BRAIN CHANGE THERAPY: Clinical Interventions for Self-Transformation

Language has extraordinary power: Just as “mere” words can precipitate wars, the right words can heal wounds that nothing else can touch. In a keynote address to the 16th International Congress on Hypnosis and Hypnotherapy, Peter Bloom (2004) noted that words can alter brain states and exclaimed, “We now have proof: Words change physiology.” Hypnotic suggestion creates changes in brain activation that are similar to actual experiences (Raz & Shapiro, 2002; Raz, Fan, & Posner, 2005). It can also override automatic processes such as implicit memory (a type of memory based on previous unconscious learning), pain perception, and attention processes (Egner & Hirsch, 2005). Additionally, the hypnotic process appears to activate brain areas involved with memory and self-imagery.

This chapter explores the nature and use of hypnosis as part of the BCT model of facilitating long-lasting state changes in clients that result in greater state flexibility and more enjoyment and confidence in daily life endeavors. We provide overviews of the neurophysiology of hypnosis, the basics of Ericksonian hypnosis, trance phenomena and their therapeutic uses, conversational hypnosis, and using hypnosis to access the wisdom of the unconscious mind—all in the context of applying the BCT approach.

All therapists know that, as with infants who have anxious attachments, some clients are harder to soothe. Frequently, the following intervention, used with a soothing tone of voice, can change the patient’s state from one of severe emotional pain to a calmer and more open state: “Tell me if I have this right and tell me if I have left anything out… .” A summary of the emotional process the client is experiencing then follows. There are times, however, when listening and reflecting what a patient says or offering soothing comments seems to be less than what the client needs. The client still may be unable to shift to a more productive state. It is at this point that hypnosis becomes a particularly valuable tool. With hypnosis, the therapist gains another avenue by which to directly and indirectly teach clients the process of changing states of consciousness, modulating affects, and learning to solve problems—the three skill domains essential for healthy living.

In this context, BCT is a process wherein clients learn to utilize their own associations; where failure is understood as an occasion for learning; where memories of success become resources; and where imagined possibilities presage actualized future success. The earliest paradigm of the hypnotic process was that change occurred by implanting suggestions in the mind. The more recently developed Ericksonian hypnosis focuses on eliciting resourceful states and abilities that the client already possesses in other contexts and applying them to the current problem area. For example, one client froze when it came to making sales calls. Upon reminding him of the courage he had demonstrated as a soldier in the Iraq war, he began to remember the state he had mustered to get through the difficult experience and to revivify it.

Through the use of formal hypnosis, a client can experience the empowering ability of changing his or her body sensation—for example, by watching an arm levitate seemingly of its own volition, by sensing numbness in one part of the body, or by raising the temperature in the hands. Any one of these can act to stimulate the curiosity circuit and lead a client to shift into a state of anticipation that life satisfaction might be a possibility. This process demonstrates to clients that not only can they control their own physiology, but, with the guidance of the therapist, there is the possibility of mastering life’s circumstances.

Neural change involves the processes of organization, disorganization, and reorganization. Prigogine (1983) suggested that systems are always moving into chaos and reorganizing into new systems. This idea can be applied to hypnosis and to psychotherapy in general. Each person’s neural patterns are organized in a particular way that predisposes him or her to a certain outlook on life and to certain emotional–physiological experiences. What becomes troubling to the client are not really external events—although they may be the triggers—but the state the person chronically experiences. Potentially even more troubling, the person’s brain may organize information in ways that may make it too painful to accomplish important goals.

As a psychotherapeutic intervention, hypnosis intentionally disrupts or disorganizes patterns of neural activity that underlie problematic states and utilizes prior experiences that have nothing to do with the perceived goal but have similar desired state experiences. Hypnotic reframing, the process of suggesting other perspectives or meanings, can assist in breaking up personal constructs that otherwise maintain problematic states. Chen (2002) suggested that since language is a product of neural activity, when neurological repatterning occurs, the client responds to situations with different verbal and nonverbal responses.

Bill worked with one client who was phobic toward tarantula spiders. Merely thinking about them would make Angie shake, sweat, and cry. She had just landed a contract for some work in Arizona; unfortunately, some species of tarantulas are native to Arizona. These spiders can become quite large, but they do not leap and their preferred defense is to retreat. If that does not work, a tarantula will pull hairs from its abdo-men and fling them at an attacker. Only in an extreme case will a tarantula bite—and, for a person, the bite is no more serious than a bee sting. Nonetheless, Angie was terrified of them. However, she liked Superman and happened to be interested in learning to skydive. So Bill hypnotized her and had her remember the Superman movie. He suggested that she visualize flying in the air with Superman. He also had her imagine how small things look from up in the sky (a dissociative review). Bill then had her focus on how much bigger she was than a tarantula. Next he suggested that she imagined Superman flying down and stomping on the spider. Following that, she imagined Superman carrying a woman down who stomped on the tarantula. After that, she envisioned the tarantula morphing into the clay character from Saturday Night Live who says “Oh, no, Mr. Bill” while it is being smashed. Finally, Bill had Angie imagine wearing cowboy boots and squashing a tarantula herself. Angie’s fear was entirely resolved in two sessions. Of course, no real tarantulas were harmed in the creation of this metaphor, nor did the client feel a need to kill them after this intervention. In a follow-up conversation, Bill learned that at one point while she was in Arizona, Angie had been able to allow one to cross the road in front of her without screaming or running away. What she had needed was to be in touch with her sense of power and her ability to take care of herself, which the metaphor stimulated.

In a review of the neurobiological research on hypnosis, Gruzelier (2006) suggested a three-stage process of the neurological response in hypnosis: (1) the sensory fixation and concentration evoked by induction activates the thalamic–cortical attentional network, which in turn engages the frontal limbic system; (2) anterior executive functions are suspended and directed by the stimulation of the frontal limbic inhibitory systems via suggestions of tiredness and relaxation; and (3) engagement of the right posterior temporal functions results in passive imagery and dreaming. What this physiology tells us is that specific brain processes and pathways are indeed altered by hypnotic states. In addition, Kosslyn, Thompson, Costantini-Ferrando, Alpert, and Spiegel discovered that hypnotic suggestions create blood flow changes and concluded that “hypnosis is a psychological state with distinct neural correlates and is not just the result of adopting a role” (Kosslyn, Thompson, Costantini-Ferrando, Alpert, & Spiegel, 2000, p. 1297). There are, in fact, neurophysiological correlates of state changes (Crawford, 1998).

Other researchers have added to our understanding of the neuromechanics of hypnosis. Rainville et al. (1999) reported that hypnosis activated the occipital region of the brain as well as the anterior cingulate cortex, the thalamus, and the brainstem. Overall, there was a decrease in cortical arousal and an increase in attention during hypnosis. Maquet et al. (1999) concluded that “hypnosis is a particular cerebral waking state where the subject, seemingly somnolent, experiences a vivid, multimodal, coherent, memory-based mental imagery that invades and fills the subject’s consciousness” (p. 332). Crawford and Gruzelier (1992) found that the theta frequency is active during hypnosis and trance phenomena. We notice that when a client enters a state of trance, anxiety often disappears and is replaced by an inner flexibility in which the person can experience a range of emotions differing from the problematic ones associated with a stuck state.

Through neuroimaging techniques, researchers have determined that hypnosis is probably a special state in which normal patterns of communication between separate cognitive systems are disturbed and the normal relationship between conflict monitoring and cognitive control is disrupted. In fact, a study done at the University of Geneva suggests that hypnosis alters neural activity by rerouting some of the connections in the brain (Oakley & Halligan, 2008). In addition, because the brain exhibits activity-dependent plasticity, and the hypnotic experience interfaces with the limbic and neocortical systems (Rossi, 2002), hypnosis can facilitate the turning on and off of gene expression (Lipton, 2005; Rossi, 2003).

