Wetterstrand (1902), who was one of Bernheim's foremost students, described the problem of suggestion in a manner that places Erickson's indirect approaches in proper historical perspective.
Suggestion, or rather suggestibility, is composed of two elements: ability to receive an impulse from without, and the ideo-plastic faculty. [The power that ideas possess to influence physiological conditions.] As these are absolutely independent of each other, we must distinguish between them. There are patients who are very impressionable, and who accept a suggested idea with absolute confidence; the influence, however, of the idea upon their physiological functions is feeble. They do not realize the suggestions, and their morbid symptoms yield with great difficulty, as their ideo-plastic conception is small. Others, on the contrary, accept suggestions slowly, are incredulous and even resist them. Nevertheless we find that the physiological and pathological processes are easily modified by the psychic influence, sometimes by autosuggestions.
In keeping with this dichotomy, Erickson's indirect approaches may be divided into two similar categories:
1. Structuring an acceptance set to facilitate the acceptance of the "suggested idea."
2. Utilizing the patient's associative processes and mental skills to facilitate the "ideo-plastic faculty."
1. Structuring an Acceptance Set. Every therapist has innumerable approaches for facilitating an atmosphere of cooperation, receptivity, and the possibility of creativity within the therapy session. Here we will only list the hypnotic forms that we have found in prominent use by Erickson in the actual process of trance induction and the facilitation of hypnotic responses. The index is keyed to illustrations and discussions of all of these hypnotic forms for facilitating an acceptance set.
The "yes set" Truisms and tautologies
Use of interesting and personally motivating material
Intercontextual cues and suggestions
Obtaining patient's assent Casual, permissive, and positive approach Vocal intonations of sincerity and intentness Validating and ratifying suggestions Covering all possibilities of response Accepting all responses as valid
2. Utilizing the Patient's Associative Structure and Mental Skills. Erickson's work is rich in hypnotic forms designed to utilize a patient's own associative structure and mental processes to facilitate the "ideo-plastic faculty."
Not all of these hypnotic forms are original with Erickson. The evocation of hypnotic phenomena by asking pointed questions, for example, is a classical approach much utilized by Braid (1846) to evoke hallucinatory phenomena in all sense modalities even while patients were apparently awake. The invention and systematic use of a variety of these hypnotic forms for the study and utilization of a patient's own associative structure and mental skills in ways that are outside his usual range of conscious ego control to effect therapeutic goals, however, does appear to be one of Erickson's original contributions to the theory and practice of "suggestion." The use of these hypnotic forms is by now so much a part of Erickson's nature that Rossi sometimes felt "woozy" and a bit in a trance even while apparently having a straightforward intellectual discussion with Erickson. Erickson himself is not always clear about the means by which his "conversation" is effective in structuring and directing a listener's associative processes in predetermined ways. Erickson maintains that fixing and focusing attention by such conversation does put the listener into trance without the need for any other formal process of induction. As we have repeatedly seen in this volume, a single sentence uttered by Erickson can be loaded with a number of hypnotic forms that catch the listener's mental fabric in various ways. In this volume it has been our precarious task to make a beginning in untangling, uncovering, and labeling some of these indirect hypnotic forms, which are listed below:
Binds and double binds
Covering all possibilities of a class of responses
Intercontextual cues and suggestions Multiple levels of communication (analogy, puns, metaphor, etc.)
Multiple tasks and serial suggestions
Not doing, not knowing
Pantomime and nonverbal suggestions
Partial remarks and dangling phrases
Utilizing need for closure Voice locus and dynamics Yes set
These hypnotic forms are all merely descriptive labels of different aspects of suggestion; they need not function independently of one another. One and the same suggestion, for example, could be a truism (because it is true), a compound suggestion (because it contains at least two connected statements), and an implication (because it implies that more than one may be immediately apparent). In fact, the art of formulating suggestions is to utilize as many of these mutually reinforcing hypnotic forms as possible in close proximity.
It is important to repeat that while Erickson does think of trance as a special state, he does not believe hypersuggestibility is a necessary characteristic of trance. That is, just because patients experience trance, it does not mean they are going to accept the therapist's suggestions. This is a major misconception that has frustrated and discouraged many workers in the past and has impeded the development of hypnosis as a science. Trance is a special state that intensifies the therapeutic relationship and focuses patients' attention on inner realities. Trance does not ensure the acceptance of suggestions. Erickson depends on the above approaches to evoke and move patients' associative processes and mental skills in certain directions to sometimes achieve certain goals. So-called suggestion is actually this process of evoking and utilizing a patient's own associations, mental skills, and mental mechanisms.
How shall we conceptualize the hypnotic forms listed above? Obviously, they are communication devices of sorts. They are all bits and pieces of the new science of pragmatics: the relation between signs and the users of signs. Since these communication devices have all been developed in clinical practice, there is an urgent need to validate them and study their parameters in controlled laboratory studies as well as in further clinical and field experiments. There appears to be an infinite expanse of exploration awaiting future workers in this area. Undoubtedly the field will continue to expand and change just as human consciousness itself develops in new ways.
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