Milton Erickson, Kay Thompson and the nature of therapeutic hypnosis, getting back to basics

by Rebecca Welch

“Get Over Yourself”


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”.

Rebecca Welch

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