Rainville (2002) compared a nonhypnotic condition with a hypnotic condition that produced brain activity involving the brainstem, thalamus, anterior cingulate cortex, right inferior frontal gyrus, and right inferior parietal lobe. The research suggested that these activations were evidence that hypnotic absorption involves executive attentional networks and is central to the hypnotic experience. Further, it pointed in the direction of a “neural signature associated with hypnosis together with increases in mental absorption and reduction in spontaneous conceptual thought commonly reported by hypnotized individuals” (Oakley & Halligan, 2008, p. 265).

Current research on the neuroscience of hypnosis is moving in two directions. The first includes studies that explore the cognitive and neural nature of hypnosis itself. For example, brain scans show that the control mechanisms for deciding what to do in the face of conflict become uncoupled when people are hypnotized. Some studies using fMRI have demonstrated specific areas of the brain that are activated with hypnosis (Jamieson, 2007; Oakley & Halligan, 2008).

The second direction explores specific hypnotic suggestions and their impact on the brain. In highly hypnotizable subjects, when suggestions were given for decreased fibromyalgia pain, certain brain areas that register discomfort “lit up” (Derbyshire, Whalley, Stenger, & Oakley, 2009). Raz, Fan, and Posner (2005) used neuroimaging techniques to determine the effect of hypnotic suggestion on the brain. They discovered that subjects who were given a string of words could block their meaning with a hypnotic suggestion to do so, and that specific brain areas, including the visual areas, modulated activity and altered information processing during hypnosis. In other experiments, in which researchers instructed subjects to avoid thinking about word associations, long-term memory was reduced (Anderson, Barr, Owall, & Jacobbson, 2004). A study using brain scans demonstrated that posthypnotic suggestion, in this case an amnesia, was reflected in the suppression of certain brain activity (Mendelsohn, Chalamish, Solomonovich, & Dudai, 2008). This capacity to suppress mental activity under hypnosis has been used to help trauma clients dampen the emotion surrounding a traumatic event while they review the memory for mastery of it (Bryant & Mallard, 2002). What then occurs is a reconsolidation of the memory without the intense emotion connected to it.

Neuroscientists have discovered that the process by which we make decisions is influenced by the amygdala, a part of the limbic system (Goleman, 2003; Shibata, 2001). To do this, the limbic system constantly monitors an individual’s circumstances. Based on a prediction of the likely outcome of any impending decision, the limbic system produces a presumed emotional response. Armed with that response, the cortex immediately and unconsciously refines the decision. Thus, stimulating appropriate affect with hypnosis can influence state and behavior change (Lankton & Lankton, personal communication, June 18, 1989).

Due to the brain’s neuroplasticity, suggestion, imagination (metaphor), and mental rehearsal can stimulate brain growth and the development of neural pathways. Each of these acts of attention causes neurons to connect in specific patterns and sequences of firing. A new idea or suggestion turns on different groups of neurons, and, when reinforced by the clinician in indirect communication, different areas of the brain light up. This implies that although it may not be easy, change is always possible.

Milton Erickson blurred the line between hypnotic and ordinary states. He suggested that everyone commonly experiences trance states, from being “lost in thought” while driving and missing a freeway exit to being so absorbed in reading a novel that hours vanish. Erickson conceived of hypnosis differently from the ways in which it had been understood historically:

Psychologists are beginning to discard the old belief that hypnosis transforms a person into some strange, passive, dominated new creature. Instead they are beginning to realize that hypnosis can be used and should be used to elicit the natural and innate behavior and reactions of the subject, and that through such a measure human behavior can be studied in a controlled and scientific manner. (Erickson, Vol. 3, p. 18)

Ultimately, Erickson defined hypnosis simply as a “focused attention” that leads to an alteration in the way a person experiences the world. The Greens suggested that at the level of brain physiology, hypnosis functions as a method of speaking directly to the limbic system (Green & Green, 1977). We would add that focused attention facilitates changes in states.

Erickson’s unique style involved strategies, multilevel communication, relationship connection, suggestion, and overt and covert persuasion. Also diverging from the mainstream psychological perspective of his day, Erickson saw the unconscious as a vast storehouse of experiences, memories, and learning—in fact, as a repository of resources that every person possesses and which can be engaged to help a client overcome some difficulty (Lankton & Lankton, 1988). For instance, under hypnotic suggestion, a client recovering from serious burns can remember the cooling sensation of holding an ice cube. He or she can then begin to imagine that coolness in the area of the burn. In response to hypnotic suggestion, the client’s physiology will shift, thereby reducing the inflammation and promoting a more rapid healing.

Erickson pointed out that the line between ordinary consciousness and trance is very fine, and that it is important to note that there are many types of trance. For example, a baseball pitcher often will be so focused that he or she sees only the catcher’s glove and shin guards, but not the batter (who is irrelevant). Neither will the pitcher hear the crowd. Good pitchers seldom remember what happens from pitch to pitch because they are so focused in the moment.

When we view a film, we step into its reality through imagination. We laugh, cry, and “suffer the slings and arrows of outrageous fortune”; we can become terrified, righteously angry, or sexually aroused. One part of the brain realizes that we are in the movie theater, but another part of the brain has identified with one or more of the characters in the film based on analogous events in our own lives. For the duration of the film, unconscious memory and imagination have been used to change states.

Reading a book, watching a movie, or simply having a daydream can not only generate an emotional response as intense as would be the case if a person were physically experiencing those events, it can also generate similar physiological responses. An individual can unconsciously change blood flow, heart rate, and blood pressure just by thinking of an arousing scene. For example, this is what happens when a person has a sexual fantasy. Similarly, using consciously focused attention, a person can engage different neural processes and turn on (or off) various physiological systems: One can raise skin temperature, lower heart rate, alter blood pressure, or redirect blood flow in his or her body. An individual can also imagine future goals and, through mental rehearsal, practice and accomplish them.

During periods of highly focused attention or trance, dissociation, a sense of automatic or unconscious motoric behavior, and an altering of sensory perceptions characteristically occur. Dissociation leads to an experience of something happening automatically, outside of one’s volition. A cellist might say, “I didn’t play the concerto; it played me.” Excellent golfers experience automatic motoric behavior as they tee off. They don’t think about their swing or their form; they simply step out of the way and let the body do what it knows so well how to do. Many athletes have had the experience of suddenly finding that the ball seems to be traveling in slow motion, such that it’s practically effortless to be at exactly the right place at the right moment to intercept it. All of these experiences are common when athletes or musicians are performing at their peak or are “in the zone,” but they are also common in everyday life.

Practically everyone has had the dissociative experience of hearing words coming out of their mouth that they had no intention of saying—for example, at a community meeting, suddenly volunteering to take on a task and immediately wondering, “Who said that?!” Anyone who drives a vehicle with a standard transmission knows a great deal about unconscious motoric behavior. When taking off uphill from a red light, it’s not possible to consciously direct two feet to manipulate three pedals with the right timing; to do it smoothly, it has to be done without conscious interference. And everyone has come to the end of an important conversation and found that much less (or more) time has elapsed than one expected.

