Milton H. Erickson

1. Milton H. Erickson Unorthodox psychiatrist, congenial family doctor, ingenious strategic psychotherapist and master hypnotherapist, Milton Erickson's influence has revolutionised Western psychotherapy. Thanks largely to Erickson the subject of hypnosis has shed its shackles of superstition and is now widely recognised as one of the most powerful tools for change.

2. Within his own life, Milton Erickson had many personal disabilities to contend with, which he often stressed helped him become proficient at practical problem solving for his clients. His 'problems' began early. Born into a poor farming community in Nevada, Erickson didn't speak until he was four. Later, he was found to have severe dyslexia, to be profoundly tone deaf and colour blind. At the age of seventeen, he was paralysed for a year by a bout of polio so bad that his doctor was convinced he would die.

3. Milton H. Erickson Milton H. Erickson is probably best remembered as the hypnotherapist who revolutionized hypnotherapy not only by developing new therapeutic techniques but also by evolving his own unique epistemology and ontology. Many attempts have been made to present and describe his main principles and practical approach in a coherent form. O'Hanlon has summarized twelve different frameworks for Ericksonian therapy and hypnosis, including one of his own (O'Hanlon, 1987).

4. Despite his handicaps (or perhaps because of), Milton Erickson went on to qualify as a medical doctor and psychiatrist. In the following years he became the World's greatest practitioner of therapeutic hypnosis and one of the most effective psychotherapists ever.

5. It was perhaps Erickson's farming background which caused him to approach psychotherapy in such a practical way. Anyone who is interested in relieving human misery and developing human potential will benefit greatly from reading about and learning from this remarkable man.

6. When Erickson was in his fifties he was struck by a second bout of polio that caused him a great deal of physical pain. Even this he was able to turn into a learning opportunity as he became highly effective at treating other people's pain with hypnosis. He details many of his approaches to sensory alteration and pain control in 'Hypnotic alteration of sensory, perceptual and psychological processes' by Milton Erickson.

7. Despite severe illness in his old age, Milton Erickson continued to teach, demonstrate and practice his remarkable skills as a therapist, even when eventually confined to a wheelchair. He died at the age of seventy nine.

8. It was perhaps Erickson's farming background which caused him to approach psychotherapy in such a practical way. Anyone who is interested in relieving human misery and developing human potential will benefit greatly from reading about and learning from this remarkable man.

9. He is noted for: His often unconventional approach to psychotherapy, such 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.) His extensive use of therapeutic metaphor and story as well as hypnosis coining the term Brief Therapy for his approach of addressing therapeutic changes in relatively few sessions

10. His use of interventions that influenced the strategic therapy and family systems therapy practitioners beginning in the 1950s including Virginia Satir and Jay Haley His conceptualization of the unconscious as highly separate from the conscious mind, with its own awareness, interests, responses, and learnings. For Erickson, the unconscious mind was creative, solution-generating, and often positive. 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. His influence on Neuro-linguistic Programming (NLP), which was in part based upon his working methods [1].

11. Milton H. Erickson Milton H. Erickson is probably best remembered as the hypnotherapist who revolutionized hypnotherapy not only by developing new therapeutic techniques but also by evolving his own unique epistemology and ontology. Many attempts have been made to present and describe his main principles and practical approach in a coherent form. O'Hanlon has summarized twelve different frameworks for Ericksonian therapy and hypnosis, including one of his own (O'Hanlon, 1987).

12. Erickson's practical approach is defined as the techniques and skills he used during therapy while the main principles are defined as the beliefs that he held in relation to doing therapy. {Erickson sometimes said he didn't understand his own work}

13. Main Principles of Erickson Hypnotherapy

14. Erickson did not believe it was necessary for himself or his patient to understand the cause of a problem in order to resolve it. In his words "Etiology is a complex matter and not always relevant to getting over a problem" (Hayley, 1973). This belief is a major shift in thinking away from a search for independent cause or truth; a search that permeates our modern culture and one that has perpetuated since the time of Aristotle (1953).

15. Erickson also believed that "insight" was an unimportant and even unnecessary part of therapy, stating that "Many psychotherapists regard as almost axiomatic that therapy is contingent on making the unconscious conscious. When thought is given to the immeasurable role the unconscious plays in the total experiential life of a person from infancy on, whether awake or asleep, there can be little expectation of doing more than making small parts of it conscious" (Erickson, 1980).

