Milton H. Erickson
Milton Hyland Erickson (5 December 1901 – 25 March 1980) was an American psychiatrist specializing in medical hypnosis and family therapy. He was founding president of the American Society for Clinical Hypnosis and a fellow of the American Psychiatric Association, the American Psychological Association, and the American Psychopathological Association. He is noted for his approach to the unconscious mind as creative and solution-generating. He is also noted for influencing brief therapy, strategic family therapy, family systems therapy, solution focused brief therapy, and neuro-linguistic programming.
Erickson is noted for his often unconventional approach to psychotherapy, as described in the book Uncommon Therapy by Jay Haley and the book Hypnotherapy: An Exploratory Casebook, by Milton H. Erickson and Ernest L. Rossi (1979, New York: Irvington Publishers, Inc.). He developed an extensive use of therapeutic metaphor and story as well as hypnosis and coined the term brief therapy for his method of addressing therapeutic change in relatively few sessions.
Beginning in the 1950s, Erickson’s use of interventions influenced strategic therapy and family systems therapy practitioners including Virginia Satir and Jay Haley. He was noted for his ability to “utilize” anything about a patient to help them change, including their beliefs, favorite words, cultural background, personal history, or even their neurotic habits.
Through conceptualizing the unconscious as highly separate from the conscious mind, with its own awareness, interests, responses, and learnings, he taught that the unconscious mind was creative, solution-generating, and often positive.
He was an important influence on neuro-linguistic programming (NLP), which was in part based upon his working methods.
Trance and the unconscious mind
Erickson believed that the unconscious mind was always listening and that, whether or not the patient was in trance, suggestions could be made which would have a hypnotic influence, as long as those suggestions found resonance at the unconscious level. The patient could be aware of this or could be completely oblivious that something was happening. Erickson would see if the patient would respond to one or another kind of indirect suggestion and allow the unconscious mind to participate actively in the therapeutic process. In this way, what seemed like a normal conversation might induce a hypnotic trance, or a therapeutic change in the subject. According to Weitzenhoffer, “[Erickson’s] conception of the unconscious is definitely not the one held by Freud.”
Erickson was an irrepressible practical joker, and it was not uncommon for him to slip indirect suggestions into all kinds of situations, including in his own books, papers, lectures and seminars. For example, a student arrived at one of the five-day intensive seminars he held in his home office near the end of his life. When Erickson asked why she had come, she replied frankly: “My teacher told me that I should come to see you before you died.” Erickson smiled and said: “You tell him that dying is the last thing I intend to do.” The group laughed at the pun. Then Erickson said, with a twinkle in his eye, “Do you want to know how to avoid dying? Always wake up every morning. And do you want to know how to ensure that you will wake up every morning?”, he continued, “Drink lots of liquids before you go to sleep!”
Erickson also believed that it was even appropriate for the therapist to go into trance.
I go into trances so that I will be more sensitive to the intonations and inflections of my patients’ speech. And to enable me to hear better, see better.
Erickson maintained that trance is a common, everyday occurrence. For example, when waiting for buses and trains, reading or listening, or even being involved in strenuous physical exercise, it’s quite normal to become immersed in the activity and go into a trance state, removed from any other irrelevant stimuli. These states are so common and familiar that most people do not consciously recognise them as hypnotic phenomena.
The same situation is in evidence in everyday life, however, whenever attention is fixated with a question or an experience of the amazing, the unusual, or anything that holds a person’s interest. At such moments people experience the common everyday trance; they tend to gaze off to the right or left, depending upon which cerebral hemisphere is most dominant (Baleen, 1969) and get that faraway or blank look. Their eyes may actually close, their bodies tend to become immobile (a form of catalepsy), certain reflexes (e.g., swallowing, respiration, etc.) may be suppressed, and they seem momentarily oblivious to their surroundings until they have completed their inner search on the unconscious level for the new idea, response, or frames of reference that will restabilize their general reality orientation. We hypothesize that in everyday life consciousness is in a continual state of flux between the general reality orientation and the momentary microdynamics of trance..
Because Erickson expected trance states to occur naturally and frequently, he was prepared to exploit them therapeutically, even when the patient was not present with him in the consulting room. He also discovered many techniques for increasing the likelihood that a trance state would occur. He developed both verbal and non-verbal techniques and pioneered the idea that the common experiences of wonderment, engrossment and confusion are, in fact, just kinds of trance.
Clearly, there are a great many kinds of trance. Many people are familiar with the idea of a “deep” trance, and earlier in his career Erickson was a pioneer in researching the unique and remarkable phenomena that are associated with that state, spending many hours at a time with individual test subjects, deepening the trance.