All of these are actually trance experiences occurring without a formal trance induction. In fact, Erickson utilized a formal trance induction only about 10–20% of the time (Zeig, personal communication, January 19, 1988). He was a master of inducing trance through a casual conversation. Then he would subtly introduce a suggestion and elicit unconscious resources to help a person. In using conversational hypnosis, a clinician might comment: “It is really difficult for you to remember feeling better because right now, having that particular feeling that you have, it is hard to notice when that feeling ends; kind of like a wave that comes and then it goes.” This comment is designed to turn on the curiosity and nurturing circuits. Erickson taught, through word and example, that where we focus the client’s attention is critical in stimulating emotional states; it can facilitate or hinder the healing process. Changes in the client’s facial expression or tone of voice and a more positive energy indicate that these goals are being accomplished.

Together, Milton Erickson and Ernest Rossi detailed a number of common trance phenomena that have therapeutic applications (Erickson, 1980; Erickson & Rossi, 1981). Understanding these allows a therapist to use hypnotic words more consciously and effectively in a healing manner.

1. Dissociation is the psychological phenomenon of experiencing an event as if it were happening to someone else. In trance, dissociation can be used strategically to review something that is emotionally or physically painful. A therapist may suggest, either directly or indirectly, that a client view a particular scene on a screen, through a window, or in a mirror. Dissociation helps a client to gain emotional or physical distance from an event.

2. Age regression occurs when a person in trance revivifies, or experiences intensely, some event from the past. In an age-regressed state, a client may learn or relearn psychological traits such as spontaneity, curiosity, playfulness, vulnerability, persistence, or the ability to take initiative. For example, using indirect techniques, a therapist may tell a story about a child to assist the client in identifying with the character and vividly reexperiencing a childhood event.

3. Amnesia is the innate ability to forget. Although most of us think of forgetting as an annoyance, forgetting a painful experience can be useful in a client’s recovery from trauma. Therapists may directly suggest that a client forget something or tell anecdotes about forgetting in order to assist a client in forgetting something.

4. Time distortion is a naturally occurring phenomenon, in or out of trance. If a person is absorbed in something interesting, a long period of time may seem quite short. The reverse is also true. A client may need to be able to shorten time to endure a physically or emotionally painful experience or expand it to complete a task. Time distortion can be suggested through an embedded suggestion or through a story about an occasion when a person lost track of time. The therapist may suggest that a client can do this out of trance.

5. Pseudo-orientation in time allows a client in trance to go into the future mentally, discover psychological resources, and then bring these abilities back into the present. A therapist may have a client picture a screen with an older self in the scene. Then the therapist may have the older, wiser, more successful self tell the younger self how he or she solved certain problems or accomplished certain tasks or goals.

6. Automatic writing is the process of writing or doodling unconsciously. Often done with the nondominant hand, automatic writing can be used to deepen trance or recover forgotten material.

7. Positive hallucinations, although often associated with mental illnesses such as schizophrenia, can be created for useful reasons by every person to some degree. Auditory hallucinations are most common, but olfactory, gustatory, kinesthetic, and visual hallucinations do occur for many people in trance. Erickson created a kinesthetic hallucination of an itch with a man suffering from phantom limb pain. He did this because he intuited that it would be difficult for his client to experience a complete lack of pain when previously the pain had been so intense. Erickson rightly thought it would be possible for his client to accept, psychologically, an irritating itch for a few days in a limb that was not present. Angered at Erickson for causing this annoying sensation, the client was ready to accept the loss of his leg and the physical comfort that accompanied the cessation of the itch.

8. Negative hallucination is the inability to perceive something that is right in front of a person. People can fail to see what is right before their eyes or to hear a person’s voice from just a few feet away. In moments of intense concentration, particularly in emergencies, a person may have no sensation of pain. Any period of intense concentration is, by definition, a trance state. A therapist might suggest that a client not experience something—for example, chronic pain—and then bring the lack of experience with him or her out of trance through a posthypnotic suggestion.

9. Posthypnotic suggestion allows skills learned in trance to become available to a client in a more common state of awareness. A therapist may suggest that a client recreate some experience he or she had during trance at a later point in time; for example, the client might find him- or herself feeling uncharacteristically relaxed while giving a presentation at work.

10. Anesthesia, the experience of a total numbness of some body part, is sometimes suggested hypnotically when a person is unable to tolerate chemical anesthesia during surgery. Since most people have had the experience of sleeping on an arm or hand and feeling a complete lack of feeling in that limb, this anecdote is frequently mentioned to a client in order to aid in the experience of numbness.

11. Analgesia allows the client to tolerate the sensation of pain while remaining mindful of the injured part of the body. Pain is important because it is protective of an injured or sick part of the body. However, pain that is too intense is counterproductive. The therapist may suggest a lessening of pain through the experience of analgesia. The pain is still present but to a lesser extent, and the client is in a better frame of mind.

12. Hypermnesia is an ability to remember in great detail events from the past. This is the opposite resource from amnesia (Lankton & Lankton, 1988). Remembering the lyrics of a song that you haven’t heard in years is a common instance of hypermnesia. A person may need to remember information for an exam or to report a crime to the police. An actor, athlete, or musician may need to recall the right lines, moves, or notes for a performance. Hypermnesia can be enhanced by linking memory to the appropriate state.

In the BCT approach we make use of trance phenomena in a highly integrated way because our therapeutic focus seeks to facilitate, engage, and shape state change. We now know that specific neural circuits can be activated or deactivated using words. While Milton Erickson was intuitively able to target a client’s particular circuits, the use of BCT techniques allows the clinician to do so intentionally. For example, telling a story or using a confusion technique can trigger the curiosity circuit and function as a bridge to another state. Telling a story that includes parental approval of a child’s mastery of a new skill can deactivate anxiety in the face of newness.

The most powerful tool in psychotherapy, no matter the approach, is empathy (Hutterer & Liss, 2006). Empathy turns on the nurturing circuit in the client and facilitates a state shift. An alignment between therapist and client occurs where there is a shared state of connection. Heinz Kohut felt that within the context of the empathic treatment bond, his clients were experiencing him as a needed extension of themselves (Rowe & Mac Isaac, 1991, p. 30). Clients record at an unconscious level the tone of voice, gaze, respiration, and posture of the therapist, and the clinician can use these subtle means to help shift the client’s state (Meares, 2005). Whenever two people have established deep rapport, each is affecting the other at a neurobiological level.

Mirror neurons enable people to synchronize with each other. Sensing a supportive environment, the client is likely to come into unconscious synchrony with the hypnotherapist. When this is not the case, the therapist can consciously come into synchrony with the client and then gradually shift the client by shifting him- or herself. Empathic suggestion, metaphor, and guided mental rehearsal may create a shared state that can be healing for the client. The combination of encouraging state entrainment through the use of empathy and then inquiring what changes a client would need to make to live in accordance with his or her own values is a powerful influence for change (Miller & Rollnick, 2002). To facilitate this process, appropriately pacing the client in terms of affect and mental focus is critical. The following experience Bill had as a boy illustrates this point.

When Bill was 8 years old, his family made a trip to Bristol, Oklahoma, where his parents had grown up. One of Bill’s great-uncles had a ranch and told the family that he had a horse for his nephew. The horse was a beautiful black-and-white paint pony—but it had never had a rider on its back. When Bill arrived at the ranch, he had visions of riding a bucking bronco and taming the horse, as he’d seen in the movies. His uncle had a different plan.

Uncle John asked Bill to name the horse. Bill chose the name “Cherokee.” His uncle silently nodded. When they entered the corral, Uncle John had Bill sit in the opposite area from where the horse stood. And then Bill’s uncle began to tell him stories of his Cherokee ancestors—a part of Bill’s heritage of which he had had no conscious knowledge—all the while repositioning Bill in relation to the horse.

