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Milton Erickson, Kay Thompson and the nature of therapeutic
hypnosis, getting back to basics by Rebecca Welch |
“Get Over Yourself”
MILTON ERICKSON, KAY THOMPSON AND THE NATURE OF THERAPEUTIC
HYPNOSIS – GETTING BACK TO BASICS
As a trainee hypnotherapist, I regarded Milton Erickson with
awe. I don't think I was alone. The usual way in which the
“founding father of modern hypnotherapy” is regarded is as
an enigma, a sort of sage or savant. If we could only
understand his thinking, we too could operate on that level.
There is no doubt that Erickson was a genius. If the many
stories are to be believed, he also worked in a age which
allowed him more therapeutic experimentation. In those days,
you did what the doctor told you. If he was a doctor of the
mind, then even more chance that he knew what he was talking
about and you didn't, and you did what you were told.
I'm quite sure that if I used some of the techniques or
approaches Erickson used with my clients today, I would
either get sued, investigated by my professional body, or at
the least, snowed under with complaints and unhappy clients.
The days when you could be downright rude to a client to
shock them into change or realisation, or set them tasks
like climbing a mountain, have gone. Nowadays we can
challenge, but such is the modern patient's concept of their
rights in the process that we have to be very subtle. And
really, that's not such a bad thing. Maybe the stories, in
any case, are exaggerated for the purposes of demonstration,
such as the disabled German patient to whom Erickson was
breathtakingly rude on a daily basis until he got up out of
his wheelchair and walked so as to get out of Milton's
office.
The mystery deepens when we read the accounts of those
Erickson selected to teach – or to allow to work with or
observe him – who did not learn. Or at least, by their own
account, they did not “get” what he was doing. Bill
O'Hanlon, in his book “Taproots – Underlying Principles of
Milton Erickson's Therapy and Hypnosis”, recounts the time
he spent with Erickson having traded his gardening skills
for Erickson's mentoring.
“He always answered questions about what he wanted done in
the garden in a straightforward way, but he was nowhere near
as enlightening when I asked him a question about therapy.
So I ended this time with Erickson more confused than when I
started. I vowed that I would someday figure out his
approach. I had the sense, as Jay Haley has said, that if I
only understood more of what Erickson was saying, my therapy
would improve greatly.”
No doubt O'Hanlon, Haley and the others did themselves a
disservice, and are better therapists for the fact that they
had to take what they saw or heard and interpret it and make
it work for them. Certainly there work bears testament to
that, and has been of immense help to others. However, the
fact remains that Milton Erickson did not teach them as we
understand that relationship to work.
Surely, however, that is the point of Erickson's work – or
it is as I see it. Utilisation was key with Erickson. He was
finding out “what worked” and employing it before Richard
Bandler ever thought of it. In having to absorb what they
had seen and heard with Erickson, rather than being told
“You do it this way” those therapists who knew him developed
their own brand of “what works” and were disciples of his
principle of taking what the client brings and using it.
This principle is at the heart of solution focused
hypnotherapy. It is the most important thing we do – the
constant awareness that the client is the expert in their
own life and not the therapist. That what is right for one
isn't right for all, and the more we script, the more we
plan, the weaker our work.
Some time has passed since I trained. I hadn't thought much
about Erickson recently, although I do take my continuing
professional development seriously. Whenever I read
something, I find myself picking out choice metaphors,
admiring elegant language patterns, and writing down fancy
new techniques and inductions. I have quite a collection of
them – I hope they have improved me as a therapist and been
useful to my clients.
It was in the spirit of CPD that Ian (my partner both in
life and in our hypnotherapy practice) emerged triumphant
from a second hand bookstore, one of his passions in life,
and said “Look what I found!” He had a copy of “The Art of
Therapeutic Communication – The Collected Works of Kay F
Thompson” edited by Saralee Kane MSW and Karen Olness MD
(Crown House Publishing Ltd, 2004 ISBN 1904424287/:CCN
2004101977).