16. Another important element of Erickson's epistemology was his emphasis on treating each person as an individual, and not according to preconceived theories of personality or by utilizing a rigid approach to therapy. Erickson had no particular theory or hypothesis about problems and had no set method of working and consequently had the flexibility to allow for alternative explanations and to change his behavior to match the needs of the individual client. In addition, he also recognized that "Your patient is one person today, quite another person tomorrow, and still another person next week, next month, next year" (Erickson, 1985[1]).

17. Erickson also believed in what has been called a naturalist approach to therapy. His belief was that people are not only capable of going into trance and experiencing all possible trance phenomena but also that they have the natural abilities needed to overcome their difficulties.

18. Similarly, Goldstone reports that "Another important element of Dr. Erickson's work was his deeply held belief that people innately have within themselves the strengths, skills, abilities, talents, resources and knowledge they need to make whatever kinds of changes they wish to make" (1998).

19. Erickson believed that people not only have all the resources they need but also that "people will make the best choices they have learned how to make" (Lankton, 1998), even if they are not conscious of this or of their process of making these choices.

20. Erickson believed that the responsibility for change rests entirely with the client and the role of the therapist to create a state of expectation of change and to provide the climate in which change can take place. As Erickson states "In psychotherapy you change no one. People change themselves. You create circumstances under which an individual can respond spontaneously and change. And that's all you do. The rest is up to them" (O'Hanlon, 1987).

21. Finally, Erickson believed that his work was complete when the presenting problem was resolved. Thus, his premise was that the long-term goal should always be the immediate goal and he did not spend time what was "behind" a symptom.

22. Practical Approach of Erickson Hypnotherapy Erickson defined hypnosis as "a state of special awareness characterized by a receptiveness to ideas" (Erickson, 1985[2]). Essentially this state was elicited using techniques such as suggestion and confusion to focus or distract the client's conscious attention in such a way that Erickson could communicate directly with a client's unconscious mind. The client would then be able to learn new behaviors and new ideas from what was presented. This learning took place in a trance state in which the client was attentive to all the information set out and demonstrated by Erickson; the client could then take on board as much or as little as was appropriate for them.

23. In order to elicit trance states and to facilitate change, Erickson utilized whatever the client brought into therapy, whether it was beliefs, behaviors, demands or resistance. His advice was never to reject or try to the behavior that the client showed in the office. He advised that "you look at it, you examine it, and you wonder how you use it" (Erickson, 1985[2]). For example, if a child sucks his thumb then which thumb he suck? The left or the right? And shouldn't he suck the other one? And what about sucking the fingers? Which one first? After Erickson repeatedly asked these sort of questions to one little boy, the boy told his grandmother "This is making me want to dislike sucking my thumb!" (Erickson, 1985[2]).

24. Erickson's acceptance of the patient's ideas and behaviors for what they were, rather than rejecting, contradicting or judging them, contributed to his ability to quickly build rapport with the patient. He also made use of biorapport, which is the rhythmical alignment of some part of his behavior to that of the client's. Examples are breathing in time with the client and making movements at the same time as the client.

25. Another technique used by Erickson was that of the double bind. This was asking a question that gave the illusion of choice, when in fact whatever choice was made, it would lead to the desired result. To a patient who said Erickson could not hypnotize them, Erickson said "I want you to stay awake, wider and wider awake, wider and wider awake" (Haley, 1963). Whatever this client did he was co-operating with Erickson in the trance induction.

26. One specific form of double bind was symptom prescription. According to Watzlawick, Bavelas and Jackson (1967) this term was first introduced in the work of the Bateson "Family Therapy in Schizophrenia" project. This involved prescribing the symptom but in an exaggerated, modified or paradoxical way. Erickson once treated a married couple who had both been bed-wetters for many years. He had them set their alarm clock to wake up in the middle of the night and instructed them both to deliberately wet their bed if their bed was dry. Thus, Erickson was modifying the patients' symptoms to make it harder {easier surely} for them to do their problem and also teaching them how to have control over their symptoms.

27. Erickson would make use of this sort of specific task assignment as well as using generic ones so as to facilitate therapeutic change. The bed-wetting example above is a specific task. However, Erickson would often ask a client to perform a generic task like climbing a local mountain while thinking about their problem and then reporting their thoughts back to him.