In fact, Uncle John was a horse whisperer who had observed mustangs in the wild and knew how to stimulate their curiosity. After they had spent a couple days just sitting at one edge of the corral, Uncle John placed a lump of sugar and an apple in Bill’s shirt pocket. After a while, the horse came up to Bill and nudged him to get a bite of the tasty treats. Uncle John told Bill to sit quietly and let the horse get to know him slowly. Eventually, he placed the apple in Bill’s hand and told him to hold it and allow the horse to eat. Then he showed Bill how to stroke the horse’s face and neck so that the two could get to know each other without fear and anxiety. The next day, Uncle John placed an apple in Bill’s hip pocket, and they walked around the corral with the pony following and every now and then nudging Bill’s behind, trying to eat the apple. Pretty soon, the horse had walked around the entire corral with Bill. The following day, Bill’s uncle placed a blanket on the horse, lifted his nephew up, and told him to just rub the pony’s neck and face, and whisper his name in his ear. Bill’s uncle walked the horse around the corral with Bill on his back. Cherokee and Bill developed a bond and, despite both the horse’s and the boy’s natural hesitation and fear, they became great friends.

This story illustrates the tools of verbal pacing and leading that Milton Erickson used when he aligned himself with a client and made a small change that he slowly expanded upon as the client solved problems. It is also an example of Erickson’s utilization principle, which states that we can acknowledge the reality of the client (the pony or young Bill) and then disorganize it (horse moved from tendency to flee, Bill moved from idea of “breaking the bronco”) by turning on the client’s curiosity. Any time we alter neural patterns, we are disorganizing them. Subsequent to that, they can be reorganized: By mirroring the horse’s behavior of staying distant but indirectly suggesting that a closer relationship would result in a food reward, curiosity was stimulated and helped the horse overcome fear. By the time the blanket was on the horse’s back, both the horse and Bill felt a sense of safety with each other, and a new behavior was in place.

Most of the time, when a therapist is warmly empathic, the client’s state shifts unconsciously in the direction of the desired and integrated state, and the clinician can follow this movement by reinforcing the state with positive comments. To disrupt the client’s rigidly held construct of reality and loosen neural connections, the therapist can intentionally use empathy in the form of conversational hypnosis, which is the use of suggestion and indirect association without a formal trance induction. However, the use of empathy is likely to miss the mark if a client is dismissive. In that case, empathy may even serve to elicit hostility. A better approach, then, is simply to mirror back what the client is saying until an opening occurs for the therapist to provide an interruption in the pattern.

Empathy has a subtle hypnotic effect in that the empathic voice tone is soothing and helps gently shift the focus of attention off the problem and on to the voice of the therapist, ultimately shifting the client’s emotional state. Hypnotic empathy spoken in genuine and caring tones also has subtle age regressive tendencies, evoking earlier times, when a person was cuddled and nurtured by a caregiver. When the gentle cooing of the therapist’s voice is allowed in, the client’s pain seems to diminish. Through empathy, the therapist intentionally facilitates the client’s brain shift to a state that is less conflicted and more flexible. This state shift in turn allows a person to open up to possibilities he or she may not have considered previously.

All psychotherapies are suggestive. Where we focus the client’s attention in therapy can lead the individual to experience positive or negative states. Carl Rogers, who contributed the idea of person-centered therapy and used unconditional positive regard, could be compared to an excellent hypnotherapist. He had the ability to use deep empathy, and while he never described his work in this way, he used suggestions in conversations. He would say, “You feel this and you feel that, and you really want to do this and that.” Because people bonded deeply to him, he was able to move people through their issues with a soothing voice tone and effect state change using positive regard, which implied that the client had the ability to work through the problem.

Conversational hypnosis is a technique within the larger body of Ericksonian hypnosis. In a conversation, not only can we embed suggestion in the dialogue, but intentionally turn on certain emotional circuits. We might say, “It is really difficult for you to remember feeling better because right now, having that particular feeling that you have, it is hard to notice when that feeling ends; kind of like a wave that comes and then it goes.” This comment is designed to turn on the curiosity and nurturing circuits. Where we focus the client’s attention is critical in stimulating emotional states; it can facilitate or hinder the healing process. Changes in the client’s facial expression or tone of voice and a more positive energy allows us to know that these goals are being accomplished.

Erickson used language adeptly in hypnosis. Understanding that hypnosis elicits resources and allows people to connect with abilities they already possess, he subtly crafted suggestions that would awaken certain psychological processes or states that an individual could use for problem resolution. For example, everyone—even those from severely deprived backgrounds—has experienced a sense of confidence, feelings of security, the ability to persevere, instances of facing a fear, etc., in some childhood setting. Erickson could find a way to elicit even a remnant of such a resource by using language with great care, circumventing the normal resistances that are evoked when we are simply told what to do. Instead, he would create a story containing a veiled reference to a client’s situation. Then, through indirect suggestion, he would offer the client a new perspective or new means by which to address it. Erickson, Rossi, and Rossi (1976) codified Erickson’s linguistic techniques as a means to influence the brain–mind–body. We have summarized them here with an example of each technique:

1. Embedded suggestion. This is a suggestion that is placed within a statement or question. The speaker shifts his or her voice tone slightly to emphasize the suggestion and indirectly lead the trance subject toward a specific goal.

EXAMPLE: I wonder just how comfortable you can feel.

2. Implication. This is a statement or question that leads another person to think of an unstated thought and to behave in accord with that unstated thought.

EXAMPLE: “I do not know exactly how your feelings will change.” [There is the implication that the individual’s feelings will change.]

3. Illusion of choice. This is a statement or question that offers only two alternatives, both leading to the same outcome.

EXAMPLE: “Do you want to go into trance, or would you prefer to just sit there quietly and focus on the sound of my voice?”

4. Truism. This is a statement that expresses something about which everyone generally agrees. The linguistic device is used to create a “yes set,” or an attitude of openness to suggestions. Therapists can lessen resistance to the introduction of a new idea or behavior more easily after a person has been in agreement about a number of things.

EXAMPLE: “Everyone knows what it is like to sleep on your arm. It gets tingly and eventually becomes numb.” [This suggestion is used to reduce resistance and elicit a yes set as the clinician teaches a person how to create a glove anesthesia (loss of sensation in the hand), which can then be generalized to another part of the body as needed for use in pain control.]

5. Suggestions covering all possible alternatives. When a therapist makes a suggestion so as to cover all possible experiences, he or she lets the client decide unconsciously just what the experience will be. Thus, there is less chance that rapport will be broken and the trance experience interrupted or ended.

EXAMPLE: “As you look at your hand, I do not know whether you will feel a tingling in your hand, or if that hand will start to feel numb. You might begin to feel lightness in one of your hands. It might be your right or your left hand. Or you might feel a heaviness, or nothing at all. I would like you to be curious about what is going to happen.” [The therapist covers all possible experiences, embedding suggestions that imply that something is going to happen.]

6. Apposition of opposites. This is a statement that describes one experience and implies that the more it happens, the more something else, seemingly the opposite, will then happen.

EXAMPLE: “The longer it takes for you to go into trance, the more surprised you will be when you finally go into trance.” [These statements are counterintuitive. Clients who are being induced to go into trance often think that when something does not happen immediately, hypnosis is not working. Alternatively, they may think that they cannot be hypnotized. When a therapist uses an apposition of opposites, he or she diffuses resistance and confuses the conscious mind with a logical though counterintuitive statement.]

EXAMPLE: “This may deepen your trance. Or it may heighten your trance experience.” [Although deepening and heightening appear to be opposites, in this case they are functionally the same.]

