Solution focused Ericksonian hypnosis for chronic pain / illness

Clinical - Ericksonian Hypnosis
for Chronic Pain and Chronic Illness

Frequently Asked Questions

The following decidedly biased answers to "frequently asked questions" about Ericksonian Hypnosis represent the opinions of Charlie Johnson and no one else.

What is Hypnosis?

There is no commonly accepted definition or unifying theory of hypnosis. It has been variously defined in terms of guided imagery, a naturally recurring yet altered state of consciousness, a relaxed hypersuggestable state, a twilight state between sleep and wakefulness, and even role playing. It is the richness and complexity of the hypnotic experience significantly complicates its definition.

Although definitions and theories overlap, investigators in the last half of the 20th Century divide the observation of hypnotic phenomena into two camps. Some of the more traditional and orthodox researchers have viewed hypnosis as a special non-ordinary state that is noticeably different from normal waking experience. A more recent, alternative perspective contends that the psychological and physical phenomena created through hypnosis are the product of commonly definable psychological, cognitive and social variables.

How one defines hypnosis presents serious implications for its utilization by both clinicians and patients. Our view most closely resembles that of Joseph Barber* when he defines hypnosis as, “an altered condition or state of consciousness characterized by markedly increased receptivity to suggestion, the capacity for modification of perception and memory, and the potential forces systematic control of a variety of usually involuntary physiological functions (such as glandular activity, vasomotor activity, etc.)” (Barber, 1996, p. 5). These hypnotic phenomena are precisely the reason that hypnosis is useful in relieving symptoms of chronic pain and illness.

What are altered states and why are they important in relieving chronic pain and chronic illness?

By altered, we refer to that state of consciousness accessed by the patient that is noticeably different from her previous, and perhaps less functional state of consciousness. Often referred to as a trance state, this distinct shift in consciousness may be facilitated through the therapist performing a hypnotic induction (hetrohypnosis) or through the patient’s own practices (self-hypnosis).

In effect, hypnosis equips the patient suffering from chronic pain and chronic illness with a resource that enables him or her to shift from a physical context of discomfort to a more comfortable (or neutral) state. Utilizing this definition, therapists and patients will expect that the process of altering one’s state of consciousness will be associated with (partial or complete) relief from the symptoms of chronic pain and illness.

What’s so different about Ericksonian hypnosis?

We view Ericksonian applications as being more ecological than other practices of hypnosis. Specifically, Ericksonian interventions are centered on the unique experiences, characteristics and resources of the patient. Erickson believed therapists and patients could easily take advantage of the fact that that "trance" occurred in everyday life. He believed that it was this naturalistic phenomenon that required therapists to direct their attention to a patient’s unique everyday experience.

This means that hypnotherapists must individualize each hypnotic intervention so as to allow patients to feel "at home" with the process. This, factor substantially reduces any resistance patients might (understandably) exhibit and helps construct an atmosphere of respect and cooperation.

What are naturalistic trance phenomena?

These are phenomena that enable and encourage us to shift from one state of consciousness to another. For example, one can have the experience of having a headache and be able to be distracted from the pain while watching a movie. The headache "state" may return after the movie, or, it is possible to shift into yet another state and continue to be distracted. Everyone has had the experience of staring vacantly into space while daydreaming or loosing track of time while leisurely drinking a cup of coffee. Ernest Rossi describes to the biological basis for common everyday trance with his concept of Ultradian Rhythms and Mihalyi Csikszentmihalyi has observed it in another form in his research on Flow.

Are you saying that everything is "trance?"

Absolutely not! "trance" by definition must include at least one hypnotic phenomenon.

What are the dangers of hypnosis?

Clinical hypnosis as a treatment medium is not inherently dangerous. No one has ever been hypnotized and "not come back." However, hypnotherapy practiced by individuals who have no psychotherapy training and/or no experience with eliciting (resource) states of security can be dangerous. We believe that hypnosis is a sub-modality of psychotherapy and think that it is especially important to have clinical training. This is particularly true when dealing in the areas of trauma.

No hypnosis should ever involve coersion. Key to the Ericksonian therapist’s values is that all hypnosis involves choice (by the patient). Coercion, real or symbolic, is antithetical to any kind of psychotherapy. Patients experiencing such phenomena from hypnotherapy sessions should quit immediately and consider reporting the action to their state licensing board.

Who is qualified to practice hypnosis?

The easy answer is someone that has received some kind of training. However, hypnosis since the 1700’s has been a refuge for medical scoundrels and charlatans, we think that you should look far beyond that. Although our view is admittedly biased, it comes from many years of interviewing individuals that have had "bad" hypnotherapy experiences, including a stint as a special investigator for the Colorado Attorney General's Office.

There are two factors involved that seriously complicate the task of finding a competent hypnotherapist. First, there is literally no regulation of hypnotherapy in the United States. Second, and as a direct result of the first factor, there are thousands, perhaps tens-of-thousands of hypnosis training "schools" that "certify," their graduates with very little clinical experience or training. This, again in our opinion, has resulted in there being substantially more incompetent than competent practitioners claiming to do hypnotherapy.

