We recently outlined the utilization theory of hypnotic suggestion as follows (F.rickson and Rossi, 1975):
Trance is a special state that intensifies the therapeutic relationship and focuses the patients attention on a few inner realities; trance does not insure the acceptance of suggestions. Erickson depends upon certain communication devices . . . to evoke, mobilize and move a patient's associative processes and mental skills in certain directions to sometimes achieve certain therapeutic goals. He believes that hypnotic suggestion is actually this process of evoking and utilizing a patient's own mental processes in ways that are outside his usual range of intentional or voluntary control.
The effective hypnotherapist learns to use words, intonations, gestures, and other things that evoke the patient's own mental mechanisms and behavioral processes. Hypnotic suggestion is not a kind of verbal magic that can be imposed on patients to make them do anything. Hypnotic suggestions are effective only to the degree that they can activate, block, or alter the functioning of natural mental mechanisms and associations already existing within the patient. Erickson likes to emphasize that hypnotic suggestion can evoke and utilize potentials that already exist within patients, but it cannot impose something totally alien. Hypersuggestibility is not necessarily a characteristic of therapeutic trance as he uses it.
In his first published paper on hypnosis (1932) Erickson found that "hypersuggestibility was not noticed" as a necessary characteristic of trance. His work with 300 subjects involved in several thousand trances led him to this conclusion:
Far from making them hypersuggestible, it was found necessary to deal very gingerly with them to keep from losing their cooperation and it was often felt that they developed a compensatory negativism toward the hypnotist to offset any increased suggestibility. Subjects trained to go into a deep trance instantly at the snap of a finger would successfully resist when unwilling or more interested in other projects. ... In brief, it seems probable that if there is a development of increased suggestibility, it is negligible in extent.
Erickson was not alone in this finding. In his review of the history of hypnosis Weitzenhoffer (1961, 1963, 1971) has pointed out that the earliest investigators (such as Bertrand, Despine, and Braid) did not view suggestibility as the essential feature of trance. It was Liebeault, and especially Bernheim (1895), who paved the way for viewing hypersuggestibility as a necessary condition for speaking of hypnosis or trance. This may have been accepted by modern experimentally oriented investigators (Hull, 1933; Hilgard, 1965) because it lent itself easily to the development of "hypnotic susceptibility scales," which were thought necessary for the quantitative study of hypnotic phenomena. Weitzenhoffer, however, has maintained the necessity of exploring the concepts of trance and suggestibility as separate issues.
For Erickson, trance and hypnotic suggestion are separate phenomena that may or may not be associated in any given individual at any given moment. Because of this Erickson (1952) has emphasized the difference between "trance induction versus trance utilization." In his early work he found it necessary to spend "four to eight or even more hours in inducing trances and in training the subjects to function adequately, before attempting hypnotic experimentation or therapy." The eight sessions of Erickson's work with Dr. S in this volume are thus a typical example of training a subject to experience trance. It will be seen that trance is a highly individualized process that can be experienced very differently even by the same person on separate occasions. For the therapeutic purposes of clinical hypnosis, however, we will focus our interest on exploring and facilitating only one particular aspect of trance. We are interested in that therapeutic aspect of trance wherein the limitations of one's usual conscious sets and belief systems are temporarily altered so that one can be receptive to an experience of other patterns of association and modes of mental functioning.
Erickson views the separate issue of hypnotic suggestion as a problem in communication and utilization. To facilitate suggestion one must learn how to communicate more effectively. A major objective of this volume is to isolate the hypnotic forms of communication Erickson uses to facilitate suggestion. These hypnotic forms are communication devices that facilitate the evocation and utilization of the patient's own associations, potentials, and natural mental mechanisms in ways that are usually experienced as involuntary by the patient. Ordinary, everyday, nonhypnotic suggestions are acted upon because we have evaluated them with our usual conscious attitudes and found them to be an acceptable guide for our behavior, and we carry them out in a voluntary manner. Hypnotic suggestion, by contrast, is different in that the patient is surprised to find that experience and behavior are altered in a seemingly autonomous manner; experience seems to be outside one's usual sense of control and self-direction. A successful clinical hypnotic experience, then, is one in which trance alters habitual attitudes and modes of functioning so that carefully formulated hypnotic suggestions can evoke and utilize other patterns of associations and potentials within the patient to implement certain therapeutic goals.
The utilization approach to trance induction (Erickson, 1958, 1959) and the utilization of the patient's presenting behavior and symptoms as an integral part of therapy (Erickson, 1955, 1965b) are among Erickson's original contributions to the field of clinical hypnosis. This utilization approach, wherein each patient's individuality is carefully studied, facilitated, and utilized, is one of the ways "clinical" hypnosis is different from the standardized approaches of experimental and research hypnosis as it is usually conducted in the laboratory. It is in the clinician's ability to evaluate and utilize patients' uniqueness together with the exigencies of their ever-changing real-life situation that the most striking hypnotic and therapeutic results are often achieved. The utilization approaches achieve their results precisely because they activate and further develop what is already within the patient rather than attempting to impose something from the outside that might be unsuitable for the patient's individuality.
Most of the indirect forms of hypnotic suggestion that were pioneered by Erickson to facilitate his utilization approach were developed in clinical practice and field experiments without the benefit of detailed analysis or controlled experimental validation. In this volume, therefore, we will begin the process of analyzing a number of these indirect terms of hypnotic suggestion, first to achieve some understanding of their clinical application, and second, to propose research that will be needed to further explore their nature and use. In this chapter we will discuss "truisms" and "not doing, not knowing" as two of the most basic forms of indirect hypnotic suggestion.
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