7. Open-ended suggestions. When a therapist suggests a means by which to respond to a situation, but does not offer any type of solution, the client has a more difficult time resisting the suggestion.

EXAMPLE: “Your mind can review all the ideas related to this situation. You don’t yet know consciously which will be the most useful for coming up with a new solution but, as you look at the ideas, you may see new possibilities.” [By making a suggestion in this manner, the client must take responsibility for the outcome, and he or she is more likely to look for more creative solutions. In addition, the therapist fosters curiosity and independence in the patient.]

8. Conscious–unconscious binds. This is a suggestion that separates the conscious and unconscious mind. There is an implication that the two are different entities and will respond differently to suggestions and to the trance experience as a whole. This bind creates a type of dissociation, where the patient begins to feel that what is occurring is doing so without his or her volition. People come to therapy because they feel stuck and in pain; they cannot figure their way out. When something seems to be occurring that the client is not consciously responsible for, he or she may have an easier time believing that change is possible.

EXAMPLE: “Your conscious mind may be distracted while I speak, while your unconscious mind can hear what I say.”

9. Double dissociative double-binds. In this case, the therapist splits the conscious and unconscious mind in a manner similar to the conscious–unconscious bind. However, the therapist continues speaking and then reverses the alternatives. This technique adds more confusion and makes it more difficult for the client to follow the therapist’s suggestions consciously. Dissociation eventually happens, and the patient experiences a trance-like state of consciousness.

EXAMPLE: “Your conscious mind may be distracted while your unconscious mind can hear what I say. Or your unconscious mind can pay attention to irrelevant things, while your conscious mind listens to what I say and develops a nice trance.” [The patient is in a bit of a quandary. If she feels distracted, is her unconscious mind listening to what is being said, but outside of her awareness? Or, if she feels distracted by irrelevant things, is that her unconscious? If she hears what the therapist is saying, is she not going into trance because she feels consciously aware of what is happening, or is this just proof that her mind has become so focused that she is indeed going into trance?]

10. Misspeaking. This technique uses phrasing such that the therapist’s words are intentionally open to multiple interpretations. The therapist may misstate something, use homonyms, or employ double entendres so that the client can hear what is being said in more than one way. Often, the client’s conscious mind will perceive an overt communication while his or her unconscious hears the intent of the therapist.

EXAMPLE: “As you sit there and listen to me, I do not know if your unconscious is going to lead you deeper into trance.” [In this case, the therapist embeds a suggestion by misspeaking. The covert suggestion, “you’re unconscious,” can be perceived as well as the overt message, “I don’t know if your unconscious … ” Another example would be, “You can sit there, can you nod?” The conscious mind will hear “… can you not?”, but the question also elicits unconscious agreement in the form of a nod of the head.]

11. Confusion using direction, time, and condition. When a therapist induces trance or attempts to help a client maintain trance, he or she may need to overload the client’s conscious or habitual way of thinking or perceiving the world. Every person has habitual ways of thinking, feeling and perceiving. These habituated perspectives act as maps that guide a person through life, helping him or her to understand, interpret, and give meaning to events and experiences. However, these maps also limit what is experienced. Psychotherapy, and particularly hypnosis, broadens a person’s internal maps so that life becomes richer with more possibilities or choices. This therapeutic process often alleviates pain that has occurred as a result of limited perception, cognition, or behavior.

EXAMPLE: “You seem to be stomping your left foot, which I thought was your right foot, and indeed was the right foot to stomp, when indeed you were stomping your left foot. What I wonder is why you are not stomping your right foot, which I thought was your left foot, and indeed was the foot you left out. Isn’t that right?” [In this situation, Carol confused her then-4-year-old daughter to help her stop a temper tantrum which was taking place in the middle of a department store.]

EXAMPLE “As I sit here, which is your there, your here is my there, and my there is your here. You can hear deeply what I say to your unconscious.” [The therapist is using directional confusion and embedded suggestions.]

12. Confusion using multiple negatives. A person can track only so many changes in a sentence. When a therapist uses multiple negatives in a sentence, it is difficult for the client to consciously follow what the therapist is saying. Multiple negatives overload the conscious tracking of what the therapist is communicating and thereby help the client move into trance. When the therapist has developed trust and rapport, confusion techniques can be a powerful way to help induce or deepen trance. It is important to note, however, that not all clients are comfortable with being confused. Betty Alice Erickson, one of Erickson’s daughters and his primary demonstration subject for over 30 years, has said that she never liked her father’s confusion techniques (Betty Alice Erickson, personal communication, May 18, 1990). For clients who have a difficult time letting go of conscious thought and attempt to analyze what is being said, confusion techniques may hinder the development of a trance.

EXAMPLE: “You don’t need to do anything with your conscious mind not to discover what state is not useful for you to communicate something meaningful.”

13. Shifting pronouns. During trance, a therapist may tell a story about a particular character. If the therapist wants the client to identify with this character for some therapeutic reason, she may begin telling the story in the third person and then, at strategic times, shift to the second person.

EXAMPLE: “I was watching a young boy kicking a soccer ball. He was kicking the ball between his two feet as he was running down the field. When you learn to kick a ball you first have to think about the action. Eventually, your unconscious mind takes over, and you don’t have to think about the activity, just the goal.” [In this case, the therapist is also embedding suggestions by changing voice tone and further underscoring the suggestion by changing the personal pronoun from third person to the second person. By delivering a suggestion in such a manner, the therapist invites the client to identify with the little child, but does so in a manner that reduces resistance. The unconscious mind is more likely to hear the reference as personal, while the conscious mind merely follows the story. The activity of kicking a soccer ball is a metaphor for pursuing any personal goal; the therapist’s intent in this scenario is to help the client realize that by staying focused on the “goal,” the activities needed to reach the goal will automatically be handled.]

14. Characters in a story. When a therapist tells a story about a child, father, mother, or some other character with whom a client has had an encounter, the client will normally think about his or her own experiences. In choosing stories, however, the therapist should be mindful of whether the client has had any unusually painful experiences with a parent, such as physical or sexual abuse (Kershaw, 1992; Lankton & Lankton, 1988).

EXAMPLE: “Once there was a little girl who wanted to make some cookies for her dolls’ tea party, but she didn’t know how to make cookies by herself. She knew how to make mud-pie cookies. But she didn’t want mud-pie cookies. She wanted real cookies. So she asked her mother to help her . . .” [Here the therapist is beginning to tell a story in which the main character wants something that is more authentic than what she knows how to create for herself and is therefore asking for help. Through the story, the therapist is embedding suggestions about the greater value of authenticity and implying that asking for assistance can be an acceptable behavior.]

Because we do not look directly into the client’s brain during a session (unless the person is hooked up to an EEG or other brain imaging equipment), we must rely on other means to track his or her experience. One of the best ways is by noticing the client’s ideomotor behavior—that is, the unconscious muscular movements that are the basis of “body language,” such as a slight change in facial expression, a shift in posture, suddenly watery eyes, dilation of the pupils, etc. (Rossi & Cheek, 1994). BCT makes extensive use of such cues because they usually accompany and reflect a change in brain state, as well as giving an indication of subjective experience. For example, if a person shifts from being identified with his or her emotional pain to being curious about it, the facial expression may change from a frown to a widening of the eyes, and a shift in emotional energy may be observed. If a therapist reframes a problem as one that may have entailed life adventures and valuable lessons, angst reflected in watery eyes may change to a surprised or excited look. The client’s unconscious communication can be understood as an ongoing reflection of his or her internal experience and brain states.