That a trance may be “light” or “deep” suggest a one-dimensional continuum of trance depth, but Erickson would often work with multiple trances in the same patient, for example, suggesting that the hypnotised patient behave “as if awake”, thereby blurring the line between the hypnotic and awake state.
Erickson believed there are multiple states that may be utilized. This resonates with Charles Tart’s idea (put forward in the book Waking Up) that all states of consciousness are trances and that what we call “normal” waking consciousness is just a “consensus trance”. NLP also makes central use of the idea of changing state, without it explicitly being a hypnotic phenomenon.
Where classical hypnosis is authoritative and direct and often encounters resistance in the subject, Erickson’s approach is permissive, accommodating and indirect. For example, where a classical hypnotist might say “You are going into a trance”, an Ericksonian hypnotist would be more likely to say “you can comfortably learn how to go into a trance”. In this way, he provides an opportunity for the subject to accept the suggestions they are most comfortable with, at their own pace, and with an awareness of the benefits. The subject knows they are not being hustled and takes full ownership of, and participates in, their transformation. Because the induction takes place during the course of a normal conversation, Ericksonian hypnosis is often known as Covert or Conversational Hypnosis.
Erickson maintained that it was not possible consciously to instruct the unconscious mind, and that authoritarian suggestions were likely to be met with resistance. The unconscious mind responds to openings, opportunities, metaphors, symbols, and contradictions. Effective hypnotic suggestion, then, should be “artfully vague”, leaving space for the subject to fill in the gaps with their own unconscious understandings – even if they do not consciously grasp what is happening. The skilled hypnotherapist constructs these gaps of meaning in a way most suited to the individual subject – in a way which is most likely to produce the desired change.
For example, the authoritative “You will stop smoking” is likely to find less leverage on the unconscious level than “You can become a non-smoker”. The first is a direct command, to be obeyed or ignored (and notice that it draws attention to the act of smoking); the second is an opening, an invitation to possible lasting change, without pressure, and is less likely to raise resistance.
Richard Bandler and John Grinder identified this kind of “artful vagueness” as a central characteristic of their ‘Milton Model’, a systematic attempt to codify Erickson’s hypnotic language patterns.
In all my techniques, almost all, there is a confusion.
A confused person has their conscious mind busy and occupied, and is very much inclined to draw upon unconscious learnings to make sense of things. A confused person is in a trance of their own making – and therefore goes readily into that trance without resistance. Confusion might be created by ambiguous words, complex or endless sentences, pattern interruption or a myriad of other techniques to incite transderivational searches.
Scottish surgeon James Braid, who coined the term “hypnotism”, claimed that focused attention was essential for creating hypnotic trances; indeed, his thesis was that hypnosis was in essence a state of extreme focus. But it can be difficult for people racked by pain, fear or suspicion to focus on anything at all. Thus other techniques for inducing trance become important, or as Erickson explained:
… long and frequent use of the confusion technique has many times effected exceedingly rapid hypnotic inductions under unfavourable conditions such as acute pain of terminal malignant disease and in persons interested but hostile, aggressive, and resistant…
Among Erickson’s best-known innovations is the hypnotic handshake induction, which is a type of confusion technique. The induction is done by the hypnotist going to shake hands with the subject, then interrupting the flow of the handshake in some way, such as by grabbing the subject’s wrist instead. If the handshake continues to develop in a way which is out-of-keeping with expectations, a simple, non-verbal trance is created, which may then be reinforced or utilized by the hypnotist. All these responses happen naturally and automatically without telling the subject to consciously focus on an idea.
This induction works because shaking hands is one of the actions learned and operated as a single “chunk” of behavior; tying shoelaces is another classic example. If the behavior is diverted or frozen midway, the person literally has no mental space for this – he is stopped in the middle of unconsciously executing a behavior that hasn’t got a “middle”. The mind responds by suspending itself in trance until either something happens to give a new direction, or it “snaps out”. A skilled hypnotist can often use that momentary confusion and suspension of normal processes to induce trance quickly and easily.
The various descriptions of Erickson’s hypnotic handshake, including his own very detailed accounts, indicate that a certain amount of improvisation is involved, and that watching and acting upon the subject’s responses is the key to a successful outcome.
Erickson described the routine as follows:
- Initiation: When I begin by shaking hands, I do so normally. The “hypnotic touch” then begins when I let loose. The letting loose becomes transformed from a firm grip into a gentle touch by the thumb, a lingering drawing away of the little finger, a faint brushing of the subject’s hand with the middle finger – just enough vague sensation to attract the attention. As the subject gives attention to the touch of your thumb, you shift to a touch with your little finger. As your subject’s attention follows that, you shift to a touch with your middle finger and then again to the thumb.
