Ericksonian Hypnosis

Milton Erickson in his therapeutic practice can be characterized as a playwright who plans a little play for each patient and then leads that patient to accept and enact the assigned role. This arrangement permits him to be authoritarian as playwright and director by providing the staging and the strategy, while the patient then provides the tactics by carrying out the assignment in his or her own way.

As I have noted earlier, despite his strongly authoritarian position as playwright and director, Erickson typically set the stage and the strategy, but left the tactics up to the patient. What is not so evident is the role of many others in producing the therapeutic successes: Joe, who enhanced Harold’s use of the library beyond the reading of children’s books; the married couple who befriended him at the trailer court; the friend who taught him to drive a truck; the transcriber and annotator of rare manuscripts with whom he lived and talked for a year and a half; his teachers (shorthand and typing, piano, guitar [?]), and his college teachers-all of whom are missing from the case study except for the briefest of mention of the piano teacher because she was a woman. […]

Harold’s life away from Erickson may have been very different from the way he appeared in Erickson’s presence. We do not know how fond he became of his teachers or they of him. Although he occasionally asked about Harold’s daily activities in detail, Erickson appears to have been more interested in his own cleverness than in finding out how Harold was perceived in the context of his daily life.

Erickson claimed that by looking at the way a married woman crossed her legs he could tell whether she was having an affair or not. I can easily believe that Erickson had an extraordinary sensitivity for nonverbal cues, but this and other unquestioned examples of Erickson’s abilities strike me as farfetched. Did anyone actually evaluate whether many married women who were having an affair, and only them, crossed their legs that way (i.e., check for false positive and false negatives)? Or when Erickson mentioned that a hypnosis speaker he had publicly dressed down apologized to the audience for his own lack of knowledge, did anyone corroborate with that speaker or someone in the audience whether matters transpired exactly as Erickson stated? I doubt it, because throughout the years I have heard some followers of Erickson repeat these types of stories and those of almost miraculous cures without a hint about corroborating evidence, follow-ups, or other validating information. To muddy the waters even more, why have not some of the followers of a therapist known to fabricate false past stories to achieve therapeutic goals wondered whether he used that same technique in his writing and teaching?

Rossi’s work is interesting and stimulating reading. It needs be kept in mind, however, that he has built a hypothetical edifice whose foundation and many of its bricks are nothing more than speculations. This does not produce a sound scientific structure. The mortar also shows weaknesses. Rossi has a tendency to confuse speculation with fact. […​Rossi] does generally ignore any data that contradict his position and he frequently misrepresents facts to suit his own purpose."

Particularly since Erickson’s death in 1980, workshops, books and self-anointed experts on Ericksonian hypnotherapy are abounding. […​] There were many times when Erickson meant to communicate on multiple levels. However. because of his reputation for the use of subtle, indirect techniques, students came to his teaching seminars expecting this mode of operation. They recorded the seminars, afterwards analyzing and reading in a great deal. Unfortunately, what students witnessed was a retired, seriously ill, old man. Today many regard it as a badge of honor to say that one "studied" with Erickson. Even hypnosis centers aligned with people who strongly clashed with Erickson are now being named after him, thereby capitalizing on his reputation. In the vast majority of cases, having "studied" or been "trained" by Milton Erickson merely means that the person listened to him for several afternoons as part of a larger group. This does not, however, keep many of these people from authoring books and sponsoring training and supervision on "Ericksonian Hypnotherapy."

Thompson, an associate and friend of Erickson for over 27 years, feels particularly strongly about this. "I firmly believe that the people who are most profiting from his death are those who never would have done so from his life. Many people feel free to interpret him now that they can do so without fear of refutation. It appears to be most1y those individuals who only had exposure to Erickson in the later years of his life who feel the need to explain him and his theories. and to make a living from the explanations. Those individuals who 'knew him when' he was vibrant and powerful would not presume to do that" (Thompson, Note I).

Another myth is that metaphors were Erickson’s primary therapeutic tool. According to this belief, the more esoteric, highly indirect and incomprehensible the metaphor, the better, and multiply embedded metaphors are unsurpassed.

Regarding the sloppy overuse of metaphor, Pearson (Note 5) recalled, "He told me within the last year before he died that one of the things that disgusted him was that so many people in trying to imitate him with embedded metaphor and parables were hiding behind that obscurity. He was very careful in what he told and why he told them."

[…​] Erickson laboriously wrote out suggestions for his patients. He even roleplayed and practiced them in front of a mirror (Thompson, Note 2). One of the ways that Erickson learned to trust his unconscious was through years of disciplined and careful preparation earlier in his career. In fact, the author believes that this compulsive, careful planning and the writing and rewriting of suggestions was a vital part of Erickson’s growth process in becoming a master clinician.

