unfortunate and unnecessary, because the language when it's integrated with a consideration of the relationship can be more powerful still. How do tell someone that you love them? The wording of that, the timing of that, the emphasis on this word or that word, yes, is ultra-important, but what are you saying? You're saying to someone that you love them. Each enhances the other in mutual service.
CH: You tell a story in your book about working with a couple stuck in an impasse. Both the husband and wife are given the suggestion to have a hallucination when they do their behavior in the pattern. The wife's part in the impasse was "bringing up the kids." Although you clearly state in the text that this was a couple you knew well and had good rapport with, I imagined a novice therapist misunderstanding the message and thinking interrupting couple's conversations about difficult topics might be a good idea. How do we as trainers in hypnosis convey the subtler relational and contextual aspects of therapy in general and hypnosis in particular?
JE: I think that's where training in the broadest sense of the word comes in. Too many people complete their coursework but don't necessarily train at the knee of someone who can give you an appreciation of that. It's important for therapists to have their own personal therapy as well as their own personal hypnotherapy, and develop a sense for that.
Now it's so common in workshops and seminars to do a demonstration, and I always do, of course. But I remember being back in graduate school and hearing five years of lectures on transference, countertransference, object relations, projective identification, every concept imaginable, but I rarely if ever had a chance to see my professors do psychotherapy. Only the family therapists did demonstrations. And I think that's where you pick it up.
A lot of that is picked up in seeing people manage a case and manage a session so that you get a chance to see someone assess and use the more subtle elements of a session. I have a supervision group in NYC that's been running for five years. We meet monthly. People bring in a patient or a colleague with a problem, and I interview them, and then we ask them to wait in the waiting room, and I discuss with the supervision group, the consultation group, what we've heard, and what I think should be done. They put in their ideas, then we have the patient come back, and I do the hypnosis, and implement the game plan. And afterwards we talk about where I departed from what we had planned and why, and get feedback from the patient. It's that kind of process that can take people to the more sophisticated level of practice. So I guess my answer to your question is that we need people who are better trained in the field, and a lot of that training needs to happen on a post-graduate level. People need to have a way to continue to develop those capacities.
CH: It makes sense that it would be a process answer, not a content answer.
JE: But I think the field has been moving in the opposite direction. I can show you ads here in the Philadelphia newspaper, and I'm sure you have similar ads down your way, in which mental health centers are asking for team leaders, and one of the qualifications you have to have is a driver's license.
CH: (laughs) Well, you never know when you're going to have to drive a client somewhere…
JE: And that's team leader! I mean, I don't know what the qualifications are for someone working one-on-one with people. I've often thought that part of the problem in curing substance abuse problems or difficult conditions like schizophrenia has less to do has less to do with the disorder itself than the people we send out to treat these folks.
CH: There's a film that Cloe Madanes showed at a workshop here a few years ago, of R. D. Laing having a conversation with an unmedicated schizophrenic as a demonstration at a large psychiatric convention. The conversation was very calm and respectful - he really connected with her, and talked in a very straightforward, loving, generous way. He didn't respond to any of her provocative, crazy statements, and she just settled down. At the end of the thirty minutes they were having this wonderful conversation, and she even wanted to sit with him while he took questions from the thousands of psychiatrists in the audience. He said, "I don't know, there are a lot of psychiatrists out there, it could be pretty stressful," but she insisted, and she did great. He was challenged by someone in a sort of pompous way to theoretically articulate his technique, and he got angry. "You're using chemicals with devastating side effects, not even properly tested for long-term side effects, without any real understanding of the biochemistry of their action, and you're insisting that I explain why I have a respectful human conversation with someone?" It was a striking example of the power of a stable, loving presence in relationship.
JE: I think Carl Whitaker could do that with patients, too, through an appreciation of the absurd, connecting with them, and appreciating them. What you describe Laing doing, and what I felt Whitaker did, was also something that Erickson did, that isn't often highlighted as a part of his work. They all developed a really deep and sincere appreciation for the dilemma of the patient and the life that they had come into, no matter how bizarre. And the logic of it, as well.
CH: It seems to me that if you don't do that, any suggestions, or advice, or help you offer is going to be fairly superficial. You may be lucky, you may take a lucky swing once in a while and connect, but…
JE: You need that appreciation that the patient came by their symptom honestly. That it's not due to a character flaw, or some fluke, or something pejorative, or what have you, but is instead something that is a logical outgrowth of some extenuating factors.