- This arousal of attention is merely an arousal without constituting a stimulus for a response.
- The subject’s withdrawal from the handshake is arrested by this attention arousal, which establishes a waiting set, and expectancy.
- Then almost, but not quite simultaneously (to ensure separate neural recognition), you touch the undersurface of the hand (wrist) so gently that it barely suggests an upward push. This is followed by a similar utterly slight downward touch, and then I sever contact so gently that the subject does not know exactly when – and the subject’s hand is left going neither up nor down, but cataleptic.
- Termination: If you don’t want your subject to know what you are doing, you simply distract their attention, usually by some appropriate remark, and casually terminate. Sometimes they remark, “What did you say? I got absentminded there for a moment and wasn’t paying attention to anything.” This is slightly distressing to the subjects and indicative of the fact that their attention was so focused and fixated on the peculiar hand stimuli that they were momentarily entranced so they did not hear what was said.
- Utilisation: Any utilisation leads to increasing trance depth. All utilisation should proceed as a continuation of extension of the initial procedure. Much can be done nonverbally; for example, if any subjects are just looking blankly at me, I may slowly shift my gaze downward, causing them to look at their hand, which I touch and say “look at this spot.” This intensifies the trance state. Then, whether the subjects are looking at you or at their hand or just staring blankly, you can use your left hand to touch their elevated right hand from above or the side – so long as you merely give the suggestion of downward movement. Occasionally a downward nudge or push is required. If a strong push or nudge is required, check for anaesthesia.
Richard Bandler was a keen proponent of the handshake induction, and developed his own variant, which is commonly taught in NLP workshops.
Any habitual pattern which is interrupted unexpectedly will cause sudden and light trance. The handshake is a particularly good pattern to interrupt because the formality of a handshake is a widely understood set of social rules. Since everyone knows that it would be impolite to comment on the quality of a handshake, regardless of how strange it may be, the subject is obliged to embark on an inner search (known as a transderivational search, a universal and compelling type of trance) to identify the meaning or purpose of the subverted pattern.
Erickson recognised that many people were intimidated by hypnosis and the therapeutic process, and took care to respect the special resistances of the individual patient. In the therapeutic process he said that “you always give the patient every opportunity to resist”. Here are some more relevant quotes pertaining to resistance:
Whatever the behaviour offered by the subjects, it should be accepted and utilized to develop further responsive behaviour. Any attempt to “correct” or alter the subjects’ behaviour, or to force them to do things they are not interested in, militates against trance induction and certainly deep trance experience.
If the patient can be led to accept one suggestion, they will more readily accept others. With resistant patients, it becomes necessary to find a suggestion that they can accept. Resistance is always important, and should always be respected, so if the resistance itself is encouraged, the patient is made to feel more comfortable, because they know that they are allowed to respond however they wish.
Many times, the apparently active resistance encountered in subjects is no more than an unconscious measure of testing the hypnotist’s willingness to meet them halfway instead of trying to force them to act entirely in accord with his ideas.
Although the idea of working with resistance is essentially a hypnotic one, it goes beyond hypnosis and trance. In a typical example, a girl that bit her nails was told that she was cheating herself of really enjoying the nail biting. He encouraged her to let some of her nails grow a little longer before biting them, so that she really could derive the fullest pleasure from the activity. She decided to grow all of her nails long enough that she might really enjoy biting them, and then, after some days, she realised that she didn’t want to bite them anyway.
Erickson is most famous as a hypnotherapist, but his extensive research into and experience with hypnosis led him to develop an effective therapeutic technique. Many of these techniques are not explicitly hypnotic, but they are extensions of hypnotic strategies and language patterns. Erickson recognised that resistance to trance resembles resistance to change, and developed his therapeutic approach with that awareness.
Jay Haley identified several strategies, which appeared repeatedly in Erickson’s therapeutic approach.
Encouraging Resistance – For Erickson, the classic therapeutic request to “tell me everything about…” was both aggressive and disrespectful, instead he would ask the resistant patient to withhold information and only to tell what they were really ready to reveal:
I usually say, “There are a number of things that you don’t want me to know about, that you don’t want to tell me. There are a lot of things about yourself that you don’t want to discuss, therefore let’s discuss those that you are willing to discuss.” She has blanket permission to withhold anything and everything. But she did come to discuss things. And therefore she starts discussing this, discussing that. And it’s always “Well, this is all right to talk about.” And before she’s finished, she has mentioned everything. And each new item – “Well, this really isn’t so important that I have to withhold it. I can use the withholding permission for more important matters.” Simply a hypnotic technique. To make them respond to the idea of withholding, and to respond to the idea of communicating.