We recommend that you consider the following when choosing a practitioner:

• The practitioner should have a graduate degree from an accredited university clinical psychotherapy program – Psychology, social Work, psychiatry, professional counseling, nursing, etc. Individuals who have not had professional clinical training or supervision with “real” psychotherapy patients should not be consulted in regard to hypnotherapy. Thus, a neurosurgeon, no matter how brilliant and experienced , won’t have the requisite training and rapport building skills to practice clinical hypnosis.

• The practitioner should have specific training in hypnosis. Importantly, the training program should require that its trainees be currently enrolled in a graduate program, have already graduated from an accredited university clinical training program, and/or be licensed to practice psychotherapy in their home state. In other words, and this is key, their hypnosis training program should not be willing to train anyone that merely has the price of admission.

• Ask practitioners about their specific experience in regard to the details and symptoms of the condition which you are seeking to relieve. What do they do to treat chronic pain, habits, anxiety etc? Have they had experience with patient with your specific personal demographics – age, gender, sexual orientation, language / cultural context, etc?

• Check for complaints in with your local licensing agencies. Even though hypnosis is not regulated in most states, many professional state licensing agencies keep complaint records on unlicensed psychotherapists.

• Beware of extravagant claims. In fact anyone that makes miraculous medical or psychological claims for hypnosis should be rejected immediately.

• Finally, you can consult several national professional societies. In addition to consulting the organizations that typically accredit mental health professionals – nursing, psychology, medicine, social work, etc. - you can check with the American Society for clinical Hypnosis, the Society for Clinical and Experimental Hypnosis, and Milton H. Erickson Foundation to see if they have any of the knowledge of the specific practitioner. They might also have a recommendation of someone in your geographic area. Their lack of knowledge doesn’t necessarily mean a lack of competence, however, nor can any recommendation guarantee competency. These are simply starting points. Incidently, all three of the above organizations have great professional publications.

Who is hypnosis "not good for?"

The most obvious answer is that no patient should be subjected to hypnotherapy who does not want it. Also, patients who are not firmly grounded in the present (place and time) should not engage in hypnotherapy until they can consistently orient themselves in "real time." Any patient who can not establish an associational cue for comfort and safety should not proceed beyond self-hypnosis activities. Patients who might be better and more briefly served by other treatment modalities (cognitive or marital therapy for example) need not engage in hypnosis.

What is hypnosis good for?

Hypnosis can be helpful for any condition that requires as part of its solution, an altered state of consciousness. This can be applied to anxiety, pain (physical and emotional), depression, compulsions and other involuntary symptoms or behavior. Performances of any kind and aspects of healing that are enhanced by the unconscious mind are also enhanced by hypnosis. Patients who might profit from some kind of post-hypnotic suggestion will also find the modality useful.

What is the relationship between Solution focused therapy and Ericksonian hypnosis?

Solution focused therapy is rooted in the work of Milton H. Erickson. Specifically, Erickson was the first therapist to write about brief therapy and was concerned in giving patients what they wanted. Like Solution focused therapists, he focused on the present and the future rather than the past. Both approaches respect and utilize the uniqueness of the individual and believe in possibilities rather than a diagnosis. Both treatment modalities bypass notions of psychopathology in an effort to value the patient's uniqueness and resources.

Solution focused therapy uses non-hypnotic tools that enable patients to "alter" their state of consciousness (from problem to solution states) to reach their goals. Whether it is constructing a new vision, projecting oneself into the future to consider new possibilities, or re-accessing past (forgotten) successes, both modalities involve a shift in consciousness that bypass problem states making it possible to explore the richness of solution states.

For more information, refer to the this chart that compares the two approaches.

Why did Erickson say that "all hypnosis is self-hypnosis?"

All Ericksonian hypnosis should involve choice. When patients have choice they also know that the control and responsibility resides with them rather than the therapist. Hypnotherapists projecting this attitude from the beginning of the first session engage little "resistance" to the concept of hypnosis.

How does "therapist-assisted" hypnosis differ from the kind of hypnosis that patients do on their own?

In therapist-assisted hypnosis the therapist facilitates both induction and hypnotherapy. In patient-directed self-hypnosis, patients induce themselves and construct their own suggestions. It has been our experience that teaching patients (at least three) self-hypnosis procedures substantially increases the success of subsequent therapist assisted hypnotherapy.

For more about Ericksonian hypnosis and chronic pain and chronic conditions check our web pages on our approach and our workshops. And, of course, check out our book!

For more information on hypnosis terms visit our hypnosis glossary.

Or, for information about differences and similarities to solution focused approaches

* Barber, J. (1996). A brief introduction to hypnotic analgesia. In J. Barber (Ed.), Hypnosis and suggestion in the treatment of pain: A clinical guide (pp. 3-32). NY: W.W. Norton & Company.

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