On rare occasions, we work with a client who does not exhibit any ideomotor signs, give any indication of state changes, or show evidence of being in a trance. Such individuals might be called nonexpressive. Although they may just sit quietly and not respond overtly, they can still be following along internally and may actually be quite involved. The person is still vividly experiencing mental events within the hypnotic state. In the complete absence of ideomotor cues, the therapist may elicit a physical response by inquiring, “Does this make sense to you?” or “Have you ever had an experience like that?” An indication as small as a client’s slight shift forward is enough to confirm that the client is following the therapist. At other times, the client will say afterwards that the experience “seemed so real,” or the client will report that what happened after the session was remarkably close to what was suggested. However, like most people, clients tend to be unconsciously expressive—often far more so than they imagine. The therapist need only be closely observant to use ideomotor cues to confirm underlying state changes.

The hypnotic experiment is a creative activity the therapist can use to demonstrate to clients that they have abilities they may not have discovered. We can use formal trance work or indirect suggestion in a conversational intervention. Before using this technique, it is important to have assessed how well the client can respond to hypnosis as well as his or her level of motivation. A client must have a compelling desire for behavior change. This is particularly true, for example, with individuals who enter therapy to deal with weight issues or to stop smoking. If the person does not have sufficient leverage with him- or herself, the result will be failure, perceived as either the therapist’s failure or as one more instance of the client’s failure. The person also needs to be somewhat cooperative. Any resistance should be understood as an indication of how much fear and trepidation the client is experiencing. In the case of resistance, the clinician should work to establish better rapport before suggesting that the client try a hypnotic experiment.

As clinicians, we need to communicate a sense of curiosity and positive certainty that the problem that brought the client to the office can be resolved. To engage the client’s curiosity, we then ask if he or she would like to “conduct an experiment.” If an individual says “yes,” we can begin to teach trance phenomena as a means of facilitating state change. For example, we may do this by having a client experience the numbing of a hand or by having a hand float in the air. Through this type of experiential learning, the person develops the ability to process multiple levels of communication. To begin the experiment, we may use one of Erickson’s indirect suggestions. We never definitively say that the hand will float; instead, we ask the client to focus on the sensation in his or her wrist and imagine that there was a balloon full of helium tied to it. Due to suggestibility, the hand is then likely to float—which validates the trance and can be used to create anesthesia (because it is difficult to move blood upward). It also creates curiosity and surprise, especially when the person recognizes that he or she does not feel his or her floating hand. To stimulate playfulness, we may add, “We would like you to enjoy seeing this hand in this position.”

Experiencing a cataleptic hand engenders both curiosity and confusion: This is not part of a person’s normal experience. If the person then begins to develop numbness or tingling (glove anesthesia), the sensation further ratifies the trance and leaves the person with an experience for which he or she may have no explanation. The hand levitation and the confusion/curiosity that it creates momentarily disrupt negative self-talk and a defeatist attitude. We also give the client credit by saying, “You didn’t know you could do this, and your conscious mind does not know what I am talking about, but your unconscious mind does, and that part of your mind is already wondering how to use this in the future.” Consciously or unconsciously, the person then learns to alter physiological sensations. This learning takes place in the context of an early learning set: It is gently suggested, through a series of metaphors and implications that reinforce curiosity and mastery of life tasks, that the client remember learning to walk, read, write, or put together puzzles. A person cannot learn these tasks as a child without also learning persistence, imagination, initiative, curiosity, and other positive states.

As the person gets better at the trance phenomena, an element of play comes into the process. “Hey, look what I can do!” becomes a common attitude. The client may even come up with connections to floating hands and glove anesthesia of which the clinician has not thought. We do not necessarily know how an individual will utilize trance phenomena or what his or her own resources may be. For example, one client who came in to stop smoking learned to levitate his hand and make it numb. He would come out of trance with his hand completely numb, as it was suggested. He enjoyed waking up a numb hand, as though he had slept on it. Fairly soon, he had stopped smoking. As it happened, he worked at a delicatessen. One day when he was chopping lettuce, he took off a chunk of his thumb, and, without missing a beat, he went into trance and stopped the bleeding. He needed no stitches and afterward barely had a scar. Ericksonian hypnosis leaves the client with a high degree of autonomy. What happens is second-order change: The client learns to learn on his or her own. While this further reinforces state change, we do not always know how the person will use the experience.

We have worked with many people who have had panic attacks and worry that they will throw up in a crowd. Stress seems to set off the nausea and panic when in public. To use the hypnotic experiment, we suggest that the person experience just a little nausea in the office and then send it away. Most clients are quite good at bringing on the symptom and just as good at sending it away. The important part of this learning experience is for the client to become more aware of the activation of a stress state, its triggers, and his or her ability to consciously direct the state.

Another hypnotic experiment is to use a blood pressure cuff and take a reading before and after a state change process. Unless the pressure is quite low normally, the client is often surprised in the change of pressure after changing states to one of lower arousal. This is particularly appropriate if a client believes that “nothing will ever change.” When a client is stuck, one of a number of things is happening. The person may be depressed or despondent; often, as a result, he or she will not notice when external or internal events do change. On the other hand, the person may become overly eager, possibly even anxious, to change, which hampers the process. In that case, too, the client may conclude that change is impossible. But when a client can demonstrate to him- or herself an ability to lower his or her blood pressure, the new skill strongly undercuts the counterproductive belief that “nothing will change.” Additionally, the shift to a more relaxed state facilitates the desired change.

As noted, gazing in a warm manner, speaking in a pleasant tone of voice, and mirroring empathic responses tend to activate resources in a client. The way we ask questions can help shift states as well. However, if the client does not have a sufficiently trusting relationship with his or her therapist, he or she may experience fear around maintaining his or her self-organization. For someone who has developed rigid states of mind, family-of-origin issues around healthy attachment frequently exist. To allow another point of view may result in having to let go of some previous way of experiencing the world.

A client who had entered therapy in order to “figure out how to live her own life” wanted to experience trance work but seemed convinced that she could not achieve a state of focused attention. She communicated this stance nonverbally through a brusque and distant manner that said, in essence, “Don’t try this with me because it won’t work.” Her conflict stemmed from believing that either she or Bill would fail. As Bill began to inquire about her background and growing edge for change, she told him that she had done what she had always not wanted to do, which was return to her old work and marry her high school sweetheart upon returning to her hometown after active service duty.

Using hypnotic empathy, Bill mirrored back to her, “So the yearning in you to do something else with your life is still right there under the surface, and it is really difficult when you become aware of it. You really love your husband, and yet something inside you seems to be knocking at your door.” Bill asked her about an experience where she felt fully comfortable and relaxed about all inner conflict. She reported that when she was at the beach, there was an expansive feeling of not being caged and feeling very free. She began to relax and soften as she described the experience of being by the water. Bill watched for the emotional shift into the access state, an openness that would allow her to work with him. When she softened, he was able to begin the deeper state work with her, and she responded positively.

Through hypnotic empathy, Bill had created a bridge from an unproductive state to a transition state, so that ultimately another intervention could be utilized. In the transition state, there is still something somewhat negative—but with less arousal, less confusion—and there is something somewhat positive that begins to open the curiosity circuit to what might be possible. It is at this point that the client demonstrates change readiness, and the rapport may become a shared state of positive trance. Within the shared state a true dialogue occurs, and the therapist may experience images or have associations that turn out to be remarkably accurate when expressed to the client. Often the client is amazed by how the therapist has “picked up” information that was not shared verbally.