Some people might react to a direction by thinking “why should I?” or “You can’t make me”, called a polarity response because it motivates the subject to consider the polar opposite of the suggestion. The conscious mind recognizes negation in speech (“Don’t do X”) but according to Erickson, the unconscious mind pays more attention to the “X” than the injunction “Don’t do”. Erickson thus used this as the basis for suggestions that deliberately played on negation and tonally marked the important wording, to provide that whatever the client did, it was beneficial: “You don’t have to go into a trance, so you can easily wonder about what you notice no faster than you feel ready to become aware that your hand is slowly rising…..”
Providing a Worse Alternative (The ‘Double Bind’) – Example: “Do you want to go into a trance now, or later?” The ‘double bind’ is a way of overloading the subject with two options, the acceptance of either of which represents acceptance of a therapeutic suggestion.
My first well-remembered intentional use of the double bind occurred in early boyhood. One winter day, with the weather below zero, my father led a calf out of the barn to the water trough. After the calf had satisfied its thirst, they turned back to the barn, but at the doorway the calf stubbornly braced its feet, and despite my father’s desperate pulling on the halter, he could not budge the animal. I was outside playing in the snow and, observing the impasse, began laughing heartily. My father challenged me to pull the calf into the barn. Recognizing the situation as one of unreasoning stubborn resistance on the part of the calf, I decided to let the calf have full opportunity to resist, since that was what it apparently wished to do. Accordingly I presented the calf with a double bind by seizing it by the tail and pulling it away from the barn, while my father continued to pull it inward. The calf promptly chose to resist the weaker of the two forces and dragged me into the barn.
Communicating by Metaphor – This is explored extensively in Sydney Rosen’s My Voice Will Go With You, but an example is given in the first chapter of David Gordon’s book Phoenix:
I was returning from high school one day and a runaway horse with a bridle on sped past a group of us into a farmer’s yard looking for a drink of water. The horse was perspiring heavily. And the farmer didn’t recognize it so we cornered it. I hopped on the horse’s back. Since it had a bridle on, I took hold of the tick rein and said, “Giddy-up.” Headed for the highway, I knew the horse would turn in the right direction. I didn’t know what the right direction was. And the horse trotted and galloped along. Now and then he would forget he was on the highway and start into a field. So I would pull on him a bit and call his attention to the fact the highway was where he was supposed to be. And finally, about four miles from where I had boarded him, he turned into a farm yard and the farmer said, “So that’s how that critter came back. Where did you find him?” I said, “About four miles from here.” “How did you know you should come here?” I said, “I didn’t know. The horse knew. All I did was keep his attention on the road.”
Erickson’s metaphorical strategies can be compared with the teaching tales of the Sufis (those of for example the Nasreddin) and the Zen tradition of Koans, each also designed to act on the unconscious mind.
Encouraging a Relapse – To bypass simple short-lived “obedience” which tends to lead to lapses in the absence of the therapist, Erickson would occasionally arrange for his patients to fail in their attempts to improve, for example by overreaching. Failure is part of life, and in that fragile time where the patient is learning to live, think and behave differently, a random failure can be catastrophic. Deliberately causing a relapse allowed Erickson to control the variables of that failure, and to cast it in a positive therapeutic light for the patient.
Encouraging a Response by Frustrating It – This paradoxical approach acts directly on the patient’s own resistance to change. Obese patients are asked to gain weight, or in a family therapy session, a stubbornly silent family member is ignored until the frustration obliges them to blurt out some desperate truth. Once again, this approach has its roots in Erickson’s hypnotic language patterns of the form “I don’t want you to go into a trance yet”.
Compare this with “Prescribing the Symptom” (below).
Utilizing Space and Position – Hypnosis and therapy are experienced subjectively by the patient, and any part of their total experience can be used to reinforce an idea. The physical position or even the posture of the patient can be a significant part of the subjective experience. Manipulating these factors can contribute to a therapeutic transformation.
If I send someone out of the room – for example, the mother and child – I carefully move father from his chair and put him into mother’s chair. Or if I send the child out, I might put mother in the child’s chair, at least temporarily. Sometimes I comment on this by saying, ‘As you sit where your son was sitting, you can think more clearly about him.’ Or, ‘If you sit where your husband sat, maybe it will give you somewhat of his view about me’. Over a series of interviews with an entire family, I shuffle them about, so that what was originally mother’s chair is now where father is sitting. The family grouping remains, and yet that family grouping is being rearranged, which is what you are after when changing a family.”