I had heard of Kay Thompson, an American dentist who used
hypnosis and hypnotherapy in her work and who was “trained”
by Milton Erickson. She died, sadly prematurely, in May 1998
and the book is an attempt to bring together her lectures,
insights and techniques as well as articles from friends,
colleagues and acquaintances – the book, perhaps, that she
never had the chance to write herself.
It is a large, thick, hardback book, and it sat on the shelf
waiting for a rainy day. When I finally picked it up and
started it, I was amazed at how easily it read and the
wealth of treasure waiting inside. I felt like an Edwardian
childrens' story heroine, discovering the phoenix and the
carpet or the door into Narnia in a corner of the home I
thought I knew well.
The book is well put together and accessible and my
congratulations go to its editors.
This is not, however, intended to be a critique of the book,
but an exploration of how Kay Thompson's work and insights
took me back to first principles and gave me an
understanding of the earlier work of Milton Erickson which
had eluded me. And from that standpoint, a new insight into
my own practice.
As hypnotherapists, the hype and mystique around our
techniques affects us, and we carry a collective burden of
responsibility for it. As Thompson says, “Hypnosis gets
blamed for all the individuals manipulating this tool. If a
surgeon does surgery and leaves a sponge in the patient, the
surgeon gets blamed. If there is a problem with hypnosis, it
isn't the dentist, the physician or the therapist that gets
blamed, it's the hypnosis”.
It is not only the newly qualified therapist who worries if
they are doing it properly. We have all come out of a
session not feeling it went quite “right” - not believing
the client got on board with the way we tried to help them,
feeling sure they won't go away and do their homework,
doubtful they will turn up for the next session. There may
be many reasons for that and often we are totally wrong. I
remember my partner coming out of just such a session – with
a young man who had come for help with weight management –
and getting an email of glowing thanks a few months later,
when not only had he lost a considerable amount of weight,
but had been inspired to make significant changes in his
life. Obviously something Ian had said or done had resonated
with him on a deep level.
Perhaps we are too tied up with our own egos. We are taught
it is necessary to have rapport with clients to work
successfully with them. However, that doesn't necessarily
mean you spend the session smiling and laughing together. At
a fundamental level, as human beings, we fret when we don't
think people like us. Therapists are people too!
This illustrates one of Kay Thompson's key messages – one
that takes us right back to Ericksonian principles. The
client will take what they need in their own way, if you
just listen to them enough to offer it. Like Erickson,
Thompson “played” with hypnosis to see what worked for each
client. Very often the work was done out of formal trance,
or at least out of closed eye trance, and it might only be
one phrase or off-the-cuff comment that struck gold with the
client, fired up their motivation and got them on board –
finding “the juice” as Bill O'Hanlon calls it.
We need to be better at listening to the client and not to
the sound of our egos, the inner monologue of metaphors,
techniques and phraseology we have chattering at the back of
our minds. As I was reading Kay Thompson's book, my partner
went on an improvisation course. His insights when he
returned struck a chord with what I had been reading, and we
both agreed – the sessions you plan most carefully are often
the least successful.
Something many new hypnotherapists fret about is the level
or extent of trance in their clients. “Are they “under?” How
can I tell? What if they come out? What if a loud noise
disturbs them?” One of the many remarkable ways in which Kay
Thompson worked – as well as Erickson – was that she was
totally relaxed about the whole trance issue.
She categorised a number of trance levels, from “hynoidal”
trance to “plenary” trance – ie, from mildly suggestible to
a coma-like state for deep healing, and thus took a
scientific approach to it. However, her view was that the
patient would adopt exactly the level of trance that they
needed to do whatever it was that they were trying to
achieve.
This would also have a different manifestation in different
clients. With some she would be able to talk to them quite
conversationally, with others the trance would be more
formal. Thompson also believed she entered trance herself
when working with clients, when lecturing, and once,
remarkably, for a period of around three months while she
healed multiple injuries from a car accident. During much of
this period she was awake, working, and functioning
normally.
The lesson for us, again, is to forget about our own egos.
Our comfort level is not the issue – to do our job we have
simply to make sure the client is facilitated to do whatever
he or she needs to.
Three keystones underpinned Kay Thompson's work, both in
therapy and in dentistry. These were motivation, utilisation
and belief.
