An introduction To Ericksonian Hypnotherapy

by John Dyckman, Ph.D. www.miltonherickson.com

Milton H. Erickson, MD, concentrated his writings about hypnosis more on the specifics of his treatments of persons than on an overarching theory of therapy.  This has led to some difficulties in understanding his work.  His case studies are complex, his inductions often subtle and his work demonstrates remarkable leaps based on his observational skills and a deep commitment to the potentials, abilities and possibilities of the individuals with whom he worked.  Fortunately he left a few important papers and books that do touch on theory.

His 1948 paper, ”Hypnotic Psychotherapy”, is heavily quoted in Erickson and Rossi’s 1979 book and it continues to be one of the best introductions to his theory.  In this early paper Erickson states that “Hypnosis does not change the person, nor does it alter his past experiential life.  It serves to permit him to learn more about himself and to express himself more adequately.”   And later; “…therapy results from an inner resynthesis of the patient’s behavior achieved by himself…In other words, hypnotic psychotherapy is a learning process for the patient, a procedure of reeducation.  Effective results in hypnotic psychotherapy, or hypnotherapy, derive only from the patient’s activities.” (Erickson, 1948)

Erickson was remarkably persuasive, and sometimes appeared to manipulate his patients into developmental progress.  However, a careful reading of his cases will show that his suggestions always served the purpose of advancing the therapeutic goals that the patient presented.  While he could be highly directive in his approach, he took his direction from the patient. Erickson saw many of the difficulties patients presented as “learned limitations” (Erickson and Rossi, 1979), that is, as behavior that once served a purpose that had now passed, leaving the behavior as a habit (what the Russian psycholinguist Lev Vygotsky called “fossilized behavior”).  The process of therapy helped the patient to disengage from the maladaptive pattern and to access ways to move forward based on the knowledge, skills and creativity that they already possessed but of which they may have not been consciously aware. 

Psychoanalysts discuss “defense interpretations” that validate the original need for the behavior, but which point out that the patient now has other ways to handle the situation. More contemporary theories discuss “re-framing”, “challenging maladaptive thought patterns” or “creating a new narrative”.   All share the process of drawing out “new” capabilities through the interpersonal process of therapy. 

Erickson and Rossi (1979) describe the process of hypnotherapy as comprising 5 stages: 1.Fixation of attention. 2.De-potentiating Habitual Frameworks and Belief Systems. 3.Unconscious Search. 4.Unconscious Process. 5.Hypnotic response. 

One of Erickson’s most important and original papers is titled “Further Techniques of Hypnosis—Utilization Techniques.”(orig.1959). After describing several cases of trance induction with patients who appear to be resisting the idea of trance, he states: “The value of this type of Utilization Technique  lies in its effective demonstration to the patient that he is completely acceptable and that the therapist can deal effectively with him regardless of his behavior. It meets both the patient’s presenting needs and it employs as the significant part of the induction procedure the very behavior that dominates the patient.” (p.35, italics in the original).  Erickson uses whateverbehavior the patient presents: pacing, rigid attention to detail, nonstop speech, defiance, etc., incorporating it into his statements to the patient.  This is an important addition to the traditional sequence of trance induction, namely observing, pacing (joining), then leading behavior.  The therapist demonstrates his acceptance of and respect for the patient. Erickson meets the person where they are, accepts them, and incorporates their behavior into the search to “side-step” their own learned limitations.