Another example of diffusing resistance can be demonstrated through the case of a client who asked to be hypnotized, although he was not sure he could go into a trance. As Carol began to work with him, he slipped into a deeper state, but he refused to let himself stay there. Carol suggested that he could come out and go back inside, in whatever way felt comfortable to him. At the end of the experience, this young man reported that his mother had left him when he was young. Even though they had a better relationship now, he had not forgiven her, and in the trance experience, he had overlaid both his yearning for that relationship and his anger onto Carol. He had a revelation that he wanted to change this dynamic in order to better relate to women in general.

Stan was the vice president of finance in a publicly-held technology company. He was well educated, articulate, and excellent at his job. At our first meeting, we noted that Stan was well-dressed and that he had an athletic build and an open and friendly manner. As we talked, he revealed that he suffered from panic attacks, some of which seemed to happen for no apparent reason. He would break out in a sweat, his heart would start racing, and he would become short of breath and begin to experience dizziness. After an examination, Stan’s cardiologist had assured him that he was not experiencing a heart attack and was, in fact, in excellent health and physical condition.

Stan also described how he had an extremely difficult time speaking in front of groups. Unfortunately, Stan’s position required him to make frequent presentations to the board of directors and department heads of his company. “I lock up. I start to stutter; I can’t remember what I was going to say; and then I start breaking out in all those symptoms. This is silly: I know these people. I play golf with some of them.” Stan went on to say that his fear was becoming worse. It had recently extended to family gatherings and reunions.

We asked Stan how long the panic attacks had been going on. He said that he had experienced this anxiety before, but this time, it was more severe and had been getting progressively worse for more than a year. He went on to say that he had been in therapy before and had learned some relaxation techniques that had originally seemed to help. Now the anxiety had come back, and he could not make any of the guided imagery or relaxation techniques work. Stan was not taking medication for this problem.

As we explored his difficulty, Stan told us that he was in his late 40s and very athletic. He had played competitive soccer until just a couple years earlier and now coached his son’s soccer team. He was an avid golfer with a very low handicap (especially for someone who only played a few times a month). Stan also liked to ski and was planning to combine snowboarding with skiing on his next trip. He had done that once before and, though he had fallen repeatedly, he had made a great deal of progress combining two very different downhill techniques. Despite his fear of public speaking, Stan had an adventuresome spirit.

The conversation led Stan to the discovery that in all the athletic activities he loved, he experienced the same physiological characteristics as in a panic attack: he sweated profusely, experienced an increased heart rate, became short of breath, and at times felt a little dizzy. Furthermore, to golf, ski, or play soccer, a person must be able to narrow his focus, particularly when hitting the golf ball or kicking the soccer ball. Then he must be able to open his focus to see the entire fairway or playing field. Each shift in focus accompanies a brain state change. This same skill is important in public speaking. A speaker must, on one hand, become absorbed and, hopefully, enjoy the topic, if he (or she) is to be an inspiring speaker. He must also open his focus so he does not lose his audience. This change in focus and state must happen repeatedly throughout a speech if the speaker is to do well.

Stan had become so narrowly focused on his audience’s reactions that he was misreading people’s behavior. A yawn or wiggling leg might mean any number of things; these behaviors did not mean necessarily that Stan was delivering a poor presentation. Being so focused on people’s reactions made him more anxious to do well, and thus, it became increasingly difficult to lose himself in his topic and enjoy what he was doing. The more overfocused Stan became, the more the anticipated anxiety occurred. Ultimately, Stan’s anticipation became a self-fulfilling prophesy, creating the very fear and panic he so desperately wanted to avoid. Consequently, Stan began to avoid making speeches, further reinforcing his belief that if he gave a speech, he would have a panic attack. The more Stan avoided the situation, the more anxious he became, and because he knew that success in his job was dependent upon his making formal presentations, the anxiety intensified and generalized to non-work-related settings.

The interventions we used made use of early learning and were focused on observing Stan’s hypnotic responsiveness. The trance phenomena that Stan displayed—for example, a floating hand—were utilized to impress upon him that something was happening beyond what he expected and already understood. Because certain sports were of inherent interest to Stan, Bill created metaphors using skiing, golf, and soccer. Those topics would potentially deepen his focus and trance experience—and, more importantly, they contained the solutions to his panic and fear of public speaking.

The following excerpts are taken from hypnosis sessions with Stan. They demonstrate a trance induction, therapeutic work utilizing resources from life experiences, a number of Ericksonian linguistic maneuvers, and the use of metaphor to change states and elicit trance phenomena and unconscious resources. Italicized words connote a subtle shift in voice tone and indicate interspersed or embedded suggestions.

Trance inductions are used to help a client focus attention and to ratify to the client that he or she is experiencing something different from his or her usual state. In the following example, Bill used mild dissociation and playfulness to disrupt the possible anticipation that nothing would happen or that hypnosis would not help the client’s problem. Even though the floating hand had nothing to do with the symptom, it was an unaccustomed phenomenon for which the client had no category. The novelty led the client to become a participant–observer of his own process, just as a meditating monk might observe his thoughts even as he disidentifies with them. Such an experience, in and of itself, helps a client begin to realize that there are things outside his or her field of experience that may lead to a lessening, or even complete cessation, of the symptomatic states that brought him or her into therapy. Trance ratification and trance phenomena are used throughout the hypnotic experience. The initial trance induction with Stan, the client, took about 20 minutes. Subsequent inductions took increasingly less time as Stan became more proficient at going into trance.

“Stan, as you sit there and I sit here, which is you’re there, and your there is my here, I would like you to do nothing but sit there and just hear what I say to you [confusion technique and misspeaking to turn on curiosity and seeking]. I don’t want you to go into trance just yet, but I would like you to focus your attention on your hands, which rest comfortably on your lap [bind of comparable alternatives]. And I don’t know if your right hand will be the right hand to experience something different, and your left hand will be left out, or if your left hand will experience something different, but I would like you to be curious which hand will begin to experience a tingling, or a lightness or even a heaviness [embedded suggestion for the curiosity circuit], and you don’t know just yet what it is that you’re going to experience, but I do hope you will enjoy what is going on [all possibilities of a class of behaviors]. And as I speak, I’m going to count from 10 to 1… . 10 … that’s right (HAND BEGINS TO MOVE SLIGHTLY), 9 … that’s right (HAND BEGINS TO LIFT UP OFF THE LAP), 8 … And you have a conscious mind and an unconscious mind. 7 … that’s right (HAND CONTINUES TO LIFT) that’s right 6 … and your unconscious mind controls you’re breathing … more slowly now… . It controls your heart rate is slower … 5 … 4 … And you didn’t know that it would be this easy, did you? But it is … 3 … that’s right (HAND LIFTS EVEN MORE). And that hand can find its most comfortable place to float, just like it is not even a part of your body … 2 … 1… . And I don’t know how well you can remember a time when your eyes became heavy, maybe you were up late studying trying to keep your eyes open, but finding that with every blink they became heavier (EYES BLINK, THEN CLOSE).

In this next segment of the transcript, Bill suggested that the client had already learned many resourceful states, such as how to get up when he falls down and how to deal with pain. In addition, Bill suggested that persistence and determination were states that Stan had experienced and could call upon now. Bill continued to speak about learning the alphabet in school, learning to read, and learning to write (a favorite that Erickson used repeatedly). He did so in the same way he had been throughout the trance. After Bill reoriented Stan to the outside world, they finished his first hypnosis session. Subsequent sessions began in much the same manner, with a trance induction and a shortened version of an early learning set.