She believed that every success depended on the client's
motivation to make the changes they were seeking help for.
“Differences in motivation,” she says, “rather than
differences in instructions, may account for differences in
the aware states of consciousness observed in trance. In
essence, the degree of attention the unconscious needed to
focus on achieving and maintaining the trance will vary
depending upon the use to be made of the trance.”
In trance, then, and with therapeutic hypnosis generally,
the motivation of the individual will dictate not only what
type and depth of trance they go into, but also the success
of the process. This includes self hypnosis and takes into
account all the reasons a client may not be prepared to
change, consciously or unconsciously, for example fear or a
secondary gain (where the condition or problem actually has
benefits for the client which they may be reluctant to give
up, either consciously or not).
Utilisation is demonstrated by transcriptions of Thompson
working with several volunteers in front of an audience as
well as anecdotally throughout the book. For example, she
combines an extended metaphor around mountain climbing (a
hobby of Thompson's as well as the client's) with a more
specific metaphor about a flower protected by a rock which
outgrows its protection and finds it restrictive in the end,
for a woman who has recently come through a divorce.
Some of her interventions are directly reminiscent of
Erickson's more sensational stories. For example, she
describes being asked to help a woman paralysed for three
years after a stroke, and lovingly cared for by her family.
Thompson felt that there was no motivation to recover and
too much secondary gain.
In front of the client and her family, she said “Hypnosis is
not going to do her any good because you have to have
motivation. She doesn't have any motivation to get better.
Why on earth would she want to get better? She's lying here
and she has all of these people.........if she gets better,
she's going to have to go back to work, she's not going to
have people take care of her. She's going to have years of
therapy before she can accomplish anything productive.
Everyone's going to get bored with that. There's no way
she's going to respond to anything we can do.”
At the end of her speech, the client, who had done nothing
for three years, raised her fist and shook it at Thompson.
Made angry, she had acquired the motivation to engage with
therapy – and Thompson had made it happen by using the only
thing she felt she had available to her. Just like Erickson,
she had subsumed her own ego for the good of her client –
whether they ended up liking her was not relevant so long as
she was able to help them.
Whether it was using tension to create more tension so as to
show the client how to relax properly, or turning the
hostility and resistance they felt towards the process back
in against the problem, Kay Thompson was a master of
utilisation and her courage and willingness to “take a
flyer” regardless of how it might make her look should be an
inspiration to us all.
The third pillar of her work was belief. Not so much in
herself – she talks of many times when she doubted her own
interventions, and once of a time when she was asked to use
hypnosis to induce surgical anaesthesia for a patient, and
was paralysed with fear beforehand at the huge
responsibility on her shoulders.
Her belief was in her patients, and was calculated to
transmit absolute confidence to them. The most famous – and
perhaps most impressive example is her frequent reference to
the way she casually tells her dental patients to stop
bleeding. When they questioned this unusual instruction, she
would say “Well, all you have to do is control your
circulation and you control your circulation all the
time.....” followed by references to running as a child on a
hot day and feeling the blood vessels under your tongue
opening up, and the sensation of blood returning to cold
feet and hands after playing in the snow.
The patient, utterly bemused, would take Thompson's calm
conviction that they could do it as proof that they could,
and it would happen. She reinforced this with every verbal
and non-verbal communication she had with them.
Just as she believed that if the motivation was right the
therapy would work, Thompson believed utterly in the
patient's ability to bring about miraculous change or
phenomena. She simply would not let her own doubt, fears,
past experiences or ego impinge on their chance of success,
and she attributed this approach to her time with Milton
Erickson. “I never cease to be amazed and delighted and
thrilled at the marvellous things that people can do. And
the fact that so many of them do them because I ask them to
do them is the most humbling experience that I can imagine.
You don't hear, in a lot of the talking about Milton
Erickson, the gentleness and respect for the
individual.................................................every
person has a right to that respect.”
This unshakeable belief in her patients is borne out time
and time again, from a dental student who created physically
impossible healing because Kay told her to, to her own
miraculous recovery from a serious car accident.