28. The use of Metaphors was used by Erickson to communicate with his clients and he often told anecdotes from his own experience, about other clients or simply made them up. His hope was that the experience of another in overcoming a problem, which is similar to the client's own, would suggest ways in which the client could deal with their situation.

29. Erickson made use of the processes of framing, deframing and reframing to alter a client's perception about a given situation. A frame being defined as an added meaning given to a sensory experience. Thus, framing is the process of giving a meaning where none already exists, deframing is the process of challenging or casting doubt on the client's current meaning and reframing is the process of providing a new or alternative meaning.

30. As a hypnotist, Erickson made use of many hypnotic phenomena. Analgesia was used to teach clients that they could control when and where they experienced pain. Amnesia was used to prevent a client's conscious mind from interfering with hypnotherapeutic work (Erickson, 1985[2]) and to overcome learned limitations. According to Erickson "All hypnotic phenomena are made up of normal everyday patterns of behavior, organized to serve intentional purposes for the patient" (Erickson, 1985[2]).

31. Confusion was another important technique used by Erickson to contend with the client's conscious mind, and thereby bypass it. When solving problems, the person's mind was most frequently concerned with limiting beliefs and ideas about how change was not possible. Hence, Erickson emphasized "that the person's conscious mind has to be contended with in some manner in order to gain access to the person's unconscious abilities" (Erickson, 1985[1]).

32. In addition, Erickson also developed a state of confusion in his clients' minds from which they were more likely to accept what he suggested as a means of replacing the uncomfortable state of confusion with a more comfortable state of understanding. As pointed out by Lankton "a client will develop a particular receptivity to incoming information at a point in therapy when the normal framework has been disrupted and suspended by an unconditioned stimulus such as a paradoxical prescription" (1998).

33. Erickson used both direct and indirect suggestions to achieve therapeutic goals. In general, he was very directive when dealing with symptoms and getting people to do things but very indirect in how people would resolve their symptoms and how they would live their lives afterwards. A direct suggestion might have been to tell the client to perform a specific therapeutic task, like buying new clothes or walking a different way to work. An indirect suggestion might have been to say something like "I don't know how quickly you can learn". This statement indirectly suggested that the client will learn, it was just a question of how quickly.

34. In contrast to many other therapeutic approaches that focus on exploring the past, Erickson worked in both a future oriented and goal oriented manner, eliciting agreed goals with patients and working together with the patient to achieve them. As stated by Erickson "Psychotherapy is sought not primarily for enlightenment about the unchangeable past but because of dissatisfaction with the present and a desire to better the future" (Watzlawick, Weakland and Fisch, 1974).

35. Conclusion

36. Erickson once said "I don't try to structure my psychotherapy except in a vague, general way" (O'Hanlon, 1987). Compromises have been made in deciding what to include and what to omit and also in deciding the length of each description, some of which are necessarily brief. In conclusion, Erickson's own advice was to "Develop your own technique. Don't try to use somebody else's technique...Don't try to imitate my voice or my cadence. Just discover your own. Be your own natural self" (O'Hanlon, 1987).

37. 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 some resonance at the unconscious level. The patient can be aware of this, or she can be completely oblivious that something is happening. Erickson would see if the patient would respond to one or another kind of indirect suggestion, and allow the unconscious mind to actively participate 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. It should be noted that "[Erickson's] conception of the unconscious is definitely not the one held by Freud."[5] 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.

38. 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.

39. 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...

40. Indirect Techniques 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 participation in their transformation.

41. Erickson maintained that it was not possible to consciously 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.

42. 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 which 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.

43. Confusion Technique In all my techniques, almost all, there is a confusion.[7] 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 other techniques to incite transderivational searches.

44. James Braid, who coined the term 'hypnosis,' claimed that focused attention ("look into my eyes...") 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 wracked by pain, angst 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...

45. The Handshake Induction Confusion is the basis of Erickson's famous hypnotic handshake. Many actions are learned and operate as a single "chunk" of behavior: shaking hands and tying shoelaces being two classic examples. 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".

46. 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.

47. By interrupting the pattern of a 'normal' handshake in some way, the hypnotist causes the subject to wonder what is going on. 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.

48. 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 key to a successful outcome. The most important thing is that the 'normal' handshake is subverted in such a way to cause puzzlement, which may then be built upon.

49. 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.

50. 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.