This may be directly compared with Fritz Perls’ use of an “empty chair” as a context for imagined interactions (where the client was often invited to occupy the chair and thus take on the role of the person imagined to be sitting there); Bert Hellinger’s approach, which requires the client to arrange family members (played by volunteers) in a row or pattern which matches the client’s internal understanding, and then to reorganise the row; and Virginia Satir’s work with tableaux and posture.
Emphasizing the Positive – Erickson claimed that his sensory “disabilities” (dyslexia, colour blindness, being tone-deaf) helped him to focus on aspects of communication and behavior which most other people overlooked. This is a typical example of emphasizing the positive.
Erickson would often compliment the patient for a symptom, and would even encourage it, in very specific ways. In one amusing example, a woman whose in-laws caused her nauseous feelings in the gut every time they visited unexpectedly was “taught” to vomit spectacularly whenever the visits were especially inconvenient. Naturally the in-laws would always sympathetically help her clean up the vomit. Fairly soon, the annoying relatives started calling in advance before turning up, to see if she were “well enough” to see them.
The subject of dozens of songs, “emphasizing the positive” is a well known self-help strategy, and can be compared with “positive reformulation” in Gestalt Therapy.
Prescribing the Symptom and Amplifying a Deviation – Very typically, Erickson would instruct his patients to actively and consciously perform the symptom that was bothering them (see the nailbiting example under #Resistance), usually with some minor or trivial deviation from the original symptom. In many cases, the deviation could be amplified and used as a “wedge” to transform the whole behaviour.
Seeding Ideas – Erickson would often ensure that the patients had been exposed to an idea, often in a metaphorical form (hidden from the conscious mind) in advance of utilizing it for a therapeutic purpose. He called this “seeding ideas”, and it can be observed to occur at many levels both coarse and fine grained, in many of his case histories. In a simple example, the question “Have you ever been in a trance before?” seeds the idea that a trance is imminent – the presupposition inherent in the word before is “not now, but later”.
Avoiding Self-Exploration – In common with most brief therapy practitioners, Erickson was entirely uninterested in analysing the patient’s early psychological development. Occasionally in his case histories, he will briefly discuss the patient’s background, but only as much as it pertains to the resources available to the patient in the present.
Shocks and ordeals
Erickson was prepared to use psychological shocks and ordeals in order to achieve given results:
When the old gentleman asked if he could be helped for his fear of riding in an elevator, I told him I could probably scare the pants off him in another direction. He told me that nothing could be worse than his fear of an elevator.
The elevators in that particular building were operated by young girls, and I made special arrangements with one in advance. She agreed to cooperate and thought it would be fun. I went with the gentleman to the elevator. He wasn’t afraid of walking into an elevator, but when it started to move it became an unbearable experience. So I chose an unbusy time and I had him walk in and out of the elevator, back in and out. Then at a point when we walked in, I told the girl to close the door and said, “Let’s go up.”
She went up one story and stopped in between floors. The gentleman started to yell, “What’s wrong!” I said, “The elevator operator wants to kiss you.” Shocked, the gentleman said, “But I’m a married man!” The girl said, “I don’t mind that.” She walked toward him, and he stepped back and said, “You start the elevator.” So she started it. She went up to about the fourth floor and stopped it again between floors. She said, “I just have a craving for a kiss.” He said, “You go about your business.” He wanted that elevator moving, not standing still. She replied, “Well, let’s go down and start all over again,” and she began to take the elevator down. He said, “Not down, up!” since he didn’t want to go through that all over again.
She started up and then stopped the elevator between floors and said, “Do you promise you’ll ride down in my elevator with me when you’re through work?” He said, “I’ll promise anything if you promise not to kiss me.” He went up in the elevator, relieved and without fear – of the elevator – and could ride one from then on.
Erickson’s work on hypnotism was controversial during his lifetime and has remained so to the present day. Some of his central presuppositions have been questioned by other researchers and the opaque nature of his explanations has led to a variety of competing interpretations of his approach.
A friend and colleague of Erickson, the hypnosis researcher André Weitzenhoffer, a prolific and well-respected author in the field of hypnosis himself, has extensively criticised the ideas and influence of Erickson in various writings, such as his textbook The Practice of Hypnotism. Weitzenhoffer displays a clear, and explicitly stated, bias against Ericksonian Hypnosis in his book, in favor of what he terms the semi-traditional, scientific, approach.