Many young therapists think that therapy must be directed to induce unbridled catharsis. However, uncontrolled catharsis may do a client more harm than good. If there is some trauma that intrudes into a person’s conscious awareness, then catharsis may be therapeutic with a safety net of positive resources, security, and trance phenomena. Having such a safety net in place is rare and should not become the primary goal of therapy. Bill used a mildly painful experience with Stan, but the focus was to remember that pain abates. This memory helped Stan relearn, from his own experience, that all people fail at tasks—but then they also recover, learn further, and then succeed. This experience was later linked more directly to his fear of public speaking. The suggestions offered were indirect. Bill used changes of tense, voice tone, and pronouns to cue the unconscious mind that a suggestion was being delivered. In each case, Bill observed Stan’s ideomotor behavior to confirm that he was having the therapeutic experience that Bill intended. Although it appears that a monologue is occurring, in reality the therapist is in a dialogue with the client, who is responding with minimal cues.

“Now all my children, on a day you could not go outside, would go to the toy box, book shelf, or closet and pick out a puzzle. Now the first puzzle you put together has only a few pieces. And you pick up the piece, and you turn it this way and that way. And you become so absorbed in what you are doing that you have no idea how much time is going by [time distortion]. And when you put that first piece in you feel a sense of pride (STAN BEGINS TO SMILE IN TRANCE) … that’s right, I want you to remember that feeling of pride (STAN CONTINUES TO SMILE) and I want you to memorize that feeling. Because you are going to use that feeling in the future in a directed fashion [posthypnotic suggestion]. Now you can talk in trance, and you can open your eyes in trance, so in a moment I am going to count to 3 and I want your eyes to open, but you can stay deeply in trance. Okay, 1 … 2 … 3 (STAN’S EYES OPEN AND HE LOOKS A BIT CONFUSED). I would like you to look at your hand (STAN LOOKS AT HIS HAND FLOATING IN MIDAIR AND BEGINS TO SMILE WHILE LOOKING A BIT CONFUSED). Have you ever seen your hand float like that before? (WITH SOME DIFFICULTY, STAN SAYS “NO”). How does it feel to see your hand floating like that, or does it even feel like your hand? (STAN SHAKES HIS HEAD JUST A BIT, INDICATING “NO”) [trance ratification and maintenance]. Your eyes can close, and you can become even more absorbed in your inner world, as your unconscious mind continues to listen to what I say.

“Some time ago I took my oldest son to get his driver’s license. And while he was taking his road test, there was this little boy in the waiting room learning to walk. Now when you learn to walk, you pull up on a sofa, a chair or a table, and you start to stand on your own two feet. This little boy stood there with his feet placed wide apart. He would pick up his foot, begin to place it down, and he would fall. And you can’t even count the number of times you fall down when you learn to walk. Most of the time, you fall where it is padded. But sometimes you fall down and bite your lip. And it hurts! (STAN’S FACE BEGINS TO WINCE EVER SO SLIGHTLY). And you don’t think the pain is going to stop, but it does. The child doesn’t know that, but an adult does (STAN’S FACE BEGINS TO RELAX). I want you to remember that the pain does go away. Now when you persist, you feel pride. And I want you to remember that feeling of persistence and determination (STAN’S FACE TIGHTENS A BIT, AND HAS A LOOK OF DETERMINATION) because you are going to use those feelings later.”

In this portion of the trance, Bill suggested that Stan increase his breathing, heart rate, and body temperature by using a metaphor about playing soccer. Implied in this section is the idea that Stan has felt the sensations of a panic attack before. Also implied is that by being able to create these physical sensations and then stop them by using just his imagination, he will be able to accomplish this goal at other times. Since this session was early in the hypnotherapy, Bill did not mention public speaking. Stan, being a moderately good hypnotic subject, was able to respond to the indirect suggestions. However, if he had not been able to do so, the rapport built in trance would not have been broken, because no direct suggestions were made concerning public speaking. The therapy was set up so that Stan could not fail to respond to the suggestions. Since he already used open and closed focus in playing golf, he had the necessary abilities to become absorbed in his speech and then return to connect with the audience.

“Stan, you told me that you have played soccer, you coach soccer, you play golf, and you ski (STAN BEGINS AN UNCONSCIOUS PRESERVATIVE NOD) [eliciting a yes set]. When you play soccer, you exert yourself, especially in the Texas heat. Your heart rate increases, your breathing increases, and you begin to perspire (IN TRANCE STAN BEGINS TO BREATHE MORE QUICKLY. HIS HEART RATE BEGINS TO INCREASE, AND HE BEGINS TO PERSPIRE SLIGHTLY). And when you exert yourself it feels good. I’d like you to remember an exciting soccer match. That’s right! I’d like you to really breathe hard, and feel the excitement as you bring the ball down field, or pass it, or make a score. When the game is over, you begin to breathe more slowly, your heart rate slows down, and you begin to feel cooler. (STAN’S HEART RATE SLOWS DOWN, HIS BREATHING DECREASES, AND HE STOPS PERSPIRING). And I want you to memorize this, because you can increase your breathing, and heart rate, and body temperature. And you can decrease them too (STAN BEGINS TO NOD UNCONSCIOUSLY). And you didn’t know you could do that just by thinking about it, did you? (STAN SHAKES HIS HEAD SLIGHTLY).”

Bill saw Stan a total of 13 times, and 10 of those sessions included hypnosis. Metaphors about playing golf were employed to help Stan use open and closed focus; metaphors about skiing and snowboarding were used to demonstrate that, in another context, Stan could fail, be unconcerned by the failure, get up, and try again. Each time, Bill watched Stan’s face and observed minimal cues to learn whether he was following the metaphor and experiencing the emotions that would commonly be engendered by it. After using these metaphors, Stan was given a posthypnotic suggestion that he could hold his hand as he would a golf club. This suggestion acted as a way to induce a light trance whenever Stan became nervous while speaking in public. He practiced this private cue during a number of sessions. Eventually he was able merely to put his thumb and forefinger together and achieve the same result of confidence and relaxation.

Stan’s panic attacks ended almost immediately. However, he did not have a major presentation scheduled for some time and wanted to continue therapy until he did. Prior to that, he attended a family reunion and experienced no discomfort. Each week Stan reported feeling more confident around his co-workers and was symptom-free in meetings where he had to discuss issues that had previously provoked discomfort. Eventually, Stan was scheduled to make a major presentation before his board of directors. His presentation went smoothly, without any signs of panic or anxiety. He told Bill that he actually enjoyed making the presentation, and they terminated therapy a couple weeks later. Bill contacted Stan 6 weeks after termination to check on him. Because of the distance he had to drive to come to the office, Bill interviewed him over the telephone. Stan was continuing to do well; he had had no panic attacks, and the fear of speaking before a large group had disappeared.

This case illustrates the disruption of a dysfunctional pattern of neural activity, as evidenced by a state change. The hypnosis utilized prior experiences that had nothing to do with the goal but that had similar state occurrences. Bill intentionally elicited memories that were tied to particular brain states. This case is also an example of the fact that an individual may initially be unable to access what he or she already knows how to do. Everyone has experience in being curious, controlling pain, exercising persistence, being nurturing, managing anger, etc. Remembering how to elicit and use these states has been suppressed only because of learned limitations. Ericksonian hypnosis depotentiates these limitations by helping a person change states. By eliciting different states, we invite the person to make enduring brain state changes that he or she had not been able to do consciously. In trance, a person may also learn a needed new skill through a metaphorical intervention. Most metaphors suggest that life is a learning process. They tend to demonstrate that the more flexible a person is and the more a person can access needed states, the more he or she lives in states of thriving.

In the next chapter we consider the many ways in which brain technology equipment can help us teach our clients how to move to, and maintain, more comfortable, flexible, and enjoyable states of being.

CHAPTER 5

Brain Change Techniques Using Ericksonian Hypnosis