CH: It makes sense in terms of their experience.
JE: It's their attempt to solve a problem the best they can knowing what they know.
CH: It seems to me that work coming from that sensibility is going to be authentic and organic rather than merely technical. I remember Steve Gilligan remarking after attending a conference that he found it depressing how much the presenters were coming from an attitude of cleverly tricking the clients out of their symptoms, not emphasizing connection or even respect. What you describe is much more about moving from a place of true connection and understanding. What you do from that place has a much better chance of resonating with the client's sensibility.
JE: Absolutely. The strategic maneuverings that you do in therapy don't feel like hollow technical tricks but instead it feels like you and the patient are together, in on a cosmic joke, and you're telling the joke together. It's as if there's a wink between the two of you. I think this is how it happens in Zen. There's a story about a woman who comes to a great Zen master with her dead child in her arms. "I hear you're enlightened and can produce miracles. I want to ask you to bring my child back to life." He answers, "First I need you to do one thing." She agrees, and he says, "I want you to go down into your town, go door to door, and find three people who have not suffered any loss such as yours in the last five years." She comes back a week later, saying she has failed in her task. She has been unable to find such people. "But it's alright, because I have been welcomed into the homes of many people, and heard about their losses, and now I am ready to go away and bury my child." So is something a technique and a trick, or an eloquent deepening of the human relationship? I think it all depends on how it's brought forth.
CH: In the training that you do, I'm curious about what kind of experiences you set up to generate these kind of learnings, opening to the deepening of experience.
JE: Well, I've been doing more and more demonstrations with audience participation, strategizing amongst the entire group, and I think that moves the group to that other level. I'm able to do that more in small group consultation when we have six or eight. It's not as feasible when there's a heavy didactic component as there will be in the two-day seminar.
CH: Will you be focusing more on beginning or intermediate level?
JE: Intermediate. I assume everyone will have some background in hypnosis and know the basics of induction and ratification and deepening, and the basics of their application. My focus will be on helping people to master the use of hypnotic phenomena as a vehicle in psychotherapy, as a way of creating change. As hypnotherapists I think we've been overly focused on giving language-based suggestions or on storytelling and metaphor, and haven't used hypnotic phenomena to help people to change. It's just been grossly ignored, and the potential there is great.
CH: I liked in the Introduction to your book your urging therapists to be bolder and more forceful in their hypnotic clinical work, to do more than vaguely hope the unconscious will do what it needs to do, exhorting the therapist to take more responsibility to focus the work.
JE: What I try to do in teaching hypnotic phenomena is to do little mini-demonstrations. There's a stance established, a certain holding - a patient/therapist, operator/subject holding and connection that is evident in the demonstration. And that is something people pick up on and begin to use automatically. So there's an attitudinal learning that is subtle but important and profound, that can picked up best in observing the demonstration.
CH: I'd be curious about hearing you expand on the attitudinal sets you're talking about.
JE: Boy, is it hard to language it. I think it emanates from an attitude of respect, of observing - of carefully putting yourself in the place of the person you're working with hypnotically. If it's at a seminar, it's someone who's volunteered to be a part of the demonstration. One way of thinking about it is that it can come out of closely observing the patient. My colleague here in Philadelphia Peter Bloom asked Milton Erickson the three most important things about doing hypnosis, and Erickson parodied the famous real estate line about location, answering, "Observe, observe, observe."
CH: What is the heart of your teaching?
JE: Technique in service of creating the existential connection of one heart to another. One of my interests these days is bringing that into a whole different area where people haven't talked about that and haven't built that kind of awareness but have instead gone even more strongly into technique. And I feel like I'm bringing the pendulum back in that area, too - and that's sports psychology.
CH: How does that relate to your clinical practice? How do the two interests inform each other?
JE: Well, when I got out to eat, I like to go to a smorgasboard, and sample a little of this, and a little of that. As a therapist, the last thing I want is a day full of depressed patients or phobic patients. I enjoy it in the same way I enjoy doing hypnosis and behavioral medicine. It's great diversity, and I'm a huge sports fan and recreational athlete myself, and it gives me an opportunity to integrate that into my clinical work.