This belief was coupled with close and empathetic
observation of her patients to see how they were responding
to treatment, whether therapeutic or dental, and what they
needed. She said she found hypnotic work exhausting – she
had to put so much of herself into it. Thompson had a number
of ways of deducing what types of technique would work with
each patient and ways of applying them – she describes this
in metaphor, at which she was so skilled, as a set of keys
to fit all the different types of lock.
This brings us to another remarkable facet of Kay Thompson's
work – her consummate skill as a wordsmith. The use of
hypnotic language demonstrated in her work is amazing.
Working once with pain control, she said “There isn't a word
that comes out of my mouth that is spontaneous. I have a
goal. You start by identifying with the patient. You get
them to distance themselves from the feeling of the
pain..................................”.
As Roxanna Erickson Klein observes, “Kay's methodology for
eliciting healing from within was clearly enhanced by her
appreciation for the value of collecting words. Kay
delighted in language play and continually worked to enhance
the communication skills that she credited Erickson for
teaching her.”
She goes on to recall how Thompson would: “(collect) pairs
of words that sounded similar and could be substituted, if
appropriate, in the message; …............(jotted) down
lists of words that had multiple meanings, then practiced
integrating them into sentences that would supply
metaphorical, therapeutic messages to the
unconscious...................carefully selected words then
precisely adjusted their punctuation, enunciation and
emphasis.” Other contributors observed similar behaviour.
There are a number of beautiful examples in the book, from
lengthy extended metaphors with deeply layered confusional
language, to staggeringly simple reframing statements which
convey considerable power. For example: “….................
and we do not know about the things we no, until its too
late, to go back and pick up the pieces of the rope that got
tied into the knots, that we didn't know how to unknot. But
with patience and persistence, you can pick at the most
painful knot, tie it into a bow that can bow, to the need to
remember that this is, was once, a not, 'not'.”
Sometimes the sentence (and sense) hung on a play around one
single word:
“If you think back to the time when that back was no longer
bothering you and you found out you could be comfortable
back then. You didn't have anything you had to back down
from or back away from. You could back out of things without
feeling bashful about it. You weren't backward saying you
wanted to back into some other kind of situation.”
And sometimes, the statement stands for itself, but sets the
client off on an internal journey of self-discovery:
“Because when you really have control you don't need it; you
can get it back anytime you want it. It's only when you
don't have control that you have to have control all the
time, because if you let it go, then you will lose it.”
Of considerable influence to others has been her famous
maxim about pain:
“Pain is a danger or warning signal. When everything that
can be done and should be done, has been done there is no
longer any reason to have the pain.”
By this she did not mean that the patient was not in pain or
would not get better, but that the reasons for the pain
should be explored and could be treated by the therapist.
Kay Thompson is remembered with affection and respect by a
large number of eminent and influential contributors in the
book and no doubt by many others, including her former
patients and their families. Her clarity of explanation and
willingness to share her skills means that those who were
fortunate enough to know her and be taught by her, as well
as those who read about her work, find it easy to learn from
her.
What is the lesson for us as 21st century therapists? There
is much to be obtained from this book, and from Thompson's
work in general. If you like language you will take away
rich metaphors, if you are a medical or dental practitioner
your understanding of your patients' psychology will be
considerably enhanced, and if you need the confidence to
obtain show-stopping effects, you will get it here.
But perhaps the main message we should take away relates to
Kay Thompson's ethos of motivation, utilisation and belief.
Listen to your patient. Work out what they need and want,
from what they don't tell you as much as what they do, and
from what their body language is telling you as they say it.
Use every means available to you to do them good, and step
out of your comfort zone when you need to. And believe they
can do it, absolutely, so they have no room for doubt.
At the same time, believe in yourself. If your clients and
patients can do it, why not you? Stop worrying about whether
you're doing it right, what you sound like, what will happen
if it doesn't work, whether they like you. In modern day
parlance which I think Kay Thompson would have liked: “Get
over yourself”.
Copyright Rebecca Welch 2010 - all
rights reserved
Rebecca Welch
www.tadpolehypnotherapy.com
www.hypnotherapyhampshire.com
www.relaxationwithhypnosis.com March 2010
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