Haley (Note 4) recently lamented that, "It is unfortunate that what Erickson most disliked is being attributed to him. He objected to dilettante therapists, and to therapists who did not train properly, plan their work with care, or master the skills of interview technique. The one thing he did not believe was that one could cure by magic or by offhand wise pronouncements and stories" (p. I)

Haley (Note 4) expressed the opinion that "it is ignorance that makes therapists choose one or two of Erickson’s procedures and make a school of them, writing books about them as if that is Erickson therapy. Erickson therapy is, by definition, variety in technique" (p. 2). Erickson was afraid that this -very thing would happen. In the week before his death, he prophesied that selfproclaimed experts about his work .'would come out of the woodwork" after he died (Pearson, Note 5).

The true legacy of Erickson was eclectic hypnosis and therapy, although unfortunately his eclecticism was intuitive and without apparent organization or easy replication. His approach was one of diversity, flexibility, and freedom to use a variety of methods. He was unwilling to be restricted by the artificial limitations of one therapeutic system, and so it is particularly unfortunate that some disciples would now create a restrictive “Ericksonian” school based on their interpretations of his work.

Lankton (2020) recently opined that Milton Erickson’s hypnotic approach evolved “and changed from being largely direct and authoritarian to egalitarian and indirect” (p. 11). […​] It is my belief that this proposition continues to perpetuate a distortion of Erickson’s hypnotic approach.

To date, I am aware of no research on Ericksonian therapy (with or without the use of hypnosis) that would meet the criteria of an empirically validated treatment? The lack of outcome research on effectiveness, coupled with the reliance on clinical anecdote or uncontrolled single-case study common in the Ericksonian literature, have created inescapable limitations for Ericksonian hypnotherapy in determining its efficacy and effectiveness.

There are three basic assumptions that underlie Ericksonian hypnosis. These assumptions are: (a) hypnosis is an altered state of consciousness with markers that are distinguishable from the waking state; (b) hypnotizability of the subject/client is primarily a function of the hypnotist’s skill (i.e. utilization strategies) and less > a function of the subject/client‘s hypnotic ability and; (c) the use of indirect hypnotic suggestion is, at least in some instances, more effective in producing hypnotic responses than is direct suggestion.

The research reviewed simply does not support long-held beliefs by Erickson or those who practice Ericksonian approachesto therapy.There is no definitive evidence for a trance state, the existence of a wise unconscious, the importance of indirect over direct suggestion, or the universality of hypnotizability. Although there are impressive and dramatic clinical anecdotes cited in the literature about Erickson and his work, there is no compelling need to invoke any sort of special curative processes active in Ericksonian approaches beyond those already documented as active in any form of effective psychotherapy (e.g., relationship, expectancies, construction of a compelling narrative, active client involvement). Unlike hypnosis as an adjunct to cognitive-behavioral therapy, it is not clear that hypnosis adds anything to this approach.

Unfortunately, many of the remarkably creative techniques that Erickson innovated have not been subject to careful, well controlled research, even though they have entered the mainstream of clinical practice. Anecdotal reports, no matter how intriguing and fascinating, do not constitute a sound rationale on which to base clinical practice. We stand on firmer ground when a particular technique or approach is supported by theory and research.

Rather than limit our discussion to the common factors that are typically identified in the literature (e.g. feedback, empathy, therapeutic alliance), we maintain that Erickson’s success, and the success of many therapeutic endeavours, can be attributed, at least in part, to the therapist’s ability to manipulate response expectancies, prime therapeutic responses, strengthen positive response sets and intentions, remove impediments to the automatic execution of desired behaviours, and disrupt or modify negative or undesirable response sets.

Erickson himself, however, never offered a formal theoretical formulation of his work. There are no entries entitled ‘theory’ in the indexes of Erickson’s collected writings, nor in Erickson’s collected lectures and seminars (Rossi et al., 1983; Rossi and Ryan, 1985), nor in any book written by him (Cooper and Erickson, 1954; Erickson et al., 1961, 1976; Erickson and Rossi, 1979, 1981). This is primarily due to Erickson’s desire to avoid structural theories for working with individuals and families in favor of formulations about the process of change itself.

Among psychotherapists there are some who worship Erickson with a reverence that borders on idolatry. Every word, sentiment, opinion, or act is presumed to have an inspired meaning. Such deification rooted in expectation of timeless power and omnipotence can ultimately lead to disillusionment. Equally prejudiced are those who regard Erickson as a maverick whose egregious methods are a passing fancy that will eventually be consigned to the dustbin of outmoded schemes. [Both] these attitudes do injustice to a highly creative and imaginative original mind…​ A poignant criticism of Erickson’s strategic therapy is that it is overvalued by those who believe that clever tactics can substitute for disciplined training.