Like the Greeks did, I think of sport as being not something that is marginal or merely entertainment. I think of sport as bringing out some of the most excellent qualities in the human being. Working in sport psychology with athletes I very much enjoy helping them develop their mind and then improve their performance. I look at it as being a spiritual kind of quest.
A good example of another place where that's spoken about is in the movie Bagger Vance. The movie is based on the Baghavad Ghita - the name Bagger Vance is a takeoff on Baghavad. I think there are a number of places in the world where the pursuit of something that should be a matter of human relating becomes a technical pursuit, and it does it a great injustice, whether it's parenting or making love or being an athlete or the psychotherapy session. They're diminished by being looked upon as only technical pursuits.
CH: Well said. I like the way you make values the context for clinical work, the ground on which the figure of technique is laid. It's a lovely way to think of clinical work in general, and specifically hypnosis, being a little of both figure and ground.
What's the most common coaching adjustment you make in teaching clinicians hypnosis, and has that changed over the years?
JE: It actually has not changed over the years. And that is for people to be patient and persistent. And nowhere does this come out more frequently than with teaching people to elicit an arm levitation. At first people think about an intervention or eliciting hypnotic phenomena as an all-or-nothing kind of thing. They say what they have to say, and it's like they've pulled the trigger and hopefully the gun will fire, and if it doesn't, you're out of luck. They look at it as a digital phenomenon. Yes or no. They do more of the same or move on to something else. But if you watch films of Milton Erickson, he would work with someone for a very long time - fifteen minutes, half an hour, whatever was needed in order to produce what was needed. We've gotten so far away from that. A lot of people have read secondary sources, but if you read Erickson's writings he talks about hypnotizing someone for three or four hours at a pop -
CH: In The February Man you read about a six-hour session, and you think, "Wow, this guy was really committed!"
JE: Exactly. Few of us have that kind of energy - or insanity.
CH: And in that context, it makes his results as little more understandable - he starts off with more talent, and then he works twice as hard as anybody else.
JE: Morning, noon and night. When Erickson would finish with his patients he'd have friends and neighbors come over and he'd do experiments and develop his skills. I think that's very important for people to keep in mind in learning hypnosis and in learning anything about psychotherapy, to be tenacious in their study of it, and really develop that. In terms of the most frequent coaching advice, it is not to give up too quickly. The fear of failure makes people give up very quickly. They often personalize what they're doing and look at it as if someone is keeping score on them. They look at it as a reflection of their worth and competence as a therapist and hypnotherapist, and that is not the case. That fear of failure leads a lot of people to limit their hypnotic work to a kind of warm, fuzzy, nice hypnosis, giving suggestions that you never quite know whether they take or not. It leads them away from doing something like arm levitation work, or having the client talk while hypnotized, or learning how to walk while in a hypnotic trance. It leads them away from doing things that may or may not work out.
CH: It really limits the good outcomes that are possible.
JE: It does. It's like playing tennis or any sport not to lose. If you play to not lose it's really hard to win.
CH: And it's not very much fun. If the only use you have for hypnosis is to help an occasional client relax, it's not going to be a very exciting or powerful part of your clinical competence.
JE: I've been doing training for almost seventeen years, and one of my biggest challenges is helping people do things differently, helping them develop an inner process whereby they evolve and change as a therapist. I think it's really important for therapists to be able to modify what they do for different patients - to develop a broad range, and work within that. It's a challenge, because I've seen so many therapist just settle into the same way of doing things over and over again - the same inductions, the same interventions. It really limits our effectiveness, and I think it contributes to burnout.
To get past this I often prescribe tasks for consultees, so that they develop a broader range. I often recommend people have a technique of the week - our equivalent of the book of the month club. It may be inducing anesthesia or positive hallucination - for that week, whenever it's clinically relevant , they use it. It's like drills in sports - fielding ten grounders in a row and making the throw to second base for the double play - the repetitive practice helps to consolidate the skill. Especially in private practice where you don't have that many outside influences, it's really important to have ways to encourage continued growth.
CH: It sounds like your training targets many levels at once. I think it'll be useful to both clinicians in direct practice and supervisers of therapists as well. It's been a delight talking with you. I'll look forward to meeting you in April.
JE: Same here.
Copyright © 2002 Chuck Holton All rights reserved.